Impact of suicide mortality on life expectancy in the United States, 2011 and 2015: age and sex decomposition.

OBJECTIVES: This study examined (1) potential differences in life expectancy when suicide as a cause of death was discounted and (2) suicide's contributions to changes in life expectancy by age group and sex. METHODS: Data were from the 2011 and 2015 National Violent Death Reporting System on all suicide decedents aged 10 years or older in 17 US states. Life tables were constructed based on the total population and all-cause mortality data from the Centers for Disease Control and Prevention. Differences in life expectancy were calculated using Arriaga's decomposition method. RESULTS: The numbers of suicide deaths in both 2011 and 2015 were 3-4 times higher among males than females in all age groups. The highest impact for both males and females was in the 55-64 age group, with changes in life expectancy of 1.64 years in 2011 and 1.60 years in 2015 for men, and 1.30 years in 2011 and 1.27 years in 2015 for women. Between 2011 and 2015, the percent change in suicide mortality rates for all age groups was 7.44% in males and 15.72% in females. However, the groups that negatively impacted changes in life expectancy due to significant increases in suicide mortality were males aged 25-34 (22.80%) and 55-64 (15.45%) and females aged 15-19 (34.74%) and 55-64 (23.15%). Eliminating suicide as a cause of death would have increased life expectancy at birth by 1.92 years for males and 1.36 years for females from 2011 to 2015. CONCLUSIONS: This study updates information on suicide and adds to calls for more effective suicide prevention efforts, especially for older adolescent girls, young men, and middle-aged men and women.

Varying Ti-6Al-4V surface roughness induces different early morphologic and molecular responses in MG63 osteoblast-like cells.

Osteoblast response to Ti implants depends not only on the chemistry of the implant but also on the physical properties of the implant surface, such as microtopography and roughness. This study was undertaken to examine early changes in cell morphology and gene expression during the early phase of osteoblast interaction with titanium alloy (Ti-6Al-4V) surfaces of two different roughnesses. MG63 osteoblast-like cells were cultured for 2, 6, 24, and 72 h on smooth (Ra=0.18+/-0.03 microm) and rough (Ra=2.95+/-0.23 microm) Ti-6Al-4V surfaces. Changes in cell proliferation were assessed by measuring cell number after 72 h in culture. Morphological characteristics were observed by scanning electron microscopy after 2, 6, and 24 h of culture. Changes in gene expression for extracellular signal-regulated kinase 2 (Erk2), type I collagen (alpha2[I] collagen), phospholipase C-gamma2 (Plc-gamma2), and beta-actin were measured by RT-PCR after 6 and 24 h in culture. Cell number was significantly higher on the smooth surface. In scanning electron micrographs, cells on smooth Ti-6Al-4V were spherical and raised up from the surface after 2 h in culture. In contrast, cells on the rough surface adopted an irregular, elongated shape that spanned across pits in the surface. At 24 h, cells on the smooth surface had flattened, become elongate, and covered the surface. In contrast, cells on the rough surface appeared more differentiated in shape and the margins of the cells were irregular, with many processes extending out, following the contour of the surface. Of the genes examined, only Erk2 and beta-actin showed a change in expression with surface roughness. Both genes were upregulated (p<0.05) on the rough surface at 6 h. These results indicate that Ti-6Al-4V surface roughness affects osteoblast proliferation, morphology, and gene expression, and that these effects can be measured after periods as short as 2-6 h.

Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea.

