Developing Age-Friendly Cities: Case Studies From Brussels and Manchester and Implications for Policy and Practice

Developing environments responsive to the aspirations of older people has become a major concern for social and public policy. Policies and programs directed at achieving “age-friendly” communities are considered to require a wide range of interventions, including actions at the level of the social and physical environment. This article compares the age-friendly approaches of two European cities, Brussels and Manchester, with a particular focus on policies and initiatives that promote active aging in an urban context. The article examines, first, the demographic, social, and multicultural contexts of Brussels and Manchester; second, the way in which both cities became members of the World Health Organization Global Network of Age-Friendly Cities and Communities; third, similarities and differences in the age-friendly approaches and actions adopted by both cities; and fourth, opportunities and barriers to the implementation of age-friendly policies. The article concludes by discussing the key elements and resources needed to develop age-friendly cities.     

Supplemental home care and topping‐up: A shift from service universalism towards a new and privatised public service model?

How does a public service model based on service universalism react to the introduction of market principles of topping up? In a recent so‐called Free Municipality Scheme (an experimental scheme that allowed for greater operational autonomy locally in an effort to reduce state bureaucracy), a number of Danish municipalities were for the first time ever allowed to compete with for‐profit providers of home care in selling supplemental home care services paid entirely by the user. The take‐home message from this experience is that the introduction of supplemental home care entails challenges and eventually wider implications for the public service model, on an economic, organisational and cultural level. Supplemental services represent a new and potentially powerful combination of market and state logics that eventually redirects away from the universalist welfare state and towards a new and increasingly privatised public service model – a model where the service level is determined by the user's capacity to purchase and pay for services. The introduction of such services therefore implies a change of the potential of the Nordic welfare state to ensure equal access regardless of class and income.     

A Scoping Review of Challenges in Adult Intimate Relationships After Childhood Sexual Abuse

Childhood sexual abuse is a severe problem worldwide. Childhood sexual abuse can be detrimental to children and their abilities to cope with and communicate in their subsequent adult intimate relationships. The aim of this review was to generate and summarize knowledge about how childhood sexual abuse manifests in adult intimate relationships so healthcare professionals can incorporate this knowledge into treatment and care. A scoping review methodology was selected because it supports examination of the extent, range, and nature of research activity. A content analysis of the studies included in this review led to three thematic categories of challenges in adult intimate relationships after childhood sexual abuse: (a) relationship satisfaction, (b) sexual satisfaction, and (c) communication and trust.     

Helping families when child sexual abuse is suspected but not proven

This paper reports from a project investigating reactions within families when intra‐familial child sexual abuse was suspected, and family members’ responses to a therapeutic approach. Data were obtained from therapeutic sessions and follow‐up interviews with mothers, children and alleged perpetrators. Before treatment the mothers felt uncertain as to how to interpret the children’s unclear signs. The children had severe symptoms, but had seldom disclosed abuse. The alleged perpetrators were often not informed about the suspicions. The families were in a state of crisis and shock, and communication within the family was characterized by uncertainty about what to talk about and whether the suspicions should be shared. In most cases after treatment the conflicts had been reduced, the children had few symptoms, supervised contact had been established, and the clients were satisfied with the treatment. One conclusion is that therapeutic sessions, where family members share information about concerns and take part in the decisions of how to protect children, seem relevant and helpful to the clients in unclear abuse cases.     

Breakdown of care: the case of Danish teenage placements

This article analyses the breakdown of teenage placements in Denmark from survey data on 227 teenagers placed in care during 2004. We explore frequencies of breakdown, time of breakdown occurrence and factors possibly causing breakdown. These are factors related to (i) the teenager, (ii) the parents, (iii) the care environment and (iv) the casework process. Results show that 26 per cent of the teenagers in the study experienced placement breakdown. Thirty per cent of these breakdowns occurred within the first 4 months of placement. A factor significantly increasing probability of breakdown was emotional problems of the teenager. A factor significantly reducing placement breakdown was the teenager having continuity with the same caseworker throughout the placement. System- and policy-related factors also proved to have an influence on breakdown rates. We discuss possible policy implications of these findings.     

