Five-year Age Groups Research Articles

A technique to determine the fastest age-adjusted masters marathon world records.

Introduction/PurposeThis study’s purpose was to develop and employ a technique to determine the fastest masters marathon world records (WR), ages 35–79 years, adjusted for age (WRadj).MethodsFrom single-age WR data, a best-fit polynomial curve (WRpred1) was developed for the larger age range of 29–80 years for women and 30–80 years for men to improve curve stability in the 35–79 years range. Due to the relatively large degree of data scatter about the curve and the resultant age bias in favor of older runners, a subsample was constituted consisting of those with the lowest WR/WRpred1 ratio within each five-year age group (N = 11). A new polynomial best-fit curve (WRpred2) was developed from this subsample to become the standard against which WR would be compared across age. WRadj was computed from WR/WRpred2 for all runners, 35–79 years, from which the top ten fastest were then determined.ResultsThe WRpred2 model reduced data scatter and eliminated the age bias. Tatyana Pozdniakova, 50 years, WR = 2:31:05, WRadj = 2:12:40; and Ed Whitlock, 73 years, WR = 2:54:48, WRadj = 1:59:57, had the fastest WRadj for women and men, respectively.ConclusionsThis technique of iterative curve-fitting may be an optimal way of determining the fastest masters WRadj and may also be useful in better understanding the upper limits of human performance by age.

Risk perception of people involved in biomonitoring of the general population living near an Italian incinerator

Introduction. The surveillance system on the health of population living near waste incinerator in Turin (SpoTT) includes an evaluation of risk perception before the entry into operation. Methods. 394 subjects (35 – 69 years) were randomly sampled from the municipal registry and stratified by sex and five-year age groups: 196 residents in the exposed area (E) and 198 in a control area (C). A questionnaire gathered information about risk perception, awareness of environmental and health issues, sources of information used, and the most reliable authorities to provide information on environment and health issues. A logistic regression was performed, controlling for exposure area, gender, age, place of birth, educational level, marital status, presence of children, perceived health status. Differences in the overall sample and between E and C by each variable are tested. Results. E group is most worried than C about anthropogenic causes (OR 2.10: 95%CI 1.36-3.22) and solid waste management (2.11:1.30-3.47). There are difference of risk perception for individuals reporting a good health status, for who has a low educational level and for the younger age class with respect to their reference categories. E consider themselves at risk for a series of illness: allergies (2.16:1.34-3.46), acute and chronic respiratory diseases (2.11:1.31-3.37; 1.95:1.20-3.17), temporary damage (4.42: 2.16-9.02), liver damage (3.77:1.98-7.17), cancers (5.62: 3.33-9.49), leukemia (7.04: 3.72-13.33) and congenital diseases (9.00:3.80-21.31). Conclusions. The survey shows a general worry status in people exposed to incinerator. The questionnaire will be offered again after three years of operation of the incinerator to monitor if there will be changes in risk perception and to check the efficacy of SPoTT communication plan.

Trends in the Incidence Rates of Chronic Hepatitis B in Poland in the Years 2005 - 2013.

BackgroundThe prevalence of newly-diagnosed cases of chronic hepatitis is decisive for the overall incidence rate of hepatitis B observed in Poland.ObjectivesWe aimed to determine the chronic hepatitis B incidence trends in Poland, taking into consideration the ages, genders, and environments of the patients.MethodsThe study is based on aggregated data from Polish descriptive epidemiological studies for the period of 2005 to 2013 (i.e., hepatitis B incidence numbers and ratios, including mixed HBV and HCV infections) as published in the annual bulletins Choroby zakazne i zatrucia w Polsce (Infectious diseases and poisonings in Poland] drawn up by the laboratory for the monitoring and analysis of epidemiological status of the department of epidemiology at the national institute of public health - national institute of hygiene (NIPH-NIH). Poland, a central European country situated in the humid continental climate zone, is classified as a highly developed country. In the analyzed period, the Polish population consisted of about 38 million people, more than 19 million of whom were women, and more than 18 million of whom were men. Among European countries, Poland has the smallest number of national and ethnic minorities. For the purposes of epidemiological supervision, a special definition of acute hepatitis B was adopted in Poland in 2005, which facilitated separate registration of acute and chronic cases.ResultsA significantly increasing chronic hepatitis B incidence trend was observed in the population of Poland, with considerable increases in incidence rates for both men and women alike. The incidence rates for inhabitants of both urban and rural areas also showed an increasing tendency. Chronic hepatitis B occurred more frequently in men and in urban areas. For each of the five-year age groups encompassing patients between 20 and 54 years of age, the increase in the incidence rate proved to be significant.ConclusionsThe registered increase in the incidence rate of chronic hepatitis B in Poland is a consequence of the new registration of cases of chronic hepatitis B acquired in the past. The problem of chronic hepatitis B can be solved by improving epidemiological supervision, enhancing the detection of frequently asymptomatic infections, and by providing easier access to optimized therapies.

Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014.

BackgroundIn 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress.MethodsUsing the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets.ResultsMore than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds.ConclusionsThe priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five-year age groups will inform countries’ decisions about next steps.

Validity of Borg’s Category Ratio 10 Scale during Maximal-graded Exercise Testing

PURPOSE: The purpose of this study was to investigate the validity of Borg’s category ratio (CR) 10 scale during maximal-graded exercise testing (GXT) and to examine the factors associated with validity for ratings of perceived exertion (RPE) in Korean adults. METHODS: We recruited 720 adult participants over 20 years of age. we divided the participants based on their sex and further subdivided them into five-year age groups, with 40 participants in each group. After exclusion of participants whose VO2max measurements were invalid or in-appropriately recorded, we had a total of 665 participants (327 male and 338 female). We measured the participants’ height and body fat percentage. Physical activity and physical self-efficiency were surveyed. Steady-state heart rate, VO2, and ratings were record last 10 seconds in every stage and end of GXT. The collected data were analyzed by descriptive statistics, correlation analysis and regression analysis using STATA 10.0 SE statistics package. RESULTS: The CR 10 scale was strongly correlated with %HR max, %heart rate reserve (HRR) and %VO2max. Estimates for relative exercise intensity at each RPE can be calculated according to the equation %HRmax=50.251+8.351×RPE-.317×PRE2 for male (r2=.779, p<.001) and, %HRmax=55.838+7.895×RPE-.332×RPE2 for female (r2=.728, p<.001). The validity was relatively higher in males and younger group But there were no difference between physical fitness, vigorous physical activity, and physical self-efficiency. CONCLUSIONS: We found that Borg’ CR10 is more effective than 15-scale RPE as a method of setting of exercise intensity in Korean adults. 색인어: 타당도, 10단계 비율척도의 운동자각도, 운동강도 Keywords: Validity, Rating of perceived exertion, Category ratio 10, Exercise intensity

Interaction of 1970–2010 breast cancer in-situ (brca, DCIS) rates with invasive breast cancer (brcainv) and mortality (brcamor): Comparative analysis of two regions with different screening mammography and therapy guidelines (ScreenMam).

e13069Background: To correlate age-standardized rates [ASRs] of DCIS, BrCaINV and BrCaMOR, separately for ages 50. British Columbia [BC] is known for earlier introduction, tighter adherence to, and more uniformity of ScreenMam than the Atlantic Provinces [AP]. Methods: Annual age-specific rates [ASRs] of DCIS, BrCaINV, and BrCaMOR were obtained for 17 five-year age groups (years 0-4 to 85+) in BC and AP, and averaged over 5-year1970-1974 to 2005-2009 periods [Lustrum], separately for ages 50. BrCaINV and BrCaMOR rates were expressed in percentages, relative to 1970-74 average. Data were obtained from Canada Public Health Agency and Canada Ca Registry database at Statistics Canada. Results: See Tables. Conclusions: DCIS: Rates are substantially increased since 1970s in both regions. For ages >50, rate stabilization is seen after 2000s, particularly in BC where the rate decrease is seen after 2005. BrCaINV: In both regions, rates for ages 50, rates are initia...

Homicide mortality rates in Canada, 2000-2009: Youth at increased risk.

