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PubMed1996

[Male life expectancy and prolongation of life expectancy were lowest in small towns in Japan].

The relationship between size of population and life expectancy of residents was investigated in 652 cities in Japan, using municipal life tables for 1985 and 1990. The following findings were seen: 1) Population size and life expectancy Life expectancy of males at age 0, 20 and 40 was lowest in small towns with a population less than 30,000 (except for age 40 in 1985), and highest in cities with a population of 70,000-199,999 in 1985 and 1990. Life expectancy of females at age 0, 20, 40 and 65 did not significantly vary with size of population in 1985 and 1990. 2) Population size and prolongation of life expectancy (1985-1990) Life expectancy was prolonged in males by 1.02, 0.88, 0.86 and 0.66 years at age 0, 20, 40 and 65, respectively. The prolongation of life expectancy of males at age 0, 20 and 40 was smallest in small towns with a population less than 30,000. Life expectancy was prolonged in females by 1.41, 1.32, 1.29 and 1.12 years at age 0, 20, 40 and 65, respectively. The prolongation of life expectancy was shortest at birth for females who lived in cities with a population of 50,000-59,999. 3) Socioeconomic factors and prolongation of life expectancy The prolongation of life expectancy of males was related to the entrance rate for high school and inversely related to the unemployment rate. The prolongation of life expectancy of females was not related to any of the socioeconomic factors studied.

Adult↗
PubMed2004

Life course influences on quality of life in early old age.

A growing literature demonstrates life course influences on health in early old age. The present paper is the first to examine whether similar processes also influence quality of life in early old age. The question is theorised in terms of structured dependency and third age, and the life course pathways by which people arrive at these destinations in later life. The issues are investigated in a unique data set that contains health and life course information on some 300 individuals mostly aged 65-75 years, enhanced in 2000 by postal survey data on quality of life. Several types of life course effect are identified at conventional levels of statistical significance. Long-term influences on quality of life, however, are less marked than those on health. Quality of life in early old age appears to be influenced primarily by current contextual factors such as material circumstances and serious health problems, with the influence of the life course limited mostly to its shaping of an individual's circumstances in later life. The implication for policy is that disadvantage during childhood and adulthood does not preclude good quality of life in early old age.

Aged↗
PubMed1984

Life events, social network, life-style, and health: an analysis of the 1979 National Survey of Personal Health Practices and Consequences.

The relationships among social structure, stress, social support, life-style health behavior, and health status are explored in this multivariate analysis of data from the National Survey of Personal Health Practices and Consequences. Path analyses showed social structural factors to influence life-style practices both directly and indirectly through social network and negative life events. For women, social network and life events had direct relationships to health related life-style practices, while age and income acted both directly and indirectly through social network and, for income, through life events. Education was also directly related to life-style. For men, social network and education had the only direct effects on health practices, and age and income had indirect effects through network. We then examined the relative contributions of the social network index elements, life events, and demographic variables to each of the life-style practices. These analyses confirmed the importance of gender, education, age, and income to predicting life-style behaviors. Negative life events were associated with smoking for both men and women, sleep for women only, and physical activity and alcohol use for men, which suggests sex-specific norms for coping with stress. For both sexes, church attendance and marriage were associated with favorable smoking and alcoholic use, implicating cognitive social support or social control as a mediator of health promotion. Finally, analyses for each gender using health status as the outcome variable indicated that age, income, education, and life events affected health directly, while the effects of church attendance and marriage were likely mediated through smoking and alcohol behaviors.

Attitude to Health↗
PubMed2006

Decomposition of life expectancy and expected life-years lost by disease.

Life expectancy is commonly used to summarize the life-time mortality experience of a population. Differences in life expectancy are well-known across different levels of socioeconomic status such as income and education. A recent simulation study of potential life-years lost has shown the effects that major diseases contribute to differences in life expectancy at birth. We propose a general methodology to decompose life expectancy and expected life-years lost by disease in order to determine the contribution of diseases to differences in life expectancy at each given age. We show that the estimates for the life expectancy, expected life-years lost and their variances at each age can be computed backward recursively from an old age. The difference in life expectancy between groups will be shown to include contributions from diseases and life-year differences which occur after an old age cut-off beyond which the contribution of diseases cannot be easily determined. Diseases will be grouped into 14 major disease categories. Data from the National Longitudinal Mortality Study will be used for demonstration purposes.

