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1.
J Alzheimers Dis ; 85(2): 627-644, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34864658

RESUMO

BACKGROUND: Actuarial and statistical methods have been proposed as alternatives to conventional methods of diagnosing mild cognitive impairment (MCI), with the aim of enhancing diagnostic and prognostic validity, but have not been compared in racially diverse samples. OBJECTIVE: We compared the agreement of consensus, actuarial, and statistical MCI diagnostic methods, and their relationship to race and prognostic indicators, among diverse older adults. METHODS: Participants (N = 354; M age = 71; 68% White, 29% Black) were diagnosed with MCI or normal cognition (NC) according to clinical consensus, actuarial neuropsychological criteria (Jak/Bondi), and latent class analysis (LCA). We examined associations with race/ethnicity, longitudinal cognitive and functional change, and incident dementia. RESULTS: MCI rates by consensus, actuarial criteria, and LCA were 44%, 53%, and 41%, respectively. LCA identified three MCI subtypes (memory; memory/language; memory/executive) and two NC classes (low normal; high normal). Diagnostic agreement was substantial, but agreement of the actuarial method with consensus and LCA was weaker than the agreement between consensus and LCA. Among cases classified as MCI by actuarial criteria only, Black participants were over-represented, and outcomes were generally similar to those of NC participants. Consensus diagnoses best predicted longitudinal outcomes overall, whereas actuarial diagnoses best predicted longitudinal functional change among Black participants. CONCLUSION: Consensus diagnoses optimize specificity in predicting dementia, but among Black older adults, actuarial diagnoses may be more sensitive to early signs of decline. Results highlight the need for cross-cultural validity in MCI diagnosis and should be explored in community- and population-based samples.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Análise Atuarial , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Cognição , Consenso , Progressão da Doença , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prognóstico
2.
PLoS One ; 16(3): e0248138, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33690624

RESUMO

There are a few existing studies on whether domestic migration improves China's pension system's fiscal sustainability in the context of rapid urbanization and industrialization. In this paper, we systematically investigate the impact of migration on the solvency of the worker's old-age insurance for urban employees by constructing actuarial and econometric models. We use panel data from 2002 to 2018, collected from 31 provinces in China. The results show that the association between migration and the solvency of pensions is an inverted-U shape along the urbanization process. Further regional comparison showed that the above-stated inverted-U curve is more pronounced in the central and western regions. We also established that the number of participants and the contribution base are the main contributors to these results. Our conclusions are important for future population policies and public pension systems in China.


Assuntos
Pensões/estatística & dados numéricos , Dinâmica Populacional/tendências , Política Pública/economia , Análise Atuarial/métodos , China , Humanos , Desenvolvimento Industrial/tendências , Seguro/tendências , Modelos Econométricos , Política Pública/tendências , Urbanização/tendências
3.
Law Hum Behav ; 45(1): 24-38, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33734747

RESUMO

Objective: The purpose of this study was to develop new 10-year recidivism rate norms as well as to update 5-year norms for the Static-99R risk tool for routine/complete samples. We also present the extrapolated sexual recidivism rates from these new 10-year norms for follow-up periods of 11 to 20 years. Hypotheses: We hypothesized that absolute-recidivism base rates (B02; i.e., the intercept centered on the median score of 2) would vary; however, the relative predictive accuracy (i.e., discrimination; B1) would be stable across samples. In addition, compared with the estimated sexual recidivism rates with a fixed 5-year follow-up time, the estimated rates with a fixed 10-year follow-up time would be expected to be consistently higher across the Static-99R scores. Method: The current study included 12 independent samples (N = 7,224 for the 5-year recidivism rate norms; N = 1,599 [k = 6] for the 10-year norms) classified as routine/complete samples, that is, relatively random samples from a correctional system. Logistic regression parameters (B02 and B1) across the studies were aggregated using fixed-effect meta-analyses. Results: There was statistically significant variability in the base rates (B02), whereas the between-sample variability in the relative-risk parameters (B1) was no more than would be expected by chance. As expected, the 10-year base rates were approximately 1.5 times higher than the 5-year base rates (7.20% vs. 4.58%), and the extrapolated 20-year sexual recidivism rates were approximately double the observed 5-year sexual recidivism rates. Conclusions: The current study provides empirical evidence to estimate 5- and 10-year sexual recidivism rates based on Static-99R total scores. Evaluators who are especially concerned about long-term sexual recidivism risk (e.g., civil commitment) can report the expected sexual recidivism risk based on the new 10-year norms and the extrapolated sexual recidivism rates for follow-up periods of 11 to 20 years. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Reincidência/estatística & dados numéricos , Medição de Risco/métodos , Delitos Sexuais/estatística & dados numéricos , Análise Atuarial , Humanos , Modelos Logísticos , Valor Preditivo dos Testes , Fatores de Tempo
4.
Sex Abuse ; 33(2): 157-175, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31674276

