A cien años de la administración científica. Análisis de las aportaciones de Taylor

Con la entrada del cronómetro en el taller como dispositivo simbólico de control, quedaba claro que, con miras a la consolidación del capitalismo industrial, la propiedad del tiempo y de los movimientos era expropiada al trabajador para pasar a manos del management que, con la aplicación de los principios de la administración científica, se encargaría de codificar, medir, fragmentar todo ese savoir-faire, antes patrimonio exclusivo del artesano, para regresarle un único método, one best way, que incluye los movimientos y las herramientas idóneas con tiempos controlados para la minimización del tiempo y el esfuerzo requeridos en la realización de la tarea. Este hecho representó un cambio organizacional que, inevitablemente, llevó a transformaciones de orden económico, ideológico, social, político, laboral y sindical, ecológico y, por supuesto, en términos de los inicios de la concepción de la administración como ciencia. Si bien los Principios de la administración científica son el retrato de un momento histórico en el que el capitalismo industrial comenzaba a consolidarse, no podemos dejar de reconocer que el principio fundacional se mantiene en la era del capitalismo postindustrial. La lógica del control y de la medición lograría el sueño dorado de toda tecnocracia: la abolición del conflicto y de toda resistencia. Al análisis de las consecuencias de la aparición del taylorismo en diversos ámbitos, dedicamos este trabajo. Finalizamos exponiendo cómo es que hoy, más que nunca, el pensamiento de Taylor cobra vigencia en un sector tan delicado como el de la gestión de las organizaciones públicas según esquemas organizacionales que incentivan la eficiencia por encima de otros valores, como la legitimidad y la eficacia política. Este tipo de acciones, indudablemente, encuentra sus cimientos en el taylorismo.With the introduction of the chronometer in the workroom as a symbolic control device, it was clear that the ownership of the time and people performance was expropiated from workforce to management, towards capitalism consolidation. With the principles of Scientific Administration, the former savoir-faire, once owned by workers, was to be codified, measured, and put into separated pieces. The goal was to take the workers back a unique method, one best way, which includes proper procedures and tools in order to control time for minimizing time and effort applied to achieve specific tasks. All the above led to changes in many different fields, such as economic, ideologies, social, politic, labour and work unions and ecological transformations. These changes impacted the beginning of the concept of Administration as a science. We must recognize that the main principle of the “Scientific Administration” is still the post-industrial capitalism era, but these principles are the portrait of an historical moment in which industrial capitalism began to consolidate itself. Through the logics of control and measurement, technocracy was achieving its golden dream: abolition of conflict and resistance. These pages are dedicated to the consequences of taylorism in different fields. We will finalize showing how Taylor´s thoughts impact today more than ever in a field as special as public organizations Management, under organizacional schemata that lead efficency above other values like legitimity and politic effectiveness. All actions towards efficiency are based, undoubtedly, in taylorism

Lessons learned after a three-year store and forward teledermatology experience using internet: Strengths and limitations

