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Much less is known about the sex gap in lifespan variation, which reflects inequalities in the length of life, than about the sex gap in life expectancy (average length of life). We examined the contributions of age groups and causes of death to the sex gap in lifespan variation for 28 European countries, grouped into five European regions. In 2010–15, males in Europe displayed a 6.8-year-lower life expectancy and a 2.3-year-higher standard deviation in lifespan than females, with clear regional differences. Sex differences in lifespan variation are attributable largely to higher external mortality among males aged 30–39, whereas sex differences in life expectancy are due predominantly to higher smoking-related and cardiovascular disease mortality among males aged 60–69. The distinct findings for the sex gap in lifespan variation and the sex gap in life expectancy provide additional insights into the survival differences between the sexes.

We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries by carefully assessing past trends and applying advanced projecting techniques. We used estimated sex and age-specific alcohol-attributable mortality fractions (AAMF) among the national populations aged 20-84, for 1990 up to 2016, from the Global Burden of Disease Study, which we adjusted at older ages. We applied age-period-cohort modelling and projection, and avoided unrealistic future crossovers and differences in age-standardised AAMF between sexes and country groups, by implementing different lower bounds and by enabling that current (stagnating) increases are turned into declines. We find that in 2016, age-standardised AAMF were substantially higher among men (10.1%) than women (3.3%), and were much higher in Eastern Europe (14.3%) than in Western Europe (8.2%) among men. From 1990 to 2016, age-standardised AAMF mostly increased in Eastern and North-western Europe, and then declined or stagnated; whereas in South-western Europe, AAMF mostly declined, albeit with decelerations, particularly among men. We project that in the future, AAMF levels will decline in all countries, and will converge across countries, but that for men, levels will be higher in Eastern and South-western Europe than in North-western Europe. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women. In sum, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries, and to converge across countries and sexes. Particularly for Eastern and North-western European countries, achieving these projected declines will require strong, ongoing public health action.

While population ageing is rising, the educational composition of elderly is rather heterogeneous. We assess educational differences in future population ageing in Asia and Europe and how future population ageing in Asia and Europe would change if the educational composition of its populations would change. We do so using a comparative population ageing measure that recalculates old-age thresholds after accounting for differences in life expectancy, and the likelihood of adults surviving to higher ages. We construct projected life-tables (2015-2020, …, 2045-2050) by educational level and sex for different regions of Asia and Europe. Based on these life-tables we calculated the future comparative prospective old-age thresholds by educational level and sex. We find that in both Asia and Europe and among both men and women, the projected old-age thresholds are higher for higher educated people than for less educated people. While Europe has a larger projected share of elderly in the population than Asia, Europe’s older population is better educated. In alternate future scenarios in which populations hypothetically have higher levels of education, the projected shares of elderly in the population decrease across all regions of Asia and Europe, but more so in Asia. Our results highlight the effectiveness of investing in education as a policy response to the challenges associated with population ageing in Asia and Europe. Such investments are more effective in the Asian regions, where the educational infrastructure is less developed.

Background: HIV-infected individuals may be at risk for the premature onset of age-associated noncommunicable comorbidities. Being HIV-positive, having comorbidities and being of higher age may adversely impact health-related quality of life (HRQL). We investigated the possible contribution of HIV infection, comorbidities and age on HRQL and depression. Methods: HIV-infected individuals and uninfected controls from the AGEhIV Cohort Study were screened for the presence of comorbidities. They completed the Short Form 36-item Health Survey to assess HRQL and the nine-item Patient Health Questionnaire to assess depression. Linear and logistic regression were used to investigate to which extent comorbidities, aging and HIV infection were independently associated with HRQL and depression. Results: HIV-infected individuals (n = 541) reported significantly worse physical and mental HRQL and had a higher prevalence of depression than HIV-uninfected individuals (n = 526). A higher number of comorbidities and HIV-positive status were each independently associated with worse physical HRQL, whereas HIV-positive status and younger age were independently associated with worse mental HRQL and more depression. The difference in physical HRQL between HIV-positive and HIV-negative individuals did not become greater with a higher number of comorbidities or with higher age. Conclusion: In a cohort of largely well suppressed HIV-positive participants and HIV-negative controls, HIV-positive status was significantly and independently associated with worse physical and mental HRQL and with an increased likelihood of depression. Our finding that a higher number of comorbidities was independently associated with worse physical HRQL reinforces the importance to optimize prevention and management of comorbidities as the HIV-infected population continues to age.

We test the hypothesis that subjective remaining life expectancy (SRLE) increased concomitantly with the rise in actuarial remaining life expectancy (ARLE) over the period 1999-2016. As earlier evidence shows the relevance of SRLE for the intention of older workers to continue working, we focus on people aged 64-67 years. We also examine the influence of personal characteristics on the trend in SRLE. We select data from six measurement waves (n=1,967 observations) of the Longitudinal Aging Study Amsterdam, which is representative for people aged 55 and over in the Netherlands. SRLE is derived from a ‘lifeline’ on which participants indicated where they stood in life at the moment of participation. We find no change over time in SRLE for men; for women, in contrast, we find a significant increase in SRLE, greater than the increase in ARLE. Among the personal characteristics, a poorer self-rated health (men), chronic diseases (women), and, unexpectedly, a higher level of education and better cognitive functioning (both genders) are associated with a shorter SRLE. For women, preference for a fixed retirement age of 65 or lower is associated with a longer SRLE. We discuss implications for the willingness of people aged 64-67 to extend working life.

