Lower Life Expectancy Research Articles

“It Has Made Me Think”: Engaging the Public with the History of Health in the Modern Irish Prison

Since the establishment of the modern prison system in the early nineteenth century, prisons and prisoners have been construed as sites of moral, social, and biological contagion. Historic and contemporary studies show that most prisoners experience severe health inequalities, higher rates of addiction and mental health issues, and lower life expectancy than the rest of the population. They also come from deprived social strata. Yet, these aspects of Irish penal history have been largely neglected in academia and popular histories. Our article discusses two public history projects—an art installation, The Trial, and a museum exhibition, Living Inside—that engaged different publics with the long history of health and welfare in Irish prisons. Developed by the research team on the Wellcome Trust Investigator Award “Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850-2000,” based at University College Dublin, the projects adopted different methodologies to engage their audiences and explore the experience and management of health and welfare in nineteenth- and twentieth-century Irish prisons. We further examine the different methodological approaches of each project, their varied aims and audiences, and the impacts reported by audiences and participants. The article also considers some of the challenges of doing this kind of public history, both in terms of working with marginalized communities and presenting research about difficult subjects to various audiences.

Public health priority setting on a national scale: The Scottish experience

ObjectivesScotland has the lowest life expectancy in Western Europe and significant health inequalities. A national review of public health in 2015 found that there was a lack of coherent action across organisational boundaries, inhibiting progress. This paper describes a rapid (four-month) systematic approach to prioritisation of Scotland's public health challenges, which was evidence-based, transparent and made use of significant stakeholder engagement. Study designCross-sectional survey of stakeholders in deliberative meetings. MethodsAn independent Expert Advisory Group (EAG) was formed to develop a typology of public health priorities, a long-list of potential priorities and ranking criteria. Deliberative stakeholder events were held at which the criteria were refined and priorities scored by participants from a wide range of stakeholder organisations. ResultsThe proposed typology identified three types of public health priorities: risk factors, social factors and system factors; medically defined disease entities were not used deliberately, to facilitate broad stakeholder participation. Fifteen criteria were identified to help identify priority issues, based on the scope of their burden, amenability to change, and multi-stakeholder preferences. Six public health priorities were selected by the EAG based on stakeholder scoring of a long-list against these criteria. ConclusionPrioritisation is important in modern public health but it is challenging due to limited data availability, lack of agreed evidence on effectiveness and efficiency of interventions, and divergent stakeholder views. The Scottish experience nevertheless shows that useful public health priorities can be agreed upon by a wide range of stakeholders through a transparent, participatory and logical process.

Health Status and Self-Perception of Health in Czech Roma Community

Abstract Background The Roma population is reported to have a lower life expectancy in several European countries. The reasons for this are not well described, which limits the development of effective health promotion programs. This report investigates some possible reasons: self-perception of health risks and discrimination in a sample of Czech Roma. The study is a part of a complex health awareness program. Methods This is a pilot descriptive, cross-sectional survey conducted in Brno, Czech Republic in March 2022. Respondents were identified by community gatekeepers using quotas of gender and education. Data on disease incidence, lifestyle, attitudes to health care and risk perception were collected. Results In the sample of 30 participants, 60% were female, average age 42±5, 60% primary education. 57% daily smokers, with an average 17 cigarettes daily during 18 years. 35% had 1 chronic disease, another 38% had 2 and more. The most prevalent diseases were hypertension (43%) and obesity (41%). 60% of respondents with hypertension as compared to 23% without hypertension considered their stroke risk as medium. 43% smokers as compared to 21% non-smokers consider their risk of COPD as medium (for lung cancer 41% vs. 0%). Roma report not visiting a doctor due to a lack of time (33%), expecting the problem to resolve itself (33%), long waiting time (33%), but not discrimination (0%). Conclusions The Roma with risk factors correctly identify their risk of stroke, COPD, lung cancer as higher. None of them feel discriminated from physicians, but they limit contact with them due to other reasons. It appears that the prevalence of risk factors is higher in the Roma when compared to Caucasians based on the European Health Interview Survey (16% female, 31% male hypertension; 14% female, 29% male obesity). Self-perception of health and feeling of discrimination in Roma communities should be taken into account when designing health interventions. Key messages

