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[Educational status and life expectancy].

The article provides a foundation for the necessity of studying the social differentiation of mortality, in particular the influence of educational status and character of labour on length of life. It is indicated that higher indices of length of life are found among populations with high educational status and among people engaged in intellectual pursuits. The description is given of the methodological approaches to the construction of life expectancy tables according to the educational status and character of labour.

Adult↗

From cure to palliation: managing the transition.

When a child is diagnosed with a life-threatening or life-limiting condition, their physical and affective world is immediately changed, regardless of the outcome of treatment. Pediatric care providers are in a unique position to offer hope to children and families even when cure is not possible. This hope focuses not only on cure, but incorporates the understanding that quality of life is not commensurate with length of life and that compassionate care can be provided in all stages of treatment.

Attitude to Death↗

To resuscitate or not: a dilemma in terminal cancer care.

One of the difficult dilemmas in terminal care is the decision on whether to start or withhold cardiopulmonary resuscitation (CPR). Is this decision made on purely medical grounds, or is it also influenced by the physician's personal characteristics or education? The aim of this study was to look at factors affecting this decision. A questionnaire was sent out to a stratified sample of 1180 Finnish doctors. The response rate was 62%. The physicians were asked whether they would (a) start CPR or (b) withhold CPR in a scenario describing the unexpected death of a young terminal cancer patient. Data were also collected on demographics, post-graduate training, experience of terminal care, general life values and attitudes, and experiences of severe illness in the family. The proportion of surgeons, internists, GPs and oncologists who said they would have started CPR was 16, 10, 19 and 14%, respectively. Among physicians aged under 35 years, from 35 to 49 years and over 49 years, the proportions of physicians choosing active CPR were 29, 14 and 13%, respectively (P<0.001). As for those with personal experience of terminal care, 13% indicated they would have started CPR compared with 23% of those who had no experience (P<0.01). Those who made a decision in favour of CPR showed a significantly (P<0.001) more negative attitude to withdrawing life-sustaining treatment and valued length of life to a much greater extent (P<0.01).

Adult↗

Evidence-based medicine, utilities, and quality of life.

Evidence-based medicine provides the highest quality of information for medical practitioners. At the top of the pyramid of evidence-based medicine are the prospective, randomized clinical trials and meta-analysis. Evidence-based medicine can be incorporated with quality-of-life parameters; the latter can be quantified using utility theory. With utility theory, utility values range from 0.0 (death state) to 1.0 (perfect health state). The higher the utility value, the better a person's quality of life. Interventional treatment can change the utility level experienced by a patient. A change in utility value induced by an interventional treatment can be amalgamated with the duration of the treatment effect to provide the number of quality-adjusted life-years (QALYs) gained by a specific treatment (QALYs = [gain in utility value] x [duration of treatment effect]). Thus, this formula takes into account both the improvement in quality of life and the improvement in length of life gained by a treatment. The number of QALYs gained by a treatment can then be incorporated with medical costs (discounted for the time value of money) to arrive at a final common denominator of $/QALY (cost per QALY). The parameter $/QALY can be used to compare the cost-effectiveness of interventional treatments across diverse specialties in medicine. In essence, this methodology allows a measure of the cost-effectiveness of a treatment that incorporates the highest quality of scientific information, clinical efficacy, patient quality-of-life preferences, and realistic costs.

Aged↗

Benefit valuation in economic evaluation of cancer therapies. A systematic review of the published literature.

Generic measures of benefit which employ individuals' preferences, such as the quality-adjusted life-year (QALY), are, in principle, the most appropriate outcome measure to use in the economic evaluation of cancer therapies. They can reflect the trade-offs between health-related quality of life (HR-QOL) and length of life, between different dimensions of HR-QOL and between the process (e.g. convenience) and outcome characteristics of treatments. This paper reviews the methods literature on preference-based measures of benefit in economic evaluation, with the aim of establishing good practice for applied studies using these methods. A systematic review of applied economic evaluations of cancer therapies which have used these types of benefit measure was performed with the aim of establishing whether studies in this area adhere to good practice. In total, 29 studies were reviewed, and the results showed that, in general, good methods are not being adopted. This may be due, in part, to authors not having the space in journals to detail their methods fully, but it is likely also to reflect the fact that good methods for the use of preference-based measures of benefit in economic evaluation have not been adequately disseminated.

