Abstract
Background
There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to ...be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes.
Methods
This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants’ access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards.
Results
The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described.
Conclusions
The European situation concerning migrants’ and refugees’ health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants’ health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants’ own views on their health and barriers to access to healthcare is key.
Background
Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of ...MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries.
Methods
Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations.
Results
The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05).
Conclusion
This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways.
OBJECTIVES
To examine the longitudinal association between frequency of moderate physical activity (PA) and overall, physical, psychological, and social frailty among community‐dwelling older adults ...older than 70 years. Second, we assessed the association between a 12‐month change in frequency of moderate PA and frailty.
DESIGN
Longitudinal cohort study.
SETTING
Community settings in Spain, Greece, Croatia, the Netherlands, and the United Kingdom.
PARTICIPANTS
A total of 1735 participants (61.1% female; mean age = 79.6 years; SD = 5.5 years).
MEASUREMENTS
The frequency of self‐reported moderate PA was measured and classified into two categories: “regular frequency” and “low frequency.” The 12‐month change in frequency of moderate PA between baseline and follow‐up was classified into four categories: “continued regular frequency,” “decreased frequency,” “continued low frequency,” and “increased frequency.” The 15‐item Tilburg Frailty Indicator assessed overall, physical, psychological, and social frailty.
RESULTS
Participants who undertook moderate PA with a regular frequency at baseline were less frail at 12‐month follow‐up than participants with a low frequency. Participants who undertook moderate PA with a continued regular frequency were least frail at baseline and at 12‐month follow‐up. After controlling for baseline frailty and covariates, compared with participants with a continued regular frequency, participants with a decreased frequency were significantly more overall (B = 1.31; 95% confidence interval CI = 0.99‐1.63), physically (B = 0.80; 95% CI = 0.58‐1.03), psychologically (B = 0.43; 95% CI = 0.30‐0.56), and socially frail (B = 0.14; 95% CI = 0.04‐0.23) at 12‐month follow‐up; participants with a continued low frequency were significantly more overall (B = 1.16; 95% CI = 0.84‐1.49), physically (B = 0.73; 95% CI = 0.51‐0.96), psychologically (B = 0.42; 95% CI = 0.29‐0.55), and socially frail (B = 0.13; 95% CI = 0.04‐0.23) at 12‐month follow‐up; the 12‐month follow‐up frailty level of participants who undertook moderate PA with an increased frequency was similar to those with a continued regular frequency.
CONCLUSION
Maintaining a regular frequency of PA as well as increasing to a regular frequency of PA are associated with maintaining or improving overall, physical, psychological, and social frailty among European community‐dwelling older adults older than 70 years. J Am Geriatr Soc 68:1484‐1493, 2020.
Both in everyday life and scholarly discourse, monogamists and polyamorists tend to unfavorably portray one another as somehow flawed, misguided, or, in a word, “inferior.” This article documents and ...critically examines two pairs of interlocked psychosocial attitudes—monopride/polyphobia and polypride/monophobia—mediating this predicament of mutual competition in the context of Western mononormative culture. The ideological nature of these “mono–poly wars” is demonstrated through a brief review of empirical literature on the psychological health and relationship quality of monogamous and polyamorous individuals and couples. The article concludes by outlining a critical pluralist approach that eschews universalizing hierarchies between monogamy and polyamory, and provides tools for making qualitative distinctions within and among relational styles.
The arrangement of β cells within islets of Langerhans is critical for insulin release through the generation of rhythmic activity. A privileged role for individual β cells in orchestrating these ...responses has long been suspected, but not directly demonstrated. We show here that the β cell population in situ is operationally heterogeneous. Mapping of islet functional architecture revealed the presence of hub cells with pacemaker properties, which remain stable over recording periods of 2 to 3 hr. Using a dual optogenetic/photopharmacological strategy, silencing of hubs abolished coordinated islet responses to glucose, whereas specific stimulation restored communication patterns. Hubs were metabolically adapted and targeted by both pro-inflammatory and glucolipotoxic insults to induce widespread β cell dysfunction. Thus, the islet is wired by hubs, whose failure may contribute to type 2 diabetes mellitus.
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•Optogenetic targeting reveals a pacemaker-like β cell subpopulation•These cells, termed hubs, are required for normal insulin release•Hubs are highly metabolic and transcriptionally immature•Hubs are targeted by a diabetic milieu to induce islet failure
Combining optogenetics and photopharmacology, Johnston et al. show that a few (1%–10%) β cells exert disproportionate control over islet responses to glucose. These specialized cells, called hubs, are transcriptionally immature and highly metabolic. Their failure during type 2 diabetes mellitus may lead to reduced insulin secretion and impaired glucose homeostasis.
Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of ...a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes.
There is interest in identifying natural products capable of manipulating rumen microbial activity to develop new feed additives for ruminant nutrition as a strategy to reduce methane. Two trials ...were performed using the in vitro gas production technique to evaluate the interaction of substrate (n = 5) and additive (n = 6, increasing doses: 0, 0.3, 3, 30, and 300 µL/L of essential oils-EO-of
or
, and monensin at 1.87 mg/L). The two EO utilized were selected because they differ markedly in their chemical composition, especially in the proportion of oxygenated compounds. For both EO, the interaction between the substrate and additive was significant for all variables; however, the interaction behaved differently for the two EO. Within each substrate, the response was dose-dependent, without effects at a low level of EO and a negative outcome at the highest dose. The intermediate dose (30 µL/L) inhibited methane with a slight reduction on substrate digestibility, with
being more effective than
. It is concluded that the effectiveness of the EO to reduce methane production depends on interactions between the substrate that is fermented and the additive dose that generates different characteristics within the incubation medium (e.g., pH); and thus, the chemical nature of the compounds of the EO modulates the magnitude of this response.
Type 2 diabetes affects over 300 million people, causing severe complications and premature death, yet the underlying molecular mechanisms are largely unknown. Pancreatic islet dysfunction is central ...in type 2 diabetes pathogenesis, and understanding islet genome regulation could therefore provide valuable mechanistic insights. We have now mapped and examined the function of human islet cis-regulatory networks. We identify genomic sequences that are targeted by islet transcription factors to drive islet-specific gene activity and show that most such sequences reside in clusters of enhancers that form physical three-dimensional chromatin domains. We find that sequence variants associated with type 2 diabetes and fasting glycemia are enriched in these clustered islet enhancers and identify trait-associated variants that disrupt DNA binding and islet enhancer activity. Our studies illustrate how islet transcription factors interact functionally with the epigenome and provide systematic evidence that the dysregulation of islet enhancers is relevant to the mechanisms underlying type 2 diabetes.
Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex ...chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.
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