Gériatrie [Review in geriatric medicine 2013].

Physical activity appears once again as the single most effective preventative intervention in older persons to delaying functional decline, avoiding falls, and mitigating the odds of developing dementia. Integrated care that promotes interdisciplinary collaboration among healthcare professionals is a major avenue to improve care coordination in polymorbid older patients. A study depicts the large gap between physicians and nurses' views about their respective skills and role in such a collaboration. On the cognitive side, while several studies show that new cohorts of older persons appear to age in better cognitive shape, results of trials of semagestat, a gamma-secretase inhibitor, and post-menopausal estrogenic therapy were disappointing. Finally, a study challenges the benefits of hydration in terminally ill patients.

L'effectivité des Conventions anti-corruption internationales : vers une Cour pénale internationale en criminalité économique pour punir le vol d'Etat

This doctoral thesis proposes an International Criminal Court Specialized in Economic Crime (ICC/EC) as a solution to the main obstacles to the effectiveness of international anti-corruption conventions studied. In fact, the dispute settlement systems of the international anti-corruption Conventions do not provide sufficient guarantees of effectiveness, and offenses and crimes of corruption are not under the jurisdiction of the International Criminal Court (ICC) derived from the Rome Statute of 2000. In a first part, this work analyzes seven international anti-corruption Conventions adopted between 1996 and 2003, respectively, by the Organization of American States (OAS), the Organization for Economic Cooperation and Development (OECD), the European Union (EU), the Council of Europe (CoE), the African Union (AU) and the United Nations (UN). In a second part, this study highlights a deficit of rationalization and optimization of offenses included in the conventions: an incomplete criminalization of legal persons for corruption, an equally insufficient criminalization for corruption of political leaders benefiting both from criminal and civil immunities, as well as the limited outcome of international asset recovery de-rived from corruption. Finally, given the previous analysis made, this thesis concludes with a pro-posal for an independent ICC/EC specific to economic crimes in order to overcome the major obstacles highlighted and which strongly affect the effectiveness of the international anti-corruption conventions. - Cet ouvrage de thèse doctorale propose, comme solution principale aux obstacles à l'effectivité des Conventions anti-corruption internationales étudiées, une Cour Pénale Internationale Spécialisée en Criminalité Economique (CPI/CE). En effet, les systèmes de règlement des différends des Conven¬tions anti-corruption internationales n'offrent pas suffisamment de gage d'effectivité et les délits et crimes de corruption transnationale ne sont pas de la compétence de la Cour Pénale Internationale (CPI) issue du statut de Rome de 2000. Dans un premier temps, le présent ouvrage analyse sept Conventions anti-corruption internationales adoptées entre 1996 et 2003, respectivement, par l'Organisation des Etats Américains (OEA), l'Organisation de Coopération et de Développement Economiques (OCDE), l'Union européenne (UE), le Conseil de l'Europe (CoE), l'Union Africaine (UA) et l'Organisation des Nations Unies (ONU). Dans un deuxième temps, l'ouvrage met en lumière un déficit de rationalisation et d'optimisation des incriminations que contiennent les Conventions, dont notamment : une incrimination lacunaire des personnes morales pour corruption, une incrimination tout aussi insuffisante pour corruption des dirigeants politiques au bénéfice d'immunités pénale et civile et une restitu¬tion internationale des avoirs issus de la corruption à portée limitée. Finalement, c'est au vu de l'analyse effectuée que le présent ouvrage conclut avec la proposition d'une CPI/CE indépendante et spécifique aux crimes économiques afin de pallier au mieux les obstacles majeurs mis en exergue et qui nuisent fortement à l'effectivité des Conventions anti-corruption internationales.

Cooperation in centralised CATI Household Panel Surveys : A Contact-based Multilevel Analysis to Examine Interviewer, Respondent, and Fieldwork Process Effects

In this research, we analyse the contact-specific mean of the final cooperation probability, distinguishing on the one hand between contacts with household reference persons and with other eligible household members, and on the other hand between first and later contacts. Data comes from two Swiss Household Panel surveys. The interviewer-specific variance is higher for first contacts, especially in the case of the reference person. For later contacts with the reference person, the contact-specific variance dominates. This means that interaction effects and situational factors are decisive. The contact number has negative effects on the performance of contacts with the reference person, positive in the case of other persons. Also time elapsed since the previous contact has negative effects in the case of reference persons. The result of the previous contact has strong effects, especially in the case of the reference person. These findings call for a quick completion of the household grid questionnaire, assigning the best interviewers to conducting the first contact. While obtaining refusals has negative effects, obtaining other contact results has only weak effects on the interviewer's subsequent contact outcome. Using the same interviewer for contacts has no positive effects.

