Variables impacting the quality of care provided by professional caregivers for peoble with mental illness: a systematic review

People with mental illness may need the support of caregivers in certain areas of their lives, and there is an increasing need for quality care for people with mental health problems by qualified health professionals. Often, these professionals may develop so-called burnout syndrome, although some authors point out that positive emotions may also arise. In addition, several variables can act as both protectors and stressors. Therefore, the main aim of the current study is to identify variables related to the professional care of people with mental illness (i.e., protective or stressor variables) through a systematic review. The review was conducted according to the PRISMA guidelines with a final selection of 20 articles found in the Web of Science, PubMed, ScienceDirect and Dialnet databases between the months of October and November 2019, and updated in June 2022. The results show that job satisfaction is a strong predictor of the quality of care, and that congruence between personal and organizational values is a very important factor. Meanwhile, working in the same job for successive years, working in community mental health teams and experiencing burnout act as stressors and reduce the quality of care provided

Subgrupos de dependencia multidimensional en adultos mayores que viven en la comunidad: un análisis de clase latente

Objetivo: Utilizar el análisis de clase latente (ACL) para la identificación de patrones de dependencia multidimensional en una muestra de adultos mayores y evaluar factores sociodemográficos predictivos de pertenencia a una clase. Métodos: Se utilizaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Se analizaron 7,920 adultos mayores, el 55% eran mujeres. El ACL fue utilizado para la identificación de subgrupos significativos. Para el ACL se realizó con el software MPlus. El modelo de clase final se eligió con base a la comparativa de estadísticas de ajuste múltiple y parsimonia teórica, con modelos de complejidad creciente analizados secuencialmente hasta que se identificó el modelo de mejor ajuste. Se incorporaron covariables para explorar la asociación entre estas variables y la pertenencia a clases. Resultados: Se identificaron tres grupos de clases basados en los nueve identificadores. “Adultos mayores activos” estaba compuesto por el 64%. “Relativamente independiente” y “Discapacidad física” comprenden el 26% y el 10% de la muestra, respectivamente. Los perfiles de “Adultos mayores activos” y “Relativamente independiente” eran comparativamente más uniformes. El grupo de “discapacidad física” comprenden a los individuos más propensos a un perfil de dependencia. Conclusiones: Estos hallazgos resaltan la utilidad de adoptar un enfoque centrado en la persona lo que sugiere nuevos horizontes de investigación e intervención a medida de las características particulares de los adultos mayores. Basado en patrones de dependencia multidimensional, este estudio identificó una tipología de dependencia utilizando datos de una encuesta representativa a nivel nacional. Objectives: Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership. Material and methods: Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership. Results: Three classes groups based on the nine indicators were identified: “Active older adults” was comprised of 64% of the sample participants, “Relatively independent” and “Physically impaired” were comprised of 26% and 10% of the sample. The “Active older adults” profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the “Active older adults” and “Relatively independent” were comparatively more uniform. Finally, respondents belonging to the “Physically impaired” profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile. Conclusions: These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey.&nbsp

Competência no setor saúde: análise da reforma sueca (1992-1995)

The paper reviews the outcomes and failures of the Swedish health care reform, as well as the lessons learned for accomplishing better financial results and quality standards.El artículo revisa los éxitos y fracasos de la reforma sueca de salud, así como las lecciones que dejó en su afán de alcanzar mejores resultados financieros y estándares de calidad.O artigo revisa os êxitos e fracassos da reforma do setor de saúde sueco, assim como as lições que deixou em sua proposta de alcançar melhores resultados financeiros e padrões de qualidade

O conceito de willingness to pay em questão

São revisadas as limitações do uso do conceito de willingness to pay (disposição a pagar) nas avaliações econômicas que se realizam no campo da saúde. Há na literatura econômica muitos investigadores que assinalam os múltiplos problemas metodológicos inerentes às estimações de willingness to pay. Por outro lado, o debate teórico-conceitual acerca da agregação das preferências individuais dentro de uma demanda agregada não está totalmente resolvido. Contudo, durante os últimos 20 anos, a estimação da disposição a pagar calculada pelos estudos tem aumentado de forma significativa, sendo em muitos casos um dos principais fatores de tomada de decisão em políticas de saúde. São apresentadas algumas das limitações desta técnica, assim como o possível efeito de distorção que poderia ter sobre as avaliações econômicas em saúde.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones económicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura económica un número importante de investigadores que señalan los múltiples problemas metodológicos que entrañan las estimaciones de willingness to pay. Por otro lado, aún el debate teórico-conceptual acerca de la agregación de las preferencias individuales dentro de una demanda agregada no ésta del todo resuelto. Sin embargo, durante los últimos 20 años la estimación de la disponibilidad a pagar dentro de las investigaciones económicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decisión en políticas de salud. Plantease alguna de las limitaciones de esta técnica, así como el posible efecto distorsionador que podría tener sobre las evaluaciones económicas que se realizan en el área de la economía de la salud

