Ten years of integrated care for the older in France

<p><strong>Background:</strong> This paper analyzes progress made toward the integration of the French health care system for the older and chronically ill population.</p><p><strong>Policies:</strong> Over the last ten years, the French health care system has been principally influenced by two competing linkage models that failed to integrate social and health care services: local information and coordination centers, governed by the social field, and the gerontological health networks governed by the health field. In response to this fragmentation, Homes for the Integration and Autonomy for Alzheimer patients (MAIAs) is currently being implemented at experimental sites in the French national Alzheimer plan, using an evidence-based model of integrated care. In addition, the state's reforms recently created regional health agencies (ARSs) by merging seven strategic institutions to manage the overall delivery of care.</p><p><strong>Conclusion:</strong> The French health care system is moving from a linkage-based model to a more integrated care system. We draw some early lessons from these changes, including the importance of national leadership and governance and a change management strategy that uses both top-down and bottom-up approaches to implement these reforms.</p

La Canal de Mancorbo: Meanings of a landscape

RESUMEN: El cuadro de Carlos de Haes Canal de Mancorbo en los Picos de Europa, de 1876, expuesto en la sala 63A del Museo del Prado (Madrid), representa un paisaje rocoso abrupto y elevado, correspondiente al frente meridional del macizo de Ándara sobre la comarca de Liébana. Esta obra está considerada como un hito capital en la pintura del paisaje del siglo xix en España. Se estudia aquí, desde una perspectiva geográfica, el marco cultural en el que se inscribe, se muestran las características del lugar representado y se razona su modo de plasmación filtrado por el arte.RÉSUMÉ: La peinture de Carlos de Haes Canal de Mancorbo en los Picos de Europa, de 1876, exposé dans la salle 63A du Musée du Prado (Madrid), représente un paysage rocheux abrupt et surélevé, correspondant a la face sud du Massif d'Ándara sur la contrée de Liébana. Cette oeuvre est considérée comme un point de repére capital dans la peinture du paysage du xixe siécle en Espagne. On étudie ici, d'un point de vue géographique, le cadre culturel dans lequel la peinture est enregistré, les caractéristiques du lieu représenté et le mode d'expression filtré par l'art.ABSTRACT: The painting of Carlos de Haes Canal de Mancorbo en los Picos de Europa, from 1876, exhibited at the Prado Museum in room 63A (Madrid), represents an abrupt and high rocky landscape, corresponding to the southern front of the Ándara Massif over the county of Liébana. This pictorial work is considered a capital milestone in the painting of landscape in Spain during the 19th century. This work studies, from a geographical perspective, the cultural framework in which it is registered, the characteristics of the represented place and the mode of expression filtered by art

Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership

<strong>Background: </strong>Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). <p><br /><strong>Purpose: </strong>To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs.</p><p><br /><strong>Results: </strong>In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase.</p><p><br /><strong>Conclusion: </strong>The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements</p

Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test

Population screening has improved early diagnosis of colorectal cancer (CRC). Nonetheless, most cases are diagnosed in symptomatic patients. Faecal immunochemical testing has been recommended for assessing patients with lower gastrointestinal symptoms, but whether it improves patient survival is unknown. Our objective was to compare CRC survival in 50- to 69-year-olds between asymptomatic screen-detected patients and symptomatic patients by route to diagnosis. Methods: We identified all cases of CRC diagnosed in 50-to 69-year-olds between 2009 and 2016, in Donostialdea (Gipuzkoa, Spain). Three groups were created: 1-screen-detected CRC; 2-CRC detected in symptomatic patients after a positive faecal immunochemical test(FIT); and 3-CRC detected in symptomatic patients without a FIT or after a negative result. We analysed survival using the Kaplan-Meier method and log-rank tests. Results: Of 930 patients diagnosed with CRC, 433 cases were detected through screening and 497 in symptomatic patients, 7.9% after a positive FIT and 45.5% by other means. The 3-year CRC survival was significantly lower in group 3 (69.5%) than groups 1 (93%; p = 0.007) or 2 (87.5%; p = 0.02). The risk of death was lower in groups 1 (HR 0.42, 95% CI 0.30–0.58) and 2 (HR 0.51; 95% CI 0.29–0.87). Conclusion: Half of CRC cases in 50- to 69-year-olds are diagnosed outside screening. Use of the FIT as a diagnostic strategy in symptomatic patients may improve survival

