The Institutional Environment and Communities of Small Firms

Summary This paper argues that the main problem of small firms in LDCs is not their size but being isolated and powerless. It is not size as such that determines the development potential of small firms, but how they relate to other firms in the industry and in which political and institutional setting they operate. This view is supported by the European example of industrial districts, in which communities of small firms have shown remarkable resilience and growth. The article draws together some key features of this small firm variant of flexible specialisation and brings out some lessons for viable small?scale industrialisation in LDCs. Particular attention is given to what role the institutional environment plays in small firms' development. The administrative and regulatory setting in LDCs is rarely supportive and often discriminatory. Résumé L'environnement institutionnel et les communautés de petites entreprises L'auteur du présent article estime que le problème majeur des petites entreprises dans les pays moins développés est leur isolement et leur manque de pouvoir, plutôt que fait même de leur faible envergure. Effectivement, ce n'est pas l'envergure qui détermine le potentiel de développement des petites entreprises mais la manière dans laquelle celles?ci entretiennent des rapports commerciaux avec les autres entreprises dans l'industrie, et le cadre politique et institutionnel dans lequel chaque entreprise opère. Cette interprétation serait confirmée par l'exemple européen des districts industriels, au sein desquels des communautés de petites entreprises ont démontré un niveau élevé de résistance et de croissance. L'article réunit certaines caractéristiques clef de cette variante ‘petites entreprises’ de la spécialisation souple, et tente d'indiquer quelles leçons cette expérience peut offrir en termes de la rentabilité de l'industrialisation de faible envergure dans les pays moins développés. Une attention particulière est accordée au rôle que l'environnement institutionnel joue dans le développement des petites entreprises. Au sein des pays moins développés, le cadre administratif et réglementaire est rarement d'un grand soutien; mais par contre, il est souvent discriminatoire. Resumen El ambiente institucional y las comunidades de pequeñas empresas El artículo argumenta que el principal problema de la pequeña empresa en países en vías de desarrollo no es su tamaño sino los factores de aislamiento y falta de influencia. El tamaño, de por sí, no determina el potencial de desarrollo de las empresas pequeñas; existen otros factores, como la forma en que se relacionan con otras empresas en la industria y el marco político e institucional en el que operan. Este punto de vista es apoyado por el ejemplo europeo en los distritos industriales en los cuales las comunidades de pequeñas empresas han demostrado un poder de recuperación y un crecimiento notables. El artículo reune algunos rasgos claves de esta variante de especialización flexible en las pequeñas empresas, y extrae algunas lecciones para la industrialización de pequeña escala en los países en vías de desarrollo. Se le presta particular atención al rol jugado por el ambiente institucional en el desarrollo de estas empresas. La administración y el marco regulador en estos países raramente son positivos y frecuentemente discriminatorios

Nursing sensitive outcomes in patients with rheumatoid arthritis: A systematic literature review

© 2017 Elsevier Ltd Background Although rheumatology nursing has been shown to be effective in managing patients with rheumatoid arthritis, patient outcomes sensitive to nursing interventions (nursing sensitive outcomes) have not been systematically studied. Objectives The objective of this study was to identify and delineate relevant patient outcomes measured in studies that reported nursing interventions in patients with rheumatoid arthritis. Design A systematic search was conducted from 1990 to 2016. Inclusion criteria were (i) patients with rheumatoid arthritis, (ii) adult population age ≥16 years, (iii) nurse as part of the care team or intervention delivery, (iv) primary research only, (v) English language, and (vi) quantitative studies with nursing sensitive outcomes. Data sources Medline, CINAHL, Ovid nursing, Cochrane library and PsycINFO databases were searched for relevant studies. Review methods Using the predetermined inclusion/exclusion criteria, nine reviewers working in pairs assessed the eligibility of the identified studies based on titles and abstracts. Papers meeting the inclusion criteria were retrieved and full texts were further assessed. Critical Appraisal Skills Programme tools were used to assess the quality of the included studies. Data on nursing sensitive outcomes were extracted independently by two reviewers. The Outcome Measures in Rheumatology comprehensive conceptual framework for health was used to contextualise and present findings. Results Of the 820 articles retrieved, 7 randomised controlled trials and 3 observational studies met the inclusion criteria. Seventeen nursing sensitive outcomes were identified (disease activity, clinical effects, pain, early morning stiffness duration, fatigue, patient safety issues, function, knowledge, patient satisfaction, confidence in care received, mental health status, self-efficacy, patient attitude/perception of ability to control arthritis, quality of life, health utility, health care resources, death). These fitted into 10 health intervention domains in keeping with the pre-specified conceptual framework for health: disease status, effectiveness, safety, function, knowledge, satisfaction, psychological status, quality of life, cost, death. A total of 59 measurement instruments were identified comprising patient reported outcome measures (n = 31), and biologic measures and reports (n = 28). Conclusions This review is notable in that it is the first to have identified, and reported, a set of multidimensional outcome measures that are sensitive to nursing interventions in rheumatology specifically. Further research is required to determine a core set of outcomes to be used in all rheumatology nursing intervention studies

