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PubMed2000

Postmenopausal hormone therapy: less favourable risk-benefit ratios in healthy Dutch women.

OBJECTIVES: To estimate the health effects of postmenopausal hormone therapy used for 10 or 20 years in a population of intermediate cardiovascular risk. DESIGN: Using existing estimates of the effect of hormone therapy on rates of myocardial infarction, hip fracture and breast cancer, a proportional multistage life table was generated to calculate the effects of use for 10 and 20 years in a synthetic cohort of Dutch women aged 55 with an average and a high-risk profile for cardiovascular disease. RESULTS: A woman of the general population who starts hormone therapy at age 55 for 10 years can prolong her life by 1 month and may postpone the occurrence of first incidence of one of the diseases under consideration by 2.4 months. One excess breast cancer case is likely to occur per 5-6 averted cases of first myocardial infarction or hip fracture. If she prolongs her use to 20 years, the gain of life expectancy and disease-free life expectancy is doubled. The risk-benefit ratio worsens to one extra breast cancer per 3-4 averted cases of the preventable diseases. For a woman with a high-risk profile, the gains in health are about twice as high as for her counterpart in the general population, and her risk-benefit ratio is also more favourable. Yet, the risk-benefit ratio still worsens for 20 as compared with 10 years of use. CONCLUSIONS: Women from the general population in the Netherlands and similar populations can achieve only a modest gain in life expectancy by using hormones during 10 or 20 years following menopause. This is a consequence of the low incidence of myocardial infarction and hip fracture and the relatively high incidence of breast cancer before the age of 75. Women at increased cardiovascular risk can benefit more from hormone therapy. But even amongst these women, the risk of breast cancer incurred with long-term use offsets much of the benefit that could accrue from changing the risk of heart disease and hip fracture.

Aged↗
PubMed2003

Cost-effectiveness of photodynamic therapy for treatment of Barrett's esophagus with high grade dysplasia.

The purpose of this study was to compare the effectiveness and cost-effectiveness of photodynamic therapy (PDT) versus surgical esophagectomy and intensive endoscopic surveillance for patients with Barrett's esophagus and high-grade dysplasia (HGD) who are operative candidates. The results of our Markov Monte Carlo model show that PDT increased life expectancy by 1.8 years and quality-adjusted life expectancy (QALE) by 1.65 years when compared to the surveillance strategy. Relative to the esophagectomy strategy, PDT resulted in a greater life expectancy by 0.8 years and 2.17 additional quality-adjusted life years (QALYs). Although PDT cost 20,400 dollars and 7,100 dollars more than surveillance and esophagectomy respectively, the resulting incremental cost-effective ratios (ICERs) of 12,400 dollars/QALY and 3,300 dollars/QALY are within commonly accepted values. These findings were sensitive to the value assigned to the quality of life after PDT, but only at unrealistic values. In conclusion, PDT increases life expectancy and is cost-effective when compared to endoscopic surveillance and surgical esophagectomy.

Barrett Esophagus↗
PubMed2005

Health expectancy in Denmark, 1987-2000.

BACKGROUND: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. METHODS: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method. RESULTS: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. CONCLUSION: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. KEY POINTS: Health expectancy expresses average lifetime in various states of health. The study examines changes in expected lifetime in selfrated good health, lifetime without longstanding illness and lifetime without longterm disability. Among 65-year-olds the percentage of disabilityfree life expectancy increased from 63.4% to 74.9% for men and from 55.6% to 61.0% for women between 1987 and 2000. Health status among elderly Danes has apparently improved, but secular trends in health expectancy depend on the choice of health indicator.

Adult↗
PubMed2001

Ten years of life: Is it a matter of choice?

