A strategic analysis of health behaviour change initiatives in Africa.

BACKGROUND: Changed health behaviours can contribute significantly to improved health. Consequently, significant investments have been channelled towards health behaviour change initiatives in Africa. Health behaviour change initiatives that address social, economic and environmental levers for behaviour change can create more sustained impact. OBJECTIVES: Through a scoping study of the literature, we explored the literature on behaviour change initiatives in Africa, to assess their typologies. We explored whether the availability of initiatives reflected country demographic characteristics, namely life expectancy, gross domestic product (GDP), and population sizes. Finally, we assessed topical themes of interventions relative to frequent causes of mortality. METHODS: We used the Behaviour Change Wheel intervention categories to categorise each paper into a typology of initiatives. Using Pearson's correlation coefficient, we explored whether there was a correlation between the number of initiatives implemented in a country in the specified period, and socio-demographic indicators, namely, GDP per capita, total GDP, population size, and life expectancy. RESULTS: Almost 64% of African countries were represented in the identified initiatives. One in five initiatives was implemented in South Africa, while there was a dearth of literature from Central Africa and western parts of North Africa. There was a positive correlation between the number of initiatives and GDP per capita. Most initiatives focused on addressing sexually transmitted infections and were short-term trials and/or pilots. Most initiatives were downstream focused e.g. with education and training components, while upstream intervention types such as the use of incentives were under-explored. CONCLUSION: We call for more emphasis on initiatives that address contextual facilitators and barriers, integrate considerations for sustainable development, and consider intra-regional deprivation.

Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020.

Importance: Amid efforts in the US to promote health equity, there is a need to assess recent progress in reducing excess deaths and years of potential life lost among the Black population compared with the White population. Objective: To evaluate trends in excess mortality and years of potential life lost among the Black population compared with the White population. Design, setting, and participants: Serial cross-sectional study using US national data from the Centers for Disease Control and Prevention from 1999 through 2020. We included data from non-Hispanic White and non-Hispanic Black populations across all age groups. Exposures: Race as documented in the death certificates. Main outcomes and measures: Excess age-adjusted all-cause mortality, cause-specific mortality, age-specific mortality, and years of potential life lost rates (per 100 000 individuals) among the Black population compared with the White population. Results: From 1999 to 2011, the age-adjusted excess mortality rate declined from 404 to 211 excess deaths per 100 000 individuals among Black males (P for trend <.001). However, the rate plateaued from 2011 through 2019 (P for trend = .98) and increased in 2020 to 395-rates not seen since 2000. Among Black females, the rate declined from 224 excess deaths per 100 000 individuals in 1999 to 87 in 2015 (P for trend <.001). There was no significant change between 2016 and 2019 (P for trend = .71) and in 2020 rates increased to 192-levels not seen since 2005. The trends in rates of excess years of potential life lost followed a similar pattern. From 1999 to 2020, the disproportionately higher mortality rates in Black males and females resulted in 997 623 and 628 464 excess deaths, respectively, representing a loss of more than 80 million years of life. Heart disease had the highest excess mortality rates, and the excess years of potential life lost rates were largest among infants and middle-aged adults. Conclusions and relevance: Over a recent 22-year period, the Black population in the US experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost when compared with the White population. After a period of progress in reducing disparities, improvements stalled, and differences between the Black population and the White population worsened in 2020.

[Recommendations for the patient during the treatment of colorectal cancer through the enhanced recovery.] / Recomendaciones para el paciente durante el tratamiento del cáncer colorrectal mediante la vía de recuperación intensificada.

It is estimated that colorectal cancer is the cancer disease with the highest incidence in Spain  due to the increase in life expectancy and changes in the lifestyle of the population . Early detection through disease screening programs allows for more effective treatment and a higher survival rate . Advances in treatment have been made, such as targeted therapies, which focus on specifically attacking cancer cells and preventing their growth . However, much remains to be done in terms of prevention and treatment of colorectal cancer. More research and medical advances are required to combat this disease.

