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2.
BMJ ; 368: l6669, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915124

RESUMO

OBJECTIVE: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME: Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Estilo de Vida Saudável/fisiologia , Expectativa de Vida , Neoplasias , Comportamento de Redução do Risco , Adulto , Consumo de Bebidas Alcoólicas , Índice de Massa Corporal , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias/psicologia , Pesquisa em Enfermagem , Estudos Prospectivos , Fumar
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 104-107, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914577

RESUMO

From 1987 to 2017, cardiovascular disease (CVD) had been ranking the first cause of death in Suzhou, and the mortality rate showed an upward trend annual percentage changes (APC=0.62%, P=0.001), while the standardized mortality rate showed a downward trend (APC=-2.65%, P<0.001). The probability of premature death of CVD declined consistently from 7.06% in 1987 to 2.00% in 2017 (APC=-4.45%, P<0.001). When the life expectancy was set at 70, the potential years of life lost rate (PYLLR) decreased from 6.35‰ in 1987 to 3.30‰ in 2017, and the standardized PYLLR decreased from 7.30‰ to 2.68‰. When the life expectancy was set at 75, the PYLLR decreased from 10.12‰ to 5.19‰, and the standardized PYLLR decreased from 11.44‰ to 3.88‰. With the increase of years, all PYLLR and standardized PYLLR showed a significantly downward trend (APC=-2.51%--3.89%, P<0.001).


Assuntos
Doenças Cardiovasculares/mortalidade , Expectativa de Vida/tendências , Mortalidade Prematura/tendências , China/epidemiologia , Humanos , Probabilidade
7.
J Surg Res ; 245: 587-592, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499364

RESUMO

BACKGROUND: Surgical disease increasingly contributes to global mortality and morbidity. The Lancet Commission on Global Surgery found that global cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study helps to address this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. MATERIALS AND METHODS: A time-and-motion analysis was utilized to calculate operating theater personnel costs per case. Ward personnel, administrative, medication, and supply costs were recorded and calculated using a microcosting approach. The cost in 2018 US Dollars (USD, $) per disability-adjusted life year (DALY) averted was calculated based on age-specific life expectancies for otherwise fatal cases. RESULTS: Data for 103 surgical patients requiring exploratory laparotomy at the Soroti Regional Referral Hospital were collected over 8 mo. The most common cause for laparotomy was small bowel obstruction (32% of total cases). The average cost per patient was $75.50. The postoperative mortality was 11.7%, and 7.8% of patients had complications. The average number of DALYs averted per patient was 18.51. The cost in USD per DALY averted was $4.08. CONCLUSIONS: This investigation provides evidence that exploratory laparotomy is cost-effective compared with other public health interventions. Relative cost-effectiveness includes a comparison with bed nets for malaria prevention ($6.48-22.04/DALY averted), tuberculosis, tetanus, measles, and polio vaccines ($12.96-25.93/DALY averted), and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20/DALY averted). Given that the total burden of surgically treatable conditions in DALYs is more than that of malaria, tuberculosis, and HIV combined, our findings strengthen the argument for greater investment in primary surgical capacity in low- and middle-income countries.


Assuntos
Análise Custo-Benefício , Países em Desenvolvimento/economia , Laparotomia/economia , Centros de Atenção Terciária/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Países em Desenvolvimento/estatística & dados numéricos , Equipamentos e Provisões Hospitalares/economia , Feminino , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Laparotomia/estatística & dados numéricos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Regionalização/economia , Centros de Atenção Terciária/estatística & dados numéricos , Uganda , Adulto Jovem
8.
Int J Radiat Oncol Biol Phys ; 106(1): 52-60, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31682969

RESUMO

PURPOSE: This prospective study aimed to determine the accuracy of radiation oncologists in predicting the survival of patients with metastatic disease receiving radiation therapy and to understand factors associated with their accuracy. METHODS AND MATERIALS: This single-institution study surveyed 22 attending radiation oncologists to estimate patient survival. Survival predictions were defined as accurate if the observed survival (OS) was within the correct survival prediction category (0-6 months, >6-12 months, >12-24 months, and >24 months). The physicians made survival estimates for each course of radiation, yielding 877 analyzable predictions for 689 unique patients. Data analysis included Stuart's Tau C, logistic regression models, ordinal logistic regression models, and stepwise selection to examine variable interactions. RESULTS: Of the 877 radiation oncologists' predictions, 39.7% were accurate, 26.5% were underestimations, and 33.9% were overestimations. Stuart's Tau C showed low correlation between OS and survival estimates (0.3499), consistent with the inaccuracy reported in the literature. However, results showed less systematic overprediction than reported in the literature. Karnofsky performance status was the most significant predictor of accuracy, with greater accuracy for patients with shorter OS. Estimates were also more accurate for patients with lower Karnofsky performance status. Accuracy by patient age varied by primary site and race. Physician years of experience did not correlate with accuracy. CONCLUSIONS: The sampled radiation oncologists have a 40% accuracy in predicting patient survival. Future investigation should explore how survival estimates influence treatment decisions and how to improve survival prediction accuracy.