BACKGROUND: Relative risk estimates suggest that effective implementation of behaviors commonly advocated in preventive medicine should increase life expectancy, although there is little direct evidence. OBJECTIVE: To test the hypothesis that choices regarding diet, exercise, and smoking influence life expectancy. METHODS: A total of 34 192 California Seventh-Day Adventists (75% of those eligible) were enrolled in a cohort and followed up from 1976 to 1988. A mailed questionnaire provided dietary and other exposure information at study baseline. Mortality for all subjects was ascertained by matching to state death tapes and the National Death Index. RESULTS: California Adventists have higher life expectancies at the age of 30 years than other white Californians by 7.28 years (95% confidence interval, 6.59-7.97 years) in men and by 4.42 years (95% confidence interval, 3.96-4.88 years) in women, giving them perhaps the highest life expectancy of any formally described population. Commonly observed combinations of diet, exercise, body mass index, past smoking habits, and hormone replacement therapy (in women) can account for differences of up to 10 years of life expectancy among Adventists. A comparison of life expectancy when these factors take high-risk compared with low-risk values shows independent effects that vary between 1.06 and 2.74 years for different variables. The effect of each variable is assessed with all others at either medium- or high-risk levels. CONCLUSIONS: Choices regarding diet, exercise, cigarette smoking, body weight, and hormone replacement therapy, in combination, appear to change life expectancy by many years. The longevity experience of Adventists probably demonstrates the beneficial effects of more optimal behaviors.

Adult↗
PubMed1997

Poverty and mortality among the elderly: measurement of performance in 33 countries 1960-92.

This paper analyses the effect of income and education on life expectancy and mortality rates among the elderly in 33 countries for the period 1960-92 and assesses how that relationship has changed over time as a result of technical progress. Our outcome variables are life expectancy at age 60 and the probability of dying between age 60 and age 80 for both males and females. The data are from vital-registration based life tables published by national statistical offices for several years during this period. We estimate regressions with determinants that include GDP per capita (adjusted for purchasing power), education and time (as a proxy for technical progress). As the available measure of education failed to account for variation in life expectancy or mortality at age 60, our reported analyses focus on a simplified model with only income and time as predictors. The results indicate that, controlling for income, mortality rates among the elderly have declined considerably over the past three decades. We also find that poverty (as measured by low average income levels) explains some of the variation in both life expectancy at age 60 and mortality rates among the elderly across the countries in the sample. The explained amount of variation is more substantial for females than for males. While poverty does adversely affect mortality rates among the elderly (and the strength of this effect is estimated to be increasing over time), technical progress appears far more important in the period following 1960. Predicted female life expectancy (at age 60) in 1960 at the mean income level in 1960 was, for example 18.8 years; income growth to 1992 increased this by an estimated 0.7 years, whereas technical progress increased it by 2.0 years. We then use the estimated regression results to compare country performance on life expectancy of the elderly, controlling for levels of poverty (or income), and to assess how performance has varied over time. High performing countries, on female life expectancy at age 60, for the period around 1990, included Chile (1.0 years longer life expectancy), China (1.7 years longer), France (2.0 years longer), Japan (1.9 years longer), and Switzerland (1.3 years longer). Poorly performing countries included Denmark (1.1 years shorter life expectancy than predicted from income), Hungary (1.4 years shorter), Iceland (1.2 years shorter), Malaysia (1.6 years shorter), and Trinidad and Tobago (3.9 years shorter). Chile and Switzerland registered major improvements in relative performance over this period; Norway, Taiwan and the USA, in contrast showed major declines in performance between 1980 and the early 1990s.

Aged↗
PubMed2004

[Effect of temperature and food concentration on the population dynamics of three Brachionus calyciflorus strains].

Effects of temperature (20 degrees C, 25 degrees C, 30 degrees C) and food concentration (1.5, 3.0, 6.0, 9.0 x 10(6) cells x ml(-1)) on the population dynamics of Brachionus calyciflorus of Qingdao, Wuhu and Guangzhou strains were studied by means of individual culture. The result showed that the temperature was an important factor affecting generation time and intrinsic rate of population increase. With rising of temperature, the intrinsic rate of population increase increased, but generation time decreased. There were significant effects of food concentration on life expectancy and average lifespan. The effect of strain on net reproductive rate, generation time, life expectancy and average lifespan was also significant. Net reproductive rate, generation time, life expectancy, and average lifespan of Guangzhou strain was all the maximum, and that of Wuhu strain minimum among the three strains. The rotifers fed on the algae at the concentration of 3.0 x 10(6) cells x ml(-1) had the longest life expectancy and average lifespan, but those at 9.0 x 10(6) cells x ml(-1) had the shortest. Net reproductive rate, generation time, gross reproductive rate, life expectancy, and average lifespan of the three strains decreased linearly with the rise of temperature, except for the net reproductive rate of Guangzhou strain, while the intrinsic rate of population increase of all the three strains and gross reproductive rate of Guangzhou strain increased linearly with the rise of temperature. The relationships between all the life history parameters of Qingdao and Guangzhou strains and food concentration were all curvilinear, however, those between generation time, average lifespan, and life expectancy of Wuhu strain and food concentration could all be described by linear regression.