Direct medical cost of COVID-19 in children hospitalized at a tertiary referral healthcare center in Mexico City

IntroductionDespite the end of the COVID-19 pandemic being declared by the WHO, the economic consequences are far from over. One of these implications was the cost of inpatient care for health institutions. To date, some studies have examined the economic burden of COVID-19 in the adult population but only a few have focused on child populations.ObjectiveTo estimate the direct medical costs of COVID-19, focusing on children in Mexico.MethodData about resources consumed during hospital stays were extracted from the medical records of patients hospitalized at a Mexican tertiary healthcare institution. Other sources of information were the unit prices of inputs and the salaries of health personnel. A micro-costing methodology was used to obtain cost results by age group over different hospital areas. Data analysis was performed with descriptive statistics and regression models to evaluate the predictors of total cost.ResultsOne hundred and ten medical records were reviewed of which 57.3% corresponded to male patients and the mean age was 7.2 years old. The estimated average cost per patient was US$5,943 (95$4,249–7,637). When the costs of the three clinical areas were summed, only the 5–10 years old group showed a maximum cost of US$14,000. The regression analysis revealed the following factors as significant: sex, age, staying at an emergency room, having a positive bacterial culture, and having comorbidities.DiscussionThe cost results were somewhat similar to those reported in children from the USA, but only regarding low severity COVID-19 cases. However, comparability between these types of studies should be done with caution due to the huge differences between the healthcare systems of countries. The study cost results may help public decision-makers in budget planning and as inputs for future cost-effectiveness studies about interventions regarding COVID-19

Item-Level Psychometric Analysis of the Psychosocial Processes at Work Scale (PROPSIT) in Workers

The structural attributes and correlates of items have an effect on their composite scores and exploring them strengthens the content validity of a measure adapted to another context. The objective of this study was to evaluate the item properties of a measure of psychosocial work factors (PWFs). Data were collected through a web platform from 188 Peruvian working adults (men = 101, 50.5%) holding various professions and jobs. The instrument was the Psychosocial Processes at Work Scale (PROPSIT), adapted for the Peruvian context. The distributional characteristics, the efficiency of its response options and its correlates with engagement, occupational self-efficacy, general stress and psychological distress (explored with a coefficient of maximum information and another of monotonic association) were analyzed. It was found that the items were asymmetrically distributed, without statistical normality and with a response tendency at low (for psychosocial risk factors (PSRFs)) and medium (favorable psychosocial resources) levels. The number of efficient response options was lower (approximately five options) than the original structure (seven options). The monotonic associations with gender and age were essentially zero and theoretically converged with the external constructs, except for some items related to job demands. The contributions of the results to the content validity of the PROPSIT and the orientation of working hypotheses about PROPSIT item constructs and measures of work effects are discussed

Hacia una base normativa mexicana en la medición de calidad de vida relacionada con la salud, mediante el Formato Corto 36

