Longevity in South African Afrikaner cows as assessed through survival analysis.

The Afrikaner breed of cattle is indigenous to South Africa and, due to their hardiness, was once the most popular breed amongst South African farmers, although in recent years their numbers have decreased. The goal of this study was to assess factors affecting length of productive life, defined as the interval between production of the first and last calf, in Afrikaner cattle using survival analysis. The data spanned 40 years with an observed measure of length of life for 29,379 cows from 374 herds. Relative to similar analyses, few (n = 2964; 8.4%) cows had records that were right censored. The median length of productive life of an Afrikaner cow was just less than 6 years. Cows that were younger at their first parturition had longer productive lives than those that were older at their first calving. Cows that were born in the period from December to February had shorter productive lives than those born between March and November. The estimated animal genetic variance of 0.266 resulted in a heritability estimate for length of productive life in Afrikaner cattle of 0.225. Thus, there appeared to be sufficient additive genetic variance in Afrikaner cattle to enable genetic improvement in their length of productive life.

Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review.

Introduction: Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice. Objective: This systematic review (SR) aims to provide a more accurate estimation of the incidence of SM, MESCC and pVCF in a clinical setting. Methods: We performed a SR of papers regarding epidemiology of SM, pVCF, and MESCC in patients with solid tumors conform PRISMA guidelines. A search was conducted in the PubMed and Web of Science database using the terms epidemiology, prevalence, incidence, global burden of disease, cost of disease, spinal metastas*, metastatic epidural spinal cord compression, pathologic fracture, vertebral compression fracture, vertebral metastas* and spinal neoplasms. Papers published between 1975 and august 2021 were included. Quality was evaluated by the STROBE criteria. Results: While 56 studies were included, none of them reports the actual definition used for MESCC and pVCF, inevitably introducing heterogenity. The overall cumulative incidence of SM and MESCC is 15.67% and 2.84% respectively in patients with a solid tumor. We calculated a mean cumulative incidence in patients with SM of 9.56% (95% CI 5.70%-13.42%) for MESCC and 12.63% (95% CI 7.00%-18.25%) for pVCF. Studies show an important delay between onset of symptoms and diagnosis. Conclusions: While the overall cumulative incidence for clinically diagnosed SM in patients with a solid tumor is 15.67%, autopsy studies reveal that SM are present in 30% by the time they die, suggesting underdiagnosing of SM. Approximately 1 out of 10 patients with SM will develop MESCC and another 12.6% will develop a pVCF. Understanding these epidemiologic data, should increase awareness for first symptoms, allowing early diagnosis and subsequent treatment, thus improving overall outcome.

The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality.

BACKGROUND: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. METHOD: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the "cross-sectional average length of healthy life" (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. RESULTS: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. CONCLUSIONS: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.

Associations of Caregiver-Oncologist Discordance in Prognostic Understanding With Caregiver-Reported Therapeutic Alliance and Anxiety.

CONTEXT: Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes. OBJECTIVES: We examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety after patient death. METHODS: We conducted a secondary analysis of data collected in a cluster randomized controlled trial from August 2012 to June 2014 in Western New York and California. At enrollment, caregivers and oncologists used a seven-point scale to rate their beliefs about the patient's curability and living two years or more: 100%, about 90%, about 75%, about 50 of 50, about 25%, about 10%, and 0%. Discordance was defined as a difference of two points or more. Outcomes at seven months after patient death included caregiver-oncologist therapeutic alliance (The Human Connection scale, modified into five items) and caregiver anxiety (Generalized Anxiety Disorder-7). We conducted multivariable linear regression models to assess the independent associations of discordance with alliance and anxiety. RESULTS: We included 97 caregivers (mean age 63) and 38 oncologists; 41% of caregiver-oncologist dyads had discordant beliefs about the patient's curability, and 63% of caregiver-oncologist dyads had discordant beliefs about living two years or more. On multivariate analysis, discordance in beliefs about curability was associated with lower anxiety (ß = -2.20; SE 0.77; P = 0.005). Discordance in beliefs about length of life was associated with a weaker alliance (ß = -5.87; SE = 2.56; P = 0.02). CONCLUSION: A better understanding of how caregivers understand and come to terms with poor prognoses will guide interventions to improve cancer care delivery and outcomes of cancer treatment.

