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[PMID]: 28931640 [Au] Autor: Miyasaki JM; Rheaume C; Gulya L; Ellenstein A; Schwarz HB; Vidic TR; Shanafelt TD; Cascino TL; Keran CM; Busis NA [Ad] Endereço: From the Department of Medicine, Division of Neurology (J.M.M.), University of Alberta, Edmonton, Canada; Member Insights Department (C.R., L.G., C.M.K.), American Academy of Neurology, Minneapolis, MN; Department of Neurology (A.E.), George Washington University, Washington, DC; Department of Neuro [Ti] Título: Qualitative study of burnout, career satisfaction, and well-being among US neurologists in 2016. [So] Source: Neurology;89(16):1730-1738, 2017 Oct 17. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To understand the experience and identify drivers and mitigating factors of burnout and well-being among US neurologists. METHODS: Inductive data analysis was applied to free text comments (n = 676) from the 2016 American Academy of Neurology survey of burnout, career satisfaction, and well-being. RESULTS: Respondents providing comments were significantly more likely to be older, owners/partners of their practice, solo practitioners, and compensated by production than those not commenting. The 4 identified themes were (1) policies and people affecting neurologists (government and insurance mandates, remuneration, recertification, leadership); (2) workload and work-life balance (workload, electronic health record [EHR], work-life balance); (3) engagement, professionalism, work domains specific to neurology; and (4) solutions (systemic and individual), advocacy, other. Neurologists mentioned workload > professional identity > time spent on insurance and government mandates when describing burnout. Neurologists' patient and clerical workload increased work hours or work brought home, resulting in poor work-life balance. EHR and expectations of high patient volumes by administrators impeded quality of patient care. As a result, many neurologists reduced work hours and call provision and considered early retirement. CONCLUSIONS: Our results further characterize burnout among US neurologists through respondents' own voices. They clarify the meaning respondents attributed to ambiguous survey questions and highlight the barriers neurologists must overcome to practice their chosen specialty, including multiple regulatory hassles and increased work hours. Erosion of professionalism by external factors was a common issue. Our findings can provide strategic direction for advocacy and programs to prevent and mitigate neurologist burnout and promote well-being and engagement. [Mh] Termos MeSH primário: Esgotamento Profissional/epidemiologia Satisfação no Emprego Neurologistas/psicologia Neurologistas/estatística & dados numéricos [Mh] Termos MeSH secundário: Adulto Esgotamento Profissional/psicologia Despersonalização/epidemiologia Feminino Seres Humanos Masculino Meia-Idade Formulação de Políticas Prevalência Remuneração Fatores de Risco Estados Unidos/epidemiologia Equilíbrio Trabalho-Vida Carga de Trabalho/psicologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171024 [Lr] Data última revisão: 171024 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170922 [St] Status: MEDLINE [do] DOI: 10.1212/WNL.0000000000004526

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[PMID]: 28760842 [Au] Autor: Murray T [Ad] Endereço: Toronto, Ont. [Ti] Título: Support grows for paying surrogates. [So] Source: CMAJ;189(30):E1004-E1005, 2017 07 31. [Is] ISSN: 1488-2329 [Cp] País de publicação: Canada [La] Idioma: eng [Mh] Termos MeSH primário: Remuneração Técnicas de Reprodução Assistida/legislação & jurisprudência Mães Substitutas/legislação & jurisprudência [Mh] Termos MeSH secundário: Canadá Feminino Seres Humanos Gravidez Técnicas de Reprodução Assistida/economia Técnicas de Reprodução Assistida/ética [Pt] Tipo de publicação: NEWS [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171102 [Lr] Data última revisão: 171102 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170802 [St] Status: MEDLINE [do] DOI: 10.1503/cmaj.1095444