A Korean multicenter study was conducted to assess the effectiveness of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dysfunction (ED) who were enrolled in 21 clinical centers. Patients with psychogenic impotence comprised about 30% of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in the clinics from 250 to 500 or 1000 mcg based on erectile response and tolerability. The erectile responses were evaluated using an erection assessment scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full tumescence, partial rigidity) was selected for home treatment. Patients who showed partial erection (score of 3) with 1000 mcg were also included in the home-treatment group. In-clinic phase: 198 men (59.3%) had maximal penile responses of score 4 or 5. The rate of maximal responses was not related to patient age, etiology or duration of the ED. A total of 228 (68.3%) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated as uncomfortable or very uncomfortable in 12%. Home phase: During the two-month period of home treatment, 178 (78.1%) men had successful sexual intercourse at least once, and 78.2% of administrations (1976) resulted in successful intercourse. The main causes of drop-out were insufficient erectile response in 27 men (11.8%), adverse reactions (mostly penile or urethral pain) in 7 (3.1%) or both in 7 (3.1%). In conclusion, transurethral alprostadil could be a suitable treatment option for patients with ED regardless of age and etiology of ED. Efficacy in an Asian population (Korea) is comparable to that reported previously in Caucasians.

Patterns and determinants of social service utilization: comparison of the childless elderly and elderly parents living with or apart from their children.

Approximately one out of five elderly persons are childless. In the absence of children who provide important emotional and instrumental cohort , are childless elderly more likely to use social services than are elderly parents? Analysis of data from the Longitudinal Survey of Aging shows that the childless elderly were more likely to say that they lacked informal instrumental support at times of illness than were the elderly parents. Nevertheless, the childless were no more likely to use social services than were the elderly parents. Strategies to improve the childless elderly's social service use are recommended.

Racial differences in the determinants of living arrangements of widowed and divorced elderly women.

Ability to afford single, separate households has been perceived as the key determinant of living alone among single older women. This paper shows that, when race is analyzed separately, family-related variables such as marital history and the number of children raised, rather than economic affordability, are the most important factors in the living arrangement decision of widowed elderly women of color. Economic affordability also turns out to be insignificant when white and nonwhite divorced elderly women are analyzed separately.

Determinants of frail elders' lengths of stay in meals on wheels.

Home-delivered meal programs such as Meals on Wheels are low-cost long-term care services that have potential for contributing to the delay of costly institutionalization and to the maintenance of self-sufficiency and quality of life among community-dwelling frail elders. In this study, reasons for elders' termination from a Meals on Wheels program and determinants of their lengths of stay in the program are analyzed. The findings show that the reasons for elders' termination are largely associated with their deteriorating health. But it was also found that a significantly higher proportion of African American elders than White elders discontinued their participation due to their dissatisfaction with the meals offered or their poor appetite. The Cox proportional hazard regression analysis also confirmed that elders' health status, race, and appetite are significantly associated with the hazard of elders' termination. Strategies to improve the acceptability of the services are discussed.

Clinical experience with transurethral microwave thermotherapy for chronic nonbacterial prostatitis and prostatodynia.

Chronic prostatitis and prostatodynia are troublesome disorders that are not responsive to any kind of treatment. Patients with treatment-resistant chronic nonbacterial prostatitis (n = 61) or prostatodynia (n = 17) for longer than 3 years underwent a single 1-hour session of transurethral microwave thermotherapy (TUMT) using the Prostatron. Complete symptom disappearance was obtained in 23% of patients and a partial response in 43%. Of the patients with prostatitis, 46% showed normalization and 31% an improvement of the leukocyte count in expressed prostatic secretion. In patients with prostatodynia, the corresponding figures were 35% and 41%. Most complications were temporary, but there was one case of epididymitis and one of reduction in the volume of the ejaculate. TUMT is well tolerated and safe, and it is effective in relieving the symptoms of many patients with nonbacterial prostatitis or prostatodynia. The possible adverse effects on fertility and urinary continence require further study.

Predictors of transitions in disease and disability in pre- and early-retirement populations.

OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period. METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses. RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes. DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.

Potential consequences of raising the Social Security eligibility age on low-income older workers.

