Search

Moderne Gesellschaften unterliegen Globalisierungsprozessen, die sich sowohl in hohen Wanderungsraten als auch in der demographischen Alterung der Bevölkerung ausdrücken. Bis jetzt nehmen ältere Menschen weniger an den Migrationsbewegungen teil als jüngere Altersgruppen. Dennoch haben Senioren in den Vereinigten Staaten wesentlichen Anteil an den Nord-Süd-gerichteten Wanderungsströmen in attraktive Regionen Floridas, Kaliforniens oder Arizonas, wo viele von ihnen in eigens entwickelte "retirement" oder "adult communities" ziehen. Diese privaten und abgeschlossenen Siedlungen werden mehr oder weniger selbstverwaltet und können ausschließlich von Interessenten mit einem Mindestalter erworben und bezogen werden, die von einer gemeinsamen Infrastruktur – wie Sicherheitsdiensten und Freizeiteinrichtungen – profitieren. In Europa war die Ruhesitzwanderung lange Jahre nur ein nationales Phänomen. Erst seit einiger Zeit wählen Senioren auch ausländische Zielgebiete – insbesondere im Mittelmeerraum – als Alterswohnsitze. Mit dem Beispiel der älteren Deutschen, die auf Mallorca eine längere Zeit im Jahr leben, kann ein detailliertes Bild ihrer soziodemographischen Merkmale, ihrer Wanderungsmotive und ihres Lebens vor Ort gezeichnet werden. Dabei zeigen sich deutliche Unterschiede in Abhängigkeit von der gewählten Wohn- und Siedlungslage. Es lassen sich im Wesentlichen drei bevorzugte Siedlungstypen abgrenzen: erstens touristisch geprägte Küstenorte, zweitens einheitlich geplante Urbanisationen sowie drittens Fincas und Siedlungen im ländlichen Raum. Von diesen weisen nur Urbanisationen, in denen etwa ein Drittel der älteren Deutschen leben, Ähnlichkeiten mit Ruhestandsgemeinden in den USA auf: Sie sind großteils abgeschlossen und privat verwaltet, und es wird eine Vielzahl von Freizeitaktivitäten angeboten. Allerdings spielen weder Alterskriterien eine Rolle beim Erwerb der Immobilien, noch weisen die Urbanisationen wesentliche Merkmale einer Selbstverwaltung auf. Gegen eine, Globalisation processes in modern societies are marked by both high migration rates and demographic ageing. Until now, the elderly population participates less in migration than younger age groups. Nevertheless, seniors in the United States have established substantial north-south flows to attractive regions in Florida, California or Arizona. Some choose "retirement" or "adult communities" as their new homes. These private and "gated" settlements are more or less self-administered and exclusively addressed to a population of a minimum age, who - as owner-occupiers - benefit from a common infrastructure, such as security services and recreational amenities. In Europe, retirement migration used to be solely a national phenomenon, but recently an increasing number of elderly migrants cross national borders, most often towards the Mediterranean. The example of elderly Germans living on Mallorca gives a detailed picture of their heterogeneity. The preferred homes are in three settlements types, each with a characteristic set of inhabitants: coastal tourism resorts, planned urbanisations, and rural settlements. Of these, only the urbanisations have clear similarities to retirement communities in the USA, in that they are "gated communities", privately managed and offer a variety of amenity facilities. Nevertheless, they do not operate age-restrictions on purchase or residence nor substantial elements of self-governance. Moreover, the European ideal that seeks to integrate elderly people into society and to reduce their spatial separation contradict the age-specific and social segregation of American retirement communities.

B cells have only recently begun to attract attention in the immunopathology of multiple sclerosis (MS). Suitable markers for the prediction of treatment success with immunomodulatory drugs are still missing. Here we evaluated the B cell response to brain antigens in n = 34 relapsing-remitting MS (RRMS) patients treated with glatiramer acetate (GA) using the enzyme-linked immunospot technique (ELISPOT). Our data demonstrate that patients can be subdivided into responders that show brain-specific B cell reactivity in the blood and patients without this reactivity. Only in patients that classified as B cell responders, there was a significant positive correlation between treatment duration and the time since last relapse in our study. This correlation was GA-specific because it was absent in a control group that consisted of interferon-beta (IFN-beta)-treated RRMS patients (n = 23). These data suggest that GA has an effect on brain-reactive B cells in a subset of patients and that only this subset benefits from treatment. The detection of brain-reactive B cells is likely to be a suitable tool to identify drug responders.

Background: The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. Objective: The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. Methods: The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. Results: Unmet needs were identified in the main categories support of family and friends,'' health care services,'' managing everyday life,'' and maintaining biographical continuity.'' Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. Conclusions: To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support.

B cells are increasingly coming into play in the pathogenesis of multiple sclerosis (MS). Here, we screened peripheral blood mononuclear cells (PBMC) from patients with clinically isolated syndrome (CIS), MS, other non-inflammatory neurological, inflammatory neurological or autoimmune diseases, and healthy donors for their B cell reactivity to CNS antigen using the enzyme-linked immunospot technique (ELISPOT) after 96 h of polyclonal stimulation. Our data show that nine of 15 patients with CIS (60.0%) and 53 of 67 patients with definite MS (79.1%) displayed CNS-reactive B cells, compared to none of the control donors. The presence of CNS-reactive B cells in the blood of the majority of patients with MS or at risk to develop MS along with their absence in control subjects suggests that they might be indicative of a B cell-dependent subpopulation of the disease. (C) 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license