Se estima que el cáncer colorrectal es la enfermedad oncológica que presenta mayor incidencia en España  debido al incremento en la esperanza de vida y a los cambios en el estilo de vida de la población . La detección precoz mediante los programas de cribado de la enfermedad permite un tratamiento más efectivo y una mayor tasa de supervivencia . Se han realizado avances en el tratamiento, como las terapias dirigidas, que se centran en atacar específicamente a las células cancerosas y prevenir su crecimiento . Sin embargo, todavía queda mucho por hacer en términos de prevención y tratamiento del cáncer colorrectal. Se requiere más investigación y más avances médicos para combatir esta enfermedad.

[Burden of non-communicable diseases attributable to population aging in China, 1990‒2050].

Objective: The direction and intensity of population aging on the burden of non-communicable diseases (NCDs) in China from 1990 to 2019 were analyzed, and the burden of NCDs in 2050 was predicted. Methods: The disease-specific disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) in the Chinese population from 1990 to 2019 were obtained from the Global Burden of Disease Study.The differences in indicators from 1990 to 2019 were attributed to the contribution of age structure, population size, and all other causes. The Bayesian age-time-cohort models were used to predict DALYs from NCDs to 2050. Results: The absolute level of DALYs caused by NCDs increased by 7.460 million from 1990 to 2019, and the age structure contributed 186.0% (95% Uncertainty Intervals (UIs): 178.4%-193.6%), population size contributed 77.0% (95% UIs: 69.5%-80.8%), all other causes contributed -163.0% (95% UIs:-163.1%- -159.3%). DALYs caused by NCDs consist of 2.527 million YLLs and 4.934 million YLDs, in which the contribution of age structure to YLLs and YLDs was 414.6% (95% UIs: 396.2%-432.5%) and 69.1% (95% UIs: 66.7%-71.4%), respectively. From 2019 to 2050, the diseases with increased DALYs due to changes in age structure are cardiovascular diseases, neoplasms, chronic respiratory diseases, neurological disorders, sense organ diseases, diabetes and kidney diseases, musculoskeletal disorders, digestive diseases, mental disorders, and skin and subcutaneous diseases in descending order. Conclusions: From 1990 to 2019, except for skin and subcutaneous diseases, the burden of other NCDs attributable to population aging increased, mainly due to disability. By 2050, the burden of NCDsattributable to population aging will continue to rise.

[Research progress on main disease-related factors of healthy life expectancy].

International research on healthy life expectancy (HALE) focuses on inequality of socioeconomic status and individual natural attributes. With the acceleration of population ageing and the increase in average life expectancy, the extension of unhealthy life expectancy and the increase of social and economic burden caused by diseases have gradually attracted the attention of countries around the world. Therefore, the evaluation of disease factors affecting HALE is a meaningful direction in the future. This study introduces the development process and commonly used measurement methods of HALE. According to the definition of health from the Global Burden of Disease Study and World Health Organization, physical and mental diseases such as cardiovascular and cerebrovascular diseases, chronic respiratory diseases, diabetes, malignant tumors and depression were selected to summarize the impact of these diseases and pre-disease states on HALE. It is expected to provide a theoretical basis for the formulation of relevant public health policies and the improvement of quality of life in China.

'Skeletal Age' for mapping the impact of fracture on mortality.