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[PMID]: 28619565 [Au] Autor: Grant-Kels JM [Ad] Endereço: Department of Dermatology, University of Connecticut, Farmington, Connecticut. Electronic address: grant@uchc.edu. [Ti] Título: Commentary: Clinical registries: The good, the bad, and the ugly. [So] Source: J Am Acad Dermatol;77(1):186-187, 2017 07. [Is] ISSN: 1097-6787 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Dermatologia/economia Sistema de Registros [Mh] Termos MeSH secundário: Dermatologia/ética Seres Humanos Seleção de Pacientes Padrões de Prática Médica Sistema de Registros/ética Remuneração Fatores de Tempo Carga de Trabalho [Pt] Tipo de publicação: EDITORIAL [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170920 [Lr] Data última revisão: 170920 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170617 [St] Status: MEDLINE

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[PMID]: 28619564 [Au] Autor: Jariwala N; Lipoff JB [Ad] Endereço: Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Drexel University School of Medicine, Philadelphia, Pennsylvania. [Ti] Título: Clinical registries: Should physicians accept payments for enrolling patients? [So] Source: J Am Acad Dermatol;77(1):183-185, 2017 07. [Is] ISSN: 1097-6787 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Conflito de Interesses/economia Dermatologia/economia Dermatologia/ética Seleção de Pacientes/ética Padrões de Prática Médica/ética Sistema de Registros/ética Remuneração [Mh] Termos MeSH secundário: Seres Humanos Padrões de Prática Médica/economia Psoríase/tratamento farmacológico [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170920 [Lr] Data última revisão: 170920 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170617 [St] Status: MEDLINE

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[PMID]: 28273550 [Au] Autor: Newnam S; Warmerdam A; Sheppard D; Griffin M; Stevenson M [Ad] Endereço: Monash University Accident Research Centre, Monash University, Australia. Electronic address: sharon.newnam@monash.edu. [Ti] Título: Do management practices support or constrain safe driving behaviour? A multi-level investigation in a sample of occupational drivers. [So] Source: Accid Anal Prev;102:101-109, 2017 May. [Is] ISSN: 1879-2057 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: It has been estimated that one-third of all work-related deaths occur while driving for work-related purposes. Despite this, many organisations are unaware of the practices, beyond those that identify and control the impact of unforeseen events (i.e., risk management), that predispose drivers to risk. This study addresses the issue by identifying the management practices operationalised as, High Performance Workplace Systems (HPWS) that influence safe driver behaviour. The study also explores the value given to safety by senior level management as a moderator of the relationship between HPWS practices and driver behaviour. Each factor was tested within a two level hierarchical model consisting of 911 drivers, nested within 161 supervisors and 83 organisations. The findings highight that under conditions of high investment in job and work design, communication and selection practices, drivers reported poorer driving behaviour. An interaction effect also demonstrated that under conditions of high investment in remuneration, drivers reported safer behaviour, but only when they perceived that managers valued and prioritised safety. The findings challenge current thinking in the management of workplace road safety. [Mh] Termos MeSH primário: Condução de Veículo Ocupações Gestão da Segurança Segurança Trabalho Local de Trabalho [Mh] Termos MeSH secundário: Acidentes de Trânsito Adulto Comunicação Feminino Seres Humanos Masculino Meia-Idade Cultura Organizacional Remuneração [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1705 [Cu] Atualização por classe: 170531 [Lr] Data última revisão: 170531 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170309 [St] Status: MEDLINE

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[PMID]: 28264677 [Au] Autor: Hill H; Birch S; Tickle M; McDonald R; Donaldson M; O'Carolan D; Brocklehurst P [Ad] Endereço: School of Dentistry, University of Manchester, Manchester, M13 9PL, UK. Harry.hill@manchester.ac.uk. [Ti] Título: Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland. [So] Source: BMC Health Serv Res;17(1):175, 2017 Mar 06. [Is] ISSN: 1472-6963 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: In May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services. METHODS: We analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system. RESULTS: No evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups. CONCLUSION: Although remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients. [Mh] Termos MeSH primário: Capitação Assistência à Saúde/estatística & dados numéricos Assistência Odontológica/economia [Mh] Termos MeSH secundário: Assistência à Saúde/economia Assistência Odontológica/utilização Odontólogos/economia Planos de Pagamento por Serviço Prestado Honorários e Preços Feminino Gastos em Saúde Acesso aos Serviços de Saúde/economia Acesso aos Serviços de Saúde/estatística & dados numéricos Seres Humanos Masculino Irlanda do Norte Projetos Piloto Atenção Primária à Saúde Estudos Prospectivos Remuneração Estudos Retrospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170906 [Lr] Data última revisão: 170906 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170308 [St] Status: MEDLINE [do] DOI: 10.1186/s12913-017-2117-3