Cancer Patients' Preferences for either Quality of Life or a Longer Life Determine Their Willingness to Talk about Forgoing Cancer-Specific Treatment.

BACKGROUND: Cancer patients often face decisions whether to proceed with cancer-specific treatment or to switch to best supportive care. In these decisions, patients' preferences should be determining cornerstones. The aim of this survey was to elicit patients' preferences regarding discussions about forgoing treatment and factors influencing their preferences. METHODS: We surveyed 194 patients at the National Center for Tumor Diseases, Germany. Quality of life (FACT-G), cancer-specific distress (QSC-R10), anxiety/depression (PHQ-4/GAD-2), preferences regarding quality/length of life (QQ), patient-physician communication (CARES-SF), and family role (CCAT-P) were assessed. RESULTS: Patients weighting quality of life over lifetime wanted their oncologists to address treatment limitations as early as possible (p = 0.00). Patients striving for a longer lifetime did not want such discussions (p = 0.05). Having discussed treatment limitations was not associated with increased anxiety, depression, or distress. Limiting treatment was discussed only with one-third of the patients with a prognosis of less than 6 months and rather with elderly patients or patients in a worse medical condition. Attributing an important role to family decisions was associated with striving for lifetime (p = 0.01). CONCLUSION: Preferences for either quality or length of life were associated with patients' willingness to discuss forgoing cancer-specific treatment. Timely discussion of realistic treatment goals is one way to avoid overtreatment. Patients striving for lifetime require increased attention and opportunities to address prognosis and risks of treatment.

Trends in inequality in length of life in India: a decomposition analysis by age and causes of death.

BACKGROUND: Studies dealing with trends in inequality in length of life in India are rare. Studies documenting the contribution of age and causes of death to the inequality in length of life are more limited. OBJECTIVE: The study aims to examine the trends in inequality in length of life in India and 15 major states of India and to decompose the inequality in length of life into the contributions of age and causes of death. METHOD: We use life table Gini coefficient (G0) to measure the inequality in length of life. We use the formulae developed by Shkolnikov, Andreev, and Begun (DR 8(11):305-358, 2003) to decompose the differences between Gini coefficients by age and cause of death. RESULT: The G0 for men has declined from 0.32 in 1981 to 0.19 in 2011. For women, G0 has decreased from 0.31 in 1981 to 0.22 in 2011. Mortality decline in the age group 0-1 year has contributed most to the decrease in G0. In contrast, mortality decline in 60+ has tended to increase the G0. The state-wide variations in the age-specific contributions to decrease in G0 were stark. The contribution of noncommunicable diseases to the male-female gap in G0 has increased between 1990 and 2010. Injuries at ages from 20 to 39 years also contributed to the male-female difference in G0 in 2010. CONCLUSION: Future studies must analyze inequality in life expectancy for assessing the performance of societies regarding length of life. CONTRIBUTION: This is the first study that provides compelling evidence on inequality in length of life in India and its major states.

Preliminary study of possible relationships between exposure to PCDD/Fs and dl-PCBs in ambient air and the length of life of people.

There is a lack of studies on the impact of very toxic and persistent organic compounds as polychlorinated dibenzodioxins (PCDDs), dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) on the population life expectancy. Preliminary studies on the relations between exposure to PCDD/Fs and dl-PCBs in ambient air and the length of life of residents of 12 cities (2 million people) in the Silesia province has been undertaken. The average length of life of inhabitants in 12 cities of Silesia province was calculated on the basis of register of deaths after excluding deaths caused by external causes and the concentration of PCDD/Fs and dl-PCBs were measured. The studies have shown that inhalation exposure to dioxins, furans and dl-PCBs could be an important factor which may shorten the life expectancy of the population. The results of preliminary studies indicate a strong correlation between the concentration of PCDD/Fs and dl-PCBs in the ambient air and the length of life of women. The conducted analysis of the regression shows that reduction of chlorinated persistent organic compounds of 10fg I-TEQ/m3 could extend life expectancy of women by approximately 4months (0.3years).

