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PubMed2001

Inequality in life expectancy, functional status, and active life expectancy across selected black and white populations in the United States.

We calculated population-level estimates of mortality, functional health, and active life expectancy for black and white adults living in a diverse set of 23 local areas in 1990, and nationwide. At age 16, life expectancy and active life expectancy vary across the local populations by as much as 28 and 25 years respectively. The relationship between population infirmity and longevity also varies. Rural residents outlive urban residents, but their additional years are primarily inactive. Among urban residents, those in more affluent areas outlive those in high-poverty areas. For both whites and blacks, these gains represent increases in active years. For whites alone they also reflect reductions in years spent in poor health.

Activities of Daily Living↗
PubMed2004

Quality-of-life considerations in patients with advanced lung cancer: effect of topotecan on symptom palliation and quality of life.

Key goals in the treatment of lung cancer are to improve both survival and quality of life (QOL). While formal techniques are frequently used to evaluate survival and response, such rigor is used less often in assessing the impact of treatment on quality of life. Many patients with lung cancer are elderly and have complex medical histories and a myriad of comorbidities. In these patients, with limited survival expectations, symptom palliation, quality of life, and convenience of therapy are especially important end points. Indeed, clinical trials are now incorporating symptom scores and QOL outcomes in their designs (now combined as "patient reported outcomes" or PROs). Moreover, symptom palliation correlates well with QOL and survival duration, providing further rationale for therapy selection based on these parameters. The potential palliative and QOL benefits of chemotherapy have been investigated for several agents in lung cancer trials. Of these, topotecan (Hycamtin; GlaxoSmithKline; Philadelphia, PA) is the best characterized in relapsed small cell lung cancer (SCLC). In a phase III trial of topotecan versus cyclophosphamide, doxorubicin (Adriamycin; Bedford Laboratories; Bedford, OH), and vincristine (Oncovin; Eli Lilly and Company; Indianapolis, IN) (CAV) in patients with recurrent SCLC, topotecan was associated with statistically significant (p < 0.05) improvements in general symptoms (e.g., fatigue and interference with daily activity) and disease-specific symptoms (e.g., dyspnea and hoarseness). Moreover, the introduction of oral therapies, such as oral topotecan, may increase the convenience of therapy by reducing the time needed for therapy and the need for frequent venipuncture. This review summarizes the role of chemotherapy in symptom palliation, with an emphasis on the impact of topotecan therapy on symptom parameters in patients with relapsed SCLC and the emerging role of oral therapy in this setting.

Antineoplastic Agents↗
PubMed2004

Life-history studies on two molecular strains of mesocestoides (Cestoda: Mesocestoididae): identification of sylvatic hosts and infectivity of immature life stages.

Life-cycle studies were conducted on 2 molecular strains of Mesocestoides tapeworms that represent different evolutionary lineages (clades A and B). Wild carnivores, reptiles, and rodents were examined for tapeworm infections at 2 enzootic sites: (1) San Miguel Island (SMI), a small island off the coast of southern California and (2) Hopland Research and Extension Center (HREC), a field station in northern California. Results indicate that deer mice (Peromyscus maniculatus) and coyotes (Canis latrans) may play an important role in the life cycles of Mesocestoides (clades A and B) in California. Over half the coyotes at HREC and at least a third of the population of island fox (Urocyon littoralis) at SMI were found to harbor clade A adult Mesocestoides spp. One of every 4 Mesocestoides-infected coyotes had tapeworms representing both clades A and B. Experimental inoculations revealed that proglottids (clades A and B) were not directly infectious to rodents, reptiles, or dogs. On the other hand, mice, lizards, and hamsters fed tetrathyridia of Mesocestoides spp. (clades A or B) developed peritoneal tetrathyridial infections. A dog that was fed tetrathyridia (clade B) developed an adult tapeworm infection. Acephalic metacestodes given orally to western fence lizards, laboratory mice, or domestic dogs did not result in metacestode or adult tapeworm infections. Whereas most clade A acephalic metacestodes from dogs were asexually proliferative, clade A tetrathyridia isolated from wild deer mice did not show evidence of asexual replication. Our study supports the hypothesis that a second, as of yet unidentified, intermediate host is necessary to complete the life cycles of Mesocestoides spp., and that acephalic metacestodes represent an aberrant form, incapable of further development.

Animals↗
PubMed1983

Pathogenic life changes in middle adulthood and coronary heart disease: a life-span developmental perspective.

