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We estimate the efficiency of health spending in 145 middle and high-income and the potential gains from improving efficiency for a range of health system outputs using Robust Data Envelopment Analysis for 2010–2014 and 2015–2019 and examine associations with health system characteristics. Focusing on Latin American and Caribbean countries, we find large variability in efficiency and overall substantial potential gains in the later period, despite improvements over time. Our results suggest that, for example, improving spending efficiency could increase life expectancy at birth by 3.5 years (4.6%), or slightly more than the 3.4-year improvement in average life expectancy in the region between 2000 and 2015. Similarly, improved efficiency could reduce neonatal mortality by 6.7 per 1,000 live births (62%), increase service coverage by 6 percentage points (8.7%), and reduce the rich-poor gap in birth attendance by 10 percentage points (12.6%). We find that governance quality is positively associated with efficiency. Overall, the findings indicate an urgent need to improve efficiency in the region and substantial scope for realizing the potential gains of such improvements. [ABSTRACT FROM AUTHOR]

Background: Current cardiovascular prevention strategies are based on studies that seldom include valvular heart disease (VHD). The role of modifiable lifestyle factors on VHD progression and life expectancy among the elderly with different socioeconomic statuses (SES) remains unknown. Methods: This cohort study included 164,775 UK Biobank participants aged 60 years and older. Lifestyle was determined using a five-factor scoring system covering smoking status, obesity, physical activity, diet, and sleep patterns. Based on this score, participants were then classified into "poor," "moderate," or "ideal" lifestyle groups. SES was classified as high or low based on the Townsend Deprivation Index. The association of lifestyle with major VHD progression was evaluated using a multistate mode. The life table method was employed to determine life expectancy with VHD and without VHD. Results: The UK Biobank documented 5132 incident VHD cases with a mean follow-up of 12.3 years and 1418 deaths following VHD with a mean follow-up of 6.0 years. Compared to those with a poor lifestyle, women and men followed an ideal lifestyle had lower hazard ratios for incident VHD (0.66 with 95% CI, 0.59–0.73 for women and 0.77 with 95% CI, 0.71–0.83 for men) and for post-VHD mortality (0.58 for women, 95% CI 0.46–0.74 and 0.62 for men, 95% CI 0.54–0.73). When lifestyle and SES were combined, the lower risk of incident VHD and mortality were observed among participants with an ideal lifestyle and high SES compared to participants with an unhealthy lifestyle and low SES. There was no significant interaction between lifestyle and SES in their correlation with the incidence and subsequent mortality of VHD. Among low SES populations, 60-year-old women and men with VHD who followed ideal lifestyles lived 4.2 years (95% CI, 3.8–4.7) and 5.1 years (95% CI, 4.5–5.6) longer, respectively, compared to those with poor lifestyles. In contrast, the life expectancy gain for those without VHD was 4.4 years (95% CI, 4.0–4.8) for women and 5.3 years (95% CI, 4.8–5.7) for men when adhering to an ideal lifestyle versus a poor one. Conclusions: Adopting a healthier lifestyle can significantly slow down the progression from free of VHD to incident VHD and further to death and increase life expectancy for both individuals with and without VHD within diverse socioeconomic elderly populations. [ABSTRACT FROM AUTHOR]

Background: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. Methods: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. Results: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. Conclusion: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region. [ABSTRACT FROM AUTHOR]

Despite its high health spending, the US shows below-average life expectancy when compared to other OECD-countries. To find explanatory factors for this paradox, this article employs a Nested Analysis combining Large N Analysis (LNA) and Small N Analysis (SNA). First, it examines how far US life expectancy deviates from OLS model predictions which include a comprehensive set of health determinants. The results show that the established determinants clearly fail to explain the US underperformance. Second, a comparative analysis between the US and Canada identifies three idiosyncratic factors that explain the US deviation: its health care system particularities (1), the opioid crisis and drug-related deaths (2), and the particularly severe impact of the COVID-19 pandemic (3). [ABSTRACT FROM AUTHOR]

