Ageing in Place, Healthy Ageing: Local Community Involvement in the Prevention Approach to Eldercare

The increase in ageing societies is posing new and urgent societal and political challenges to meeting people's medical, personal, and social needs in old age. Ageing should not be considered a uniform phase of life and at least three phases should be distinguished: (a) silver age, (b) the mildly frail age, and (c) those at risk of dependency. Policy tools and logics should prevent and support specific needs in a life‐course approach and the preventive approach is seen as among the most useful interventions, with a baseline objective to promote ageing in place, minimize the institutionalization of care, and prevent psychophysical deterioration by supporting older people and their families through tailor‐made approaches and policies. Our study focuses on the project Invecchiare bene/Bien vieillir (ageing well) funded by Interreg Alcotra France-Italy and implemented in the Valleys of Monviso in northern Italy. The project targets older people living at home in mountainous areas, where healthy ageing is difficult due to chronic diseases and social isolation. This article presents an analysis of preventive‐based interventions and services that promote innovative ageing policies and investigates the involvement of the local community and how it can lead to the deployment of new preventive measures. The research covers the direct impact on the health and living conditions of the recipients (older people) and innovation by the local care model (among social workers and the local community). Qualitative (documentary analysis, semi‐structured interviews, and focus groups) as well as quantitative (questionnaire and secondary data analysis) methods were used

Sostegno ai poveri : quale riforma? : dal Reddito di Cittadinanza all'Assegno di Inclusione : analisi dell'Alleanza contro la povertà in Italia

Poche prestazioni sociali in Italia sono state oggetto di aspri scontri, anche ideologici, quanto il Reddito di Cittadinanza (RdC). Da un lato la retorica della panacea contro i mali del welfare italiano e dell'abolizione della povertà; dall'altro quella di una misura che incentiva l'ozio, facile preda dei furbetti quando non delle organizzazioni criminali. Coerentemente con le promesse fatte in campagna elettorale, il governo Meloni ha introdotto una riforma che supera il RdC, integralmente sostituito da nuove misure di contrasto alla povertà e di inclusione lavorativa: l'Assegno di Inclusione e il Supporto per la Formazione e il Lavoro. La riforma Meloni va nella direzione di superare i limiti e correggere gli errori di disegno e attuazione del RdC? Le nuove misure funzioneranno oppure la riforma avrà creato nuovi problemi, forse maggiori di quelli che si propone di risolvere? Per rispondere a queste domande, il volume prende le mosse da un'analisi sistematica dei risultati e dei limiti principali del RdC nei suoi quattro anni di vita. Questo consente di avanzare delle considerazioni sulla riforma Meloni, valutandola rispetto a come dovrebbe funzionare uno schema di contrasto alla povertà, un tema al centro dell'elaborazione progettuale e dell'azione dell'Alleanza contro la povertà in Italia sin dalla sua costituzione. Sostegno ai poveri: quale riforma? si rivolge a un pubblico vasto, interessato alle questioni economiche e sociali del nostro Paese, così come al pubblico dell'accademia e al mondo di chi si occupa professionalmente delle politiche sociali, e ai giornalisti e ai policy-maker che si occupano di questioni di politica economica. Il volume è il frutto del lavoro svolto dagli autori nel Comitato scientifico dell'Alleanza contro la povertà in Italia, nata nel 2013, che raggruppa un ampio numero di soggetti sociali che hanno deciso di contribuire in maniera collettiva alla costruzione di adeguate politiche pubbliche contro la povertà assoluta nel nostro Paese

Health-related quality of life in patients with chronic myeloid leukemia receiving first-line therapy with nilotinib