Empirical evidence is reviewed about the contributions of life changes and the coronary-prone behavior pattern in the development of myocardial infarction in middle adulthood. Since established clinical risk factors account for about half of the total variance, it is necessary to explore in more detail the crucial developmental role that distressing psychologic and social parameters should play. Because of the generally prolonged incubation period of the effects of psychosocial risk factors, it is proposed that they should be studied from a life-span developmental perspective. Two metamodels seem appropriate in this respect: a mechanistic model by Dohrenwend and Dohrenwend, and an organismic model by Levinson. After scrutinizing some properties of these models, including their potential explanatory power, it is argued that an organismic model may predict better the pathogenic development of distressing psychosocial risk constellations over consecutive phases in the life course of the heart patient.

Adult↗
PubMed1985

Perception of life event stress in patients with chronic duodenal ulcer. A comparison of the rating of life events by duodenal ulcer patients and community controls.

Stress is often claimed by doctors and patients to be an aetiological factor in peptic ulcer disease. The aim of the present study was to investigate whether ulcer patients perceive that they would react more strongly than normal to life event stress. Seventy-three patients with duodenal ulcer and their sex- and age-matched controls rated 81 events for the amount of distress and life change they considered the events would cause them personally. With regard to individual events, only one difference emerged: female patients rated promotion at work significantly lower for distress than did controls, when event experience was taken into account. There was a systematic tendency for ratings of male patients to be lower than those of controls. These observations suggest that duodenal ulcer patients do not perceive that their reaction to life events would be in excess of normal.

Adolescent↗
PubMed1994

Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group.

A head and neck cancer specific questionnaire module designed to be used in quality of life assessments before, during, and after radiotherapy and surgery, with or without combinations with chemotherapy has been developed in accordance with guidelines given by the EORTC Quality of Life Study Group. Relevant issues were generated by means of literature search, and interviews with specialists and patients. Pre-testing of a preliminary questionnaire module was performed in patients from Norway, Sweden, Denmark, United Kingdom and French-speaking Belgium. The resulting head and neck cancer module, the EORTC QLQ-H&N37, includes 37 items concerning disease and treatment related symptoms, social function and sexuality. By using a combination of the general EORTC QLQ-C30 and the EORTC QLQ-H&N37, health-related quality of life measurements may be compared between studies in different cancer populations, and still be sensitive to changes in the target population.

Europe↗
PubMed1992

Measuring the quality of life of women with rheumatoid arthritis or systemic lupus erythematosus: a Swedish version of the Quality of Life Scale (QOLS).

The Quality of Life Scale (QOLS) was translated into Swedish and reliability and validity was studied. The Swedish version (QOLS-S) was given to 100 women with rheumatoid arthritis or systemic lupus erythematosus along with the Arthritis Impact Measurement Scales and a visual analog pain scale. Disease activity was also measured using the Ritchie Articular Index and a patient version of the Systemic Lupus Activity Measure. Results indicated that the QOLS-S had high test-retest reliability (r = .84 for a 4-week interval) and internal consistency reliability (alpha = .82 at Time 1 and .88 at Time 2). An hypothesis that the QOLS-S would have low to moderate correlations with measures of health status and disease activity was supported. We conclude that the QOLS-S is a reliable and valid measure of quality of life in Swedish women with RA and SLE and that it provides a measure of quality of life that is distinct from health status and disease activity.

Adult↗
PubMed1997

Differences over the life span in daily life-style regularity.

A diary-based instrument-the Social Rhythm Metric (SRM)-was used to assess the level of stability of daily social and behavioral rhythms in a group of 239 healthy subjects (112 male, 127 female) ranging in age from 20 to 89 years. Each subject completed the instrument for two consecutive weeks, which were averaged to yield one measure (SRM score) of life-style regularity [range 0 (least regular) to 7 (most regular)] and another of activity level index (ALI), corresponding to the number of (diary listed) activities done per week (max. = 119). SRM score increased reliably with age group at an average rate of 0.018 units per year. ALI showed an "inverted U"-shaped function with a maximum at about 50 years. SRM changes appeared not to be related to demographic differences between the age groups, although ALI differences may have been so related. No main effects or interactions were found with gender. Life-style regularity appears to increase over the life span in response to both biological and psychosocial changes and may represent an adaptation to age-related changes in the circadian system's sensitivity to entraining agents. Regular behavioral rhythms may be conducive to continued good health and well-being.

Activities of Daily Living↗
PubMed1991

[Correlation of health status, disability and hospital life and satisfaction with quality of life in elderly in-patients].

