Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA)

Introduction Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. Aim To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. Methods Literature review and consensus of expert opinion. Results and conclusion MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach.

Quality of life instruments in studies of menorrhagia: a systematic review

BACKGROUND: The use of quality of life (QoL) instruments in menorrhagia research is increasing but there is concern that not enough emphasis is placed on patient-focus in these measurements, i.e. on issues which are of importance to patients and reflect their experiences and concerns (clinical face validity). The objective was to assess the quality of QoL instruments in studies of menorrhagia. STUDY DESIGN: A systematic review of published research. Papers were identified through MEDLINE (1966-April 2000), EMBASE (1980-April 2000), Science Citation Index (1981-April 2000), Social Science Citation Index (1981-April 2000), CINAHL (1982-1999) and PsychLIT (1966-1999), and by manual searching of bibliographies of known primary and review articles. Studies were selected if they assessed women with menorrhagia for life quality, either developing QoL instruments or applying them as an outcome measure. Selected studies were assessed for quality of their QoL instruments, using a 17 items checklist including 10 items for clinical face validity (issues of relevance to patients' expectations and concerns) and 7 items for measurement properties (such as reliability, responsiveness, etc.). RESULTS: A total of 19 articles, 8 on instrument development and 11 on application, were included in the review. The generic Short Form 36 Health Survey Questionnaire (SF36) was used in 12/19 (63%) studies. Only two studies developed new specific QoL instruments for menorrhagia but they complied with 7/17 (41%) and 10/17 (59%) of the quality criteria. Quality assessment showed that only 7/19 (37%) studies complied with more than half the criteria for face validity whereas 17/19 (90%) studies complied with more than half of the criteria for measurement properties (P = 0.0001). CONCLUSION: Among existing QoL instruments, there is good compliance with the quality criteria for measurement properties but not with those for clinical face validity. There is a need to develop methodologically sound disease specific QoL instruments in menorrhagia focussing both on face validity and measurement properties.

The Great Slump of 2008–9 and Ukraine's integration with the European Union

For a number of years following the Orange revolution of 2004, Ukraine aspired to join the European Union. Although full integration was never a short-term prospect, European integration, through the Association Agreement and the Deep and Comprehensive Free Trade Area, offers considerable benefits to Ukraine. However, the country was severely affected by the Great Slump of 2008–9 in the global economy, and this profoundly negative experience has shaped Ukrainian domestic and foreign policy in the subsequent period, putting paid to aspirations to EU membership and influencing the Ukrainian government's decision to seek a closer relationship with Russia immediately following the presidential election of 2010. Nevertheless, closer relations with Russia should not adversely affect Ukraine's efforts at EU integration.

A study of performance and regulation in telecommunications in the European Union

This thesis looks at two issues. Firstly, statistical work was undertaken examining profit margins, labour productivity and total factor productivity in telecommunications in ten member states of the EU over a 21-year period (not all member states of the EU could be included due to data inadequacy). Also, three non-members, namely Switzerland, Japan and US, were included for comparison. This research was to provide an understanding of how telecoms in the European Union (EU) have developed. There are two propositions in this part of the thesis: (i) privatisation and market liberalisation improve performance; (ii) countries that liberalised their telecoms sectors first show a better productivity growth than countries that liberalised later. In sum, a mixed picture is revealed. Some countries performed better than others over time, but there is no apparent relationship between productivity performance and the two propositions. Some of the results from this part of the thesis were published in Dabler et al. (2002). Secondly, the remainder of the tests the proposition that the telecoms directives of the European Commission created harmonised regulatory systems in the member states of the EU. By undertaking explanatory research, this thesis not only seeks to establish whether harmonisation has been achieved, but also tries to find an explanation as to why this is so. To accomplish this, as a first stage to questionnaire survey was administered to the fifteen telecoms regulators in the EU. The purpose of the survey was to provide knowledge of methods, rationales and approaches adopted by the regulatory offices across the EU. This allowed for the decision as to whether harmonisation in telecoms regulation has been achieved. Stemming from the results of the questionnaire analysis, follow-up case studies with four telecoms regulators were undertaken, in a second stage of this research. The objective of these case studies was to take into account the country-specific circumstances of telecoms regulation in the EU. To undertake the case studies, several sources of evidence were combined. More specifically, the annual Implementation Reports of the European Commission were reviewed, alongside the findings from the questionnaire. Then, interviews with senior members of staff in the four regulatory authorities were conducted. Finally, the evidence from the questionnaire survey and from the case studies was corroborated to provide an explanation as to why telecoms regulation in the EU has reached or has not reached a state of harmonisation. In addition to testing whether harmonisation has been achieved and why, this research has found evidence of different approaches to control over telecoms regulators and to market intervention administered by telecoms regulators within the EU. Regarding regulatory control, it was found that some member states have adopted mainly a proceduralist model, some have implemented more of a substantive model, and others have adopted a mix between both. Some findings from the second stage of the research were published in Dabler and Parker (2004). Similarly, regarding market intervention by regulatory authorities, different member states treat market intervention differently, namely according to market-driven or non-market-driven models, or a mix between both approaches.

