Electoral Democracy and Working-Age Mortality.

Policy Points The erosion of electoral democracy in the United States in recent decades may have contributed to the high and rising working-age mortality rates, which predate the COVID-19 pandemic. Eroding electoral democracy in a US state was associated with higher working-age mortality from homicide, suicide, and especially from drug poisoning and infectious disease. State and federal efforts to strengthen electoral democracy, such as banning partisan gerrymandering, improving voter enfranchisement, and reforming campaign finance laws, could potentially avert thousands of deaths each year among working-age adults. CONTEXT: Working-age mortality rates are high and rising in the United States, an alarming fact that predates the COVID-19 pandemic. Although several reasons for the high and rising rates have been hypothesized, the potential role of democratic erosion has been overlooked. This study examined the association between electoral democracy and working-age mortality and assessed how economic, behavioral, and social factors may have contributed to it. METHODS: We used the State Democracy Index (SDI), an annual summary of each state's electoral democracy from 2000 to 2018. We merged the SDI with annual age-adjusted mortality rates for adults 25-64 years in each state. Models estimated the association between the SDI and working-age mortality (from all causes and six specific causes) within states, adjusting for political party control, safety net generosity, union coverage, immigrant population, and stable characteristics of states. We assessed whether economic (income, unemployment), behavioral (alcohol consumption, sleep), and social (marriage, violent crime, incarceration) factors accounted for the association. FINDINGS: Increasing electoral democracy in a state from a moderate level (defined as the third quintile of the SDI distribution) to a high level (defined as the fifth quintile) was associated with an estimated 3.2% and 2.7% lower mortality rate among working-age men and women, respectively, over the next year. Increasing electoral democracy in all states from the third to the fifth quintile of the SDI distribution may have resulted in 20,408 fewer working-age deaths in 2019. The democracy-mortality association mainly reflected social factors and, to a lesser extent, health behaviors. Increasing electoral democracy in a state was mostly strongly associated with lower mortality from drug poisoning and infectious diseases, followed by reductions in homicide and suicide. CONCLUSIONS: Erosion of electoral democracy is a threat to population health. This study adds to growing evidence that electoral democracy and population health are inextricably linked.

Socioeconomic Determinants of Anticipated and Actual Caregiving for Older Adults in India.

This study investigates adult children's informal caregiving for, and living arrangements with, older parents in urban India. We differentiated between anticipated caregiving, for respondents whose parents and parents-in-law do not currently need care, and actual caregiving, for respondents who have at least one parent or parent-in-law with care needs. The results based on the 2011 Osaka University Preference Parameters Study reveal different antecedents of anticipated and actual care. Females have lower odds of anticipated care but there were no gender differences in actual caregiving. Married people have higher odds of anticipating financial assistance, but lower odds of providing actual caregiving. Religiosity is positively related to anticipated care and co-residing but not actual caregiving. Wealth increases the odds of anticipating providing housework as well as anticipated and actual financial assistance, while decreasing the odds of actual care. Given these findings, strengthening public pension and long-term care services is warranted.

Estimating the EQ-5D-5L value set for the Philippines.

BACKGROUND: The Philippines has recommended the use of Quality-Adjusted Life Years (QALYs) in government health technology assessments (HTA). We aimed to develop a value set for the EQ-5D-5L based on health preferences of the healthy general adult population in the Philippines. METHODS: Healthy, literate adults were recruited from the Philippine general population with quota targets based on age, sex, administrative region, type of residence, education, income, and ethnolinguistic groups. Each participant's preference was elicited by completing Composite Time Trade-Off (C-TTO) and Discrete Choice Experiment (DCE) tasks. Tasks were computer-assisted using the EuroQol Valuation Technology 2.0. To estimate the value set, we explored 20- and 8-parameter models that either use c-TTO-only data or both c-TTO and DCE (also called hybrid models). Final model choice was guided by principles of monotonicity, out-of-sample likelihood, model fit, and parsimony. RESULTS: We recruited 1000 respondents with demographic characteristics that approximate the general population such as 49.6% Female, 82% Roman Catholic, 40% in urban areas, and 55% finished high school. None of the 20-parameter models demonstrated monotonicity (logical worsening of coefficients with increasing severity). From the 8-parameter models, the homoscedastic TTO-only model exhibited the best fit. From this model, mobility and pain/ discomfort had the highest effect on utilities. CONCLUSION: The selected model for representing the Philippine general population preferences for EQ-5D-5L health states was an 8-parameter homoscedastic TTO-only model. This value set is recommended for use in QALY calculations in support of HTA-informed coverage decisions in the Philippines.