To examine the potential consequences of raising the Social Security retirement age on future cohorts of low-income elders, this study, based on data from the Health and Retirement Study, 1992-1994, identifies factors that may hinder or facilitate continuous employment among older workers born between 1931 and 1941. Specifically, following the analysis of labor-force participation rates and self-reported reasons for non-work, multivariate logistic regression models tested the relationship between individual strengths and constraints, social-structural opportunities and constraints, and economic need variables and the likelihood of work. The findings show that for both men and women, having disabilities was the most significant predictor of non-work. Racial differences, especially in men's labor-force participation rates, appeared to be due in large part to significant racial differences in disability rates. A higher proportion of blacks and Hispanics than whites also reported that they were unemployed. Based on the findings, raising the Social Security eligibility age is likely to result in increased numbers of Disability Insurance (DI) claimants, and the fiscal impact of such an increase needs to be examined. The need to assist unemployed older persons is also discussed.

Determinants of engagement in paid work following social security benefit receipt among older women.

Work behavior among older men approaching or following retirement has received considerable research attention over the past two decades, but research on older women's work behavior is still in its incipient stage. Based on data from the 1982 New Beneficiary Survey (NBS) and the 1991 New Beneficiary Follow-up (NBF), this study analyzes the extent and determinants of employment among women who received their first Social Security benefits between 1980 and 1981. More than one fourth of the women continued to work or rejoined the labor force following their first Social Security benefit receipt. Financial need was found to be the primary reason for and the most significant determinant of women's continuing work or (re)entry into the labor force. But the level of education, health, spouse's work status, and previous work history were also found to be significant determinants of the likelihood and duration of their employment following Social Security receipt.

Racial differences in retirement income: the roles of public and private income sources.

Despite great overall improvement in the elderly's economic status over the past two decades, minority elders still comprise the poorest population group of all. Nonetheless, the income security of minority elders has not been given special attention in the scrutiny in recent years of the size and the future of various federal programs affecting older persons. Based on data from the 1971, 1981, and 1991 public-use data tapes of the Current Population Survey, the racial difference in income status of the elderly and the role of Social Security and Supplemental Security income versus that of income from private sources are analyzed in terms of how income inequality among races is ameliorated or escalated. The findings show that racial/ethnic differences in income status increased between 1970 and 1990. The findings also confirm that, for both elderly singles and couples, Social Security is the most important income source. Without it, poverty rates among elderly black couples, for example, would have increased by as much as 48.5 percentage points in 1990. Policies that would help improve the income status of the low-income elderly are discussed.

A comparative study of elderly SSI recipients, denied applicants, and eligible nonapplicants.

Based on data from the 1982 Social Security New Beneficiary Survey (NBS), the 1991 New Beneficiary Follow-up (NBF), and Social Security administrative records, this study analyzed determinants of the elderly's Supplemental Security Income (SSI) participation, denied application, and nonapplication. In the analysis, SSI application is conceptualized as an outcome of a complex interaction among financial, sociodemographic, health, and informational factors as well as those indicative of elderly persons' subjective perception of need. The findings indeed confirmed that objective financial need does not automatically lead to SSI application. Sociodemographic and health-related factors mediating the objective financial need are identified, although the subjective perception of need and informational barriers requires further evaluation. Policy implications include continued dissemination of information about SSI and relaxation of the resource test to qualify more low-income elderly.

Relationship between life satisfaction and postretirement employment among older women.

Although older persons' engagement in postretirement employment has been perceived to foster successful aging, the relationship between postretirement employment and elders' perceived quality of life has not been empirically tested. This article analyzes the effects of postretirement employment on older women's life satisfaction by comparing those who continued to work or (re)entered the labor market with those who did not engage in paid work after the receipt of their first Social Security benefits. The findings show that postretirement employment in itself does not contribute to older women's life satisfaction, but financial resources and especially the older women's concerns about their own financial situation are potent determinants of their life satisfaction. The need to incorporate the role of financial resources and subjective financial satisfaction in the theoretical framework for elders' perceived quality of life is discussed.

Factors affecting SSI support for sheltered care residents with serious mental illness.

