Legitimidad de los operadores móviles en los usuários de Medellín, Colombia: aproximación teórica y empírica / Legitimacy of mobile operators in Medellín, Colombia, users: theoretical and empirical approach / Legitimidade das operadoras móveis entre os usuários em Medellín, Colômbia: uma abordagem teórica e empírica

RESUMEN El objetivo de este artículo es medir la percepción de la legitimidad de los operadores móviles por parte de los usuarios de Medellín, Colombia, partiendo de un modelo teórico sustentado en la relación entre las dimensiones cognitiva, moral y pragmática de la legitimidad. Los datos se obtuvieron de una encuesta a una muestra de 1.094 usuarios de telefonía móvil de la ciudad. El modelo se validó utilizando el Análisis Factorial Confirmatorio. Los hallazgos muestran que la legitimidad cognitiva, moral y pragmática de los usuarios de los servicios de los operadores móviles están relacionadas, de donde se infiere que los operadores deben desarrollar estrategias comunicativas considerando todas las dimensiones de la legitimidad para tener una mejor aceptación de sus clientes. CLASIFICACIÓN JEL 120; 18

AВSTRACT The aim of this paper is to measure the perception of the legitimacy of mobile operators by the users of Medellín, Colombia, founding from a theoretical model based on the relationship between the cognitive, moral, and pragmatic dimensions of legitimacy The data was obtained from a survey of a sample of 1,094 mobile phone users from the city The model was validated using Confirmatory Factor Analysis. The findings show that the cognitive, moral, and pragmatic legitimacy of the users of the services mobile operators are related, from which it is inferred that the operators must develop communication strategies considering all the dimensions of legitimacy to have a better acceptance of their customers. JEL CLASSIFICATION 120; 18

RESUMO O objetivo deste artigo é medir a perceção da legitimidade das operadoras móveis pelos usuários em Medellín, Colômbia, com base em um modelo teórico baseado na relação entre as dimensões cognitiva, moral e pragmática da legitimidade. Os dados foram obtidos de uma pesquisa com uma amostra de 1.094 usuários de telefones celulares na cidade. O modelo foi validado utilizando a Análise Confirmativa de Fatores. As conclusões mostram que a legitimidade cognitiva, moral e pragmática dos usuários de serviços das operadoras móveis está relacionada, da qual se deduz que as operadoras devem desenvolver estratégias comunicativas considerando todas as dimensões de legitimidade para ter uma melhor aceitação por parte de seus clientes. CLASSIFICAÇÃO JEL 120; 18

Mortalidad materna en el departamento de Cauca, un estudio en el régimen subsidiado / Maternal mortality in the state of Cauca: a study in the subsidized system / Mortalidade materna no departamento do Cauca, um estudo no regime subsidiado

Resumen Objetivo: Describir algunas características epidemiológicas y del registro de las muertes maternas presentadas en la población afiliada a una empresa prestadora de servicios de salud del régimen subsidiado, en el departamento de Cauca (Colombia). Metodología: Estudio descriptivo, retrospectivo. Se realizó análisis univariado para la caracterización de las muertes, mapeo para la ubicación espacial y presentación gráfica sobre el número de casos por año. Se incluyó análisis bivariado con U de Mann-Whitney y Kruskal-Wallis. Se evaluó la concordancia en los registros mediante el estadístico Kappa. Resultados: Se presentaron 34 muertes maternas entre los años 2009 y 2014, con una razón de mortalidad materna de 193, 141, 231, 67 y 110 muertes por cada 100 000 nacidos vivos, para el periodo 2010-2014. Los casos ocurrieron en mujeres que en su mayoría residían en área rural dispersa (67,6 %), tenían nivel educativo bajo (63,3 %), eran amas de casa (73,5 %) y no asistieron o asistieron tardíamente al control prenatal (67,7 %). Se identificó pobre concordancia entre los documentos institucionales y los reportes al Sistema de Vigilancia en Salud Pública colombiano (K= -0,0282, p= 0,8116). Conclusiones : Las muertes maternas presentadas en la entidad en el periodo de estudio y que tuvieron un perfil enmarcando en condiciones de riesgo, en su mayoría eran prevenibles. A pesar de que la entidad utilizó una estrategia para identificar demoras o retrasos en tres aspectos de cada caso de mortalidad materna, se requiere que dicha evaluación se cumpla para todos los eventos, acompañada de registros completos que faciliten los procesos de seguimiento.

