Incremento y diversidad de las personas mayores emigrantes en Europa / Increase and diversity of elderly immigrants in Europe

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Social and health factors influencing poor nutritional status among rural elderly Malays.

BACKGROUND: Older people especially those residing in rural areas are at a greater risk of malnutrition. OBJECTIVE: To assess nutritional status and social and health factors influencing poor nutritional status among rural elderly Malays. DESIGN AND METHODS: Cross-sectional study on 350 elderly Malays, aged 60 years and above selected from 11 traditional villages in a rural area of Malaysia. Nutritional status was assessed using anthropometric measurements such as body weight, height, demispan and mid-upper arm circumference (MUAC). A questionnaire was administered to obtain information on social and health aspects. Multiple regression analysis was used to determine social and health predictors of poor nutritional status as assessed by Body Mass Index (BMI) and mid-upper arm circumference (MUAC). RESULTS: In this sample, 38% of the subjects were underweight according to BMI < 18.5 kg/m2, particularly women. Women were also found to be four and three times more likely to be peripherally wasted, as assessed respectively by MUAC (p<0.05), and by corrected arm muscle area (p<0.005). It was found that 12% of subjects were overweight, the majority of whom were women. The predictors of BMI were unable to cook, reported insufficient money to buy food, smokers and perceived weight loss. The predictors of MUAC were: unable to cook, single, reported insufficient money to buy food, smokers, loss of appetite, depended on others for main economic resources, and perceived weight loss. CONCLUSION: The nutritional status of the elderly is rather unsatisfactory. Recognition of social and health factors associated with the poor nutritional status will allow appropriate intervention to enhance the quality of life of the elderly.

Primary health care services for single homeless people: defects and opportunities.

BACKGROUND: An innovative residential centre in west London during 1997-1998 helped older rough sleepers leave the streets and resettle in conventional homes. Many clients presented with multiple physical illnesses complicated by chronicity and poor management. The centre initially experienced difficulties in obtaining health care for the residents, briefly relied on an A&E department for treatment of serious and minor ailments, and latterly was served by a GP practice supported by special funding. OBJECTIVE: The aims of this study were to describe the problems of providing at short notice primary health care services to a high-need group, and the prospective opportunities for the delivery of the required care. METHOD: A monitoring study collected routine operational data, life histories from 88 residents using a semi-structured questionnaire and information from 61 residents about their contacts with GPs before residence in the centre. Interviews were also conducted with the centre's staff, a Health Authority officer and a GP who treated the residents. RESULTS: The medical care of the residents was a major concern. Many had physical illnesses yet three-fifths had not seen a GP for more than 5 years. Many were not registered, even among those who recently had become homeless. It was difficult to organize the residents' medical care and to access special funding at short notice. When funding was secured, there were difficulties in contracting the service. CONCLUSION: Current registration and commissioning procedures are ill fitted to provide primary care services to a high-needs group at short notice. Primary Care Groups, special funding and contractual arrangements provide opportunities for GPs and primary health care workers to provide an improved service to marginalized and special needs groups. The responsibility to identify and respond to exceptional needs should be clearly defined and allocated.

The responsibility to care for single homeless people.

This paper examines the reasons why in contemporary Britain many single homeless people with severe physical and mental health problems and welfare needs do not receive the treatment, care and financial support that they manifestly need, and in particular considers the interaction between their personal characteristics and the organisation and the obligations of services. Homelessness is a complex concept associated with problems of housing, health, social care and income. The greatest weaknesses of the service system are that no single agency has a statutory responsibility to ensure that vulnerable homeless people are served, and none of the generalist welfare agencies have a duty to seek out those who do not present. As a result, single homeless people fall between the housing, health and social services and amass exceptional unmet needs. The paper appraises the approaches to single homeless people's problems that have recently been introduced by the Rough Sleepers' Unit (RSU), and discusses the ways in which current reforms of the welfare services may impact on the situation of homeless people. With the possibility that the RSU's prime responsibility for commissioning single homeless people's services will transfer to local authorities in 2002, the paper concludes by specifying the implications for voluntary and statutory providers and makes recommendations about the attribution of the responsibility to care for this vulnerable group.

The achievements of a multiservice project for older homeless people.

This report of the achievements of an experimental multiservice center in London for older street people begins with reviews of the types of long-term accommodation available for resettlement and the work of its outreach team, 24-hour open access rooms, and residential, assessment, and resettlement services. Two outcomes are examined: whether users returned to the streets and whether they were resettled in long-term housing. Those with alcohol dependency were most difficult to resettle. Logistic regression analyses of the factors influencing the two outcomes indicate that the duration of residence in the center was the the predominant influence.