Background: Fragility fracture is associated with an increased risk of mortality, but mortality is not part of doctor-patient communication. Here, we introduce a new concept called 'Skeletal Age' as the age of an individual's skeleton resulting from a fragility fracture to convey the combined risk of fracture and fracture-associated mortality for an individual. Methods: We used the Danish National Hospital Discharge Register which includes the whole-country data of 1,667,339 adults in Denmark born on or before January 1, 1950, who were followed up to December 31, 2016 for incident low-trauma fracture and mortality. Skeletal age is defined as the sum of chronological age and the number of years of life lost (YLL) associated with a fracture. Cox's proportional hazards model was employed to determine the hazard of mortality associated with a specific fracture for a given risk profile, and the hazard was then transformed into YLL using the Gompertz law of mortality. Results: During the median follow-up period of 16 years, there had been 307,870 fractures and 122,744 post-fracture deaths. A fracture was associated with between 1 and 7 years of life lost, with the loss being greater in men than women. Hip fractures incurred the greatest loss of life years. For instance, a 60-year-old individual with a hip fracture is estimated to have a skeletal age of 66 for men and 65 for women. Skeletal Age was estimated for each age and fracture site stratified by gender. Conclusions: We propose 'Skeletal Age' as a new metric to assess the impact of a fragility fracture on an individual's life expectancy. This approach will enhance doctor-patient risk communication about the risks associated with osteoporosis. Funding: National Health and Medical Research Council in Australia and Amgen Competitive Grant Program 2019.

Osteoporosis is a 'silent disease' which often has no immediate symptoms but gradually weakens bones and makes them more likely to break. A bone fracture caused by osteoporosis in people over the age of 50 is linked to long-term health decline and in some cases, even early death. However, poor communication of the mortality risk to patients has led to a low uptake of treatment, resulting in a crisis of osteoporosis management. The impact of a fracture on life expectancy is typically conveyed to patients and the public in terms of probability (how likely something is to occur) or the relative risk of death compared to other groups. However, statements such as "Your risk of death over the next 10 years is 5% if you have suffered from a bone fracture" can be difficult to comprehend and can lead to patients underestimating the gravity of the risk. With the aim of devising a new way of conveying risks to patients, Tran et al. analyzed the relationship between fracture and lifespan in over 1.6 million individuals who were 50 years of age or older. The findings showed that one fracture was associated with losing up to 7 years of life, depending on gender, age and fracture site. Based on this finding, Tran et al. proposed the idea of 'skeletal age' as a new metric for quantifying the impact of a fracture on life expectancy. Skeletal age is the sum of the chronological age of a patient and the estimated number of years of life lost following a fracture. For example, a 60-year-old man with a hip fracture is predicted to lose an estimated 6 years of life, resulting in a skeletal age of around 66. Therefore, this individual has the same life expectancy as a 66-year-old person that has not experienced a fracture. Skeletal age can also be used to quantify the benefit of osteoporosis treatments. Some approved treatments substantially reduce the likelihood of post-fracture death and translating this into skeletal age could help communicate this to patients. For instance, telling patients that "This treatment will reduce your skeletal age by 2 years" is easier to understand than "This treatment will reduce your risk of death by 25%". Given the current crisis of osteoporosis management, adopting skeletal age as a new measure of how the skeleton declines after a fracture could enhance doctor-patient communication regarding treatment options and fracture risk assessment. Tran et al. are now developing an online tool called 'BONEcheck.org' to enable health care professionals and the public to calculate skeletal age. Future work should investigate the effectiveness of this new metric in conveying risk to patients, compared with current methods.

Effect of environmental NGOs on human health in China: An empirical analysis.

The emergence of environmental nongovernmental organizations (ENGOs) has proved beneficial in improving environmental quality and related health issues. Therefore, this study attempts to investigate the impact of ENGO on human health in China from 1995 to 2020. To investigate the relationship between the variables, we have employed the ARDL model. The ARDL model results demonstrate that the long-run impact of ENGO is negative on infant mortality and death rate, meaning that an increase in the proportion of ENGOs in China considerably decreases infant mortality and death rate. On the other hand, ENGOs have a favorable influence on life expectancy in China, demonstrating ENGOs' supporting role in raising birth life expectancy. In the short run, estimates of ENGOs have no substantial influence on newborn mortality and death rates in China, whereas ENGOs have a positive and significant impact on life expectancy. These results imply that ENGOs help improves people's health status in China, which is also supported by the rise in GDP, technology, and health expenditures. The causal analysis confirms the bi-directional causal link between ENGO and IMR and ENGO and LE, while the unidirectional causal link runs from ENGO to DR. The results of the study provide insights into the impact of environmental NGOs on human health in China and may help guide policies aimed at improving public health outcomes through environmental protection efforts.