Animals↗
PubMed1996

The elimination of selected chronic diseases in a population: the compression and expansion of morbidity.

OBJECTIVES: This study evaluates the effect of eliminating a specific disease on the mortality, long-term disability, and overall health status of a population. Primarily, it examines whether elimination leads to a compression of morbidity. METHODS: The Sullivan method was used to calculate disability-free life expectancy. Cause-deleted disability prevalence was estimated with a multiple logistic regression model that used data from the Dutch National Survey of General Practice. Cause-deleted probabilities of dying were derived with the cause-elimination life-table technique, assuming independence among competing causes of death. RESULTS: Eliminating disabling nonfatal diseases such as arthritis/back complaints results in a decline in life expectancy with disability--that is, an absolute compression of morbidity. Eliminating highly fatal diseases such as cancer leads to an increase in the number of years and the proportion of life with disability--that is, a relative expansion of morbidity. CONCLUSIONS: While eliminating fatal diseases leads to an increase in disability-free life expectancy, life expectancy with disability may increase as well. This represents an increasing burden to society. On the other hand, eliminating nonfatal disabling diseases leads to absolute compression of morbidity.

Adolescent↗
PubMed1991

Hydrogen peroxide production by mitochondria may be a biomarker of aging.

The hypothesis that rate of intracellular prooxidant production is associated with the rate of aging was tested by comparing the rate of H2O2 generation by mitochondria in houseflies of similar chronological but different physiological ages. Physiological age represents the life expectancy or 'nearness to death'. Average and maximum life spans of flies were extended 2-fold by the elimination of flying activity. In addition, using senescence-related loss of flight ability as a phenotypic marker of impending death, relatively short-lived and long-lived subpopulations of flies were isolated from cohort populations. Rate of H2O2 generation was measured fluorometrically in mitochondria from thoracic flight muscles using alpha-glycerophosphate as a substrate and without employing any respiratory inhibitors as is often the case in mammalian studies. The rate of mitochondrial H2O2 release was found to be associated with life expectancy or the physiological age of flies rather than the chronological age. At the same chronological age, mitochondria from flies with a shorter life expectancy had a markedly higher rate of H2O2 generation than those with a longer life expectancy. Results of this and some previous studies in this laboratory are interpreted to suggest that the rate of prooxidant generation rather than the level of antioxidant defenses may be a key correlate of the rate of aging.

Aging↗
PubMed1995

[Causes of adult mortality in developing and developed countries with low mortality rates].

"In a certain number of developing countries, life expectancy levels now approach those of the developed world. But, though life expectancies at birth may be similar, the infant mortality rate in developing countries remains higher, but is compensated by a lower rate of mortality for adults. Is it to be expected that as infant mortality rates continue to decline, the developing countries will maintain their advantageous adult mortality rates and that life expectancy will forge ahead of the level achieved in developed countries?... To answer this question, recent trends in adult cause-specific mortality rates in four developing countries (Chile, Hong Kong, Mexico, and Costa Rica) were compared with those in three industrialized countries (France, Germany and Japan). The results were inconclusive. Whilst life expectancies in some of these countries may be expected to forge ahead (Chile, Hong Kong), in others the margin between their life expectancies and those of developed countries have already narrowed." (SUMMARY IN ENG)

Adult↗
PubMed1992

Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk.

