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Formulation of goals for life expectancy at birth in Costa Rica (report of one experience).

Costa Rican authorities have finished a national adaptation of the goals of the Hemisphere's Ten-Year Health Plan for the Americas and have formulated a National Health Plan for 1974-1980. This work was coordinated by the Health Sector Planning Unit and was assisted by various multidisciplinary and multi-institutional working groups. The methodology set forth in this article was developed by a group responsible for formulating goals with regard to life expectancy--the last of five health-related subjects analyzed, and one regarded as dependent on the rest. In brief, this methodology was as follows: Birth rates, death rates, and life expectancy at birth in the other countries of the Region and in a developed country (Sweden) were compared with those prevailing now and in the past in Costa Rica. This served as a basis for projecting Costa Rica's future prospects if no changes were made, or if certain changes were made through implementation of new programs. This was followed by analysis of leading caused of death in the country--by age group and vulnerability of those dying, and by probably reductions in mortality that would result from achieving the goals established for other programs. On this basis, various alternative reductions in mortality for each age groups were considered. Using these alternative, abridged life tables were devised, and these in turn were used to draw up a table showing the life expectancy at birth that would result from realization of each alternative. This made it possible to derive life expectancy goals that were consistent with the goals for reducing mortality in each age group that were formulated during the sectoral planning process. It is hoped that this general procedure, illustrated here with data from the Costa Rican case, may prove useful to others engaged in health planning work.

Adolescent

Future life expectations and self-esteem of the adolescent survivor of childhood cancer.

The number of adolescent cancer survivors has increased dramatically over the past decade as the result of improved treatment and diagnostic techniques. This population brings with them unique characteristics and concerns. The present study consisted of interviews with 10 adolescent survivors of childhood cancer and their parents. It investigated the adolescent's present self-esteem, the future life expectations held by both the teenagers and parents, and the relationship between the variables. Results indicated that the adolescents felt moderately competent in their lives (measures of self-esteem) and the parents felt more certain than their children that the teenagers would accomplish the tasks deemed appropriate for entry into a healthy adulthood. Pearson correlations showed a strong relationship between parents' future life expectations and adolescents' self-esteem (r = .82; P = .002), but not between parents' and adolescents' future life expectations or between the adolescents' future life expectations and self-esteem. The results are significant in addressing the impact parents can have on their child's self-esteem.

Adolescent

Potential gains in life expectancies by partial elimination of leading causes of death in Texas.

Potential gains in life expectancies among Texas population by partial elimination of 3 major causes of death are examined on the basis of the available statistics from the population census and mortality statistics for 1970. Contrary to the popular anticipation of longer potential gains, the results are not particularly encouraging. The number of years of life that would be gained during the working ages by 50% elimination of major cardiovascular diseases is less than 1/2 of 1 year, about 1/4 of 1 year by 50% elimination of malignant neoplasms, and less than 1/4 of 1 year by 50% elimination of motor vehicle accidents. Even with a scientific breakthrough in combating those causes of death it appears that future gains in life expectancies for working ages will not be spectacular. The implications of the results in relation to the current debate on the national health policy are discussed.

Accidents, Traffic

Adding years to life: effect of avoidable mortality on life expectancy at birth.

STUDY OBJECTIVE: The aim was to determine the number of years that could be gained by preventing avoidable deaths. DESIGN: The study arose from the concept of avoidable causes of death and life expectancy at birth. Four abbreviated life tables were computed. The first included all causes of death; the second excluded all avoidable causes of death; the third and fourth excluded respectively primary and secondary avoidable causes of death. SETTING: Mortality and population data were taken from Mortality Statistics Offices in Valencia Region, Spain. MAIN RESULTS: Life expectancy at birth (LEB) was 75.7 years. After removing all avoidable deaths, LEB increased by 1.74 years. This improvement is attributed to avoidable deaths by primary prevention (1.09 years) and avoidable death by secondary prevention (0.37 year). CONCLUSIONS: According to these results the greatest improvement in LEB would be gained by primary prevention.

Cause of Death

Life expectancy, its relation to sexual activity and body weight in male inbred mice.