[Reflections about the efficiency criteria for cancer treatments during marketing authorization application]. / Réflexions sur les critères d'évaluation des traitements anticancéreux lors des procédures d'autorisation de mise sur le marché

Although clear and validated recommendations exist concerning the evaluation of cancer treatments at the international level, the criteria retained to obtain the marketing authorization (MA) are multiple and heterogeneous. This qualitative survey explores the opinion related to the assessment of cancer treatment among the several concerned population. By the way of semi-structured interviews, our aim was to elicit perceptions toward the criteria which should be retained during the process of MA, by patients, oncologists, members of the pharmaceutical industry, health decision-makers and general population. Our survey emphasizes the variability of the significations associated with the criteria of efficiency of cancer treatments according to the characteristics of the respondents. We also have observed some common expectations from patients and oncologists toward the economic and political aspect, but also from the whole respondents toward the importance of the comfort of the patients. Lastly, the necessity to define specific criteria related to clinical cases emerges.

Potential effects on fertility and child health and survival of birth-spacing preferences in sub-Saharan Africa.

Using Demographic and Health Survey data from 20 sub-Saharan African countries, this article compares the actual lengths of birth intervals to women's reported preferred lengths, and assesses the implications of the difference between the two for selected demographic and health indicators. The results show a clear pattern. In Comoros, Ghana, Kenya, Rwanda, and Zimbabwe, women prefer much longer birth intervals than those they actually have, compared with women in the other 15 countries studied. As a consequence, the potential effects of spacing preferences on the level of fertility and on the prevalences of short (less than 24 months) birth intervals and child malnutrition are greatest in the same five countries. The covariates of preferred birth-interval lengths are also examined. An explanation is offered for this pattern, based on the observed sharp decline in fertility recently experienced by these five "forerunners." In general, women who know, approve of, discuss, and use family planning prefer longer intervals than do their counterparts. The policy and program relevance of these results is discussed.

The effects of water supply and sanitation on childhood mortality in urban Eritrea.

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post-neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post-neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for.

Sibling mortality correlation in Kenya.

This paper examines whether infant and child mortality risks among successive siblings are closely correlated, and if so, whether the survival status of the preceding child is an important factor affecting infant and child mortality in Kenya. The data were drawn from the 1988/89 Kenya Demographic and Health Survey. Logistic regression was used as the major method of data analysis. The results show that both infant and child mortality rates are significantly higher among subsequent children whose preceding siblings had died in infancy than for those whose preceding sibling had survived through infancy. The effect of the survival status of the preceding child on infant mortality was statistically strong, even after a large number of control variables were taken into account. However, its effect on child mortality appears to be spurious since it was rendered statistically insignificant when just a few control variables were introduced into the analysis. The results provide empirical evidence that infant and child mortality risks among successive siblings are closely correlated in Kenyan families, and that the effect of the survival status of the preceding child is important in determining infant mortality but not child mortality.

Looking back at the century of population.

PIP: This article reports experts' views on the important population trends and events observed in the 20th century. One expert mentioned that demographically the 20th century was the most remarkable century ever. Among its major features were the following: highest rate of growth; highest annual increment; shortest period in history to add 1 billion people; unprecedented decline in fertility; unparalleled increases in life expectancy, with dramatic declines in mortality; and rapid urbanization and the emergence of megacities. An expert from Paris cited changes in ethnic composition in the US and changes in the religious composition of Europe. Among the events considered as important population trends for the 20th century are the following: fertility decline; increase in proportion of older persons; development of hormonal contraceptives; stagnation of population growth in economically rich and industrialized countries; literacy rate of the population; promotion of gender equality and equity; women's empowerment; adoption of broad reproductive health/rights policies; and prevention and treatment of sexually transmitted diseases, including HIV/AIDS.^ieng

Improvement in female survival: a quiet revolution in Bangladesh.

PIP: This article examined the time trends of mortality and made a relative comparison of the mortality changes between males and females in different age groups in a rural area in Bangladesh between 1970 and 1995. Data from the Matlab Demographic Surveillance System were used for the study. Two areas were compared: 1) the maternal and child health/family planning (MCH/FP) area and 2) the other area known as the comparison area. Data showed that the mortality situation improved in both areas in every age group within the study period. However, the improvement was much greater for females in infancy and at ages 1-4 and 5-14. While improvement was seen in both areas, greater improvement was observed in the MCH/FP area, indicating a gain in life expectancy that is greater in females than in males. These improvements, however, were still below expectation for infants and children in the 1-4 age group. Thus, more efforts need to be exerted to maintain the improvement in female survival and eliminate excess female child mortality in Bangladesh.^ieng

Child survival and development.