The Legitimation of authority in the European Union

The founding Treaties of the European Union (EU) provide the Commission with bureaucratic structures and functions, and the authority to take a political leadership role in the integration process. However, the legitimacy of the Commission's authority to act either as a bureaucracy or as a political institution is periodically contested, as is the authority and leadership of its President. Max Weber's theory of the legitimation of authority suggests itself in this context as a working tool for assessing the nature of institutional and individual authority and leadership in the Commission and the broader EU context. Weber's typology of authority offers both an understanding of the changes in the Commission's fortunes within the 'would-be polity' of the European institutions, and an appraisal of claims to authority at the individual level by the Commission President. When applied to two contrasting moments in the Commission's life during the presidency of Jacques Delors (the generating of the White Papers of 1985 and 1993), Weber's typology provides an explanation for the evolution of the legitimation of these forms of authority in terms of, first, the Union's imperfect provisions for legitimate claims to leadership authority on 'charismatic' grounds and, second, the absence in the Union of resources for leadership legitimacy based on 'traditional'-type authority, such as explicit, popular, or party political European-wide support for the project of European union. These are resources which, if present in the EU, would legitimise calls to reform the EU's institutions in the direction of more integration and a more federal polity. The case studies offer an appraisal of the functioning and malfunctioning of authority within the Union, as well as a critical assessment of the applicability of the Weberian model to the legitimation of authority in the EU.

Methodology of photic stimulation revisited:updated European algorithm for visual stimulation in the EEG laboratory

Intermittent photic stimulation (IPS) is a common procedure performed in the electroencephalography (EEG) laboratory in children and adults to detect abnormal epileptogenic sensitivity to flickering light (i.e., photosensitivity). In practice, substantial variability in outcome is anecdotally found due to the many different methods used per laboratory and country. We believe that standardization of procedure, based on scientific and clinical data, should permit reproducible identification and quantification of photosensitivity. We hope that the use of our new algorithm will help in standardizing the IPS procedure, which in turn may more clearly identify and assist monitoring of patients with epilepsy and photosensitivity. Our algorithm goes far beyond that published in 1999 (Epilepsia, 1999a, 40, 75; Neurophysiol Clin, 1999b, 29, 318): it has substantially increased content, detailing technical and logistical aspects of IPS testing and the rationale for many of the steps in the IPS procedure. Furthermore, our latest algorithm incorporates the consensus of repeated scientific meetings of European experts in this field over a period of 6 years with feedback from general neurologists and epileptologists to improve its validity and utility. Accordingly, our European group has provided herein updated algorithms for two different levels of methodology: (1) requirements for defining photosensitivity in patients and in family members of known photosensitive patients and (2) requirements for tailored studies in patients with a clear history of visually induced seizures or complaints, and in those already known to be photosensitive.

Eastern European capitalism in the making by Elena A. Iankova

Book review: Eastern European capitalism in the making, by Elena A. Iankova Cambridge: Cambridge University Press, 2002. 237, £37.50, ISBN 0 521 81314 X

Roman Catholicism, diplomacy, and the European communities, 1958-1964

This article investigates the Roman Catholic Church's role in the process of European integration from the first Hallstein Commission in 1958 to the failure of the Holy See's application to establish a diplomatic representation at the European Economic Community in 1964. The article focuses on the Church's response toward emerging European institutions and shows that local mobilization in Luxembourg, Strasbourg, and Brussels was instrumental in shaping relations between the Catholic Church and the European Communities (EC). The Church's position toward the EC, placing local communities as prime actors in dialogue with European institutions, reflected the sensitive nature of religion during the Cold War.

Representing religion in the European Union:does God matter?

Religious actors are becoming part of the EU bureaucratic system, and their mobilisation in Brussels and Strasbourg in the last decade has increased dramatically. This book explores the mechanism and impact of religious representation by examining relations between religious practitioners and politicians in the European Union from the Second World War until today. This book seeks to answer the following questions: How do (trans)national religious groups enter into contact with European institutions? What are the rationale and the mechanisms of religious representation in the European Union? How are religious values transposed into political strategies? What impact has relations between religious practitioners, EU officials and politicians on the construction of the European Union? Examining religious representation at the state, transnational and institutional levels, this volume demonstrates that ‘faith’ is becoming an increasingly important element of the decision-making process. It includes chapters written by both academics and religious practitioners in dialogue with European institutions and will be of great interest to students and scholars of European politics, history, sociology of religion, law and international relations.

The influence of newer member states in the European Union:the case of Poland and the Eastern partnership

This article seeks to examine and assess the role of Poland in the early stages of the making of the Eastern Partnership of the European Union. First, it briefly reviews Poland's aims and ambitions with regard to the European Union's policy towards its eastern neighbours, both before and since it joined the European Union in 2004. Second, it describes and analyses the Eastern Partnership, including its added value for the European Neighbourhood Policy. Third, it draws on a range of interviews carried out by the authors in Brussels and Warsaw on Poland's role in the initial formation of the Eastern Partnership, as seen by its partners in the other member states and European institutions. In addition, it seeks to unpack some of the early stage lessons learnt by the Polish government about how best to achieve its ambitions in the European Union, and notes the remaining weaknesses of the Polish administration, particularly in the area of administrative capacity. © 2013 University of Glasgow.

Rebuilding the city:a focus for European industrial policy?

While the city offers the potential of dynamic agglomeration economies which can spur the achievement of economic growth and act as an engine that powers the economy, it often appears as a centre of crisis in mature ‘developed’ regions and countries, even before the most recent economic downturn. This paper attempts to reconcile these two seemingly paradoxical observations by bringing in a strategic choice perspective to explain how concentrated strategic decision making in the corporate entities that dominate our cities has diminished the very diversity that Jacobs identified as being essential for cities to flourish and develop. The industrial policy implications for cities are subsequently explored in terms of building new industrial districts, developing high skill ecosystems, and fostering multinational webs of cities, all with the aim of ensuring the conditions exist in cities for creativity and development to flourish, notably a diverse and democratic economic system.

The reluctant hegemon? Germany moves centre stage in the European Union

Introduction to special issue: The JCMS Annual Review of the European Union in 2010