Number Of Healthy Years Research Articles

Quality with underlying epistemological criteria

Introduction: the fact that a term is freely used and decoded according to the nature in which it is intended to be applied or towards the semiotic sense that the reader assigns to it implies a review of the various ways in which it is interpreted and to the origin of the concept of quality, and it is often observed that the concept of quality is given a partial and not integral content. The objective of the work is directed to the theoretical description of quality in health, detailing concepts, characteristics and application. Methods: qualitative, narrative and exploratory study based on literature review. Development: quality of care is the set of technical-scientific, material and human characteristics that the health care provided to beneficiaries must have, in order to achieve the possible effects that will result in the greatest number of healthy years of life and a cost that is socially and economically viable for the system and its members. Its characteristics are timeliness, agility, accessibility, continuity, sufficiency, safety, comprehensiveness and integrity, logical-scientific rationality, cost-effectiveness, efficiency, humanity, information, transparency, consent and degree of user satisfaction; in a technical and applied sense, several models have been used in quality evaluation, among which the pioneer Donabedian stands out, who developed a model based on three areas: structure, process and results; Galán developed another model focused on the evaluation of the attributes of quality: care, demand, supply, process, results and impact. Conclusions: quality in Health is made up of a set of values, principles, policies and action strategies aimed at promoting change and improvement activities in the organization, in order to obtain the greatest satisfaction of the staff and the patient; and it must be defined, planned, programmed, its real cost determined, evaluated and, fundamentally, led by the management teams.

Calculation of Disability-adjusted Life Years (DALY) in Patients with Indolent Systemic Mastocytosis (ISM)

The DALY is a metric used to quantify the burden of diseases that cause significant patient disability; DALY value of ‘0=perfect health’ and ‘1=death’. DALYs are useful in assessing the number of healthy years lost due to a disabling condition and inform the impact of treatment interventions across patient populations and the allocation of healthcare resources. DALYs have not been calculated for ISM, a mast cell disease which causes debilitating symptoms and impaired quality of life.

The gaps in health-adjusted life Expectancy (HALE) by income and region in Korea

Abstract This study aims to calculate the health-adjusted life expectancy (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in sex, income level and region. The study was carried out on total population receiving national health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. The primary outcome was HALE in the Korean population. The second outcome was the HALE’s gap in terms of sex, income, and region. Our results revealed that HALE increased from 2008 (68.89 years) to 2019 (70.58 years). HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2019, the gap in HALE between Q1 and Q2, the lower income group, was about 5.70 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to increase HALE at the national level. Key messages • Males’ health level may be more sensitive to the socioeconomic level than females’ health level. • In the 5th National Health Plan (HP2030), it was decided to set a target value for the overall goals based on this result.