Cost-Benefit Analysis↗

Impact of type traits on functional herd life of Quebec Holsteins assessed by survival analysis.

Survival analysis was used to study the effects of composite and descriptive linear type traits on functional herd life of Quebec Holsteins. Functional herd life was defined as the length of life from first calving to death, culling, or censoring, and was adjusted for 305-d milk production. The dataset contained information from 331,105 cows from Quebec province calving for the first time between 1981 and 1995; 58% of the records had type information. Weibull models were fitted to analyze the data. The hazard function was described as the product of a baseline hazard function and the time-independent effects of age at first calving and type, and the time-dependent effects of year of calving, stage of lactation x lactation number, annual change in herd size, 305-d milk production, and herd-year (random). Analyses were done one at a time for each type trait. The strongest relationships between survival and composite type traits were found for final score, mammary system, and feet and legs. Among the linear type traits, the highest impact on functional herd life was found for traits related to the udder.

Animals↗

Hormonal therapy and genital tract cancer.

The use of hormonal replacement therapy following genital tract cancer is often denied to women because of the fear of increasing the risk of recurrence or new growth. The paucity of articles written on this subject during the past decade is an indication of the attitude of the medical profession to the needs of women suffering from symptoms of sex hormone deficiency. During 1994-1995 there were few articles published on the use of hormonal therapy to treat menopausal symptoms following genital tract cancer. Several articles, however, reviewed the relationship between hormones and genital tract cancer, some explored the value of antioestrogens in controlling recurrent or secondary disease, and a few others discussed the risk of developing uterine cancer when tamoxifen was used to manage postmenopausal breast cancer. Some suggestions are made that will allow women suffering from symptoms of hormone deficiency to receive alternative regimens of hormonal therapy. Maintaining quality of life without reducing the potential length of life is paramount in reaching a decision on the use of hormonal therapy following genital tract cancer.

Contraindications↗

Effect of abdominal compression on minute ventilation of patients with chronic obstructive lung disease and bronchial asthma.

The effects of manual compression of the upper lateral abdomen (C) of 73 cases of obstructive airway disease were studied in respect to the change in minute ventilation (V) 10 minutes after the procedure was performed. A mean decrease of 13% in V was found in the majority of 15 cases of bronchial asthma or chronic bronchitis and 43 patients with chronic obstructive lung disease. The use of manual compression as a therapeutic measure depends largely on the abrupt reduction of lung volume in cases of obstructive airway disease in which over-inflation of the lung is present as an acute or chronic disorder. The degree and duration of clinical benefit, i.e., relief of dyspnea, depends on such factors as the volume of air trapped in the lungs, broncho-constriction through pathologic change or bronchospasm and impairment of elastic recoil of the pulmonary parenchyma. The lowered V recorded 10 minutes after C is performed suggests that decrease in dyspnea is associated with enhanced efficiency of ventilation in some subjects with obstructive airway disease, including those with bronchial asthma as well as COLD. A brief description is presented of 10 patients with COLD in whom manual compression and other features of a rehabilitation program were employed. Mean length of life of five living subjects is 12.6 years after beginning of therapy. The mean length of life of five who died was 10.2 years after beginning of treatment.

Abdomen↗

Life expectancy with cognitive impairment in the older population of the United States.

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated. METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment. RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy. DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

Aged↗

Family relationships, social support and subjective life expectancy.