Development of a Prediction Model for Healthy Life Years Without Activity Limitation: National Cross-sectional Study.

BACKGROUND: In some countries, including Japan-the leading country in terms of longevity, life expectancy has been increasing; meanwhile, healthy life years have not kept pace, necessitating an effective health policy to narrow the gap. OBJECTIVE: The aim of this study is to develop a prediction model for healthy life years without activity limitations and deploy the model in a health policy to prolong healthy life years. METHODS: The Comprehensive Survey of Living Conditions, a cross-sectional national survey of Japan, was conducted by the Japanese Ministry of Health, Labour and Welfare in 2013, 2016, and 2019. The data from 1,537,773 responders were used for modelling using machine learning. All participants were randomly split into training (n=1,383,995, 90%,) and test (n=153,778, 10%) subsets. Extreme gradient boosting classifier was implemented. Activity limitations were set as the target. Age, sex, and 40 types of diseases or injuries were included as features. Healthy life years without activity limitations were calculated by incorporating the predicted prevalence rate of activity limitations in a life table. For the wide utility of the model in individuals, we developed an application tool for the model. RESULTS: In the groups without (n=1,329,901) and with (n=207,872) activity limitations, the median age was 47 (IQR 30-64) and 69 (IQR 54-80) years, respectively (P<.001); female sex comprised 51.3% (n=681,794) in the group without activity limitations and 56.9% (n=118,339) in the group with activity limitations (P<.001). A total of 42 features were included in the feature set. Age had the highest impact on model accuracy, followed by depression or other mental diseases; back pain; bone fracture; other neurological disorders, pain, or paralysis; stroke, cerebral hemorrhage, or infarction; arthritis; Parkinson disease; dementia; and other injuries or burns. The model exhibited high performance with an area under the receiver operating characteristic curve of 0.846 (95% CI 0.842-0.849) with exact calibration for the average probability and fraction of positives. The prediction results were consistent with the observed values of healthy life years for both sexes in each year (range of difference between predictive and observed values: -0.89 to 0.16 in male and 0.61 to 1.23 in female respondents). We applied the prediction model to a regional health policy to prolong healthy life years by adjusting the representative predictors to a target prevalence rate. Additionally, we presented the health condition without activity limitations index, followed by the application development for individual health promotion. CONCLUSIONS: The prediction model will enable national or regional governments to establish an effective health promotion policy for risk prevention at the population and individual levels to prolong healthy life years. Further investigation is needed to validate the model's adaptability to various ethnicities and, in particular, to countries where the population exhibits a short life span.

Beyond the biomedical, towards the agentic: A paradigm shift for population health science.

Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. In this paper, we argue that the biomedical model and its underlying scientific paradigm of causal determinism, which currently dominate population health, cannot meet population health needs. While criticism of the biomedical model is not new, this paper advances the field by going beyond criticism to recognize the need for a paradigm shift. In the first half of the paper, we present a critical analysis of the biomedical model and the paradigm of causal determinism. In the second half, we outline the agentic paradigm and present a structural model of health based on generalizable, group-level processes. We use the experience of the COVID-19 pandemic to illustrate the practical applications of our model. It will be important for future work to investigate the empirical and pragmatic applications of our structural model of population health.

Premature mortality and years of potential life lost from cardiovascular diseases: Protocol of a systematic review and meta-analysis.

