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Early life influences on life-long patterns of behavior and health.

The stability of a child's early life has profound effects on physical and mental health, and unstable parent-child relationships, as well as abuse, can lead to behavioral disorders and increased mortality and morbidity from a wide variety of common diseases later in life. One common consequence, namely, depressive illness, is associated with chemical imbalances in the brain and hormonal dysregulation, constituting a form of allostatic load that alters interpretations of stimuli and influences, behavioral, and hormonal responses to potentially stressful situations. The brain not only encodes information and controls the behavioral responses but it is also changed structurally by those experiences. Structural changes in the hippocampus and amygdala, which are important brain structures for cognition and emotion, are representative of what may be occurring throughout the brain as a result of allostatic load resulting from the chronic stress of a disorder such as depression. Such structural changes include dendritic debranching and hypertrophy, cell proliferation, and synaptic remodeling; they are produced by the combined overactivity of stress hormones and endogenous neurotransmitters. These mediators are normally involved in adaptation, but can also promote damage when they are dysregulated and over-active. They are very likely to be strongly biased by early life experiences. The findings from animal models thus provide a basis for understanding potential mechanisms of environmental and developmental determinants of individual differences in human stress reactivity, as well as anxiety, depression, and a host of related systemic disorders. There is an increasing amount of translational research that is beginning to tie the basic research to clinical outcomes of individuals exposed to abusive or inconsistent care-giving in early life. A major goal of studies on this important topic is to define times in development and strategies for intervening to prevent or reverse the effects of adverse early life experiences. Although prevention is clearly the preferable route, some degree of reversal of psychopathology and pathophysiology caused by early life adversity appears to be an achievable goal.

Amygdala↗

The use of drugs with a life-shortening effect in end-of-life care in neonates and infants.

OBJECTIVE: The purpose was to describe the use of drugs with a possible or certain life-shortening effect in end-of-life care in infants and to evaluate the possibly lethal effect. DESIGN: For 292/298 deaths of live born infants (<1 year), in a 1-year period (between 1 August 1999 and 31 July 2000) in Flanders, Belgium, the attending physician could be identified and was sent an anonymous questionnaire. The questionnaires relating to deaths directly preceded by the administration of drugs were reviewed by a multi-disciplinary panel. RESULTS: The response rate was 86.6% (253/292). In 57 cases (22.5%), drugs were administered directly before death. In 17/57 cases, the physician explicitly intended to hasten death. In 16/17 cases information about the drug(s) was available: opioids were administered in 14, a muscle relaxant in 5 and potassium chloride in 3 cases. In 13 cases where the lethal effect could be evaluated, the panel judged that the drugs were effective in hastening death in 10 cases. In most cases the estimated life-shortening was <24 h. In 40/57 cases the physician administered drugs to alleviate pain and/or symptoms, taking into account a possible life-shortening effect without explicitly intending it. Opioids were administered in all 30 cases where information about the drug(s) was supplied. In 13 cases the lethal effect could be evaluated, and in 6 cases the panel judged that the drugs had hastened death. CONCLUSIONS: When life-shortening was explicitly intended, (dosages of) drugs were likely to be lethal. Drugs administered also clearly hastened death in some cases where life-shortening was not explicitly intended.

Analgesics, Opioid↗

Growth rate and life span in Drosophila. II. A biphasic relationship between growth rate and life span.

The relationship between growth rate and life span was studied in Drosophila by varying the amount of yeast available to each developing larva at constant temperature, 25 degrees C. With one approach the larvae developed in a standard medium at constant larval density and a varying amount of yeast added on the medium. Across the entire growth rate range covered in this way (10-100 micrograms/day, male flies) imaginal life span depended on growth rate in a biphasic way, the relationship having a parabolic form with a maximum at about 55 to 60 micrograms/day. Similar covariation of growth rate and life span was obtained by varying larval density at a constant amount of added yeast. With both these approaches growth rate variation was due to opposite variations of both components of growth rate, i.e. duration of development and body size. However, development in a medium without nutrients but with a varying amount of added yeast at constant larval density led to a similar biphasic relationship between growth rate and life span although duration of development did not vary. Therefore, the present results are not compatible with the hypothesis that there is a single causal negative relationship between growth rate and life span and demonstrate that duration of development is not a causative factor of the biphasic relationship between growth rate and life span established here.

