Iowa's Rural Alzheimer's Demonstration Project, July 1, 2004 - June 31, 2007

The Iowa Department of Elder Affairs, in collaboration with the Iowa Department of Elder Affairs (IDEA) and the University of Iowa College of Nursing (UI CON), has been engaged in developing and evaluating community based services for persons with dementia in the state of Iowa over the past 7 years under two grants form the Administration on Aging. In the current grant period, the involved agencies have completed a collaborative effort aimed to increase the capacity of Adult Day Health and Respite (ADR) providers in serving persons with dementia. Adult day services and respite care were identified by participants in the initial grant through various processes and service providers as important components of caring for persons with dementia and that there was a gap of these services in the state. Therefore, adult day and respite services were chosen as a target for the second AoA grant. The focus, in particular, was to enhance capacity to care for persons with later stages of the disease and those in rural settings as well as to begin to develop services that are more responsive to emerging minority populations. The process of the grant provided the state with a rich amount of information about the status of Iowa’s Adult Day Service providers in general and in regard to provision of dementia specific services, as well as valuable insights into the capability of rural communities to serve persons with dementia and their caregivers at home. Final Performance Report

Formation of the long range Dpp morphogen gradient.

The TGF-β homolog Decapentaplegic (Dpp) acts as a secreted morphogen in the Drosophila wing disc, and spreads through the target tissue in order to form a long range concentration gradient. Despite extensive studies, the mechanism by which the Dpp gradient is formed remains controversial. Two opposing mechanisms have been proposed: receptor-mediated transcytosis (RMT) and restricted extracellular diffusion (RED). In these scenarios the receptor for Dpp plays different roles. In the RMT model it is essential for endocytosis, re-secretion, and thus transport of Dpp, whereas in the RED model it merely modulates Dpp distribution by binding it at the cell surface for internalization and subsequent degradation. Here we analyzed the effect of receptor mutant clones on the Dpp profile in quantitative mathematical models representing transport by either RMT or RED. We then, using novel genetic tools, experimentally monitored the actual Dpp gradient in wing discs containing receptor gain-of-function and loss-of-function clones. Gain-of-function clones reveal that Dpp binds in vivo strongly to the type I receptor Thick veins, but not to the type II receptor Punt. Importantly, results with the loss-of-function clones then refute the RMT model for Dpp gradient formation, while supporting the RED model in which the majority of Dpp is not bound to Thick veins. Together our results show that receptor-mediated transcytosis cannot account for Dpp gradient formation, and support restricted extracellular diffusion as the main mechanism for Dpp dispersal. The properties of this mechanism, in which only a minority of Dpp is receptor-bound, may facilitate long-range distribution.

Mise à jour sur l'hépatite E [An update on hepatitis E].

The hepatitis E virus (HEV) is an RNA virus transmitted via the fecal-oral route or through uncooked animal meat products. Of the 4 known genotypes, genotype 3 is responsible for autochthonous infections in industrialized countries, with a seroprevalence in Switzerland estimated as high as 22%. The majority of infections is asymptomatic but a minority of patients, notably men over 50 or with underlying liver disease, can present with severe acute hepatitis. Chronic hepatitis E with HEV of genotype 3 has been observed in immunosuppressed patients, mostly transplant recipients. Serology is not sufficiently sensitive, especially in immunosuppressed patients, making PCR identification the preferred test for diagnosing active infection. Ribavirin or interferon-alpha can be used to treat chronic hepatitis E if reduction of immunosuppressive treatment does not result in viral elimination.

Faire entendre sa voix

Dans une société du consentement, chacun devrait pouvoir exprimer sa voix. Mais tout enfant apprend à parler en faisant usage de la parole des autres. Dans quelle mesure ce que dit le nouveau venu n'est-il pas une pure reproduction de ce que disent ses aînés ? Si chacun a la voix de sa communauté, qu'est-ce que peut bien vouloir dire « liberté d'expression » ? J'aimerais montrer qu'une voix n'est pas quelque chose que l'on a, mais quelque chose que l'on fait entendre au cours d'un apprentissage. Le problème est politique : ma voix est liée à ma place dans une communauté. In a society of consent, each and everyone should express their own voice. However, a child learns how to speak using the words of the others. To which extent the newcomer isn't just reproducing what his elders say ? If everyone speaks through their community's voice, what does « freedom of speech » mean ? I want to demonstrate that a voice isn't something that one has, it's something that one acquires through education. This is a political problem : my voice is linked to my place in a community.