BACKGROUND: Although a wealth of efficacy and safety data is available for many tyrosine kinase inhibitors used in chronic myeloid leukemia (CML), there is a dearth of information on their impact on patients' health-related quality of life (HRQOL). The primary objective of this study was to evaluate HRQOL and fatigue outcomes in patients with CML receiving first-line therapy with nilotinib. METHODS: This was a multicenter, prospective study enrolling 130 patients with chronic-phase CML. HRQOL and fatigue were evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and its validated Fatigue module at the baseline and then at 3, 6, 12, 18, and 24 months. The primary prespecified HRQOL endpoints defined in the study protocol for longitudinal analysis were the Physical Functioning, Social Functioning, Role Functioning, and Fatigue scales. The remaining scales were investigated on an exploratory basis. RESULTS: The rate of baseline compliance with the HRQOL assessment was 95.4% (124 of 130), and the rate of overall compliance with HRQOL forms was 91%. Among the 4 prespecified primary HRQOL endpoints, statistically significant improvements over time were found for Physical Functioning (P =.013), Role Functioning (P =.004), and Fatigue (P <.001). Clinically meaningful improvements were found already 3 months after the treatment start. The baseline patient self-reported fatigue severity was an independent predictive factor for the achievement of a major molecular response with an odds ratio of 0.960 (95% confidence interval, 0.934-0.988; P =.005). CONCLUSIONS: For most patients, HRQOL improvements with nilotinib occur during the early phase of therapy and are maintained over time. Also, a more systematic HRQOL evaluation during the diagnostic workup of CML may help to predict clinical outcomes. Cancer 2018;124:2228-37. © 2018 American Cancer Society

The Changing Role of the State in the Italian Healthcare System

The present study describes and explains the changing role of the state in the Italian healthcare system since the beginning of the 1970s, with a particular focus on developments following 1978 when the healthcare system was transformed from a social insurance system into a national health service. In order to address these changes in a systematic way, we track healthcare system development along three dimensions: regulation, financing, and service provision. With regard to regulation, we observe a relative retreat of the state due to decentralization processes and internal market mechanisms. Quantitative measures for the financing and service provision dimension also indicate a modest relative retreat of the state. Taking regional data into account, we identify a clear North-South-divide in the public/private mix of financing and service provision. Although the focus of the paper is to describe the changing role of the state in the Italian healthcare system, we also offer preliminary explanations. We seek to identify the role of exogenous shocks such as economic crises versus endogenous stressors specific to the healthcare system itself (i.e. inherent inefficiencies) on healthcare system change. Therefore, the paper aims to provide a tentative, yet dynamic account of healthcare system change that is both descriptive and explanatory.Dieses Papier behandelt die veränderte Rolle des Staates im italienischen Gesundheitssystem seit den 1970er Jahren. Italien vollzog zum Beginn des Untersuchungszeitraums einen Systemwechsel von einem Sozialversicherungssystem zu einem Nationalen Gesundheitsdienst. Um die anschließenden Wandlungsprozesse in systematischer Form zu erfassen, unterscheiden wir zwischen drei Dimensionen von Staatstätigkeit im Gesundheitswesen: Regulierung, Finanzierung und Leistungserbringung. In der Regulierung beobachten wir einen relativen Rückzug des Staates durch Dezentralisierungsprozesse und die partielle Einführung interner Märkte. Dieser Befund deckt sich auch mit den quantitativen Analysen zur Finanzierung und Leistungserbringung. Durch die Einbeziehung regionaler Daten zeigt sich zudem ein klares Nord-Süd-Gefälle, das sich sowohl im öffentlichen Anteil an der Finanzierung als auch an der Leistungserbringung widerspiegelt. Das Papier beschränkt sich nicht auf die Beschreibung des Staatswandels, sondern bietet auch erste Erklärungen für diese Beobachtungen. Dazu werden sowohl exogene Faktoren wie wirtschaftliche Krisen oder Europäisierung als auch endogene Stressoren wie systeminhärente Defizite betrachtet

Euclid: Identifying the reddest high-redshift galaxies in the Euclid Deep Fields with gradient-boosted trees