To estimate and compare Canadian homicide mortality rates (HMRs) and trends in HMRs across age groups, with a focus on trends for youth. Data for the period of 2000 to 2009 were collected from Statistics Canada's CANSIM (Canadian Statistical Information Management) Table 102-0540 with the following ICD-10-CA coded external causes of death: X85 to Y09 (assault) and Y87.1 (sequelae of assault). Annual population counts from 2000 to 2009 were obtained from Statistics Canada's CANSIM Table 051-0001. Both death and population counts were organized into five-year age groups. A random effects negative binomial regression analysis was conducted to estimate age group-specific rates, rate ratios, and trends in homicide mortality. There were 9,878 homicide deaths in Canada during the study period. The increase in the overall homicide mortality rate (HMR) of 0.3% per year was not statistically significant (95% CI: -1.1% to +1.8%). Canadians aged 15-19 years and 20-24 years had the highest HMRs during the study period, and experienced statistically significant annual increases in their HMRs of 3% and 4% respectively (p &lt; 0.05). A general, though not statistically significant, decrease in the HMR was observed for all age groups 50+ years. A fixed effects negative binomial regression model showed that the HMR for males was higher than for females over the study period [RRfemale/male = 0.473 (95% CI: 0.361, 0.621)], but no significant difference in sex-specific trends in the HMR was found. An increasing risk of homicide mortality was identified among Canadian youth, ages 15-24, over the 10-year study period. Research that seeks to understand the reasons for the increased homicide risk facing Canada's youth, and public policy responses to reduce this risk, are warranted.

Prevalence of the geriatric syndromes and frailty in older men living in the community: The Concord Health and Ageing in Men Project.

To describe the age at which the geriatric syndromes and frailty become common in community-dwelling men. The Concord Health and Ageing in Men Project involves a population-based sample of 1705 community-dwelling men aged 70 and over from a defined geographic region in Sydney. Data were obtained by physical performance tests, clinical examinations, and questionnaire to determine the prevalence of the following conditions by five-year age group. Poor mobility, recurrent falls, urinary incontinence, dementia and frailty phenotype were all uncommon (less than 10%) in men in their 70s, but the prevalence of each of these conditions exceeded 10% in men aged 85-89. The prevalence of Frailty Index-defined frailty, multimorbidity, polypharmacy and instrumental activities of daily living dependence was constantly high in all age groups. The different health-care needs of the 'old old' aged 85 years and older should be accounted for in health service planning.

Spatial diversity of demographic aging in Poland

In the assessment of the demographic age and ageing a lot of measures are being exploited. Among the most commonly used may be mentioned those which express the relationship between the number of people in two age groups (the elderly and the general population or younger age group). Rarely are used such measures, which take into account all the age structure of the population. The article presents a new method to analyze spatial diversity of the population age structure using the method of agglomeration with the Euclidean metric. The test objects were the voivodships (provinces), and the explanatory variables were five-year age groups (20 variables). In addition, a hypothetical business was introduced, which has a regressive age structure. Its introduction allowed for an evaluation of how the test regions differ not only among themselves, but also how far they deviate from the pattern of development of the Polish population. Considerations were conducted separately for men and women and the 1991, 2001, 2011.

Age–period–cohort analysis of the suicide rate in Korea

BackgroundThe suicide rate has been increasing in Korea, and the country now has the highest rank in the world. This study aimed to present the long-term trends in Korea's suicide rate using Joinpoint analysis and age–period–cohort (APC) modeling. MethodsThe population and the number of suicides for each five-year age group were obtained from the National Statistical Office for the period 1984–2013 for Koreans aged 10 years and older. We determined the changes in the trends in age-standardized mortality rates using Joinpoint. APC modeling was performed to describe the trends in the suicide rate using the intrinsic estimator method. ResultsThe age-standardized suicide rate in men rapidly increased from 1989 to 2004, and slightly increased thereafter, whereas the suicide rate in women increased from 1989 to 2009 and then decreased thereafter. Within the same period, the suicide rate was higher among the older age groups than in the younger groups. Within the same birth cohort, the suicide rate of the older groups was also higher than that in the younger groups. Within the same age group, the suicide rate of the younger cohorts was higher than it was in the older cohorts. In the APC modeling, old age, recent period, and having been born before 1924 were associated with higher suicide rates. LimitationsThe accuracy and completeness of the suicide rate data may lead to bias. ConclusionsThis study showed an increasing trend in the suicide rates for men and women after 1989. These trends may be mainly attributed to cohort effects.