Adult↗
PubMedDate not supplied

Living with incurable cancer at the end of life--patients' perceptions on quality of life.

This study describes incurably ill cancer patients' perceptions of the quality of life at the end of life. Purposeful sampling was used to get as comprehensive descriptions as possible about quality of life. Five patients participated in repeated focus groups. Content analysis showed that the patients emphasized what they could perform and enjoy in daily life, not their shortcomings. Five themes were developed: "valuing ordinariness in life," "maintaining a positive life," "alleviated suffering," "significant relations," and "managing life when ill." The themes describe that the patients could participate in daily and social life despite cancer. Relation with family and palliative team deepened during the progress of illness in such that a resonance developed in communication. Other important findings were that patients' memories helped them to maintain a positive life and that the patients used individual strategies to relieve pain by emotional and physical distractions. For the patients, managing life as ill meant taking actions with creative thinking in solving problems as a way to cope and achieve quality of life. These positive findings from the focus groups have led to continued research regarding how patients with incurable cancer perceive quality of life.

Activities of Daily Living↗
PubMed2003

The life mission theory II. The structure of the life purpose and the ego.

Pursuing your life mission is often very difficult, and many frustrations are experienced along the way. Major failures to bring out our potential can cause us considerable emotional pain. When this pain is unbearable, we are induced to shift from one intention and talent to another that better allows us to adapt and survive. Thus, we become set on a course that brings out a secondary or tertiary talent instead of the primary talent. This talent displacement may be expressed as a loss of our true nature or true self. The new purpose in life now functions as the core of a new personality: the ego. The ego has a structure similar to that of the true self. It is anchored in a talent and it draws on subtalents. But the person who is centered in his or her ego is not as powerful or talented as the person he or she originally was, living the primary purpose of life. This is because the original personality (the true self or "higher self") is still there, active and alive, behind the ego. Symptoms, disorders, and diseases may be explained by the loss of energy, joy in life, and intuitive competence because of inner conflicts, which may be alleviated or cured in the salutogenetic process of Antonovsky that helps patients find their sense of coherence or their primary purpose in life. Many cases of reduced ability to function, physically as well as psychologically, socially or sexually, can also be explained and alleviated in this way. When a person discovers his true talent and begins to use it with dedication, privately as well as professionally, his life will flourish and he may overcome even serious disease and great adversity in life. The salutogenetic process can also be called personal development or "quality of life as medicine". It is important to note that the plan for personal development laid out by this theory is a plan not for the elimination of the ego, but for its cultivation. An existentially sound person still has a mental ego of course, but it is centered on the optimal verbal expression of the life mission. Such an ego is not in conflict with one's true self, but supports the life and wholeness of the person, although in an invisible and seamless way. The more developed the person, the more talents are taken into use. So although the core of existence remains the same throughout life, the healthy person continues to grow. As the number of talents we can call on is unlimited, the journey ends only at death. Understanding the concept of the ego, it is very easy for the physician to motivate the patient to go through a lot of difficulties in order to grow and develop, and when the patient fully understands the concept of the ego and the true self (higher self), the patient gets a strong feeling of direction in personal development, and a motivation to fight the internal obstacles for quality of life, health, and the ability to function.

Adult↗
PubMed2003

Measurement of quality of life II. From the philosophy of life to science.

We believe it should be possible to make operational the philosophical ideas of the good life in order to make it the object of scientific research. The Quality of Life Research Center in Copenhagen, Denmark has therefore spent the last several years with these questions and tried to find practical and evidence-based scientific solutions. This paper describes the theoretical road taken in moving from the abstract philosophy of life to the actual questionnaire. It presents an important aspect of our work with the quality-of-life (QOL) concept though the last decade. We have developed the quality-of-life philosophy; the SEQOL, QOL5, and QOL1 questionnaires; the quality-of-life theory; and the quality-of-life research methodology. We carried out quality-of-life population surveys and developed techniques for improving quality of life with the chronically sick patient. This paper presents the struggle to create a rating scale for the generic measurement of the global quality of life, based on quality-of-life theory, derived from quality-of-life philosophy. The developed rating scale is a ratio scale combining a Likert scale, a visual analogue scale, and a numerical scale, to a reduced combination scale. This allows for the extraction of as much information from the respondents as possible without exhausting them unduly or demanding more than can be reasonably expected.