Perception of the damaging effects of smoking, and brief cessation counselling by doctors.

An open prospective study was conducted among the patients visiting an urban medical policlinic for the first time without an appointment to assess whether the immigrants (who represent more than half of our patients) are aware of the health effects of smoking, whether the level of acculturation influences knowledge, and whether doctors give similar advice to Swiss and foreign smokers. 226 smokers, 105 Swiss (46.5%), and 121 foreign-born (53.5%), participated in the study. 32.2% (95% CI [24.4%; 41.1%]) of migrants and 9.6% [5.3%; 16.8%] of Swiss patients were not aware of negative effects of smoking. After adjustment for age, the multivariate model showed that the estimated odds of "ignorance of health effects of smoking" was higher for people lacking mastery of the local language compared with those mastering it (odds ratio (OR) = 7.5 [3.6; 15.8], p < 0.001), and higher for men (OR = 4.3 [1.9; 10.0], p < 0.001). Advice to stop smoking was given with similar frequency to immigrants (31.9% [24.2%; 40.8%] and Swiss patients (29.0% [21.0%; 38.5%]). Nonintegrated patients did not appear to receive less counselling than integrated patients (OR = 1.1 [0.6; 2.1], p = 0.812). We conclude that the level of knowledge among male immigrants not integrated or unable to speak the local language is lower than among integrated foreign-born and Swiss patients. Smoking cessation counselling by a doctor was only given to a minority of patients, but such counselling seemed irrespective of nationality.

Comunidade política, imigração e coesão social: o caso português

This work contributes to an understanding of how the existence of multiple ethnic- cultural belongings in the political community concurs with the maintenance of a socially cohesive and politically united community. Considering the immigration reality in Portugal, we tried to identify the bonds that link immigrants to the political community and how those bonds can be mobilized to integrate immigrants in a common living project inside the national territory. Methodologically, this investigation is based in a qualitative and quantitative analysis of the policies and measures applied in Portugal in the immigration sphere, as well as the results of the empirical work we carried out with two immigration groups (Brazilians and Cape Verdeans) living in Lisbon’s metropolitan area, and the answers to a survey we sent to immigrant associations. The results of this research revealed the existence of a certain political ambivalence concerning the immigrant integration process, which expresses itself to a certain degree in the way national citizens and immigrants appraise the immigrant contribution to Portuguese society. The prevailing and blurred idea states that immigration expenses don’t make up for the benefits, and that is likely to influence the mutual relationship established between the two. Despite the existence of objective situations of social and economic disparity and despite a feeling of discrimination shared between immigrants, it is possible to identify a progressive citizenship universalization and the formal acceptance of immigrant religious and cultural traditions, even though the Portuguese parliament does not reflect such diversity. Thus, we perceive the possibility of warranting specific ethnic and cultural minority rights without the ethnicization or culturalization of political representation, and the general standards that serve as a backbone to the national political community might be enough to warrant that protection. Notwithstanding, some signs suggest that immigrant access to public sphere might not be easy, and this might have repercussions in the visibility and in the public discussion of demands, with outcomes on the type of integration policies Portugal applies.

O poder local em Timor em contexto multicultural

O trabalho que agora se apresenta é fruto, antes de mais, de uma relação especial com Timor. Não necessariamente pela dimensão histórica das várias presenças naquele território mas, e acima de tudo, pela relação pessoal e afectiva com alguns dos responsáveis políticos e religiosos daquele jovem país. Um convite, formulado em 2007 por Xanana Gusmão, levou-nos a calcorrear todo o território num curto espaço de três semanas, corria o Verão de 2008. O objectivo era a análise, no terreno, da viabilidade da instalação de um poder local num país recentemente tornado independente. Timor, fruto da sua história e, muito em especial, das características antropológicas do seu povo, é uma nação assumidamente multicultural. Das origens ancestrais das suas comunidades, dos reinos dispersos que pulverizam o pequeno território, das suas lideranças e dos vários dilectos, associados à longa e marcante presença portuguesa, bem como outras ocupações de países estrangeiros, com destaque para a Indonésia, resulta um caldo cultural, a todos os níveis peculiar. Aqui e acolá ouvimos o povo, entrevistámos e reunimos com os 432 chefes de suco existentes no país, entrevistámos chefes de aldeia e anciãos, reunimos com políticos, sacerdotes, professores e jornalistas. Interpretámos, ou tentámos interpretar, as condicionantes e os cuidados que se devem observar na preparação do quadro jurídico para reger a municipalidade em Timor: as suas vertentes electivas, funcionais, financeiras e fiscalizadoras. Revistámos a História de Timor e passámos por Cabo Verde, país de referência internacional ao nível da sua gestão pública, muito em especial a autárquica. Fizemos, também, óbvia referência à história do poder local em Portugal. Das consultas, do muito que observámos e estudámos, resulta um desinteressado contributo para a implementação do poder local em Timor, com as conclusões que incorporam alertas e sugestões.

