Juan Nicolás Peña-Sánchez

Bio: Juan Nicolás Peña-Sánchez is an academic researcher from University of Saskatchewan. The author has contributed to research in topics: Inflammatory bowel disease & Medicine. The author has an hindex of 12, co-authored 41 publications receiving 429 citations.

Rural and urban disparities in the care of Canadian patients with inflammatory bowel disease: a population-based study.

Abstract: Background and aims Canada's large geographic area and low population density pose challenges in access to specialized health care for remote and rural residents. We compared health services use, surgical rate, and specialist gastroenterologist care in rural and urban inflammatory bowel disease (IBD) patients in Canada. Methods We used validated algorithms that were applied to population-based health administrative data to identify all people living with the following three Canadian provinces: Alberta, Manitoba, and Ontario (ON). We compared rural residents with urban residents for time to diagnosis, hospitalizations, outpatient visits, emergency department (ED) use, surgical rate, and gastroenterologist care. Multivariable regression compared the outcomes in rural/urban patients, controlling for confounders. Provincial results were meta-analyzed using random-effects models to produce overall estimates. Results A total of 36,656 urban and 5,223 rural residents with incident IBD were included. Outpatient physician visit rate was similar in rural and urban patients. IBD-specific and IBD-related hospitalization rates were higher in rural patients (incidence rate ratio [IRR] 1.17, 95% CI 1.02-1.34, and IRR 1.27, 95% CI 1.04-1.56, respectively). The rate of ED visits in ON were similarly elevated for rural patients (IRR 1.53, 95% CI 1.42-1.65, and IRR 1.33, 95% CI 1.25-1.40). There were no differences in surgical rates or prediagnosis lag time between rural and urban patients. Rural patients had fewer IBD-specific gastroenterologist visits (IRR 0.79, 95% CI 0.73-0.84) and a smaller proportion of their IBD-specific care was provided by gastroenterologists (28.3% vs 55.2%, P 65 years (33.0% vs 59.2%, P<0.0001). Conclusion There were lower rates of gastroenterologist physician visits, more hospitalizations, and greater rates of ED visits in rural IBD patients. These disparities in health services use result in costlier care for rural patients. Innovative methods of delivering gastroenterology care to rural IBD patients (such as telehealth, online support, and remote clinics) should be explored, especially for communities lacking easy access to gastroenterologists.

Factors Associated with Satisfaction of Hospital Physicians: A Systematic Review on European Data.

Abstract: Background: Physician satisfaction is a multidimensional concept related to many factors. Despite the wide range of research regarding factors affecting physician satisfaction in different European countries, there is a lack of literature reviews analyzing and summarizing current evidence. The aim of the article is to synthetize the literature studying the factors associated with physician satisfaction. Methods: We searched: MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library from January 2000 to January 2017. The eligibility criteria included: (1) target population: physicians working in European hospitals; (2) quantitative research aimed at assessing physician satisfaction and associated factors; (3) use of validated tools. We performed a narrative synthesis. Results: After screening 8585 records, 368 full text articles were independently checked and finally 24 studies were included for qualitative analysis. The included studies surveyed 20,000 doctors from 12 European countries. The tools and scales used in the analyzed research to measure physician satisfaction varied to a large extent. We extracted all pre-specified factors, reported as statistically significant/non-significant. Analyzed factors were divided into three groups: personal, intrinsic and contextual factors. The majority of factors are modifiable and positively associated with characteristics of contextual factors, such as work-place setting/work environment. In the group of work-place related factors, quality of management/leadership, opportunity for professional development and colleague support have been deemed statistically significant in numerous studies. Conclusions: We identified more studies appraising the effect of contextual factors (such as work environment, work-place characteristics), highlighting a positive association between those factors and physician satisfaction, compared with personal and intrinsic factors. Numerous studies confirmed statistically significant associations between physician satisfaction and quality of management, professional development and colleague support/team climate. Due to the health workforce crisis, knowledge regarding physician satisfaction and associated factors is essential to healthcare managers and policy makers for more stable human resources management.

Combined Biologic and Immunomodulatory Therapy is Superior to Monotherapy for Decreasing the Risk of Inflammatory Bowel Disease-Related Complications.