People with diabetes have a substantial lower life expectancty

Abstract Background People with diabetes live shorter lives on average than people without diabetes. This is not only because they have diabetes, but also more often other chronic diseases. This causes a greater risk of death. It makes a difference what kind of diabetes someone has. In type 1 diabetes, the natural immune system does not work properly. In type 2, an unhealthy lifestyle plays a role. An unhealthy lifestyle increases the chance that someone will get type 2 diabetes and the chance that that person will die of another disease, such as cardiovascular disease. Methods RIVM has linked general practitioners’ data from 2012-2019 to the vital statistics of the Dutch National Statistical Office. The population of people registered with and without diabetes were coupled with the mortality data. Making use of life tables, associated life expectancies were calculated. For people under the age of 45, no robust analysis could be made. Results People aged 45 with type 1 diabetes live on average 13 years shorter than people without diabetes. For a 45-year-old with type 2 diabetes, that is on average 4 years shorter. The chance of dying is about 5 times greater for people aged 45 to 60 with type 1 diabetes than for people without diabetes of this age. This difference becomes smaller as they get older, because people without diabetes also get one or more diseases more often. In type 2 diabetes, the mortality rate for people aged 45 to 60 years is about 2 times greater than for people without diabetes. Again, the difference decreases as they age. Conclusions A substantial lower life expectancy of 13 years for type 1 and 4 years for type 2 diabetes has different societal and policy consequences. Since type diabetes 1 is unavoidable, more attention should be given to living with this condition, while for type 2 prevention of for example overweight should get attention. Key messages • People with for type 1 and type 2 diabetes have 13 and 4 years lower life expectancy. • More attention should be given to prevention and to living with diabetes.

Application of the patient navigation model with people experiencing homelessness: a scoping review

Abstract Background Barriers in accessing healthcare services are a common issue that contributes to the disproportionately poor health outcomes in people who experience homelessness. A possible way to overcome these barriers and meaningfully engage with this under-served population is through the implementation of the so called patient navigation (PN) models. We conducted a systematic scoping review to gain a better understanding on how PN models are utilized with people experiencing homelessness and other comparable populations and to identify their features, barriers and facilitators to their implementation and their outcomes. Methods A systematic scoping review was done based on a predetermined protocol. We conducted a search of Web of Science, PubMed/Medline and Scopus databases on the 15th of June 2021. A narrative analysis of the included studies was conducted. Results Our search yielded 1203 hits, and after removing 475 duplicates, we were left with 728 publications of interest. Finally, 21 studies have been included in the review, comprising of nine review articles and 12 individual studies, with most studies stemming from the USA. Results show that PN models are consistently associated with improvements in a wide range of health related outcomes, mostly with timely access to healthcare services. Implementation strategies and measurements used in assessing PN models show heterogeneity between studies. However, a number of consistencies were found including; a longitudinal approach, using of non-clinical navigators who share similarities to the participant groups and who engage as facilitators. Additional considerations for gender and age may further improve the outcomes. Conclusions In order to improve on the success of the PN models and their application in removing barriers to healthcare access for people experiencing homelessness, more research is needed that focuses on the feasibility, acceptability and scalability of the approach outside the USA. Key messages • People experiencing homelessness experience considerable barriers in accessing healthcare service leading to disproportionately larger burden of disease as well as lower life expectancy. • Patient navigation models have a great potential in removing barriers and facilitating timely access to healthcare services in people experiencing homelessness.

Is Less Always More? A Prospective Two-Centre Study Addressing Clinical Outcomes in Leadless versus Transvenous Single-Chamber Pacemaker Recipients.

(1) Background: Leadless (LL) stimulation is perceived to lower surgical, vascular, and lead-related complications compared to transvenous (TV) pacemakers, yet controlled studies are lacking and real-life experience is non-conclusive. (2) Aim: To prospectively analyse survival and complication rates in leadless versus transvenous VVIR pacemakers. (3) Methods: Prospective analysis of mortality and complications in 344 consecutive VVIR TV and LL pacemaker recipients between June 2015 and May 2021. Indications for VVIR pacing were “slow” AF, atrio-ventricular block in AF or in sinus rhythm in bedridden cognitively impaired patients. LL indication was based on individualised clinical judgement. (4) Results: 72 patients received LL and 272 TV VVIR pacemakers. LL pacemaker indications included ongoing/expected chronic haemodialysis, superior venous access issues, active lifestyle with low pacing percentage expected, frailty causing high bleeding/infectious risk, previous valvular endocarditis, or device infection requiring extraction. No significant difference in the overall acute and long-term complication rate was observed between LL and TV cohorts, with greater mortality occurring in TV due to selection of older patients. (5) Conclusions: Given the low complication rate and life expectancy in this contemporary VVIR cohort, extending LL indications to all VVIR candidates is unlikely to provide clear-cut benefits. Considering the higher costs of LL technology, careful patient selection is mandatory for LL PMs to become advantageous, i.e., in the presence of vascular access issues, high bleeding/infectious risk, and long life expectancy, rendering lead-related issues and repeated surgery relevant in the long-term perspective.