OBJECTIVE: To estimate the occupational risk from infection with the human immunodeficiency virus (HIV) in terms of loss of (quality-adjusted) life expectancy, and to compare that risk to those posed by other hazards faced by health care workers. DESIGN: Decision-analytic model. RESULTS: For a 30-year-old female health care worker (unvaccinated for hepatitis B virus [HBV]), the loss of life expectancy from a needlestick from a symptomatic HIV-positive (HIV+) patient is 39 days (range, 17 to 93 days), as compared with a loss of 17 days from a needlestick from a patient who is hepatitis-B-surface-antigen-positive (HBsAg+), and 38 days from a needlestick from a patient who is hepatitis-B-e-antigen-positive (HBeAg+). When morbidity is included in the analysis of risk (through calculation of the quality-adjusted loss of life expectancy), the risk from both HBV and HIV increases. The quality-adjusted loss of life expectancy due to a needlestick exposure from a symptomatic HIV+ patient is 45 days (range, 20 to 108 days), as compared with a quality-adjusted loss of life expectancy of 48 days from a needlestick from an HBsAg+ patient, and 109 days from a needlestick from a patient who is known to be HBeAg+. By comparison, a cross-country automobile trip is associated with a loss of life expectancy of approximately 1 day. The 45- to 50-day loss of quality-adjusted life expectancy from percutaneous exposures to HIV and HBV is approximately the same magnitude as the gain in life expectancy from 10 years of annual screening for breast cancer with mammography and physical examination. CONCLUSIONS: The risk associated with percutaneous exposures to symptomatic HIV+ patients is comparable to other risks that health care workers have faced knowingly and have accepted in the recent past. However, the loss of quality-adjusted life expectancy associated with a needlestick exposure is significant. Identification of cost-effective methods that increase the safety of medical personnel but also ensure full access to high-quality care for HIV+ patients should be a high priority.

Acquired Immunodeficiency Syndrome↗
PubMed1994

A guide for surveillance of patients with Barrett's esophagus.

OBJECTIVE: Barrett's esophagus (columnar metaplasia of the distal esophagus due to chronic gastroesophageal reflux) affects nearly 700,000 people in the United States, and carries a risk of esophageal adenocarcinoma that is 30-125 times that of an age-matched population. Patients who develop high grade dysplasia are at greatest risk. Current recommendations are for endoscopic surveillance to detect dysplasia and to diagnose carcinoma while it is in an early and possibly treatable stage. In addition, some authorities recommend esophagectomy for high grade dysplasia, whereas others reserve esophagectomy only for those with cancer. There are no controlled trials demonstrating that surveillance increases life expectancy in patients with Barrett's esophagus. Furthermore, endoscopic surveillance of this large group with Barrett's esophagus may be costly, and associated with considerable morbidity. Therefore, our objective was to assess the effectiveness and cost-effectiveness of endoscopic surveillance in patients with Barrett's esophagus. METHODS: Design--Decision analysis using a computer cohort simulation (Markov). We examined 12 strategies: (A) no endoscopic surveillance. Esophagectomy is performed only if cancer is detected by biopsy. (B) no surveillance. Esophagectomy is performed if high grade dysplasia is detected by biopsy: (C1-C5) surveillance at intervals from 1 to 5 yr, with esophagectomy if cancer is diagnosed, and (D1-D5) surveillance at intervals from 1 to 5 yr with esophagectomy if high grade dysplasia is diagnosed. We measured life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness ratios for each strategy. Data Sources--Medline Search and bibliographies of retrieved articles; expert opinion when published data were not available. RESULTS AND CONCLUSIONS: Annual surveillance with esophagectomy for high grade dysplasia prevents cancer and is the preferred strategy, if only length of life (life expectancy) is considered. For those who consider both length and quality of life, endoscopy every 2-3 yr will provide the greatest quality-adjusted life expectancy. When costs are considered, endoscopy every 5 yr also increases life expectancy and has an incremental cost-effectiveness ratio similar to common medical practices. The cumulative incidence of cancer and the quality of life with an esophagectomy had the greatest impact on the decision for surveillance and the optimal surveillance strategy.

Adenocarcinoma↗
PubMed2003

Relative and absolute gender gap in all-cause mortality in Europe and the contribution of smoking.

This paper examined whether international variations in absolute and relative gender differences in mortality are related to the overall mortality rates, and whether the international variation in gender gap in mortality can in part be explained by smoking. I used data on mortality from all causes in 32 European countries published by the World Health Organisation, and indirect estimates of mortality attributable to smoking in the age band 35-69 years by Peto et al. The main analyses were restricted to the age band 35-69 years but results for mortality at all ages were virtually identical. The overall mortality rates (both sexes combined) were strongly related to absolute gender differences (r = 0.91) but only weakly to relative differences (r = 0.35). The gender gap was larger in eastern than in western Europe for rate differences (1005 vs. 530 per 100,000, respectively), but it was similar for rate ratios (2.3 vs. 2.1, respectively). Both absolute and relative gender differences in mortality were strongly related to the difference between men and women in the proportion of all deaths attributed to tobacco (partial correlations, after controlling for the overall death rates, were 0.59 and 0.66, respectively). Excluding tobacco-related deaths attenuated the associations between the overall mortality rates with absolute differences (r = 0.70) and reduced the difference in the absolute gender gap between eastern and western Europe. More importantly, excluding tobacco-related deaths eliminated entirely the association with relative differences (r = -0.15) as well as any suggestion that the relative gender gap is larger in eastern than in western Europe. These results show that tobacco plays an important role in generating international differences in the size of gender gap in mortality. The much discussed association between' the overall life expectancy and the gender gap in life expectancy is a numerical product of absolute death rates (differences in life expectancy are driven by differences in rates). The association of overall mortality with male/female mortality ratios is much weaker.