UK and western European late-age mortality: trends in cause-specific death rates, 1960-1990.

Age, sex and cause-specific death rates for the elderly population of 16 western European countries are examined for 1960, 1970, 1980 and 1990. Over the 30 years, the all-cause rates have fallen by around 23-41% depending on age and sex. Mortality from stroke has declined substantially and from cardiovascular disorders has recently fallen, but cancer health rates have increased among men. A comparison of the UK death rates with the west European and Swiss rates finds relative improvement in the UK for male mortality, but that female mortality at the younger ages has worsened sharply. Cardiovascular and stroke mortality is now exceptionally high in the UK among females aged 60-64 years and the 1980s trends for the 60-64 and 70-74 years age groups were unfavourable for several other causes of death.

Activation of microtubule-associated protein kinase (Erk) and p70 S6 kinase by D2 dopamine receptors.

The ability of human and rat D2(short) and D2(long) dopamine receptors to activate microtubule-associated protein (MAP) kinase (Erk1/2) and p70 S6 kinase has been investigated in recombinant cells expressing these receptors. In cells expressing the D2(short) receptor, dopamine activated both enzymes in a transient manner but with very different time courses, with activation of Erk being much quicker. Activation of both enzymes by dopamine was dose-dependent and could be prevented by a range of selective dopamine antagonists. Excellent correlations were observed between the potencies of the antagonists for blocking enzyme activation and their affinities for the D2 dopamine receptor. Activation of Erk and of p70 S6 kinase via the D2 dopamine receptors was prevented by pretreatment of the cells with pertussis toxin, indicating the involvement of G proteins of the Gi or Go family. Inhibitors of phosphatidylinositol 3-kinase (PI 3-kinase) were found to block substantially, but not completely, activation of p70 S6 kinase by dopamine, suggesting the involvement of PI 3-kinase-dependent and -independent signalling pathways in its control by dopamine. p70 S6 kinase activation was completely blocked by rapamycin. In the case of Erk, activation was partially blocked by wortmannin or LY294002, indicating a possible link with PI 3-kinase.

Oral or parenteral administration of replication-deficient adenoviruses expressing the measles virus haemagglutinin and fusion proteins: protective immune responses in rodents.

The genes encoding the measles virus (MV) haemagglutinin (H) and fusion (F) proteins were placed under the control of the human cytomegalovirus immediate early promoter in a replication-deficient adenovirus vector. Immunofluorescence and radioimmune precipitation demonstrated the synthesis of each protein and biological activity was confirmed by the detection of haemadsorption and fusion activities in infected cells. Oral as well as parenteral administration of the H-expressing recombinant adenovirus elicited a significant protective response in mice challenged with MV. While the F-expressing adenovirus failed to protect mice, cotton rats immunized with either the H- or F-expressing recombinant showed reduced MV replication in the lungs. Antibodies elicited in mice following immunization with either recombinant had no in vitro neutralizing activity, suggesting a protective mechanism involving a cell-mediated immune response. This study demonstrates the feasibility of using oral administration of adenovirus recombinants to induce protective responses to heterologous proteins.

Use of recombinant antigens as diagnostic reagents in enzyme-linked immunosorbent assays.

The introduction of genetic engineering techniques has allowed the controlled and efficient production of recombinant proteins. This presents scientists with the opportunity to use a wide range of proteins for a number purposes, previously unavailable because of problems relating to expression, purification, or stabihty when considering the use of native proteins.

British retirees in Malta: components of the cross-national relationship.

"The paper focuses on three aspects of the retirement of British citizens to Malta and Gozo: the evolution of the British settlement, four pathways to the islands, and the formation of the current demographic and household characteristics.... The immigration of British retirees to Malta has fluctuated in volume and character over the last 35 years, partly in response to changes in Maltese fiscal and residence policies, and partly reflecting the changing demand for overseas retirement settlement in the UK. The substantial contribution of intercommunal married couples to the British retired resident population and the buoyancy of both tourist visits and new arrivals suggests that its size will at least be stable or will grow slowly for many decades to come."

International retirement migration in Europe.

"This paper presents a review and prospectus of international retirement migration (IRM), dealing mainly with European evidence but also referring to some analogous trends in North America. The paper is in three main parts. It first makes the case for regarding IRM as a significant aspect of population geography and of migration studies; in certain areas of Mediterranean Europe, IRM also has effects on regional economic geography. The second section of the paper discusses some of the early findings from a comparative study of British elderly residents in Tuscany, Malta, the Costa del Sol and the Algarve.... The final part of the article offers further reflections on why IRM is important--for the individual migrants themselves, for the host communities, and for public policy."