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[PMID]: 28240040 [Au] Autor: Karakolias S; Kastanioti C; Theodorou M; Polyzos N [Ad] Endereço: 1 Democritus University of Thrace, Komotini, Greece. [Ti] Título: Primary Care Doctors' Assessment of and Preferences on Their Remuneration. [So] Source: Inquiry;54:46958017692274, 2017 Jan. [Is] ISSN: 1945-7243 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Despite numerous studies on primary care doctors' remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care's new structure in an effort to converge with international standards. [Mh] Termos MeSH primário: Atitude do Pessoal de Saúde Médicos de Atenção Primária/economia Médicos de Atenção Primária/psicologia Setor Público Remuneração [Mh] Termos MeSH secundário: Grécia Seres Humanos Reembolso de Incentivo Salários e Benefícios Inquéritos e Questionários [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1705 [Cu] Atualização por classe: 170502 [Lr] Data última revisão: 170502 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170228 [St] Status: MEDLINE [do] DOI: 10.1177/0046958017692274

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[PMID]: 28219445 [Au] Autor: Maini R; Hotchkiss DR; Borghi J [Ad] Endereço: London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom. Rishma.Maini@lshtm.ac.uk. [Ti] Título: A cross-sectional study of the income sources of primary care health workers in the Democratic Republic of Congo. [So] Source: Hum Resour Health;15(1):17, 2017 Feb 20. [Is] ISSN: 1478-4491 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: In the Democratic Republic of Congo (DRC), the state system to remunerate health workers is poorly functional, encouraging diversification of income sources and corruption. Given the central role that health workers play in health systems, policy-makers need to ensure health workers are remunerated in a way which best incentivises them to provide effective and good quality services. This study describes the different sources and quantities of income paid to primary care health workers in Equateur, Maniema, Kasai Occidental, Province Orientale and Kasai Oriental provinces. It also explores characteristics associated with the receipt of different sources of income. METHODS: Quantitative data on the income received by health workers were collected through baseline surveys. Descriptive statistics explored the demographic characteristics of health workers surveyed, and types and amounts of incomes received. A series of regression models were estimated to examine the health worker and facility-level determinants of receiving each income source and of levels received. Qualitative data collection was carried out in Kasai Occidental province to explore perceptions of each income source and reasons for receiving each. RESULTS: Nurses made up the majority of workers in primary care. Only 31% received a government salary, while 75% reported compensation from user fees. Almost half of all nurses engaged in supplemental non-clinical activities. Receipt of government payments was associated with income from private practice and non-clinical activities. Male nurses were more likely to receive per diems, performance payments, and higher total remuneration compared to females. Contextual factors such as provincial location, presence of externally financed health programmes and local user fee policy also influenced the extent to which nurses received many income sources. CONCLUSIONS: The receipt of government payments was unreliable and had implications for receipt of other income sources. A mixture of individual, facility and geographical factors were associated with the receipt of various income sources. Greater co-ordination is needed between partners involved in health worker remuneration to design more effective financial incentive packages, reduce the fragmentation of incomes and improve transparency in the payment of workers in the DRC. [Mh] Termos MeSH primário: Renda Motivação Enfermeiras e Enfermeiros/economia Atenção Primária à Saúde Setor Público Qualidade da Assistência à Saúde Remuneração [Mh] Termos MeSH secundário: Adulto Estudos Transversais República Democrática do Congo Países em Desenvolvimento Emprego Planos de Pagamento por Serviço Prestado Feminino Governo Pessoal de Saúde/economia Serviços de Saúde Seres Humanos Masculino Meia-Idade Reembolso de Incentivo Salários e Benefícios Sexismo [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171102 [Lr] Data última revisão: 171102 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170222 [St] Status: MEDLINE [do] DOI: 10.1186/s12960-017-0185-4