Animals↗

The 'ABC for life' programme - teaching basic life support in schools.

BACKGROUND: Less than 1% of the general public know how to assess or manage someone who has collapsed. It has been estimated that if 15-20% of the population were capable of performing cardiopulmonary resuscitation (CPR), mortality of out of hospital cardiac arrest could be decreased significantly. Training basic life support (BLS) skills to school children would be the most cost effective way of achieving this goal and ensuring that a large proportion of the population acquire basic life saving skills. AIMS: To assess retention of knowledge of basic life support 6 months after a single course of instruction in cardiopulmonary resuscitation designed specifically for school children. SETTING: School pupils in a rural location in one region of the United Kingdom. METHODS: A course of instruction in cardiopulmonary resuscitation - the 'ABC for life' programme - specifically designed to teach 10-12-year-old school children basic life support skills. The training session was given to school pupils in a rural location in Northern Ireland. A 22 point questionnaire was used to assess acquisition and retention of basic life support knowledge. RESULTS: Children instructed in cardiopulmonary resuscitation showed a highly significant increase in level of knowledge following the training session. While their level of knowledge decreased over a period of 6 months it remained significantly higher than that of a comparable group of children who had never been trained. CONCLUSION: A training programme designed and taught as part of the school curriculum would have a significant impact on public health.

Cardiopulmonary Resuscitation↗

Life review therapy as an intervention to manage depression and enhance life satisfaction in individuals with right hemisphere cerebral vascular accidents.

This pilot study sought to determine if the use of Life Review Therapy would result in lower levels of depression and higher degrees of life satisfaction in individuals with right hemisphere cerebral vascular accidents (CVAs). Fourteen subjects in a southern rehabilitation center were randomly assigned to either an experimental or control group. The experimental group received three one-hour sessions of Life Review Therapy and the control group viewed three one-hour sessions of neutral video with a follow-up discussion. Following the third session of each group, subjects were administered the Zung Scale for Depression and the Life Satisfaction Index--Form Z. A one-way ANOVA revealed a significantly lower level of depression (p <.01) and a significantly higher degree of life satisfaction (p <.01) in the Life Review Therapy group.

Aged↗

Meaning and purpose in life and well-being: a life-span perspective.

Three hundred men and women at five developmental stages from young adulthood to the old-old completed measures of life attitudes and well-being. Significant age differences were found on five life attitude dimensions: Life Purpose (LP), Death Acceptance (DA), Goal Seeking (GS), Future Meaning (FM), and Existential Vacuum (EV). LP and DA increased with age; GS and FM decreased with age; EV showed a curvilinear relationship with age. Significant sex differences were found for Life Control (LC) and Will To Meaning (WM). Women viewed life as more under their control and expressed a stronger will to find meaning as compared with males. FM, LP, and LC were found to predict psychological and physical well-being; EV, GS, and DA predicted psychological and physical discomfort. Preliminary findings attest to the importance of various life attitudes in promoting health and wellness.

Adult↗

Longevity and metabolism in Drosophila melanogaster: genetic correlations between life span and age-specific metabolic rate in populations artificially selected for long life.

