Health Expectancy Research Articles

Pneumococcal and influenza vaccination coverage among at-risk adults: A 5-year French national observational study

IntroductionThe risk of developing pneumococcal infections increases with certain chronic conditions and in immunocompromised patients. We aimed to monitor pneumococcal vaccination coverage in at-risk patients and to examine factors associated with pneumococcal vaccination in France. Material and methodsIn this annual cross-sectional study, at-risk patients were extracted between 2014 and 2018 from the National Health Insurance’s (NHI) General scheme’s claims database with their vaccine reimbursements. Descriptive analyses and a logistic model were performed to assess the influence of healthcare use and medical and demographic factors on pneumococcal vaccination. Results and discussionIn 2018, 4.5% of 4,045,021 at-risk adults were up to date with their pneumococcal vaccination. During the study period, the number of patients with chronic medical conditions (86% of 4,045,021) increased by 10.1%, but vaccination coverage decreased from 12.9% to 2.9%. The population with immunocompromised status (14% of 4,045,021) increased by 16.2% and vaccination coverage from 10.3% to 18.8%. Influenza vaccination coverage was much higher and stable (around 45.0%). Factors associated with pneumococcal vaccination were: immunocompromised status vs. having a chronic medical condition (odds ratio [OR] 4.72), influenza vaccination (OR 2.36–3.42), hepatitis B vaccination (OR 2.82), DTPolio vaccination (OR 1.52), ≥5 specialist physicians’ visits (OR 1.17), and age above 74 (OR 1.12). Pneumococcal vaccine dispensing was extremely low (median of 9per GP,1per specialist over 9 years) despite frequent healthcare visits. ConclusionPneumococcal and influenza vaccination coverage of adults at risk of pneumococcal disease fell well below public health expectations. Invitations for pneumococcal vaccination should be sent by the NHI to high-risk patients. Patient management protocols should include pneumococcal vaccination. Patients with multiple comorbidities are a high-priority population given the large potential health gains offered by pneumococcal vaccination. Commitment of both scientific societies and health authorities is urgently needed to increase vaccination coverage in at-risk populations.

(Un-) healthy ageing: Geographic inequalities in disability-free life expectancy in England and Wales.

Health expectancies are an indicator of healthy ageing that reflect quantity and quality of life. Using limiting long term illness and mortality prevalence, we calculate disability-free life expectancy for small areas in England and Wales between 1991 and 2011 for males and females aged 50-74, the life stage when people may be changing their occupation from main career to retirement or alternative work activities. We find that inequalities in disability-free life expectancy are deeply entrenched, including former coalfield and ex-industrial areas and that areas of persistent (dis-) advantage, worsening or improving deprivation have health change in line with deprivation change. A mixed health picture for rural and coastal areas requires further investigation as do the demographic processes which underpin these area level health differences.

The Relationship Between Sexual Activity and Heart Rate Variability in Menopausal Women.

Background:Menopause is an important life stage for women, which can bring along sexual and cardiac problems. Increased heart rate variability is an indicator of parasympathetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile–vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women.Methods:We evaluated 130 menopausal patients aged 45-60 years, without chronic disease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording.Results:Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P = .004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P = .001; number of NN intervals exceeding 50 milliseconds: P = .011; percentage of adjacent RR intervals with a difference of duration >50 ms: P = .009; low frequency: P = .011; high frequency: P = .008, low frequency/high frequency: P = .018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause duration, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were independently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P = .005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P = .014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P = .049, respectively).Conclusion:In healthy menopausal women, continued sexual activity with penile–vaginal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.

Challenges of Plastic Waste and It’s Recycling, A Threat to Environment: A Case Study of Kanpur City

Materials and manufactured products process which fluctuate the balance of their production and rate of destruction are usually led to retrogression in the environment. Plastic products are considered one such material which gives rise to a big threat towards environment. A huge-huge amount of plastic in many forms is produced and dropped into the environment and naturally the homeostatic process of environment is itself unable to degrade the material produced with that’s why plastic recycling is an important issue in present scenario of the society. Un-organized recycling and non-biodegradability of plastic products produce the degree of devastation to the environment and the consequences of devastation are directly proportional to the health and life expectancy of mankind. This paper tries to deal with the investigation about the challenges of plastic waste as well as plastic bags that turns into a threat to the environment. Mostly, plastic waste is considered recyclable, but with the passing of time it is noticed that recycled products are proved more harmful to the environment so it is crystal clear that recycling is not more sheltered and permanent solution for the plastic waste disposal.