Human Development↗
PubMed2005

Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis.

Limited information exists about the consequences of hypertension during adulthood on residual life expectancy with cardiovascular disease. We aimed to analyze the life course of people with high blood pressure levels at age 50 in terms of total life expectancy and life expectancy with and without cardiovascular disease compared with normotensives. We constructed multistate life tables for cardiovascular disease, myocardial infarction, and stroke using data from 3128 participants of the Framingham Heart Study who had their 50th birthday while enrolled in the study. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to disease, and disease to death) by categories of blood pressure level and adjusted by age, sex, and confounders. Irrespective of sex, 50-year-old hypertensives compared with normotensives had a shorter life expectancy, a shorter life expectancy free of cardiovascular disease, myocardial infarction, and stroke, and a longer life expectancy lived with these diseases. Normotensive men (22% of men) survived 7.2 years (95% confidence interval, 5.6 to 9.0) longer without cardiovascular disease compared with hypertensives and spent 2.1 (0.9 to 3.4) fewer years of life with cardiovascular disease. Similar differences were observed in women. Compared with hypertensives, total life expectancy was 5.1 and 4.9 years longer for normotensive men and women, respectively. Increased blood pressure in adulthood is associated with large reductions in life expectancy and more years lived with cardiovascular disease. This effect is larger than estimated previously and affects both sexes similarly. Our findings underline the tremendous importance of preventing high blood pressure and its consequences in the population.

Adult↗
PubMed2001

The interplay and etiological continuity of neuroticism, difficulties, and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life.

OBJECTIVE: Stressful life events, long-term difficulties, and high neuroticism are established risk factors for depression. Less is known about their role in late-life depression, how they modify or mediate one another's effects, and whether this differs between major and subsyndromal, first and recurrent episodes. METHOD: The authors used a prospective case-control design nested in a community survey of elderly subjects that included a measure of neuroticism. They compared 83 survey participants who subsequently developed a depressive episode with 83 randomly selected comparison participants. The authors determined dates of onset, history, and severity of episodes and dates of occurrence and severity of stressful life events and difficulties. RESULTS: Stressful life events did not mediate the effects of high neuroticism and difficulties at onset, possibly because of the uncontrollable nature of common stressful life events in later life. Without both high neuroticism and difficulties, stressful life events did not increase risk. High neuroticism and difficulties increased risk, even without a stressful life event. In the presence of high neuroticism and/or difficulties, the depressogenic effect of stressful life events was substantial, suggesting effect modification. The authors found no evidence to suggest etiological discontinuity between major and subsyndromal episodes. First and recurrent episodes showed a discontinuous pattern of associations. Severe stressful life events had weaker associations, but high neuroticism and mild stressful life events had stronger associations with recurrent than with first episodes. CONCLUSIONS: This study demonstrated the usefulness of a dynamic stress-vulnerability model for understanding late-life depression. Evidence was found suggesting etiological discontinuity between first and recurrent but not between major and subsyndromal episodes.

Aged↗
PubMed1997

[Evaluation of quality of life in oncology. Rationale and objectives of the first phase of the Quality of Life in Oncology project].