Employment generation by small firms in Spain

Despite the relevance in terms of policy, we still know little in Spain about where and by whom jobs are created, and how that is affecting the size distribution of firms. The main innovation of this paper is to use a rich database that overcomes the problems encountered by other firm-level studies to shed some light on the employment generation of small firms in Spain. We find that small firms contribute to employment disproportionately across all sectors of the economy although the difference between their employment and job creation share is largest in the manufacturing sector. The job creators in that sector are both new and established firms whereas only new small firms outperform their larger counterparts in the service sector. The large annual job creation of the small firm size class is shifting the firm size distribution towards the very small production units, although not uniformly across industries of different technology intensit

Development of multivariable models to predict change in Body Mass Index within a clinical trial population of psychotic individuals

Many antipsychotics promote weight gain, which can lead to non-compliance and relapse of psychosis. By developing models that accurately identify individuals at greater risk of weight gain, clinicians can make informed treatment decisions and target intervention measures. We examined clinical, genetic and expression data for 284 individuals with psychosis derived from a previously published randomised controlled trial (IMPACT). These data were used to develop regression and classification models predicting change in Body Mass Index (BMI) over one year. Clinical predictors included demographics, anthropometrics, cardiac and blood measures, diet and exercise, physical and mental health, medication and BMI outcome measures. We included genetic polygenic risk scores (PRS) for schizophrenia, bipolar disorder, BMI, waist-hip-ratio, insulin resistance and height, as well as gene co-expression modules generated by Weighted Gene Co-expression Network Analysis (WGCNA). The best performing predictive models for BMI and BMI gain after one year used clinical data only, which suggests expression and genetic data do not improve prediction in this cohort

Friedrich Hayek and his visits to Chile

F. A. Hayek took two trips to Chile, the first in 1977, the second in 1981. The visits were controversial. On the first trip he met with General Augusto Pinochet, who had led a coup that overthrew Salvador Allende in 1973. During his 1981 visit, Hayek gave interviews that were published in the Chilean newspaper El Mercurio and in which he discussed authoritarian regimes and the problem of unlimited democracy. After each trip, he complained that the western press had painted an unfair picture of the economic situation under the Pinochet regime. Drawing on archival material, interviews, and past research, we provide a full account of this controversial episode in Hayek’s life

Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study

BACKGROUND: A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. METHODS: Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. RESULTS: Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%), eye contact (49%), good attention (52%), encouraging asking questions (47%), and emphasizing on the patients' understanding of the provided information (52%). The doctors enquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. CONCLUSION: The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to compliance with the guidelines need to be further explored. Improving the work situation mainly for the diabetes nurses and further improvement in the organizational efficiency of diabetes services such as lowering the number of patients in diabetes clinic, are suggested

Dementia care initiative in primary practice – study protocol of a cluster randomized trial on dementia management in a general practice setting

<p>Abstract</p> <p>Background</p> <p>Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support. However, the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive. Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers. The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement. In this paper the study protocol is described.</p> <p>Methods/Design</p> <p>The IDA (Initiative Demenzversorgung in der Allgemeinmedizin) project is designed as a three armed cluster-randomized trial where dementia patients and their informal caregivers are recruited by general practitioners. Patients in the study region of Middle Franconia, Germany, are included if they have mild or moderate dementia, are at least 65 years old, and are members of the German AOK (Allgemeine Ortskrankenkasse) sickness fund. In the control group patients receive regular treatment, whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment, recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up. The study recruitment and follow-up took place from July 2005 to January 2009. 303 general practitioners were randomized of which 129 recruited a total of 390 patients. Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint. Secondary endpoints are cognitive status, activities of daily living, burden of care giving as well as healthcare costs. For an economic analysis from the societal perspective, data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance.</p> <p>Discussion</p> <p>From a public health perspective, the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector. For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness.</p> <p>Trial registration</p> <p>ISRCTN68329593</p

The historical origins of corruption in the developing world: a comparative analysis of East Asia

A new approach has emerged in the literature on corruption in the developing world that breaks with the assumption that corruption is driven by individualistic self-interest and, instead, conceptualizes corruption as an informal system of norms and practices. While this emerging neo-institutionalist approach has done much to further our understanding of corruption in the developing world, one key question has received relatively little attention: how do we explain differences in the institutionalization of corruption between developing countries? The paper here addresses this question through a systematic comparison of seven developing and newly industrialized countries in East Asia. The argument that emerges through this analysis is that historical sequencing mattered: countries in which the "political marketplace" had gone through a process of concentration before universal suffrage was introduced are now marked by less harmful types of corruption than countries where mass voting rights where rolled out in a context of fragmented political marketplaces. The paper concludes by demonstrating that this argument can be generalized to the developing world as a whole

The Difficult Transition from Clientelism to Citizenship: Lessons from Mexico

Electoral competition is necessary but not sufficient for the consolidation of democratic regimes; not all elections are free and fair; nor do they necessarily lead to actual civilian rule or respect for human rights. If there is more to democracy than elections, then there is more to democratization than the transition to elections. But in spite of the rich literature on the emergence of electoral competition, the dynamics of political transitions toward respect for other fundamental democratic rights is still not well understood.Political democracy is defined here in classic procedural terms: free and fair electoral contestation for governing offices based on universal suffrage, guaranteed freedoms of association and expression, accountability through the rule of law, and civilian control of the military. Although analyses of democratization typically acknowledge that these are all necessary criteria, most examine only electoral competition. This study, however, develops a framework for explaining progress toward another necessary condition for democratization respect for associational autonomy, which allows citizens to organize in defense of their own interests and identities without fear of external intervention or punishment