Constipation is a prevalent gastrointestinal disorder that affects people globally, decreasing their quality of life and life expectancy. Individuals with schizophrenia often suffer from constipation, which could be a result of the illness itself or the side effects of psychotropic medications. However, little research has been conducted on factors contributing to constipation in individuals with schizophrenia. To address this issue, we conducted a survey using self‐administered questionnaires and medical records to identify factors associated with constipation in psychiatric outpatients. This study included 399 patients with schizophrenia, resulting in a high prevalence of constipation (43.4%). The analysis suggested that female gender, the doses of antiparkinsonian medications, and benzodiazepine sleeping pills may be associated with constipation. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is becoming more widespread globally. Thanks to renal replacement therapy (RRT) methods, the life expectancy of CKD patients is gradually increasing. Today, the notion of quality of life has come to the forefront in evaluating treatment efficacy with increasing life expectancy. Among the RRT methods, kidney transplantation is the one that improves the quality of life the most. Polypharmacy is a concept that has been on the agenda recently and is known to have adverse effects on quality of life. Kidney transplant patients are frequently exposed to polypharmacy due to immunosuppressive drugs and comorbidities, particularly during the initial stages of transplantation. In our study, the KDQOL-SF questionnaire was administered to 128 kidney transplant recipients who visited the Nephrology outpatient clinic between October 2023 and November 2023. Those taking ≥6 medications were defined as the group exposed to polypharmacy. Polypharmacy was considered present in 74 of the patients involved in the study. The mean age of the patients was 51.8 ±11.5 years in the polypharmacy group and 42.4 ±12.5 years in the non-polypharmacy group. In renal transplant patients, the quality of life was notably reduced in the polypharmacy group. The presence of polypharmacy showed a statistically significant correlation with age, comorbidity, multimorbidity, marital status, and primary disease. The group with polypharmacy had notably lower scores in all sub-parameters of the KDQOL-SF. In conclusion, our study determined that the presence of polypharmacy had a negative impact on the quality of life of renal transplant patients. Polypharmacy was found to be associated with age, comorbidity and multimorbidity. [ABSTRACT FROM AUTHOR]

This research aims to fill a notable need in current scholarly works by investigating the often-neglected impact of fossil fuel consumption, particularly oil and gas, on life expectancy. To examine the correlation between economic growth, national healthcare spending, and oil and gas usage on life expectancy in Malaysia from 1980 to 2020, we employ the Autoregressive Distributed Lag (ARDL) method, acknowledging its substantial implications for sustainable development. According to the findings of our study, the growth of the economy and the rise in the amount of gasoline consumed both have a positive impact on the average lifespan of individuals. In spite of this, the rise in the cost of medical treatment and the increase in the amount of oil that is consumed have a negative effect on life expectancy, both in the short term and in the long term. The coefficients have a substantial magnitude for a prolonged duration, highlighting the enduring influence. These results emphasize the need for policymakers to prioritize alternative energy sources and enhancements in healthcare quality to foster longevity and enhance the overall well-being in Malaysia. Furthermore, our study suggests that augmenting healthcare expenditure should be coupled with measures to ameliorate environmental quality for a more substantial positive impact on human well-being. [ABSTRACT FROM AUTHOR]

INTRODUCTION The purpose of this study was to examine the prevalence, clinical characteristics, and changing trends of non-smokers with lung cancer (LC) based on data from a population-wide cancer registry in northern China. METHODS The study used LC incidence and follow-up data from 2010 to 2019 from the Cancer Registry System of Tianjin city, which included 82769 cases. Trends in the incidence and proportion of non-smokers with LC were examined by joinpoint regression analysis. Life table and Cox survival analyses were used to calculate the survival rates and compare the death hazard ratios (HRs) in different groups, respectively. RESULTS Among the 82769 new diagnosis cases of LC during 2010 to 2019, there were 34589 (41.8%) current smokers, 14913 (18.0%) ex-smokers, 28123 (34.0%) non-smokers, and 5144 (6.2%) unknowns. The proportion of non-smokers changed slightly from 2010 (35.36%) to 2019 (36.87%) (annual percentage change, APC= -0.01%, p>0.05). This proportion declined in men (2010 vs 2019; 22.06% vs 20.66%) and increased in women (2010 vs 2019; 53.02% vs 62.35%), and in the 0--44 years age group it showed an upward trend from 2015 to 2019 (APC=4.82%, 95% CI: 1.8--7.9). Compared with smokers with LC, non-smokers with LC were predominantly females (64.15% vs 27.26%), had a predominantly adenocarcinoma histological subtypes (76.71% vs 42.22%), and had a 20% lower risk of death than smokers (HR=0.80; 95% CI: 0.78--0.81). CONCLUSIONS The proportion of non-smokers with LC was relatively high in northern China, with an increasing trend in the proportion of females and younger age groups. Non-smokers with LC had different epidemiological and clinical characteristics compared with smokers with LC. [ABSTRACT FROM AUTHOR]