Reciprocal associations between affectual, associational, and normative solidarity with parents during children's early to established adulthood.

Intergenerational solidarity has become increasingly important to understand, as close family members mobilize the provision of social support across generations and contribute to family wellbeing. However, less is known about continuity and change in normative (eldercare norms), affectual, and associational solidarity with mothers and fathers as children emerge into full or established adulthood. Therefore, we focused on reciprocal associations between three dimensions of intergenerational solidarity (normative, affectual, and associational) as reported by young-adult children from their early twenties to late thirties. Data were derived from respondents in the Longitudinal Study of Generations: daughters reported about relationships with 291 mother-father pairs and sons reported about relationships with 309 mother-father pairs in 2000, 2005, and 2016. Autoregressive cross-lagged models prospectively predicted mutual influences among the three dimensions of solidarity across daughter-parent and son-parent relationships. In addition, multiple group analysis was conducted to examine the children's gender difference. We found that normative solidarity and emotional closeness with mothers were mutually reinforcing in daughters' and sons' parental relationships. However, normative solidarity predicted emotional closeness with fathers in both daughter-parent and son-parent relationships. The study concludes that sons and daughters establish eldercare norms based on emotional components of solidarity with mothers, and suggest that filial duty is a key reason why mother-child relations become close over the family life course.

La solidaridad intergeneracional se ha vuelto cada vez más importante de comprender, ya que los familiares cercanos movilizan el apoyo social entre las generaciones y contribuyen al bienestar familiar. Sin embargo, se sabe poco acerca de la continuidad y el cambio en la solidaridad normativa (las normas de cuidado de los adultos mayores), afectiva y asociativa con las madres y los padres a medida que los hijos entran en la adultez completa o definitiva. Por lo tanto, nos centramos en las asociaciones recíprocas entre las tres dimensiones de solidaridad intergeneracional (normativa, afectiva y asociativa) según lo informado por los hijos jóvenes-adultos desde sus veinte hasta sus cuarenta años. Los datos se tomaron de personas encuestadas en el Estudio Longitudinal de Generaciones: las hijas informaron acerca de las relaciones con 291 pares de madres y padres y los hijos informaron acerca de las relaciones con 309 pares de madres y padres en los años 2000, 2005 y 2016. Los modelos autorregresivos de retardo cruzado predijeron prospectivamente influencias mutuas entre las tres dimensiones de solidaridad en las relaciones entre la hija y el padre/la madre y las relaciones entre el hijo y el padre/la madre. Además, se realizaron análisis multigrupo para analizar la diferencia de género de los hijos. Descubrimos que la solidaridad normativa y la cercanía emocional con las madres se reforzaron mutuamente en las relaciones parentales de las hijas y los hijos. Sin embargo, la solidaridad normativa predijo la cercanía emocional con los padres tanto en las relaciones entre la hija y el padre/la madre como en las relaciones entre el hijo y el padre/la madre. En el estudio se llega a la conclusión de que los hijos y las hijas establecen normas de cuidado de los adultos mayores basándose en los componentes emocionales de la solidaridad con las madres, y se sugiere que el deber filial es un motivo clave por el cual las relaciones entre madre e hijos se vuelven cercanas durante el transcurso de la vida familiar.

Cost-effectiveness analysis of the 2019 cigarette excise tax reform in the Philippines.

In this past decade alone, the Philippines has made major strides in increasing the price of cigarettes. This study estimated the cost-effectiveness of the most recent cigarette price increase of about 29% brought about by Republic Act (RA) 11346 in 2019. A static or a single cohort model was populated with locally-sourced inputs whenever possible. Public payer and societal perspectives were taken wherein the former only considered direct costs and tax revenue gained earmarked for the health sector while the latter adds indirect costs in the form of productivity losses. A 7% discount rate was applied. Increasing the price of cigarettes by about 29% was found to prevent about 1961 tobacco-related deaths which translate to about 34,571 disability adjusted life years (DALYs) saved. Savings incurred from hospitalizations prevented and additional excise tax revenues for health was about USD 367 Million. But when productivity losses averted due to the lives saved and the higher cost of hospitalizations were accounted for in the societal perspective, the excise tax reform yielded USD 415 Million net gain. It would save the public payer USD 10,612 per DALY averted while society at large stand to save USD 11,955 per DALY averted. Tax increases like RA 11346 yield significant revenue that can be used towards public health programs.