INTRODUCTION: Despite the burden of cardiovascular disease (CVD) continuing to increase globally, no comprehensive meta-analyses have been conducted quantifying premature CVD mortality. This paper reports the protocol for a systematic review and meta-analysis to derive updated estimates of premature CVD mortality. METHODS AND EXPECTED OUTPUTS: This review will include the studies that reported premature CVD mortality based on standard premature mortality indicators, including years of life lost (YLL), age standardized mortality rate (ASMR) or standardised mortality ratio (SMR). PUBMED, Scopus, Web of Science (WoS), CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) will be used as the literature databases. The study selection as well as the evaluation of the quality of the included articles will be done independently by two reviewers. Pooled estimates of YLL, ASMR, and SMR will be computed by applying random-effects meta-analysis. Heterogeneity among selected studies will be assessed using the I2 statistic and Q statistic with associated p-values. A funnel plot analysis and Egger's test will be conducted to assess the potential impact of publication bias. Depending on data availability, we propose to conduct subgroup analyses by sex, geographic location, main CVD types, and study time. Reporting of our findings will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. CONCLUSION: Our meta-analysis will provide a comprehensive synthesis of the available evidence on premature CVD mortality, which is a major public health concern worldwide. The results of this meta-analysis will have important implications for clinical practice and public health policy, providing insights into strategies to prevent and manage premature CVD mortality. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42021288415. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288415.

Rheumatic heart disease burden, trends, and inequalities in Asia, 1990-2019.

BACKGROUND: Rheumatic heart disease (RHD) is a serious global public health problem. OBJECTIVES: This study aims to characterise the regional burden, trends, and inequalities of RHD in countries and territories in the Asian Region. METHODS: The RHD disease burden was measured in terms of the numbers of cases and deaths, prevalence, disability-adjusted life years (DALYs), disability-loss healthy life years (YLDs), and years of life lost (YLLs) in 48 countries in the Asian Region. Data on RHD were extracted from the 2019 Global Burden of Disease. This study analysed changing trends in the burden between 1990 and 2019, quantified regional inequalities in mortality, and classified countries by 2019 YLLs. RESULTS: There were an estimated 22 246 127 cases of RHD in the Asian Region in 2019 and 249 830 deaths. The prevalence of RHD in the Asian Region in 2019 was 9% lower than the global estimate, while mortality was 41% higher. The mortality rate for RHD in the Asian Region trended downwards from 1990 to 2019, with an average annual percentage change of -3.2% (95% UI -3.3 to -3.1). From 1990 to 2019, absolute inequality in RHD-related mortality decreased in the Asian Region while relative inequality increased. Of the 48 countries studied, twelve had the highest level of RHD YLLs in 2017 and the smallest reduction in YLLs from 1990 to 2019. CONCLUSION: Although the burden of RHD in the Asian Region has steadily decreased since 1990, it remains a serious public health issue requiring greater attention. In the Asian Region, inequalities in the distribution of the RHD burden remain significant, with economically deprived countries typically bearing a greater share of the load.

Change trend and gender differences in disability-free life expectancy among older adults in China, 2010-2020.

Objective: The goal of the present study was to investigate gender differences in disability-free life expectancy (DFLE) and DFLE/LE ratio among older adults in China; portray changing trend from 2010 to 2020; and discuss the implications for public policies. Methods: Mortality data and disability rate data were derived from the Sixth China Population Census in 2010 and the Seventh China Population Census in 2020. The study assessed disability status of older adults based on self-assessment health in the above censuses. Life table and Sullivan method were used to estimate LE, DFLE, and DFLE/LE ratio by gender. Results: DFLE increased from 19.33 to 21.78 years for 60-year-old males, while from 21.94 to 24.80 years for 60-year-old females, from 2010 to 2020, respectively. DFLE/LE ratio was 96.40% for 60-year-old males and 94.86% for 60-year-old females in 2010, while DFLE/LE ratio was 96.63% for 60-year-old males and 95.44% for 60-year-old females in 2020, respectively. In terms of gender differences in DFLE/LE ratio, men aged 60 are 1.19 percentage points higher than women at the same age; men aged 70 are 1.71 percentage points higher than women; men aged 80 are 2.87 percentage points higher than women. Conclusion: From 2010 to 2020, the DFLE of China's male and female older adults increased simultaneously with the increase of LE, and the DFLE/LE ratio also increased. However, the DFLE/LE ratio of female older adults is lower than that of male at the same age, and this gender difference is narrowing over the decade but has not yet been eliminated, especially the health disadvantage of female older adults among the oldest old age group (age 80 and above) is more prominent.

