Which European model for elderly care? Equity and cost-effectiveness in home based care in three European countries

Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall cost-effectiveness of the provisions as well as on employment equity for the care workers. Comparison between alternative types of provisions within each country suggests that home based care is generally, although not consistently, more cost-effective than care within institutions. Comparison of home care provisions across the three countries suggests that the Italian and the Danish systems are the most cost effective, but the Danish system is more equitable, overall. These latter findings are partly explained by progressive replacement in Italy of unpaid family carers with low cost immigrant workers directly employed by the families and often cohabiting with the elderly, the migrant-in-the-family model of long term care. This new model has spread across Southern Europe and raises complex issues of equity and sustainability from an employment perspective.ederly care, cost-effectiveness, migration, welfare

Which European model for elderly care? Equity and cost-effectiveness in home based care in three European countries

Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall cost-effectiveness of the provisions as well as on employment equity for the care workers. Comparison between alternative types of provisions within each country suggests that home based care is generally, although not consistently, more cost-effective than care within institutions. Comparison of home care provisions across the three countries suggests that the Italian and the Danish systems are the most cost effective, but the Danish system is more equitable, overall. These latter findings are partly explained by progressive replacement in Italy of unpaid family carers with low cost immigrant workers directly employed by the families and often cohabiting with the elderly, the migrant-in-the-family model of long term care. This new model has spread across Southern Europe and raises complex issues of equity and sustainability from an employment perspective.elderly care; long term care; cost-effectiveness; migration; welfare

Evidence on women trafficked for sexual exploitation: A rights based analysis

The aim of this paper is to investigate which factors influence the pattern of enforcement (violation) of basic rights among women trafficked for sexual exploitation. A conceptual frameworkis adopted where the degree of agency and the possibility to influence the terms of sex-based transactions are seen as conditional on the enforcement of some basic rights. Using IOM data on women assisted in exiting from trafficking for sexual exploitation, we investigate the enforcement (violation) of five uncompromisable rights, namely the right to physical integrity, to move freely, to have access to medical care, to use condoms, and to exercise choice over sexual services. By combining classification trees analysis and ordered probit estimation we find that working location and country of work are the main determinants of rights enforcement, while individual and family characteristics play a marginal role. Specifically, we find that (i) in lower market segments working on the street is comparatively less ‘at risk’ of rights violation; (ii) there is no consistently ‘good’ or ‘bad’ country of work, but public awareness on trafficking within the country is important; (iii) the strength of organized crime in the country of work matters only in conjunction with other local factors, and (iv) being trafficked within one’s country, as opposed to being trafficked internationally, is associated with higher risk of rights violationhuman trafficking, sexual exploitation, basic rights, classification and regression trees, ordered probit

Membrane-model systems to study EGFR-ARNO interaction

Transmembrane proteins are involved in important biological functions, such as in transport of molecules, and in signal transduction. They represent almost 25 % of the proteome and constitute important drug targets. The study of transmembrane proteins has been a major challenge for biochemical research over the past decades. Transmembrane proteins are unstable and prone to aggregation when examined apart from the plasma membrane. Artificial, yet native-like membrane systems have allowed for the identification of the structure and function of several transmembrane proteins. In this thesis, the analysis of different membrane-model systems to study a particular transmembrane protein, namely EGFR (epidermal growth factor receptor) is reported. Moreover, the interactions of EGFR with a cytosolic factor, i.e. ARNO (Arf nucleotide binding site opener), is analyzed. EGFR is involved in many cellular functions and alteration of its activity often leads to cancer development. ARNO acts as a GEF (guanine nucleotide exchange factor) for Arf (ADP ribosylation factor), due to its Sec7 domain. Furthermore, ARNO contains a PH (pleckstrin homology) domain, important for interactions with anionic lipids at the plasma membrane. By using nanodiscs, the conditions for the interaction between ARNO and anionic lipids in a membrane-like system were recreated. In addition, nanodiscs were used as a system to study a recently developed small-molecule inhibitor for the PH domain. Summarizing, nanodiscs were identified to be not only a suitable system to study protein-membrane interactions, but to be a viable in vitro system to study small-molecule compounds. Moreover, starting with receptor-micelles and proceeding to more complex artificial systems, such as bicelles, nanodiscs, and membrane sheets, ARNO-dependent EGFR phosphorylation and the interaction between the two proteins were evaluated. It has been previously reported that ARNO enhances EGFR phosphorylation in living cells, as well as the phosphorylation of the soluble intracellular domain of EGFR in membrane-free experiments. Depending on the membrane system, weak interactions between the Sec7 domain of ARNO and the JM (juxtamembrane) region of EGFR were observed. Nevertheless, ARNO-dependent EGFR activation was not observed in membrane-like systems. By using membrane sheets, the co-localization between ARNO and EGFR at the plasma membrane was detected. Furthermore, ARNO may have an effect on EGFR by decreasing receptor clustering and making EGFR more accessible for intracellular co-factors. These findings can open the way for a deeper understanding of the activation mechanisms of EGFR via ARNO