PIP: India is home to over 382.9 million children, the largest number of any country in the world. This number only shows that the country has made commendable progress in various child survival and development indicators such as infant mortality rate, education, and immunization during the last 50 years. However, according to the 1981 census, 53% of young children (0-6 years) suffered from malnutrition and about 13 million infants were being added to the child population annually. This rate of increase poses a significant problem for national development that requires immediate action. It should be understood that early childhood (0-6 years) is a very critical period for a child's physical and socio-psychological development. In view of this, the government, state and the voluntary sector implemented a large number of programs for children and nursing and expectant mothers to enable children to develop their full potential; however, these efforts were far from satisfactory. Nutritional problems of children of urban slums have increased in magnitude and there is a high prevalence of protein malnutrition among preschoolers. In addition, dietary intake of vitamin A is low among pregnant women belonging to poor communities and low-income groups. With all these problems, a tremendous task awaits the government.^ieng

Interactions between development and human health.

PIP: The policy reform in China, which was adopted 20 years ago, has greatly boosted the country's economic development as a whole, but has in the process widened the economic gaps between the eastern and western part of the country. This paper examines the existing disparities between China's two regions, particularly the eastern and western part in terms of average life expectancy, infant mortality, and causes of death relative to its realization in achieving sustainable development. It is evident that the level of life expectancy in western China in the early 1990s did not measure up to the level of the early 1970s in the eastern provinces. Average life expectancy in the eastern provinces ranged over 70 years in 1990 with its infant mortality rate registering between 8.8 and 29.2 per 1000, whereas the life expectancy in the western areas ranged below the national average of 68.6 years and 37.3-96.2 per 1000 for its infant mortality rate. In the context of the causes of death, poverty-related and infectious diseases are considered as the main causes for the disparity between the eastern and western China in mortality rates. Level of socioeconomic development; population development; poor sanitary condition; poor health-care facilities; and adverse natural conditions and a fragile ecological environment are the compounding factors for these disparities. Several recommendations for decision-makers in implementing strategies to achieve sustainable development are presented.^ieng

The impact of HIV / AIDS on child survival and development in Kenya.

PIP: This paper focuses on the impact of HIV/AIDS on child survival and development in Kenya. The rapid spread of HIV, mainly through heterosexual contact and mother-to child transmission, contributes to the increasing rates of infant and under-five mortality in Kenyan provinces. Moreover, the impact of AIDS on the well-being of children is likely to worsen, as preliminary findings of the 1999 sentinel surveillance data indicate that HIV prevalence among the adult population is still rising. Poverty increases the vulnerability of children to HIV/AIDS. In addition, it may increase the likelihood that women become commercial sex workers as an alternative source of income. Poverty also increases the risk of illness and death through poor access to basic services. Poor environmental sanitation and lack of access to safe water sources increase the vulnerability of children to the impact of the infection. As a consequence, more and more children will be infected and affected by HIV/AIDS, and the ability of HIV-positive parents to care for their children will be impaired, while the number of orphans will continue to increase dramatically as parents die within a short period. Recommended strategies in combating the epidemic and improving the well-being of children are outlined.^ieng

[Population statistics] as of January 1, 2000.

PIP: This table presents the population statistics of Thailand as of January 1, 2000. Thailand has a total population of 61,737,000; 30,726,000 are males and 31,011,000 are females. The urban areas have a population of 18,972,000, while the rural areas have a population of 42,765,000. The population numbers, by region, are the following: northern, 12,117,000; northeastern, 20,164,000; southern, 7,957,000; central (excluding Bangkok Metropolis), 13,654,000; Bangkok Metropolis, 7,845,000. Children (under age 15) numbered 14,764,000; labor force participants (ages 15-59), 41,647,000; the elderly (ages 60-79), 4,974,000; those aged 80 and above, 352,000; the school-age population (ages 6-21), 16,703,000; reproductive-age women (ages 15-44), 16,697,000; and the voting population (ages 18 and over), 43,691,000. The crude birth rate (per 1000 population) is 16.4, and the crude death rate is 6.5. Thailand has a natural growth rate of 1.0% and an infant mortality rate (per 1000 live births) of 22.4. Life expectancy at birth among males and females is 69.9 and 74.9, respectively. The total fertility rate is 1.9/woman, the contraceptive prevalence rate is 72.2%, and the ratio of females per 1 male is 1.0 for ages 0-59, 1.1 for ages 60-79, and 2.0 for ages 80 and over.^ieng

[Population statistics] as of July 1, 2000.