RESUMO

The predictive validity of risk assessment instruments for persons who have committed sexual offenses has improved tremendously in the last four decades, but the progress has been limited to Western offender populations. The aim of this study was to examine the predictive validity of Static-99R, Stable-2007, Sexual Violence Risk-20, Version 2 (SVR-20 v2), Psychopathy Checklist-Revised (PCL-R), and Level of Service/Case Management Inventory (LS/CMI) in predicting recidivism of persons convicted on sexual offenses in Singapore. Retrospective data of 134 such persons were used to code the various instruments. Receiver operating characteristic analyses revealed that combined Static-99R/Stable-2007 new standardized risk ratings, SVR-20 v2 total scores and risk ratings, PCL-R total scores, as well as LS/CMI total scores and risk ratings predicted sexual recidivism. All the aforementioned instruments' total scores and risk ratings (if applicable) predicted any recidivism. However, risk profiles of this sample differed significantly from the normative Western samples.


Assuntos
Análise Atuarial/instrumentação , Reincidência , Medição de Risco/métodos , Delitos Sexuais , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Singapura/epidemiologia , Adulto Jovem
5.
Int J Radiat Oncol Biol Phys ; 110(1): 188-195, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29395629

RESUMO

PURPOSE: To quantitatively evaluate published experiences with hepatic stereotactic body radiation therapy (SBRT), to determine local control rates after treatment of primary and metastatic liver tumors and to examine whether outcomes are affected by SBRT dosing regimen. METHODS AND MATERIALS: We identified published articles that reported local control rates after SBRT for primary or metastatic liver tumors. Biologically effective doses (BEDs) were calculated for each dosing regimen using the linear-quadratic equation. We excluded series in which a wide range of BEDs was used. Individual lesion data for local control were extracted from actuarial survival curves, and data were aggregated to form a single dataset. Actuarial local control curves were generated using the Kaplan-Meier method after grouping lesions by disease type and BED (<100 Gy10 vs >100 Gy10). Comparisons were made using log-rank testing. RESULTS: Thirteen articles met all inclusion criteria and formed the dataset for this analysis. The 1-, 2-, and 3-year actuarial local control rates after SBRT for primary liver tumors (n = 431) were 93%, 89%, and 86%, respectively. Lower 1- (90%), 2- (79%), and 3-year (76%) actuarial local control rates were observed for liver metastases (n = 290, log-rank P = .011). Among patients treated with SBRT for primary liver tumors, there was no evidence that local control is influenced by BED within the range of schedules used. For liver metastases, on the other hand, outcomes were significantly better for lesions treated with BEDs exceeding 100 Gy10 (3-year local control 93%) than for those treated with BEDs of ≤100 Gy10 (3-year local control 65%, P < .001). CONCLUSIONS: Stereotactic body radiation therapy for primary liver tumors provides high rates of durable local control, with no clear evidence for a dose-response relationship among commonly utilized schedules. Excellent local control rates are also seen after SBRT for liver metastases when BEDs of >100 Gy10 are utilized.


