Luis Andrés López-Fernández

Influence of the doctor's gender in the satisfaction of the users.

This study was carried out in the framework of a wider research project concerning the degree of patient satisfaction with the various types of primary health care. We have studied the relationship among the gender of the doctor, the gender of the patient and the type of primary health care center involved. In 1 type of primary care center (health centers) the medical staff work as a team, whereas in the other (ambulatory care services), the doctor works alone. The survey was conducted among 86 doctors and 860 patients from urban areas in Andalusia, Spain. The degree of patient satisfaction was tested on Likert scales. Both male and female patients attended by female doctors were more satisfied than those attended by male doctors (P < 0.005). Both male and female patients were attended in equal proportions by both male and female doctors (P > 0.20). Overall patient satisfaction values were not affected by the patients gender (P > 0.40). In comparing overall satisfaction among patients according with the doctors gender and type of primary health care center, there was a greater degree of satisfaction with female doctors working in health centers (P < 0.01) and no difference existed in ambulatory care services in this area.

Está en peligro la cobertura universal en nuestro Sistema Nacional de Salud

El Real Decreto-Ley 16/2012, de 20 de abril, de medidas urgenes para garantizar la sostenibilidad del Sistema Nacional de Salud mejorar la calidad y seguridad de sus prestaciones1, modifica lementos sustantivos de nuestro sistema sanitario. Su capítulo 1 ealiza un cambio estratégico de mucha profundidad en el Sistema acional de Salud (SNS), al modificar el contenido del artículo 3 e la Ley de Cohesión 16/2003, que definía como titulares de los erechos a la protección de la salud y a la atención sanitaria a: . . .Todos los españoles y los extranjeros en el territorio nacional en os términos previstos en el artículo 12 de la Ley Orgánica 4/2000»2, que ahora pasa a tener la siguiente redacción: «La asistencia saniaria en España, con cargo a fondos públicos, a través del Sistema acional de Salud, se garantizará a aquellas personas que ostenten a condición de asegurado». Además, el decreto no hace mención al partado de la reciente Ley General de Salud Pública, que mediante l redactado «1. Se extiende el derecho al acceso a la asistencia saniaria pública, a todos los españoles residentes en territorio nacional, los que no pudiera serles reconocido en aplicación de otras normas el ordenamiento jurídico»3 generalizaba el derecho a la asistencia anitaria pública al incorporar los escasos colectivos que, por carenias del desarrollo reglamentario de las normas precedentes, habían uedado sin contemplar. El derecho a la asistencia sanitaria estaba vinculado a la poseión de la ciudadanía española o del empadronamiento en España. ste derecho pasa ahora a estar vinculado a la situación de estar segurados o de ser beneficiarios de la Seguridad Social. La difeencia es sustancial. Si teníamos el derecho por ser españoles y por er residentes, «todos» teníamos el derecho; si lo tenemos por estar segurados o ser beneficiarios, tenemos que verificar y demostrar ue tenemos el derecho. Respecto a la condición de ser beneficiario, e asigna su determinación a la Tesorería General de la Seguridad ocial, lo que introduce la duda sobre si esta disposición es conordante con lo que determinan algunos estatutos de autonomía, ormas de rango superior al Decreto Ley analizado. Tras décadas de trabajo de integración y de ampliación progreiva de la cobertura hasta alcanzar la universalidad de nuestro SNS, on hitos claros en la Ley General de Sanidad (1986), la financiación e la sanidad por impuestos (1999), las Leyes de Extranjería (2000), ohesión (2003) y la Ley General de Salud Pública (2011), el decreto rovoca una quiebra del modelo de universalidad, con pérdidas raves de derechos, al implantar un sistema basado en el aseguamiento. Para clarificar muchos de los huecos que el sistema deja

Gender and the professional career of primary care physicians in Andalusia (Spain)

BackgroundAlthough the proportion of women in medicine is growing, female physicians continue to be disadvantaged in professional activities. The purpose of the study was to determine and compare the professional activities of female and male primary care physicians in Andalusia and to assess the effect of the health center on the performance of these activities.MethodsDescriptive, cross-sectional, and multicenter study. Setting: Spain. Participants: Population: urban health centers and their physicians. Sample: 88 health centers and 500 physicians. Independent variable: gender. Measurements: Control variables: age, postgraduate family medicine specialty (FMS), patient quota, patients/day, hours/day housework from Monday to Friday, idem weekend, people at home with special care, and family situation. Dependent variables: 24 professional activities in management, teaching, research, and the scientific community. Self-administered questionnaire. Descriptive, bivariate, and multilevel logistic regression analyses.ResultsResponse: 73.6%. Female physicians: 50.8%. Age: female physicians, 49.1 ± 4.3 yrs; male physicians, 51.3 ± 4.9 yrs (p < 0.001). Female physicians with FMS: 44.2%, male physicians with FMS: 33.3% (p < 0.001). Female physicians dedicated more hours to housework and more frequently lived alone versus male physicians. There were no differences in healthcare variables. Thirteen of the studied activities were less frequently performed by female physicians, indicating their lesser visibility in the production and diffusion of scientific knowledge. Performance of the majority of professional activities was independent of the health center in which the physician worked.ConclusionsThere are gender inequities in the development of professional activities in urban health centers in Andalusia, even after controlling for family responsibilities, work load, and the effect of the health center, which was important in only a few of the activities under study.

Diferencias de género en la percepción del logro profesional en especialistas de medicina familiar y comunitaria

BACKGROUND The concept of achievement is important to study the professional development. In medicine there are gender inequalities in career. The purpose was to know and compare the professional achievements perceptions and attributions of female and male primary care physicians in Andalusia. METHOD Qualitative study with 12 focus groups (October 2009 to November 2010). POPULATION primary care physicians. SAMPLE intentionally segmented by age, sex and health care management. Were conducted by sex: two groups with young physicians, two groups with middle aged and two with health care management. TOTAL: 32 female physician and 33 male physicians. Qualitative content analysis with Nuddist Vivo. RESULTS Female and male physicians agree to perceive internal achievements and to consider aspects inherent to the profession as external achievements. The most important difference is that female physician related professional achievement with affective bond and male physician with institutional merit. Internal attributions are more important for female physician who also highlight the importance of family, the organization of working time and work-family balance. Patients, continuing education, institutional resources and computer system are the most important attributions for male physician. CONCLUSIONS There are similarities and differences between female and male physicians both in the understanding and the attributions of achievement. The differences are explained by the gender system. The perception of achievement of the female physicians questions the dominant professional culture and incorporates new values in defining achievement. The attributions reflect the unequal impact of family and organizational variables and suggest that the female physicians would be changing gender socialization.

Validación de escala para evaluar la relación familia-trabajo en médicas y médicos de familia

Background: Studying the work-family relationships is important because it affects the personal and professional life. Women increases in medicine without redistribute domestic tasks and responsibilities. The purpose of this study was to create and validate a scale of work-family relations in women and men family physician (FP) in Andalusia. Methods: Cross sectional and multicenter study. The study population were FP of urban primary care centres, sample=500FP (50% by sex). We studied: sex, age, postgraduate family medicine specialty, care burden (2 variables), and family burden (7 variables). We design, and included in self-administered questionnaires, a scale of 13 questions on work-family relations. Bivariate analysis, exploratory factor and multiple regressions to test the convergent validity was performed. Results: The response rate was 73.6%. We identified two dimensions, Overloading and Family Support Deficit (OFSD) (5 questions), and Work-Family Conflict (WFC) (6 questions), in both, female FP score higher than their peers. There are more family variables associated with both dimensions in female FP, it expresses differences in the complexity of the causes of OFSD and WFC by sex. Conclusion: The scale obtained is valid, reliable and gives two empirical dimensions of family-work relationships.BACKGROUND Studying the work-family relationships is important because it affects the personal and professional life. Women increases in medicine without redistribute domestic tasks and responsibilities. The purpose of this study was to create and validate a scale of work-family relations in women and men family physician (FP) in Andalusia. METHODS Cross sectional and multicenter study. The study population were FP of urban primary care centres, sample=500FP (50% by sex). We studied: sex, age, postgraduate family medicine specialty, care burden (2 variables), and family burden (7 variables). We design, and included in self-administered questionnaires, a scale of 13 questions on work-family relations. Bivariate analysis, exploratory factor and multiple regressions to test the convergent validity was performed. RESULTS The response rate was 73.6%. We identified two dimensions, Overloading and Family Support Deficit (OFSD) (5 questions), and Work-Family Conflict (WFC) (6 questions), in both, female FP score higher than their peers. There are more family variables associated with both dimensions in female FP, it expresses differences in the complexity of the causes of OFSD and WFC by sex. CONCLUSION The scale obtained is valid, reliable and gives two empirical dimensions of family-work relationships.

Repensar la Carta de Ottawa 30 años después

A 30 años de la Carta de Ottawa1 para la promoción de la salud, aprobada en noviembre de 1986, es válido preguntarse cómo ha logrado influenciar las políticas de salud pública o específicamente, como señala la Carta, «avanzar hacia una nueva salud pública»2. Cada efeméride de la Carta de Ottawa se escriben editoriales o suplementos de revistas sobre su alcance. Por ello cabe preguntarse qué nuevo tenemos que decir, qué pensamos de los avances o fracasos de la Carta de Ottawa (ya sea en su diseño, sus contenidos o su implementación) y, por último, qué vigencia tiene en la época actual considerando los profundos cambios que se han producido en todo el mundo. Tales reflexiones son las que se comparten en este editorial. Los problemas y los desafíos que se presentan para la salud son muchos de ellos similares o incluso los mismos ya descritos; lo que cambian son los contextos, y lo que se requiere son nuevas intervenciones o estrategias para su abordaje.