Comparison of EU Countries in Terms of Population Ageing

The article compared the EU countries in terms of selected demographic indicators related to the issue of population ageing, which is also faced by the countries of the old continent. The aim of the paper was to implement the typology of the 27 EU countries through a cluster analysis considering 9 demographic indicators. From the methodological point of view, factor, cluster and discriminant analysis were used. Demographic data on population ageing were obtained from the Eurostat database. The analyses were carried out for the year 2020. Based on the results of the analyses, the countries were grouped into 5 clusters according to the similarity of demographic characteristics related to population ageing. The most numerous first group included the countries of Western Europe together with the 5 countries of the former socialist bloc. This cluster was characterized by the highest overall fertility rate. The second group included mostly the countries of the Eastern bloc, which are characterized by the highest mortality rate and the lowest life expectancy, the lowest average age of first-time mothers, and a negative migration rate. The third group included 5 large countries in terms of the number of inhabitants; these countries are the oldest EU countries. From the perspective of the indicators of ageing, the fourth cluster appeared to be the youngest, characterized by the highest birth rate. The last cluster consisted of two EU countries, which were characterized by the highest life expectancy as well as the highest gross migration rate.

The state of health in Indonesia's provinces, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

SummaryBackgroundAnalysing trends and levels of the burden of disease at the national level can mask inequalities in health-related progress in lower administrative units such as provinces and districts. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to analyse health patterns in Indonesia at the provincial level between 1990 and 2019. Long-term analyses of disease burden provide insights on Indonesia's advance to universal health coverage and its ability to meet the United Nations Sustainable Development Goals by 2030.MethodsWe analysed GBD 2019 estimated cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 286 causes of death, 369 causes of non-fatal health loss, and 87 risk factors by year, age, and sex for Indonesia and its 34 provinces from 1990 to 2019. To generate estimates for Indonesia at the national level, we used 138 location-years of data to estimate Indonesia-specific demographic indicators, 317 location-years of data for Indonesia-specific causes of death, 689 location-years of data for Indonesia-specific non-fatal outcomes, 250 location-years of data for Indonesia-specific risk factors, and 1641 location-years of data for Indonesia-specific covariates. For subnational estimates, we used the following source counts: 138 location-years of data to estimate Indonesia-specific demographic indicators; 5848 location-years of data for Indonesia-specific causes of death; 1534 location-years of data for Indonesia-specific non-fatal outcomes; 650 location-years of data for Indonesia-specific risk factors; and 16 016 location-years of data for Indonesia-specific covariates. We generated our GBD 2019 estimates for Indonesia by including 1 915 207 total source metadata rows, and we used 821 total citations.FindingsLife expectancy for males across Indonesia increased from 62·5 years (95% uncertainty interval 61·3–63·7) to 69·4 years (67·2–71·6) between 1990 and 2019, a positive change of 6·9 years. For females during the same period, life expectancy increased from 65·7 years (64·5–66·8) to 73·5 years (71·6–75·6), an increase of 7·8 years. There were large disparities in health outcomes among provinces. In 2019, Bali had the highest life expectancy at birth for males (74·4 years, 70·90–77·9) and North Kalimantan had the highest life expectancy at birth for females (77·7 years, 74·7–81·2), whereas Papua had the lowest life expectancy at birth for males (64·5 years, 60·9–68·2) and North Maluku had the lowest life expectancy at birth for females (64·0 years, 60·7–67·3). The difference in life expectancy for males between the highest-ranked and lowest-ranked provinces was 9·9 years and the difference in life expectacy for females between the highest-ranked and lowest-ranked provinces was 13·7 years. Age-standardised death, YLL, and YLD rates also varied widely among the provinces in 2019. High systolic blood pressure, tobacco, dietary risks, high fasting plasma glucose, and high BMI were the five leading risks contributing to health loss measured as DALYs in 2019.InterpretationOur findings highlight that Indonesia faces a double burden of communicable and non-communicable diseases that varies across provinces. From 1990 to 2019, Indonesia witnessed a decline in the infectious disease burden, although communicable diseases such as tuberculosis, diarrhoeal diseases, and lower respiratory infections have remained a main source of DALYs in Indonesia. During that same period, however, all-ages death and disability rates from non-communicable diseases and exposure to their risk factors accounted for larger shares of health loss. The differences in health outcomes between the highest-performing and lowest-performing provinces have also widened since 1990. Our findings support a comprehensive process to revisit current health policies, examine the root causes of variation in the burden of disease among provinces, and strengthen programmes and policies aimed at reducing disparities across the country.FundingThe Bill & Melinda Gates Foundation and the Government of Indonesia.TranslationFor the Bahasa Indonesia translation of the abstract see Supplementary Materials section.