Active civic participation of immigrants in Portugal

Portugal’s historical past strongly influences the composition of the country’s immigrant population. The main third-country foreign nationals in Portugal originate traditionally from Portuguese-speaking African countries (namely Cape Verde, Angola, Guinea Bissau, and S. Tomé e Príncipe) and Brazil. In 2001, a newly created immigrant status entitled “permanence” authorization uncovered a quantitative and a qualitative change in the structure of immigrant population in Portugal. First, there was a quantitative jump from 223.602 foreigners in 2001 to 364.203 regularized foreigners in 2003. Secondly, there was a substantial qualitative shift in the composition of immigrants. The majority of the new immigrants began coming from Eastern European countries, such as Ukraine, Moldavia, Romania, and the Russian Federation. Thus, European countries outside the E.U. zone now rank second (after African countries) in their contribution of individuals to the stocks of immigrant population in Portugal. The differences between the new and traditional immigration flows are visible in the geographical distribution of immigrants and in their insertion into the labour market. While the traditional flows would congregate around the metropolitan area of Lisbon and in the Algarve, the new migratory flows tend to be more geographically dispersed and present in less urbanized areas of Portugal. In terms of insertion in the labour market, although the construction sector is still the most important industry for immigrant labour, Eastern European workers may also be found in the agriculture and manufacturing sectors. The institutional conditions that encourage immigrants’ civic participation are divided at three different levels: the state, the local, and the civil society levels. At the state level, the High Commissioner for Migrations and Ethnic Minorities is the main organizational structure along with a set of interrelated initiatives operating under specific regulatory frameworks, which act as mediators between state officials and the Portuguese civil society, and more specifically, immigrant communities. At the local level, some municipalities created consultative councils and municipal departments aiming at encouraging the participation and representation of interests from immigrant groups and association in local policies. In the civil society sphere, the main actors in Portugal spurring immigrants civic participation are immigrant associations, mainstream associations directed toward immigration topics, and unions. The legal conditions framing immigrants’ access to social housing, education, health, and social security in Portugal are also considered to be positive. Conditions restricting immigrants’ civic participation are mainly normative and include the Portuguese nationality law, the regulations shaping the political participation of immigrants, namely in what concerns their right to vote, and employment regulations restricting immigrants’ access to public administration positions. Part II of the report focuses on the active civic participation of third country immigrants. First, reasons for the lack of research on this issue in Portugal are explained. On the one hand, the recent immigration history and the more urgent needs regarding school and economic integration kept this issue out of the research spotlight. On the other hand, it was just in the beginning of the 1990s that immigrants took the very first steps toward collective mobilisation. Secondly, the literature review of Portuguese bibliography covers research on third country immigrants’ associative movement, research on local authorities’ policies and discussion about ethnic politics and political mobilisation of immigrants in Portugal. As political mobilisation of these groups has been made mainly through ethnic and/or migrant organisations, a brief history of immigrants' associative movement is given. Immigrant associations develop multiple roles, covering the social, the cultural, the economic and the political domains. Political claiming for the regularisation of illegal immigrants has been a permanent and important field of intervention since the mid-1990s. Research results reveal the com5 plex relations between ethnic mobilisation and the set of legal and institutional frameworks developed by local and national governmental authorities targeted to the incorporation of minority groups. Case studies on the Oeiras district and on the Amadora district are then presented. Conclusions underline that the most active immigrant groups are those from Cape Verde and Guinea Bissau, since these groups have constituted a higher number of ethnic associations, give priority to political claiming and present a more politicised discourse. Reflecting on the future of research on civic participation of third country immigrants in Portugal, the authors state that it would be interesting and relevant to compare the Portuguese situation with those of other European countries, with an older immigration history, and analyse how the Portuguese immigrants’ associative movement will be affected by a changing legal framework and the emergence of new opportunities within the set of structures regarding the political participation of minority groups.