Precursory Prevention: Togetherness for Better Health

Precursory Prevention: Togetherness for Better Health

A Qualitative Investigation of Older Adults’ Conceptualization of Quality of Life and a Think-Aloud Content Validation of the EQ-5D-5L, SF-12v2, Warwick Edinburgh Mental Well-Being Scale, and Office of National Statistics-4.

ObjectivesOld age is characterized by declining health, comorbidities, and increasing health and social care service use. Traditionally, patient-reported outcome measures (PROMs) including the EQ-5D-5L and SF-12v2 have focused on health. Nevertheless, aged care often aims to improve broader elements of quality of life (QoL), captured by well-being measures, such as the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Office of National Statistics-4 (ONS-4). This study investigates older adults’ conceptualization of QoL and the content validity of the EQ-5D-5L, SF-12v2, WEMWBS, and ONS-4 in measuring their QoL. MethodsQualitative cognitive think-aloud interviews were undertaken with older adults aged 75+, exploring their views on what was important to QoL and, for each measure, the relevance, acceptability, and interpretation of items; suitability of response options; and the comprehensiveness of the measure. Conceptualization of QoL was analyzed thematically and content validity using framework analysis. ResultsTwenty interviews were undertaken. Older adults’ conceptualization of QoL centered on health, ability to perform usual activities, social contact, and emotional functioning. Possible response shift was observed, as older adults assessed their health relative to lower health expectations at their age or to people in worse states. Participants questioned the relevance of negatively phrased mental items and often preferred the functioning-focused EQ-5D-5L to more subjective ONS-4 and WEMWBS items. Domains suggested to improve comprehensiveness included social contact, coping, security, dignity, and control. ConclusionsThese findings are useful to researchers developing new PROMs for older adults or for the developers of included PROMs considering permanently adapting or bolting-on domains to improve content validity in older adults.

Sex differences in the mortality rate for coronavirus disease 2019 compared to other causes of death: an analysis of population-wide data from 63 countries.

Men are more likely than women to die due to coronavirus disease 2019 (COVID-19). An open question is whether these sex differences reflect men’s generally poorer health and lower life expectancy compared to women of similar ages or if men face a unique COVID-19 disadvantage. Using age-specific data on COVID-19 mortality as well as cause-specific and all-cause mortality for 63 countries, we compared the sex difference in COVID-19 mortality to sex differences in all-cause mortality and mortality from other common causes of death to determine the magnitude of the excess male mortality disadvantage for COVID-19. We found that sex differences in the age-standardized COVID-19 mortality rate were substantially larger than for the age-standardized all-cause mortality rate and mortality rate for most other common causes of death. The excess male mortality disadvantage for COVID-19 was especially large in the oldest age groups. Our findings suggest that the causal pathways that link male sex to a higher mortality from a SARS-CoV-2 infection may be specific to SARS-CoV-2, rather than shared with the pathways responsible for the shorter life expectancy among men or sex differences for other common causes of death. Understanding these causal chains could assist in the development of therapeutics and preventive measures for COVID-19 and, possibly, other coronavirus diseases.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10654-022-00866-5.

Practical considerations for colorectal cancer screening in older adults.

Recent guidelines recommend that colorectal cancer (CRC) screening after age 75 be considered on an individualized basis, and discourage screening for people over 85 due to competing causes of mortality. Given the heterogeneity in the health of older individuals, and lack of data within current guidelines for personalized CRC screening approaches, there remains a need for a clearer framework to inform clinical decision-making. A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment, post-treatment survival, and increasing life expectancy in the population. In this review, we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity, frailty, and cognitive status. We will also review screening modalities and endoscopic technique for minimizing risk, the risks of screening unique to older adults, and CRC treatment outcomes in older patients, in order to provide important information to aid CRC screening decisions for this age group. This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools, and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.

'The likes of me running and walking? No chance': Exploring the perceptions of adult patients with bronchiectasis towards exercise.

Objective: To explore the views and experiences of adult patients with bronchiectasis towards exercise. Methods: Semi-structured interviews with ten patients with bronchiectasis were conducted to explore perceptions of exercise, potential barriers and facilitators of exercise. Inductive thematic analysis was used to identify key themes. Findings: Five main themes: 1. The language of exercise 2. Facilitators to exercise 3. Barriers to exercise 4. Exercise has a positive impact on health and life expectancy 5. Grief regarding loss of ability Discussion: Participants perceived exercise as positive, but there was variance regarding what this entailed. Findings suggest healthcare professionals should consider the language used when prescribing exercise and provide clarity for patients and reflect on their own role in advising on exercise. There were both common and differing barriers and facilitators to exercise between participants. Holistic needs and the identification of these potential barriers and facilitators to exercise could aid compliance. Further research is needed to explore generalisability and the effectiveness of behaviour change models to improve engagement with exercise.