Abstract Objective: To describe epidemiological characteristics, as well as maternal deaths registration characteristics in the population registered in a subsidized healthcare service provider in the state of Cauca (Colombia). Methodology: Descriptive, retrospective study. Univariate analysis was performed for the characterization of deaths, a mapping of their spatial location, and a graphical presentation of the number of deaths per year. Bivariate analysis with the Mann-Whitney U test and the Kruskal-Wallis test was also implemented. The concordance in records was assessed using Cohen's Kappa coefficient. Results: There were 34 maternal deaths between 2009 and 2014, with a rate of maternal mortality of 193, 141, 231, 67 and 110 deaths per 100,000 live births for the period from 2010 to 2014. The incidents occurred in women who mostly resided in scattered rural areas (67.6 %), had a low level of education (63.3 %), were housewives (73.5 %) and did not attend antenatal care or did it lately (67.7 %). Poor concordance was identified between institutional documents and reports to the Colombian Public Health Surveillance System (K = -0.0282, p = 0.8116). Conclusions: The maternal deaths compiled from the entity information system during the study and which had a profile linked to risky conditions were, in most cases, preventable. Although the entity used a strategy to identify delays in three aspects of each maternal mortality case, this assessment is to be completed for all events, accompanied by complete records to facilitate follow-up processes.

Resumo Objetivo: Descrever algumas características epidemiológicas e o cadastro de óbitos maternos apresentados na população afiliada a uma empresa prestadora de serviços de saúde do regime subsidiado "SISBEN", no departamento do Cauca (Colômbia). Metodologia: Estudo descritivo, retrospectivo. Foi realizada uma análise univariada para caracterização dos óbitos, mapeamento para localização espacial e apresentação gráfica do número de casos por ano. A análise bivariada com Mann-Whitney U e Kruskal-Wallis foi incluída. A concordância nos cadastros foi avaliada pela estatística Kappa. Resultados: Houve 34 óbitos maternos entre 2009 e 2014, com uma taxa de mortalidade materna de 193, 141, 231, 67 e 110 óbitos por 100.000 nascidos vivos, no período 2010-2014. Os casos ocorreram em mulheres que residem principalmente em área rural dispersa (67,6%), com baixa escolaridade (63,3%), eram donas de casa (73,5%) e não compareciam ou compareciam tardiamente ao controle pré-natal (67,7%). Foi identificada ínfima concordância entre documentos institucionais e relatórios para o Sistema de Vigilância em Saúde Pública da Colômbia (K = -0,0282, p = 0,8116). Conclusões: Os óbitos maternos apresentados na entidade durante o período do estudo e com perfil emoldurado em condições de risco eram principalmente evitáveis. Embora a entidade tenha utilizado uma estratégia para identificar atrasos ou atrasos em três aspectos de cada caso de mortalidade materna, é necessário que essa avaliação seja realizada para todos os eventos, acompanhada de cadastros completos que facilitem os processos de acompanhamento.

Caracterización de la atención psicoterapéutica en la IPS CES Sabaneta, Colombia, 2014-2015 / Characterization of psychotherapeutic assistance in the IPS CES Sabaneta, Colombia, 2014-2015