O poder local em Timor em contexto multicultural

This study, now on presentation, comes as a result of a special relationship established with East Timor. Not necessarily through the several historical presences in that territory but, above all, through the emotional and personal relationships with some of the political and religious leaders of this young country. An invitation, made in 2007 by Xanana Gusmão, led us throughout the whole territory in a short time of three weeks, running the summer of 2008. Its purpose was the analysis, on the ground, of the possibility of installing local administration in a country which had recently became independent. Timor, as a result of its history, but mostly of the anthropological characteristics of its people, is an openly multicultural nation. The ancestral origins of their communities, its scattered kingdoms that spray along such a small territory, its leaders and many dialects, associated with the long portuguese presence, as well as other occupations made by foreign countries, especially Indonesia, became a cultural melting pot truly unique. Here and there we heard the people and interviewed and met the 432 local elected leaders of the country. We interviewed village elders and meet with politicians, priests, teachers and journalists. We have interpreted, or tried to, the actual conditions and cautions that must be observed in preparing the legal framework to govern the municipality in East Timor: its elective, functional, financial and oversight aspects. We have reviewed Timor’s history and took Cape Verde’s example as an international reference on its public administration, mostly its local authorities. We made also the obvious reference to the portuguese local government’s history. From search, and much of the observed and studied, remains a selfless contribution to the implementation of local government in East Timor, with alerts that incorporate conclusions and suggestions.

Health-related quality of life in migrant preschool children.

BACKGROUND: Minority groups have a lower health-related quality of life (HRQOL), but there is little information if this finding also applies to children. In this study, we compared HRQOL between young children with and without migrant parents. METHODS: Two cross-sectional studies of culturally diverse preschool populations in Switzerland: Ballabeina (40 preschools, 258 girls and 232 boys aged 4 to 6 years) and Youp'là Bouge (58 child care centers, 453 girls and 522 boys aged 2 to 4 years). Most children were born in Switzerland (Ballabeina: 92.3%; Youp'là Bouge: 93.7%). Number of migrant parents was considered as the main exposure. HRQOL was measured using the 23-item Pediatric Quality of Life Inventory. RESULTS: Children of migrant parents had a significantly lower HRQOL total score (mean ± SD, Ballabeina: 84.2 ± 9.1; 82.7 ± 9.6 and 81.7 ± 11.7 for children with none, one or two migrant parents, respectively; Youp'là Bouge: 83.8 ± 8.6; 82.9 ± 9.5; 80.7 ± 11.7, all p < 0.05). Similar results were found in Ballabeina and Youp'là Bouge for social, school and physical functioning (all p < 0.05), but not for emotional functioning. The differences in HRQOL measures were partly mediated by children's place of birth, parental education, paternal occupational level, children's BMI, screen time and physical activity in one study (Ballabeina), but not in the other (Youp'là Bouge). CONCLUSION: In preschoolers, children of migrant parents have lower HRQOL than children of non-migrant parents. These differences are only partly mediated by other sociocultural characteristics or lifestyle behavior. These families may need assistance to prevent further inequalities.

IRM cardiaque: imagerie de référence dans le diagnostic de la myocardite aiguë [Cardiac magnetic resonance in acute myocarditis: a new non-invasive diagnostic gold standard?].

Acute myocarditis was until recently one of the most difficult diagnoses in cardiology. The spectrum of signs and symptoms is very wide, the usual non-invasive tests lack specificity and the myocardial biopsy is only performed in a minority of cases to confirm the diagnosis. Due to its unique ability to directly image myocardial necrosis, fibrosis and oedema, cardiac magnetic resonance (CMR) is now considered the primary tool for noninvasive assessment of patients with suspected myocarditis. CMR is also useful for monitoring disease activity under treatment. Myocarditis has been associated with the development of dilated cardiomyopathy; CMR could play a role in the follow-up of such cases to detect the progression toward a dilatative phenotype. Precise mapping of myocardial lesions with cardiac MRI is invaluable to guide myocardial biopsy and increase its diagnostic yield by improving sensitivity.