In This Issue

HomeCirculation ResearchVol. 130, No. 2In This Issue Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIn This Issue Ruth Williams Ruth WilliamsRuth Williams Search for more papers by this author Originally published20 Jan 2022https://doi.org/10.1161/RES.0000000000000527Circulation Research. 2022;130:163is related toWnt5a Promotes Lysosomal Cholesterol Egress and Protects Against AtherosclerosisDevelopment and Validation of a Long-Term Incident Heart Failure Risk ModelCommon Genetic Variants Contribute to Risk of Transposition of the Great ArteriesCommon Genetic Variants Contribute to Risk of Transposition of the Great Arteries (p 166)Škorić-Milosavljević et al identify a risk locus for dextro-transposition of the great arteries.Dextro-transposition of the great arteries (D-TGA) is a severe congenital heart defect in which the plumbing of the two major outflows—the aorta and pulmonary artery—are switched and thus the majority of the body is deprived of oxygen. While specific genetic mutations have been identified in certain cases of D-TGA, in most cases the underlying cause is unclear. Škorić-Milosavljević and colleagues have therefore undertaken a genome-wide association study (GWAS) to search for loci conferring D-TGA risk. In a study of more than 5 million single nucleotide polymorphisms in the genomes of 1,237 D-TGA patients and 3,711 controls, the team identified an associated locus at chromosome position 3p14.3 containing an apparent regulatory element. Since the element was conserved in the mouse genome, the team performed functional studies showing that it bound transcription factor TBX20 and suppressed expression of nearby gene, Wnt5a, which encodes a heart development factor. Notably, both TBX20 and WNT5A have been previously implicated in development of the heart’s outflow tract. Together, the findings not only provide insight into the pathology of D-TGA, but also offer a basis for possible genetic counseling of D-TGA affected families.Download figureDownload PowerPointWnt5a Promotes Lysosomal Cholesterol Egress and Protects Against Atherosclerosis (p 184)Awan et al examine Wnt5a’s lesser-known role in cholesterol homeostasis.It is well established that signaling via the Wnt family of proteins drives all manner of developmental processes including cell fate determination, proliferation and migration. Recently however, Wnt signaling has also been implicated in lipid homeostasis. Mutations that impair Wnt signaling have been shown to cause hyperlipidemia in mice and humans with Wnt signaling activity being inversely correlated with atherosclerosis severity. Because the protein Wnt5a in particular has been shown to inhibit cellular cholesterol accumulation, Awan and colleagues investigated the role of this Wnt protein in mice and human cells. Mice whose vascular smooth muscle cells (VSMCs) lacked Wnt5a developed more severe atherosclerosis compared with control animals, the team showed, while human VSMCs lacking Wnt5a accumulated far greater amounts of cholesterol in the lysosomes than did cells with normal levels of Wnt5a. The team’s further cellular analyses showed that Wnt5a normally associates with lysosomes where it promotes the catabolism of lysosomal cholesterol (via activation of lysosomal lipase) and promotes cholesterol egress via the endoplasmic reticulum. In revealing how cholesterol is trafficked by Wnt5a, the findings may help to inform future cholesterol regulating treatments.Download figureDownload PowerPointDevelopment and Validation of a Long-Term Incident Heart Failure Risk Model (p 200)Khan et al develop an equation for calculating an individual’s long-term risk of heart failure.In the US, heart failure (HF) contributes to approximately 1.2 million hospitalizations and 300,000 deaths annually with an estimated healthcare cost of over $10 billion. With both the incidence rates and costs expected to rise, a method for predicting individuals’ HF risk would enable preventative interventions, such as diet and blood pressure treatments, to be initiated early thus prolonging the number of healthy years. To develop such a prediction tool, Khan and colleagues studied decades of health data on 24,838 individuals collected as part of five separate long-running National Heart Lung and Blood Institute (NHLBI) studies. The individuals included in the model development were, at baseline, aged between 20 and 59 with no cardiovascular disease diagnosis. Analysis of their body mass indices, blood pressures, total cholesterol levels, high-density lipoprotein levels, smoking statuses, diabetes diagnoses and other cardiovascular health data over several decades enabled the team to develop an equation for predicting an individual’s likelihood of developing HF in the next 30 years. The hope is, such personalized risk estimates will help guide patient-doctor discussions regarding cardiovascular health, lifestyle choices and medical interventions, say the team.Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesWnt5a Promotes Lysosomal Cholesterol Egress and Protects Against AtherosclerosisSara Awan, et al. Circulation Research. 2022;130:184-199Development and Validation of a Long-Term Incident Heart Failure Risk ModelSadiya S. Khan, et al. Circulation Research. 2022;130:200-209Common Genetic Variants Contribute to Risk of Transposition of the Great ArteriesDoris Škorić-Milosavljević, et al. Circulation Research. 2022;130:166-180 January 21, 2022Vol 130, Issue 2 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/RES.0000000000000527 Originally publishedJanuary 20, 2022 PDF download Advertisement

User Centered Virtual Coaching for Older Adults at Home Using SMART Goal Plans and I-Change Model.

Preventive care and telemedicine are expected to play an important role in reducing the impact of an increasingly aging global population while increasing the number of healthy years. Virtual coaching is a promising research area to support this process. This paper presents a user-centered virtual coach for older adults at home to promote active and healthy aging and independent living. It supports behavior change processes for improving on cognitive, physical, social interaction and nutrition areas using specific, measurable, achievable, relevant, and time-limited (SMART) goal plans, following the I-Change behavioral change model. Older adults select and personalize which goal plans to join from a catalog designed by domain experts. Intervention delivery adapts to user preferences and minimizes intrusiveness in the user’s daily living using a combination of a deterministic algorithm and incremental machine learning model. The home becomes an augmented reality environment, using a combination of projectors, cameras, microphones and support sensors, where common objects are used for projection and sensed. Older adults interact with this virtual coach in their home in a natural way using speech and body gestures on projected user interfaces with common objects at home. This paper presents the concept from the older adult and the caregiver perspectives. Then, it focuses on the older adult view, describing the tools and processes available to foster a positive behavior change process, including a discussion about the limitations of the current implementation.