Do supportive personal relationships increase subjective life expectancy? The objective existence of family relationships and the subjective sense of having someone to call on in need may increase the length of life a person expects by creating assurance about the future, by reinforcing healthy habits, and by improving current health. Using the 1995 Aging, Status, and Sense of Control representative sample of 2,037 Americans ages 18-95, we find that having adult children and surviving parents increases the length of life one expects, but young children in the home does not, and marriage only contributes years of life expected for older men. People expect to live longer when they report high levels of emotional support, and the association is mediated entirely by the perception that one has someone to call on when one is sick. People with informal health support expect to live longer than those without it, and this is especially true for persons with physical impairments. Although informal health practices shape subjective life expectancy, they explain little of the effects of supportive relationships. People who smoke, drink heavily, and have poor nutritional habits expect shorter lives, and those who walk and exercise expect longer lives. Better current health is associated with higher subjective life expectancy, but it does not explain the impact of supportive relationships. Most of the impact of supportive relationships appears to be a direct result of projected security about the future. Feeling that you have someone who would care for you if sick appears to increase the sense of security about surviving future health crises, thereby increasing one's perceived inventory of the essential property--life itself.

Adolescent↗

Hip axis length in mid-life Japanese and Caucasian U.S. residents: no evidence for an ethnic difference.

The rate of hip fracture in Japanese women is approximately 50% lower than that of Caucasian women. Shorter hip axis length (HAL) in Japanese women is one possible explanation underlying the observed ethnic difference in fracture risk. We measured HAL in a community-based sample of Japanese (n=267) and Caucasian (n=199) women, aged 46 years on average, residing in Los Angeles, California. We hypothesized that HAL would be shorter in the Japanese women compared with the Caucasian women, and that this ethnic difference would persist after height adjustment. Unadjusted mean HAL was 101.45 mm in Japanese women and 105.98 mm in Caucasians (p<0.0001). Average height-adjusted HAL was 103.24 and 103.58 mm in Japanese and Caucasians, respectively (p=0.52). The relation between HAL and height was linear across the range of values observed in each ethnicity. Results were similar in analyses that compared Caucasians to Japanese women born in the US (n=142) or outside the US (n=125). We conclude that there was no Japanese-Caucasian difference in height-adjusted HAL in our study sample.

Adult↗

[Evolution of the member population of the French Academy of Medicine].

This survey includes all the 843 members of the French Academy of Medicine elected over the last 150 years (1850-1999). Various variables are analysed, namely the age at election, the length of life and the duration of membership. The main trends observed during the 20th century are the following. 1. A regular increase in the length of life (about 20 years), greater than in the overall French population. 2. A rising in the mean age at election until 1970 and a stabilisation afterwards. 3. A steady increase of the mean age of the population of members. Some projections are also developed for the next 25 years, based on various hypotheses: 1. A continuation of the current trends, taking only into account the foreseeable lengthening of life; this makes the difficulties observed during the last two decades becoming more acute; 2. The introduction of new rules such as a decrease in the mean age at election, or the settling of an upper age limit for regular membership (giving access to an Emeritus status). These measures induce a decrease of the mean age of the population, less or more intense. Some of the assumptions may also have a negative effect, by reducing the turnover rate.

Academies and Institutes↗

INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial--a prospective, multicenter, European randomized trial.

PURPOSE: This study describes the design of an ongoing randomized trial initiated to compare the 2-year outcome of uncomplicated type B aortic dissection when treated by endovascular implantation of a Medtronic Talent stent graft adjunctive to best medical treatment versus best medical treatment alone. METHODS: Patients older than 18 years with type B aortic dissection as diagnosed by computed tomography or magnetic resonance angiography are randomized to either a thoracic aortic endoprosthesis and antihypertensive treatment, called "stent grafting," or a tailored antihypertensive treatment, called "medical treatment." Only patients in a clinically stable condition and without spontaneous thrombosis of the false lumen after 14 days of the index dissection are considered eligible for study inclusion. RESULTS: Primary outcome measure is all-cause mortality. Secondary outcome variables include conversion to stent and/or surgery, induced thrombosis of the false lumen, cardiovascular morbidity, aortic expansion (>5 mm/y of maximum diameter including true and false lumina), quality of life, and length of intensive care unit and hospital stay. The study design calls for 136 patients to be randomized and monitored for 24 months. CONCLUSIONS: The INSTEAD trial is the first randomized trial investigating the role of endoluminal treatment of uncomplicated type B aortic dissection. By the end of December 2004, 125 patients were randomized, accounting for 92% of the target. Final results of the INSTEAD trial should be available in 2006.

