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Results for “Life Expectancy--changes”

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PubMed2003

Measuring the side effects of taxane therapy in oncology: the functional assesment of cancer therapy-taxane (FACT-taxane).

BACKGROUND: Cancer chemotherapy with some of the taxane class of agents can be associated with significant neurotoxicity, arthralgias, myalgias, and skin changes that may offset the therapeutic benefits of taxane use. METHODS: The authors developed and tested a set of questions to assess these important side effects of taxane therapy from the patient's perspective. The current study evaluated the taxane subscale of the Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. Reliability, validity, and responsiveness to expected change were evaluated in the context of an ongoing clinical trial comparing four cycles of carboplatin plus paclitaxel with a strategy of carboplatin plus paclitaxel until disease progression in patients with advanced nonsmall cell lung carcinoma (NSCLC). RESULTS: The 16-item Taxane subscale score and the 11-item peripheral neuropathy subset both demonstrated excellent internal consistency and concurrent validity, and the scores worsened as one would predict during a 12-week treatment course of taxane therapy. Results of the psychometric analyses supported the use of this subscale for measuring the unwanted adverse consequences of effective cancer therapies. Measuring the patient perception of treatment side effects also allowed a preliminary exploration of the relative quality of life (QOL) impact of symptom relief and treatment toxicity. The results indicated that toxicity and symptom improvement may make relatively equivalent contributions to total QOL as measured by the summary score from a multidimensional QOL instrument, the Functional Assessment of Cancer Therapy-General. However, symptom status and improvement appear to play a stronger role than taxane toxicity in patients' global rating of their QOL. CONCLUSIONS: Future research might examine this question of competing benefits as a potential aid to decision-making regarding the administration of toxic therapies in the setting of advanced disease.

Antineoplastic Agents, Phytogenic↗

PubMed2000

The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. The AGIS Investigators.

OBJECTIVE: To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery. METHODS: The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures. MAIN OUTCOME MEASURES: Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA). RESULTS: Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively. CONCLUSIONS: On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT-trabeculectomy-trabeculectomy sequence for black patients and of the trabeculectomy-ALT-trabeculectomy sequence for white patients without life-threatening health problems. The choice of treatment should take into account individual patient characteristics and needs.

Adult↗

PubMed1993

Coping with the Gulf war: subculture differences among ischemic heart disease patients in Israel.

The purpose of this study was to assess short term effects of the Gulf war on ischemic heart disease patients of different ethnic origin. Three dimensions of patients' reactions to the war situation were studied: psychological, physical and behavioral. The study first focused on changes in patients' responses on these dimensions over three stages of the war, differentiated according to degree of threat. Second, differences stemming from ethnic origin were examined among patients who live in the same geographical region, use the same health services and were exposed to the same threatening life event. One hundred ischemic heart disease patients were interviewed while waiting in outpatient hospital clinics for a regular examination at the end of the war. The results of intrapersonal comparisons showed that the intensity of responses, as expected, increased significantly on the three dimensions from the week before the war started to the first week of the war, which was the most stressful period for Israelis. During the last week of the war, however, when stress was significantly reduced, the expected change was found primarily with regard to psychologic responses. That is, worries were significantly reduced, but no significant reduction in frequency of anginal pain and in drug consumption followed, indicating differences in the adjustment process on the psychologic and physical levels. Subcultural differences were found in the studied responses: Patients of Asian or North African countries of origin reported having more frequent anginal pains, and consuming more drugs than patients from Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗

PubMed1996

Symptom experiences of midlife women: observations from the Seattle Midlife Women's Health Study.