Population predictors of community health and social service use in Northern Ireland.

STUDY OBJECTIVE: To investigate the characteristics of elderly populations associated with variations in their use of community health and personal social services and to test the hypotheses that the variations are related to: (a) the age structure of an elderly population; (b) the population's socioeconomic composition, including the level of deprivation; and (c) household or living arrangements. DESIGN: A common file of 1991 population census and 1994 NHS community trust operational variables was constructed for 67 postcode sectors, with the independent variables describing the age-sex groups to be studied. Clear criteria for the exclusion of "empty" sectors were developed. Relationships using bivariate and multivariate correlation and stepwise multiple regression were explored. SETTING: Eastern Health and Social Services Board area, Northern Ireland (Belfast and hinterland). PARTICIPANTS: Population of statutory pensionable age; in aggregate, younger and older age bands. MAIN RESULTS: The age structure or mean age of the elderly population had only a weak association with the community health and social service client rate, but there were strong associations with socio-economic variables, particularly the percentage of those living alone who were without a car and the percentage of pensioner households that included an adult of below pensionable age. Parsimonious multiple regression models accounted for between 46% and 80% of the variation in the NHS community trust client rate. Greater explanations were achieved for the young elderly population than for those aged 75+ years and, when the population was divided between young and old age bands, for men than for women. CONCLUSIONS: Community health and social services for elderly people in eastern Northern Ireland were focused on those with a low income and those who were not co-resident with adults of working age. When local elderly populations are compared, per capita morbidity and dependency are often higher where the mean age is low, and vice versa, because of the inverse relationship between socioeconomic status and survival in old age. Capitation scales for resource allocation with positive age weighting will be of little use if no account is taken of the relative prevalence of need in the youngest or base age group.

Immunization of mice with plasmid DNA expressing the measles virus nucleoprotein gene.

The measles virus (MV) nucleocapsid (N) protein gene has been inserted into a plasmid vector so as to place the gene under the control of the strong constitutive human cytomegalovirus major immediate early promoter. On intramuscular injection of pMV64 DNA into C3H/He mice, seroconversion with increasing titers of N-specific serum IgG antibodies was observed over a period of 3 months. However, when 3-week-old mice were immunized by intramuscular injection of pMV64 in a two-dose schedule, and challenged intracranially with a rodent-adapted measles virus strain (CAM/RB) at 5 weeks of age, no significant protective response was seen. The lack of effective protection evoked by DNA immunization in this model, where MV challenge must take place before 8 weeks of age, may be due to inefficient induction of cell-mediated immunity resulting from expression in muscle tissue, compounded by a relatively slow rise in immune response compared with that seen with the recombinant adenovirus.

Live viral vectors : construction of a replication-deficient recombinant adenovirus.

Since the use of molecular biology and genetic engineering techniques has become widespread, a new generation of candidate vaccines has been developed, including live viral vectors (1, 2). The basis of using recombinant viruses as potential vaccines involves the incorporation of specific genes from a pathogenic organism into the genome of a nonpathogenic or attenuated virus. The recombinant virus can then infect specific eukaryotic cells either in vivo or in vitro, and cause them to express the recombinant protein. In our laboratory, successful results have been obtained using replication-deficient recombinant adenoviruses as immunizing agents for tick-borne encephalitis virus NSl protein (3) and measles virus nucleoprotein (4), both of which elicit a protective immune response.

Housing aspirations and migration in later life: developments during the 1980s.

"This paper tests hypotheses concerning the differentiation of early and late old age in the United Kingdom with reference to housing preferences and requirements and their translation into migration. Evidence is drawn from the 1991...census and from a representative sample of elderly people in SE England. The sources demonstrate the continued elaboration of long-distance, metropolitan-decentralizing migrations around the age of retirement. Also shown are relatively high rates of residential mobility among people in their seventies and eighties. Most of their migrations are short distance, but nonetheless with a net redistributional effect that sustains urban decentralization at the oldest ages. There is no evidence of significant return migration to London at advanced ages. From the survey responses, distinctive housing dissatisfactions are identified in early and late retirement, but neither set exactly matches expressed motivations for moves."

Expression of the measles virus nucleoprotein gene in Escherichia coli and assembly of nucleocapsid-like structures.