Características de la familia de origen y de la familia formada por las médicas y los médicos de familia de Andalucía

Characteristics of the Family of Origin and Family Formed by Women and Men Primary Care Physicians of Andalusia, Spain Background: The origin and formed family characteristics are related to physician’s professional career. The purpose of this study was to know and compare by sex the characteristics of the origin family and formed family of women and men family physician in Andalusia. Methods: Cross sectional and multicenter study. Setting: Urban primary health care centres from Andalusian province capitals. Participants: Physician of primary health care centres. Inclusion criteria: at least one year using computerized medical history with the same quota patients. Multistage random sample, 88 primary health care centres and 500 physicians, 50% of both sexes (alpha=5%, power=90%, precision=15%). Postal auto administrated questionnaire. Variables: sex, age, tutor of resident in family medicine, last father’s activity, last mother’s activity, number of brothers or sisters, family situation, last couple’s activity (if any), to have or not children.

Professional Success and Gender in Family Medicine: Design of Scales and Examination of Gender Differences in Subjective and Objective Success Among Family Physicians

Two components of professional success have been defined: objective career success (OCS) and subjective career success (SCS). Despite the increasing number of women practicing medicine, gender inequalities persist. The objectives of this descriptive, cross-sectional, and multicenter study were (a) to construct and validate OCS and SCS scales, (b) to determine the relationships between OCS and SCS and between each scale and professional/family characteristics, and (c) to compare these associations between male and female family physicians (FPs). The study sample comprised 250 female and 250 male FPs from urban health centers in Andalusia (Spain). Data were gathered over 6 months on gender, age, care load, professional/family variables, and family–work balance, using a self-administered questionnaire. OSC and SCS scales were examined by using exploratory factorial analysis and Cronbach’s α, and scores were compared by gender-stratified bivariate and multiple regression analyses. Intraclass correlation coefficients were calculated using a multilevel analysis. The response rate was 73.6%. We identified three OCS factors and two SCS factors. Lower scores were obtained by female versus male FPs in the OCS dimensions, but there were no gender differences in either SCS dimension.

Evaluación del impacto en la salud del proyecto de reurbanización de la calle San Fernando en Alcalá de Guadaíra (Sevilla)

OBJECTIVES This study describes the design and implementation of a health impact assessment (HIA) conducted in 2010 of the regeneration project of San Fernando Street, the main avenue crossing the San Miguel-El Castillo neighborhood in Alcala de Guadaíra (Seville, Spain). This project is part of the wider URBAN Plan aimed at the social, urban and economic regeneration of the citys historic center. METHODS This experience followed the standard HIA stages and procedures. The review of published evidence was complemented with new qualitative information gathered by means of a participative workshop with the local population and interviews with social and health workers involved in the neighborhood. RESULTS During the building stage of the project, the adverse impacts were related to a worsening of the air quality, increased noise pollution, mobility restrictions and a higher risk of accidents, particularly among older or disabled people. Once the building stage was finished, the health benefits were associated with significant improvements in physical accessibility and the populations access to health services and other goods and services. Other positive effects were the enhanced safety and attractiveness of the neighborhood and the new opportunities for socializing, social cohesion and increasing the communitys self-esteem. CONCLUSIONS This is the first HIA experience in Andalusia whose results have been integrated into a formal cycle of decision making in the local community. This experience has provided new evidence of the potential of HIA and its applicability and acceptance at the municipal level and has has also facilitated a learning process and the piloting of new methods and tools associated with the HIA process.Objetivos Se presenta la experiencia de una evaluacion del impacto en la salud realizada en 2010 sobre el proyecto de reurbanizacion de la calle San Fernando, via principal de acceso al barrio de San Miguel-El Castillo, en Alcala de Guadaira (Sevilla). Constituye esta una de las primeras actuaciones previstas en el Plan URBAN de regeneracion social, urbana y economica del casco historico del municipio. Metodos Se han seguido las cinco fases y los procedimientos clasicos de una evaluacion del impacto en la salud. La revision de la evidencia se ha complementado con una consulta a la poblacion afectada en forma de taller participativo, asi como con entrevistas a profesionales sociosanitarios con implicacion en el barrio. Resultados Durante las obras, los impactos negativos se relacionan con los efectos nocivos del proyecto sobre la calidad del aire, el nivel de ruidos, las restricciones a la movilidad y el riesgo de siniestralidad, en especial entre la poblacion mayor o con movilidad reducida. Cuando finalicen, se preven mejoras en determinantes del entorno fisico tales como la accesibilidad y la conectividad del barrio con servicios sanitarios y otros bienes y servicios en otras zonas del municipio. Tambien se preven impactos positivos vinculados a la seguridad y el atractivo del barrio, asi como nuevas oportunidades para la sociabilidad, la cohesion social y la autoestima comunitaria. Conclusiones Se trata de la primera experiencia en Andalucia cuyos resultados se han integrado en un ciclo formal de toma de decisiones de ambito local. Ello ha permitido valorar el potencial, la aplicabilidad y la aceptacion de la evaluacion del impacto en la salud en el ambito municipal, asi como facilitar un proceso de aprendizaje y un pilotaje de metodos y herramientas adaptadas.