Body weight of male mice of five inbred strains caged in groups of five was determined three times between the ages of 80 and 100 days, representing the individual fully grown body weight. Sexual activity of each mouse (number of ejaculations and intromissions) was estimated under competitive conditions between the ages of 120 and 150 days in eleven repetitions. Within all inbred strains only about half of the males displayed sexual activity when confronted with an estric female. The other do not. The animals remained in their cage groups until natural death after 727 +/- 215 days (C57BL/6), 638 +/- 260 days (BALB/c), 630 +/- 187 days (CBA), 560 +/- 230 days (DBA/2) and 317 +/- 62 (AKR) days. Only amongst the sexually active animals did individual life span correlate with the number of ejaculations. This was seen in C57BL/6, CBA and DBA/2. Particularly sexually successful animals, carrying out the most ejaculations, live 10-20% longer than their (subdominant) competitors displaying less sexual success. Sexually inactive males (characterised by no ejaculations and less other sexual activities) show that this characteristic of their personalities imposes no limitation upon their life expectancy. Fully grown body weight and the individual life span correlates within the strains DBA/2, C57BL/6 and BALB/c. Medium-sized animals have a greater life expectancy than small or large ones.

Animals

Happiness, time consciousness, and subjective life expectancy.

84 men and 141 women enrolled at a university reported their sexes and ages, rated their happiness and their time consciousness, and estimated how many more years they expected to live. Men significantly overestimated their subjective life span compared to actuarial data. Women (but not men) who were happier tended to be younger, had greater subjective life expectancies, and felt that they had lived a smaller percentage of their total lives. Both older men and older women tended to be more time conscious.

Adult

[Multi-infarct dementia in nursing home patients; more comorbidity and shorter life expectancy than in Alzheimer's disease].

A retrospective analysis of the medical charts of 117 patients (50 men and 67 women) with multi-infarct dementia took place. All patients admitted to the psychogeriatric nursing home 'Joachim en Anna' in Nijmegen between 1980 and 1989 were studied. The aim of the study was to obtain epidemiological information and to investigate the prevalence of comorbid conditions, prognosis and mortality. The results were compared with patients with Alzheimer's disease. The patients remained in the institute for 1.4 years and the mean total duration of the disease was 5.3 years. About twenty-five percent died in the first three months of admission. Life expectation, counted from time of admission, was 6 years shorter in comparison with Dutch mortality tables. Morbidity frequently seen at admission included circulatory system diseases and cerebrovascular accidents. The risk factor hypertension was seen in a smaller percentage of patients than expected. During the stay the diseases most frequently diagnosed were respiratory and urinary tract infections, adverse effects of drugs, constipation and chronic ulcers of the skin. About twenty percent of the patients were struck by a (recurrent) cerebrovascular accident or a transient ischaemic attack. Most patients died of dehydration or bronchopneumonia. There was, apart from the diagnosis of multi-infarct dementia, no single patient aspect that could predict a poor prognosis. Nursing home patients with multi-infarct dementia are clearly different from patients with Alzheimer's disease. Time spent in the nursing home and duration of disease are shorter. They have more comorbid conditions, especially of a cardiovascular nature, and they have a poor life expectation.

Aged

The late effects of selected immunosuppressants on immunocompetence, disease incidence, and mean life-span. III. Disease incidence and life expectancy.

The effect of various immunosuppressive treatments on mean life-span and disease incidence have been studied. Significant life shortening was seen only in mice which recieved X-irradiation early in life and can be ascribed primarily to an increased incidence of certain malignancies. Marginal life shortening was seen in cyclophosphamide-treated animals, however, survival patterns between those and control animals did not differ until 30 months of age and the magnitude of life-shortening never approached that seen in X-irradiated animals. Thymectomy, splenectomy or cortisone treatment did not alter survival. All immunosuppressive treatments enhanced mortality due to non-neoplastic diseases, however, only a small percentage of animals die with these disease entities. With the exception of cortisone all immunosuppressive treatments increased the incidence of neoplastic disease. However, their effects on various neoplastic processes were variable and unpredictable. Four primary patterns in terms of relative immune competence, disease incidence and life expectancy were seen. Thus, immunodepression may of may not correlate with increased disease incidence, which in turn may or may not have a life-shortening effect. These findings are discussed in terms of the marked reduction of both humoral and cell-mediated immunity normally seen in aged mice and the significance of postulated immune surveillance mechanisms to survival.

Age Factors

Risk factor dynamics, mortality and life expectancy differences between eastern and western Finland: the Finnish Cohorts of the Seven Countries Study.