Social differentials in the impact of risk factor exposures on life expectancy and health expectancy

Social differentials in the impact of risk factor exposures on life expectancy and health expectancy

Experience of mothers after the diagnosis of congenital malformation and the expectations of care

Objective: to understand the experience of mothers after the diagnosis of congenital malformation and the expectations of care from the health and social network. Methods: qualitative research based on Social Phenomenology, with the participation of six mothers living in border towns, by means of semi-structured interviews. Results: the reports brought information about the diagnosis of congenital malformation, the experience of pregnancy, becoming a mother of a child with malformation and the expectations of health and social care. Conclusion: the social group studied experienced the diagnosis of malformation with suffering, emotional repercussions and changes in their daily lives. Contributions to practice: communication by the health team contributes to understanding and facing the malformation. The importance of the family and social network support was highlighted. It is necessary to develop professional skills related to communication and to make more investments in training and working conditions that allow more time for the care of this public.

Expansion, Compression, Neither, Both? Divergent Patterns in Healthy, Disability-Free, and Morbidity-Free Life Expectancy Across U.S. Birth Cohorts, 1998-2016.

This article explores how patterns of health, morbidity, and disability have changed across successive generations of older adults in the United States. Using a novel method for comparing state-specific partial life expectancies-that is, total life expectancy (LE), and health expectancies (HEs) in different health states, bounded between two ages-I explore changes in healthy life expectancy across successive birth cohorts of the U.S. population. Results show that little compression of disability is occurring across cohorts, LE with chronic morbidities has expanded considerably, and self-rated health is improving across cohorts, but only at ages 70+. These findings suggest that successive cohorts in the U.S. population may be on divergent paths in terms of late-life health and well-being. Exploring heterogeneity in these patterns, I find that less educated individuals have substantially lower partial LE and disability-free LE than those with more schooling, and that disability-free life is declining among those with less than a high school diploma. Differences in HEs are pervasive across racial and ethnic groups, and both disabled LE and unhealthy LE are expanding in some disadvantaged subgroups. The continued increases in partial LE with morbidities across successive cohorts, and the broad stagnation of disability-free and healthy LE, present a broad view of a U.S. population in which successive generations are not living healthier lives.

User acceptance of wearable intelligent medical devices through a modified unified theory of acceptance and use of technology.

BackgroundThe acceptance of wearable intelligent medical devices and the factors influencing behavioral intention to use them have been scarcely studied. This study aimed to increase the current understanding of wearable intelligent medical devices and investigate the factors influencing their acceptance.MethodsIntegrating the unified theory of acceptance and use of technology and the theory of perceived risk, and based on the features of wearable intelligent medical devices, we proposed a modified unified theory of acceptance and use of technology model to identify factors influencing the acceptance of these devices. Using data collected from 2,192 respondents in China from an online survey, we used structural equation modeling to test the measurement and structural models.ResultsThe findings suggested that facilitating conditions (path coefficient =0.942, P<0.001) were critical to the use of wearable intelligent medical devices. Behavioral intention significantly mediated the effects of perceived risk, perceived cost, health expectation, perceived ease of use, and social influence on user behavior (path coefficient =0.210, P<0.001). Health expectation (path coefficient =0.860, P<0.001), perceived ease of use (path coefficient =0.289, P<0.001), and social influence (path coefficient =0.153, P<0.001) were found to play essential roles in predicting behavioral intention. Perceived cost (path coefficient =0.034, P<0.05) and perceived risk (path coefficient =−0.031, P<0.05) had no significant effect on behavioral intention. People with underlying diseases had lower health expectations and perceived costs.ConclusionsThe modified unified theory of acceptance and use of technology model in our research is a reliable model to evaluate the user acceptance of wearable intelligent medical devices.

Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study.