Adult↗
PubMed2002

Multiple stressors in Caenorhabditis elegans induce stress hormesis and extended longevity.

We demonstrate here that the nematode Caenorhabditis elegans displays broad hormetic abilities. Hormesis is the induction of beneficial effects by exposure to low doses of otherwise harmful chemical or physical agents. Heat as well as pretreatment with hyperbaric oxygen or juglone (a chemical that generates reactive oxygen species) significantly increased subsequent resistance to the same challenge. Cross-tolerance between juglone and oxygen was also observed. The same heat or oxygen pretreatment regimens that induced subsequent stress resistance also increased life expectancy and maximum life span of populations undergoing normal aging. Pretreatment with ultraviolet or ionizing radiation did not promote subsequent resistance or increased longevity. In dose-response studies, induced thermotolerance paralleled the induced increase in life expectancy, which is consistent with a common origin.

Adaptation, Physiological↗
PubMed1996

Trends in prostate cancer survival in Sweden, 1960 through 1988: evidence of increasing diagnosis of nonlethal tumors.

BACKGROUND: The incidence of prostate cancer has increased during the past 30 years but has been paralleled by increases in survival rates from this disease, despite the absence of documented major improvement in curative treatment. Since a high prevalence of microscopic prostate cancer has been observed in autopsied men and because many prostate cancers may never surface clinically, increased diagnostic activities might have led to increased detection of less aggressive tumors. PURPOSE: This study was conducted to elucidate whether the trends in prostate cancer incidence and patient survival may be due to increasing diagnoses of nonlethal tumors. METHODS: We analyzed a population-based cohort comprising all cases of prostate cancer (n = 80,901) detected in Sweden during the period of 1960 through 1988. Five hundred eighteen patients (0.64% of the total number) who could not be followed because of emigration or an incomplete national registration number were excluded. Observed and relative survival rates were calculated for the entire cohort of 80,383 assessable patients per 5-year age group in 5-year periods of diagnosis and according to diagnostic method and were compared between geographic areas with differences in incidence rates. To estimate the independent effects of these determinants, multivariate analyses were performed. RESULTS: For the 80,383 patients with complete follow-up, the 10- and 20-year observed survival rates were 17.5% (95% confidence interval [CI] = 17.2%-17.9%) and 3.5% (95% CI = 3.2%-3.7%), and the relative survival rates were 41.1% (95% CI = 40.3%-41.9%) and 28.6% (95% CI = 26.5%-30.1%), respectively. Relative survival rates improved markedly over time; 10-year relative survival rates increased from 29% (95% CI = 27%-31%) among case patients diagnosed in 1960 through 1964 to 45% (95% CI = 43%-46%) among those diagnosed in 1975 through 1979. Relative survival rates leveled off after about 18 years at 18% (95% CI = 15%-20%) among patients diagnosed in 1960 through 1964 and at 31% (95% CI = 28%-34%) among those diagnosed in 1970 through 1974. An even more favorable outlook was observed in those case patients diagnosed later. In areas with a high or low incidence of prostate cancer, the 10-year relative survival rates were 45% (95% CI = 44%-47%) and 36% (95% CI = 34%-38%), respectively. In the early 1960s, the calculated loss of life expectancy after diagnosis varied from about 68% (95% CI = 61%-75%) of the expected length of life in the youngest age group to about 48% (95% CI = 46%-50%) in the oldest age group. From 1960 through 1964 to 1985 through 1988, the loss of life expectancy decreased by more than 50% in all age groups. The differences in relative survival rates between age groups were small, with a gradual decrease in age groups more than 60-64 years of age. CONCLUSIONS: Most of the great temporal improvement and geographic variation in survival rates are quantitatively consistent, with likely increases in the rate of detection of nonlethal tumors. IMPLICATIONS: The increase in relative survival rates must be taken into consideration when evaluating the outcome of treatment of prostate cancer, since nonrandomized comparisons may be confounded by time trends. Diagnosis of nonlethal tumors raises concerns because the individual would suffer from the psychologic burden of a cancer diagnosis without any therapeutic benefit.