The Gaps in Health-Adjusted Life Years (HALE) by Income and Region in Korea: A National Representative Bigdata Analysis.

This study aims to calculate the health-adjusted life years (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in income level and region. The study was carried out on total population receiving health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. Our results revealed that HALE increased from 2008 to 2018. HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2018, the gap in HALE between Q1 and Q2, the lower income group, was about 5.57 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to promote HALE at the national level.

Applying natural language processing to electronic medical records for estimating healthy life expectancy

Health-adjusted life expectancy (HALE), measures the overall health of a population by adjusting life expectancy for years lived with disability. HALE allows for monitoring changes of population health over time, by providing a measure of the number of healthy years expected for different age groups. HALE calculations require data on morbidity, but even though high quality data sources are crucial for estimations of population health, such sources are not available for all countries, specifically in lower income regions [1].

Disability-free life expectancy estimates for Brazil and Major Regions, 1998 and 2013.

Life expectancy at age 60 in Brazil has increased by around nine years in a little over 50 years. This general gain in life expectancy at national level has been heterogeneous across the country's major regions. Furthermore, little is known about how increases in life expectancy at age 60 across regions influence the number of years lived with some form of associated disability or the number of years lived free from disability. This study aimed to analyze increases in total life expectancy and its components [disability-free life expectancy (DFLE) and disability life expectancy (DLE)] at ages 60, 70, and 80 in Brazil and Major Regions in 1998 and 2013. The study used data on disability obtained from the 1998 National Household Sample Survey (PNAD - acronym in Portuguese) and 2013 National Health Survey (PNS- acronym in Portuguese) and used the Sullivan method to estimate DFLE by sex and age. The findings show that there was an increase in life expectancy and a concomitant increase in DFLE between 1998 and 2013. However, the gains in DFLE were not statistically significant in the North and Center-west regions. This means that, with the exception of the latter regions, in addition to living longer, the Brazils population aged 60 years can expect to live a greater number of healthy years.

Attitude Examination Related to Breast Cancer Among Women in Bács-Kiskun County, Hungary

Abstract Breast cancer is the most commonly diagnosed type of cancer and a leading cause of mortality among women both in developed and developing countries all over the world. Our research questions were the following: 1. What is the ratio of women participating in mammography screening? 2. What factors influence the attendance of the screening? A quantitative, cross-sectional, and descriptive study (2013) examined women aged 35-65 without a history of breast cancer from Kecskemét City and its region. Non-random, convenience sampling method was applied in the study. The self-edited and self-administered questionnaire included the following groups of questions: socio-demographic data, attitude examination related to screening, reasons for absence. Besides SPSS Statistics, 20.00 test, x2 test, t-test, and ANOVA were used (p<0.05). During the Principal Component Analysis, 23 variables of the motivational scale were grouped into six theoretical subgroups, and the Cronbach-alpha value was 0.758. The mean age of the participants was 49.96±8.91 years.71% of the interviewees never attended breast cancer screening. Regarding the sample, the mean age of women participating in the screening for the first time was 39.66±12.21 years. Women with college/university degree attained high scores on the knowledge test (p<0.05). A significant part of women went to the screening because they feel responsibility for their health status or due to the family history of breast cancer. Fear, shame, or inconveniencies during examination did not affect participation in screening. Prevention programs play a significant role in the improvement of the health status of the Hungarian population. Mortality and morbidity indicators can be reduced by regularly organized, preventive activities based on appropriate knowledge. Thus, the number of healthy years can be increased.