Associations Between Gender Gaps in Life Expectancy, Air Pollution, and Urbanization: A Global Assessment With Bayesian Spatiotemporal Modeling.

Objectives: It's evident that women have a longer life expectancy than men. This study investigates the spatiotemporal trends of gender gaps in life expectancy (GGLE). It demonstrates the spatiotemporal difference of the influence factors of population-weighted air pollution (pwPM2.5) and urbanization on GGLE. Methods: Panel data on GGLE and influencing factors from 134 countries from 1960 to 2018 are collected. The Bayesian spatiotemporal model is performed. Results: The results show an obvious spatial heterogeneity worldwide with a continuously increasing trend of GGLE. Bayesian spatiotemporal regression reveals a significant positive relationship between pwPM2.5, urbanization, and GGLE with the spatial random effects. Further, the regression coefficients present obvious geographic disparities across space worldwide. Conclusion: In sum, social-economic development and air quality improvement should be considered comprehensively in global policy to make a fair chance for both genders to maximize their health gains.

Reducing mitochondrial ribosomal gene expression does not alter metabolic health or lifespan in mice.

Maintaining mitochondrial function is critical to an improved healthspan and lifespan. Introducing mild stress by inhibiting mitochondrial translation invokes the mitochondrial unfolded protein response (UPRmt) and increases lifespan in several animal models. Notably, lower mitochondrial ribosomal protein (MRP) expression also correlates with increased lifespan in a reference population of mice. In this study, we tested whether partially reducing the gene expression of a critical MRP, Mrpl54, reduced mitochondrial DNA-encoded protein content, induced the UPRmt, and affected lifespan or metabolic health using germline heterozygous Mrpl54 mice. Despite reduced Mrpl54 expression in multiple organs and a reduction in mitochondrial-encoded protein expression in myoblasts, we identified few significant differences between male or female Mrpl54+/- and wild type mice in initial body composition, respiratory parameters, energy intake and expenditure, or ambulatory motion. We also observed no differences in glucose or insulin tolerance, treadmill endurance, cold tolerance, heart rate, or blood pressure. There were no differences in median life expectancy or maximum lifespan. Overall, we demonstrate that genetic manipulation of Mrpl54 expression reduces mitochondrial-encoded protein content but is not sufficient to improve healthspan in otherwise healthy and unstressed mice.

[Aortic stenosis: TAVI for all patients?] / Sténose aortique : TAVI en première intention pour tous les patients ?

Over the last 21 years, the paradigm has shifted from an initial use of TAVI for inoperable aortic stenosis cases to recognition of its benefits for all categories of patients. Since 2021, the European Society of Cardiology has recommended first-line transfemoral TAVI from the age of 75 for all categories of patients with aortic stenosis (high, intermediate, low risk). However, in Switzerland, the Federal Office of Public Health currently places a restriction on the reimbursement of low-risk patients, which is expected to be reassessed in 2023. Surgery remains the best therapeutic option for patients with an unfavorable anatomy and for those whose life expectancy exceeds the potential durability of the valve. In this article we will discuss the evidence supporting TAVI, its current indications and initial complications as well as areas for improvement to potentially further expand its indications.

Au cours des deux dernières décennies, le paradigme est passé d'une utilisation initiale du TAVI pour les cas de sténose aortique inopérables à une reconnaissance de ses bénéfices pour toutes les catégories de patients. Depuis 2021, la Société européenne de cardiologie recommande le TAVI transfémoral en première intention dès 75 ans pour toutes les catégories de patients avec sténose aortique (risque élevé, intermédiaire, bas). En Suisse, l'Office fédéral de la santé publique impose une restriction pour le remboursement des patients à bas risque, avec une réévaluation prévue durant l'année 2023. Cependant, la chirurgie garde une place particulière pour les patients avec une anatomie défavorable et pour ceux dont l'espérance de vie dépasse la durabilité potentielle de la valve. Dans cet article, nous discutons des preuves, des indications actuelles, des complications initiales du TAVI et des points à améliorer pour potentiellement étendre davantage les indications.