The Sense and Nonsense of Anaemia Analysis in Relation to Mortality in General Practice

Introduction: Anaemia is a common finding in general practice, with a prevalence rising from about 5% in the age group 50-64 years to over 20% in the age group 85+ years. Anaemia has been associated with increased all-cause mortality in a general practice population. However, only the influence of the four main causes of anaemia (anaemia of chronic disease, nutrient deficiency, renal anaemia and unknown anaemia) on mortality has been analysed.We prospectively studied the influence of a wide range of causes of anaemia on mortality, including less prevalent causes such as folic acid deficiency and haemolysis. In addition, we calculated the standardized mortality ratio for men and women per five-year age group to determine up to which age anaemia continues to exert a negative influence on mortality.Methods: Between the 1st of February 2007 and the 1st of February 2014, patients aged 50 years or older and presenting to their general practitioner with a newly diagnosed anaemia (i.e. no anaemia the preceding two years) were included in the study. Anaemia was defined as a haemoglobin level below 13.7 g/dL (8.5 mmol/L, men) and below 12.1 g/dL (7.5 mmol/L, women). A wide range of laboratory parameters was established for each patient. Based on the laboratory results, two independent experts determined the cause or causes of anaemia.Patients were followed until either their deaths or until the 1st of September 2014, at which moment they were censored at the last date they were documented as alive in the hospital or laboratory information system. Mortality risk of the overall Dutch population in the year 2010 was extracted from Statistics Netherlands, which collects all population statistics in the Netherlands, and compared to the mortality risk of the anaemic cohort.Results: A total of 2929 patients were included in the study, 1428 men (median age 72 years, range 50-101) and 1501 women (median age 77 years, range 50-103). Among the patients presenting with a single cause of anaemia, anaemia of chronic disease was found 848 times (29.0%), haemoglobinopathy 18 times (0.6%), haemolysis 10 times (0.3%), possible bone marrow disease 42 times (1.4%), other causes 64 times (2.2%) and renal anaemia 290 times (9.9%). Iron deficiency was found 499 times (17.0%), vitamin B12 deficiency 61 times (2.1%) and folic acid deficiency 11 times (0.4%). A total of 260 patients (8.9%) presented with multiple causes while the cause remained unknown in 826 patients (28.2%).A Cox proportional hazards model was used to assess the influence of the different causes of anaemia on mortality, correcting for age, gender and severity of anaemia. Patients presenting with an unknown cause were used as the reference group. We found significant hazard ratios for the following causes: anaemia of chronic disease (HR = 2.1 95% CI 1.64-2.70, P < 0.001), possible bone marrow disease (HR = 3.08 95% CI 1.72-5.52, P < 0.001), folic acid deficiency (HR = 6.89 95% CI 2.79-17.04, P < 0.001), renal anaemia (HR = 2.15 95% CI 1.61-2.87, P < 0.001) and multiple causes (HR = 2.31 95% CI 1.69-3.16, P < 0.001).The mortality risk of the anaemic general practice population was compared to the mortality risk of the overall Dutch population. Statistically significant standardized mortality ratios were observed for both men (M) and women (W) in the age groups 50-54 years (M:5.01, and W:5.30), 60-64 years (M:4.32, and W:3.57), 70-74 years (M:1.96, and W:2.04), 75-79 years (M:1.69, and W:2.09) and 80-84 years (M:1.34, and W:1.50). In addition, significant ratios were observed for men in the age groups 55-59 years (4.40) and 65-69 years (2.91). From age group 85-89 years and up, no significant effect of all-cause anaemia on mortality was found.Conclusion: Anaemia of chronic disease, possible bone marrow disease, folic acid deficiency, renal anaemia and presenting with multiple causes of anaemia are associated with a higher mortality. An increased standardized mortality ratio was demonstrated until the age of 85 years. The ratio showed a linear decrease with age. Above 85 years no increased mortality risk for patients with all-cause anaemia was found. DisclosuresSonneveld:Janssen-Cilag, Celgene, Onyx, Karyopharm: Honoraria, Research Funding; novartis: Honoraria.