Objetivo. Presentar los resultados de la aplicación del cuestionario de formato corto 36 (SF-36) en dos estados de México (Sonora y Oaxaca), comparando con los niveles de calidad de vida en las provincias de Canadá y en Estados Unidos de América. Material y métodos. Los datos provienen de la encuesta de acceso, uso y calidad de los servicios de salud en dos estados de México. El instrumento del SF-36 incluye 36 preguntas que generan ocho dimensiones diferentes sobre calidad de vida relacionada con la salud; a partir de estas dimensiones, se estima un componente físico y otro mental. Para el análisis se calcularon las calificaciones promedio para cada dimensión del SF-36 para toda la muestra, por género y grupos de edad, en cada estado. Las diferencias regionales se evaluaron mediante la diferencia en los promedios. Resultados. Se obtuvo respuesta de 98.5% de las 4 200 viviendas seleccionadas, con porcentajes de respuesta similar en Oaxaca y Sonora. Respondieron al cuestionario 5 961 individuos mayores de 25 años de edad. Los hombres tuvieron mayores puntajes que las mujeres en todas las dimensiones y en los dos componentes. En uno u otro sexo la mayor variación en los adultos hasta de 64 años de edad tendió a concentrarse en tres dimensiones: salud general, función social y salud mental; en el grupo de 65 a 74 años de edad se concentró en función social y salud mental; y en mayores de 75 años, en salud mental. Se observó variación en un número mayor de dimensiones en los grupos de adultos jóvenes (25 a 44 años), mientras que en las mujeres se observó una mayor variación en los extremos, en los grupos de edad de 25 a 34 años de edad y de 75 y más. Los puntajes promedio en nuestra muestra fueron más altos que los observados en Canadá y Estados Unidos de América en cinco de las dimensiones y en los dos componentes, en tanto que Canadá presentó puntajes más altos en las tres dimensiones escalas restantes (salud general, función social y salud mental). Conclusiones. En ausencia de datos representativos del ámbito nacional, queremos proponer el uso de nuestros resultados como una base normativa en México, para que los investigadores que utilicen el SF-36 puedan comparar sus resultados con referencias ajustadas por género y edad a escala poblacional. Puesto que las dos regiones estudiadas son claramente contrastantes en su desarrollo social y económico, cuando se trate de pacientes de regiones con mayor desarrollo económico se recomendaría utilizar los datos de Sonora como estándar normativo, y Oaxaca en el caso de pacientes de regiones con menor desarrollo económico. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/ salud/index.htm

Parametric and Nonparametric Analysis of the Internal Structure of the Psychosocial Work Processes Questionnaire (PROPSIT) as Applied to Workers

The study of the dimensionality or internal structure of a measure has a definitional purpose with notable theoretical and practical implications; this aspect can be analyzed via both parametric and nonparametric approaches. The latter are probably used less often to validate constructs in the context of psychosocial work factors. The aim of the present manuscript was to employ both nonparametric (DETECT and AISP-Mokken) and parametric (semiconfirmatory factor analysis) procedures to analyze the internal structure of the Psychosocial Work Processes Questionnaire (PROPSIT) in the context of two samples of Peruvian workers located in the city of Lima, Perú, with one sample drawn from various work centers (n = 201) and the other comprising elementary education teachers (n = 158). The nonparametric results indicated that the content of the PROPSIT is sufficiently multidimensional to be able to describe a variety of psychosocial factors, while the parametric results require modification of the measurement model to obtain greater factorial congruence. In general, the analyses show a similar structure to those discussed by previous preliminary studies that have reported similar item-level performances. Some findings and considerations for future research are discussed

El concepto de willingness-to-pay en tela de juicio O conceito de willingness to pay em questão The willingness-to-pay concept in question

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones económicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura económica un número importante de investigadores que señalan los múltiples problemas metodológicos que entrañan las estimaciones de willingness to pay. Por otro lado, aún el debate teórico-conceptual acerca de la agregación de las preferencias individuales dentro de una demanda agregada no ésta del todo resuelto. Sin embargo, durante los últimos 20 años la estimación de la disponibilidad a pagar dentro de las investigaciones económicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decisión en políticas de salud. Plantease alguna de las limitaciones de esta técnica, así como el posible efecto distorsionador que podría tener sobre las evaluaciones económicas que se realizan en el área de la economía de la salud.São revisadas as limitações do uso do conceito de willingness to pay (disposição a pagar) nas avaliações econômicas que se realizam no campo da saúde. Há na literatura econômica muitos investigadores que assinalam os múltiplos problemas metodológicos inerentes às estimações de willingness to pay. Por outro lado, o debate teórico-conceitual acerca da agregação das preferências individuais dentro de uma demanda agregada não está totalmente resolvido. Contudo, durante os últimos 20 anos, a estimação da disposição a pagar calculada pelos estudos tem aumentado de forma significativa, sendo em muitos casos um dos principais fatores de tomada de decisão em políticas de saúde. São apresentadas algumas das limitações desta técnica, assim como o possível efeito de distorção que poderia ter sobre as avaliações econômicas em saúde.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations