Development of the set of scales to assess the job satisfaction among physicians in Peru: validity and reliability assessment

Background: To assess the validity and reliability of the set of scales (general professional activity, health services management, and working conditions) on the different areas of job satisfaction in Peruvian physicians based on the data from the National Survey of Satisfaction of Users in Health (ENSUSALUD). Method: We carried out a psychometric study based on the secondary data analysis of Questionnaire 2 of ENSUSALUD-2016. Participants were selected from a two-stage stratified national probability representative sampling by political region. Validity was assessed by exploratory and confirmatory factor analyses, and measurement invariance analysis. We assessed the reliability using internal consistency coefficients (alpha and omega). The set of scales were composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center. Results: We included 2137 participants in the analysis. The general professional activity scale with six items (Comparative Fit Index, CFI = 0.946; Root Mean Square Error of Approximation, RMSEA = 0.071; Standardized Root Mean Square Residual, SRMR = 0.035), the health services management scale with eight items (CFI) = 0.972; RMSEA = 0.081; SRMR = 0.028), showed good measurement properties for the one-dimensional model. The working conditions scale with eight items for individual conditions and three items for infrastructural conditions (CFI = 0.914; RMSEA = 0.080; SRMR = 0.055) presented adequate measurement properties with a two-dimensional model. The invariance analysis showed that comparisons between sex, age, civil status, medical speciality, working in other institutions, work-related illness, chronic disease, and time working in the healthcare center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90). Conclusions: The set of scales has a solid factorial structure and measurement invariance, making it possible for group comparison. The study achieved stability in the scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative of the country level.Revisión por pare

Relationship between job satisfaction, burnout syndrome and depressive symptoms in physicians: a cross-sectional study based on the employment demand-control model using structural equation modelling

Objective To evaluate the relationship between job satisfaction, burnout syndrome (BS) and depressive symptoms (DS) based on the job demand-control framework model on a nationally representative sample of physicians working in the Peruvian Health System. Setting We carried out a secondary data analysis of the National Survey of Satisfaction of Users in Health 2016 in Peru. Primary and secondary outcome measures Our study assessed the development of the predictive model and had two parts: (1) to evaluate the association among the variables based on the job demand-control framework, and (2) to assess the proposed model acceptability using the structural equation modelling approach to estimate goodness-of-fit indices (GOFIs). Participants We excluded physicians older than 65 years, who did not report income levels or who had missing data related to the workplace. Thus, we analysed 2100 participants. Results The prevalence of DS was 3.3%. Physicians' work-related illnesses had more probability to result in DS (prevalence ratio=2.23). DS was moderately related to BS dimensions (r>0.50); nevertheless, the relationships between DS and the three job satisfaction scales were weak (r<0.30). The first predictive model based on the variables, DS, BS and job satisfaction, had low GOFIs (comparative fit index (CFI)=0.883; root mean square error of approximation (RMSEA)=0.125). In a second evaluation, we used models with correlated errors obtaining optimal GOFIs (CFI=0.974; RMSEA=0.060). Conclusions Our study identified a stable model to explain the relationship between job satisfaction, BS and DS among physicians. The results are consistent with the job demand-control framework. They could be applied to decision-making in occupational contexts in Latin American low/middle-income countries.Revisión por pare

Inequalities in infant vaccination coverage during the COVID-19 pandemic: A population-based study in Peru

Objective: To identify the associated factors and assess the inequalities of full vaccination coverage (FVC) among Peruvian infants aged 12–23 months during the COVID-19 pandemic in a nationally representative sample. Methods: We carried out a population-based cross-sectional study based on a secondary data analysis using the 2021 Peruvian Demographic Health Survey (DHS) in infants aged 12 to 23 months. The sampling design was probabilistic, multistage, stratified, and independent at both departmental and area of residence levels. FVC was defined according to the WHO definition. We performed generalized linear models (GLM) Poisson family log link function to estimate crude (aPR) and adjusted prevalence ratios (aPR). Also, for inequality assessment, we calculated the concentration curve (CC), concentration index (CI), and Erreygers normalized concentration index (ECI). Results: We included 4,189 infants in our analysis. Nationwide, the prevalence of FVC was 66.19% (95% CI: 64.33–68). Being younger, having a mother with no education or primary education, belonging to a large family, having no access to mass media, having had six or fewer ANC visits, and having a mother whose age was under 20 at first delivery were inversely associated with FVC. Meanwhile, living in the Highlands or on the rest of the coast, and living in rural areas were directly associated with FVC. We found a pro-rich inequality in FVC based on wealth-ranked households (CI: 0.0066; ECI: 0.0175). Conclusion: FVC has dropped among Peruvian infants aged between 12 and 23 months. There were several factors associated with FVC. It was more concentrated among the better-off infants, although in low magnitude.Revisión por pare

Disparities in scientific research activity between doctors and nurses working in the Peruvian health care system: Analysis of a nationally representative sample

Aim To evaluate disparities in the frequency of scientific activity between medical doctors and nurses in Peru. Methods We carried out a secondary data analysis of the National Health Services Users’ Satisfaction Survey (ENSUSALUD), 2016. This nationally representative survey evaluates doctors and nurses working in clinical settings. We defined scientific activity as i) having published an original article (journal indexed in Web of Science, Scopus or Medline); and ii) having authored an abstract in a national or international conference. We estimated crude and adjusted disparities prevalence ratios (aDPR) and 95% confidence intervals (95%CI). Results We included 2025 doctors and 2877 nurses in the analysis; 71% of doctors doctor were male, and 93% of nurses were female (p<0.001). Among doctors, 13.9% had published an article, and 8.4% presented an abstract at a conference in the last two years, while these proportions were 0.6% and 2.5% for nurses, respectively. The adjusted models showed that doctors, when compared to nurses, were approximately 27 times likely to have published a paper (aDPR = 27.86; 95% CI 10.46 to 74.19) and twice as likely to have authored a conference abstract (aDPR = 2.51; 95% CI 1.39 to 4.53). Conclusions There are important disparities in scientific activity between doctors and nurses working in clinical settings in Peru. Disparities are more significant for article publication than for authoring in conference abstracts. We suggest public policies that promote research dissemination between health professionals, with emphasis on nurses.Revisión por pare

Access to healthcare among international migrants in Chile during the pandemic: results from a quantitative poll

El objetivo del estudio fue analizar barreras de acceso a la atención de salud en Chile reportadas por migrantes internacionales residentes en la región metropolitana del país y factores asociados. Para ello, se aplicó una encuesta en formato digital sobre vulnerabilidades y recursos de comunidades migrantes en Chile para enfrentar la pandemia SARS-CoV-2. Se realizó análisis descriptivo y estratificado por variables demográficas, socioeconómicas, tipo de previsión de salud y estatus migratorio. Como resultados, inmigrantes provenientes de Haití reportaron el mayor porcentaje de barreras de acceso a la atención en salud, esto tras ajustar por variables sociodemográficas y estatus migratorio.The objective of the study was to analyze barriers to access to health care in Chile reported by international migrants residing in the metropolitan region of the country and associated factors. For this purpose, a digital survey on vulnerabilities and resources of migrant communities in Chile to face the SARS-CoV-2 pandemic was applied. A descriptive and stratified analysis was performed by demographic and socioeconomic variables, type of health provision and migratory status. As results, immigrants from Haiti reported the highest percentage of barriers to health care access, after adjusting for socio-demographic variables and migratory status

Factores asociados a la calidad de la atención en población adulta afiliada a la Seguridad Social: El caso peruano

Objetive: To identify factors associated with perceived quality of care in the adult population affiliated with Social Security Health (EsSalud) Material and methods: We analyzed the National Socioeconomic Survey of Access to Health of the EsSalud Insured. Perceived quality of health care was evaluated in ambulatory care, hospitalization and emergency medical services. We reported adjusted ratios of means (RMa) estimated by multiple Poisson regression. Results: Being employed (RMa=0.98; IC95% 0.96-0.99), not knowing the services provided by EsSalud (RMa=0.97; IC95% 0.95-1.00), not receiving information about right to health (RMa=0.95; IC95% 0.93-0.98), perceiving as low the level of accessibility to the health facility (RMa=0.97; IC95% 0.95-0.99) and not feeling comfortable in the health facility of EsSalud (RM=0.92; IC95% 0.91-0.94) were factors associated with lower scores of perceived quality in ambulatory care. In hospitalization, being between 40-59 years old (RMa=0.93; IC95% 0.88-0.97), having a low wealth index (RMa=0.92; IC95% 0.87-0.97), not having received information about right to health (RMa=0.90; IC95% 0.84-0.95) and not feeling comfortable in the health facility of EsSalud (RMa=0.92; IC95% 0.89-0.96) were associated with lower quality score. In emergency, not feeling comfortable in the health facility of EsSalud (RMa=0.89; IC95% 0.93-1.00) was the only factor associated with a lower perceived quality score. Conclusions: We identified factors related to users and service offerings independently associated with perceived quality of care, which can be considered by decision makers for better management of EsSalud.Objetivo: Identificar factores asociados a calidad percibida de atención en la población adulta afiliada al Seguro Social en Salud (EsSalud). Material y métodos: Analizamos la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. La calidad percibida fue evaluada en consultorio externo, hospitalización y emergencias. Reportamos razones de medias ajustadas (RMa) estimadas mediante regresión de Poisson múltiple. Resultados: Estar empleado (RMa=0,98; IC95% 0,96-0,99), no conocer los servicios que brinda EsSalud (RMa=0,97; IC95% 0,95-1,00), no recibir información sobre los derechos como usuarios (RMa=0,95; IC95% 0,93-0,98), valorar como bajo el nivel de accesibilidad al EESS (RMa=0,97; IC95% 0,95-0,99) y no sentirse cómodo en el EESS al que acude (RM=0,92; IC95% 0,91-0,94) fueron factores asociados a menor puntaje de calidad percibida en consultorio externo. En hospitalización, tener entre 40-59 años (RMa=0,93; IC95% 0,88-0,97), contar con un índice de riqueza bajo (RMa=0,92; IC95% 0,87-0,97), no haber recibido información sobre los derechos como usuarios (RMa=0,90; IC95% 0,84-0,95) y no sentirse cómodos en el EESS (RMa=0,92; IC95% 0,89-0,96) se asociaron a menor puntuación de calidad. En emergencia, no sentirse cómodo en el EESS (RMa=0,89; IC95% 0,93-1,00) fue el único factor asociado a una menor puntuación de calidad percibida. Conclusiones: Identificamos factores relativos a los usuarios y a la oferta de servicios independientemente asociados a calidad percibida de atención, los cuales pueden ser considerados por los tomadores de decisiones para la mejor gestión de EsSalud

Diabetes mellitus and diabetic nephropathy in Peru

Objectives: To describe the scientific literature production in Peru about type 2 diabetes mellitus (DM) and diabetic nephropathy (DN). Methods: A non-systematic review of the scientific production about DM and DN in peruvian population and has been published in national and international medical journals until february 2015 was conducted. We used the databases Medline, Web of Science, Scopus, SciELO and Google Scholar. The results were divided a priori into 5 areas: Prevalence DM 2, clinical management of the diabetic patient, diagnosis of DN, risk factors for albuminuria, and early assessment of DN. Results: We found 22 items. The prevalence of DM varies depending on the definition and study population and was higher on the coast than in the highlands (4.3% vs. 2.1%). In public hospitals in Lima, 40% of diabetic patients have HbA1c> 7%. Likewise, the control of DM patients in Peru is poor compared with their Latin American counterparts. The “screening” of the NFD is uncommon, only 8.9% of patients have albuminuria in their assessments in hospitals nationwide. Modifiable factors associated with albuminuria in patients with DN were found such as glucose (OR 1.19 95% CI 1.05 to 1.34), hypertension (OR 0.48 95% CI 0.33 to 0.70) and stages of chronic kidney disease OR: 93 (p = 0.007). There are hospitals where nephrology care in patients with DN is mostly under emergency conditions. Conclusions: The results of these articles reflect that there are aspects in the screening and management of both diseases that can be improved and scarcity of studies on the subject in Peru

Health in Chile&rsquo;s Recent Constitutional Process: A Qualitative Thematic Analysis of Civil Proposals

(1) Background: In response to the recent political crisis in Chile, the &ldquo;Agreement for Social Peace and the New Constitution&rsquo;&rsquo; was approved. We aimed to analyze the health-related civil proposals uploaded to the official website for popular participation in the new constitution in Chile. (2) Methods: We carried out a qualitative thematic analysis of 126 health-related valid proposals. Moreover, we analyzed their link to the Health Goals 2030, established by the Ministry of Health of Chile and to the Sustainable Development Goals (SDGs). (3) Results: Sixteen main categories were reached. In all, they were organized into four main areas: (i) the right to health and the establishment of a universal health system; (ii) effective access to selected healthcare services; (iii) improving health outcomes for all and for the relevant subgroups; and (iv) the social determinants of health, health in all the policies, and community health. We found that these four areas were strongly linked to the Health Goals 2030 for Chile and to the SDGs. (4) Conclusions: Despite the fact that the new constitutional proposal was rejected in September 2022, the civil health-related proposals and the areas of health and healthcare were of interest to the citizens as the request showed a strong demand from the population for participation in matters of health, healthcare, and public health