We measured age-specific metabolic rates in 2861 individual Drosophila melanogaster adult males to determine how genetic variation in metabolism is related to life span. Using recombinant inbred (RI) lines derived from populations artificially selected for long life, resting metabolic rates were measured at 5, 16, 29, and 47 days posteclosion, while life spans were measured in the same genotypes in mixed-sex population cages and in single-sex vials. We observed much heritable variation between lines in age-specific metabolic rates, evidence for genotype x age interaction, and moderate to large heritabilities at all ages except the youngest. Four traits exhibit evidence of coordinate genetic control: day 16 and day 29 metabolic rates, life span in population cages, and life span in vials. Quantitative trait loci (QTL) for those traits map to the same locations on three major chromosomes, and additive genetic effects are all positively correlated. In contrast, metabolic rates at the youngest and oldest ages are unrelated to metabolic rates at other ages and to survival. We suggest that artificial selection for long life via delayed reproduction also selects for increased metabolism at intermediate ages. Contrary to predictions of the "rate of living" theory, we find no evidence that metabolic rate varies inversely with survival, at the level of either line means or additive effects of QTL.

Aging↗

Think positively and feel positively: optimism and life satisfaction in late life.

This study developed a dispositional path model of life satisfaction for community dwelling Chinese elderly living in Hong Kong. A sample of 117 elderly completed scales measuring life satisfaction, optimism, self-esteem, relationship harmony, self-construals, and perceived/expected health and financial status. Modeling revealed that life satisfaction was predicted by self-esteem and relationship harmony, which in turn were predicted by independent and interdependent self-construals, respectively. In addition, optimism predicted life satisfaction directly and indirectly through self-esteem and relationship harmony. Financial status mediated entirely the effect of optimism on life satisfaction. Health status was predicted by optimism but did not predict life satisfaction. Optimism is a key contributor to subjective well being because it fosters self-esteem, relationship harmony, and positive perceptions of financial conditions.

Aged↗

Comprehensive life table of computer-assisted predictive mathematical relationship between age and life expectancy, survival probability or death rate in US adults.

A microcomputer program in BASIC for predicting life expectancy by age in US adults was designed. Formulas used in this study were derived from the data reported by the National Center for Health Statistics. A comprehensive life table that shows the relationship between age and death rate, survival probability or life expectancy for each year between 25 and 85 years of age was obtained in this study, using a newly designed computer program for predicting life expectancy by age and the program for survival probability previously published by the author. The comprehensive life table may be useful for clinical evaluation of patients and further helpful for biomedical investigation and epidemiological evaluation of US adults.

Adult↗

Impact of survival probability, life expectancy, quality of life and patient preferences on do-not-attempt-resuscitation orders in a hospital. Resuscitation Committee.

Consensus exists that a do-not-attempt-resuscitation order (DNAR) is appropriate if a resuscitation attempt is futile. Less agreement exists when this point is reached. We investigated the influence of three major considerations for in-hospital DNAR orders: expected survival probability after resuscitation, prospects of the patients' current condition without a cardiac arrest and the patients' autonomous decision not to want resuscitation. We calculated an expected survival probability according to two multi-morbidity prediction scores for each patient, assuming the event of cardiac arrest. The prospects of the current condition without a cardiac arrest was estimated by the patients' physician, in terms of life expectancy and quality of life (level of dependency after discharge and pain). The patients' preference was documented from the medical records. A total of 470 patients were included in the study. Fifty-eight patients (12%) had a DNAR-order, 11 of these patients (19%) wanted no resuscitation. The patients' prospects (life expectancy, dependency after discharge), and age proved to be independently associated with the presence of a DNAR order. The odds ratio (OR) for the presence of a DNAR order was 37 (CL 14-107) for an estimated life expectancy less than 3 months, 13 (CL 4-41) for a life in a nursing home and four (CL 2-12) for an age of 80 years and older. Expected survival probability after resuscitation and pain were not independently associated with a DNAR order. We conclude that resuscitation is considered futile on the basis of the patients' age and prospects without cardiac arrest and that the impact of expected survival probability on these decisions is small.

Aged↗

Life stress, life-styles, depression, and illness in adult women.