Effect of resveratrol on alcohol-induced mortality and liver lesions in mice

Es reproducción del documenteo publicado en http://dx.doi.org/10.1186/1471-230X-6-35Background Resveratrol is a polyphenol with important antiinflammatory and antioxidant properties. We investigated the effect of resveratrol on alcohol-induced mortality and liver lesions in mice. Methods Mice were randomly distributed into four groups (control, resveratrol-treated control, alcohol and resveratrol-treated alcohol). Chronic alcohol intoxication was induced by progressively administering alcohol in drinking water up to 40% v/v. The mice administered resveratrol received 10 mg/ml in drinking water. The animals had free access to standard diet. Blood levels were determined for transaminases, IL-1 and TNF-α. A histological evaluation was made of liver damage, and survival among the animals was recorded. Results Transaminase concentration was significantly higher in the alcohol group than in the rest of the groups (p < 0.05). IL-1 levels were significantly reduced in the alcohol plus resveratrol group compared with the alcohol group (p < 0.05). TNF-α was not detected in any group. Histologically, the liver lesions were more severe in the alcohol group, though no significant differences between groups were observed. Mortality in the alcohol group was 78% in the seventh week, versus 22% in the alcohol plus resveratrol group (p < 0.001). All mice in the alcohol group died before the ninth week. Conclusion The results obtained suggest that resveratrol reduces mortality and liver damage in mice

Mentoria, Economia i Dret per a Intèrprets

Aprofundir en el coneixement dels principis deontològics de la professió d'intèrpret. Establir contacte amb professionals de la interpretació activa que puguin orientar els estudiants en el desenvolupament de la seva carrera professional. Enfrontar-se als nivells habituals d'exigència en l'exercici de la interpretació professional. Conèixer la interpretació professional en les institucions europees a través de les classes virtuals oferides en el marc de l'assistència pedagògica del SCIC de la Comissió Europea. - Aproximar-se a la interpretació professional a l'Oficina d'Interpretació de Llengües del Ministeri d'Afers Exteriors Introduir a l'estudiant en els conceptes teòrics bàsics de l'àmbit de l'economia, aplicables a la interpretació de conferències. Introduir l'estudiant en els conceptes teòrics bàsics de l'àmbit del dret, aplicables a la interpretació de conferènciesTo learn more about the interpreting profession's deontological principles. To meet practising professional interpreters who can offer career guidance. To experience working to the standards generally required of professional interpreters. To find out about professional interpreting in the European institutions through the virtual classes offered as part of the training assistance available from the European Commission's Directorate-General for Interpretation (SCIC). To findout about professional interpreting in the Language Interpreting Office of Spain's Ministry of Foreign Affairs.Profundizar en el conocimiento de los principios deontológicos de la profesión de intérprete. Establecer contacto con profesionales de la interpretación en activo que puedan orientar a los estudiantes en el desarrollo de su carrera profesional. Enfrentarse a los niveles de exigencia habituales en el ejercicio de la interpretación profesional. Acercarse a la interpretación profesional en las instituciones europeas a través de las clases virtuales ofrecidas en el marco de la asistencia pedagógica del SCIC de la Comisión Europea. - Acercarse a la interpretación profesional en la Oficina de Interpretación de Lenguas del Ministerio de Asuntos Exteriores Introducir al estudiante en los conceptos teóricos básicos del ámbito de la economía, aplicables a la interpretación de conferencias. Introducir al estudiante en los conceptos teóricos básicos del ámbito del derecho, aplicables a la interpretación de conferencia

O Mundo dos trabalhadores e seus arquivos

Edición 2Apresenta debates sobre os documentos compilados por arquivos operários, rurais, sindicais e populares, bem como sobre as particularidades que o tratamento desses acervos implica, constituindo um fórum privilegiado para promover a recuperação e preservação dos arquivos dos trabalhadores e suas organizações. A nova edição permite o acesso aos textos publicados a um maior número de pessoas, abrindo caminho para o II Seminário Internacional O Mundo dos Trabalhadores e seus Arquivos, que está em preparação.1 Mundo dos trabalhadores - a cidade e o campo. 2 Arquivo, memória e cidadania - o sentido dos arquivos. 3 Política de organizacao - preservacao e acesso. 4 As centrais sindicais - organizacao dos seus documentos e a preservacao da memória. 5 As universidades e a preservacao dos arquivos dos trabalhadores. 6 Programa do seminário internacional o mundo dos trabalhadores e seus arquivos