Resumen Los cambios en la cosmovisión imperante en los últimos decenios han traído consigo sujetos con nuevas características, intereses y exigencias, que han impactado a la psicología clínica en tanto le exigen nuevas formas de comprender e intervenir las problemáticas demandadas por ellos en contextos institucionales, entre otros. De cara a estas nuevas realidades y con el fin de hacer más pertinentes las intervenciones psicoterapéuticas, se realizó una caracterización de las mismas en la Institución Prestadora de Servicios de Salud -IPS- CES Sabaneta (Colombia) durante los años 2014-201 5, a través de un análisis descriptivo de 9.140 registros de atención y 532 historias clínicas elegidas aleatoriamente. Se estudiaron aspectos sociodemográficos, administrativos y teórico-técnicos de la atención a partir de análisis de frecuencia, medidas de tendencia central, de dispersión y de forma. Se encontró que consultan tres hombres por cada mujer, siendo la población entre los 6 y 18 años la que tiene el mayor peso (59,77%). Los trastornos emocionales y del comportamiento fueron el principal diagnóstico (44,92%), seguido por los trastornos neuróticos secundarios a situaciones estresantes y somatomorfos (18,6%). Llama la atención la baja prevalencia de los trastornos de personalidad (0,56%) y que el 48,9% de los pacientes asistió a un máximo de seis sesiones. Los resultados permiten ajustar los perfiles y estrategias de atención de acuerdo con las problemáticas más prevalentes, así como los procesos administrativos y formativos relacionados con ellas.

Abstract The changes happened in the prevailing worldview in the last decades have brought subjects with new characteristics, interests and requirements, which have had an impact on the clinical psychology, as a consequence, they require from clinical psychology new ways of understanding and controlling the arisen issues that concern the institutional contexts. In order to face these realities, relevant psychotherapeutic interventions were implemented through a characterization of health attendance carried out in IPS CES Saba-neta during 2014-201 5, conducted by a descriptive analysis of 9140 records of assistance and an analysis of 532 clinical records, chosen randomly. Sociodemographic, administrative and theoretical-technical aspects of the care service were studied based on frequency analysis, measures of central tendency and dispersion using the SPSS software. It was found that 3 men in 1 woman attend to medical service, being the population between ages of 6 and 18 the one that present the highest weight (59, 77 %). Emotional and behavioral disorders were the main diagnosis (44.92%), followed by neurotic disorders secondary to stressful and somatomorphic situations (18.6%). It is noticed the low prevalence of personality disorders (0.56%) even though 48.9% of patients attended a maximum of six sessions. The results allow adjusting the profiles and care service strategies according to the most prevalent problems, as well as the administrative and formative processes that involve these issues.

Assessment of the current status and issues in acceptance of clients with high medical acuity at long term care service provider offices and facilities in area B / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : One of the key challenges in promotion of medical and nursing care collaboration in long term care is the difficulty in understanding the current state of acceptance of clients with high medical acuity by local long term care service providers. This study therefore aimed to clarify the current state and issues regarding such clients.<br><b>Methods</b> : Information was obtained via face to face interviews at 102 facilities out of 105 located in Area B in Prefecture A.<br><b>Results</b> : (1) Most of the facilities, except Long-Term Care Health Facilities, do not have night shift nurses, making it difficult for them to accept anyone who needs a medical procedure, such as tube feedings or sputum suctioning. <br>(2) The number of the facilities accepting elderly clients who require sputum suctioning decreased after the current regulations came into force, due to lack of human resources to provide the time off for training of the staff, and concern regarding costs of training and equipment given the current provider business environment. <br>(3) Lack of understanding by physicians appears to be the largest challenge with regards to end-of-life care, and is a larger factor than lack of understanding and experience of the facilities.<br><b>Conclusion</b> : Collaboration between medical and nursing care needs to be further enhanced based on clear understanding of roles and reality of the facilities.

Study of Patient Dissatisfaction in Government Hospital.

The present study was conducted to know the various reasons for patient dissatisfaction at various places and explanations of service providers for patient dissatisfaction. 400 patients selected from all departments and key service providers at Government Medical College Hospital, Miraj. 364 (91%) patients had one/ more dissatisfaction/s to report. Of the 37 types of dissatisfaction reported, 10 were found to be of serious nature viz. cursory clinical examination (56%), lack of counseling (40%), inadequate privacy during clinical examination (14.28%), lack of explanation regarding drug schedule (43%), unsatisfactory emergency management (32.95%), occurrence of post-operative surgical complications (28.82%), discharged without relief (6.18%) and illegal demand of money, etc. Most of these were ‘acts of omission’ on part of service providers. In terms of legal liability, the ‘service-provider’ constitutes a ‘collective responsibility’ with respect to application of law.