Abstract: Background and aims The combination of infliximab and azathioprine is more efficacious than either therapy alone for Crohn's disease [CD] and ulcerative colitis [UC]. However, it is uncertain whether these benefits extend to real-world clinical practice and to other combinations of biologics and immunomodulators. Methods We collected health administrative data from four Canadian provinces representing 78 413 patients with inflammatory bowel disease [IBD] of whom 11 244 were prescribed anti-tumour necrosis factor [anti-TNF] agents. The outcome of interest was the first occurrence of treatment failure: an unplanned IBD-related hospitalization, IBD-related resective surgery, new/recurrent corticosteroid use or anti-TNF switch. Multivariable Cox proportional hazards modelling was used to assess the association between the outcome of interest and receiving combination therapy vs anti-TNF monotherapy. Multivariable regression models were used to assess the impact of choice of immunomodulator or biologic on reaching the composite outcome, and random effects generic inverse variance meta-analysis of deterministically linked data was used to pool the results from the four provinces to obtain aggregate estimates of effect. Results In comparison with anti-TNF monotherapy, combination therapy was associated with a significant decrease in treatment ineffectiveness for both CD and UC (CD: adjusted hazard ratio [aHR] 0.77, 95% confidence interval [CI] 0.66-0.90; UC: aHR 0.72, 95% CI 0.62-0.84). Combination therapy was equally effective for adalimumab and infliximab in CD. In UC azathioprine was superior to methotrexate as the immunomodulatory agent (aHR = 1.52 [95% CI 1.02-2.28]) but not CD (aHR = 1.22 [95% CI 0.96-1.54]). Conclusion In an analysis of a database of real-world patients with IBD, combination therapy decreased the likelihood of treatment failure in both CD and UC.

Using Multivariate Statistics

Abstract: Thank you for downloading using multivariate statistics. As you may know, people have look hundreds times for their favorite novels like this using multivariate statistics, but end up in infectious downloads. Rather than reading a good book with a cup of tea in the afternoon, instead they juggled with some harmful bugs inside their laptop. using multivariate statistics is available in our digital library an online access to it is set as public so you can download it instantly. Our books collection saves in multiple locations, allowing you to get the most less latency time to download any of our books like this one. Merely said, the using multivariate statistics is universally compatible with any devices to read.

Human MotivationThe Mind in Action: A Study of Motives and Values. A. Campbell Garnett

Abstract: In his Preface the author' says that he started out to review all the more important theories upon the topics ordinarily discussed under human motivation but soon found himself more and more limited to the presentation of his own point of view. This very well characterizes the book. It is a very personal product. It is an outline with some defense of the author's own thinking about instincts and appetites and sentiments and how they function in human behavior. And as the author draws so heavily upon James and McDougall, especially the latter, the book may well be looked upon as a sort of sequel to their efforts. There is a thought-provoking distinction presented between instinct and appetite. An instinct is said to be aroused always by something in the external situation; and, correspondingly, an appetite is said to be aroused by sensations from within the body itself. This places, of course, a heavy emphasis upon the cognitive factor in all instinctive behaviors; and the author prefers to use the cognitive factor, especially the knowledge of that end-experience which will satisfy, as a means of differentiating one instinct from another. In this there is a recognized difference from McDougall who placed more emphasis for differentiation upon the emotional accompaniment. The list of instincts arrived at by this procedure is much like that of McDougall, although the author is forced by his criteria to present the possibility of food-seeking and sex and sleep operating both in the manner of an appetite and also as an instinct. The Shand-McDougall concept of sentiment is taken over and used in the explanation of moral motivation. There is the development within each personality of a sentiment for some moral principle. But this sentiment is not a very powerful motivating factor. It is reinforced by social pressures and by religion, which is treated as an effort of finite man to live in harmony with the infinite reality. Those whose psychological thinking is largely in terms of McDougall will doubtless find this volume a very satisfying expansion; but those who are at all inclined to support their psychological thinking by reference to experimental studies will not be so well pleased. The James-Lange theory, for example, is discussed without mention of the many experimental studies which it has provoked. Theoretical sources appear in general to be preferred to experimental investigations.

Internet, phone, mail and mixed-mode surveys: the tailored design method: reseña

Abstract: Resena de la obra de Don A. Dillman, Jolene D. Smyth y Leah Melani Christian: Internet, Phone, Mail and Mixed-Mode Surveys. The Tailored Design Method. New Jersey: John Wiley and Sons

Importance of work environments on hospital outcomes in nine countries

Abstract: PURPOSE To determine the effect of hospital work environments on hospital outcomes across multiple countries. DESIGN Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009. MAIN OUTCOME MEASURES Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care. RESULTS High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes. CONCLUSIONS Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.

The four epidemiological stages in the global evolution of inflammatory bowel disease.

Abstract: Inflammatory bowel disease (IBD) is a global disease; its evolution can be stratified into four epidemiological stages: Emergence, Acceleration in Incidence, Compounding Prevalence and Prevalence Equilibrium. In 2020, developing countries are in the Emergence stage, newly industrialized countries are in the Acceleration in Incidence stage, and Western regions are in the Compounding Prevalence stage. Western regions will eventually transition to the Prevalence Equilibrium stage, in which the accelerating prevalence levels off as the IBD population ages and possibly as a result of an unexpected rise in mortality during the COVID-19 pandemic. Mitigating the global burden of IBD will require concerted efforts in disease prevention and health-care delivery innovations that respond to changing demographics of the global IBD population. In this Perspective, we summarize the global epidemiology of IBD and use these data to stratify disease evolution into four epidemiological stages.