Incidencia hospitalaria, tendencia y distribución municipal del cáncer de próstata en el área de salud de León (1996-2010)

Prostate cancer (PC) is the most prevalent among men and yet its risk factors are little known. This article aims to determine the hospital incidence, trend and municipal distribution of PC in Health Area of León (HAL). We included new cases of prostate cancer (ICD-9: 185, ICD-10: C61) enrolled in the Hospital Tumor Registry of the Complejo Asistencial Universitario de León, between 1996 to 2010 with residence in HAL. We calculated crude triennial hospital incidences and adjusted at global and European population. As denominator we used the INE population data disaggregated by five-year age groups of residents in municipalities of the HAL. To analyze the spatial distribution, we estimated municipal relative risks (RR) smoothed by fitting the Besag, York and Mollié model and the posterior probability (PP) of RR >1 using Bayesian methods. 3,366 cases were included. Standardized rates at European population amounted of 30.3 (1996-98) to 119.0 (2008-2010) new cases per 100,000 men. The number of organ-confined cases were increased from 281 (1999-2001) to 999 (2008-2010). PSA determinations amounted from 30,985 (1999-2001) to 117 396 (2008-2010). A great increase was observed in the frequency of PC at the expense of organ-confined cases which correlate very well with PSA determinations performed in HAL. There were no differences of interest in the municipal distribution incidences.

Living, working and earning for people with disabilities in Australia

The purpose of this article is to consider the extent to which disabilities are likely to affect the length of a career and earnings potential. The net worklife expectancy for persons with a profound, severe, moderate or mild disability in Australia was determined. This was compared this to those with no disability. Tables for five-year age groups to age 65 are produced for males and females. There is a marked theoretical reduction of worklife capacity at all levels of disability and across every age group. The net effect of restricted vocational potential is likely to be a reduced worklife and diminished earnings for those with disabilities. This finding is considered in the light of current career development theory and practice.

Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996–2010)

ObjectiveSpain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. Material and methodsThe new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996 and 2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR>1. Results1573 cases were included. Incidence rates standardized to European population increased among men from 20.8/100,000 (1996–98) to 33.1/100,000 (2006–2008) and among women these rates increased from 1.9/100,000 to 5.9/100,000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. ConclusionsBladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexes, particularly in women are observed.

Descriptive epidemiology of traumatic injuries in 18890 adults: a 5-year-study in a tertiary trauma center in iran.

Background:Basic epidemiological data can provide estimates when discussing disease burden and in the planning and provision of healthcare strategies. There is little quantitative information in the literature regarding prevalence of traumatic injuries from developing countries.Objectives:The aim of the current preliminary study was to reveal the prevalence and age and gender distribution of various traumatic injuries in a tertiary referral orthopedic hospital in Iran.Patients and Methods:In a prospective descriptive study, all traumatic injured patients attending the Orthopedic Trauma Unit of our center in a five year period were included. Demographic details, the cause of injury, injury classification and treatment were recorded. For each of the five-year age groups and each gender we calculated the numbers with fractures, dislocations, soft tissue injuries, ligamentous injuries and lacerations and derived average age and gender-specific prevalence as well as seasonal variations.Results:A total of 18890 adults were admitted, 13870 (73.4%) males and 5020 (26.6%) females. There were 8204 (43.4%) fractures. The male fracture age distribution curve was unimodal and there was a detectable bimodal pattern in females. Under 65 years males are 3 times more likely to sustain a fracture than females which decreases to equal risk over the age of 65. The most common fracture site was distal radius/ulna (13.8%), followed by tibial diaphysis (8.8%), proximal femur (7.8%), finger phalanges (6.4%), metacarpals (6%) and metatarsals (5.9%). There were seasonal variations in fracture incidence with peaks in February, March and October. The least number of fractures occurred in June.Conclusions:The risk of traumatic injuries is higher among specific age groups with different patterns emerging for men and women. Thus, the descriptive epidemiology will provide useful information for treatment or injury prevention strategies, resource allocation, and training priorities.

