Comparability of Health Care Responsiveness in Europe using anchoring vignettes from SHARE

The aim of this paper is to measure and to correct for the potential incomparability of responses to the SHARE survey on health care responsiveness. A parametric approach based on the use of anchoring vignettes is applied to cross-sectional data (2006-07) in ten European countries. More than 6,000 respondents aged 50 years old and over were asked to assess the quality of health care responsiveness in three domains: waiting time for medical treatment, quality of the conditions in visited health facilities, and communication and involvement in decisions about the treatment. Chopit models estimates suggest that reporting heterogenity is influenced by both individual (socio-economic, health) and national characteristics. Although correction for differential item functioning does not considerably modify countries ranking after controlling for the usual covariates, about two thirds of the respondents' self-assessments have been re-scaled in each domain. Our results suggest that reporting heterogenity tends to overestimate health care responsiveness for "time to wait for treatment", whereas it seems to underestimate people's self-assessment in the two other domains.Anchoring Vignettes, Cross-Country Comparison, Chopit Model

Self-Perception of Aging and Vulnerability to Adverse Outcomes at the Age of 65-70 Years

Objectives. This study examines the relationship between self-perception of aging and vulnerability to adverse outcomes in adults aged 65-70 years using data from a cohort of 1,422 participants in Lausanne, Switzerland. Methods. A positive or negative score of perception of aging was established using the Attitudes Toward Own Aging subscale including 5 items of the Philadelphia Geriatric Center Morale Scale. Falls, hospitalizations, and difficulties in basic and instrumental activities of daily living (ADL) collected in the first 3 years of follow-up were considered adverse outcomes. The relationship between perception and outcomes were evaluated using multiple logistic regression models adjusting for chronic medical conditions, depressive feelings, living arrangement, and socioeconomic characteristics. Results. The strongest associations of self-perception of aging with outcomes were observed for basic and instrumental ADL. Associations with falls and hospitalizations were not constant but could be explained by health characteristics. Conclusions. A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors such as a low-economic status, living alone, multiple chronic medical conditions, and depressive feelings contribute to a negative self-perception of aging but do not explain the relationship with incident activities of daily living disabilit

Violence en psychiatrie: une recherche prospective au Département Universitaire de Psychiatrie Adulte (DUPA) interrogée à la lumière du modèle cindynique

Le management des risques dans les institutions psychiatriques représente aujourd'hui un challenge majeur pour les cliniciens, les administrateurs et les décideurs politiques. Il pose la question de la formation des équipes au management de la violence et de l'évaluation des patients dans la clinique quotidienne. Cet article fait le lien entre une étude, menée sur un an dans une institution psychiatrique et un modèle de management des risques, le modèle cindynique. Les résultats doivent interroger sur les représentations du phénomène de violence par les différents acteurs, l'appropriation par les équipes d'outils d'évaluation de la dangerosité et sur la communication dans l'équipe pluridisciplinaire et avec le patient

Prevalence of Frailty in Middle-Aged and Older Community-Dwelling Europeans Living in 10 Countries

Background Frailty is an indicator of health status in old age. Its frequency has been described mainly for North America; comparable data from other countries are lacking. Here we report on the prevalence of frailty in 10 European countries included in a population-based survey. Methods Cross-sectional analysis of 18,227 randomly selected community-dwelling individuals 50 years of age and older, enrolled in the Survey of Health, Aging and Retirement in Europe (SHARE) in 2004. Complete data for assessing a frailty phenotype (exhaustion, shrinking, weakness, slowness, and low physical activity) were available for 16,584 participants. Prevalences of frailty and prefrailty were estimated for individuals 50-64 years and 65 years of age and older from each country. The latter group was analyzed further after excluding disabled individuals. We estimated country effects in this subset using multivariate logistic regression models, controlling first for age, gender, and then demographics and education. Results The proportion of frailty (three to five criteria) or prefrailty (one to two criteria) was higher in southern than in northern Europe. International differences in the prevalences of frailty and prefrailty for 65 years and older group persisted after excluding the disabled. Demographic characteristics did not account for international differences; however, education was associated with frailty. Controlling for education, age and gender diminished the effects of residing in Italy and Spain. Conclusions A higher prevalence of frailty in southern countries is consistent with previous findings of a north-south gradient for other health indicators in SHARE. Our data suggest that socioeconomic factors like education contribute to these differences in frailty and prefrailt

Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne Cohort Lc65+.