Context. ALMA observations show that dusty, distant, massive (M* &amp; 1011 M ) galaxies usually have a remarkable star-formation activity, contributing of the order of 25% of the cosmic star-formation rate density at z 3 5, and up to 30% at z ∼ 7. Nonetheless, they are elusive in classical optical surveys, and current near-IR surveys are able to detect them only in very small sky areas. Since these objects have low space densities, deep and wide surveys are necessary to obtain statistically relevant results about them. Euclid will potentially be capable of delivering the required information, but, given the lack of spectroscopic features at these distances within its bands, it is still unclear if Euclid will be able to identify and characterise these objects. Aims. The goal of this work is to assess the capability of Euclid, together with ancillary optical and near-IR data, to identify these distant, dusty, and massive galaxies based on broadband photometry. Methods. We used a gradient-boosting algorithm to predict both the redshift and spectral type of objects at high z. To perform such an analysis, we made use of simulated photometric observations that mimic the Euclid Deep Survey, derived using the state-of-the-art Spectro-Photometric Realizations of Infrared-selected Targets at all-z (SPRITZ) software. Results. The gradient-boosting algorithm was found to be accurate in predicting both the redshift and spectral type of objects within the simulated Euclid Deep Survey catalogue at z &gt; 2, while drastically decreasing the runtime with respect to spectral-energy-distribution-fitting methods. In particular, we studied the analogue of HIEROs (i.e. sources selected on the basis of a red H - [4:5] &gt; 2:25), combining Euclid and Spitzer data at the depth of the Deep Fields. These sources include the bulk of obscured and massive galaxies in a broad redshift range, 3 &lt; z &lt; 7. We find that the dusty population at 3 . z . 7 is well identified, with a redshift root mean squared error and catastrophic outlier fraction of only 0:55 and 8:5% (HE = 26), respectively. Our findings suggest that with Euclid we will obtain meaningful insights into the impact of massive and dusty galaxies on the cosmic star-formation rate over time

Euclid preparation. XXXI. Performance assessment of the NISP Red-Grism through spectroscopic simulations for the Wide and Deep surveys

This work focuses on the pilot run of a simulation campaign aimed at investigating the spectroscopic capabilities of the Euclid Near-Infrared Spectrometer and Photometer (NISP), in terms of continuum and emission line detection in the context of galaxy evolutionary studies. To this purpose we constructed, emulated, and analysed the spectra of 4992 star-forming galaxies at $0.3 \leq z \leq 2.5$ using the NISP pixel-level simulator. We built the spectral library starting from public multi-wavelength galaxy catalogues, with value-added information on spectral energy distribution (SED) fitting results, and from Bruzual and Charlot (2003) stellar population templates. Rest-frame optical and near-IR nebular emission lines were included using empirical and theoretical relations. We inferred the 3.5$\sigma$ NISP red grism spectroscopic detection limit of the continuum measured in the $H$ band for star-forming galaxies with a median disk half-light radius of \ang{;;0.4} at magnitude $H= 19.5\pm0.2\,$AB$\,$mag for the Euclid Wide Survey and at $H = 20.8\pm0.6\,$AB$\,$mag for the Euclid Deep Survey. We found a very good agreement with the red grism emission line detection limit requirement for the Wide and Deep surveys. We characterised the effect of the galaxy shape on the detection capability of the red grism and highlighted the degradation of the quality of the extracted spectra as the disk size increases. In particular, we found that the extracted emission line signal to noise ratio (SNR) drops by $\sim\,$45$\%$ when the disk size ranges from \ang{;;0.25} to \ang{;;1}. These trends lead to a correlation between the emission line SNR and the stellar mass of the galaxy and we demonstrate the effect in a stacking analysis unveiling emission lines otherwise too faint to detect.Comment: 23 pages, 21 figure

Aging and Long-Term Care Problems During the Covid-19 Pandemic

The Covid-19 Pandemic, while disrupting many aspects of life, has had an enormous effect on the health care system in all countries, with long-term care (LTC) facilities being disproportionately affected. Nursing homes and senior living communities were in the difficult position of keeping older people safe while providing care and mitigating infection risks for patients and staff. At the same time, the pandemic brought into question the capacity of LTC systems' to efficiently respond to nontraditional societal needs: Older adults living at home experienced enormous consequences in their daily lives, such as loneliness, scarcity, and inadequate health care and LTC services and assistance. Beginning with a brief description of the welfare systems' characteristics, in this chapter we investigate the impact of the Covid-19 Pandemic on older adults across a selection of European countries during the past 3&nbsp;years, including how care changed for LTC residents and older people living at home, and identify the main weaknesses of the LTC systems. We also identify facilitating factors of the difficulties and policy tools to help reform this sector by looking at the Pandemic as a possible window of opportunity to overcome the obstacles to building sustainable LTC systems. In fact, the European population over-80 is expected to more than double by 2050, leading to significantly increased demand for LTC. This demographic challenge has been accompanied by changing social patterns, such as smaller families, different residential patterns, and increased female labor force participation, all of which are contributing to an increased need for paid care and innovative services