To examine satisfaction with quality of life among elderly people with active diseases, in-patients aged 65 and over in Tokyo Metropolitan Geriatric Hospital were interviewed. Multivariate analysis was performed using Hayashi's quantification theory (the 2nd family). The dependent variable was the question "are there any satisfactory aspects of your becoming old?" and 18 explanatory variable items including age, gender, activity of daily living (ADL) and physical and mental status. Among 68 patients examined, 49 cases fulfilled all the items. The correlation ratio was 0.353, and rate of correct discrimination was 77.6% (78.9% and 76.7% of positive and negative responses, respectively). The range and correlation coefficient of ADL and age were greater than those of other items. Affirmative answers increased with advancing age and loss of independency in ADL responded negatively. Poor prognosis also affected satisfaction with life. These results suggest that age and progression of disability are important factors which determine life satisfaction in elderly in-patients.

Activities of Daily Living↗
PubMed2003

Life style and cardiovascular risk factors in the Japanese population--from an epidemiological survey on serum lipid levels in Japan 1990 part 1: influence of life style and excess body weight on HDL-cholesterol and other lipid parameters in men.

Low HDL-cholesterol (HDL-C) has long been used as an important predictor of coronary artery disease (CAD), although HDL-C values themselves are influenced by various factors including serum triglyceride (TG) levels, obesity, and life style. In view of the importance of the metabolic syndrome as a risk factor of CAD, changes in HDL-C and other lipid parameters in the Japanese population associated with life style, especially in males, were analyzed in this study based on data obtained in an epidemiological survey carried out in 1990. Smokers had higher TG and lower HDL-C levels than non-smokers, while BMI and LDL-C were slightly decreased by smoking in middle-aged men (40-59 years old). Increases in both HDL-C and TG due to alcohol consumption were associated with an increase in BMI in younger men aged 20-39. In middle-aged men, significant increases in HDL-C were seen in every quintile of BMI, while the increase in TG levels due to alcohol was small. Middle-aged men engaged in occupations requiring greater physical activity also had higher HDL-C levels in every quintile of BMI. The influence of life style on serum lipid parameters appeared to be mostly expressed as a function of BMI in younger men, while it appeared to be independent of BMI in older men.

Adult↗
PubMed1999

[The pain takes hold of life. A qualitative study of how patients with chronic back pain experience and cope with their life situation].

Living with daily pain during a long period of time is a considerable strain which affects many aspects of life. The aim of this study was to explore the experiences and coping strategies of patients with chronic low back pain. A strategic sample of 22 patients with chronic low back pain were interviewed according to a semistructured qualitative method: 14 women and eight men, with a mean age of 46 and a mean duration of illness of 15 years. 18 had been treated with low back surgery. All patients had pain every day. 19 were never without pain. They reported disturbed sleep, irritable mood and depression; 15 had thought of suicide. They felt constantly worn out. The pain influenced their everyday life and their total situation. The lives of patients with intermittent daily pain were less affected. The patients were asked what advice they would give to others in a similar situation. Their main point was not to give up, to focus less on the pain and the limitations and more on everything that could bring dedication and joy to everyday life.

Adaptation, Psychological↗
PubMed1998

Quality of life decisions at the beginning of life: ethical considerations.

The burdens of life with treatment may outweigh the benefits. Under which set of circumstances and to what extent a neonate should receive medical intervention is a difficult ethical issue involving principles and cultural aspects which may be in conflict. The nature of the disease, the risks involved in treatment or non-treatment, the degree to which therapy will extend life, the discomfort associated with therapy, the anticipated quality of life, the wishes of surrogates, and national cultural mores are the important considerations in determination of the neonate's best interest in order to arrive at ethically defensible decisions. These decisions are not necessarily cross-culturally uniform.

Congenital Abnormalities↗
PubMed1999

Quality of life of patients with perennial allergic rhinitis: preliminary validation of the Rhinoconjunctivitis Quality of Life Questionnaire in Singapore.

Though sufferers of perennial allergic rhinitis do not die from their ailment, they endure years of chronic nose disease that Interferes with many important aspects of their lives. A rhinitis-specific instrument to gauge the quality of life of patients with this disease was published in 1991. Here, we validated the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for use in English-speaking patients with perennial allergic rhinitis. We established that the RQLQ distinguishes between patients and control, demonstrates internal consistency and is sensitive to change. This study suggests that the RQLQ can be used to assess the quality of life of patients with perennial allergic rhinitis in Singapore.

Adolescent↗
PubMed2000

How problematic are various aspects of quality of life in patients with cancer at the end of life?