Is less always more? A prospective two-centre study addressing clinical outcomes in leadless versus transvenous single-chamber pacemaker recipients

Abstract Background Transvenous (TV) pacemakers are a well established treatment of bradyarrhythmias yet their complications, namely bleeding, infection and pneumothorax, still pose challenges to modern cardiology. This applies particularly to the older patient subgroup requiring single-chamber pacing due to comorbid atrial fibrillation (AF). Furthermore, conditions such as superior venous access issues, high infectious, or bleeding risk may complicate or preclude transvenous lead implantation. While VVIR leadless (LL) pacemakers aim to tackle these shortcomings, a comparison with contemporary single-chamber TV cohorts is currently lacking thus hindering a clear definition of the scope of LL pacing in clinical practice. Purpose To prospectively analyse survival and complication rates in leadless versus transvenous single-chamber pacemaker recipients. Methods This is a prospective analysis of 344 consecutive patients who received single-chamber TV or LL pacemakers between June 2015 and May 2021 in two tertiary cardiology centres. Indications for single-chamber pacing were “slow” AF, atrio-ventricular block with comorbid AF (either permanent or accepted as “destination rhythm”) or with sinus rhythm in bedridden cognitively impaired patients. LL indications were ongoing or expected chronic haemodialysis (6.9%), superior venous access issues such as occlusion (11.1%) or need for its preservation (9.7%), active lifestyle with low amount of pacing expected (22.2%), frailty causing high bleeding and infectious risk (23.6%), as well as recent valvular endocarditis (2.8%) or implantable electronic device infection requiring extraction (5.6%). Results 72 patients (20.9%) received LL and 272 (79.1%) TV single-chamber pacemakers. In keeping with LL indications, diabetes and ongoing haemodialysis were more prevalent in the LL population. No significant difference in overall complication rate was observed between LL and TV patients (5.6% vs. 5.1%, p=0.33) apart from haematomas, which occurred more frequently in the LL population. Only 1 haematoma in the TV group required surgical reintervention. TV recipients survival was lower with greater cardiovascular mortality, likely due to selection of significantly older patients. Conclusions Given the limited complication rate observed in this contemporary single-chamber TV cohort and low life expectancy of this particular population, extending LL indications to all VVIR candidates is unlikely to provide a clearcut survival advantage. Considering the higher costs of LL technology, these data prompt a careful selection of those cases where LL approach does indeed provide an advantage. In addition to the setting of vascular access issues and high bleeding or infectious risk, these may include patients with sufficient life expectancy where lead-related risks may indeed adversely affect prognosis. Based on our patient selection criteria, LL might account for approximately 20% of VVIR pacing recipients. Funding Acknowledgement Type of funding sources: None.

Influences of area-level sociodemographic factors on heat-related mortality in Europe: insights to guide adaptation strategies