Aged↗

Hormonal factors and melanoma in women.

The effect of exogenous hormones and reproductive factors on the risk of melanoma in women was investigated in a case-control study. Data from 91 women, aged from 15 to 81 years, and 91 matched controls were analysed in relation to use of oral contraceptives (OC), parity, age at the birth of the first child, and calculated length of ovulatory life. When potential confounding factors (including pigmentary characteristics and the lifetime exposure to sunlight were taken into account, there was no increase in risk of melanoma in relation to OC use, parity, or age at the birth of the first child. An unexplained association between melanoma and ovulatory life of greater length than 20 years was observed. The general findings of this study suggest that neither hormonal nor reproductive factors increase the risk of melanoma in women.

Adolescent↗

Quality of life--economic aspects.

The interest for quality of life assessments in health care has grown during recent years. From the economist's point of view, quality of life is an appropriate outcome measure in economic assessments of health care as a tool in priority settings. In quality adjusted life-years (QALYs) improvements in the length of life and in its quality are amalgamated into one single index. Different types of medical interventions can be compared by calculations of costs per gained QALY. Unsolved problems still remain with QALYs but with scarce resources within the health care sector measures like QALYs provide a powerful guidance in priority settings.

Cost Allocation↗

The fates of Czechoslovak contestants in Olympic games.

Since the Second Olympic Games of the new era up to the Games in 1988 on the whole 2031 Czechoslovak competitors participated in both Summer and Winter Games. The author succeeded in compiling items on the length of life and causes of decease of 265 Olympic participants who died up to the end of 1989. The study of those items revealed that the length of living of those athletes who died in the period 1950 till 1989 was 67.4 years. That indice may be compared with men in population with a mean length of life 67.7 years in 1988. It is however necessary to take into consideration that the studied sample of Olympic competitors represents a certain selection of men. The causes of natural death of Olympic competitors do not differ in principle from natural deceases of other former Czechoslovak athletes and also no expressive differences were found in comparison with natural causes of death of men in population.

Aged↗

Relationship of head circumference to length in the first 400 days of life: a mnemonic.

The relationship between length and head circumference can be expressed by the simplified formula: head circumference (centimeters) = 0.5 length +9.5 +/- 2.5; head circumference (inches) = 0.5 length + 3.75 +/- 1. This formula is accurate for 95% of measurements in the first 400 days of life. The correlation coefficient of length to head circumference is .94 (P = .0001).

Body Height↗

Life span, morphology, and pathology of diet-restricted germ-free and conventional Lobund-Wistar rats.

The effect of germ-free life and dietary restriction (DR) on life span and pathology was investigated in isolator housed germ-free (GF) and conventional (CV) Lobund-Wistar rats fed either ad libitum or restricted to 12 grams per day (70% of adult ad libitum intake) of a natural ingredient diet from weaning. The median length of life of ad libitum CV and GF rats was 31.0 and 33.6 months respectively, while DR increased the median length of life of CV and GF rats to 38.6 and 37.8 months respectively. DR reduced the frequency or postponed the occurrence of diseases which eventually lead to death in the Lobund-Wistar rat. This was especially true of prostate adenocarcinoma, prostatitis, and mammary fibroma. The reduced early food intake and smaller body weight of adult GF rats may be the reason ad libitum fed GF rats live slightly longer than their CV counterparts, but GF life was without additional effect on life span when food intake was restricted.

Adrenal Gland Neoplasms↗