Comunidade política, imigração e coesão social: o caso português

O presente trabalho é um contributo para entender em que medida a existência de múltiplas pertenças étnico-culturais na comunidade política é conciliável com a manutenção de uma comunidade socialmente coesa e politicamente unitária. Tendo em conta a realidade imigratória em Portugal, procurou-se saber quais os laços que ligam os imigrantes à comunidade política e em que medida eles podem ser mobilizados para a integração dos imigrantes num projecto comum de vivência em território nacional. Metodologicamente, este trabalho tem por base a análise qualitativa e quantitativa das políticas e medidas adoptados em Portugal em matéria de imigração, bem como, os resultados do trabalho empírico por nós realizado junto de dois grupos de imigrantes (brasileiros e cabo-verdianos) residentes na área metropolitana de Lisboa, assim como os resultados de um questionário enviado às associações de imigrantes. Os resultados da pesquisa apontam para a existência de uma certa ambivalência política no processo de integração dos imigrantes, a qual se reflecte de algum modo na forma como os nacionais e os imigrantes valorizam o contributo dos imigrantes para a sociedade portuguesa, sobressaindo uma ideia difusa generalizada de que os custos da imigração não compensam os seus benefícios, o que provavelmente afectará o relacionamento recíproco. Apesar de situações objectivas de desigualdade social e económica e da percepção de discriminação existente entre os imigrantes, é possível identificar uma progressiva universalização da cidadania e a aceitação formal das tradições religiosas e culturais dos imigrantes, mesmo não sendo o parlamento português representativo dessa diversidade. Deste modo, afigura-se ser possível assegurar direitos específicos de protecção das minorias étnicas e culturais sem que seja necessária a etnicização ou a culturalização da representação política e os princípios gerais que estruturam a comunidade política nacional poderão ser suficientes para assegurar essa protecção. No entanto, existem indícios que sugerem que o acesso dos imigrantes à esfera pública poderá não ser fácil, o que se poderá traduzir na visibilidade e na discussão pública das suas reivindicações, com consequências a nível do tipo de políticas de integração adoptadas em Portugal.

A health behaviour cross-sectional study of immigrants and non-immigrants in a Swiss urban general-practice setting.

BACKGROUND: Little is known about smoking, unhealthy use of alcohol, and risk behaviours for sexually transmitted diseases (STDs) in immigrants from developed and developing countries. METHOD: We performed a cross-sectional study of 400 patients who consulted an academic emergency care centre at a Swiss university hospital. The odds ratios for having one or more risk behaviours were adjusted for age, gender, and education level. RESULTS: Immigrants from developing countries were less likely to use alcohol in an unhealthy manner (OR = 0.35, 95% CI 0.22-0.57) or practise risk behaviours for STDs (OR = 0.31, 95% CI 0.13-0.74). They were also less likely to have any of the three studied risk behaviours (OR = 2.5, 95% CI 1.5-4.3). DISCUSSION: In addition to the usual determinants, health behaviours are also associated with origin; distinguishing between immigrants from developing and developed countries is useful in clinical settings. Surprisingly, patients from developing countries tend to possess several protective characteristics.

Baseline data of a population-based cohort of patients with diabetes in Switzerland (CoDiab-VD)

QUESTIONS UNDER STUDY: To describe a population-based sample of patients with diabetes and the quality of their care in the canton of Vaud, Switzerland, as a baseline measure for the evaluation of the "Programme cantonal Diabète". METHODS: We conducted a self-administered paper-based questionnaire survey. Non-institutionalised adult (aged ≥18 years) patients with diabetes diagnosed for at least 1 year and residing in the canton of Vaud were recruited by community pharmacies. Women with gestational diabetes, people with obvious cognitive impairment or people not sufficiently fluent in French were excluded. Primary outcomes were recommended processes-of-care and outcomes of care (glycosylated haemoglobin [HbA1c], generic and disease-specific health-related quality of life (HRQoL), overall care score in relation to the Chronic Care Model). Other measures included diabetes education, self-management support and self-efficacy, health status, health behaviour and demographics. RESULTS: A total of 519 patients with diabetes were included. Whereas the mean HbA1c level was 7.3% (n = 177, 95% confidence interval 7.1-7.5), diabetes-specific processes-of-care and influenza vaccination were reported by less than two-thirds of the patients. Physical activity and diet recommendations results mirrored patients' difficulties with their management in daily life and diabetes-specific HRQoL was worst in the dimensions relative to diet (eating and drinking) and sex life. A minority of patients reported ever having participated in diabetes education courses (32.8%). Overall, patients were satisfied with their care and the support they received. CONCLUSIONS: This study provides a broad picture of the experiences of people living with diabetes in the canton of Vaud. It shall guide the development of targeted interventions within the "Programme cantonal Diabète".