Integrated Care Models for Managing and Preventing Frailty: A Systematic Review for the European Joint Action on Frailty Prevention (ADVANTAGE JA).

Frailty requires concerted integrated approaches to prevent functional decline. Although there is evidence that integrating care is effective for older people, there is insufficient data on outcomes from studies implementing integrated care to prevent and manage frailty. We systematically searched PubMed and Cochrane Library database for peer-reviewed medical literature on models of care for frailty, published from 2002 to 2017. We considered the effective and transferable components of the models of care and evidence of economic impact, where available. Information on European Union-funded projects or those registered with the European Innovation Partnership on Active and Healthy Ageing, and grey literature (including good practices) were also considered. We found 1,065 potential citations and 170 relevant abstracts. After excluding reports on specific diseases, processes or interventions and service models that did not report data, 42 full papers met the inclusion criteria. The evidence showed that few models of integrated care were specifically designed to prevent and tackle frailty in the community and at the interface between primary and secondary (hospital) care. Current evidence supports the case for a more holistic and salutogenic response to frailty, blending a chronic care approach with education, enablement and rehabilitation to optimise function, particularly at times of a sudden deterioration in health, or when transitioning between home, hospital or care home. In all care settings, these approaches should be supported by comprehensive assessment and multidimensional interventions tailored to modifiable physical, psychological, cognitive and social factors.

Migration and mortality: a 20 year follow up of Finnish twin pairs with migrant co-twins in Sweden.

STUDY OBJECTIVE: Finland has a higher mortality overall and for major causes of death than Sweden, primarily in men. The objective of this study was to analyse mortality in migrants from Finland to Sweden. DESIGN: A longitudinal study based on the Finnish Twin Cohort Study. Information about migration from Finland to Sweden, duration of stay in Sweden for the migrants, and deaths 1976-1995 was obtained from national registers. Observed numbers of deaths in migrants were compared with expected numbers based on the age standardised mortality experience of the Finnish Twin Cohort. First deaths in migrants and non-migrants of migrant discordant pairs were compared controlling for genetic and early childhood factors. PARTICIPANTS: Twin pairs of the Finnish Twin Cohort Study where at least one twin had migrated to Sweden (1542 twin pairs). MAIN RESULTS: Among men, migrants from Finland to Sweden showed an overall similar mortality compared with all subjects of the Finnish Twin Cohort (SMR 1.1; 95% CI 0.9 to 1.4). Mortality from non-violent causes was increased for migrants with at most 20 years in Sweden (SMR 1.9; 95% CI 1.2 to 2.6) and decreased in those with a longer stay (SMR 0.7; 95% CI 0.4 to 0.9). Similar results were obtained concerning first deaths in twin pairs discordant for migration. Among women, migrants had an increased mortality overall (SMR 1.4; 95% CI 1.0 to 1.8), from cardiovascular disease (SMR 1.7; 95% CI 1.0 to 2.7), and from violent causes (SMR 2.5; 95% CI 1.2 to 4.6) compared with all women of the Finnish Twin Cohort. In analyses of migrant discordant pairs only first deaths from cardiovascular disease tended to be more common in the migrants than in non-migrant co-twins. CONCLUSIONS: Migrants from Finland to Sweden seem to have an overall mortality comparable to that prevailing in Finland suggesting no strong influence on mortality by the migration. Duration of stay seems to be associated with mortality in the migrants, at least in men, with a lower mortality after several years in Sweden.

Greenhouse gases in non-oxygenated and artificially oxygenated eutrophied lakes during winter stratification.

Concentrations of dissolved methane (CH4), carbon dioxide (CO2), and nitrous oxide (N2O) were measured in the water columns of non-oxygenated and artificially oxygenated, ice-covered eutrophied lakes in the mid-boreal zone in Finland during late winter 1997 and 1999. Sampling was conducted during winter stratification, the critical period for oxygen (O2) deficiency in seasonally ice-covered, thermally stratified lakes. Oxygen concentrations were maintained at least at a moderate level throughout the oxygenated water columns, whereas the non-oxygenated columns suffered anoxic hypolimnia. The mean concentrations of dissolved CH4 exceeding the atmospheric equilibrium were greater in the non-oxygenated water columns (20.6-154 microM) than in the oxygenated ones (0.01-1.41 microM). In contrast, the mean excess CO2 concentrations varied less between the non-oxygenated and oxygenated sites (0.28-0.47 and 0.25-0.31 mM, respectively). Oxygenated water columns had greater mean excess concentrations of N2O (0.018-0.032 microM) than the non-oxygenated ones (0.005-0.024 microM). If the accumulated greenhouse gas stores in the water columns during winter are assumed to be released to the atmosphere during the spring overturn, the global warming potentials (GWP, time horizon 100 yr) of these potential emissions at the non-oxygenated, eutrophic study sites ranged from 177 to 654 g CO2 equivalent (CO2-e) m-2 compared with 144 to 173 g CO2-e m-2 at the oxygenated sites. The increase in the accumulation of CH4 was the main reason for the higher GWP of the non-oxygenated sites. Anthropogenic eutrophication of lake ecosystems can generate increased CH4 emissions due to associated O2 depletion of their sediment and water column.

Managing international migration: past, present, and future trends and issues.

PIP: The author provides a brief overview of current international migration trends. Aspects considered include economic motives for migration, refugee migration, migration policies and human rights, and political factors. Comments by Jean-Yves Carlier are included (pp. 192-3).^ieng

Comparing European and North American international migration.

PIP: International migration is a vast, complex, and heterogeneous field of study. It requires not only knowledge about dynamic processes in the past and at present and in various regions of the world, but also interdisciplinary cooperation, not least in order to achieve a good theoretical development. Theories about international migration tend to be built on particular periods or regions. The test of these theories comes through comparative research. A comparison of North American and European immigration and immigration policy could examine 1) whether immigration is permanent or temporary, 2) the desire of Europeans for short-term immigration to allow the integration of the large numbers of immigrants from the recent past, 3) the differential development of welfare states, 4) the likely long-term outcome of large waves of immigration, and 5) the legal status of aliens.^ieng

Dual citizenship and political integration.

PIP: On the premise that representative government cannot properly function without the political participation of a large active segment of its constituents represented by permanent immigrants without citizenship, this article 1) reviews some attempts to resolve such an anomalous situation; 2) suggests naturalization as an instrument to correct it and describes the naturalization rate and the reasons for the low propensity for naturalization in various North European countries; 3) surveys the phenomenon of dual citizenship, the reasons for its increase as well as its increase as well as its inconveniences and advantages; and 4) hypothesizes that future increases in dual citizenship will protect political integration. Labor immigration will probably not be encouraged again, as it was some 20 years ago, but large international migration will take place both within Europe and to Europe from other continents. There are many indications that in the future many more Europeans will possess dual or multiple nationality, and this, in combination with more weight on a person's effective residence, will promote political integration of those large groups of immigrants and their descendants, who now stand outside the political systems without proper representation.^ieng