Assuntos
Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Radiocirurgia/métodos , Análise Atuarial , Neoplasias Colorretais/patologia , Relação Dose-Resposta à Radiação , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Neoplasias Hepáticas/mortalidade , Modelos Biológicos , Modelos Teóricos , Probabilidade , Dosagem Radioterapêutica , Eficiência Biológica Relativa , Resultado do Tratamento
6.
Curr Cardiol Rep ; 22(11): 138, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910320

RESUMO

PURPOSE OF REVIEW: To determine if subsidizing the cost of a food-based intervention for managing hyperlipidemia could be cost-effective under commercial insurance and/or Medicare coverage scenarios. RECENT FINDINGS: A large number of patients eligible for pharmaceutical treatment of hyperlipidemia either cannot or will not use lipid lowering drugs, leaving them at increased cardiovascular risk. Lipid levels can be modified by diet, but food has never enjoyed covered benefit status. We evaluated the financial implications of providing insurance coverage for a specifically formulated suite of food products previously documented to yield statistically significant lipid reductions, using multiple product uptake and lipid impact scenarios in both commercially covered and Medicare-covered populations. Even after controlling for multiple confounders, we noted positive payback on subsidizing the cost of lipid-lowering foods under all scenarios. Addressing a root cause of hyperlipidemia by directly encouraging dietary modification provides a cost-effective alternative for cholesterol management, especially for statin intolerant or statin unwilling patients.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Análise Atuarial , Idoso , LDL-Colesterol , Custos de Cuidados de Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Medicare , Estados Unidos
7.
J Public Health (Oxf) ; 42(4): 717-722, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-32894287

RESUMO

BACKGROUND: The mortality effects of COVID-19 are a critical aspect of the disease's impact. Years of life lost (YLLs) can provide greater insight than the number of deaths by conveying the shortfall in life expectancy and thus the age profile of the decedents. METHODS: We employed data regarding COVID-19 deaths in the USA by jurisdiction, gender and age group for the period 1 February 2020 through 11 July 2020. We used actuarial life expectancy tables by gender and age to estimate YLLs. RESULTS: We estimated roughly 1.2 million YLLs due to COVID-19 deaths. The YLLs for the top six jurisdictions exceeded those for the remaining 43. On a per-capita basis, female YLLs were generally higher than male YLLs throughout the country. CONCLUSIONS: Our estimates offer new insight into the effects of COVID-19. Our findings of heterogenous rates of YLLs by geography and gender highlight variation in the magnitude of the pandemic's effects that may inform effective policy responses.


Assuntos
COVID-19/mortalidade , Expectativa de Vida , Análise Atuarial , Fatores Etários , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Fatores Sexuais , Estados Unidos/epidemiologia
8.
J Alzheimers Dis ; 78(1): 371-386, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986674

RESUMO

BACKGROUND: Research suggests that actuarial neuropsychological criteria improve the accuracy of mild cognitive impairment (MCI) diagnoses relative to conventional diagnostic methods. OBJECTIVE: We sought to examine the utility of actuarial criteria relative to consensus diagnostic methods used in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS), and more broadly across the continuum of normal aging, MCI, and dementia. METHODS: We compared rates of cognitively normal (CN), MCI, and dementia diagnoses at baseline using actuarial versus consensus diagnostic methods in 1524 individuals from the NACC UDS. RESULTS: Approximately one-third (33.59%) of individuals diagnosed as CN and more than one-fifth (22.03%) diagnosed with dementia based on consensus methods, met actuarial criteria for MCI. Many participants diagnosed with MCI via consensus methods also appeared to represent possible diagnostic errors. Notably, the CNa/CNc group (i.e., participants diagnosed as CN based on both actuarial [a] and consensus [c] criteria) had a lower proportion of apolipoprotein E ɛ4 carriers than the MCIa/MCIc group, which in turn had a lower proportion of ɛ4 carriers than the dementia (Dem)a/Demc group. Proportions of ɛ4 carriers were comparable between the CNa/CNc and CNa/MCIc, MCIa/MCIc and MCIa/CNc, MCIa/MCIc and MCIa/Demc, and Dema/Demc and Dema/MCIc groups. These results were largely consistent with diagnostic agreement/discrepancy group comparisons on neuropsychological performance. CONCLUSION: The present results extend previous findings and suggest that actuarial neuropsychological criteria may enhance diagnostic accuracy relative to consensus methods, and across the wider continuum of normal aging, MCI, and dementia. Findings have implications for both clinical practice and research.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Análise Atuarial , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Apolipoproteínas E , Cognição , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos
9.
Am J Ind Med ; 63(10): 936-948, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32725660