BackgroundEurope is the world region most affected by heat-attributable mortality, but impact patterns are heterogenous. We aimed to assess the contributions to this heterogeneity of four area-level predictors (education, life expectancy, the ratio of older to younger people [ageing index], and relative income) to identify general adaptation strategies. MethodsWe extracted four outcomes from a heat-mortality study covering 147 areas in 16 European countries: the rate of increase in risk at (1) moderate and (2) extreme temperatures, (3) the minimum mortality percentile, and (4) the underlying mortality rate. We used structural equation modelling to quantify the direct and indirect associations between the predictors and outcomes, accounting for country-level random effects. FindingsHigher levels of education (compared with lower levels) were directly associated with lower heat-related mortality burdens via reduced risk at moderate and extreme temperatures, and lower underlying mortality rates. However, it had ambiguous indirect associations with heat-related mortality burden through positive associations with life expectancy, ageing index, and relative income. Higher life expectancy (compared with lower life expectancy) had contradictory relations with the mortality burden, being associated with higher risk at moderate temperatures but lower underlying mortality rates. A higher ageing index (compared with a lower index) was associated with higher burdens through higher risk at extreme temperatures and higher underlying mortality rates. Relative income made a small and ambiguous contribution. The relative magnitudes of the county-level random effects suggested innate human physiology had a major role in risk at extreme temperatures but that addressing modifiable sociomaterial conditions might reduce the burden via influence on risk at moderate temperatures and the underlying mortality burden. InterpretationOur findings support three general adaptation strategies, showing the need for both general social transformation and focused climate-specific interventions: (1) general social strategies to improve health and reduce underlying mortality, (2) targeted social interventions to address factors instilling patterns of vulnerability at moderate temperatures, and (3) specific actions during extreme temperatures. FundingThe EU's Horizon 2020 research and innovation programme (grant agreement 865564 European Research Council Consolidator Grant EARLY-ADAPT).

Medicine Security in Sub-Saharan Africa: Improving Access to Drugs Via Utilization of Novel Technologies

Background: Providing all citizens with fair and equitable access to healthcare remains one of the most challenging issues facing most African countries today. The health indices of the Sub-Saharan Africa show how much it is lacking in managing and properly funding its health sector. The rates of maternal and newborn mortality continue to be the highest and the lowest life expectancy on a global scale. Millions of Africans continue to perish from diseases that are treatable and avoidable, including such as viral diarrhea and malaria. In the last few decades, novel drug delivery technologies have emerged and evolved into various drug delivery systems with various drug release mechanisms. This has altered the way individuals now access medications. Presently, several creative approaches, based on partnerships, intellectual property, and technology are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. The purpose of this study is to review the Medicine Security in Sub-Saharan Africa and proffer recommendations on how access to drugs can be improved via utilization of novel technologies. Method: A review of the Medicine Security in Sub-Saharan Africa was focused on underlining novel technologies that will improve access to drug. Result: Recommendations were suggested to improve drug access via novel technologies in SubSaharanAfrica. Conclusion: Making sure that patients have timely and affordable access to safe and effective medicines, stimulating innovation by providing incentives for research that will lead to innovative medicines that effectively target real therapeutic needs, and safeguarding sustainability by developing the mechanisms to purchase these medicines at affordable prices in order to protect the sustainability of pharmaceutical budgets are essential to improving access to drugs within SubSaharan Africa.

Assessing The Dangers Of A Hospital Stay For Patients With Developmental Disability In England, 2017-19.

People with developmental disability have higher health care needs and lower life expectancy compared with the general population. Poor quality of care resulting from interpersonal and systemic discrimination may further entrench existing inequalities. We examined the prevalence of five avoidable in-hospital patient safety incidents (adverse drug reactions, hospital-acquired infections, pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis, and postoperative sepsis) for four developmental disability groups (people with intellectual disability, chromosomal abnormalities, pervasive developmental disorders, and congenital malformation syndrome) in the English National Health Service during the period April 2017-March 2019. We found that the likelihood of experiencing harm in disability groups was up to 2.7-fold higher than in patients without developmental disability. Patient safety incidents led to an excess length-of-stay in hospital of 3.6-15.4 days and an increased mortality risk of 1.4-15.0percent. We show persisting quality differences in patients with developmental disability, requiring an explicit national policy focus on the needs of such patients to reduce inequalities, reach parity of care, and lower the burden on health system resources.

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. US Centers for Disease Control and Prevention and Diabetes Australia.

Analysis of Dominant Factors that Effect Delayed Diagnosis in Women with Breast Cancer in Baladhika Husada Hospital Jember

Background: Delayed diagnosis will have an impact on poor prognosis and complicate the treatment of breast cancer, contributing to low life expectancy for breast cancer patients. The study aims to find the factors that play the most role in influencing the behavior of women with breast cancer as well as dig deeper into the things behind the patient in making decisions that have an impact on delayed diagnosis. Methods: The study uses an analytical observational design with quantitative and qualitative mixed methods. Collecting data was conducted from April until June 2021 on 76 women with breast cancer at Baladhika Husada Hospital Jember based on classification into case and control groups. The sampling method used purposive sampling and the Lemeshow formula. Results: The results showed the factor that dominates the occurrence of delayed diagnosis is alternative medicine (p = 0.013; OR 11.03). Based on the results of the study, patients who undergo alternative medicine are 11 times more at risk of delayed diagnosis of breast cancer compared to patients who do not undergo alternative treatment.Conclusions: The patient’s background in choosing alternative medicine is supported by various reasons including concerns about medical treatment methods, concerns about nominal medical costs, and negative information from the surrounding. Thus, it can be concluded that the dominant factor affecting the delay in the diagnosis of women with breast cancer is alternative medicine.