Objectives: Human mortality is U‐shaped and, therefore, defines an age x* separating lives with an overall negative net change in mortality from lives with an overall positive net change in mortality. How has age x* changed, also relatively to life expectancy, over recent human history? And how does x* compare between humans and other primates, the mortality of which is also U‐shaped? Methods: Modeling data from the Human Mortality Database, the historical change of x* in advanced economies is reported and compared with that of primates in wild and captive conditions the demography of which was already modeled in the literature. Results: In humans, a marked decline in x* for both sexes, also relatively to their life expectancy, is associated with medical and economic progress. Comparing wild with captive conditions in nonhuman primates, magnitude, and direction of the change in x*, both relatively to life expectancy and absolutely, can depend on genus and sex. Conclusions: With medical and economic progress, human lives have transitioned from a negative to a positive net change in mortality independently of sex. There is no evidence of an analogous transition occurring in other primates when their environment is made more benign. [ABSTRACT FROM AUTHOR]

Introduction: This study primarily focuses to investigate the occurrence of frailty and the factors that contribute to it among older adults with hypertension in China. Evidence have shown a consistent increase in the life expectancy globally. Consequence to this, is the increase in the number of older adults population. As the population age, they are usually accompanied by health challenges mostly long-term conditions such as hypertension. Materials and methods: Three online databases; PubMed, Scopus and Web of Science were access literature for this review. A total of nine articles that fulfil the inclusion criteria were found and included for this review in line with PRISMA guideline. Results: Findings reveals the prevalence of frailty among hypertensive Chinese older adult's ranges from 9.8% to 42.4%. With regards to factors influencing frailty among older adults in China, depression and lack of adequate social support were the predominant factors that were found to be influencing frailty among this group. Conclusion: The study therefore recommends that adequate social and emotional support to the elderly hypertensive in China is consequential to healthy aging. [ABSTRACT FROM AUTHOR]

Palliative care is a comprehensive approach aimed at improving the quality of life for patients and their families. The symptom burden and care needs of patients with end-stage, non-malignant diseases are similar to those experienced by patients with advanced cancer. Therefore, the World Health Organization (WHO) has recommended the expansion of palliative care to encompass a broad spectrum of diseases. However, in Korea, the adoption of palliative care for non-malignant conditions remains markedly low, presenting numerous challenges that differ from those associated with cancer. Key barriers to implementing hospice care for non-malignant diseases include the difficulty in predicting end-of-life and a general lack of awareness about hospice palliative care among healthcare providers, patients, and their families. Additionally, there is a risk that suggesting palliative care to patients with non-malignant diseases might be misinterpreted as an endorsement by healthcare providers to cease treatment or abandon the patient. This article explores strategies to broaden the scope of hospice and palliative care for patients with non-malignant diseases. [ABSTRACT FROM AUTHOR]

Background: Achondroplasia can result in many skeletal manifestations, and degenerative osteoarthritis can develop in patients with achondroplasia. Morphologic changes to both the humerus and glenoid--short humeri with patulous metaphyses and a medialized glenoid--can cause challenges that must be overcome to achieve a successful surgical result in a patient with shoulder dysfunction. Because patients with achondroplasia have near-normal life expectancies, the operative shoulder must be functional as well as quite durable in the long term. In an achondroplastic dwarf with shoulder osteoarthritis and rotator cuff insufficiency, achieving functionality and durability requires the use of a reverse total shoulder arthroplasty (TSA). This procedure has its own set of issues, namely, baseplate fixation and correction of glenoid medialization, if present. Case Report: We present the case of an adult with achondroplastic dwarfism with shoulder osteoarthritis and rotator cuff insufficiency and report the 2-year clinical results for this patient after reverse TSA. Conclusion: Reverse TSA is a viable treatment option for adult achondroplastic patients with shoulder dysfunction. Careful pre-operative planning is required to ensure a good clinical result in patients with potentially dysplastic anatomy. [ABSTRACT FROM AUTHOR]

Young people's mental and substance use disorders are a significant public health issue worldwide. A large proportion of the world's disease burden among young people is attributable to mental health disorders. This study examines the prevalence of mental and substance use disorders, the incidence of self-harm behaviors, years lived with disability, and years of life lost by country-level income groups and gender among young people (10–24 years) in 185 countries at two time points: 1990 and 2019. A descriptive study was conducted using secondary data extracted from the Global Burden of Disease Study (GBD) 2019 to estimate the prevalence of mental health and substance use disorders, as well as self-harm behaviors among young people. Percentage changes in 1990–2019, 95% uncertainty intervals (UIs), and correlations with the socio-demographic index, sustainable development goals were examined. The findings showed that globally, the prevalence of mental and substance use disorders among young people of both genders slightly decreased from 1990. However, these rates varied significantly across country-level income groups and sexes. High-income countries showed significantly the highest increase of mental health disorder rates at these time points, while lower-middle-income countries had the greatest decrease in the study. Furthermore, females displayed higher incidence rates of self-harm at younger ages compared to males across all income-based groups. These findings provide valuable insights for policymakers, enabling them to better understand the situation and make data-driven policy decisions. This includes estimating the economic burden of disorders, planning services, and allocating resources effectively. Highlights: Children and youth make up approximately 45% of the world's population, yet 10–20% of them experience mental health problems. Mental health and substance use disorders remain one of the most significant leading causes of disease burden among the 10–24 age group, particularly in high-income countries. The overall percentage change in substance use disorders among young people in high-income countries increased for both sexes between 1990 and 2019. Since 1990, self-harm has remained a leading cause of Years of Life Lost (YLLs) among young people in 185 countries. Nevertheless, a decrease of 31% in males and 50% in females was observed over the 30-year period. Comprehensive action plans and strategies are essential for reducing the risk of mental health and substance use disorders in young people. [ABSTRACT FROM AUTHOR]