RESUMO

BACKGROUND: Thoroughbred horse farm workers self-report a high frequency of work-related injuries and pain. However, an analysis of Thoroughbred horse farm workers' compensation injury claims is absent from the literature, yet may benefit worker safety. METHODS: We analyzed workers' compensation insurance firm data containing 2276 claims filed between 2008 and 2015. Injury frequency, cost, and lost time per cause, nature, and body part injured were examined qualitatively and via univariate tests. Factors associated with high cost and high duration lost time claims were modeled via multivariable logistic regression. RESULTS: The average Thoroughbred worker claim cost $4,198 and accrued 10 days lost time, involving strikes (57% of total claims), sprains/strains (34%), and wrist/hand injuries (18%). Injuries primarily occurred on mornings (54%), weekdays (79%), and during the transition from breeding to sales (23%). Jobs with a high level of horse contact had significantly higher cost ($6,487) and higher duration lost time (16.8 days) claims, with significantly higher cost claims on the weekends ($6,471) and from the oldest workers ($7466), vs reference groups. Logistic models indicate significantly increased odds of a high-cost injury among high horse contact jobs (OR = 1.87; 95% C.I. = 1.53-2.29) and older age tertiles (1.38; 1.08-1.75; 1.70, 1.32-2.18). The odds of a high duration lost time injury are significantly increased among high horse contact jobs (1.91; 1.53-2.39) and males (1.50, 1.13-1.98), with significantly reduced odds among the most tenured workers (0.74; 0.56-0.99). CONCLUSIONS: Our findings elucidate factors to reduce injury frequency, cost, and lost time among Thoroughbred horse farm workers.


Assuntos
Análise Atuarial/estatística & dados numéricos , Criação de Animais Domésticos/estatística & dados numéricos , Fazendeiros/estatística & dados numéricos , Traumatismos Ocupacionais/epidemiologia , Indenização aos Trabalhadores/estatística & dados numéricos , Análise Atuarial/economia , Adulto , Criação de Animais Domésticos/economia , Animais , Feminino , Cavalos , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema Musculoesquelético/lesões , Traumatismos Ocupacionais/economia , Fatores de Risco , Indenização aos Trabalhadores/economia
10.
Int J Technol Assess Health Care ; 36(2): 96-103, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32340631

RESUMO

OBJECTIVES: Quality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) are commonly used in cost-effectiveness analysis (CEA) to measure health benefits. We sought to quantify and explain differences between QALY- and DALY-based cost-effectiveness ratios, and explore whether using one versus the other would materially affect conclusions about an intervention's cost-effectiveness. METHODS: We identified CEAs using both QALYs and DALYs from the Tufts Medical Center CEA Registry and Global Health CEA Registry, with a supplemental search to ensure comprehensive literature coverage. We calculated absolute and relative differences between the QALY- and DALY-based ratios, and compared ratios to common benchmarks (e.g., 1× gross domestic product per capita). We converted reported costs into US dollars. RESULTS: Among eleven published CEAs reporting both QALYs and DALYs, seven focused on pharmaceuticals and infectious disease, and five were conducted in high-income countries. Four studies concluded that the intervention was "dominant" (cost-saving). Among the QALY- and DALY-based ratios reported from the remaining seven studies, absolute differences ranged from approximately $2 to $15,000 per unit of benefit, and relative differences from 6-120 percent, but most differences were modest in comparison with the ratio value itself. The values assigned to utility and disability weights explained most observed differences. In comparison with cost-effectiveness thresholds, conclusions were consistent regardless of the ratio type in ten of eleven cases. CONCLUSIONS: Our results suggest that although QALY- and DALY-based ratios for the same intervention can differ, differences tend to be modest and do not materially affect comparisons to common cost-effectiveness thresholds.


Assuntos
Análise Atuarial/métodos , Análise Custo-Benefício/métodos , Avaliação da Tecnologia Biomédica/métodos , Pessoas com Deficiência , Humanos , Anos de Vida Ajustados por Qualidade de Vida
11.
Behav Sci Law ; 38(3): 246-258, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32222084

RESUMO

This article focuses on two aspects of actuarial risk at sentencing, the accuracy of the instrument and the outcome it predicts. For theoretical reasons rooted in the cognitive decision-making and sentencing literature, there is a danger that judges and other practitioners might come to overly rely on a "high risk" label or designation without appreciating the accuracy of the prediction or the actual outcome being predicted. Using sentencing and recidivism data from Pennsylvania (n = 10,000), two simple risk instruments are constructed to illustrate the critical importance of understanding accuracy and outcome before relying on the risk tool information.