UNLABELLED: Symptoms experienced by perimenopausal women are varied with little agreement about their nature, cause or stability. OBJECTIVE: To describe the type and stability of symptoms experienced by midlife women. METHODS: A community-based sample of 301 women ages 35-55 (Mean 41.1; S.D. = 4.2), had at least one menstrual period in the past year, and took no ovarian hormones. Women completed a daily symptom diary for at least one cycle for 3 consecutive years. Symptoms were rated from zero to four. The 5 premenses days were targeted for consistency and as those most symptomatic. Twenty-eight symptoms commonly reported as perimenopausal were factor analyzed using principal components analysis with varimax rotation. Test-retest reliability and stability estimates were calculated according to the method of Heise (Heise, D. Am Sociol Rev 1969; 34: 93-101) that accounts for expected change over time. RESULTS: Twenty-five of the 28 symptoms loaded on five factors labeled dysphoric mood, vasomotor, somatic, neuromuscular, and insomnia together accounting for 51.7% of the variance. Test-retest reliability estimates were highest for dysphoric mood (r = 0.78) and somatic (r = 0.70) symptoms. The reliability for the other three clusters ranged from r = 0.65 to r = 0.53). The stability of the clusters across 3 years was high for dysphoric mood, neuromuscular, and insomnia. The vasomotor and somatic clusters had the most change between years 1 and 3. DISCUSSION: These results indicate that dysphoric mood is not a part of vasomotor symptoms or insomnia or other somatic symptoms suggesting an origin for vasomotor symptoms apart from the other symptoms. The stability of dysphoric mood across 3 years suggests a chronic situation possibly due to high stress, overwork, or an ongoing emotional illness. The stability of the neuromuscular and insomnia symptoms suggests underlying chronic physical conditions. The reduction in stability of vasomotor symptoms may reflect the changing nature of hormones as women approach menopause. Finally, the low stability of somatic symptoms suggests that they represent acute episodic illnesses. Together the identification of five distinct symptom clusters with varying stability over 3 years suggests that they are due to different underlying mechanisms and are not all attributed to the changing hormone patterns associated with the menopausal transition. Many other events in a midlife woman's life can account for these symptoms including life stress and acute and chronic illnesses.

Adult↗

PubMed1993

An evaluation of an asthma quality of life questionnaire as a measure of change in adults with asthma.

In assessing the effectiveness of management strategies for patients with asthma, it is important to measure outcomes which are relevant to the concerns of patients. Quality of life is one such outcome which may not be adequately reflected in lung function measurements. We have developed an asthma quality of life questionnaire (the AQLQ) for this purpose. The aim of this study was to test the validity and responsiveness of the AQLQ as a measure of change. Forty four adults with asthma were assessed on two occasions 4 months apart. On each occasion subjects completed the AQLQ and the Sickness Impact Profile (SIP). Lung function and the degree of bronchial hyperresponsiveness (BHR) were measured and diary cards were used to derive a symptom score and mean daily peak flow variability. The relation of change in AQLQ scores to change in the other outcomes was assessed. Questionnaire responsiveness was assessed by comparing the change in AQLQ scores between 19 improved and 20 stable subjects. Improvement was assessed on lung function and BHR criteria. As expected, change in AQLQ score was correlated with change in symptom score (r = 0.37, 95% CI -0.04 to 0.64) and change in BHR (r = 0.38, 95% CI 0.06 to 0.64). The associations with change in peak flow variability (r = 0.12, 95% CI -0.26 to 0.47) and change in SIP score (r = 0.18, 95% CI -0.12 to 0.45) were in the expected direction but weaker than expected. The AQLQ was capable of detecting differences between improved and stable subjects (p = 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2005

Follow-up care for childhood cancer survivors: a focus group analysis.

Follow-up of survivors of childhood cancer is recommended to improve detection of late-effects, and provide individuals with information and advice. This study aimed to follow-up survivors of childhood cancer and report on their attitudes to current follow-up methods. Twenty-six survivors (13-25 years) of childhood cancer and their parent(s) attended focus groups (n = 7) to discuss views about follow-up care. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three themes were identified: strategies to achieve a normal life (through playing down possibility of late-effects or careful monitoring of health); expectations about follow-up (facts and information, advice about self-care, everyday living, and psychosocial consequences) and preferences for different models of care. Given that some families had reservations about the benefits of follow-up, it is important that services address survivors' interests and meet their expectations. Changes to service delivery must take account of individual needs and expectations. Possible limitations of focus group methods (recruitment, bias reduction, methods of analysis and influence of other participants' views) are discussed.