Assuntos
Expectativa de Vida , Neoplasias/mortalidade , Radio-Oncologistas , Idoso , Competência Clínica , Confiabilidade dos Dados , Feminino , Previsões , Humanos , Avaliação de Estado de Karnofsky/estatística & dados numéricos , Modelos Logísticos , Masculino , Metástase Neoplásica , Neoplasias/patologia , Neoplasias/radioterapia , Estudos Prospectivos , Radio-Oncologistas/estatística & dados numéricos , Análise de Sobrevida , Assistência Terminal , Fatores de Tempo
11.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 123-128, jan.-dez. 2020. tab, ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1048296

RESUMO

Objetivo: analisar a esperança de vida e a depressão em pessoas vivendo com HIV/Aids. Método: trata­se de uma pesquisa descritiva, quantitativa realizada com 17 pessoas com HIV/Aids que recebem atendimento em um Hospital de Referência para Doenças Infectocontagiosas no município de João Pessoa/PB, Brasil. Para coleta de dados utilizou-se uma Escala de Esperança de Vida e a Escala de Depressão HAM-D. Resultados: quanto ao tipo de exposição que levou ao diagnóstico de HIV/Aids 88,2%(15) revelaram o sexo desprotegido, o estado civil de maior prevalência foi o solteiro 58,8%(10). Os dados referentes a esperança de vida apresentaram escore médio 38,47±7,45, mediana 39, máximo 48 e mínimo 27. Conclusão: a fé e a esperança têm importantes valores, contribuindo na capacidade de lidar com situações difíceis e na manutenção da qualidade de vida, sendo facilitadoras das consequências psicossociais acerratadas por essa condição


Objective: to analyze life expectancy and depression in people living with HIV / Aids. Method: this is a descriptive, quantitative study of 17 people with HIV/Aids who receive care at a Reference Hospital for Infectious Diseases in the city of João Pessoa / PB, Brazil. A Life Expectancy Scale and the HAM-D Depression Scale were used for data collection. Results: regarding the type of exposure that led to the diagnosis of HIV/Aids, 88.2% (15) revealed unprotected sex, the single most prevalent civil status was the unmarried 58.8% (10). Life expectancy data presented a mean score of 38.47 ± 7.45, median 39, maximum 48 and minimum 27. Conclusion: faith and hope have important values, contributing to the capacity to deal with difficult situations and to maintain the quality of life, facilitating the psychosocial consequences of this condition


Objetivo: analizar la esperanza de vida y la depresión en las personas que viven con el VIH / SIDA. Método: se trata de una investigación descriptiva, cuantitativa realizada con 17 personas con VIH/SIDA que reciben atención en un Hospital de Referencia para Enfermedades Infectocontagiosas en el municipio de João Pessoa / PB, Brasil. Para la recolección de datos se utilizó una Escala de Esperanza de Vida y la Escala de Depresión HAM-D. Resultados: en cuanto al tipo de exposición que llevó al diagnóstico de VIH / SIDA el 88,2% (15) reveló el sexo desprotegido, el estado civil de mayor prevalencia fue el 58,8% (10). Los datos referentes a la esperanza de vida presentaron escore promedio 38,47 ± 7,45, mediana 39, máximo 48 y mínimo 27. Conclusión: la fe y la esperanza tienen importantes valores, contribuyendo en la capacidad de lidiar con situaciones difíciles y en el mantenimiento de la situación calidad de vida, siendo facilitadoras de las consecuencias psicosociales acorraladas por esa condición


Assuntos
Humanos , Expectativa de Vida , HIV , Depressão , Brasil
12.
J Assoc Physicians India ; 67(12): 75-76, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801335

RESUMO

Human lifespan has seen a rise globally. Extended lifespan is a trend projected to persist and continue. The gap is wide: from 52.67 years in the Central African Republic to 80.3 years in the OECD (Canada, Germany, Mexico, France, Japan, UK). In India the expectancy was 68.8 years in 2018. Concordant with the enhanced life span have been studies that explain determinants and mechanisms of human longevity, much of which has been attributed to better public health measures and improved care. The natural twin consequences of longevity: a) Frailty its characteristics and management and b) the behavioural cum attitudinal phenomenon of Ageism have come to the fore and require appropriate corrections. Physicians need to be aware of the demographic changes and implications thereof in management and healthcare. The medical aspects of either are elaborated.