Gériatrie [Review in geriatric medicine 2013].

Physical activity appears once again as the single most effective preventative intervention in older persons to delaying functional decline, avoiding falls, and mitigating the odds of developing dementia. Integrated care that promotes interdisciplinary collaboration among healthcare professionals is a major avenue to improve care coordination in polymorbid older patients. A study depicts the large gap between physicians and nurses' views about their respective skills and role in such a collaboration. On the cognitive side, while several studies show that new cohorts of older persons appear to age in better cognitive shape, results of trials of semagestat, a gamma-secretase inhibitor, and post-menopausal estrogenic therapy were disappointing. Finally, a study challenges the benefits of hydration in terminally ill patients.

Peut-on traiter la maladie d'Alzheimer [Is there a treatment for Alzheimer's disease?].

Alzheimer's disease is a frequent neurodegenerative disease, which affects more than one third of elderly persons over 80 years. No curative treatment is currently available for this disease, but symptomatic treatments have produced significant improvements in patients' condition. Cholinesterase inhibitors should be prescribed for early and moderate stages and memantine for more severe stages of the disease. These drugs have an impact on cognitive performances, may delay functional decline and improve behaviour disturbances. From a preventive perspective, evidence of benefit from early management of vascular risk factors is accumulating. In the near future, the improved comprehension of the underlying mechanisms of Alzheimer's disease will hopefully bring new treatments, thats will delay or modify its course.

Ageing prisoners' health care: analysing the legal settings in Europe and the United States.

BACKGROUND: Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention. OBJECTIVE: The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (U.S.). METHODS: Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the U.S. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and U.S. Supreme Court judgements. RESULTS: Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners. CONCLUSION: No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners.

Le devenir féminin transgenre : une étude qualitative et réflexive sur le genre, la corporéité et la subjectivité sexuelle

RésuméCette thèse en psychologie qualitative et critique de la santé propose un éclairage, sur la subjectivité transgenre, différent des modèles dominants en clinique. Les nosologies de type DSM et de la psychiatrie dominante focalisent sur la seule question de la transition transsexuelle, elles utilisent la sexualité comme outil dans les diagnostics différentiels permettant d'effectuer le gatekeeping de la transition médicalisée du genre. Elles sont décrites comme un dispositif de médicalisation du genre, induisant des pratiques maltraitantes. Une méthodologie qualitative inspirée de la théorie ancrée ainsi que de l'analyse réflexive est utilisée. Un échantillon de 15 personnes représentant la diversité des personnes transgenres FtM a été recruté. Les données provenant d'entrevues non directives sont analysées dans une perspective verticale et horizontale. Les résultats soulignent l'inadéquation des typologies cliniques, de la place qui est donnée à la sexualité dans les procédures diagnostiques et de l'opposition qu'elles construisent entre identité (de genre) et sexualité. Ils plaident pour une vision deleuzienne de type nomade, incarnée et sexuée de la subjectivité transgenre.AbstractThe broad of this study in critical health psychology is to build an understanding of transgender subjectivity which contrast with dominant clinical models. DSM nosology types and dominant psychiatry have traditionally focused only on transsexual transitioning. They use sexuality as a diagnostic tool to address the gatekeeping of the medical transition. These practices have been described as medicalization of gender, inducing mistreatment. A qualitative methodology mixing grounded theory and reflexivity has been used. A sample of 15 persons has been recruited to represent transgender FtM diversity. Data were collected through in-depth interview and analysed case by case and by themes. Results show that dominant clinical typologies of TG are inappropriate, as well as the way sexuality is used in this practices and the opposition between (gender) identity and sexuality. We propose a deleuzian concept of becoming and multiplicity to understand transgender subjectivity.

Do Financial Incentives Affect Firms' Demand For Disabled Workers?

A number of OECD countries aim to encourage work integration of disabled persons using quota policies. For instance, Austrian firms must provide at least one job to a disabled worker per 25 nondisabled workers and are subject to a tax if they do not. This "threshold design" provides causal estimates of the noncompliance tax on disabled employment if firms do not manipulate nondisabled employment; a lower and upper bound on the causal effect can be constructed if they do. Results indicate that firms with 25 nondisabled workers employ about 0.04 (or 12%) more disabled workers than without the tax; firms do manipulate employment of nondisabled workers but the lower bound on the employment effect of the quota remains positive; employment effects are stronger in low-wage firms than in high-wage firms; and firms subject to the quota of two disabled workers or more hire 0.08 more disabled workers per additional quota job. Moreover, increasing the noncompliance tax increases excess disabled employment, whereas paying a bonus to overcomplying firms slightly dampens the employment effects of the tax.