PURPOSE/OBJECTIVES: To identify aspects of quality of life (QOL) in patients receiving end-of-life care that are most and least problematic for patients. DESIGN: Descriptive using secondary analysis of data from an earlier QOL study. SETTING: A large not-for-profit hospice that primarily provides home care in southwest Florida. SAMPLE: 231 homecare hospice patients with cancer. METHODS: Item analysis of items on the Hospice Quality-of-Life Index. MAIN RESEARCH VARIABLES: Psychophysiologic, functional, and social/spiritual well-being. FINDINGS: Patients had the most problems in the area of functional well-being and the least problems with social/spiritual well-being. Most common physical problems included constipation and dyspnea. CONCLUSIONS: Patients with end-stage cancer are able to maintain their relationships with God and with family and friends even in the face of marked functional difficulties and troublesome physical symptoms. IMPLICATIONS FOR NURSING PRACTICE: A continued focus on the patient and family by the interdisciplinary healthcare team is warranted.

Adaptation, Psychological↗
PubMedDate not supplied

[Analysis of survival and mortality curves with the model of vital receptors. The maximal life span. Effect of temperature on the life span. The mortality probability density function (mortality curve) and its parameters].

We have continued an analysis of survival curves by the model of the vital receptors (MVR). The main types survival function (E-, TW- and GM-distributions) have been considered. It was found that the maximal life span depends on the threshold concentration of vital receptors. Equations are obtained for the dependence of the maximal life span on the kinetic parameters in the reactions of inactivation, destruction and inactivation. Dependence of maximal time life on initial size of the population have been considered. The influence of temperature on the survival curves is analysed by E-distribution. Equations are founded for the description of thermosurvival and thermoinactivation curves. Equation are obtained for the dependence of density function and it characteristics (modal and antimodal age, coefficient of asymmetry) on the MVR parameters. It was shown that E-, TW- and GM-distribution has different types of asymmetry. The coefficient of asymmetry of GM-distribution is associated on the MVR parameters. It is assumed that symmetry of the curves of mortality and birth-rate is coordinated by the mechanisms of MVR.

Algorithms↗
PubMed2000

The Circle of Life. The AHA recognizes end-of-life programs with awards.

The Circle of Life awards were presented for the first time this year by the American Hospital Association to highlight breakthrough innovations in end-of-life care. The three award winners, profiled here, demonstrate that care, comfort, and compassion must go hand-in-hand in the final stage of life.

American Hospital Association↗
PubMed1998

[Evaluation of the effect of causes of death of advanced schistosomiasis patients on the life span of population by using potential years of life lost analysis].

AIM: To evaluate the effect of the causes of death of advanced schistosomiasis patients on the life span of population in an area where schistosomiasis had been under control by applying the indicators of potential years of life lost (PYLL) and rate of PYLL (PYLLR). METHODS: Using the formula of calculation of PYLL and PYLLR, the causes of death of 487 patients of advanced schistosomiasis in 3 previously endemic townships of Shanghai suburb. RESULTS: Of 487 cases who died between 1955 and 1995, the PYLLR of all causes of death was 256.3@1000. The main causes of death were hepatic failure (100.3@1000), liver carcinoma (43.4@1000) and cancer of other organs (24.8@1000). In the 1960s, the PYLLR of advanced schistosomiasis complicated with hepatic failure and upper digestive tract hemorrhage was 222.2@1000 and 34.5@1000, the PYLLR of the complications of schistosomal liver cirrhosis, hepatic failure and hemorrhage accounted for 67.5% of the total PYLLR, being apparently higher in the non-splenectomy group than in the splenctomty group. After the schistosomiasis was under control, both PYLL and PYLLR decreased linearly. As compared with the 1960s, the PYLLR of all causes of death and the causes of death of the complications of schistosomal liver cirrhosis in the 1990s has declined by 62.9% and 83.2%, respectively, the PYLLR of upper digestive tract hemorrhage was found only 0.3@1000 in the last 5 years. CONCLUSION: PYLL and PYLLR analysis could be used to quantify the effect of complications of advanced schistosomiasis and other causes of death on the life span of population.

Adolescent↗
PubMed2002

A life needs model of pediatric service delivery: services to support community participation and quality of life for children and youth with disabilities.

This article presents a life needs model of pediatric service delivery that is based on the values of the intrinsic worth, dignity, and strengths of individuals. This developmental, socio-ecological model outlines the major types of service delivery needs of children and youth with disabilities, their families, and their communities within three spheres of life (the personal, interpersonal, and external spheres). The model legitimizes the concept of need, emphasizes the values of family-centered services, and recognizes child and family strengths and capacities. We discuss the utility of this transdisciplinary model in guiding pediatric service delivery to meet the long-range goals of community participation and quality of life of children and youth with disabilities.

Adolescent↗