Living longer with disability in China and G20 nations: a quantitative model for the Sustainable Development Goal for health post-2015: a reproducible study

BackgroundEvidence from the Global Burden of Disease Study 2010 is consistent with the expectation that, in China, where the number of healthy years lost to disability at birth in 2010 was 7·95 years compared with the median of 10·51 (median absolute deviation=1·15) of G20 nations, post-2015 a society living longer will lose an increasing number of years to non-fatal disease and injury. We generated the conditional hypothesis that this expansion of morbidity also has economic effects: in 2012, with a per-person total health expenditure of 480 purchasing power parity in international dollars, China was the third lowest spender among the G20 nations (median 2222, median absolute deviation 1723). We reviewed published work on convergence of health status and analysed data from the Global Health Data Exchange (GHDx) of the Institute for Health Metrics and Evaluation, the University of Washington, Seattle, WA, USA, and from the WHO Health Expenditure Statistics Database. MethodsReproducibility can improve evidence-based research, engage stakeholders, and promote transparency among health policy makers. For these reasons, this study uses open-access R software and public repositories of the GHDx (454 410 records) and the WHO Health Expenditure Statistics Database (164 220 records); our statistical inference can be downloaded from GitHub, and reproduced and improved by fellow researchers. We tested the multiple linear model that, within the reference population of G20 nations, per-person total health expenditure is related to health-adjusted life expectancy (HALE) and the number of years lived with disability (YLD). FindingsIn our reference population, the log transformation of per-person total health expenditure is positively related to HALE and YLD (R2 0·61; F-statistic 33; p<0·001; variance inflation factor 1·35), with YLD showing the strongest incremental effect: per-person total health expenditure increases exponentially by 1·47 times (95% CI 1·21–1·79) per additional year of disability versus 1·11 times (95% CI 1·05–1·17) per additional year of health-adjusted life expectancy. InterpretationWe generated the conditional hypothesis that post-2015 in China, if YLD and HALE converge towards the median of G20 nations, per-person total health expenditure will grow from 480 to 2195 purchasing power parity in international dollars (95% CI 1827–2636). Our results lent support to the conclusion that YLD and HALE are relevant quantities for an evidence-based assessment of the sustainability of the health development agenda in China and G20 nations post-2015. FundingUniversity of Bergamo, Bergamo, Italy.

Gerontechnology and age diversity

Purpose In studies of older adults, research design still often describes ages 55+ as the target group. This is controversial for several reasons. Life expectancy in western countries, as well as the number of healthy years, has increased significantly. Statistics show that commonly the age when some kind of support is required is 75+. Research also shows that attitudes, preferences, and the use of technology are different in different age groups. More focus should therefore be put on research designs in which the target group reports a need for support in their daily life. Method The data for this paper were gathered from Finnish project User Centered Technology for Elderly People and Care Givers (KAKATE). Two surveys (n = 1265) have been done by interviews with a structured questionnaire of people in the age range 55 to 89 years. Results & Discussion The goal of the KAKATE Project is to determine how technology can be used to support older people in their homes and to assist caregivers in their work. The need for better usability and for devices and applications that are easier to use has been recognized for many years, and many worthwhile improvements have been introduced. However, wider and more successful adoption of technology into supportive use in daily life has been fairly slow. This paper proposes that one crucial reason for this is that the age diversity within older people is not fully understood. The age diversity of older people must be taken into consideration and manifested in future research design, if there is to be full participation by the elderly in technology developments, and if these technology developments are to contribute to the independence of all age groups of older people.

Work Longer, Live Healthier: The Relationship Between Economic Activity, Health and Government Policy

· In the past 50 years, labour market participation among older people has declined significantly, though the trend has reversed a little in recent years. In the EU, about 70 per cent of people aged between 60 and 64 are inactive.· In the case of the UK there has been a significant drop in the employment rate among older men. The employment rate among men aged 55-59 decreased from over 90 per cent to less than 70 per cent between 1968 and the end of the 1990s. Employment for men aged 60-64 slumped from around 80 per cent to 50 per cent and, for those aged 65-69, it halved from 30 per cent to about 15 per cent.· As with the rest of the OECD, this trend has reversed in recent years. The employment rate in 2008 was about 80 per cent for the 55-59 group, 60 per cent for the 60-64 group, and 20 per cent for the 65-69 age group.· Whilst people have been retiring earlier on average, they have also been living longer. A 61-year-old man in 1960 had the same probability of dying within a year as a 70-year-old man in 2005.· Healthy life expectancy at age 65 has also increased in the UK, although at a somewhat slower pace than regular life expectancy. This would suggest that people have the capability to work longer, though perhaps not to increase their working life on a one-for-one basis as life expectancy increases. Life expectancy at age 65 increased by 4.2 years for men between 1981 and 2006. During the same period, healthy life expectancy at age 65 increased by 2.9 years for men.· Increases in the number of healthy years of life that we can enjoy have not been reflected in longer working lives – indeed, the reverse is the case: people were working longer half a century ago.· If rising pension ages and labour force participation at older ages caused greater ill health then it would be a matter for concern. Most research on the relationship between health and working in old age has produced ambiguous results. Research in this area is inherently difficult because of the fact that, just as retirement can influence health, health can influence retirement decisions.· To date, research has not generally examined the relationship between the number of years spent in retirement and health. This issue is important. It is possible that health will initially improve when somebody retires and then, after a while, start to deteriorate due to reduced physical activity and social interaction.· New research presented in this paper indicates that being retired decreases physical, mental and self-assessed health. The adverse effects increase as the number of years spent in retirement increases.· The results vary somewhat depending on the model and research strategy employed. By way of example, the following results were obtained: Retirement decreases the likelihood of being in ‘very good’ or ‘excellent’ self-assessed health by about 40 per cent Retirement increases the probability of suffering from clinical depression by about 40 per cent Retirement increases the probability of having at least one diagnosed physical condition by about 60 per cent Retirement increases the probability of taking a drug for such a condition by about 60 per cent.· Higher state pension ages are not only possible (given longer life expectancy) and desirable (given the fiscal costs of state pensions) but later retirement should, in fact, lead to better average health in retirement. As such the government should remove impediments to later retirement that are to be found in state pension systems, disability benefit provision and employment protection legislation.

Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010

Healthy life expectancy (HALE) summarises mortality and non-fatal outcomes in a single measure of average population health. It has been used to compare health between countries, or to measure changes over time. These comparisons can inform policy questions that depend on how morbidity changes as mortality decreases. We characterise current HALE and changes over the past two decades in 187 countries. Using inputs from the Global Burden of Disease Study (GBD) 2010, we assessed HALE for 1990 and 2010. We calculated HALE with life table methods, incorporating estimates of average health over each age interval. Inputs from GBD 2010 included age-specific information for mortality rates and prevalence of 1160 sequelae, and disability weights associated with 220 distinct health states relating to these sequelae. We computed estimates of average overall health for each age group, adjusting for comorbidity with a Monte Carlo simulation method to capture how multiple morbidities can combine in an individual. We incorporated these estimates in the life table by the Sullivan method to produce HALE estimates for each population defined by sex, country, and year. We estimated the contributions of changes in child mortality, adult mortality, and disability to overall change in population health between 1990 and 2010. In 2010, global male HALE at birth was 58·3 years (uncertainty interval 56·7-59·8) and global female HALE at birth was 61·8 years (60·1-63·4). HALE increased more slowly than did life expectancy over the past 20 years, with each 1-year increase in life expectancy at birth associated with a 0·8-year increase in HALE. Across countries in 2010, male HALE at birth ranged from 27·9 years (17·3-36·5) in Haiti, to 68·8 years (67·0-70·4) in Japan. Female HALE at birth ranged from 37·1 years (26·9-43·7) in Haiti, to 71·7 years (69·7-73·4) in Japan. Between 1990 and 2010, male HALE increased by 5 years or more in 42 countries compared with 37 countries for female HALE, while male HALE decreased in 21 countries and 11 for female HALE. Between countries and over time, life expectancy was strongly and positively related to number of years lost to disability. This relation was consistent between sexes, in cross-sectional and longitudinal analysis, and when assessed at birth, or at age 50 years. Changes in disability had small effects on changes in HALE compared with changes in mortality. HALE differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. HALE is an attractive indicator for monitoring health post-2015. The Bill & Melinda Gates Foundation.

Preventive health engineering in earlier and later life

Preserving autonomy and independence up to the highest ages calls for a major reduction in chronic conditions. By applying the Compressing Morbidity concept that concentrates the period of senescence near the end of life, the number of healthy years can be enlarged. Many chronic conditions are elicited by lifetime exposures to environmental factors, such as (indoor) air pollution (asthma, COPD, lung cancer), noise exposure (hearing disorders), or physically unbalanced work or sports (mobility disorders), to name a few. Unfortunately, in earlier life there is little interest in expected later health. Persuasive technology is useful here. Since, in the Western World, our environment is mainly man-made, improved technology has a major role in preventing noxious exposures to high-intensity light or noise, polluted air, or infested water, while respecting freedom of choice of individual persons. Ambient intelligence seems to be the best approach to realize these objectives, since it may take different exposures at various times under varying circumstances into account. Assessing costs and gains in health and longevity from an economic point of view is useful in showing societal sustainability of preventive measures to be taken at the regional level.