The complexity of Supplemental Security Income (SSI) regulations and procedures allegedly inhibits eligible persons with serious mental illness from obtaining and retaining support. This study examined factors affecting continued SSI support among 393 sheltered care residents with serious mental illness ten years after an initial positive eligibility determination. At follow-up between 1983 and 1985 of 225 cohort members, 182 were receiving SSI benefits, 28 were eligible for SSI due to their low income but were not receiving benefits, and 15 were income-ineligible. The financially needy were most likely to receive SSI support for longer periods of time, and the most severely disturbed spent the least amount of time on SSI. Income-eligible nonrecipients were likely to be young, transient patients using emergency room services as opposed to receiving outpatient counseling.

Apoptosis and nuclear shapes in benign prostate hyperplasia and prostate adenocarcinoma: comparison with and relation to Gleason score.

PURPOSE: To compare differences in the number of apoptotic bodies and nuclear shapes (size and roundness) between untreated benign prostate hyperplasia (BPH) and untreated advanced prostate adenocarcinoma (PCA) and to elucidate differences in apoptosis number and nuclear shapes with increasing malignant potentiality, by Gleason score, in PCA. METHODS: A retrospective study was conducted on 40 patients with BPH and 12 patients with PCA I (Gleason score 2-4), 14 patients with PCA II (Gleason score 5-7) and 14 patients with PCA III (Gleason score 8-10). The frequency of apoptotic bodies (mean percentage calculated from 200 cells/high-power field over 10 fields) was examined on immunostain. Nuclear shapes were determined by an automatic image analyzer. Over 100 hyperplastic cells or cancer cells were detected by the image analyzer. RESULTS: The mean number of apoptotic bodies in BPH and PCA I were not significantly different, but patients with PCA II and PCA III showed significantly higher numbers of apoptotic bodies than patients with BPH. Patients with PCA III had significantly more apoptotic bodies than patients with PCA I. Benign prostate hyperplasia nuclei had the smallest mean nuclear area and the largest mean nuclear peripheral ellipse among the four groups. The study showed that PCA I, II, III nuclei had significantly larger areas and a less circular shape than nuclei from patients with BPH. Nuclei from patients with PCA I were smaller in size and rounder than nuclei from patients with PCA III. CONCLUSIONS: The present study clearly shows the presence of apoptosis in BPH and PCA and shows an increasing number of apoptotic bodies with higher cellular malignancy. The nuclear shapes in PCA were more irregular and larger in size with increasing cellular malignancy. As expected, nuclei in BPH were smaller in size and rounder than those of cancer nuclei.

Caspase-3/CPP32 immunoreactivity and its correlation with frequency of apoptotic bodies in human prostatic carcinomas and benign nodular hyperplasias.

AIMS: Apoptosis is mediated by apoptosis-specific genes, certain oncogenes and tumour suppressor genes. Caspase-3, a group of cystein proteases, is involved in the induction of apoptosis and has been considered to correlate with apoptosis. The aim of this study was to determine whether caspase-3 is expressed in prostatic carcinoma and benign prostatic hyperplasia, and correlated with the apoptosis. METHODS AND RESULTS: We studied the apoptotic index and caspase-3 immunoreactivity in 40 cases of benign nodular hyperplasia (BPH) and 40 cases of prostate carcinoma (PCA) by in-situ labelling and immunohistochemistry. The mean number of apoptotic bodies in cases with BPH was not significantly different from cases with PCA I (Gleason score 2-4), but samples from patients with PCA II (Gleason score 5-7) and PCA III (Gleason score 8-10) showed a significantly higher apoptotic number than cases with BPH. Positive staining for caspase-3 was seen in 42.5% (17/40) of the BPH, and 27.5% (11/40) of the PCA: PCA I was 41.7% (5/12), PCA II 14.3% (2/14) and PCA III was 28.6% (4/14). CONCLUSIONS: Based on our results, the number of apoptotic bodies was not correlated with the caspase-3 expression and there was no relationship between caspase-3 expression and Gleason score. However, the number of apoptotic bodies was significantly higher in cases with intermediate (Gleason score 5-7) and high-grade (Gleason score 8-10) PCAs than cases with BPH and low-grade PCAs (Gleason score 2-4).