Mixed-method study (small group discussions and online literature search). Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord injury (SCI) in the low income and lower-middle-income countries (LIC/LMIC) located in Asia. Small group discussions in three biomedical conferences in Dhaka, Bangladesh and Kualalampur, Malaysia. Three small group discussions (30-45 min each) were held during three international conferences in 2019. The conferences brought together experts in the fields of neurology, rehabilitation, neurorehabilitation, and bioethics. A summary of SCI practice points and dilemmas were documented including goals of care, duties of rehabilitation professionals, health care worker-patient relationships, roles, and expectations of family members at different care settings. There is a paucity of literature on this topic. The application of the principles of contemporary bioethics in the pluralistic societies of LIC/LMIC can be challenging. The ethical dilemmas faced by rehabilitation professionals working in LIC/LMIC are diverse and different from those reported from the Western and developed countries. Ethical issues and dilemmas identified were understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters. We have summarized the possible ethical issues and dilemmas which rehabilitation professionals in LIC/LMIC may encounter during delivery of SCI rehabilitation services. We hope it generates a discussion on an often-neglected aspect of SCI care in the LIC/LMIC and helps identify the complexities of ethical dilemmas unique to persons with SCI living in a developing country.

Analisis Dampak Kesehatan Masyarakat Terhadap Pembangunan Ekonomi: Studi Kasus Kotabumi

Public health is a vital resource for the growth and life of a nation. One effort to improve health degrees is to improve environmental health. Environmental health is an important factor in social life, even being a determinant of the welfare of the population. Health is one of the essential human resources needed to sustain economic development. This is because health is a prerequisite to increasing productivity, so health and economics have a powerful influence on one another. Health affects the economy, with high public health levels, the productivity of human labor is also high. When comparing the welfare rates of various community groups, it is important to look at life expectancy and annual income levels. In countries with better health rates, the average live longer, which means they have a financial opportunity to earn more. According to kotabumi's rate of life expectancy and public health, it is concluded that the region's health status still requires special attention. Keywords : Health, Ecomomics, and Life Expectancy

Fertility in Africa: Dynamics and Challenges of Development

This research is interested in the links between the fertility of women and the economic and social development of their country. It is part of an African context marked by weak indicators of economic and social development but with high indicators of demographic growth. Methodologically, quantitative data relating to demographic, economic, social and health variables are analyzed using a Principal Component Analysis, evolution curves, and projections to the year 2100. The results show that some African countries, despite their high fertility rates, benefit from social progress related to health and life expectancy even if their economy seems to be negatively affected especially by the high dependency indices of young people. Strong inequalities in fertility rates are also noted between different countries and different geographic regions, making the geography of the African population plural. The various demographic projections made show real opportunities for the continent's economic development in the future.

Treatment options for secondary osteonecrosis of the knee.

Knee osteonecrosis is a debilitating progressive degenerative disease characterized by subchondral bone ischemia. It can lead to localized necrosis, tissue death, and progressive joint destruction. For this reason, it is essential to diagnose and treat this disease early to avoid subchondral collapse, chondral damage, and end-stage osteoarthritis, where the only solution is total knee arthroplasty. Three types of knee osteonecrosis have been documented in the literature: spontaneous or primitive, secondary, and post arthroscopy. Spontaneous osteonecrosis is the most common type studied in the literature. Secondary osteonecrosis of the knee is a rare disease and, unlike the spontaneous one, involves patients younger than 50 years. It presents a particular set of pathological, clinical, imaging, and progression features. The management of secondary osteonecrosis is determined by the stage of the disorder, the clinical manifestation, the size and location of the lesions, whether the involvement is unilateral or bilateral, the patient's age, level of activity, general health, and life expectancy. This review aims to present the recent evidence on treatment options for secondary osteonecrosis of the knee, including conservative treatment, joint preserving surgery, and knee replacement.

Crocodylus porosus Sera a Potential Source to Identify Novel Epigenetic Targets: In Silico Analysis.

We have previously found that sera from Crocodylus porosus contain anticancer agents and the treatment of MCF7 cells with this serum resulted in the differential expression of 51 genes. The purpose of this study was to use in silico analysis to identify genes that might be epigenetically modulated in cells treated with crocodile serum and to understand the role of potential genes as novel candidates with epigenetic therapeutic potential. The findings report five proto-oncogenes (TUBA1B, SLC2A1, PGK1, CCND1, and NCAPD2) and two tumor suppressor genes (RPLP2, RPL37) as novel therapeutic targets. Furthermore, we present a comprehensive overview of relevant studies on epigenetic regulation of these genes along with an insight into their clinical implications. Therefore, elucidating the molecules present in the serum and gut bacteria of reptiles such as crocodiles may offer insights into the role of these genes on longevity, health, disease, and life expectancy.