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[PMID]: 28216529 [Au] Autor: Akazawa H [Ti] Título: Remuneration in the Form of No Remuneration. [So] Source: Nihon Hoshasen Gijutsu Gakkai Zasshi;73(2):i, 2017. [Is] ISSN: 0369-4305 [Cp] País de publicação: Japan [La] Idioma: jpn [Mh] Termos MeSH primário: Tecnologia Radiológica [Mh] Termos MeSH secundário: Revisão da Pesquisa por Pares Remuneração Sociedades Médicas [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 171018 [Lr] Data última revisão: 171018 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170221 [St] Status: MEDLINE [do] DOI: 10.6009/jjrt.2017_JSRT_73.2.i

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[PMID]: 28173813 [Au] Autor: Russo G; Pavignani E; Guerreiro CS; Neves C [Ad] Endereço: International Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 100, Lisbon, Portugal. g.russo@qmul.ac.uk. [Ti] Título: Can we halt health workforce deterioration in failed states? Insights from Guinea-Bissau on the nature, persistence and evolution of its HRH crisis. [So] Source: Hum Resour Health;15(1):12, 2017 Feb 07. [Is] ISSN: 1478-4491 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Guinea-Bissau is one of the world's poorest and least developed countries. Amid poverty, political turmoil and state withdrawal, its health workforce (HW) has been swamped for the last four decades in a deepening crisis of under-resourcing, poor performance and laissez-faire. METHODS: The present study aimed at analysing the human resources for health (HRH) situation in Guinea-Bissau in light of the recent literature on distressed health systems, with the objective of contributing to understanding the ways health workers react to protracted turmoil, the resulting distortions and the counter-measures that might be considered. Through document analysis, focus group discussions, 14 semi-structured and 5 in-depth interviews, we explored patterns as they became visible on the ground. RESULTS: Since independence, Guinea-Bissau experienced political events that have reflected on the healthcare arena and on the evolution of its health workforce, such as different coup attempts, waves of diaspora and shifting external assistance. The chronic scarcity of funds and a 'stable political instability' have lead to the commercialisation of public health services and to flawed mechanisms for training and deploying health personnel. In absence of any form of governance, health workers have come to own and run the health system. We show that the HRH crisis in Guinea-Bissau can only be understood by looking at its historical evolution and at the wider socio-economic context. There are no quick fixes for the deterioration of HRH in undergoverned states; however, the recognition of the ingrained distortions and an understanding of the forces determining the behaviour of key actors are essential premises for the identification of solutions. CONCLUSIONS: Guinea-Bissau's case study suggests that any policy that does not factor in the limited clout of health authorities over a effectively privatised healthcare arena is doomed from the start. Improving health system governance and quality of training should take precedence over expanding HRH. A bloated and ineffective workforce must be managed through incentives rather than administrative orders, in order to improve skills and productivity against higher remuneration and better working conditions. Donor support might be crucial to trigger positive changes, through realistic and sustained investments. [Mh] Termos MeSH primário: Distúrbios Civis Serviços de Saúde Comunitária/recursos humanos Assistência à Saúde/recursos humanos Países em Desenvolvimento Pessoal de Saúde Administração de Recursos Humanos Pobreza [Mh] Termos MeSH secundário: Competência Clínica Serviços de Saúde Comunitária/normas Assistência à Saúde/normas Educação Organização do Financiamento Grupos Focais Governo Guiné-Bissau Pessoal de Saúde/educação Política de Saúde Acesso aos Serviços de Saúde Seres Humanos Cooperação Internacional Satisfação no Emprego Política Privatização Qualidade da Assistência à Saúde Remuneração [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170919 [Lr] Data última revisão: 170919 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170209 [St] Status: MEDLINE [do] DOI: 10.1186/s12960-017-0189-0

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