Although the subjective nature of quality of life perception is generally accepted, less attention has been paid to the procedure of selecting domains to be explored with questionnaires. In most cases domains are selected by panel of experts. It is not known whether these domains are relevant for the patients. Moreover, questionnaires developed in 'foreign' countries may not be culturally sound or relevant for patients living in different cultural background. In order to explore what really contributes to quality of life of Italian patients, a survey was conducted with the aim of identifying any dimension of quality of life, positively or negatively impacted on from the illness and therapies. A sample of two hundred and eighty eight cancer patients with previously specified characteristics (primary tumor, stage of disease and place of residence) were identified. After consenting to partecipate to the study, a staff member (a physician, a nurse or a psychologist) asked the patient to complete an open-ended questionnaire in the out-patient clinic or at home. This questionnaire, partially derived from a study by Padilla et al. made up of 5 questions: 'What does the term quality of life mean to you?', 'What contributes to a good quality of life?', 'What contributes to a poor or bad quality of life?', 'Which either physical or psychological symptom interferes with your quality of life?', 'State any positive or negative change in your quality of life, due to illness or treatments'. The first question was asked to explore the meaning of quality of life for the patient; the second and third question were asked to determine the contents of quality of life not health related; the fourth question and the diary provided information about quality of life contents related to his own experience of disease. Two hundred and forty eight questionnaires (86.1%) were obtained from 7 Cancer Centres participating to the study (Genova, Milano, Roma, Perugia, Napoli, Cagliari, Palermo). All the questionnaires were transcribed and subsequently broken down in phrases on a form that allowed coding. Three raters (a research nurse, an oncologist and a clinical psychologist) made the content analysis using as conceptual framework the list of domains identified by the Italian Society of Psycho-Oncology. The present study shows the possibility to define the content domain of quality of life attributes for cancer patients, using patients as experts.

Adolescent↗
PubMed1998

[Active life expectancy, life expectancy and ADL in Japanese elderly].

The purpose of the present Study is to analyze the incidence of loss of active life and death rates over a 36 month period in elderly people living a home, to attempt to determine relationships of index of ADL for bed ridden elderly to incidence and expectancies of active life loss, for life and active life. The definition of loss of activities was as follows: Long term (over six months) medication at home, long term (over six months) admission to hospital or intermediate institute for elderly, admission to nursing home or death. Subjects were 6,883 people living at home in Ogi, Sage prefecture, aged 70 years or older. A total of 6,753 people could be followed up for thirty six months, with 287 people having long term medication at home, 389 people having long term admission in hospital or intermediate institute for elderly, 45 people were admission to nursing home and of these groups defined as experiencing, 490 people were died of all subjects, 746 deaths were observed. The main results were as follows: (1) Annual mortality rate was 5.4% for males, 3.0% for females, and annual rate of active life loss was 7.1% for males, 6.0% for females. Life expectancy for the 70-74 year group was 13.7 years for male, 17.9 years for female, and active life expectancy for the 70-74 year group was 12.0 year for males, 13.9 years for females. The difference between life expectancy and active life expectancy was 1.7 years for male, 4.2 years for female, which can be considered the average length of term requiring care. (2) From the relation between scale of active daily living for the handicapped elderly and the life expectancies of life and active life by Cox proportional hazard model analysis of survival, controlling for age and sex, five categories of classification for active daily living for a handicapped elderly were developed: 1-very healthy with abilities for using transportation (train and bus); 2-abilities of moving in the neighborhood by oneself; 3-abilities of moving in the neighborhood with help; 4-Chair-bound, 5-Bed-bound.

Activities of Daily Living↗
PubMed2000

The association between early life lung function and wheezing during the first 2 yrs of life.

Reports have suggested that certain infants are predisposed to wheezing in the first 2 yrs of life due to abnormal lung function, prior to the first wheezing illness. The authors investigated the association between infant lung function and wheeze during the first 2 yrs of life. A cohort of 253 infants was evaluated. Respiratory function assessment was performed at 1, 6, and 12 months of age. Parental history of asthma, atopy, and maternal antenatal smoking habits were recorded. An infant was identified as having wheezed on the basis of parental report and, where possible, physician diagnosis. One hundred and sixty infants (63%) had complete diary and questionnaire information on wheeze available for analysis. Of these: 79 infants (50%) had never wheezed (NW) during the first 2 yrs of life and 81 had reported wheeze (W) (50%). Of those with a report of wheeze, the distribution through the first 2 yrs of life was; 28 during the first year of life only (Y1), 21 in the second year of life only (Y2), and 32 wheezed in both the first and second years of life (Y1&2). At the age of 1 month, prior to any lower respiratory illness, the W group had impaired lung function in comparison to the NW group. In Y1 infants, the neonatal lung function differences resolved by 12 months of age. In Y2 and Y1&2 infants lung function differences persisted throughout the first year of life. Prevalence of parental asthma and maternal antenatal smoking was increased in the W group p=0.001, p=0.008, respectively), in comparison to the NW infants. Maternal antenatal smoking prevalence was increased in the Y2 and Y1&2 infants in comparison to the NW group (p=0.04), (p=0.01), respectively. Wheezing during the first year of life is often a transient condition which improves with time. It appears to be related to early life reduced small airway calibre. Wheezing that begins or persists into the second year of life is usually associated with a different abnormality of the airways. Commencement or persistence of wheeze into the second year of life may be part of the clinical entity recognized as asthma.