The relationships between life stress and depression and physical illness were investigated in a sample of 122 normal adult women. Results indicated that life stress was associated with both illness and depression in this sample but that both type of stress and life-style were important moderators of these relationships. Thus, work stresses were associated with illness (not depression), and the relationship between life stress and illness was strongest among work-centered women. Family stresses were associated with depression (not illness), and the relationship between life stress and depression was strongest among housewives. Implications for sex role definitions are discussed.

Adult↗

"Sticking jewels in your life": exploring women's strategies for negotiating an acceptable quality of life with multiple sclerosis.

The authors explored women's strategies for achieving quality of life with multiple sclerosis (MS) through interviews with 27 women, most of whom had lived with MS for more than 5 years. Analysis of the semistructured interviews followed the interpretative phenomenological approach. The women portrayed living with MS as an ongoing process of negotiation and described gaining quality of life through looking after health; maintaining meaningful occupations and roles; establishing mutual relationships; clarifying beliefs, aspirations, and philosophy of life; activism on disability issues; consciously valuing positive life experiences; and finding benefits in adversity. Despite recounting resourceful strategies, many acknowledged ongoing difficulties. Some narratives suggested a mesh or tapestry of coexisting positive and negative experiences. Others portrayed an adversarial relationship, with the positive and negative forces in their lives constantly battling for supremacy. A wide array of flexible, evolving strategies was required to achieve an acceptable quality of life with MS.

Adaptation, Psychological↗

Health-related quality of life and health-adjusted life expectancy of people with diabetes in Ontario, Canada, 1996-1997.

OBJECTIVE: To estimate the burden of illness from diabetes using a population health survey linked to a population-based diabetes registry. RESEARCH DESIGN AND METHODS: Measures of health-related quality of life (HRQOL) from the 1996/97 Ontario Health Survey (n = 35,517) were combined with diabetes prevalence and mortality data from the Ontario Diabetes Database (n = 487,576) to estimate the impact of diabetes on life expectancy, health-adjusted life expectancy (HALE), and HRQOL. RESULTS: Life expectancy of people with diabetes was 64.7 and 70.7 years for men and women, respectively-12.8 and 12.2 years less than that for men and women without diabetes. Diabetes had a large impact on instrumental and basic activities of daily living, more so than on functional health. HALE was 58.3 and 62.7 years, respectively, for men and women-11.9 and 10.7 years less than that of men and women without diabetes. Eliminating diabetes would increase Ontario life expectancy by 2.8 years for men and 2.6 years for women; HALE would increase by 2.7 and 3.2 years for men and women, respectively. CONCLUSIONS: The burden of illness from diabetes in Ontario is considerable. Efforts to reduce diabetes would likely result in a "compression of morbidity." An approach of estimating diabetes burden using linked data sources provides a robust approach for the surveillance of diabetes.

Adolescent↗

Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study.

OBJECTIVE: Physical activity is associated with a reduced risk of developing diabetes and with reduced mortality among diabetic patients. However, the effects of physical activity on the number of years lived with and without diabetes are unclear. Our aim is to calculate the differences in life expectancy with and without type 2 diabetes associated with different levels of physical activity. RESEARCH DESIGN AND METHODS: Using data from the Framingham Heart Study, we constructed multistate life tables starting at age 50 years for men and women. Transition rates by level of physical activity were derived for three transitions: nondiabetic to death, nondiabetic to diabetes, and diabetes to death. We used hazard ratios associated with different physical activity levels after adjustment for age, sex, and potential confounders. RESULTS: For men and women with moderate physical activity, life expectancy without diabetes at age 50 years was 2.3 (95% CI 1.2-3.4) years longer than for subjects in the low physical activity group. For men and women with high physical activity, these differences were 4.2 (2.9-5.5) and 4.0 (2.8-5.1) years, respectively. Life expectancy with diabetes was 0.5 (-1.0 to 0.0) and 0.6 (-1.1 to -0.1) years less for moderately active men and women compared with their sedentary counterparts. For high activity, these differences were 0.1 (-0.7 to 0.5) and 0.2 (-0.8 to 0.3) years, respectively. CONCLUSIONS: Moderately and highly active people have a longer total life expectancy and live more years free of diabetes than their sedentary counterparts but do not spend more years with diabetes.