Sistemas de alocação de recursos a prestadores de serviços de saúde - a experiência internacional / Resource allocation systems for health service providers - the international experience

O artigo apresenta as formas tradicionais de alocação de recursos a prestadores de serviços de saúde e se concentra na apresentação e discussão de experiências alternativas encontradas no contexto internacional. Aponta, ainda, as tendências atuais formuladas nos países da OECD, que consistem na adoção de sistemas mistos ou complementados pelo ajuste por desempenho, sendo este predominantemente referido a resultados sobre a saúde da população, ou seja, à efetividade dos serviços de saúde. Ainda, destaca-se uma tendência a adotar sistemas de alocação de recursos diferenciados, segundo o nível de atenção do prestador: aos centros de atenção primária responsáveis pela saúde da população de um dado território, corresponde a alocação de recursos per capita ajustada por risco (ou, em alguns casos, por linhas de cuidado), enquanto os hospitais são em alguns casos remunerados por orçamento global ajustado por desempenho e, em outros, por pagamento prospectivo por procedimento.

This article presents the traditional ways of allocating resources to health service providers and focuses on the presentation and discussion of alternative experiences found in the international context. It also shows the current trends in the OECD countries, involving the adoption of mixed systems or performance-related bonuses, the latter being predominantly referred to the effects on the health of the population, i.e. the effectiveness of the health services. It further stresses the tendency to adopt resource allocation systems that are differentiated according to the level of care provider: to primary care centers, responsible for the health of the population of a given territory, a per capita adjusted for risk factor is granted (or, in some cases, resource allocation defined for lines of care), while in other cases hospitals are either paid according to a performance-adjusted global budget or through prospective payment per procedure.

Transição tecnológica em uma operadora de plano de saúde: o olhar do usuário / Technological transition in a supplemental health care provider: the user's viewpoint

O setor de saúde suplementar no Brasil vem experimentando, nos últimos anos, novos modelos de atenção à saúde. O presente estudo teve como objetivo caracterizar como os usuários percebem e se posicionam em relação à implantação da Estratégia Saúde da Família (ESF) por uma operadora do tipo autogestão. Utilizando-se de grupos focais com usuários considerados "aderidos" e "não-aderidos" à ESF, a pesquisa revela que os usuários têm uma compreensão bastante clara do significado da estratégia, inclusive de seus fortes elementos racionalizadores, percebem as contradições e deficiências no seu processo de formulação e implantação e mantêm um elevado grau de autonomia na escolha dos serviços que lhe sejam mais adequados, muito influenciados pelo tipo de inserção que têm no estabelecimento bancário que mantém a operadora. O usuário percebe, ainda, o impasse da autogestão entre manter uma ampla rede credenciada de livre acesso ou conseguir avançar no sentido de fazer da ESF o eixo estruturante de sua rede assistencial.

The Brazilian supplemental health care sector has been experiencing new health care models in the last few years. This paper aims at featuring how users perceive and how they express themselves in relation to the deployment of a program known as Family Health Strategy (FHS) by a self-management health care provider. Through focal groups, the research reveals that users present a rather clear view on the meaning of strategy, including its remarkable rationalizing elements. In addition, they percept contradictions as well as deficiencies in the formulation and deployment process, and they keep a high level of autonomy in the choice for more adequate services, which are greatly influenced by the type of insertion that they exert in the bank institution that maintains the health care service provider. Users also perceive the predicament presented by self-management regarding the maintenance of a broad authorized free access network and the advance towards turning FHS into the structuring backbone of its assistance network.

