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Results for “Length Of Life--determinants”

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PubMedDate not supplied

Contribution of cause-specific mortality to changing sex differences in life expectancy: seven nations case study.

During the last two decades some industrialized nations witnessed varying degrees of constriction in their sex gaps in overall life expectancy. We investigate this development by paying particular attention to the contributions of major causes of death to the change in the difference between 1970 and 1990. The analysis is based on the experiences of seven nations: Australia, United States, Sweden, England and Wales, Portugal, Hungary, and Japan. In the first four countries the gap has been narrowing during the last twenty years; in Hungary and Japan, the difference remains substantial and continues to expand; in Portugal the situation is characterized by a slowdown in the amount by which the sex gap is expanding over time. We apply decomposition analysis to answer the following questions: (1) What is the relative contribution of major causes of death to sex differences in average length of life within broad age categories? (2) How do the contributions of age and cause of death vary across time to either widen or narrow the sex gap in survival? (3) How do the patterns of cause contribution vary across societies?

Adolescent↗
PubMed1997

Is length of life predictable?

A random sample of death records of adult males from the period 1967 to 1970 was chosen from the South Australian Registry of Births, Deaths, and Marriages. The natural parents of these individuals were identified by cross-referencing to birth certificates, and an extensive search was made of the death records for these parents. In this manner random families were selected for which, where possible, the cause of death and length of life of each family member were determined. Here, we analyze the association between sons and their parents in length of life and report the statistically useful correlations that were found. These correlations enable the calculation of a life table for a male conditional on his current age and the lifetimes of his parents. Comparisons are made with the uninformed population life table based solely on sex and year of birth.

Adult↗
PubMed2007

Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life.

BACKGROUND: Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD), but depression's impact on COPD outcomes has not been fully investigated. We evaluated the impact of comorbid depression on mortality, hospital readmission, smoking behavior, respiratory symptom burden, and physical and social functioning in patients with COPD. METHODS: In this prospective cohort study, 376 consecutive patients with COPD hospitalized for acute exacerbation were followed up for 1 year. The independent associations of baseline comorbid depression (designated as a Hospital Anxiety and Depression Scale score of > or =8) with mortality, hospital readmission, length of stay, persistent smoking, and quality of life (determined by responses to the St George Respiratory Questionnaire) were evaluated after adjusting for potential confounders. RESULTS: The prevalence of depression at admission was 44.4%. The median follow-up duration was 369 days, during which 57 patients (15.2%) died, and 202 (53.7%) were readmitted at least once. Multivariate analyses showed that depression was significantly associated with mortality (hazard ratio, 1.93; 95% confidence interval, 1.04-3.58), longer index stay (mean, 1.1 more days; P = .02) and total stay (mean, 3.0 more days; P = .047), persistent smoking at 6 months (odds ratio, 2.30; 95% confidence interval, 1.17-4.52), and 12% to 37% worse symptoms, activities, and impact subscale scores and total score on the St George Respiratory Questionnaire at the index hospitalization and 1 year later, even after controlling for chronicity and severity of COPD, comorbidities, and behavioral, psychosocial, and socioeconomic variables. CONCLUSIONS: Comorbid depressive symptoms in patients with COPD are associated with poorer survival, longer hospitalization stay, persistent smoking, increased symptom burden, and poorer physical and social functioning. Interventions that reduce depressive symptoms may potentially affect COPD outcomes.

Aged↗
PubMedDate not supplied

Outcomes of minimally invasive antireflux operations in the elderly: a comparative review.

BACKGROUND AND OBJECTIVES: The objectives of this study were to assess the impact of age following laparoscopic fundoplication (LF). METHODS: From March 1993 to November 1998, 193 patients underwent LF. Patients comprised 150 young individuals (age<60; median 41) and 43 older individuals (age>60; median 68). Follow-up included heartburn scores, dysphagia scores, and quality of life determined by the Short Form 36 Health Survey (SF36). RESULTS: Older patients had more cardiac disease, psychiatric disorders, prior cancers, and upper abdominal operations (P<0.05). DeMeester scores were similar (young 70/older 69). Complications occurred in 13 (8.7%) of the young and 5 (11.6%) of the older patients (P=0.142). No perioperative deaths occurred. Length of stay was longer (P<0.000) in older patients (2.9 versus 1.6 days); resumption of oral intake (young-1.2; older-1.3 days) and return to normal activity (young-3.6; older-4.4 weeks) were similar. Follow-up was available in 102 young (median 17 months) and 35 older (median 18 months) patients. Heartburn and dysphagia scores were excellent in both groups. SF36 scores were similar in both groups. Only 6 (5.9%) of the young group and 1 (2.9%) of the older group were dissatisfied (P=0.652). CONCLUSIONS: Despite differences in comorbid disease, outcomes were similar in both groups. LF should be considered a therapeutic option in the older patient with reflux.

Adolescent↗
PubMed1994

Posttranscriptional regulation of cyclin B messenger RNA expression in the regenerating rat liver.