A cross-sectional study on the determinants of health-related quality of life in the Philippines using the EQ-5D-5L.

PURPOSE: The purpose of this study was to identify the determinants of Filipinos' health-related quality of life (HRQoL). METHODS: Data were collected from 1000 Filipinos across the nation who reported that they did not have known active disease or disability. HRQoL was measured through EuroQoL's (EQ) 5-level tool (EQ-5D-5L) and the EQ Visual Analog Scale (EQ-VAS). Both were implemented via the EQ Valuation Technology software. HRQoL was regressed on socioeconomic characteristics (age, sex, marital status, educational attainment, employment, poverty status, and availability of savings), social support factors (religion, religious attendance, and caregiving status), community- or societal-level factors (type and major island group of residence), and disease status. RESULTS: Majority of respondents reported that they did not have any problems across all EQ-5D-5L dimensions, namely mobility, self-care, usual activity, pain or discomfort, and anxiety or depression. Pain or discomfort had the highest rate of respondents reporting slight to extreme problems followed by anxiety or depression. Having savings was positively associated with HRQoL, while religious attendance, caregiver status, living in an urban area, living in Visayas or Mindanao, and having a diagnosed disease were negatively associated with HRQoL. CONCLUSION: This current study confirms that HRQoL varied across socioeconomic statuses and communities in the Philippines.

Price Elasticity of cigarette smoking demand in the Philippines after the 2012 Sin Tax Reform Act.

The Philippine tobacco excise tax reform law passed in 2012 drastically increased cigarette prices which were historically low. A pack of 20 cigarettes costing nine cents (US Dollar) or less was taxed five cents in 2011. When the reform took effect in 2013, each pack was taxed 24 cents which is almost five times the 2011 rate. Alongside the increase in tax is a decline in the prevalence of tobacco use from 28.3% in 2009 to 23.8% in 2015. Seven years since the reform took effect, policymakers are still debating whether the tax introduced was high enough to significantly reduce smoking prevalence. This study estimated the total price elasticity of cigarette demand using regression analyses on the pooled Philippine 2009 and 2015 Global Adult Tobacco Survey data with the excise tax as an instrumental variable. Information from both tax regimes provided the variation in cigarette prices that allowed for the estimation of the price elasticity of smoking participation and intensity. Age, sex, urban residence, educational attainment, employment status, wealth quintile, and media exposure were used as control variables. Results confirm that cigarette demand is inelastic, given that total cigarette price elasticity of demand ranges from -0.56 to -1.10 which means that for every 10% price increase, total cigarette demand declines by 5.6% to 11.0%. This study also provides total price elasticities for different subpopulations. Future studies can use these elasticity estimates to forecast smoking prevalence and provide policy recommendations.

Mental and physical health among 'sandwich' generation working-age adults in the United States: Not all sandwiches are made equal.

Objective: This research examined mental and physical health differences by (1) potential upward and downward care recipients and (2) heterogenous time and money transfer arrangements among working-age adults aged 35-64 in the U.S. who are considered to belong to the 'sandwich generation'. Methods: Data for this study came from the Panel Study of Income Dynamics 2013 Family File and Rosters and Transfers module (n = 4609). For the second study objective, we restricted the analytic sample to individuals with at least one living parent/parent-in-law and at least one child (n = 2228). We varied the sandwich generation experience by whether upward (i.e., to parent), downward (i.e., to children), or transfers at both directions occurred. We then fit a series of logistic regression models to study psychological distress and self-rated health status differences among various classifications of sandwich generation, controlling for basic sociodemographic factors and living arrangements. For both samples, we ran separate models for those without underaged coresident children. Results: Compared to respondents without potential care recipients, sandwiched individuals do not differ concerning severe psychological distress or poor/fair health. Conditional on being sandwiched between parents/parents-in-law and adult children, providers of both upward and downward time transfers have almost twice the odds of having severe psychological distress while money providers to parents/parents-in-law have about 1.6 times higher odds of reporting poor/fair health status. Conclusion: This study dispels the notion that being part of the sandwich generation is automatically deleterious to mental and physical health. Rather, it is the provision of certain transfers whilst being sandwiched that is associated with worse health outcomes.

American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Anterior Cruciate Ligament Injuries.

Management of Anterior Cruciate Ligament Injuries : Evidence-based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of anterior cruciate ligament injurie in both skeletally mature and immature patients. This guideline contains eight recommendations and seven options to assist orthopaedic surgeons and all qualified physicians managing patients with ACL injuries based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.