OBJECTIVES: To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria. DESIGN: Population-based cohort study of noninstitutionalized elderly adults at baseline; cross-sectional analysis. SETTING: Lausanne, Switzerland. PARTICIPANTS: One thousand two hundred eighty-three individuals with complete data on frailty, aged 65 to 70 (58.5% women). MEASUREMENTS: Frailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥ 2 chronic diseases: comorbidity) and limitations in activities of daily living (ADLs, basic and instrumental). RESULTS: At baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants (P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression. CONCLUSION: Prefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases

A Signaling Pathway Involving TGF-β2 and Snail in Hair Follicle Morphogenesis

In a common theme of organogenesis, certain cells within a multipotent epithelial sheet exchange signals with their neighbors and develop into a bud structure. Using hair bud morphogenesis as a paradigm, we employed mutant mouse models and cultured keratinocytes to dissect the contributions of multiple extracellular cues in orchestrating adhesion dynamics and proliferation to shape the cluster of cells involved. We found that transforming growth factor β2 signaling is necessary to transiently induce the transcription factor Snail and activate the Ras-mitogen-activated protein kinase (MAPK) pathway in the bud. In the epidermis, Snail misexpression leads to hyperproliferation and a reduction in intercellular adhesion. When E-cadherin is transcriptionally down-regulated, associated adhesion proteins with dual functions in signaling are released from cell-cell contacts, a process which we demonstrate leads to Ras-MAPK activation. These studies provide insights into how multipotent cells within a sheet are stimulated to undergo transcriptional changes that result in proliferation, junctional remodeling, and bud formation. This novel signaling pathway further weaves together the web of different morphogens and downstream transcriptional events that guide hair bud formation within the developing skin

Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis

<p><b>Background:</b> Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood.</p> <p><b>Methods and Findings:</b> Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations.</p> <p><b>Conclusions:</b> Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.</p&gt

How taphonomic alteration affects the detection and imaging of striations in stab wounds

Stabbing with a kitchen knife is a common methodof homicide in Europe. Serrated knives may leave tool mark-ings (striations) in tissues. Documentation of striations is nec-essary for their use as forensic evidence. Traditional methods(physical casting and photography) have significant limita-tions, and micro-computed tomography (micro-CT) has beentrialled in cartilage toBvirtually cast^wounds. Previous re-search has shown the proportion of striations in cartilage fallsfollowing decomposition. This project has investigated theeffects of taphonomic alteration and documentation methodsof striations in porcine skin. Fresh, decomposed, mummified,burnt and waterlogged stab wounds in a porcine analoguewere excised and imaged using photography, stereo-opticalmicroscopy and micro-CT. The proportion of striations ineach taphonomic group was determined from the images byindependent analysts. Striations were observed more frequent-ly in serrated blade wounds, although they were also identifiedin non-serrated blade wounds. The proportion of woundsshowing striations declined following decomposition. An in-versely proportional linear correlation between advancing de-composition and proportion of striations existed. Dehydration(mummification and burning) rendered serrated and non-serrated blade wounds indistinguishable. Water compositionaffected the preservation of striations. Identification ofstriations gradually declined after decomposition in tap water,but persisted to a point when left in brackish water. All threetechniques imaged striations; however, the optimum tech-nique was stereo-optical microscopy due to practical advan-tages and specific limitations affecting photography and mi-cro-CT. This study demonstrates the effects of taphonomicalteration on striations and suggests stereo-optical microscopyis the optimum method for their documentation

The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty

BACKGROUND: Frailty is a relatively new geriatric concept referring to an increased vulnerability to stressors. Various definitions have been proposed, as well as a range of multidimensional instruments for its measurement. More recently, a frailty phenotype that predicts a range of adverse outcomes has been described. Understanding frailty is a particular challenge both from a clinical and a public health perspective because it may be a reversible precursor of functional dependence. The Lausanne cohort Lc65+ is a longitudinal study specifically designed to investigate the manifestations of frailty from its first signs in the youngest old, identify medical and psychosocial determinants, and describe its evolution and related outcomes. METHODS/DESIGN: The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934-1938) in the non-institutionalized population of Lausanne (Switzerland). The baseline data collection was completed among 1422 participants in 2004-2005 through questionnaires, examination and performance tests. It comprised a wide range of medical and psychosocial dimensions, including a life course history of adverse events. Outcomes measures comprise subjective health, limitations in activities of daily living, mobility impairments, development of medical conditions or chronic health problems, falls, institutionalization, health services utilization, and death. Two additional random samples of 65-70 years old subjects will be surveyed in 2009 (birth year 1939-1943) and in 2014 (birth year 1944-1948). DISCUSSION: The Lc65+ study focuses on the sequence "Determinants --> Components --> Consequences" of frailty. It currently provides information on health in the youngest old and will allow comparisons to be made between the profiles of aging individuals born before, during and at the end of the Second World War