Unidades de tratamiento del ataque cerebrovascular (UTAC) en Chile

Stroke is a major public health problem in Chile, with an incidence similar to that of many industrialized nations, it accounts for 10% of all deaths and ranks 5th in number of healthy years of life lost to a disease. Organized inpatient care for stroke patients has been shown in systematic reviews of randomized clinical trials to be effective in preventing death, disability and institutional care, without increasing length of stay compared to usual care. Organized stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a dedicated ward (stroke ward) of which there are various possible models; acute stroke units which accept patients acutely but discharge early (usually within 7 days). This could include an "intensive" model of care with continuous monitoring and high nurse staffing levels; comprehensive (i.e. combined acute and rehabilitation) stroke units which accept patients acutely but also provide rehabilitation for at least several weeks if necessary. The way in which stroke units affect outcome is through reduction of complications of immobility and probably non specific neuroprotection. Stroke units should deliver high quality evidence based interventions to all eligible patients and should maintain high standards of care through staff training, guidelines and protocols, audit and quality assurance. Given that stroke is one of the fifty six health priorities in the health reform, inpatient stroke care should be delivered through stroke units organized in hospitals throughout Chile.

Healthy life expectancy in Brazil: applying the Sullivan method

The objective of this study is to present the method proposed by Sullivan and to estimate the healthy life expectancy using different measures of state of health, based on information from the World Health Survey carried out in Brazil in 2003. By combining information on mortality and morbidity into a unique indicator, simple to calculate and easy to interpret, the Sullivan method is currently the one most commonly used for estimating healthy life expectancy. The results show higher number of healthy years lost if there is a long-term disease or disability that limits daily activities, regardless of the difficulty in performing such activities or the severity of the functional limitations. The two measures of healthy life expectancy adjusted by the severity of functional limitation show results very similar to estimates based on the perception of state of health, especially in advanced age. It was also observed, for all measures used, that the proportion of healthy years lost increases significantly with age and that, although females have higher life expectancy than males, they live proportionally less years in good health.

Lung glutathione reductase induction in aging catalase-depleted frogs correlates with early survival throughout the life span

A comprehensive experimental study on free radical-related parameters was performed in the lung throughout the life span of 220 initially young or old frogs. No age related differences were found transversely or longitudinally for lung superoxide dismutase, catalase, Se-dependent and -independent glutathione peroxidases, glutathione reductase, GSH, GSSG, or GSSG/GSH ratio. Continuous catalase depletion with aminotriazole led to glutathione reductase induction in the lung after 14.5 months of experimentation. This was accompanied by a great increase in survival rate of treated animals in relation to control (especially in the old group). After 26.5 months of experimentation, glutathione reductase induction was lost and GSSG/GSH values tended to increase. This was followed by a 3-month long period of acute decrease in survival rate of treated animals. It is suggested that a high antioxidant/prooxidant balance is of protective value against causes of early death and can possibly be used in the future (when appropriately controlled) to increase the number of healthy years of the normal life span.

A critical re-examination of the economics of blindness prevention under the Onchocerciasis Control Programme.

This article is a critical re-examination of the recent cost-effectiveness analysis of the Onchocerciasis Control Programme (OCP) in West Africa, undertaken by Prost and Prescott in 1984. We use the same approach, namely, measuring effectiveness of the programme by the number of healthy years of life added by the prevention of blindness. This work focuses on certain technical aspects of the data used for estimating parameter values in the cost-effectiveness calculations. Through examination of available data and the relationships between certain key variables, we estimate values that differ substantially from Prost and Prescott for the population at risk, the incidence and prevalence of onchocercal blindness, and the years of healthy life lost due to blindness. Our final results suggest that depending on the discount rate that the OCP is 7-40 times more costly as measured by discounted years of productive life added than measles immunisation. These results are in contradiction to Prost and Prescott's estimation that the OCP was more cost-effective than measles immunisation. We, however, feel that our results do not demonstrate that OCP is an inefficient use of resources. Rather, they call into question the methods used and the relevance of comparing measles immunisation and onchocerciasis control. In a subsequent article, we hope to deal directly with these conceptual problems by presenting separate humanitarian and economic cost-effectiveness measures.