Adolescent↗

PubMed2006

Separation of time scales, fixation probabilities and convergence to evolutionarily stable states under isolation by distance.

To a first order of approximation, selection is frequency independent in a wide range of family structured models and in populations following an island model of dispersal, provided the number of families or demes is large and the population is haploid or diploid but allelic effects on phenotype are semidominant. This result underlies the way the evolutionary stability of traits is computed in games with continuous strategy sets. In this paper similar results are derived under isolation by distance. The first-order effect on expected change in allele frequency is given in terms of a measure of local genetic diversity, and of measures of genetic structure which are almost independent of allele frequency in the total population when the number of demes is large. Hence, when the number of demes increases the response to selection becomes of constant sign. This result holds because the relevant neutral measures of population structure converge to equilibrium at a rate faster than the rate of allele frequency changes in the total population. In the same conditions and in the absence of demographic fluctuations, the results also provide a simple way to compute the fixation probability of mutants affecting various ecological traits, such as sex ratio, dispersal, life-history, or cooperation, under isolation by distance. This result is illustrated and tested against simulations for mutants affecting the dispersal probability under a stepping-stone model.

Ecology↗

PubMed2002

Assessing health-related quality of life following myocardial infarction: is the SF-12 useful?

We report on the responsiveness of the SF-12 to changes in quality of life following acute myocardial infarction. Scores at 1, 6, 12, and 24 weeks postdischarge were compared with pre-MI health. Statistically significant differences and standardized response means were examined. Results were compared with the SF-36 subscales and previous reports. Respondents (n = 65) reported the expected poorer physical health at every follow-up, while expected changes in emotional health were observed at 6 but not 24 weeks. Comparison with the SF-36 subscales showed that although the SF-12 reflected the expected pattern of physical health, the summary score obscured an important association between perceptions of general health and participation in usual activities. This information is relevant for developing and evaluating rehabilitation interventions and self-managed recovery following MI. The SF-12 scores obscure important distinctions between quality of life domains, and are therefore not recommended for use following acute MI.

Analysis of Variance↗

PubMed1999

Evaluation of methods for assessing visual function of infants.

PURPOSE: Commonly used behavioral and electrical testing methods for estimation of visual acuity and visual function in infants yield different estimates and may not accurately predict visual acuity and visual function in later life. Moreover, neither test-retest variability nor side-by-side comparisons of the various methods have been thoroughly evaluated in the same infant population. The purpose of this study was to provide such an evaluation. METHOD: The test-retest variability of visual acuity and visual function was evaluated for the Teller Acuity Card (TAC) procedure, sweep visual evoked potential (VEP), as well as latency and amplitude measured by transient pattern VEP. Groups of approximately 20 infants contributed test-retest data. Visual function estimated by the various methods in a larger group of infants (n = 118) was compared. Correlations between methods and the validity of the various methods to detect maturational changes between 4 and 8 months of age were also assessed. Administration of these tests was according to standard and usual procedures. RESULTS: The average percent difference between test and retest estimates of acuity as well as the SD was lowest for transient VEP latency (3%, 7% SD). The other methods were markedly more variable: sweep VEP (2%, 22% SD), TAC procedure (8%, 20% SD), and transient VEP amplitude (7.5%, 39% SD). Average coefficients of variation showed a similar trend: transient VEP latency, 8%; sweep VEP, 15%; TACs, 30%; and transient amplitude, 53%. Correlations among estimates by the methods were poor, but expected changes in visual maturation from 4 to 8 months of age were detected with all methods. CONCLUSIONS: All methods evaluated provide valid and reliable test-retest data for a group, but are less valid for estimating visual acuity and visual function of an individual subject. The poor correlations between any 2 of the testing methods suggest that each test assesses a different aspect of vision. Nonetheless, expected maturational changes between 4 and 8 months of age were readily detectable by all methods evaluated.