Purpose This paper presents a three-year teledermatology evaluation experience. The aim is to explain the methodology followed, present the evaluation results, discuss critically the issues that emerged during the experience and report the main lessons learned. Methods A complete design and evaluation methodology was conducted to fully address significant issues arising from other previous teledermatology experiences. First, system-design requirements and image quality issues were studied. Then, a detailed clinical concordance study was undertaken to determine the accuracy of diagnoses made using teledermatology in order to assess different dermatological clinics. Finally, an impact study on the health system was performed. Furthermore, clinical, technical, social and alignment outcomes were analyzed during the study and at the end of it, in order to understand how emerging factors affected the final setup of the teledermatology system. Results The most important results reported in this study can be summarized as follows. (1) A complete web-based environment for teledermatology support was developed as a result of a dynamic evaluation process with clinical personnel. (2) A total of 120 teleconsultations (82 pediatric and 28 adult) were made during the clinical concordance study. Concordance analysis was carried out for each dermatological disease group. High concordance rates were found in pediatrics for inflammatory dermatoses (76%) and also for adults (75%) with infections and infestations. (3) Physicians were satisfied with the teledermatology system but the time dedicated to consultation in primary care was a limiting factor (19 min for each teleconsultation). (4) An extensive discussion about the successful and the limiting aspects of the teledermatology experience revealed the reasons behind the final decision not to proceed with its implementation. It was considered not to be aligned with Health Care Organization (HCO) strategy and consequently did not achieve high-level support for its long-term implementation. Conclusions A high degree of diagnostic accuracy both for pediatric and adult consultations was achieved using the teledermatology system with affordable technical requirements. Its usefulness for filtering dermatological referrals was also demonstrated in the study. Nevertheless, other factors such as the reorganization required for the physicians’ time schedule, remuneration issues, absence of EHR (electronic health record) integration and lack of interaction with the HCO were important limiting factors. This led to the conclusion that under the evaluation conditions long-term set-up was not possible. It was also concluded that HCO participation would have been essential for both the evaluation study and the long-term set-up of the system. Highlights This paper reports a realistic experience in the design and evaluation of a telemedicine solution for remote dermatology consultation (tele-dermatology) in Aragón, Spain. ► This study takes a different approach discussing the strengths and limitations of a teledermatology experience in a realistic manner. ► A list of lessons learned is provided for future teledermatology implementations. Many pediatricians are involved in the experience providing in this way a detailed concordance analysis for children dermatological clinics

The effect of self-efficacy expectations in the adherence to a gluten free diet in celiac disease

Objective: To analyse the effect of general and specific self-efficacy on the adherence to a gluten free diet (GFD) in patients with celiac disease along with the effect of other relevant variables. Design: 271 patients with celiac disease participated in this transversal descriptive study and completed a series of questionnaires regarding adherence (CDAT), general self-efficacy (GSES) and specific self-efficacy (Celiac-SE) and quality of life (CD-Qol), among others. Main Outcome Measures: Dependent variable was adherence to the Gluten Free Diet (GFD). Main independent variables were general self-efficacy, specific self-efficacy and quality of life. Model tests were conducted using regression analysis. Results: 71.9% of patients show an excellent or good adherence to the diet. Higher levels of adherence are positively associated to a high expectancy of specific self-efficacy, to the perceived adoption of recommended behaviours, risk perception and better quality of life (these variables accounted for 36.4% of the variance in the adherence to a GFD, p <.001). Conclusions: Specific self-efficacy rather than general has a predictive value in adherence to a GFD. Therefore, we need to develop and transculturally adapt new instruments to assess specific self-efficacy. Celiac-SE has proved to be a useful scale for this objective

Development and validation of a specific self-efficacy scale in adherence to a gluten-free diet

The aim of this study was to develop a scale to assess the levels of specific self-efficacy in order to enhance adherence to a gluten-free diet and the life quality of celiac patients. Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed people. The only treatment is a strict lifelong gluten-free diet. Within the framework of Social Cognitive Theory, expectation of self-efficacy is understood as the degree in which a person believes himself to be capable of performing a certain task (e.g., adhering to a gluten-free diet), a construct which has been widely studied in its relation with adopting healthy behaviors, but scarcely in relation to celiac disease. A validation study was carried out in various stages: preparation of the protocol; construction of the questionnaire and a pilot run with 20 patients; validation of the scale with 563 patients and statistical analysis. A 25-item scale was developed. Feasibility was excellent (99.82% of participants completed all the questions). Factorial analysis pointed to the existence of five factors that explained 70.98% of the variance with a Cronbach alpha of 0.81 for the scale overall and between 0.64 and 0.90 for each factor. The scale showed a Spearman''s Rho coefficient of 0.279 with the General self-efficacy Scale. This easily administered scale provides good psychometric properties for evaluating specific self-efficacy of celiac patients in adhering to treatment. It seeks to be the first scale that provides not only a measurement of specific self-efficacy in celiac disease, but also to determine its levels for each of the areas as a first step toward designing interventions of self-management and empowerment programs to cope with the disease