Work in inflammatory and degenerative joint diseases

This article focuses on work disability and sick leave and their cost; it also discusses the value of vocational rehabilitation programmes in rheumatic conditions such as rheumatoid arthritis, ankylosing spondylitis, hip and knee osteoarthritis. It acknowledges the importance of work not only for the worker who has one of these diseases but also for the public purse. Much can be done to improve the health of the persons and reduce their disability and its impact in the workplace which will have an important effect on their and their family's quality of life. It is important that neither rehabilitation nor vocational rehabilitation are regarded as bolt-on activities after drug treatment but are seen as an integral part of effective management. Publications dealing with return to work are relatively common in rheumatoid arthritis, less common in ankylosing spondylitis and relatively rare in osteoarthritis. Vocational rehabilitation programmes should aim to facilitate job retention or, failing that, to improve the ability to return to work. The process must be started with in the health arena and it has to be recognised that slow or poor practice in the health service can jeopardise the patient's work potential

Life expectancy with and without disability

Average life expectancy reached 78.8 years in Europe in 2002 (WHO 2003); most Europeans can, therefore, now anticipate living well past 75 years of age. Projections in industrialized nations suggest a continuing mortality decline in the next decades 1 while birth rates will probably continue to decline, resulting in further ageing of these nations. As those aged 80 years and over are the fastest expanding segment of the older population, concerns are growing about a potential dramatic increase in the number of disabled persons. The ageing of the population and the related increase in chronic disease burden have already had major impacts on most Western health-care systems, and will probably further affect these systems in the future as the baby-boom generation becomes older. For instance, in Switzerland, it is estimated that costs due to long-term care could more than double by 2030, from 6.5 to 15.3 billion SFr.2 Similar trends are expected in most European countries. As a consequence, postponement of the onset of disability, with a compression of functional dependency into a shorter period towards the end of life, is becoming a major goal. To successfully achieve this goal and improve the control of growing health and social care expenditures, various strategies of health promotion and disease prevention are developed and tested. Although several of these experiences had some effects on functional decline and institutional placement, they have not been shown to be cost-effective. Additional strategies are, therefore, needed to prevent or delay the onset of disability in older persons, reduce functional impairment, and face the challenge of an increasing disabled elderly population.