Asthma↗
PubMed1991

Perceived quality of life and preferences for life-sustaining treatment in older adults.

We investigated whether perceived quality of life is associated with preferences for life-sustaining treatment for older adults. Participants included chronically ill, elderly outpatients (N = 258) and their primary physicians (N = 105). Patients and physicians were independently administered a questionnaire regarding patient quality of life and preferences for cardiopulmonary resuscitation and mechanical ventilation for the patient. Physicians rated patients' global quality of life, physical comfort, mobility, depression, anxiety, and family relationships significantly worse than did patients. Nearly all perceptions of patients' quality of life were significantly associated with physicians' perceptions, but not patients' treatment preferences. Patient-physician agreement on patient global quality of life was not significantly associated with agreement regarding treatment preferences. We conclude that primary physicians generally consider their older outpatients' quality of life to be worse than do the patients. Furthermore, physicians' estimations of patient quality of life are significantly associated with physicians' attitudes toward life-sustaining treatment for the patients. For the patients, however, perceived quality of life does not appear to be associated with their preferences for life-sustaining treatment.

Aged↗
PubMed2001

Self-report quality of life as a predictor of hospitalization for patients with LV dysfunction: a life course approach.

For this secondary data analysis of a large clinical drug study, researchers investigated the independent prognostic utility of self-report quality-of-life measures versus clinical measures for assessing patient risk for heart-failure-related hospitalization. The experience of heart failure varies over the life course; hence, four age groups were investigated. Quality-of-life measures, specifically health-related quality-of-life and psychosocial quality-of-life measures, were found to be independent and significant predictors of heart-failure-related hospitalizations, as compared to traditional clinical indicators. In addition, the psychosocial quality-of-life measure varied by age group in its importance as a predictor of hospitalization, suggesting differential relevance over the life course. Specifically, psychosocial quality of life was most strongly predictive of hospitalization for those ages 21-44, was less predictive for those ages 45-54, and was nonsignificant for those 55-64 years of age and those 65 and over. Including self-report quality-of-life measures provides a more complete picture of the factors associated with risk of hospitalization at different points in the life course for individuals with heart failure. These findings suggest that researchers and practitioners could use self-report quality-of-life measures as additional prognostic indicators of a patient's condition and risk for heart-failure-related hospitalization, especially for younger patients.

Activities of Daily Living↗
PubMed2002

Quality of life, life satisfaction, and spirituality: comparing outcomes between rehabilitation and cancer patients.

OBJECTIVE: To determine differences in quality of life, life satisfaction, and spirituality across different patient groups and to determine what factors may relate to these three outcomes across rehabilitation and cancer patients. DESIGN: Subjects were first stratified by five diagnostic groupings. Patient data were then regrouped for additional analytic purposes into two large cohorts. All subjects completed questionnaires once. Differences in scores and correlations were computed, and regression models were specified. RESULTS: Group differences were found across the quality of life measures used in the study. There were also differences in life satisfaction and spiritual well-being. Spirituality was found to be associated with both quality of life and life satisfaction, although it was not a significant predictor in a multivariate context. CONCLUSIONS: In general, subjects with prostate cancer reported higher scores across all measures. Spirituality showed a strong association with both life satisfaction and quality of life, and it was a significant predictor of life satisfaction among rehabilitation subjects. Factors such as age, marital status, and work status, in addition to specific dimensions of quality of life, such as social functioning and functional well-being, were found to be associated with total quality of life.

Amputation, Surgical↗