Assuntos
Ageismo , Fragilidade , Longevidade , Canadá , França , Alemanha , Humanos , Índia , Japão , Expectativa de Vida
13.
Kardiologiia ; 59(12): 54-63, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849312

RESUMO

Increase in life expectancy during the second part of the 20th century is accompanied by increase in proportion of elderly and senile age population. However, despite the increase in life expectancy, the prevalence of most chronic diseases and functional impairments rises with age. Elderly and senile age is associated with the risk of cardiovascular diseases (CVD), therefore the problem of managing elderly patients with CVD becomes especially urgent.


Assuntos
Cardiologia , Doenças Cardiovasculares , Geriatria , Idoso , Doença Crônica , Humanos , Expectativa de Vida
14.
Artigo em Russo | MEDLINE | ID: mdl-31884762

RESUMO

The demand for research in the context of identifying the relationship between socioeconomic factors and the medical and demographic indicators of individual regions is conditioned by continuing deterioration of the health status of population of the subjects of the Russian Federation, which occurs under the influence of unfavorable environmental factors. The purpose of research is to carry out comprehensive analysis of the medical and demographic indicators of population health of the region in 2012-2017, taking into account the influence of regional health factors. Materials and methods. The study applied such research techniques as the Pearson's correlation analysis with matrix construction. The processing was performed using the software Statistica 6.0. To test the hypothesis of normal distribution, the Shapiro-Wilk criterion was applied. The significance of differences was determined by the Student's criterion. The differences were considered statistically significant with p<0.05. The study used data of the State statistical Report of the Ministry of Health of the Russian Federation in 2012-2017. The results. The study established that the Trans-Baikal Krai is characterized by a decrease in population size up to 1.9%, a decrease in the birth rate up to 18.5%, a significant decrease in natural growth, an average mortality rate and an increase in life expectancy by 4.89%. According to the Human Development Reports, the Trans-Baikal Krai takes the 76th position among the regions of the Russian Federation. The comprehensive assessment of the socio-economic conditions of the region allowed to identify the factors with the maximum degree of influence on the condition of public health, among which the resource characteristics of the regional health system are of significant importance, that determines the need for long-term study of the effect of these indicators on the level of regional health.


Assuntos
Nível de Saúde , Expectativa de Vida , Coeficiente de Natalidade , Demografia , Humanos , Mortalidade , Federação Russa , Fatores Socioeconômicos
15.
Artigo em Russo | MEDLINE | ID: mdl-31884767

RESUMO

The main causes of aging of the population are decreasing of birth rate, increasing of life expectancy, increasing of mortality rate of population of able-bodied age. The continuing aging of population results in increasing of number of elderly people requiring social and medical care. The role of social service institutions is increasing. The purpose of study is to assess activities of the division's centers of social services to elderly age and disabled citizen in the Russia for 2007-2017. The article presents analysis of the indices of functioning of the centers of social support of elderly population and disabled persons in the Russian Federation. In 2007-2017 in the conditions of aging of population most of the indices of divisions of the centers of social support of elderly population and disabled persons decreased except social rehabilitation divisions and divisions of social service at home. The methods. The normative documents regulating activity of the centers of social services and their structural divisions are investigated. The indices of functioning of divisions centers of the social support of elderly population and disabled persons such as day care, temporary residence, social and rehabilitation services, social services at home, specialized social and medical services at home, urgent social services in Russia, were analyzed according to the Federal State Statistics Service (Rosstat) for period of 11 years. The analytical and statistical methods were used. Conclusion. In the Russian Federation, the last decade has been characterized by significant increase in the total proportion number of persons over working age (from 20,8 to 25,0%). At the same time, decreasing of indices of functioning of divisions of temporary residences, day care, specialized divisions of social and medical services at home, urgent social services divisions, reduction in the number of social workers centers of social services to elderly age and disabled citizens was established.


Assuntos
Pessoas com Deficiência , Apoio Social , Idoso , Humanos , Expectativa de Vida , Federação Russa , Serviço Social
16.
JAMA ; 322(20): 1963-1965, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31769810
17.
JAMA ; 322(20): 1996-2016, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31769830

RESUMO

Importance: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing. Objective: To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends. Evidence: Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined. Findings: Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states. Conclusions and Relevance: US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.


Assuntos
Expectativa de Vida/tendências , Mortalidade/tendências , Adolescente , Adulto , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Masculino , Pessoa de Meia-Idade , Determinantes Sociais da Saúde , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Estados Unidos/epidemiologia , Adulto Jovem
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