Processus de reconnaissance et d'identification de personnes décédées

Recognition and identification processes for deceased persons. Determining the identity of deceased persons is a routine task performed essentially by police departments and forensic experts. This thesis highlights the processes necessary for the proper and transparent determination of the civil identities of deceased persons. The identity of a person is defined as the establishment of a link between that person ("the source") and information pertaining to the same individual ("identifiers"). Various identity forms could emerge, depending on the nature of the identifiers. There are two distinct types of identity, namely civil identity and biological identity. The paper examines four processes: identification by witnesses (the recognition process) and comparisons of fingerprints, dental data and DNA profiles (the identification processes). During the recognition process, the memory function is examined and helps to clarify circumstances that may give rise to errors. To make the process more rigorous, a body presentation procedure is proposed to investigators. Before examining the other processes, three general concepts specific to forensic science are considered with regard to the identification of a deceased person, namely, matter divisibility (Inman and Rudin), transfer (Locard) and uniqueness (Kirk). These concepts can be applied to the task at hand, although some require a slightly broader scope of application. A cross comparison of common forensic fields and the identification of deceased persons reveals certain differences, including 1 - reverse positioning of the source (i.e. the source is not sought from traces, but rather the identifiers are obtained from the source); 2 - the need for civil identity determination in addition to the individualisation stage; and 3 - a more restricted population (closed set), rather than an open one. For fingerprints, dental and DNA data, intravariability and intervariability are examined, as well as changes in these post mortem (PM) identifiers. Ante-mortem identifiers (AM) are located and AM-PM comparisons made. For DNA, it has been shown that direct identifiers (taken from a person whose civil identity has been alleged) tend to lead to determining civil identity whereas indirect identifiers (obtained from a close relative) direct towards a determination of biological identity. For each process, a Bayesian model is presented which includes sources of uncertainty deemed to be relevant. The results of the different processes combine to structure and summarise an overall outcome and a methodology. The modelling of dental data presents a specific difficulty with respect to intravariability, which in itself is not quantifiable. The concept of "validity" is, therefore, suggested as a possible solution to the problem. Validity uses various parameters that have an acknowledged impact on teeth intravariability. In cases where identifying deceased persons proves to be extremely difficult due to the limited discrimination of certain procedures, the use of a Bayesian approach is of great value in bringing a transparent and synthetic value. RESUME : Titre: Processus de reconnaissance et d'identification de personnes décédées. L'individualisation de personnes décédées est une tâche courante partagée principalement par des services de police, des odontologues et des laboratoires de génétique. L'objectif de cette recherche est de présenter des processus pour déterminer valablement, avec une incertitude maîtrisée, les identités civiles de personnes décédées. La notion d'identité est examinée en premier lieu. L'identité d'une personne est définie comme l'établissement d'un lien entre cette personne et des informations la concernant. Les informations en question sont désignées par le terme d'identifiants. Deux formes distinctes d'identité sont retenues: l'identité civile et l'identité biologique. Quatre processus principaux sont examinés: celui du témoignage et ceux impliquant les comparaisons d'empreintes digitales, de données dentaires et de profils d'ADN. Concernant le processus de reconnaissance, le mode de fonctionnement de la mémoire est examiné, démarche qui permet de désigner les paramètres pouvant conduire à des erreurs. Dans le but d'apporter un cadre rigoureux à ce processus, une procédure de présentation d'un corps est proposée à l'intention des enquêteurs. Avant d'entreprendre l'examen des autres processus, les concepts généraux propres aux domaines forensiques sont examinés sous l'angle particulier de l'identification de personnes décédées: la divisibilité de la matière (Inman et Rudin), le transfert (Locard) et l'unicité (Kirk). Il est constaté que ces concepts peuvent être appliqués, certains nécessitant toutefois un léger élargissement de leurs principes. Une comparaison croisée entre les domaines forensiques habituels et l'identification de personnes décédées montre des différences telles qu'un positionnement inversé de la source (la source n'est plus à rechercher en partant de traces, mais ce sont des identifiants qui sont recherchés en partant de la source), la nécessité de devoir déterminer une identité civile en plus de procéder à une individualisation ou encore une population d'intérêt limitée plutôt qu'ouverte. Pour les empreintes digitales, les dents et l'ADN, l'intra puis l'inter-variabilité sont examinées, de même que leurs modifications post-mortem (PM), la localisation des identifiants ante-mortem (AM) et les comparaisons AM-PM. Pour l'ADN, il est démontré que les identifiants directs (provenant de la personne dont l'identité civile est supposée) tendent à déterminer une identité civile alors que les identifiants indirects (provenant d'un proche parent) tendent à déterminer une identité biologique. Puis une synthèse des résultats provenant des différents processus est réalisée grâce à des modélisations bayesiennes. Pour chaque processus, une modélisation est présentée, modélisation intégrant les paramètres reconnus comme pertinents. À ce stade, une difficulté apparaît: celle de quantifier l'intra-variabilité dentaire pour laquelle il n'existe pas de règle précise. La solution préconisée est celle d'intégrer un concept de validité qui intègre divers paramètres ayant un impact connu sur l'intra-variabilité. La possibilité de formuler une valeur de synthèse par l'approche bayesienne s'avère d'une aide précieuse dans des cas très difficiles pour lesquels chacun des processus est limité en termes de potentiel discriminant.

Motility tests for drugs preventing PolyQ aggregation in recombinant Caenorhabditis elegans.

The pathological formation of proteinaceous aggregates that accumulate into the brain cells of patients are hallmarks of neurodegenerative diseases such as Alzheimer's disease, amyotrophic lateral sclerosis and the heterogeneous group of polyglutamine (polyQ) diseases. In the polyQ diseases, the most upstream events of the pathogenic cascade are the misfolding and aggregation of proteins, such as huntingtin in Huntington's disease, that contain expanded stretch of glutamine residues above 35--‐40 repeats. This expanded polyQ stretch triggers the misfolding and aggregation of cytotoxic polyQ proteins in the neurons that cause cell death through different processes, like apoptosis, excessive inflammation, formation of free radicals, eventually leading to neuronal loss and neurodegeneration. This study focuses on the cellular network of chaperone proteins that can prevent protein aggregation by binding misfolding intermediates and may, as in the case of HSP70, actively unfold misfolded proteins into refoldable non--‐toxic ones (Hinault et al., 2010; Sharma et al., 2011). The chaperones can also collaborate with the proteasome to convert stable harmful proteins into harmless amino acids. Thus, the chaperone proteins that are the most important cellular factors of prevention and curing of protein misfolding, are negatively affected by aging (Morley et al., 2002) and fail to act properly in the neurons of aged persons, which eventually may lead to neurodegenerative pathologies. The general aim of this research was to identify least toxic drugs that can upregulate the expression of chaperone genes in cells suffering from polyQ--‐ mediated protein aggregation and degeneration. The specific aim of this study was to observe the effect of ten drugs on polyQ aggregation in a recombinant nematode Caenorhabditis elegans expressing a chimeric protein containing a sequence of 35 glutamines (Q35) fused to the green fluorescent protein in muscle cells, which causes an age--‐ and temperature--‐ dependent phenotype of accelerated paralysis. The drugs were selected after having proven their causing the overexpression of chaperone proteins in a previous wide screening of 2000 drugs on the moss plant Physcomitrella patens. The screening that we performed in this study was on these ten drugs. It suggested that piroxicam and anisindione were good reducers of polyglutamine disease mediated paralysis. A hypothesis can be made that they may act as good enhancers of the heat shock response, which causes the overexpression of many HSP chaperones and thus reduce motility impairment of polyQ disease expressing nematodes. Piroxicam was found to have the greatest effect on reducing polyQ35 proteins aggregates mediated paralysis in a dose--‐dependent manner but was also found to either have a toxic effect on wild type C.elegans, either to change its natural motility behavior, eventually reducing its motility in both cases. Chloroform should be preferred over DMSO as a drug solvent as it appears to be less toxic to C.elegans.

3

What is a virtual person? What is it used for? What is its added value? Virtual persons sometimes describe avatars and new forms of identities in online games. They also appear in other contexts; some authors use them in the legal domain. Within FIDIS, the concept of virtual person has been extended in order to better describe and understand new forms of identities in the Information Society in relation to rights, duties, obligations and responsibilities. Virtual persons, as other virtual entities, exist in the virtual world, the collection of all (abstract) entities which are or have been the product of the mind or imagination. The virtual world -not to be confused with the digital world- allows a unified description of many identity-related concepts that are usually defined separately without taking into consideration their similarities: avatars, pseudonyms, categories, profiles, legal persons, etc. The legal system has a long experience of using abstract entities to define rules, categories, etc., in order to associate legal rights, obligations, and responsibilities to persons that can be considered instances of these abstract entities in specific situations. The model developed within FIDIS intentionally uses a similar construction. n this chapter, after having explained the model, we apply it to pseudonyms. Then we explore the concept of virtual persons from a legal perspective. Eventually, we introduce trust in the light of virtual persons.

The spiritual needs model: spirituality assessment in the geriatric hospital setting

Clinicians increasingly agree that it is important to assess patients' spirituality and to incorporate this dimension into the care of elderly persons, in order to enhance patient-centered care. However, models of integrative care that take into account the spiritual dimension of the patient are needed in order to promote a holistic approach to care. This research defines a concept of spirituality in the hospitalized elderly person and develops a model on which to base spirituality assessment in the hospital setting. The article presents in detail the different stages in the conceptualization of The Spiritual Needs Model.

Evidence for chronic low-grade systemic inflammation in individuals with agoraphobia from a population-based prospective study.

BACKGROUND: Anxiety disorders have been linked to an increased risk of incident coronary heart disease in which inflammation plays a key pathogenic role. To date, no studies have looked at the association between proinflammatory markers and agoraphobia. METHODS: In a random Swiss population sample of 2890 persons (35-67 years, 53% women), we diagnosed a total of 124 individuals (4.3%) with agoraphobia using a validated semi-structured psychiatric interview. We also assessed socioeconomic status, traditional cardiovascular risk factors (i.e., body mass index, hypertension, blood glucose levels, total cholesterol/high-density lipoprotein-cholesterol ratio), and health behaviors (i.e., smoking, alcohol consumption, and physical activity), and other major psychiatric diseases (other anxiety disorders, major depressive disorder, drug dependence) which were treated as covariates in linear regression models. Circulating levels of inflammatory markers, statistically controlled for the baseline demographic and health-related measures, were determined at a mean follow-up of 5.5 ± 0.4 years (range 4.7 - 8.5). RESULTS: Individuals with agoraphobia had significantly higher follow-up levels of C-reactive protein (p = 0.007) and tumor-necrosis-factor-α (p = 0.042) as well as lower levels of the cardioprotective marker adiponectin (p = 0.032) than their non-agoraphobic counterparts. Follow-up levels of interleukin (IL)-1β and IL-6 did not significantly differ between the two groups. CONCLUSIONS: Our results suggest an increase in chronic low-grade inflammation in agoraphobia over time. Such a mechanism might link agoraphobia with an increased risk of atherosclerosis and coronary heart disease, and needs to be tested in longitudinal studies.