The effect of devolution on health: a generalised synthetic control analysis of Greater Manchester, England

The devolution of public services from central to local government can increase sensitivity to local population needs but might also reduce the expertise and resources available. Little evidence is available on the impact of devolution on population health. We evaluated the effect of devolution affecting health services and wider determinants of health on life expectancy in Greater Manchester, England. We estimated changes in life expectancy in Greater Manchester relative to a control group from the rest of England (excluding London), using a generalised synthetic control method. Using local district-level data collected between Jan 1, 2006 and Dec 31, 2019, we estimated the effect of devolution on the whole population and stratified by sex, district, income deprivation, and baseline life expectancy. After devolution, from November, 2014, life expectancy in Greater Manchester was 0·196 years (95% CI 0·182-0·210) higher than expected when compared with the synthetic control group with similar pre-devolution trends. Life expectancy was protected from the decline observed in comparable areas in the 2 years after devolution and increased in the longer term. Increases in life expectancy were observed in eight of ten local authorities, were larger among men than women (0·338 years [0·315-0·362] for men; 0·057 years [0·040-0·074] for women), and were larger in areas with high income deprivation (0·390 years [0·369-0·412]) and lower life expectancy before devolution (0·291 years [0·271-0·311]). Greater Manchester had better life expectancy than expected after devolution. The benefits of devolution were apparent in the areas with the highest income deprivation and lowest life expectancy, suggesting a narrowing of inequalities. Improvements were likely to be due to a coordinated devolution across sectors, affecting wider determinants of health and the organisation of care services. The Health Foundation and the National Institute for Health and Care Research.

Inverse Lansing Effect: Maternal Age and Provisioning Affecting Daughters' Longevity and Male Offspring Production.

AbstractMaternal age effects on offspring life history are known in a variety of organisms, with offspring of older mothers typically having lower life expectancy (the Lansing effect). However, there is no consensus on the generality and mechanisms of this pattern. We tested predictions of the Lansing effect in several Daphnia magna clones and observed clone-specific magnitude and direction of the maternal age effect on offspring longevity. We also report ambidirectional, genotype-specific effects of maternal age on the propensity of daughters to produce male offspring. Focusing on two clones with contrasting life histories, we demonstrate that maternal age effects can be explained by lipid provisioning of embryos by mothers of different ages. Individuals from a single-generation maternal age reversal treatment showed intermediate life span and intermediate lipid content at birth. In the clone characterized by the "inverse Lansing effect," neonates produced by older mothers showed higher mitochondrial membrane potential in neural tissues than their counterparts born to younger mothers. We conclude that an inverse Lansing effect is possible and hypothesize that it may be caused by age-specific maternal lipid provisioning creating a calorically restricted environment during embryonic development, which in turn reduces fecundity and increases life span in offspring.

Ecological variations in adult life table attributes of Aedes aegypti (L.) from the desert and coastal regions of India.

The ecological variation in biological and adult life-table attributes of two populations of Aedes aegypti (Diptera: Culicidae) from the desert (Jodhpur) and coastal (Kolkata) regions of India are assessed to understand the reproductive and survival strategies. The results showed that females lived longer than males in both strains. The desert strain was more r-strategist because of its higher intrinsic rate of increase (rm =0.23), finite rate of increase (λ=1.25), lower life expectancy of males (7.9 days) and females (14.4 days), mean generation time (T=19.2 days) and doubling time (DT=3.0 days). However, there was no difference in net reproductive rate (R0 ) between the desert and coastal strains. The coastal strain showed a longer female life expectancy (22.0 days) than the desert strain (14.4 days). However, the fecundity (eggs/female/day) was lower in the coastal strain (11.4) than in the desert strain (15.1). Conclusively, the desert (Jodhpur) strain is adapted to a better r-strategy than the coastal (Kolkata) strain of Ae. aegypti, which might be helpful to flourish in harsh environmental conditions. This study may provide accurate predictions of Ae. aegypti population dynamics for vector management.