The economic impact of premature mortality in Cabo Verde: 2016-2020.

Mortality analysis studies in Cabo Verde are scarce and those available are limited to short periods of analysis and to specific population groups. National mortality data reports do not quantify the burden of disease associated with premature mortality. This study estimated the years of potential life lost (YPLL), years of potential productive life lost (YPPLL) and the costs associated with them in Cabo Verde from 2016 to 2020 and aimed to determine trends of early mortality due to all causes of death. Mortality data were obtained from the Ministry of Health, Cabo Verde. Deaths that occurred from 2016 to 2020, in individuals aged between one (1) and 73 years old were analyzed by sex, age group, municipality and cause of death. YPLL, YPPLL and cost of productivity lost (CPL) were estimated using life expectancy and the human capital approach methods, respectively. There were 6100 deaths recorded in the sample population and males represented 68.1% (n = 4,154) of the reported deaths. The number of deaths verified corresponded to 145,544 YPLL, of which 69.0% (n = 100,389) were attributed to males. There were 4,634 deaths among individuals of working age, which resulted in 80 965 YPPLL, with males contributing 72.1% (n = 58,403) of the total YPPLL. The estimated CPL due to premature death was 98,659,153.23 USD. Injuries and external causes together accounted for 21,580,954.42 USD (21.9%) of CPL, while diseases of the circulatory system 18,843,260.42 USD (19.1%) and certain infectious and parasitic diseases accounted for 16,633,842.70 USD (16.9%). The study demonstrated the social and economic burden of premature mortality. The YPLL, YPPLL and CPL measures can be used to complement measures traditionally used to demonstrate the burden and loss of productivity due to premature mortality and to support resource allocation and public health decision making in Cabo Verde.

Immortalized erythroid cells as a novel frontier for in vitro blood production: current approaches and potential clinical application.

BACKGROUND: Blood transfusions represent common medical procedures, which provide essential supportive therapy. However, these procedures are notoriously expensive for healthcare services and not without risk. The potential threat of transfusion-related complications, such as the development of pathogenic infections and the occurring of alloimmunization events, alongside the donor's dependence, strongly limits the availability of transfusion units and represents significant concerns in transfusion medicine. Moreover, a further increase in the demand for donated blood and blood transfusion, combined with a reduction in blood donors, is expected as a consequence of the decrease in birth rates and increase in life expectancy in industrialized countries. MAIN BODY: An emerging and alternative strategy preferred over blood transfusion is the in vitro production of blood cells from immortalized erythroid cells. The high survival capacity alongside the stable and longest proliferation time of immortalized erythroid cells could allow the generation of a large number of cells over time, which are able to differentiate into blood cells. However, a large-scale, cost-effective production of blood cells is not yet a routine clinical procedure, as being dependent on the optimization of culture conditions of immortalized erythroid cells. CONCLUSION: In our review, we provide an overview of the most recent erythroid cell immortalization approaches, while also describing and discussing related advancements of establishing immortalized erythroid cell lines.

EFFECT OF URBANIZATION ON DENSITY OF THE GENERAL PRACTITIONERS, AVERAGE LIFE EXPECTANCY AND MORTALITY FROM THE DISEASES OF CIRCULATORY SYSTEM.