AS VICISSITUDES DA DEMOCRATIZAÇÃO DO ENSINO SUPERIOR: ALGUMAS REFLEXÕES SOBRE A REALIDADE BRASILEIRA

O texto parte da análise de uma pesquisa descritiva sobre a trajetória educacional/profissional de 117 mestrandos matriculados em nove cursos oferecidos pela Universidade Federal de Santa Catarina. A investigação objetivava discutir, dentre outras questões, o acesso e a democratização do ensino superior no país diante dos dados de elitização do ensino superior no Brasil. O estudo caracteriza-se como descritivo do tipo levantamento, com enfoque comparativo (KERLINGER, 1979). Os resultados apontam que os condicionantes sociais são elementos definidores no acesso e permanência na universidade. E não há, por assim dizer, uma única educação, pois ela não é igual para todos. Embora existam esforços para democratizar a educação e aqui, especificamente, o ensino superior, ela manifesta-se diferentemente no tempo e no espaço, de acordo com os determinantes históricos que a sustentam

A Comparison and Evaluation of Performances among Crop Yield Forecasting Models Based on Remote Sensing: Results from Tte Geoland Observatory of Food Monitoring

In the context of the GEOLAND EC FP6 project the comparison of different remote sensing based approaches for yield forecasting over large areas in Europe are tested and results inter-compared. In particular the methods tested include the ones in use within the MARS-Crop Yield Forecasting System as the results from the Crop Growth Monitoring System model and vegetation indicators derived from Low Resolution SPOT-VGT and NOAA Images, METEOSAT based yield forecasting and ERS-Scatterometer Crop Performance Index. Performances of the different models were tested in Spain, Belgium and Poland. The inter-comparisons of the crop yield forecasts were mainly based on the forecasting error obtained from the different approaches based on the Root Mean Square Forecast Error (RMSFE). This error was derived by comparing the predicted yields of the different models with the official yield as from official statistics (EUROSTAT). The comparison of the RMSFE was used to verify the convergence of results from the different models, the reliability of the information, i.e. precision and bias, and its precocity compared to the crop cycle. The results showed that the indicators are able to give reliable information with some differences: remote sensing indicators are more precise and accurate in southern areas (less cloud cover) while in northern areas good results are obtained under the use of better local calibrations of traditional crop yield forecasting systems and/or the use of additional information for instance remote sensing data as inputs into advanced crop modelling systems. Furthermore, in order to take care of the different time series length available, a qualitative indicator called Performance Score (Ps) was introduced. The analysis of the Ps showed that when a long time series of observation is available greater advantages are obtained from RS rather than from more advanced crop models.JRC.DDG.H.4-Monitoring agricultural resource

A comparison and evaluation of performances among crop yield forecasting models based on remote sensing: Results from the GEOLAND Observatory of Food Monitoring