Air Pollution: Sources and its Effects on Humans and Plants

Pollution of air is among the serious issue that the world is confronting today in developed and developing countries. An escalating numberof automobiles and industries incessantly add toxic gases like SO2, NOx, and particulate matter into the atmosphere. Simultaneously,secondary pollutant tropospheric O3 formed by the reactions of primary pollutant is equally hazardous. Suspension of these contaminantsin air leads to damaging effects on human health and plant productivity and results in the degradation of ecosystems and biodiversity.Human health issues associated with pollutants in air include cardiovascular and respiratory diseases, nervous and reproductive systemdisorders, lowered life expectancy, and mutations. Moreover, air pollutants negatively affect different morphological and physiologicalcharacteristics of the plants. Air pollutants generate reactive oxygen species that negatively affect various physiological pathways inthe plants inducing their anti-oxidative defense system to counteract oxidative stress. Air pollutants are also accountable for injury tovegetation and losses in crop productivity which is an increased cause of concern. Hence considering the air pollution menace, effectiveregulations, policies, and strategies should be developed for good human health, agricultural production, and food security.

Telomere Length Associations With Clinical Diagnosis, Age, and Polygenic Risk Scores for Anxiety Disorder, Depression, and Bipolar Disorder

BackgroundAccelerated biological aging might contribute to the lower life expectancy of individuals with mental disorders. The aim of this study was to characterize telomere length, a biological hallmark of aging, in individuals with mental disorders. MethodsThe UK Biobank is a multicenter community-based observational study that recruited >500,000 middle-aged and older adults. Average leukocyte telomere length (telomere repeat copy number/single-copy gene ratio) was measured using quantitative polymerase chain reaction. Polygenic risk scores (PRSs) were calculated for individuals of European ancestry. We estimated differences in telomere length between individuals with anxiety disorder, depression, or bipolar disorder and people without mental disorders and examined associations with psychotropic medication use, age, and PRSs for these 3 disorders. ResultsThe analyses included up to 308,725 participants. Individuals with depression had shorter telomeres than people without mental disorders (β = −0.011, 95% CI, −0.019 to −0.004, Bonferroni-corrected p = .027). Associations between bipolar disorder and telomere length differed by lithium use. There was limited evidence that individuals with an anxiety disorder had shorter telomeres. There was no evidence that associations between age and telomere length differed between individuals with and without these disorders. PRSs for depression, but not anxiety disorder or bipolar disorder, were associated with shorter telomeres (β = −0.006, 95% CI, −0.010 to −0.003, Bonferroni-corrected p = .001). ConclusionsDifferences in telomere length were observed primarily for individuals with depression or bipolar disorder and in individuals with a higher PRS for depression. There was no evidence that the association between age and telomere length differed between individuals with and without an anxiety disorder, depression, or bipolar disorder.

DETERMINAN KEJADIAN STROKE PADA LANSIA (SCOOPING REVIEW)

The factors that cause stroke in the elderly, until now are still research that must be treated quickly, to minimize the mortality rate due to stroke events. The purpose of this study is to examine more deeply the factors triggering stroke in the elderly. This study uses the scoping review method. The inclusion criteria in the scoping review are articles published in databases of journals indexed in PubMed, Google Scholar, Science Direct, and ProQuest in English, with a cross-sectional design, case-control, Retrospective, and cohort. This journal was published in the period 2010 – 2021 so 12 articles that met the inclusion criteria were obtained. Results: The search results were 1,320 articles from 4 databases (PubMed, Google Scholar, Science Direct, and ProQuest) where 465 duplicate articles were deleted. Of the remaining 855 articles, 843 were excluded after screening for eligibility because they were irrelevant. The remaining 12 articles will be qualitatively analyzed using the NVIVO-12 plus application. Analysis shows that age, gender, smoking, and obesity are triggering factors for stroke in the elderly. The increase in risk factors for stroke in the elderly is due to increasing age prone to diseases (smoking and obesity) that are not controlled so that they will experience stroke events. On the other hand, non-compliance with preventive measures so that they have a low life expectancy due to the incidence of stroke. Smoking and obesity are high-risk for stroke because the blood vessels will narrow and cause blockages. So that more attention is paid to prevention and treatment to minimize the incidence of stroke as well as to improve the quality of life.