OBJECTIVE: The aim: Comparative analysis of average life expectancy, mortality from diseases of the circulatory system, gross regional product, and density of general practitioners in regions with different levels of urbanization. PATIENTS AND METHODS: Materials and methods: We compared the following characteristics of groups classified by level of urbanization: average density of general practitioners per 10,000, average life expectancy and mortality from diseases of the circulatory system per 1,000, average gross regional product per 1 person. RESULTS: Results: The groups did not differ in average life expectancy. The highest rate of mortality from diseases of the circulatory system- in the group with average level of urbanization, the lowest- in the group with low level of urbanization (p<0.05). The highest value of gross regional product per person is in the group with high level of urbanization, and the lowest is in the group with low level (p<0.05). The lowest density of primary care doctors per 10,000 is in the group with high level of urbanization, and the highest is in the group with low level of urbanization (p<0.05). CONCLUSION: Conclusions: When planning staffing of health care institutions, it is necessary to take into account the level of urbanization of the region and ensure status of the general practitioner as a leading medical specialist responsible for medical care during the first meeting with the patient and his subsequent follow-up.

Life expectancy, mortality risks and cause of death in patients with serious mental illness in South East London: a comparison between 2008-2012 and 2013-2017.

BACKGROUND: People with serious mental illness (SMI) have a significantly shorter life expectancy than the general population. This study investigates whether the mortality rate in this group has changed over the last decade. METHODS: Using Clinical Record Interactive Search software, we extracted data from a large electronic database of patients in South East London. All patients with schizophrenia, schizoaffective disorder or bipolar disorder from 2008 to 2012 and/or 2013 to 2017 were included. Estimates of life expectancy at birth, standardised mortality ratios and causes of death were obtained for each cohort according to diagnosis and gender. Comparisons were made between cohorts and with the general population using data obtained from the UK Office of National Statistics. RESULTS: In total, 26 005 patients were included. In men, life expectancy was greater in 2013-2017 (64.9 years; 95% CI 63.6-66.3) than in 2008-2012 (63.2 years; 95% CI 61.5-64.9). Similarly, in women, life expectancy was greater in 2013-2017 (69.1 years; 95% CI 67.5-70.7) than in 2008-2012 (68.1 years; 95% CI 66.2-69.9). The difference with general population life expectancy fell by 0.9 years between cohorts in men, and 0.5 years in women. In the 2013-2017 cohorts, cancer accounted for a similar proportion of deaths as cardiovascular disease. CONCLUSIONS: Relative to the general population, life expectancy for people with SMI is still much worse, though it appears to be improving. The increased cancer-related mortality suggests that physical health monitoring should consider including cancer as well.

Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study.

BACKGROUND: Health inequalities are often assessed in terms of life expectancy or health-related quality of life (HRQoL). Few studies combine both aspects into quality-adjusted life expectancy (QALE) to derive comprehensive estimates of lifetime health inequality. Furthermore, little is known about the sensitivity of estimated inequalities in QALE to different sources of HRQoL information. This study assesses inequalities in QALE by educational attainment in Norway using two different measures of HRQoL. METHODS: We combine full population life tables from Statistics Norway with survey data from the Tromsø study, a representative sample of the Norwegian population aged ≥ 40. HRQoL is measured using the EQ-5D-5L and EQ-VAS instruments. Life expectancy and QALE at 40 years of age are calculated using the Sullivan-Chiang method and are stratified by educational attainment. Inequality is measured as the absolute and relative gap between individuals with lowest (i.e. primary school) and highest (university degree 4 + years) educational attainment. RESULTS: People with the highest educational attainment can expect to live longer lives (men: + 17.9% (95%CI: 16.4 to 19.5%), women: + 13.0% (95%CI: 10.6 to 15.5%)) and have higher QALE (men: + 22.4% (95%CI: 20.4 to 24.4%), women: + 18.3% (95%CI: 15.2 to 21.6%); measured using EQ-5D-5L) than individuals with primary school education. Relative inequality is larger when HRQoL is measured using EQ-VAS. CONCLUSION: Health inequalities by educational attainment become wider when measured in QALE rather than LE, and the degree of this widening is larger when measuring HRQoL by EQ-VAS than by EQ-5D-5L. We find a sizable educational gradient in lifetime health in Norway, one of the most developed and egalitarian societies in the world. Our estimates provide a benchmark against which other countries can be compared.