Tendencia y distribución municipal de la incidencia de cáncer de vejiga en el área de salud de León (1996-2010)

ObjectiveSpain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. Material and methodsthe new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. Results1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. Conclusionsbladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed.

Abstract W P80: Predictors of Cognitive Status in Post-Aneurysm Surgery Patients

Introduction: Patients who undergo surgical treatment for ruptured intracranial aneurysms may have a different risk profile for a spectrum of cognitive impairment based upon characteristics at presentation of their subarachnoid hemorrhage. Methods: The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) is a multi-center, prospective, randomized clinical trial investigation of whether induced hypothermia during surgical treatment for subarachnoid hemorrhage resulted in improved outcomes. Cognitive status was defined by raw Mini-Mental Status Examination (MMSE) cutoff scores. A normal cognition was defined as a MMSE score of 28 or greater. Mildly impaired patients were defined as a score of 24-27, and severely impaired patients were defined as those with a score of less than 24. Age was analyzed by five-year age groups, with the exception of patients 30 or younger and patients 75 and older. Ordinal logistic regression was utilized to determine the final predictors. Results: Of the 1,000 patients who were followed for cognitive testing, 61 died and 21 were medically untestable. Five patients refused testing and tests were not administered to 30 patients. A total of 883 patients completed the MMSE at 3 months post-surgery. Based on the raw MMSE scores, the median score for the severely impaired patients was 20 (IQR: 16-22), 26 (IQR: 25-27) for mildly impaired patients, and 29 (IQR: 29-30) for cognitively normal patients. Gender, and race were found to be statistically significant (p&lt;.05) predictors after controlling for age and education. Baseline Rankin Score and the occurrence of a leakage or rupture during surgery were also predictive of cognitive status. The World Federation of Neurosurgical Societies Score, the Fisher’s SAH Score, and aneurysm size and location were not found to be statistically significant. Conclusion: Patients with surgical treatment for subarachnoid hemorrhage share several demographic risk factors associated with cognitive changes in the general public, but have additional neurological risk factors associated with SAH and aneurysm procedures.

Decline in Unmet Need Is Not Main Reason for Rise In Contraceptive Prevalence

Although contraceptive prevalence has increased substantially in Sub-Saharan Africa during the past two decades, for the most part the gains have not been driven by a decline in unmet need, according to an analysis of Demographic and Health Survey (DHS) data. (1) Examining trends in 22 countries that had multiple DHS surveys between 1990 and 2011, the investigators found that, on average, contraceptive prevalence rose by 13 percentage points--from 17% to 30%--between a country's first and most recent surveys. However, the proportion of women with unmet need fell by a mean of only four percentage points, a decline smaller than the simultaneous decrease in the proportion of women with no need (e.g., those wanting more children soon). Few studies have examined longitudinal changes in unmet need and lack of need among cohorts of women. However, Madsen and colleagues note that DHS data offer a useful substitute. Because the surveys in a particular country are typically administered about five years apart, one can use consecutive surveys to track changes in contraceptive use and nonuse among five-year cohorts of women; for example, a random sample of 25-29-year-old woman in a given survey will draw from the same pool of women as a sample of 20-24-year-old women in the previous survey, simulating a longitudinal cohort study. The current study used this approach to analyze DHS data collected between 1990 and 2011 from 22 countries in Sub-Saharan Africa. All countries had at least two surveys during that period, and most had four; in nearly all cases, the earliest survey for a particular country was conducted before 1998 and the most recent after 2005. For each survey, women aged 15-49 who were married or in a union were categorized, according to standard DHS definitions, as either being contraceptive users, having unmet need, having no need or being infecund. The investigators examined trends in these four categories in two ways. First, they performed period analyses to assess changes in the prevalence of the categories among women in each five-year age-group (e.g., whether the prevalence of contraceptive use, unmet need, no need and infecundity among 20-24-year-olds in a country's first survey differed from the prevalence among 20-24-year olds in subsequent surveys). These analyses included both descriptive and regression analyses. Second, as noted earlier, the investigators performed cohort analyses in which women in each five-year age-group were assumed to represent the same population as the next oldest five-year age-group in the following survey. Although the mean interval between surveys was, in fact, about five years, 21% of surveys were either less than four years apart or more than 6.5 years apart. Nonetheless, the authors retained these outliers in order to maintain comprehensive coverage and adequate sample size; supplementary analyses indicated that retention of the full sample did not meaningfully affect the results. Period analyses revealed that, on average, contraceptive prevalence in a given country rose by 13 percentage points (from 17% to 30%) between a country's first and last surveys (mean interval, 14 years). At the same time, countries had mean declines of four percentage points in the proportion of women with unmet need, five points in the proportion with no need and four points in the proportion who were infecund. Consistent with these findings, a multiple linear regression model more closely linked the increase in contraceptive prevalence to a decline in lack of need (coefficient, -1. …

