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

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

Quale futuro? Alcune considerazioni sulle politiche industriali e le politiche per lo sviluppo

Il saggio propone specifiche misure per il potenziamento delle scuole tecniche e professionali e per lo sviluppo di forme di cooperazione tra i dipartimenti di economia e i dipartimenti di ingegneria in Emilia Romagna illustandone le implicazioni per lo sviluppo locale

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

Quantum gradient evaluation through quantum non-demolition measurements

We discuss a Quantum Non-Demolition Measurement (QNDM) protocol to estimate the derivatives of a cost function with a quantum computer. %This is a key step for the implementation of variational quantum circuits. The cost function, which is supposed to be classically hard to evaluate, is associated with the average value of a quantum operator. Then a quantum computer is used to efficiently extract information about the function and its derivative by evolving the system with a so-called variational quantum circuit. To this aim, we propose to use a quantum detector that allows us to directly estimate the derivatives of an observable, i.e., the derivative of the cost function. With respect to the standard direct measurement approach, this leads to a reduction of the number of circuit iterations needed to run the variational quantum circuits. The advantage increases if we want to estimate the higher-order derivatives. We also show that the presented approach can lead to a further advantage in terms of the number of total logical gates needed to run the variational quantum circuits. These results make the QNDM a valuable alternative to implementing the variational quantum circuits

Coastline and climatic changes in the Punic period (V-III century B.C.): archaeological and paleobotanical indicators (South Sardinia – West Mediterranean Sea)

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Epidemiology of hydatidosis in the province of Sassari, Italy

Cystic echinococcosis is endemic in certain parts of the world, including Sardinia, Italy. It was performed a study in the province of Sassari in order to evaluate the incidence of the infection in man and the effects of control programs since 1964 to 2002. Data obtained by surgical records, hospital discharge forms, radiological and pathological files were collected using a case report form. During the years 1964- 2002, 2702 new cases were identified (average annual incidence: 17 per 100,000) and 1981 (73.3%) were submitted to surgical treatment. In 57.3% municipalities no cases were observed during the years 1998- 2002. Males are more affected (56.2%), mostly farmers-shepherdess (68.6 per 100,000) and pensioners (59.6 per 100,000). Control measures led to a significant decline in the incidence rate of hydatidosis during the period 1964-2002, dropping by 27.6 per 100,000. The mean age of surgical patients increased during the years of surveillance, such as the surgical liver/lung ratio as a consequence of a cohort effect. The durability of control programs is the corner stone for obtaining a significant decrease of this infection

Outcomes of Emergent Isolated Coronary Bypass Grafting in Heart Failure Patients

: Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7-95% CI 3.31-140; p = 0.002) and postoperative acute renal failure (OR 15.9-95% CI 0.66-203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47-95% CI 1.15-10.5; p = 0.028), along with age (HR 1.28-95% CI 1.21-1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure. © 2022 by the authors

Leptin directly stimulates thermogenesis in skeletal muscle

AbstractUsing a method involving repeated oxygen uptake (MO2) determinations in skeletal muscle ex vivo, the addition of leptin was found to increase MO2 in soleus muscles from lean mice. These effects were found to be inhibited by phosphatidylinositol 3-kinase inhibitors, absent in muscles from obese Leprdb mice which have the dysfunctional long form of leptin receptor, and blunted in muscles from diet-induced obese mice in the fed state but not during fasting. These findings indicate that leptin has direct thermogenic effects in skeletal muscle, and that these effects require both the long form of leptin receptors and phosphatidylinositol 3-kinase signalling

MBOAT7 is anchored to endomembranes by six transmembrane domains.

Abstract Membrane bound O-acyltransferase domain- containing 7 (MBOAT7, also known as LPIAT1) is a protein involved in the acyl chain remodeling of phospholipids via the Lands' cycle. The MBOAT7 is a susceptibility risk genetic locus for non-alcoholic fatty liver disease (NAFLD) and mental retardation. Although it has been shown that MBOAT7 is associated to membranes, the MBOAT7 topology remains unknown. To solve the topological organization of MBOAT7, we performed: A) solubilization of the total membrane fraction of cells overexpressing the recombinant MBOAT7-V5, which revealed MBOAT7 is an integral protein strongly attached to endomembranes; B) in silico analysis by using 22 computational methods, which predicted the number and localization of transmembrane domains of MBOAT7 with a range between 5 and 12; C) in vitro analysis of living cells transfected with GFP-tagged MBOAT7 full length and truncated forms, using a combination of Western Blotting, co-immunofluorescence and Fluorescence Protease Protection (FPP) assay; D) in vitro analysis of living cells transfected with FLAG-tagged MBOAT7 full length forms, using a combination of Western Blotting, selective membrane permeabilization followed by indirect immunofluorescence. All together, these data revealed that MBOAT7 is a multispanning transmembrane protein with six transmembrane domains. Based on our model, the predicted catalytic dyad of the protein, composed of the conserved asparagine in position 321 (Asn-321) and the preserved histidine in position 356 (His-356), has a lumenal localization. These data are compatible with the role of MBOAT7 in remodeling the acyl chain composition of endomembranes