Telecommunication reforms, access regulation, and Internet adoption in Latin America

The authors review the stylized facts on regulatory reform in telecommunications and its effects on telecommunications development and Internet penetration in Latin America. Relying on data from the International Telecommunication Union, the Information for Development Program (InfoDev), and the World Bank for 1990-99, the authors then test econometrically the determinants of the differences in Internet penetration rates across Latin America. The results show that effective implementation of the reform agenda in telecommunications regulation could accelerate adoption of the Internet in Latin America-even though it is only part of the solution (income levels, income distribution, and access to primary infrastructure are the main determinants of growth in Internet connections and use). Regulation will work by cutting costs. Cost cutting will require that regulators in the region take a much closer look at the design of interconnection rules and at the tradeoffs that emerge from the complex issues involved. It will also require a commitment to developing analytical instruments, such as cost models, to sort out many of the problems. Appropriate cost models will generate benchmarks that are much more consistent with the local issues and with the local cost of capital than international benchmarks will ever be for countries in unstable macroeconomic situations. Cost cutting will require an equally strong commitment to imposing regulatory accounting systems that reduce the information asymmetrics that incumbents use to reduce the risks of entry. All these changes will ultimately require a stronger commitment by competition agencies, since in many countries a failure to negotiate interconnection agreements will raise competition issues just as often as it will raise regulatory questions.Rural Communications,Information Technology,Telecommunications Infrastructure,Knowledge Economy,Health Monitoring&Evaluation,Knowledge Economy,Information Technology,Health Monitoring&Evaluation,Rural Communications,Education for the Knowledge Economy

Diagnostic odyssey for rare diseases: exploration of potential indicators

To explore whether an accurate, robust and cost-effective method can be developed for the routine measurement of the rare diseases diagnostic odysseys to enable the impact of interventions and policies, such as the 2013 UK Strategy for Rare Diseases, to be evaluated

The Friends and Family Test in general practice in England: a qualitative study of the views of staff and patients.

BACKGROUND: The Friends and Family Test (FFT) was introduced into general practices in England in 2015 to provide staff with information on patients' views of their experience of care. AIM: To examine the views of practice staff and patients of the FFT, how the results are used, and to recommend improvements. DESIGN AND SETTING: A qualitative study of a national representative sample of 42 general practices. METHOD: Semi-structured interviews with 43 clinicians, 48 practice managers, and 27 patient representatives. Interviews were audiotaped, transcribed, and analysed thematically. RESULTS: Although the FFT imposed little extra work on practices, it was judged to provide little additional insight over existing methods and to have had minimal impact on improving quality. Staff lacked confidence in the accuracy of the results given the lack of a representative sample and the risk of bias. The FFT question was judged to be inappropriate as in many areas there was no alternative practice for patients to choose, patients' individual needs would not be the same as those of their friends and relatives, and an overall assessment failed to identify any specific aspects of good- or poor-quality care. Despite being intended to support local quality improvement, there was widespread unease about the FFT, with many responders perceiving it as a tool for national bodies to monitor general practices. CONCLUSION: If the use of a single-item questionnaire is to continue, changes should be made to the wording. It should be focused on stimulating local quality improvement, and practice staff should be supported to use the results effectively

Early evaluation of the integrated care and support pioneers programme: interim report

This interim report is intended to provide a description of (roughly) the first twelve months of Pioneer development, drawing out some of the similarities and differences between the sites, the barriers they are encountering in their ambitious attempts to integrate health and social care services, and the approaches they are taking to overcome these barriers. This progress report of the development of the Pioneers during their first year presents interim findings which may be subject to change by the time the final report of the early evaluation is independently peer reviewed and prepared for publication in summer 2015