Kernel density estimation for heavy-tailed distributions using the champernowne transformation

When estimating loss distributions in insurance, large and small losses are usually split because it is difficult to find a simple parametric model that fits all claim sizes. This approach involves determining the threshold level between large and small losses. In this article, a unified approach to the estimation of loss distributions is presented. We propose an estimator obtained by transforming the data set with a modification of the Champernowne cdf and then estimating the density of the transformed data by use of the classical kernel density estimator. We investigate the asymptotic bias and variance of the proposed estimator. In a simulation study, the proposed method shows a good performance. We also present two applications dealing with claims costs in insurance.     

Machine Learning Methods as a Tool for Predicting Risk of Illness Applying Next‐Generation Sequencing Data

Next‐generation sequencing (NGS) data present an untapped potential to improve microbial risk assessment (MRA) through increased specificity and redefinition of the hazard. Most of the MRA models do not account for differences in survivability and virulence among strains. The potential of machine learning algorithms for predicting the risk/health burden at the population level while inputting large and complex NGS data was explored with Listeria monocytogenes as a case study. Listeria data consisted of a percentage similarity matrix from genome assemblies of 38 and 207 strains of clinical and food origin, respectively. Basic Local Alignment (BLAST) was used to align the assemblies against a database of 136 virulence and stress resistance genes. The outcome variable was frequency of illness, which is the percentage of reported cases associated with each strain. These frequency data were discretized into seven ordinal outcome categories and used for supervised machine learning and model selection from five ensemble algorithms. There was no significant difference in accuracy between the models, and support vector machine with linear kernel was chosen for further inference (accuracy of 89% [95% CI: 68%, 97%]). The virulence genes FAM002725, FAM002728, FAM002729, InlF, InlJ, Inlk, IisY, IisD, IisX, IisH, IisB, lmo2026, and FAM003296 were important predictors of higher frequency of illness. InlF was uniquely truncated in the sequence type 121 strains. Most important risk predictor genes occurred at highest prevalence among strains from ready‐to‐eat, dairy, and composite foods. We foresee that the findings and approaches described offer the potential for rethinking the current approaches in MRA.     

Integrated Approaches for the Public Health Prioritization of Foodborne and Zoonotic Pathogens

To address the persistent problems of foodborne and zoonotic disease, public health officials worldwide face difficult choices about how to best allocate limited resources and target interventions to reduce morbidity and mortality. Data‐driven approaches to informing these decisions have been developed in a number of countries. Integrated comparative frameworks generally share three methodological components: estimating incidence of acute illnesses, chronic sequelae, and mortality; attributing pathogen‐specific illnesses to foods; and calculating integrated measures of disease burden such as cost of illness, willingness to pay, and health‐adjusted life years (HALYs). To discuss the similarities and differences in these approaches, to seek consensus on principles, and to improve international collaboration, the E.U. MED‐VET‐NET and the U.S.‐based Food Safety Research Consortium organized an international conference convened in Berlin, Germany, on July 19–21, 2006. This article draws in part on the deliberations of the conference and discusses general principles, data needs, methodological issues and challenges, and future research needs pertinent to objective data‐driven analyses and their potential use for priority setting of foodborne and zoonotic pathogens in public health policy.     

‘I didn’t think I would be emotional until I started saying the oath’ – emotionalising and ritualising citizenship

ABSTRACT

The quote in the title from a newly naturalised citizen emphasises that taking an oath and affirming one’s loyalty to a new country can be experienced as a surprisingly emotional matter. But how does the ritual transformation of migrant identities turn into an emotional experience? This paper explores primarily the emotional dimension of naturalisation rituals and the distributed agency involved in two concrete cases from Australia and Denmark. Although practical reasons may be considered to be the most important motivating factor when it comes to applying for citizenship, these are often mixed with a more identity-based perception of citizenship as a symbol of affiliation with the new society. And citizenship ceremonies become one of the occasions in which the symbolic and emotional dimensions of citizenship are enacted. Thus, the introduction of ceremonies in an increasing number of countries may be considered a step towards the emotionalisation of citizenship, in order to ensure cohesion, unity, and a sense of belonging, since the emotional significance of citizenship is considered to be a guarantee for loyalty and the desired civil awareness.