Assuntos
Análise Atuarial , Direito Penal , Tomada de Decisões , Reincidência , Humanos , Pennsylvania , Medição de Risco
12.
Radiother Oncol ; 142: 154-161, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31563411

RESUMO

BACKGROUND AND PURPOSE: High-dose fractionated radiotherapy is often necessary to achieve long-term tumor control in several types of tumors involving or within close proximity to the brain. There is limited data to guide on optimal constraints to the adjacent nontarget brain. This investigation explored the significance of the three-dimensional (3D) dose distribution of passive scattering proton therapy to the brain with other clinicopathological factors on the development of symptomatic radiation necrosis. MATERIALS AND METHODS: All patients with head and neck, skull base, or intracranial tumors who underwent proton therapy (minimum prescription dose of 59.4 Gy(RBE)) with collateral moderate to high dose radiation exposure to the nontarget brain were retrospectively reviewed. A mixture cure model with respect to necrosis-free survival was used to derive estimates for the normal tissue complication probability (NTCP) model while adjusting for potential confounding factors. RESULTS: Of 179 identified patients, 83 patients had intracranial tumors and 96 patients had primary extracranial tumors. The optimal dose measure obtained to describe the occurrence of radiation necrosis was the equivalent uniform dose (EUD) with parameter a = 9. The best-fit parameters of logistic NTCP models revealed D50 = 57.7 Gy for intracranial tumors, D50 = 39.5 Gy for extracranial tumors, and γ50 = 2.5 for both tumor locations. Multivariable analysis revealed EUD and primary tumor location to be the strongest predictors of brain radiation necrosis. CONCLUSION: In the current clinical volumetric data analyses with multivariable modelling, EUD was identified as an independent and strong predictor for brain radiation necrosis from proton therapy.


Assuntos
Encéfalo/patologia , Encéfalo/efeitos da radiação , Terapia com Prótons/efeitos adversos , Lesões por Radiação/patologia , Análise Atuarial , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Fracionamento da Dose de Radiação , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico por imagem , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/radioterapia , Necrose , Probabilidade , Terapia com Prótons/métodos , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos , Adulto Jovem
13.
Rejuvenation Res ; 23(1): 17-18, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578937

RESUMO

The case of Jeanne Calment and her exceptional longevity has attracted worldwide attention, detailed examination, and some skepticism. Most recently, it has been suggested that Jeanne Calment's record is spurious and the result of identity fraud by her daughter. Although there is merit to subjecting claims of extreme longevity to scrutiny, either validating or debunking a single case has a negligible impact on scientific knowledge of aging and lifespan.


Assuntos
Análise Atuarial , Longevidade/fisiologia , Idoso de 80 Anos ou mais , Humanos , Reprodutibilidade dos Testes
14.
Law Hum Behav ; 44(1): 37-50, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31697098

RESUMO

OBJECTIVE: This study empirically evaluated risk judgments made using the Risk for Sexual Violence Protocol (RSVP; Hart et al., 2003), a widely used set of structured professional guidelines for assessing and managing sexual violence risk. HYPOTHESIS: Based on evaluations of other structured professional judgment guidelines, we hypothesized that judgments made using the RSVP would demonstrate good interrater reliability, concurrent validity, and predictive validity. METHOD: Based on file review, research assistants made ratings using the RSVP and two commonly used actuarial tools for sexual violence risk assessment in a sample of 100 adult male sexual offenders who successfully completed a community-based sex offender treatment program. Recidivism information was obtained from official records 10 years after treatment completion. RESULTS: With respect to interrater reliability, judgments of the presence and relevance of individual risk factors ranged from moderate to almost perfect, and those for composite scores reflecting the sum of these ratings were almost perfect. Interrater reliability for integrative summary risk ratings was substantial to almost perfect. Regarding concurrent validity, the findings indicated that judgments made using the RSVP had moderate to large and statistically significant correlations with scores on the actuarial tools. Finally, with respect to predictive validity, RSVP presence total scores and summary risk ratings were predictive of new sexual violence over the follow-up, and the magnitude of their predictive validity effect sizes was similar to that of scores on the actuarial tools. CONCLUSIONS: The findings supported the potential utility of the RSVP in practice. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Assuntos
Psicologia Forense , Guias como Assunto , Medição de Risco/métodos , Delitos Sexuais/prevenção & controle , Análise Atuarial , Adulto , Idoso , Canadá/epidemiologia , Humanos , Julgamento , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Delitos Sexuais/estatística & dados numéricos , Análise de Sobrevida
15.
PLoS Biol ; 17(9): e3000432, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31518381