Prior studies have not accounted for male mortality being higher in east than west Finland. Efforts to identify the mechanisms producing higher mortality in the east, due primarily to cardiovascular diseases (CVD), initially focused on a search for new risk factors. An alternate approach is to examine the assumptions of the analysis. This was investigated using a model which described (a) changes in risk factors over time, (b) dependency of risk factor effects on age, and (c) interactions and nonlinear effects of risk factors on mortality. The model was applied to 25-year follow-up data from cohorts of eastern (N = 823) and western (N = 888) Finnish men using pulse pressure, diastolic blood pressure, body mass index, total cholesterol, vital capacity index, cigarette smoking, and heart rate as risk factors. At age 40, men in the west had a life expectancy 2.4 years higher. Of the difference 29% (0.7 years) was associated with area differences in risk factor means, variances, and their change with age. The remainder, 1.7 years, was associated with age differences in the relation of risk factor interactions to CVD mortality. Possible reasons for these differences, such as joint elevation of several risk factors inducing rapid progression of atherogenesis, are discussed. No significant area differences were observed for mortality from either cancer or other causes.

Adult

Life expectancy without surgery in tetralogy of Fallot.

All published autopsy cases of patients with tetralogy of Fallot who died without surgical treatment were studied to determine the life expectancy of such persons. In addition, the data from a study of persons with tetralogy alive in Denmark in 1949 were reanalyzed. The survival data from these two sources were remarkably similar, indicating that 66 percent of persons with tetralogy of Fallot not treated surgically live to age 1 year, 49 percent to age 3 years and 24 percent to age 10 years; thereafter, the hazard function (or instantaneous risk of death) remains constant. The chance of survival is significantly less when pulmonary atresia, rather than stenosis, is present.

Adolescent

Life expectancy in keratoconus.

It is observed that few patients over the age of 60 regularly attend the keratoconus clinic at Moorfields Eye Hospital. The hypothesis that patients with keratoconus have a shorter life expectancy owing to underlying connective tissue related disease was tested. From patient records a sample of 337 keratoconus patients aged at least 40 years by 1991 were identified, of which 279 were living, 13 were deceased, and 45 were untraceable. The mortality rate for keratoconus patients was compared with that of the general population using actuarial English life tables. Results show no significant difference between the general population mortality rate and that of the keratoconus sample even with adjustment for social class. Possible explanations for the non-attendance of older patients are discussed.

Adult

Follow-up 15 years after a geronto-psychiatric prevalence study. Conditions concerning death, cause of death, and life expectancy in relation to psychiatric diagnosis.

In relation to a follow-up 15 years after a geronto-psychiatric prevalence investigation of the population aged 65+ in a rural population, analysis has been made of the type of death certificate, residence at time of death, place of death, cause of death and life-expectancy in relation to psychiatric diagnoses prevalent in 1961.

Aged

[Life expectancy in penile carcinoma (statistical evaluation of 150 penile carcinomas in the period 1912-1970)].

In the period 1912-1970 in the Göttingen area, 150 patients suffering from penis carcinoma were investigated and/or treated. With regard to method of treatment, three periods can be distinguished: 1912-1930, 1931-1948, and 1949-1970. During the first period, treatment was chiefly radiotherapy, in the second chiefly surgery, and in the third combined radiotherapy and surgery. Independent of the type of therapy and period of observation, the 3-, 5-, and 10-year survival rates were 52.5%, 46.7%, and 31.4%, respectively. The greatest life expectancy was that following combined surgical and high-voltage therapy. The importance of lymphography is emphasized.

Adult

Natural history and life expectancy in severe alpha1-antitrypsin deficiency, Pi Z.

Clinical data from 246 adult Swedish individuals with severe alpha1-antitrypsin deficiency, Pi Z, diagnosed in 1963--77, were analyzed. Primary emphysema was present in 109 cases. Of 75 Pi Z patients with other types of chronic obstructive pulmonary disease (COPD), all but 7 showed signs of emphysema. Median age at onset of dyspnoea in Pi Z smokers was 40 years, compared to 53 in non-smokers (p less than 0.001). Of the Pi Z individuals over the age of 50, 19% had a diagnosis of liver cirrhosis and 15% signs of glomerular renal damage. Of 91 deceased patients, 56 died from COPD and 12 from liver disease. A greatly reduced survival was demonstrated in Pi Z individuals, regardless of sex. Smoking Pi Z individuals had a significantly lower life expectancy than Pi Z non-smokers (p less than 0.01).

Adult

Improved life expectancy for children with exstrophy of the bladder.

Life-table techniques demonstrate a 98% ten-year survival, a 96% 20-year survival, and 91% 35-year survival of children with exstrophy of the bladder. These figures represent a vast improvement over the earlier figures, due in large part to technical advances that have been made in areas of surgery, anesthesia, and antibacterial and metabolic therapy.

Adolescent