PIP: This Mahidol Population Gazette presents Thailand's population and demographic estimates as of July 1, 2000, using the standard techniques of demographic analysis. The paper provides estimates of Thailand's total population, population by sex, population in urban and rural areas, population by region, and by age group. In addition, figures of crude birth and death are listed per 1000 population, natural growth rate, and infant mortality rate per 1000 live births, male and females' life expectancy at birth and at age 60, total fertility rate, contraceptive prevalence rate. The number of the aged population in 2020 is also presented. Presented in a bar graph is a population pyramid for Thailand in the year 2000, illustrating male and females' age and year of birth.^ieng

Reducing perinatal HIV transmission in developing countries through antenatal and delivery care, and breastfeeding: supporting infant survival by supporting women's survival.

In 1998, a joint UNAIDS/UNICEF/WHO working group announced an initiative to pilot test an intervention to reduce perinatal transmission of human immunodeficiency virus (HIV), based on new guidelines on HIV and infant feeding. This intervention for developing countries includes short-course perinatal zidovudine (AZT) treatment and advice to HIV-positive women not to breastfeed their infants, where this can be done safely. The present paper raises questions about the extent of the public health benefit of this intervention, even though it may be cost-effective, due to the limited capacity of antenatal and delivery services to implement it fully. It argues that it is necessary to provide universal access to replacement feeding methods and support in their safe use, not only for women who have tested HIV-positive during pregnancy, but also for untested women who may also decide not to breastfeed, some of whom may be infected with HIV or may acquire HIV during the breastfeeding period. It further argues that additional funding, more staff, staff training, and improved capacity and resources are also needed to integrate this intervention successfully into antenatal and delivery care. The intervention will prevent some infants from getting HIV even in the absence of many of these changes. However, a comprehensive approach to HIV prevention and care in developing countries that includes both women and infants would promote better health and survival of women, which would in turn contribute to greater infant health and survival. If combination antiretroviral therapy in the latter part of pregnancy and/or during the breastfeeding period can be shown to be safe for infants, preliminary evidence suggests that it might reduce perinatal HIV transmission as effectively as the current intervention and, in addition, might allow the practice of breastfeeding to be preserved.

PIP: This paper comments on the extent of the public health benefit of perinatal zidovudine treatment and breast-feeding replacement initiatives in the poorer developing countries. This kind of intervention may prevent many infants from getting HIV infection. However, additional funds, as well as additional staff, staff training, and improved capacity and resources are needed to integrate this intervention successfully into antenatal and delivery care. In addition, replacement feeding methods must be accessible and there should be support in using them safely, not only for HIV-positive women but also for untested women who fear that they may be infected with the disease, and for those at risk of infection in the breast-feeding period. However, a more comprehensive, broad-based approach to HIV prevention and care in relation to pregnancy that include treatment for both women and infants is presented. It promotes prolonged health and survival in women, which would consequently contribute to improved infant and child health and survival.

Children in an ageing society.

PIP: This paper explores the implications of demographic aging for children and pediatric practice in the Western society. It focuses on the social class differences in childbearing patterns, specific issues related to disability, and distribution of resources between age groups. Women in the Western world are now having children at an older age than at any time in the past 50 years. Voluntary childlessness or deliberate delay in childbearing is common among highly educated women. This changing pattern in childbearing may increase and polarize health and wealth inequalities. With advancements in neonatal and pediatric care which prolong life expectancy and survival of disabled children, it is projected that there will be an increasing number of very old parents caring for severely disabled offspring. Meanwhile, there are also many children who are carrying considerable burdens of caring for their disabled parents. The community burden of disability will continue to rise. The needs of the elderly population may drain resources from child health services. Despite this demographic pattern, care for the children is still important. Health care authorities must not become contented with the existing pediatric care services just because demographic changes require that the nation should invest more in care of the older population.^ieng