American Academy of Orthopaedic Surgeons Clinical Practice Guideline Case Study: Management of Anterior Cruciate Ligament Injuries.

Considering the frequency of anterior cruciate ligament (ACL) tears, optimal management of these injuries was the subject of a 2022 clinical practice guideline update from The American Academy of Orthopaedic Surgeons (AAOS) with input from representatives from the American Orthopaedic Society for Sports Medicine, the Pediatric Orthopaedic Society of North America, the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the American Academy of Physical Medicine and Rehabilitation, and the American College of Emergency Physicians. The eight recommendations and seven options to guide orthopaedic surgeons and other physicians managing patients with these anterior cruciate ligament injuries are based on the best current available evidence. The cases presented in this article are examples designed to demonstrate the clinical application of these guidelines.

Does religiosity in early adulthood predict change in filial eldercare norms after midlife among baby boomers?

This study investigated whether patterns of religious change from early to middle adulthood is associated with patterns of change in filial norms from midlife to later life. Tracking change across 45 years of the adult life span, we link developmental processes occurring at two stages of life using midlife as the point of inflection. Respondents consisted of 436 individuals in the Baby Boom generation who participated in the Longitudinal Study of Generations from Waves 1 (1971) to 9 (2016). We conducted latent class and latent transition analysis to identify religious classes and their transitions over several decades, and latent growth curve modeling to identify change in filial norms. We identified three religiosity classes in Waves 1 and 5-strongly religious, weakly religious, and moderately religious-and five patterns of religious transitions. These transitions were then used to predict change in filial norms between Waves 5 and 9. Respondents who remained weakly religious from early to mid-adulthood reported weaker filial norms in midlife, compared to those who became more religious, and declined more rapidly in their strength of filial norms after middle age. Those who stayed weakly religious also declined more rapidly post-middle age. Our findings link dynamics in religiosity and filial norms across disparate stages of the adult life span and suggest that religious orientations earlier in adulthood are linked to filial norms at time of life when responsibilities for eldercare become a concern for one's parents as well as oneself. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stability and change of religiosity among baby boomers in adulthood: Associations with familism over time.

While it is commonly understood that familism is influenced by religiosity, less is known about how religiosity between young adulthood and midlife is related to the trajectory of familism from midlife over the later life course. In this study, we identified a multidimensional typology of religiosity among baby boomers in young adulthood and midlife, explored how membership in this religious typology changed from young adulthood to midlife, and examined how transition patterns of religiosity were associated with familism over time. We used data from a sample of 471 baby boomers (mean age 19 years in 1971) from the Longitudinal Study of Generations (LSOG), Wave-1 (1971) through Wave-8 (2005). Using latent class and latent transition analysis, we identified three latent religiosity classes in Wave-1 (1971) and Wave-3 (1988): strongly religious, weakly religious, and privately religious, and identified nine transition patterns of religiosity from you between these waves from young adulthood to midlife. Using latent growth curve analysis (Wave-3 to Wave-8), we found that respondents who remained strongly or privately religious or whose religiosity increased had higher initial levels of familism (Wave-3) compared to those who stayed in the weakly religious class. However, the gap in familism across religiosity transition patterns decreased over time up to late middle age. Our findings indicate that while religiosity was positively associated with familism, its impact weakened over time possibly due to change in the centrality of family life and societal factors.

New treatment strategies for advanced-stage gastrointestinal stromal tumours.

When gastrointestinal stromal tumour (GIST), the most common form of sarcoma, was first recognized as a distinct pathological entity in the 1990s, patients with advanced-stage disease had a very poor prognosis owing to a lack of effective medical therapies. The discovery of KIT mutations as the first and most prevalent drivers of GIST and the subsequent development of the first KIT tyrosine kinase inhibitor (TKI), imatinib, revolutionized the treatment of patients with this disease. We can now identify the driver mutation in 99% of patients with GIST via molecular diagnostic testing, and therapies have been developed to treat many, but not all, molecular subtypes of the disease. At present, seven drugs are approved by the FDA for the treatment of advanced-stage GIST (imatinib, sunitinib, regorafenib, ripretinib, avapritinib, larotrectinib and entrectinib), all of which are TKIs. Although these agents can be very effective for treating certain GIST subtypes, challenges remain and new therapeutic approaches are needed. In this Review, we discuss the molecular subtypes of GIST and the evolution of current treatments, as well as their therapeutic limitations. We also highlight emerging therapeutic approaches that might overcome clinical challenges through novel strategies predicated on the biological features of the distinct GIST molecular subtypes.

Educational disparities in adult health across U.S. states: Larger disparities reflect economic factors.

Introduction: Education level is positively associated with adult health in the United States. However, new research shows that the association is stronger in some U.S. states than others, and that states with stronger associations also tend to have poorer overall levels of health. Understanding why educational disparities in health are larger in some states than others can advance knowledge of the major drivers of these disparities, between individuals and states. To that end, this study examined how key mechanisms (economic conditions, health behaviors, family, healthcare) help explain the education-health association in each state and whether they do so systematically. Methods: Using data on over 1.7 million adults ages 25-64 in the 2011-2018 Behavioral Risk Factor Surveillance System, we estimated the association between education level and self-rated health in each state, net of age, sex, race/ethnicity, and calendar year. We then estimated the contribution of economic, behavioral, family, and healthcare mechanisms to the association in each state. Results: The strength of the education-health association differed markedly across states and was strongest in the Midwest and South. Collectively, the mechanisms accounted for most of the association in all states, from 55% of it in North Dakota to 73% in Oklahoma. Economic (employment, income) and behavioral (smoking, obesity) mechanisms were key, but their contribution to the association differed systematically across states. In states with stronger education-health associations, economic conditions were the dominant mechanism linking education to health, but in states with weaker associations, the contribution of economic mechanisms waned and that of behavioral mechanisms rose. Discussion: Meaningful reductions in educational disparities in health, and overall improvements in health, may come from prioritizing access to employment and livable income among adults without a 4-year college degree, particularly in Southern and Midwestern states.

A dichotomy of smokers in the Philippines following sin tax reform: Distinguishing potential quitters from those unlikely to quit.

The Philippine government significantly raised cigarette excise taxes in 2013, following passage of the landmark Sin Tax Reform Act of 2012. As a result, cigarette prices increased substantially. Given varying smokers' responses to the price increase, we examined underlying typologies of Filipino smokers and assessed how these typologies determine smoking intensity. We used cross-sectional data from the 2015 wave of the Philippine Global Adult Tobacco Survey (N = 1,651). To uncover typologies, random effects latent class modelling was used on six individual smoker responses (attempting to stop, thinking about quitting, decreasing sticks smoked, switching to cheaper brands, buying in bulk, and asking from others). Bivariate and multivariate analyses were employed to uncover determinants of typologies and smoking intensity. We found two typologies based on smokers' response. The first group, called "potential quitters" (62.62%), is composed of smokers who are more likely to consider quitting and decrease sticks smoked. The second group, called "unlikely to quit" (37.38%), have smokers who opt for price-minimization strategies like switching to cheaper brands, buying in bulk, or asking cigarettes from others. Potential quitters tend to be female, a student, and less nicotine dependent. They smoke up to three fewer sticks than those unlikely to quit, controlling for other factors. Nicotine dependence stood out as the most important predictor of being in the unlikely to quit group. The dominant role of nicotine dependence in determining a smoker's typology points to the need for non-price based measures, such as those targeted towards highly-nicotine dependent smokers, to complement tax-induced price increases and comprehensively address the smoking problem.

The Role of Optimism on the Relationship Between Activity Limitations and Life Satisfaction Among Middle-Aged and Older Adults in the United States: A Growth Curve Model of Changes Over Time.

Activity limitations can diminish life satisfaction. This study explored the role of optimism on the relationship between changes in activities of daily living and instrumental activities of daily living (ADL/IADL) limitations and life satisfaction over time among middle-aged and older adults. Growth curve modeling accounting for intra- and inter-individual changes in life satisfaction was applied to the 2008-2018 waves of the Health and Retirement Study Leave Behind Survey subsample (n = 39,122 person-years). After controlling for sociodemographic factors, physical functioning decline adversely affected life satisfaction (ßADL = -0.12, ßIADL = -0.13, p < 0.001), but the negative consequences reduced slightly through optimism (ßADL = -0.11, ßIADL = -0.12, ßoptimism = 0.47, p < 0.001). Increasing optimism could reduce the negative consequences of ADL/IADL limitations on life satisfaction among middle-aged to older adults.

Religiosity of Baby-Boomers in Young Adulthood: Associations with Psychological Well-Being over the Life Course.