To investigate the use of fusion systems to aid the purification of recombinant proteins for structure/function studies and potential uses as diagnostic reagents, the measles virus (MV) gene encoding the nucleoprotein was cloned and expressed in Escherichia coli in three forms: as a full-length intact protein and as two fusion proteins. Expression of the intact N gene under the control of the tac promoter in the pTrc99c plasmid produced a protein of the correct size (60 kDa) which represented approx. 4% of the total cellular protein, and was recognised by known measles positive human sera. 'Herringbone' structures characteristic of paramyxovirus nucleocapsids (NuC) were identified in fractured cells examined by electron microscopy. The production of NuC-like structures in a prokaryotic cell indicates folding of the nucleoprotein can occur in the absence of MV genomic RNA, other MV-encoded gene products and eukaryotic cell proteins or RNA, to produce structures which are morphologically and antigenically similar to those seen in virus-infected cells. Conversely, synthesis of N protein as a fusion protein with either E. coli beta-galactosidase or the E. coli maltose-binding protein resulted in the production of fused proteins which could not be assembled into NuC-like structures or readily used as diagnostic reagents. However, the ability of MV N protein to form NuC-like structures in E. coli will facilitate structure/function and mutational analysis of the NuC protein.

Production of measles nucleoprotein in different expression systems and its use as a diagnostic reagent.

Measles nucleoprotein has been successfully expressed in three different hosts, bacterial (Escherichia coli BL21 DE3), insect (Spodoptera frugiperda; Sf9) and mammalian (primary human fibroblasts) cells, each producing an antigenic protein of M(r) 60 kDa. The nucleoprotein produced in all three hosts was used in an ELISA for the detection of antibodies to measles virus in a cohort of haemagglutinin-positive or -negative human sera. Data produced from baculovirus and adenovirus-based antigens indicated that there was good correlation between the ELISA results and previous haemagglutination inhibition test data, and there was little background interference by cellular proteins or the development of false positive or negative results. The assay was rapid as it could be carried out in under 4 h, sensitive as the sera could be diluted by at least 1000-fold, and versatile as both IgG and IgM could be detected and differentiated.

Measles virus nucleocapsid protein expressed in insect cells assembles into nucleocapsid-like structures.

The gene encoding the major nucleocapsid, N, protein of measles virus has been inserted into a baculovirus vector under the control of the polyhedrin promoter. Insect cells infected with this recombinant baculovirus synthesize high levels of measles N protein, up to 40% of total soluble cell protein. The recombinant protein is recognized by sera from convalescent patients, vaccinees and patients with subacute sclerosing panencephalitis and thus could form the basis of a simple diagnostic assay. Nucleocapsid-like structures, similar to those found in mammalian cells infected with measles virus, can be observed in both the nucleus and cytoplasm of the infected insect cells. These have many structural features in common with nucleocapsids found in measles virus-infected cells, but are longer (up to 2 microns) and have a lower buoyant density. Measles N protein thus appears to be capable of assembling into nucleocapsid-like structures in the absence of measles virion RNA or other viral proteins.

The membrane binding C-terminus of protein A from Staphylococcus aureus affects its cellular localization and causes structural deformation when expressed in Escherichia coli.

Protein A from Staphylococcus aureus is a powerful diagnostic reagent and has several uses in human disease therapy. Expression in non-pathogenic Escherichia coli containing recombinant plasmids coding for this protein has increased its availability, but can reduce the stability of the plasmid-bearing host. By employing immune electron microscopy, we have determined that E. coli containing stable plasmids coding for a truncated version of protein A, without the membrane binding site, secrete this protein through the cytoplasmic membrane and into the periplasmic space, where it accumulates. E. coli containing unstable plasmids, however, which code for the complete protein including the membrane-binding site, target the protein into the cytoplasmic membrane. This accumulation of protein A in the E. coli cytoplasmic membrane inhibits the formation of septa between dividing cells and results in aberrant elongated, multi-chromosomal forms.

Expression of recombinant protein A from the lac promoter in Escherichia coli JM83 is not subject to catabolite repression when grown under specific conditions of continuous culture.

Although widely used in experimental and industrial situations, genetically engineered plasmids containing the lac promoter from Escherichia coli are subject to catabolite repression when grown in glucose-containing media. Several methods of overcoming this problem have been investigated by studying the expression of the protein A gene from Staphylococcus aureus under the control of the Escherichia coli lac promoter. When glycerol is used as a sole carbon source, the plasmid is unstable and is rapidly lost from the culture. When the bacteria are grown in chemostats under glucose limitation, the plasmid is maintained, even at high dilution rates, and the expression of protein A is similar to that observed when glycerol was used. The balance between metabolic load and protein A expression seems to be maintained by reducing the gene dose to a tolerable level. Depending on the metabolic conditions prevailing in the culture, this is achieved, either by reducing the copy number of the plasmid or in extreme cases by removing the plasmid altogether.