Age Distribution↗
PubMed2004

No evidence for a genetic relationship between Alzheimer's disease and longevity.

OBJECTIVE: Late onset Alzheimer's disease (AD) is frequent in subjects who have reached an age above the average life expectancy. AD and life expectancy are both influenced by genetic factors. Consequently, a possible genetic relationship between AD and longevity was investigated using family study data. METHODS: First-degree relatives of patients with AD (n = 645) and of non-demented controls (n = 1,106) were examined by direct interview or by family history in the case of already deceased or unavailable subjects. Survival of subjects with an assumed familial load for AD (i.e. first-degree relatives of AD patients) and of controls was compared using the Kaplan-Meier analysis and log-rank statistics. RESULTS: Relatives with AD reached higher ages than other family members. However, there was no significant co-aggregation of AD and longevity in first-degree relatives of AD patients in comparison with those of controls. This applied to all diseased as well as non-demented relatives. CONCLUSIONS: Longevity is an independent prerequisite for the development of the disease, but is not genetically related to AD. The apparent longevity in relatives with AD is likely to result from the selection of subjects fulfilling this prerequisite.

Age Factors↗
PubMed2004

Physical health monitoring of patients with schizophrenia.

OBJECTIVE: Schizophrenia is associated with several chronic physical illnesses and a shorter life expectancy, compared with life expectancy in the general population. One approach to improving the health of patients with schizophrenia is to improve the monitoring of physical health that occurs in psychiatric settings. The authors discuss a consensus panel's recommendations for improving the physical health monitoring of patients with schizophrenia who are treated in outpatient settings. METHOD: A consensus meeting including psychiatric and other medical experts assembled on October 17-18, 2002, to evaluate the existing literature and to develop recommendations for physical health monitoring of patients with schizophrenia. Conference participants reviewed the literature in the following areas: 1) weight gain and obesity; 2) diabetes; 3) hyperlipidemia; 4) prolongation of the QT interval on the ECG; 5) prolactin elevation and related sexual side effects; 6) extrapyramidal side effects, akathisia, and tardive dyskinesia; 7) cataracts; and 8) myocarditis. Experts for each topic area formulated monitoring recommendations that were discussed by all of the participants until a consensus was reached. RESULTS: Consensus recommendations included regular monitoring of body mass index, plasma glucose level, lipid profiles, and signs of prolactin elevation or sexual dysfunction. Information from monitoring should guide the selection of antipsychotic agents. Specific recommendations were made for cardiac monitoring of patients who receive medications associated with QT interval prolongation, including thioridazine, mesoridazine, and ziprasidone, and for monitoring for signs of myocarditis in patients treated with clozapine. Patients who receive both first- and second-generation antipsychotic medications should be examined for extrapyramidal symptoms and tardive dyskinesia. Patients with schizophrenia should receive regular visual examinations. CONCLUSIONS: The conference participants recommended that mental health care providers perform physical health monitoring that typically occurs in primary care settings for their patients who do not receive physical health monitoring in those settings. This change in usual practice is recommended on the basis of the conference participants' belief that this additional monitoring will result in the earlier detection of common, serious risk factors that could, without detection and intervention, contribute to impaired health of patients with schizophrenia.

Adult↗
PubMed1994

[Decrease in the expectation of life at birth in the Netherlands during 1993].

"With a few [exceptions] the age-specific mortality quotients based on observations during 1993 [in the Netherlands] were higher than the 1992-based ones. The increase is strongest in the lower and the higher ages.... It can be shown that the most important contributors to the decrease of the expectation of life at birth for boys was due to increased mortality quotients in the age groups 55 1/2-60 1/2 years or over. For girls the age groups 65 1/2-70 1/2 or over are most important." (SUMMARY IN ENG)

Age Factors↗