Probabilistic Model to Analyze Patient Accessibility to Medical Facilities Using Geographic Information Systems

In this study, we developed a probabilistic model to analyze patient accessibility to hospitals by using a geographic information system (GIS). In the consideration of patient accessibility, we do not have correct patient addresses because of the laws related to protection of a patient's personal information. Thus, we use a representational place in the city or the ZIP code of the area. However, this may lead to a decline in the accuracy of the analysis. In this study, we used a 500-m mesh map and obtained the population gender and age group data from the national census data, in order to estimate the patient accessibility to medical facilities in small areas. We calculated the probability that a patient lives in each mesh on the basis of the population gender and five-year age group data. We selected the appropriate mesh on the basis of this probability and investigated the time distance from the estimated mesh to each hospital by using a GIS. As a result, we calculated the time distance and its distribution by using the proposed method from limited available information. Further, we found that in the target cities, the average time distance to hospital calculated using the proposed method was longer than that calculated by using a previous method; the percentage of patients who took more time than the city average to reach a hospital by using the proposed method. This method is very useful when planning the geographical resource allocation of medical services.

Inequalities in healthy life expectancy between ethnic groups in England and Wales in 2001

Objectives. We aim to develop robust estimates of disability-free life expectancy (DFLE) and healthy life expectancy (HLE) for ethnic groups in England and Wales in 2001 and to examine observed variations across ethnic groups.Design. DFLE and HLE by age and gender for five-year age groups were computed for 16 ethnic groups by combining the 2001 Census data on ethnicity, self-reported limiting long-term illness and self-rated health using mortality by ethnic group estimated by two methods: the Standardised Illness Ratio (SIR) method and the Geographically Weighted Method (GWM).Results. The SIR and GWM methods differed somewhat in their estimates of life expectancy (LE) at birth but produced very similar estimates of DFLE and HLE by ethnic group. For the more conservative method (GWM), the range in DFLE at birth was 10.5 years for men and 11.9 years for women, double that in LE. DFLE at birth was highest for Chinese men (64.7 years, 95% CI 64.0–65.3) and women (67.0 years, 95% CI 66.4–67.6). Over half of the ethnic minority groups (men: 10; women: 9) had significantly lower DFLE at birth than White British men (61.7 years, 95% CI 61.7–61.7) or women (64.1 years, 95% CI 64.1–64.2), mostly the Black, Asian and mixed ethnic groups. The lowest DFLE observed was for Bangladeshi men (54.3 years, 95% CI 53.7–54.8) and Pakistani women (55.1 years, 95% CI 54.8–55.4). Notable were Indian women whose LE was similar to White British women but who had 4.3 years less disability-free (95% CI 4.0–4.6).Conclusions. Inequalities in DFLE between ethnic groups are large and exceed those in LE. Moreover, certain ethnic groups have a larger burden of disability that does not seem to be associated with shorter LE. With the increasing population of the non-White British community, it is essential to be able to identify the ethnic groups at higher risk of disability, in order to target appropriate interventions.