Determinant factors on the adoption of application service providers in hospital information systems / 대한의료정보학회지

OBJECTIVE: An application service provider (ASP) is a business that provides computer-based services to customers over a network. The need for ASPs has developed due to increasing costs of information systems, which have far exceeded the price-range of small to medium sized businesses. The ASP could be considered as a potential strategy in hospital information systems (HIS). This study investigates significant factors influencing the adoption of an ASP in hospitals. METHODS: Two survey instruments were developed for information technology (IT) experts in hospitals and IT companies, respectively, and a total of 101 responses were analyzed using SAS, version 9.1. Respondents' characteristics were presented using descriptive statistics, while factor analyses were performed for ASP characteristics and influencing factors for ASP adoption. Regression analyses enabled the understanding of relationships between factors and attitudes toward ASP adoption. RESULTS: Nine factors were derived: efficiency, availability, responsiveness, security, resistancy, service quality, attitude toward information-oriented work of CEO or IT experts, environment, and user attitude. Except for responsiveness and CEO or IT experts' attitude, the seven factors had significant effects on the adoption of an ASP in hospitals. In particular, security and user attitude showed negative effects on ASP adoption. There were variations in the subsystems of HIS. CONCLUSION: For adopting ASP in hospitals, efficiency, availability, security, resistancy, service quality, environment, and user attitude need to be considered, especially security and user attitude. This study allowed the understanding and comparative analysis of user (hospitals) and supplier (IT companies) perspectives of information systems in terms of ASP adoption in hospitals.

Qualitative study on the effects of prevention and control and influencing factors for pulmonary tuberculosis in rural area of Chongqing / 重庆医科大学学报

Objective:To analyze the current situation and the problems and influencing factors of TB control from health service providers in rural area of Chongqing city to provide references.Methods:The leaderships of relevant departments,TB patients or suspects,normal residents and doctors were interviewed by qualitative methods such as key information interviews,in-depth interview,focus group discussion.Results:Diagnostic delay,failure in referring or tracing and patients'adherence are the main problems of TB prevention and control in rural area of chongqing city.Health service providers'capacity and attitude impacted its effect.These factors are further related to the implementation of policies,hospital infrastructure,the mechanisms of health financing and management.Conclusion:Greater importance should be attached to the rural doctors.In order to improve the effects on the control of TB,the government should strengthen training,funding and management.

Effect of the Service Providers' Perceived Service Quality on Customer Loyalty in Restaurants / 대한지역사회영양학회지

Due to the diversification of the food industry and its heightened competition, the marketing strategy to be required the most would be to improve competitiveness by enhancing customer loyalty as a resulting variable of customer satisfaction. Thus, this study, taking a food service provider as a subject, is to find factors and the scope of the perceived quality ; and to analyze how far the perceived service quality factor as such could explain customer's overall satisfaction and customer loyalty ; finally to provide basic data for establishing a customer satisfaction marketing strategy as related to customer loyalty. The results of the study are as below. 1) 25 factors of service quality perceived by a food service provider have been categorized into 8 independent dimensions through factor analysis. Each of them are named 'Employee attitude', 'Cleanliness', 'Reputation', 'Reliability', 'Food', 'Price', 'Convenience', 'Variety', all of which explain 64.3% of the service again quality perception level. 2) After classifying customers into 3 groups according to two criteria -"will buy the service again" and "will suggest it to others" and making a pair of service providers with each customer, each customer loyalty group compared the service quality perception factor of the food service provider. The result was that the group having both the "will buy the service again" and "will suggest to others" criteria, that is, with higher loyalty, tend to have higher points than other group s in the dimension of 'Employee attitude' and 'Cleanliness'(p<0.05), which means these two dimensions are closely related to customer loyalty. 3) From a regression analysis for the service quality perception level of the food service provider and overall satisfaction, it has been found that : the regression models are different for each group, that 'Employee attitude' seems to be related more closely to the group with higher loyalty(p<0.05); that the 'Price' dimension is found to be a meaningful factor to the group categorized not having "will buy the service again" and "will suggest to others" criteria(p<0.05).