Evaluation of the Heatwave Plan for England

• The Heatwave Plan for England (HWP) aims to protect health and reduce harm from severe hot weather. It is a good practice guide underpinned by a heat-health watch alert system. The alert system is managed by Public Health England (PHE), who commission the Met Office to provide the forecast for the alerts. In the event of an upcoming period of severe weather where regionally defined temperature thresholds are predicted to be breached, heat-health alerts are cascaded to the Cabinet Office and all health, social care and public services, including NHS providers and local authorities, to enable them to implement their local protection plans. • This evaluation examined the contribution of the HWP to protecting the health of the population during hot weather by conducting: 1) a time-series analysis to establish the relationship between hot weather and adverse health outcomes; 2) case studies of local implementation of the HWP in five areas in England, along with a national survey of nurses in hospital, community and care home settings; and 3) a survey of the general public to explore whether people protect themselves and others by following the advice set out in the HWP. Epidemiological relationship between hot weather and health • The relationship between temperature and mortality, and between temperature and emergency hospital admissions (as indicators of the health impact of hot weather), suggests that hot weather in England is associated with an increase in deaths and emergency hospital admissions. • There is no evidence that general summertime relationships between temperature and mortality and between temperature and emergency hospital admissions have changed substantially in the years since the introduction of the first HWP in 2004. • Since the largest number of excess deaths and hospital admissions associated with heat take place outside of heatwave alert periods, this raises questions about the appropriateness of current threshold levels as well as the need to place more emphasis on general preparedness strategies as represented by levels 0 and 1 of the HWP. Implementation of the Heatwave Plan for England • Some interviewees noted that there could be sub-regional variation in maximum temperatures within Met Office regions, with some areas (e.g. on the coast) being less likely to experience severe hot weather even when other areas within the same region exceed the alert threshold. This led to some local authorities ignoring regional alerts, and to possibly underestimate current and future risks, as they rarely experienced temperatures that exceeded alert thresholds. • Local heatwave plans were closely aligned with the national HWP, particularly in the heat-health alert system guidance offered in the Plan. However, heatwaves were often assessed as lower risk than other weather-related hazards (such as floods and cold weather) and were often given a lower priority in planning • Heatwave planning was largely seen as an exercise in emergency preparedness and focused on ‘warning and informing’ through the alert system, rather than as a strategic objective of long-term public health and environmental planning. • The role of Clinical Commissioning Groups (CCGs) in planning and implementing local heatwave plans was not clear; in some areas CCGs were reported to be taking a key role in planning and co-ordinating the health response, while in others they were said to be acting in a more supportive role, with NHS England taking the lead. • Emergency planners, mainly in local authorities and acute trusts, said that they adopted a ‘wait and see’ approach, employing professional judgment before escalating actions during a heatwave. Some noted that plans may not work as well if a heatwave alert comes over a weekend, when relevant managers may not be at work. • Many frontline staff, including nurses surveyed, reported to be unaware of any local heatwave plans, and unfamiliar with the HWP guidance, but most said they knew what to do to protect their patients and clients ahead of and during heatwaves. However, not all the actions stated by frontline staff during the 2017 and 2018 heatwaves were appropriate or in line with HWP guidance, and many reported taking few or none of the recommended HWP actions during an alert. • Many frontline nurses surveyed said that they struggled to protect their patients during heatwaves, reporting their organisations to be often ill prepared for severe heat events. Many said that they were working in difficult and challenging conditions: often in old and poorly designed buildings not well adapted for climate change; a lack of funding and resources to implement many HWP actions; and often poor working conditions with inflexible organisational policies. • During alert periods, it was reported to be difficult to reach all high-risk groups, especially those who might be ‘below the radar’ of health or social services, such as people with social care needs who do not qualify for means-tested social support, agricultural labourers and homeless people. Managers said that they tended to rely on health information for the general public to reach these groups. • General practices may often be well placed to support these high-risk patients, as they tend to have better access to vulnerable groups missing to other NHS providers and local authorities, but their role in the HWP was not clear as they do not have contractual duties for emergency planning, and there are concerns about whether they would have capacity. • Unless there was a heat-related ‘major-incident’, few mechanisms were said to be in place to monitor activities during and following a heatwave alert, so managers were not able to formally assess how well their organisations performed during the alert period

Patients with multiple sclerosis: a burden and cost of illness study

Background Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease negatively impacting patients' physical, psychological and social well-being with a significant economic burden. Objectives The study estimates MS burden and cost of illness in Italy from a societal perspective in 2019. Methods Information on the impact of the disease on daily activities, symptoms, employment, resource utilization and the role of caregivers was collected through questionnaires completed by 944 patients and caregivers. Results were stratified according to both disease severity and payer. Mean costs and overall costs were extrapolated from the sample to the Italian MS population considering published distribution of severity. Results The study showed a great impact of the disease on daily and work activities increasing with the disability. The overwhelming burden of fatigue emerged. Mean annual costs were estimated at euro39,307/patient (euro29,676, euro43,464 and euro53,454 in mild, moderate and severe cases, respectively). Direct healthcare costs were the major component (euro21,069), followed by indirect costs (euro15,004). The overall cost of the disease in Italy was euro4.8 billion. The National Healthcare System (NHS) sustained most of the costs (80%), most notably direct healthcare costs, while patients paid almost all non-healthcare expenses. Conclusions This study confirmed that MS carries a substantial burden to patients and society, highlighting the need for awareness of this disease

Comparing data quality from personal computers and mobile devices in an online survey among professionals

It is increasingly common for respondents to complete web surveys using mobile devices (smartphones and tablets) rather than personal computers/laptops (PCs). Evidence of the impact of the use of mobile devices on response and data quality shows mixed results and is only available for general population surveys. We looked at response quality for a work-related survey in the UK among general practitioners (GPs). GPs were sent email invitations to complete a web survey and half (55%) completed it on a mobile device. While GPs using a mobile device were less likely to complete the full questionnaire than those using a PC, we found no differences in data quality between mobile and PC users, except for PC users being more likely to respond to open-ended questions

Public attitudes to, and behaviours taken during, hot weather by vulnerable groups: results from a national survey in England.

BACKGROUND: Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0-4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave. METHODS: As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: 'vulnerable' (aged 75+), 'potentially vulnerable' (aged 18-74 in poor health) and 'not vulnerable' (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + . RESULTS: Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun's ultra-violet radiation on the skin than on the effects of hot temperatures on health. CONCLUSIONS: Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures