Dépistage et prévention chez les aînés: quelles interventions proposer, à qui, et jusqu'à quel âge [Screening and prevention in the elderly: which interventions should be proposed, to whom, and up to what age?].

Recommendations on preventive services rarely mention how to apply them to older people. Even though general criteria (prevalence of disease, quality of screening tests) that influence screening's efficacy remain important, appropriateness of screening in older persons depends much more on individual criteria, such as comorbidity, functional status, and life expectancy. More than with any other age group, patients preferences regarding future investigation and treatment guide the clinical decision. This article focuses on primary and secondary prevention, and discusses specific criteria to consider in each patient. A table summarizes the appropriate recommendations.

Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials.

BACKGROUND: Control of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity. METHODS AND RESULTS: Randomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty-nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (-7.6 mm Hg, 95% CI: -9.0 to -6.3; I(2)=67%) and diastolic BP (-3.9 mm Hg, 95% CI: -5.1 to -2.8; I(2)=83%). The 95% PI ranged from -13.9 to -1.4 mm Hg for systolic BP and from -9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly. CONCLUSIONS: Pharmacist interventions - alone or in collaboration with other healthcare professionals - improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost-effective, and least time-consuming intervention should be addressed with further research.

Office of Treasurer of State Iowa Educational Savings Plan Trust, Independent Auditor's Reports Financial Statements and Supplementary Information, June 30, 2004

State Agency Audit Report

Vaccine and immunotherapeutic interventions.

PURPOSE OF REVIEW: As we enter the fourth decade in HIV epidemic, advances in understanding HIV pathogenesis and development of potent and safer antiretroviral drugs have been spectacular. More than 30 antiviral drugs have been registered and the impact of combination antiviral therapy on morbidity and mortality has been dramatic. However, despite long-term virus suppression, HIV invariably rebounds after interruption of therapy. Long-term antiviral therapy does not cure HIV infection nor does it induce restoration/development of virus-specific immune responses capable of controlling HIV replication. Therefore, development of immune-based interventions is needed to restore effective defenses that can lead to HIV functional cure and ultimately eradication. RECENT FINDINGS: Therapeutic vaccination and immune interventions that generate de-novo or that boost preexisting HIV-specific T-cell responses are being investigated as a potential means to achieve a 'functional HIV cure'. One major hurdle in the quest of an HIV cure is control and elimination of the HIV latent reservoir. Several immune interventions that target the latent reservoir have been tried in recent years. In parallel, several therapeutic vaccination strategies have been developed and tested in early clinical studies. Recent encouraging studies show for the first time that vaccination can have an impact on HIV load. SUMMARY: This review summarizes the main immune interventions evaluated over the last years. Ways to improve them, as well as challenges in monitoring/evaluating effects of such strategies, are being discussed. In addition, clinical efficacy and potential clinical benefits of immunotherapeutic interventions are particularly difficult to measure. This review highlights current assays used and their shortcoming.

Economic crisis and recovery: changes in second birth rates within occupational classes and educational groups

This study assesses the decline in second birth rates for men and women across different skill levels in transitional Russia. Changes within educational groups and occupational classes are observed over three distinct time periods: the Soviet era, economic crisis, and economic recovery. The most remarkable finding is the similarity in the extent second birth rates declined within educational groups and occupational classes during the economic crisis. Although further decline occurred in the recovery period, more variation emerged across groups.

Assessment and reuse of contents in the competence-based educational platform InterMediActor

This paper describes a failure alert system and a methodology for content reuse in a new instructional design system called InterMediActor (IMA). IMA provides an environment for instructional content design, production and reuse, and for students’ evaluation based in content specification through a hierarchical structure of competences. The student assessment process and information extraction process for content reuse are explained.

Hierachy-based methodology for producing educational contents with maximal reutilization

Computer based training or distance education are facing dramatic changes withthe advent of standardization efforts, some of them concentrating in maximal reuse.This is of paramount importance for a sustainable -cost affordable- production ofeducational materials. Reuse in itself should not be a goal, though, since manymethodological aspects might be lost. In this paper we propose two contentproduction approaches for the InterMediActor platform under a competence-basedmethodology: either a bottom-up approach where content is designed from scratchor a top-down methodology where existing material can be gradually adapted tofulfil requisites to be used with maximal flexibility into InterMediActor.

Guiding students through competence-based educational material

Student guidance is an always desired characteristic in any educational system, butit represents special difficulty if it has to be deployed in an automated way to fulfilsuch needs in a computer supported educational tool. In this paper we explorepossible avenues relying on machine learning techniques, to be included in a nearfuture -in the form of a tutoring navigational tool- in a teleeducation platform -InterMediActor- currently under development. Since no data from that platform isavailable yet, the preliminary experiments presented in this paper are builtinterpreting every subject in the Telecommunications Degree at Universidad CarlosIII de Madrid as an aggregated macro-competence (following the methodologicalconsiderations in InterMediActor), such that marks achieved by students can beused as data for the models, to be replaced in a near future by real data directlymeasured inside InterMediActor. We evaluate the predictability of students qualifications, and we deploy a preventive early detection system -failure alert-, toidentify those students more prone to fail a certain subject such that correctivemeans can be deployed with sufficient anticipation.

Office of Treasurer of State Iowa Educational Savings Plan Trust Independent Auditor's Reports Finanical Statements and Supplementary Information, June 30, 2005.

Office of Treasurer of State, Iowa Educational Savings Plan Trust (Trust) for the year ended June 30, 2005. Independent Auditor's Report, Financial Statements and Supplementary Information.

The impact of women's educational and economic resources on fertility: Spanish birth cohorts 1901-1950

In this chapter we portray the effects of female education and professional achievement on fertility decline in Spain over the period 1920-1980 (birth cohorts of 1901-1950).A longitudinal econometric approach is used to test the hypothesis that the effects of women’s education in the revaluing of their time had a very significant influence on fertility decline. Although in the historical context presented here improvements in schooling were on a modest scale, they were continuous (with the interruption of the Civil War) and had a significant impact in shaping a model of low fertility in Spain. We also stress the relevance of this result in a context such as the Spanish for which liberal values were absent, fertility control practices were forbidden, and labour force participation of women was politically and socially constrained.

The Sociology of educational mismatch

This paper studies the theoretical relationships between core research lines of sociology such as intergenerational mobility, class structure, cultural capital and educational mismatches. By educational mismatch we mean two things. Firstly an individual can be horizontally mismatched whereby their field of study is inadequate for the job. Another direction of educational mismatch is the so called vertical mismatch where worker possesses more/less education than the job requires resulting in over-/under-education. While analyzing the educational mismatches I keep present the conclusions of Rational Action Theory on individuals’ rational choices in their educational careers. I arrive to conclusions where the influences between educational mismatches and social classes are bidirectional and one can establish fairly clear theoretical links between class of origins and likelihood of being educationally mismatched.

Parental investments in children: how bargaining and educational homogamy affect time allocation

This study examines parental time investment in their children, distinguishing between developmental and non-developmental care. Our analyses centre on three influential determinants: educational background, marital homogamy, and spouses' relative bargaining power. We find that the emphasis on quality care time is correlated with parents' education, and that marital homogamy reduces couple specialization, but only among the highly educated. In line with earlier research, we identify gendered parental behaviour. The presence of boys is an important condition for fathers' time dedication, but primarly among lower educated fathers. To the extent that parental stimulation is decisive for child outcomes, our findings suggest the persistence of important inequalities. This emerges through our special attention to behavioural differences across the educational distribution among households.