Aging↗

PubMed1997

Health-related quality of life after elective surgery: measurement of longitudinal changes.

OBJECTIVE: To examine the responsiveness of the 36-Item Short Form Health Survey (SF-36) to clinical changes in three surgical groups and to study how health-related quality of life (HRQL) changes with time among patients who undergo total hip arthroplasty, thoracic surgery for treatment of non-small-cell lung cancer, or abdominal aortic aneurysm (AAA) repair. DESIGN: Prospective cohort study with serial evaluations of HRQL preoperatively and at 1, 6, and 12 months after surgery. SETTING: University tertiary care hospital. PATIENTS: Of 528 patients, more than 50 years of age, who were admitted for these elective procedures, 454 (86%) provided preoperative health status data and are members of the study cohort. At 12 months after surgery, 439 (93%) of the cohort was successfully contacted and 390 (90%) provided follow-up interviews. MEASUREMENTS AND MAIN RESULTS: The Medical Outcomes Study SF-36, the Specific Activity Scale, five validated health transition questions, and a 0 to 100 scale measure of global health were used to assess changes in health status at 1, 6, and 12 months after surgery. Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries. However, by 6 months after surgery, most patients experienced significant gains in the majority of the dimensions of health, and these gains were sustained at 12 months after surgery. Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions, to changes on the Specific Activity Scale and global health rating question, and to clinical parameters for persons who had AAA repair. These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures. CONCLUSIONS: For the total hip arthroplasty patients, responsiveness was greatest for the SF-36 scales that measure physical constructs. However, for the two other procedures and at various points of recovery, significant changes were observed for all eight subscales, suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up, and that multidimensional measures are needed to fully capture changes in HRQL after surgery.

Aged↗

PubMed1986

The development of migration expectations: changes throughout the lifecourse.

This research examines how the relative influence of factors that determine an individual's expectations of moving varies throughout the lifecourse. Factors representing personal characteristics, ties to origin, and ties to potential destinations were used to discriminate between expected migrants and nonmigrants in three population subgroups representing different stages of life. These subgroups included a general adult population, a preretirement population, and an elderly population. The results indicate that personal characteristics are most influential among preretirement persons, ties to origin are most influential among the general and elderly populations, and ties to potential destinations are influential among all population subgroups.

Adult↗

PubMed1991

Perceived controllability of expected psychological change across adulthood and old age.

This cross-sectional study focuses on adults' beliefs about the controllability of developmental change in adulthood and old age. Young (n = 33; age range 20-36 years), middle-aged (n = 35; age range 40-55 years), and older (n = 32; age range 60-85 years) adults rated an extensive list of psychological attributes in terms of the degree of expected developmental increase across the adult life span (ages 20-90), the perceived controllability of these changes, their desirability, and their expected age-related timing. The findings indicate a substantial degree of similarity in young, middle-aged, and old adults' overall beliefs about controllability. The three adult age groups agreed in perceiving developmental changes in adulthood as fairly controllable, and with regard to their relative controllability (rank ordering of change-sensitive attributes). Changes expected to occur later in life were consensually perceived to be less desirable, and less desirable changes were perceived as less controllable. However, there were clear age-related differences involving both the age timing of expected changes and the age of respondents. A comparison between the three subject age groups revealed twofold differences: First, the relationship between desirability and perceived controllability was found to increase with subjects' age; second, Q-technique factor analysis showed that large subgroups of the young and the middle-aged adults, but not the old adults, tended to perceive psychological attributes associated with late onset decline as relatively lower in controllability.