Female life expectancy is higher than that of males, and this gender gap is largest in Eastern Europe. Sergi Trias-Llimós and Fanny Janssen show that alcohol-attributable mortality explained more than 15% of this gap in eight Central and Eastern European (CEE) countries in 2012, and describe how the situation has evolved over time. Their results suggest that effectively tackling alcohol abuse among young men in these countries would help to reduce the gender gap in life expectancy.

Many students have difficulties giving meaning to algebra. In this study, we investigated how graphing formulas by hand can help grade 11 students to give meaning to algebraic formulas, defined as the ability to “read through” an algebraic formula: i.e., to recognize its structure and to link it to graphical features. During five 90-minute lessons, 21 students worked on graphing tasks focusing on recognition and heuristic search. To assess the effects of this intervention, a graphing task, and a cardsorting task were administered to the students. In addition, six students were asked to think aloud during the graphing task. The results of the card-sorting task showed that 14 students used categories similar to the ones experts use, but had trouble in consistently categorizing all formulas. The thinkingaloud protocols showed that the students improved their recognition of basic functions and graph features, and their qualitative reasoning, which allowed them to give meaning to algebraic formulas

In Europe, the smoking epidemic has clearly affected mortality levels and trends, as well as differences therein between countries and sexes. In 2014, smoking reduced the life expectancy levels of European countries on average by 2.7 years among men and by 1.0 years among women, and smoking contributed 28% to the sex difference in life expectancy. The smoking epidemic is most advanced in North-Western Europe, where smoking-attributable mortality is abating among men but still nearing its peak among women, resulting in small differences between both sexes. If we eliminate smoking-related mortality, life expectancy would not have stagnated in countries like Denmark and the Netherlands in the 1950s and 1960s among men and in the 1980s and 1990s among women. Generally, without smoking, life expectancy would have increased more strongly and in a more similar manner among men and women.

Purpose In neuro-oncology, 3 Tesla (3T) MRI is the current clinical standard for tumor localization, radiotherapy volume delineation and stereotactic (radio)surgery. With superior SNR and image resolution, anatomical 7T MRI can visualize micro-vascularization in glioblastomas potentially allowing improved target volume delineation. However, concerns regarding geometrical distortion (GD) with increasing field strength (B0) are detrimental for applications of 7T MRI in image-guided interventions. For high-precision treatment strategies, the spatial integrity of anatomical images needs to be warranted within ±1 mm. The aim of the study was to evaluate B0- and sequence-related GD in clinically relevant 7T pulse sequences and compare it to equivalent 3T sequences, and CT images. Material & Methods To quantify B0- and sequence-related GD in T1-GRE, T1-TFE, T2-TSE, T2-TSE FLAIR on 7T pulse sequences, a dedicated anthropomorphic head-phantom (CIRS Model 603A) was used. The phantom is composed of bone- /soft-tissue equivalent materials and contains a rigid 3D grid (3 mm rods spaced 15 mm apart). System-based distortion correction methods were applied to restore the gradient uniformity for 3T and 7T. For all CT and MR images, 436 points of interests (POIs) were defined by manual reconstruction of the 3D grid points in the respective images. GD was assessed in 3 ways. Firstly, global GD was estimated by the mean absolute difference (MADglobal) between the measured and the true Euclidian distances of all unique combinations of POIs, independent of location within the phantom. Secondly, local GD was estimated by MADlocal between the measured and the true Euclidian distances of all POIs relative to the magnetic field isocenter. Thirdly, a distortion map was created by evaluating 3D displacement vectors for each individual grid point. Results MADglobal in 3T and 7T images ranged from 0.19−0.75 mm and 0.27−1.91 mm, respectively, and was more pronounced than in CT images. CT was not completely free of GD with MADglobal ranging from 0.14−0.64 mm. B0-related GD was larger in 7T than in 3T MRI with MADlocal ranging from 0.11-0.73 mm and 0.21-1.81 mm, respectively (p

Longevity levels and trends in Europe In Europe, individuals nowadays experience longer lives than ever before. Whereas Europeans born at the beginning of the 20th century, could expect to live on average around 50 years, life expectancy at birth (e0) is currently around 78 years in Europe. This European average is 6 years higher than the current world average of life expectancy at birth, which amounts to 72 years. The gradual increase in life expectancy in the 20the century for Europe as a whole can be related mainly to socio-economic development and related medical progress. However, important differences within Europe exist in the speed of the increase in life expectancy , and – as a result – in current levels of life expectancy.