Opinions and beliefs held by Spanish teenagers regarding tobacco and alcohol consumption: A descriptive study

Background: Preventive strategies are the most effective approach for dealing with issues of substance abuse, particularly in teenagers. Such strategies adapt well to this target population. Our objective was to reveal the opinions and beliefs held by teenagers about tobacco and alcohol as types of drugs, and their effects on health. Methods: In this cross-sectional study, participants completed a self-administered questionnaire based on the World Health Organization “Health Behaviour of School-aged Children” study. Our sample included 1,005 schoolchildren aged between 11 and 13 years, resident in the province of Co´rdoba in Spain. Descriptive and univariate analyses were performed using a chi-squared test. Results: Of respondents, 25% (95% confidence interval [CI]: 22.2–27.6%) and 61% (95% CI: 58.0–64.1%), respectively, did not consider tobacco or alcohol to be drugs. No relationship was found between tobacco and alcohol use, and the belief that these are drugs (p = 0.477 and p = 0.217, respectively). A total 98.2% of adolescents surveyed (95% CI: 97.3–99.1%) believed that tobacco causes physical damage, mainly to the lungs, heart, and to the developing fetus. Additionally, 92.4% (95% CI: 90.6–94.0%) believed that alcohol is detrimental to health and identified the liver as the organ most frequently damaged by alcohol consumption. The media was identified as the main source of information about these substances by 78.0% of respondents (95% CI: 75.4–80.6%). Conclusions: Teenagers possess an acceptable level of knowledge and information about the negative effects of tobacco and alcohol on health; however, many of them do not consider these substances to be drug

Non-equilibrium dynamics and floral trait interactions shape extant angiosperm diversity.

Why are some traits and trait combinations exceptionally common across the tree of life, whereas others are vanishingly rare? The distribution of trait diversity across a clade at any time depends on the ancestral state of the clade, the rate at which new phenotypes evolve, the differences in speciation and extinction rates across lineages, and whether an equilibrium has been reached. Here we examine the role of transition rates, differential diversification (speciation minus extinction) and non-equilibrium dynamics on the evolutionary history of angiosperms, a clade well known for the abundance of some trait combinations and the rarity of others. Our analysis reveals that three character states (corolla present, bilateral symmetry, reduced stamen number) act synergistically as a key innovation, doubling diversification rates for lineages in which this combination occurs. However, this combination is currently less common than predicted at equilibrium because the individual characters evolve infrequently. Simulations suggest that angiosperms will remain far from the equilibrium frequencies of character states well into the future. Such non-equilibrium dynamics may be common when major innovations evolve rarely, allowing lineages with ancestral forms to persist, and even outnumber those with diversification-enhancing states, for tens of millions of years

The emotional well-being of Long COVID patients in relation to their symptoms, social support and stigmatization in social and health services: a qualitative study

Background Long COVID patients have experienced a decline in their quality of life due to, in part but not wholly, its negative emotional impact. Some of the most prevalent mental health symptoms presented by long COVID patients are anxiety, depression, and sleep disorders. As such, the need has arisen to analyze the personal experiences of these patients to understand how they are managing their daily lives while dealing with the condition. The objective of this study is to increase understanding about the emotional well-being of people diagnosed with long COVID. Methods A qualitative design was created and carried out using 35 patients, with 17 participants being interviewed individually and 18 of them taking part in two focus groups. The participating patients were recruited in November and December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza (Northern Spain) and from the Association of Long COVID Patients in Aragon. The study topics were emotional well-being, social support networks, and experience of discrimination. All an inductive thematic content analyses were performed iteratively using NVivo software. Results The Long COVID patients identified low levels of self-perceived well-being due to their persistent symptoms, as well as limitations in their daily lives that had been persistent for many months. Suicidal thoughts were also mentioned by several patients. They referred to anguish and anxiety about the future as well as a fear of reinfection or relapse and returning to work. Many of the participants reported that they have sought the help of a mental health professional. Most participants identified discriminatory situations in health care. Conclusions It is necessary to continue researching the impact that Long COVID has had on mental health, as well as to provide Primary Health Care professionals with evidence that can guide the emotional treatment of these patients

Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain

The purpose of this study is to understand the health-related quality of life (HRQoL) in patients with celiac disease (CD) and analyze its main determinants. A transversal descriptive study of 738 patients with celiac disease was carried out. A series of questionnaires were answered related to their HRQoL, adherence to a gluten-free diet (GFD), and self-efficacy beliefs among other relevant variables. Regression analyses were carried out in order to explore the predictive variables in adherence to the GFD and HRQoL. A total of 61.2% showed a good HRQoL, and the main predictors of HRQoL were specific self-efficacy, adherence to the diet, risk perception, time since diagnosis, and age. While 68.7% of participants showed good or excellent adherence to the GFD, and the main predictors of adherence were specific self-efficacy, perceived adoption of recommended behaviors, HRQoL and gender. The HRQoL of patients with CD, and adherence to the GFD in Spain, are good. It is the self-efficacy expectation, measured specifically and not generally, which is the best predictor of both adherence and HRQoL. It is necessary to develop programs to improve the HRQoL of patients with CD that focus on improving specific self-efficacy

Variables associated with a higher awareness of gender-based violence by students of the health sciences and social work

Objective To determine the attitudes towards equality and prevention of gender-based violence, and analyze variables associated with a higher awareness of gender-based violence by students of the health sciences and social work degrees. Method A cross-sectional descriptive study was carried out. The sample consisted of 437 students of the health sciences and social work degrees at the University of Zaragoza (Spain) during 2018 and 2019. The variables of the study were: Socio-demographic variables, academic variables, feminism attitudes towards women''s movement using Feminism and the women''s movement scale (FWMS), attitudes on gender-based violence using the Gender Equality and Prevention of Gender-based Violence Scale (GEPGVS). A correlational study and multiple linear regression were performed, in order to analyze the associated variables. Results Differences in attitudes towards gender-based violence were observed according to sex, age and attitudes in line with the feminist movement. Regarding the linear regression model, the results showed that the FWMS is a predictor of GEPGVS, as well as sex. Conclusions Holding attitudes in line with the feminist movement is a factor that may be promoted in order to increase the awareness of gender-based violence. Objetivo Determinar las actitudes hacia la igualdad y la sensibilización en cuanto a la violencia de género, y analizar las variables asociadas a una mayor sensibilización sobre la violencia de género de los estudiantes de ciencias de la salud y trabajo social. Método Se realizó un estudio descriptivo transversal. La muestra consistió en 437 estudiantes de los grados de ciencias de la salud y trabajo social de la Universidad de Zaragoza (España) durante 2018 y 2019. Las variables del estudio fueron variables sociodemográficas, variables académicas, actitudes hacia el movimiento feminista usando la Feminism and the women''s movement scale (FWMS) y actitudes hacia la violencia de género mediante la Escala sobre Igualdad y Prevención de la Violencia de Género (EIPVG). Se realizaron un estudio correlacional y una regresión lineal múltiple para conocer las variables asociadas a una mayor sensibilización. Resultados Se observaron diferencias en las actitudes hacia la violencia de género en función del sexo, la edad y las actitudes favorables al movimiento feminista. Con respecto al modelo de regresión lineal, los resultados mostraron que la FWMS es un predictor de la EIPVG, así como el sexo. Conclusiones Las actitudes favorables al movimiento feminista son un factor que puede promoverse para incrementar la sensibilización sobre la violencia de género

Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study

Introduction and Objective: The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care. Methods: A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann–Whitney, chi-square, and Fisher’s U statistics. A multivariate analysis (ordinary logistic regression) was performed. Results: The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072). Conclusion: These indicators should be considered by primary care physicians when attending patients suffering from major depression