Adult↗

PubMed2005

Evidence for synergy between saccades and smooth pursuit during transient target disappearance.

Visual tracking of moving objects requires prediction to compensate for visual delays and minimize mismatches between eye and target position and velocity. In everyday life, objects often disappear behind an occluder, and prediction is required to align eye and target at reappearance. Earlier studies investigating eye motion during target blanking showed that eye velocity first decayed after disappearance but was sustained or often recovered in a predictive way. Furthermore, saccades were directed toward the unseen target trajectory and therefore appeared to correct for position errors resulting from eye velocity decay. To investigate the synergy between smooth and saccadic eye movements, this study used a target blanking paradigm where both position and velocity of the target at reappearance could vary independently but were presented repeatedly to facilitate prediction. We found that eye velocity at target reappearance was only influenced by expected target velocity, whereas saccades responded to the expected change of target position at reappearance. Moreover, subjects exhibited on-line adaptation, on a trial-by-trial basis, between smooth and saccadic components; i.e., saccades compensated for variability of smooth eye displacement during the blanking period such that gaze at target reappearance was independent of the level of smooth eye displacement. We suggest these results indicate that information arising from efference copies of saccadic and smooth pursuit systems are combined with the goal of adjusting eye position at target reappearance. Based on prior experimental evidence, we hypothesize that this spatial remapping is carried out through interactions between a number of identified neurophysiological structures.

Adaptation, Physiological↗

PubMed2005

Adherence to an exercise prescription scheme: the role of expectations, self-efficacy, stage of change and psychological well-being.

OBJECTIVES: Poor rates of adherence to exercise prescription schemes present a potential barrier to the goal of increasing physical activity in patient samples. This study investigated the role of participant expectations, self-efficacy, stage of change and psychological well-being in adherence to a 12-week course of gym based exercise. It also aimed to assess the impact of failure to adhere on self-efficacy and psychological well-being. METHOD: The 119 participants, referred by their medical practitioner for a course of exercise, completed questionnaires at the start of the course and 77 went on to complete second questionnaires. Objective measures included a range of physiological measures based on gym assessments. RESULTS: Participants typically had high expectations of the scheme. Those who completed the course had more modest expectations of change and came closer to achieving these expected changes than those who dropped out. Initial stage of change and self-efficacy did not discriminate between the two groups. While self-efficacy improved over the scheme for completers, it tended to deteriorate for drop-outs. GHQ scores also failed to improve over time for drop-outs. CONCLUSION: Overly optimistic expectations of inexperienced exercisers may lead to disappointment and attrition. Interventions to ensure realistic expectations might increase success and prevent potential negative effects of failure.

Adaptation, Psychological↗

PubMed1993

Potential health benefits of nutrition label changes.

OBJECTIVES: The Nutrition Labeling and Education Act of 1990 mandates the Food and Drug Administration to promulgate changes in nutrition labeling regulations. This study investigates the potential health benefits associated with expected changes in food consumption resulting from the act. METHODS: This paper provides four estimates of the potential health benefits from the dietary changes expected to occur as a result of the 1990 act. The upper bound estimates begin with the premise that all consumers will adopt the daily reference values of total fat, saturated fat, and cholesterol. The lower bound estimate is based on consumers' responses to a shelf-labeling program sponsored by the Food and Drug Administration in the 1980s. A computer model developed by Dr. Warren Browner and his associates was used to estimate the health benefits from reduced nutrient intakes. RESULTS: Estimates of the number of discounted life-years gained nationwide for the first 20 years after the implementation of the act range from a high of 1.2 million to a low of 40,000. CONCLUSIONS: The results of the study highlight that relatively small changes in nutrient intakes may generate large public health benefits.

Adult↗

PubMed2002

Listening to injured workers: how recovery expectations predict outcomes--a prospective study.