Although several studies have discovered positive relationships between religion and various aspects of mental health, less is known about longitudinal associations between religiosity and psychological well-being over the life course. We examined how religious latent classes during the transition to adulthood are associated with trajectories of psychological well-being over 45 years. We selected 798 young-adults baby-boomers from the 1971 wave of the Longitudinal Study of Generation (mean age: 19 years) and tracked their psychological well-being over nine waves up to the 2016 wave (mean age: 64 years). Latent class analysis focused on four religiosity domains (religious service attendance, religious intensity, civic value of religion, literal beliefs) identified four distinct latent religious classes: strongly religious, weakly religious, liberally religious, and privately religious. Results of latent growth curve modeling showed that strongly religious baby-boomers during the transition to adulthood generally reported better psychological well-being than weakly religious baby-boomers at the same stage in life. In addition, psychological well-being in strongly, liberally, and privately religious baby-boomers followed a consistently upward trend across the life course, whereas among weakly religious baby-boomers psychological well-being followed an inverted u-curve (increased until mid-40s and decreased thereafter). Findings suggest that earlier religiosity may serve as a significant predictor affecting psychological well-being throughout the adult life course.

COVID-19 Death Rates Are Higher in Rural Counties With Larger Shares of Blacks and Hispanics.

PURPOSE: This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. METHODS: COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. FINDINGS: Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. CONCLUSION: COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.

Influenza-associated excess mortality in the Philippines, 2006-2015.

Influenza-associated mortality has not been quantified in the Philippines. Here, we constructed multiple negative binomial regression models to estimate the overall and age-specific excess mortality rates (EMRs) associated with influenza in the Philippines from 2006 to 2015. The regression analyses used all-cause mortality as the dependent variable and meteorological controls, time, influenza A and B positivity rates (lagged for up to two time periods), and annual and semiannual cyclical seasonality controls as independent variables. The regression models closely matched observed all-cause mortality. Influenza was estimated to account for a mean of 5,347 excess deaths per year (1.1% of annual all-cause deaths) in the Philippines, most of which (67.1%) occurred in adults aged ≥60 years. Influenza A accounted for 85.7% of all estimated excess influenza deaths. The annual estimated influenza-attributable EMR was 5.09 (95% CI: 2.20-5.09) per 100,000 individuals. The EMR was highest for individuals aged ≥60 years (44.63 [95% CI: 4.51-44.69] per 100,000), second highest for children aged less than 5 years (2.14 [95% CI: 0.44-2.19] per 100,000), and lowest for individuals aged 10 to 19 years (0.48 [95% CI: 0.10-0.50] per 100,000). Estimated numbers of excess influenza-associated deaths were considerably higher than the numbers of influenza deaths registered nationally. Our results suggest that influenza causes considerable mortality in the Philippines-to an extent far greater than observed from national statistics-especially among older adults and young children.

Cardiovascular and Psychophysical Response to Repetitive Lifting Tasks in Women.

BACKGROUND: Understanding the cardiovascular and psychophysical demands of repetitive lifting tasks is important in job design strategies. This study determined the cardiovascular (oxygen consumption (VO2) and heart rate (HR) and psychophysical response to repetitive lifting tasks in women. METHODS: Ten female (age 27 ± 5 yrs) participants transferred 11.4, 15.9, and 20.5 kg weights back and forth from a rung 40.6 cm high to a rung 156.2 cm high. Rungs were 195.6 cm apart horizontally. Three, 10 minute bouts (1 = 11.4 kg; 2 = 15.9 kg; 3 = 20.5 kg) were performed at 6 lifts per minute. Cardiovascular and psychophysical (rating of perceived exertion, RPE) parameters were monitored throughout the bouts. VO2max and HRmax were determined via a maximal treadmill test. RESULTS: VO2, HR, and RPE were significantly different between each work bout (p < 0.01), with each outcome variable increasing as load increased. VO2max and HRmax equaled 46.5 ± 7.5 mL·kg-1·min-1 and 191 ± 11 bpm, respectively. Work at 11.4 kg was performed at 38% VO2max and 63% HRmax; at 15.9 kg at 41% VO2max and 72% HRmax; and at 20.5 kg at 49% VO2max and 81% HRmax. RPE at 11.4, 15.9, and 20.5 kgs were: 8.4 ± 1.6, 11.4 ± 1.9, and 15.0 ± 2.2. CONCLUSION: During these repetitive lifting tasks, metabolic cost and perceived exertion increased with weight lifted; average work intensity ranged from 63 to 81% of HRmax and 38 to 49% of VO2max. Results have important implications in relation to job pacing and design, and worksite health promotion strategies aimed at reducing work place injury.