Adult↗

[Sex differential in life expectancy at birth in Japan: (2) trends in sex differential in life expectancy at birth from 1920 to 1990].

Sex differentials in life expectancy at birth in Japan are analyzed for the period 1920 to 1990. The results show that there was a general increase in differences in mortality by sex over time. "The sex differential in age-specific death rate in 0-4 year age group (particularly age 0) explained most of the sex differential in life expectancy at birth before 1947. After 1950, the age group of 60-79 played a major role in the sex differential in life expectancy at birth. It is noteworthy that female mortality exceeded male mortality in age groups of 2-41 before 1930. Consequently, excess of female mortality reduced the sex differential in life expectancy at birth at that period. As for the sex differential in mortality rates by causes of death, tuberculosis, pregnancy and childbirth related disease exerted a great influence...before 1940. Recently, malignant neoplasms, heart diseases, cerebrovascular diseases, and accidents [have] become leading contributors to the sex differentials in life expectancy at birth." (SUMMARY IN ENG)

Age Factors↗

Physician orders for life-sustaining treatment form: honoring end-of-life directives for nursing home residents.

Physician Orders for Life-Sustaining Treatment (POLST) form provides choices about end-of-life care and gives these choices the power of physician orders. The POLST form assures end-of-life choices can be implemented in all settings, from the home through the health-care continuum. The use of the POLST form was evaluated in a pilot study in nursing homes in two eastern Washington counties. Chart reviews and template analysis of interviews revealed the POLST form accurately conveyed end-of-life wishes in 19 of 21 cases. An informed consent process was evidenced in 16 of 21 cases, and the POLST form was congruent with residents' existing advance directives for health care. The findings support the continued use, development, and evaluation of this promising tool for improving end-of-life care.

Advance Directives↗

Maintaining quality of life at the end of life.

Despite the successful growth of the hospice movement during the past 30 years in the United States, almost 85% of Americans continue to die in hospitals or nursing homes. While the benefits of palliative care principles are well established, palliative care interventions remain underused in clinical practice in the settings in which most Americans die. Our premise is that physicians as a group perpetuate end-of-life suffering rather than ease the transition from life to death. We also believe that maintaining quality of life (QOL) at the end of life requires a multidimensional approach orchestrated by physicians drawing on the full range of available physical, psychological, social, and spiritual interventions. This article defines the meaning of QOL at the end of life and then examines the ramifications of failing to attend to QOL concerns in dying patients. It reviews strategies that physicians can use to advance palliative care approaches, thereby reducing terminally ill patients' suffering in the institutions in which most die.

Aged↗

[2 scenarios on extension of life. Various social consequences of a higher life expectancy].

This article explores the potential consequences of an extra life extension till 2010. For this purpose the method of scenario analysis is used. Life extension is defined as an extra increase in life expectancy at birth (compared to the 'normal' demographic forecast). The optimistic scenario is based on an equal delay of both death and the prevalence of disease and disability. In the pessimistic scenario, only death is delayed, which brings more morbidity. It is stressed that the development of morbidity considerably influences the social consequences of extra life extension, such as the use older people make of the (health) care services system, and the socio-economic and the socio-cultural position of the elderly. In the optimistic scenario the pressure on care services is more or less the same as it would be according to the normal demographic forecast, although the patients/clients are older. Due to the extra increase in life expectancy the costs of social security will be much higher. The percentage of people incapable of work, the age of retirement, the position of the elderly employee in the labour force and the norms and values concerning old age differ in both scenarios.

Aged↗