RESUMO

The concept of actuarial senescence (defined here as the increase in mortality hazards with age) is often confounded with life span duration, which obscures the relative role of age-dependent and age-independent processes in shaping the variation in life span. We use the opportunity afforded by the Species360 database, a collection of individual life span records in captivity, to analyze age-specific mortality patterns in relation to variation in life span. We report evidence of actuarial senescence across 96 mammal species. We identify the life stage (juvenile, prime-age, or senescent) that contributes the most to the observed variation in life span across species. Actuarial senescence only accounted for 35%-50% of the variance in life span across species, depending on the body mass category. We computed the sensitivity and elasticity of life span to five parameters that represent the three stages of the age-specific mortality curve-namely, the duration of the juvenile stage, the mean juvenile mortality, the prime-age (i.e., minimum) adult mortality, the age at the onset of actuarial senescence, and the rate of actuarial senescence. Next, we computed the between-species variance in these five parameters. Combining the two steps, we computed the relative contribution of each of the five parameters to the variance in life span across species. Variation in life span was increasingly driven by the intensity of actuarial senescence and decreasingly driven by prime-age adult mortality from small to large species because of changes in the elasticity of life span to these parameters, even if all the adult survival parameters consistently exhibited a canalization pattern of weaker variability among long-lived species than among short-lived ones. Our work unambiguously demonstrates that life span cannot be used to measure the strength of actuarial senescence, because a substantial and variable proportion of life span variation across mammals is not related to actuarial senescence metrics.


Assuntos
Longevidade , Mamíferos/fisiologia , Mortalidade , Análise Atuarial , Animais , Biometria , Feminino
16.
Risk Anal ; 39(11): 2391-2407, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31194898

RESUMO

The value of a statistical life (VSL) is a widely used measure for the value of mortality risk reduction. As VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a "dread disease," which supports the use of a "cancer premium." The objective of this study is to investigate the existence of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest, and amyotrophic lateral sclerosis (ALS). Data were collected from 500 individuals in the Swedish general population of 50-74-year olds using a web-based questionnaire. Preferences were elicited using the contingent valuation method, and a split-sample design was applied to test scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accidents. A premium (92-113%) for cancer was found in relation to road traffic accidents. The premium was higher for cancer with a shorter time from diagnosis to death. A premium was also found for sudden cardiac arrest (73%) and ALS (118%) in relation to road traffic accidents. Eliminating risk was associated with a premium of around 20%. This study provides additional evidence that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.


Assuntos
Análise Atuarial , Medição de Risco , Valor da Vida , Acidentes de Trânsito/mortalidade , Idoso , Esclerose Amiotrófica Lateral/mortalidade , Feminino , Parada Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Neoplasias Pancreáticas/mortalidade
17.
Int J Offender Ther Comp Criminol ; 63(14): 2466-2482, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31185761

RESUMO

Although risk in the criminal justice field has been subject to intensive international debate, it has not incorporated China and its growing field of community corrections. This article assesses the current initiative of developing actuarial assessment tools in China and contrasts this with its use in the correctional context. There is certainly a rift in the understanding of risk, particularly, between the risk factors in Western risk assessment tools, the political construction of risk, and the local practitioners' embrace of correctional work. However, this article suggests that under the current mode of risk governance in China, actuarial assessment tools promoted in the correctional field simply add another layer of social control. The article highlights the importance of political and social rationalities and environments behind the construction of risk.


