The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.

Organisational and methodical aspects of drug and addiction prevention among young people. Developments in the Ukraine, in Germany, Spain and Russia (Project Description)

From october 2000 to march 2003 the project has been coordinated by the institute of social work and welfare studies of the TU Dresden and financed by the European Commission (INCO-COPERNICUS-Programme). It was an international cooperation between the TU Dresden (Germany), the University of Internal Affairs and the National Technical University in Kharkiv (Ukraine), the research institute AREA in Valenciá (Spain) and the Belgorod Juridical Institute of the Ministry of Internal Affairs (Russia) which was established for improving the knowledge base of drug prevention activities by the East European partners. The overall aim of the project was the analysis and elaboration of approaches to drug and addiction prevention. Under consideration of the specific conditions within the East-European countries this work should contribute to the development of pluralistic approaches towards health promotion which are embedded into an intercultural, European horizon.

Aortic valve replacement and concomitant procedures with the Perceval valve: results of European trials.

BACKGROUND The Perceval (Sorin Group, Milan, Italy) is a self-anchoring sutureless aortic valve prosthesis. We report the short- to midterm results of combined aortic valve replacement (AVR) with concomitant procedures in elderly patients undergoing operation as part of 3 consecutive prospective multicenter European studies. METHODS From April 2007 to February 2013, 243 patients (mean age, 79.7 ± 5.1 years; female patients, 61%; median EuroSCORE, 9%) underwent AVR with concomitant procedures. The concomitant procedures were coronary artery bypass grafting (CABG) (182 cases), septal myectomy (21 cases), CABG + other procedures (18 cases), and 22 other procedures. Primary and secondary end points included implant feasibility and safety (for mortality and morbidity) and efficacy (New York Heart Association [NYHA] class improvement and hemodynamic results) of the prosthesis at the different follow-up periods. Data were expressed as mean ± standard deviation. Kaplan-Meier analysis was performed for survival analysis. RESULTS Mean aortic cross-clamp and extracorporeal circulation (ECC) times were 50.7 ± 22.8 minutes and 78.9 ± 32.3 minutes, respectively. Thirty-day mortality was 2.1%. Mean postoperative gradient and effective orifice area were 10.1 ± 4.7 mm Hg and 1.5 ± 0.4 cm(2) and 8.9 ± 5.6 mm Hg and 1.6 ± 0.4 cm(2), respectively, at 1 year. There were early explantations, 4 of which resulted from paravalvular leaks. One additional valve explantation resulted from aortic root bleeding, probably caused by excessively extensive decalcification. In the late period, there was 1 mild paravalvular leak and no intravalvular insufficiency. No migration, dislodgement, or degeneration of the valve occurred during follow-up. Median follow-up was 444 days. CONCLUSIONS These trials confirm the safety and efficacy of the Perceval sutureless aortic valve, especially in elderly patients requiring AVR + concomitant procedures. In this patient group, sutureless valves may be advantageous compared to transcatheter valve implantations as concomitant procedures other than percutaneous coronary artery angioplasty are not always possible in the latter.

Religion as Culture? How European and American High Courts Endorse Majority Religion

This paper examines a trend in European and American High Courts to endorse majority religion by transforming it into “culture”, and thus by secularizing it. To dissociate religion and state is the hallmark of the liberal state. However, no state has ever managed a perfect separation, not even the American. Under conditions of mounting religious pluralism and ongoing secularization, there is pressure on the state to live up to its “neutrality”. A main strategy to square the circle of neutrality and incomplete dissociation from religion is to declare it “culture”, which gives the state the license to associate or even identify with it (as guardian of nationhood). The paper compares recent American and European High Court rules on religious symbols (especially crucifixes) that exhibits this strategy, addressing similarities and differences as well as the limits and pitfalls of “culturalizing” religion.

The Sahel Crisis: Where do European and African Perspectives Meet? IES Policy Brief Issue 2013/02/March 2013

Summary. The crisis in Mali has brought the Sahel to the centre of international attention. This fragile region not only suffers from longstanding development challenges, but also from an acute security vacuum that has triggered military intervention. Many questions have arisen as a consequence of the crisis. Has the European Union the ability to cope with such a complex and dynamically evolving security environment? How have divergent views on the political roadmap to be adopted, and the lack of resources at the African level, impacted the crisis response? Can the different players involved agree on what are the most pertinent needs and challenges to be addressed? Are they ready for long-term engagement? Can regional organisations effectively collaborate and are they able to successfully integrate different agendas? Following a conference organised by the Institute for European Studies, the Egmont Institute and the Observatoire de l’Afrique on these questions this Policy Brief builds on the findings of the conference and provides an analytical overview of the regional crisis by focusing on the main challenges facing the Sahel, the local and regional dynamics at play and the military and security response.