The growing family of cyclin genes and their products have been identified as important regulatory participants in the eukaryotic cell cycle. Cyclin proteins are currently postulated to act at the G1 restriction point, entry and exit of S phase, and the G2-M transition. We have cloned a rat cyclin B complementary DNA (cDNA) and have investigated cyclin B mRNA expression and regulation in the regenerating rat liver following 70% partial hepatectomy (PH). Sequence analysis of the rat cyclin cDNA revealed greater than 82% identity to type B1 human and murine cyclin genes. The rat cyclin cDNA was used to probe Northern blots of polyadenylated enriched RNA from regenerating rat liver from 0 through 96 h post-PH. Two species of rat cyclin B transcript were detected which mapped at 1.6 and 2.4 kilobases in length. Steady-state transcript levels began to appear around 24 h post-PH, which coincides with peak DNA synthesis. However, expression of the cyclin B transcripts peaked at 48 h and was 20-fold greater than at 24 h post-PH. Smaller peaks of expression occurred at 30 and 72 h. Run-off transcription assays using nuclei isolated at various times post-PH indicated no change in transcriptional rate during the period of regeneration. In vivo mRNA half-life determinations were performed at 24, 40, and 48 h post-PH. The half-lives of both transcript species were almost identical and were determined to be greater than 12 h at 24 h post-PH, and 2.4 h at 40 and 48 h post-PH. Protein inhibition with cycloheximide increased the signal intensity of both transcripts between 48 and 54 h post-PH but had no detectable effect on 0 h transcript expression. Steady-state levels of thymidine kinase mRNA showed a similar pattern of expression by Northern analysis through 96 h post-PH as cyclin B. The present study indicates that the appearance of cyclin B mRNA in the regenerating rat liver is coincident with peak DNA synthesis, although its own peak expression is significantly delayed. Steady-state transcript levels appear to be regulated primarily by posttranscriptional events of which changes in mRNA stability may be an important determinant. We propose that the involvement of cyclin B in the cell cycle machinery is controlled at several different levels of gene expression.

Amino Acid Sequence↗
PubMed2004

Meta-analytic evidence of increased breakthrough bleeding during prophylaxis with B-domain deleted factor VIII.

A recent meta-analysis of 13 observational studies suggested reduced haemostatic efficacy during prophylaxis and shortened half-life of B-domain deleted factor VIII (BDD-rFVIII) as compared with full-length factor VIII (FL-FVIII). The meta-analysis included a multivariate model that took both dose and age into account. In addition, several assumptions and interpretations were required in order to conduct the meta-analysis. It is important to test the impact of such assumptions and interpretations through sensitivity analysis. In the published meta-analysis, results of several sensitivity analyses were described involving the effect of study design; heterogeneity of subjects in some studies; type of assay used for half-life determinations; and year of publication. In two subsequent brief reports, additional sensitivity analyses addressed choice of median-to-mean conversion factor over a wide range of scenarios and use of age at start of prophylaxis vs mean age during prophylaxis in the multivariate model. A recognized inherent difficulty in the meta-analysis of multiple published reports from similar studies is the possibility of some subject or data overlap. Therefore, the present communication details further sensitivity analyses encompassing assumptions regarding the possibility of subject duplication in a subgroup of subjects from one study and possible duplication of pharmacokinetic data from two smaller studies within the reports of two larger studies. All the sensitivity analyses support the main conclusions of the meta-analysis, namely, that BDD-rFVIII substantially increases the risk of breakthrough bleeding during prophylaxis, possibly at least partly because of shorter half-life than that of FL-FVIII.

Data Interpretation, Statistical↗
PubMed1997

Intensive care unit management in liver transplant recipients: beneficial effect on survival and preservation of quality of life.

Determinants of outcome of intensive care unit (ICU) stay and quality of life in survivors was prospectively assessed in 50 consecutive liver transplant recipients requiring intensive care unit (ICU) management. Variables assessed included demographic, clinical and laboratory characteristics, measures of severity of illness (Child-Pugh, Apache II, and organ system failure scores) and quality of life measures (physical functioning, perceived quality of life, stress, depression, and adaptive coping). Overall ICU survival was 82% (41/50). Nonsurvivors had significantly higher acute physiology scores (p = 0.03). Apache II score (p = 0.03), Karnofsky score (p = 0.01) and serum bilirubin (p = 0.05) on admission than survivors. Nonalert mental status (p = 0.0002), hypothermia (p = 0.035) and hypotension (p = 0.027) on admission were significantly associated with mortality. During the ICU stay, requirement of mechanical ventilation (p = 0.02), duration of ventilation (p = 0.01), requirement of dialysis (p = 0.0005), development of pulmonary infiltrates (p = 0.0001) and infections in the ICU (p = 0.003) were significantly associated with mortality. Requirement of mechanical ventilation was an independently significant predictor of mortality (with mechanical ventilation, dialysis and infections in the logistic regression analysis model). There was no difference in post-discharge quality of life (as assessed by the perceived quality of life, stress, depression, and coping scores) in survivors of ICU stay as compared with patients who never required ICU care. Our study suggests that the ICU management can have a positive impact on outcome for liver transplant recipients. If they survive (and 82% did in this study), their quality of life is unaffected and as good as those whose postoperative course was not complicated by a critical illness requiring ICU care.

Adult↗