Assuntos
Análise Atuarial/normas , Crime/prevenção & controle , Direito Penal/métodos , Criminosos/classificação , Reincidência/prevenção & controle , Medição de Risco/normas , Políticas de Controle Social , China , Humanos , Risco
18.
Risk Anal ; 39(11): 2369-2390, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31108566

RESUMO

This article estimates the value of a statistical life (VSL) for Chile under the hedonic wage method while accounting for individual risk preferences. Two alternative measures of risk aversion are used. First, risk aversion is directly measured using survey measures of preferences over hypothetical gambles, and second, over observed individual behaviors that may proxy for risk preferences, such as smoking status, are used. I reconcile the results with a theoretical model of economic behavior that predicts how the wage-risk tradeoff changes as risk aversion differs across individuals. The VSL estimates range between 0.61 and 8.68 million dollars. The results using smoking behavior as a proxy for risk attitudes are consistent with previous findings. However, directly measuring risk aversion corrects the wage-risk tradeoff estimation bias in the opposite direction. The results are robust to other observed measures of risk aversion such as drinking behavior and stock investments. Results suggest that, consistent with the literature that connects smoking behavior with labor market outcomes, smoking status could be capturing poor health productivity effect in addition to purely risk preferences.


Assuntos
Análise Atuarial , Medição de Risco , Valor da Vida , Adulto , Chile , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino
19.
J Surg Oncol ; 120(2): 193-199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31042013

RESUMO

BACKGROUND: While survival after surgical treatment of extremity soft tissue sarcoma (STS) is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant as it accounts for time already survived. We compared actuarial survival and CS of STS patients. MATERIALS AND METHODS: We analyzed 567 patients who underwent surgery for localized extremity STS. Actuarial survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to evaluate factors associated with disease-specific survival. Five-year CS (CS5) estimates at "χ" year(s) after surgery were calculated as CS5 = S(χ + 5)/S(χ). RESULTS: Whereas actuarial survival decreased over time, CS5 increased. The postsurgical 1-, 3-, and 5-year CS5 values were 84.5%, 90.0%, and 93.8%, respectively, whereas the 6-, 8-, and 10-year actuarial survival rates were 82.0%, 79.4%, and 78.5%, respectively. The calculated CS5 exceeded actuarial survival especially in patients with risk factors such as large tumor size and Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grades 2 and 3 tumors. Patients with tumor size ≥5 cm had an actuarial survival of 73.9% at 10 years compared to a CS5 of 95.4% in patients alive at 5 years. Likewise, patients with FNCLCC grade 3 tumors had an actuarial survival of 71.1% at 10 years compared to a CS5 of 96.0% in patients alive at 5 years. CONCLUSIONS: Survival estimation by determination of CS can be dynamic and accurate especially in high-risk patients. CS can be useful for survival prediction and clinical decision making in extremity STS patients.


Assuntos
Extremidades , Sarcoma/mortalidade , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/cirurgia , Análise Atuarial , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida
20.
Seizure ; 69: 125-132, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31026743

RESUMO

PURPOSE: To explore the retention rates and the efficacy and tolerability of perampanel (PER) by using monthly real life data for a period of 12 months. METHODS: Longitudinal outcomes of (PER) usage were assessed using actuarial statistics in an observational nonrandomised multicentre study of 181 people with epilepsy (PWE) refractory to first and second line drugs. Graded seizure outcomes, toxicity and the dose of PER were recorded for each month. RESULTS: PWE were followed for a mean of 15.1 months. The total cumulative probability for retention on PER at 12 months was 61.7% and for ≥50% improvement was 38.2%. Most improvements in seizure control occurred soon after initiation of PER, 17% by one month, 32% by six months and 38% by twelve months, and mostly at low doses 53% on 2 mg and 90% up to 6 mg. Improvements, when they occurred, were sustained. The most common side effects were neuropsychiatric, occurring in 28%. The emergence of side effects did not appear to be dose related. Although people with intellectual disability (ID) were more likely to remain on PER they did not show improved seizure control and also reported more side effects. Patients treated with VNS and PER had a worse outcome. CONCLUSION: Overall around a third of people showed a useful, response to PER therapy. The response to PER is noted usually early in the treatment and for the majority of the patients for doses up to 8 mg.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Piridonas/uso terapêutico , Convulsões/tratamento farmacológico , Análise Atuarial , Adulto , Quimioterapia Combinada/métodos , Feminino , Humanos , Deficiência Intelectual , Masculino , Pessoa de Meia-Idade , Nitrilas , Estudos Retrospectivos , Resultado do Tratamento
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