BACKGROUND: Rigorous evidence on factors affecting the prognosis of work-related soft-tissue injuries remains limited. Although shown to be important for a wide variety of clinical conditions, recovery expectations have rarely been assessed as prognostic factors for workers with soft-tissue injuries. We examined the predictive role of various measures of recovery expectations among workers with injuries resulting in time off work. METHODS: We identified a prospective cohort of 1566 injured workers shortly after they filed a claim for their injury with the Ontario Workers' Compensation Board (OWCB). They had soft-tissue injuries to the back or upper or lower extremities, had new, lost-time claims from May to November 1993 and were still off work at the time of the first interview. We interviewed participants by telephone within 3 weeks after the injury and measured their recovery expectations (perceptions regarding progress, expected change in condition, expected time until return to usual activities and expectations regarding return to usual job) along with other, potentially important prognostic factors. The primary outcome was total time receiving 100% wage-replacement benefits during the year following injury, obtained from OWCB administrative files. Self-reported measures of pain, health-related quality of life and functional status, obtained up to 4 times during the year following injury, were both independent predictors and secondary outcomes. RESULTS: The 4 measures of recovery expectations together explained one-sixth of the variation in time receiving benefits. All but expectations regarding return to usual job were individually predictive of time receiving benefits. Judging one's recovery as much better than expected resulted in a 30% (95% confidence interval [CI] 9%-46%) faster rate of stopping receiving benefits (and likely returning to work) compared with judging one's recovery as much worse than expected. Similarly, participants who expected to return to usual activities within 3 weeks had a 37% (95% CI 26%-47%) faster rate of stopping receiving benefits than those who responded "Don't know" to this question, and participants who stated that they were fully recovered or would get better soon had a 25% (CI 5%-40%) faster rate than those who thought they would never get or stay better. Positive recovery expectations were also associated with reductions in pain grade and improvement in functional status outcomes. INTERPRETATION: Expectations regarding recovery may provide useful information on the complex process of recovering from work-related soft-tissue injuries. For clinicians, patients' negative or uncertain expectations may indicate the need for further probing and intervention on psychosocial factors to facilitate recovery.

Adult↗

PubMed2005

Cost-effectiveness of Chagas disease interventions in latin america and the Caribbean: Markov models.

Chagas disease is a parasitic disease in Latin America. Despite vector control programs that have reduced incidence by 70%, there are at least 12-14 million prevalent cases. We used a Markov model to examine strategies for control and treatment of Chagas disease that compared annual costs, life expectancies, and cost-effectiveness of three vector control and drug treatment strategies. Vector control programs alone and vector control plus drug treatment are dominant over no vector control (i.e., less costly and save more lives), and vector control plus drug is highly cost-effective compared with vector control alone. We demonstrated expected changes in deaths over time resulting from various prevention approaches. Vector control affects primarily incidence, not decreasing deaths and prevalence for 30 years, while drug treatment affects prevalence and deaths immediately. The best strategy to combat Chagas disease is combinations of vector control and a potential new drug.

Adolescent↗

PubMed2005

Changes of defense mechanisms and personality profile during group analytic treatment.

Researching efficiency of group-analytic treatment and following Foulkes' principle of the "group-as-a-whole", the methodology was applied. That enabled the evaluation of expected changes of group members individually, as well as the group-as-a-whole. In this study three small groups (20 patients) were followed up and changes were evaluated after second and after fourths years of group analysis. Two measuring instruments--The Life Style Index and Defence Mechanisms Scale (LS-DM) and Minnesota Multiphase Personality Inventory (MMPI-201) were applied. Each member of the group was assessed by self-evaluation as well as the group-as-a-whole. The results of the research indicated that changes of the personality occurred. Changes consisted in lowering of defensive activities that was tending towards more mature defences. Changes also consisted in lowering ratings on the pathological parts of the MMPI-scales reflecting shifting of the conflict level. The results could be predictive for positive outcome of group analysis. More studies are needed.

Adult↗