In the context of the GEOLAND EC FP6 project the comparison of different remote sensing based approaches for yield forecasting over large areas in Europe are tested and results inter-compared. In particular the methods tested include the ones in use within the MARS-Crop Yield Forecasting System as the results from a Crop Growth Monitoring model (Alterra) and vegetation indicators derived from Low Resolution VGT and NOAA Images (VITO, IGiK), METEOSAT based yield forecasting (EARS) and ERS-Scatterometer Crop Performance Index (TPF and NEO). Performances of the different models were tested in Spain, Belgium and Poland. The inter-comparison of the crop yield forecasts were mainly based on the forecasting error obtained from the different approaches based on the Root Mean Square Forecast Error (RMSFE). This error was derived by comparing the predicted yields of the different models with the official yield from EUROSTAT. The comparison of the RMSFE was used to verify the convergence of results from the different models, the reliability of the information, i.e. precision and bias, and its precocity compared to the crop cycle. The results showed that the indicators are able to give reliable information with some differences: remote sensing indicators are more precise and accurate in southern areas (less cloud cover) while in northern areas good results are obtained under the use of better local calibrations of traditional crop yield forecasting systems, the use of additional information or the additional use of remote sensing data as inputs into advanced crop modelling systems. Furthermore, in order to take care of the different time series length available, a qualitative indicator called Performance Score (Ps) was introduced. The analysis of the Ps showed that when a long time series of observation is available greater advantages are obtained from RS rather than from more advanced crop models.JRC.DG.G.3-Monitoring agricultural resource

Costs and prospects for home based Long Term Care in Northern Italy: the Galca survey

An important issue in the design of sustainable Long Term Care policies is the relative social cost of community or home based care versus institutional care. Here we undertake this cost comparison making use of the findings from the GALCA surveys on Long Term Care in Denmark, Ireland and Italy but confining attention to Italy. The survey for Italy was conducted in the municipality of Modena that may be considered broadly representative of Long Term Care conditions in the North of the country. It offers detailed descriptions of the carers and the cared for ranging from demographic and epidemiological characteristics to labour market position. The survey also allows to accurately compile all the ‘inputs’ that go into home care, from ‘unpaid’ family labour and paid labour of immigrant minders to public and private services. Based on this information, we calculate the overall, per elderly social cost of home based care and find that home based care is more cost effective than institutional care even if the opportunity cost of ‘unpaid’ family carers is valued and included in the calculation. We discuss the reasons for cost effectiveness and identify some of the risk factors that threaten the long term sustainability of current home care arrangements in Italy. JEL classification: H51, I11, J14, J22. Keywords: Government Expenditure and Health; Analysis of Health Care Market, Economics of the Elderly; Time allocation and Labour Supply JEL classification: H51, I11, J14, J22. Keywords: Government Expenditure and Health; Analysis of Health Care Market, Economics of the Elderly; Time allocation and Labour Supply Acknowledgements This paper is drawn from the final report of the project Galca Gender Analysis and Long Term Care) financed by the European Commission and led by the Fondazione Giacomo Brodolini. Our thanks go the staff, the Secretary and the President of the Fondazione for support during the project and encouragement to circulate its findings

A Fuzzy Set Approach to Measuring Violence Against Women and Its Severity

We develop a scale of severity of violence against women based on fuzzy set theory. The scale can be used to derive fuzzy indexes of violence which account for the prevalence, frequency and severity of violence. Using the results of the survey conducted by the European Agency for Human Rights (FRA) we find strong congruence of ranking between the proposed scale and three widely used alternatives – the Conflict Tactic Scale, The Severity of Violence Against Women Scale and the Index of Spouse Abuse. Unlike existing alternatives, however, the scale that we propose is based on objective information rather than subjective assessment; it is parsimonious in terms of the amount of information that it requires; and it is less vulnerable to risks of cultural bias. As an example of the uses to which fuzzy measurement of violence can be put, we compute fuzzy indexes of intimate partner violence for European countries and find a clear, inverse correlation across countries with the degree of gender equality