North Rhine-Westphalia and the European Union. ZEI Discussion Paper C232, 2015

Keynote speech at the Final Ceremony of the ZEI Class of 2015. On the occasion of the Final Ceremony of the ZEI Master of European Studies “Class of 2015”, Prime Minister Hannelore Kraft congratulated the this year’s graduates and at the same time the ZEI and its staff for its past twenty years of innovative and successful academic work. Twenty years in which the European Union has succeeded in making progress in many areas, like Economic and Monetary Union, EU enlargement, introduction of the Euro and the changing role of the regions in the EU. North Rhine-Westphalia, the 8th largest region in the EU, is conducting proactive policy both in Berlin and in Brussels and combines European and regional politics in many areas. The European Union has to face new challenges, which can be only solved successful and confidence building as a common and even closer Union.

The Inefficiency of Self-Sufficiency: Uzbekistan's Response to CASA-1000

Thesis (Master's)--University of Washington, 2016-06

The Bumpy Road to Democracy: Success and Failure in the Integration of Ethnic Armenians in the Republic of Georgia

Thesis (Master's)--University of Washington, 2016-06

Anti-Trafficking Policy Compliance with International Norms in Estonia and the Former Soviet Space

Thesis (Master's)--University of Washington, 2016-06

Is Crimea Kosovo? Fundamental Misunderstandings and Failed Diplomacy Between Russia and the West in the Post-Cold War International System

Thesis (Master's)--University of Washington, 2016-06

Planning for a Communist Future: Professionalization, Nationalism, and Planning Practice in Soviet Moscow, 1964-1974

Thesis (Master's)--University of Washington, 2016-06

Comparing the conditions for small business and entrepreneurship in Sweden and Australia: Lessons for the European Charter for Small Enterprises

A growing body of literature is concerned with explaining cross-national performance of small business and entrepreneurs in advanced economies. This literature has considered a range of policy and institutional variables which create an environment supportive of small firms and entrepreneurial activities including macroeconomic variables such as taxation, labour market regulation, social security and income policy; regulatory factors such as establishment legislation, bankruptcy policy, administrative burdens, compliance costs, deregulation and competition policy; and cultural factors such as social and cultural norms that support entrepreneurship. However, this literature has not always distinguished between the policy environment of small firms operating in different industry sectors. The purpose of this paper is to examine the institutional and policy environment of small firms in knowledge intensive sectors. The characteristics of the business environment of particular relevance to knowledge intensive firms are somewhat different from the conditions for entrepreneurship and small business success more generally. This paper compares the science, technology and industry infrastructure of Australia, Denmark, Sweden with other OECD countries. The purpose of the paper is to identify cross-national differences in the business environment of small knowledge intensive firms. The paper seeks to explore whether particular institutional environments appear to be more supportive of small firms in knowledge intensive sectors.

European integration and democratic consolidation: Spain, Poland and Turkey in comparative perspective

The study explored when, under what conditions, and to what extent did European integration, particularly the European Union’s requirement for democratic conditionality, contribute to democratic consolidation in Spain, Poland, and Turkey? On the basis of a four-part definition, the dissertation examined the democratizing impact of European integration process on each of the following four components of consolidation: (i) holding of fair, free and competitive elections, (ii) protection of fundamental rights, including human and minority rights, (iii) high prospects of regime survival and civilian control of the military, and (iv) legitimacy, elite consensus, and stateness. To assess the relative significance of EU’s democratizing leverage, the thesis also examined domestic and non-EU international dynamics of democratic consolidation in the three countries. By employing two qualitative methods (case study and process-tracing), the study focused on three specific time frames: 1977–1986 for Spain, 1994–2004 for Poland, and 1999–present for Turkey. In addition to official documents, newspapers, and secondary sources, face-to-face interviews made with politicians, academics, experts, bureaucrats, and journalists in the three countries were utilized. The thesis generated several conclusions. First of all, the EU’s democratizing impact is not uniform across different components of democratic consolidation. Moreover, the EU’s democratizing leverage in Spain, Poland, and Turkey involved variations over time for three major reasons: (i) the changing nature of EU’s democratic conditionality over time (ii) varying levels of the EU’s credible commitment to the candidate country’s prospect for membership, and (iii) domestic dynamics in the candidate countries. Furthermore, the European integration process favors democratic consolidation but its magnitude is shaped by the candidate country’s prospect for EU membership and domestic factors in the candidate country. Finally, the study involves a major policy implication for the European Union: unless the EU provides a clear prospect for membership, its democratizing leverage will be limited in the candidate countries.

Rethinking Care Through Social Reproduction: Articulating Circuits of Migration

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.