OA40 How ethnicity influences outcomes in early inflammatory arthritis - equality but not equity: findings from a national cohort

Abstract Background/Aims Patients of Black, Asian and Minority Ethnic (BAME) backgrounds are more likely to report poorer health and low life expectancy. Focusing on patients with early inflammatory arthritis (EIA), we used the National Early Inflammatory Arthritis Audit (NEIAA) to evaluate the relationship between ethnicity, clinician and patient reported outcomes against the seven quality metrics set out in NICE (National Institute for Health and Clinical Excellence) quality standard QS33. Methods The study is an observational cohort design. Data were from adult patients newly diagnosed with EIA first seen within rheumatology services in England and Wales between May 2018 and March 2020. Ethnicity was grouped into the following binary categories of ethnic minority groups: BAME (including Black British/African/Caribbean, Asian/Asian British, mixed, other) and White. Analyses were performed on sociodemographic, quality metrics, clinical and patient reported outcomes at baseline and three months follow up. Logistic regression was used to calculate the odds of disease remission and meeting quality metrics by ethnicity. Models were adjusted for age, gender, smoking, comorbidity, deprivation, and disease factors (seropositivity, disease severity [DAS28]). Results A total of 35,807 patients were included in the analyses. The BAME cohort accounted for 14% of patients and had proportionately more females. Smoking and comorbidity levels were lower. BAME patients were younger and more likely to be seropositive for rheumatoid factor or CCP antibodies. Compared to White patients, BAME patients were more likely to be referred within 3 days of suspicion of EIA and start treatment within 6 weeks. However, BAME patients had lower odds of disease remission at 3 months follow up despite multilevel adjustments and reported more symptoms of depression and anxiety. Detailed data on clinical and patient reported outcomes after 3 months of specialist care are presented in the table below. Conclusion Although there is parity between care delivery for BAME and White patients, BAME patients had worse outcomes in this large multinational cohort. Urgent attention needs to be paid to further investigating the reasons for this and redesigning care pathways to address this inequity. Disclosure M. Adas: None. S. Balachandran: None. T. Esterine: None. P. Amlani-Hatcher: None. S. Oyebanjo: None. H. Lempp: Other; HL is the coordinator of the Patient Panel of the NEIAA. J. Ledingham: Other; is a BSR trustee. J. Galloway: Honoraria; has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB. K. Kumar: None. S. Dubey: Other; has been paid financial compensation for educational meeting on impact of ethnicity sponsored by Janssen.

Returning a Shelter Dog: The Role of Owner Expectations and Dog Behavior

Simple SummaryMost dog adopters are typically highly satisfied with dog ownership, although a number of adopted dogs are returned to animal shelters following adoption, which can be stressful for the owner and the dog. In this study, we looked at adopters’ expectations for dog ownership prior to adoption and their experience with dog behavior in the first days, weeks, and months following adoption relative to the risk of return. We found owners who returned their dog to the shelter within three months of adoption had higher expectations for their dog to be healthy, exhibit desirable behavior, and for the human–dog bond compared with adopters who did not return their dogs. There were no differences in expectations for ownership responsibilities and challenges between returning and non-returning owners. We also found two-thirds of owners experienced some behavioral problems following adoption, although behaviors such as training difficulty and fear decreased over time. Our findings may be useful for animal shelters to reduce returns by ensuring adopters have realistic expectations about the human–dog relationship and the occurrence of behavioral problems.Millions of animals are adopted from animal shelters in the United States each year, although some are returned post-adoption, which can decrease both the animals’ chances of future adoptions and the owners’ willingness to adopt again. In this study, we investigated the impact of adopter expectations for ownership and animal behavioral problems on post-adoptive dog returns at a large animal shelter in South Carolina. Between June–September 2021, 132 dog adopters completed a survey about their expectations for ownership through Qualtrics. Twenty-nine adopters returned their dogs to the shelter within three months of adoption, with a median length of ownership of eight days. Owners completed follow-up questionnaires about their perceptions of adoption and dog behavior at two days, two weeks, and four months post-adoption. Categorical principal component analysis revealed three factors pertaining to adopters’ expectations for ownership. Independent t-tests showed returning owners had significantly higher expectations for dog behavior and health (t = −2.32, p = 0.02) and the human–dog bond compared with non-returning owners (t = −2.36, p = 0.02). Expectations for ownership responsibilities did not differ between the groups. Two-thirds of adopters experienced dog behavioral problems post-adoption, although training difficulty decreased significantly between two days and four months (F = 5.22, p = 0.01) and nonsocial fear decreased between two weeks and four months post-adoption (X2 = 10.17, p = 0.01). Shelters may benefit from utilizing adoption counselling to ensure adopters understand the potential for dog behavioral problems in the early stages of ownership and develop appropriate expectations for the human–dog relationship. Post-adoption behavioral support may also help some owners to overcome behavioral difficulties as their dogs adapt to the new environment.