CSmoothing allows an analyst to use the so-called Controlled Smoothing technique to estimate trends in a time series framework. In this Web-tool (Shiny), the analyst may apply the methodology to at most 3 mortality time series simultaneously, as well as to other kind of time series individually. Likewise, this smoothing approach allows the analyst to establish one, two or three segments in order to take into account possible changes in variance regimes. For estimating trends it uses different amounts of smoothness, both globally for the total data set and through some partial indices for each selected segment. It is also possible to endogenously fix the points where the segments start and end (the cutoff points) with continuous joints. Additionally, intervals of different standard deviations for their respective trends are given. Particular emphasis is placed on a big data set of log mortality rates, log(qx), taken from period life tables of the Human Mortality Database (HMD) (University of California Berkeley (USA) and and Max Planck Institute for Demographic Research (Germany)), 2021). In all cases, dynamic graphs and several statistics related to the Controlled Smoothing technique are illustrated. [ABSTRACT FROM AUTHOR]

Background: Treatment options for people with haemophilia are evolving at a rapid pace and a range of prophylactic treatment options using various technologies are currently available, each with their own distinct safety and efficacy profile. Treatment goals: The access to replacement therapy and prophylaxis has driven a dramatic reduction in mortality and resultant increase in life expectancy. Beyond this, the abolition of bleeds and preservation of joint health represent the expected, but rarely attained, goals of haemophilia treatment and care. These outcomes also do not address the complexity of health‐related quality of life impacted by haemophilia and its treatment. Conclusion: Capitalizing on the major potential of therapeutic innovations, 'Normalization' of haemostasis, as a concept, should include the aspiration of enabling individuals to live as normal a life as possible, free from haemophilia‐imposed limitations. To achieve this—being supported by the data reviewed in this manuscript—the concept of haemostatic and life Normalization needs to be explored and debated within the wider multidisciplinary teams and haemophilia community. [ABSTRACT FROM AUTHOR]

In an era of rising global life expectancies, research focuses on enhancing the quality of extended years. This review examines the link between mitochondrial function and aging, highlighting the importance of healthspan alongside lifespan. This involves significant human and economic challenges, with longer lifespans often accompanied by reduced well‐being. Addressing mitochondrial decline, exploring targeted interventions, and understanding the complexities of research models are vital for advancing our knowledge in this field. Additionally, promoting physical exercise and adopting personalized supplementation strategies based on individual needs can contribute to healthy aging. The insights from this Perspective article offer a hopeful outlook for future advances in extending both lifespan and healthspan, aiming to improve the overall quality of life in aging populations. [ABSTRACT FROM AUTHOR]

Background: In the last two decades, tyrosine kinase inhibitors (TKIs) and advances in molecular diagnostics have revolutionized management and long-term clinical outcomes in chronic myeloid leukemia (CML). Real-world data from different countries allow for the identification of country-specific issues in the clinical management and development of specific plans for improvement. Here, we aimed to analyze the trend in overall survival in Bulgarian CML patients since 2000. Methods: We retrieved publicly available Bulgarian CML data from several sources such as the Bulgarian National Cancer Registry, Bulgarian National Statistical Institute, and National Health Insurance Fund since 2000. We used the retrieved data of a total of 1513 Bulgarian CML patients to describe the trends in overall survival (OS), conditional overall survival, life expectancy, and life years lost over five time periods. We also described the trends in healthcare expenditures for TKIs and CML patients' coverage with TKIs since 2014. Results: In both uni- and multivariate models, we found a constant increase in OS over the three 5-year periods until 2014. The period 2015–2019 was not associated with an additional increase in OS. Identical dynamics in the improvement in life expectancy (LE) and in life years lost (LYLs) was observed. Additionally, conditional 5-year survival did not improve during 2015–2019 in comparison to 2010–2014. Population-level data did not show consistent changes in the documented number of deaths due to CML since 2013. The period after 2013 is marked by a constant increase in the annual expenditures for TKIs, reaching to about 2.0 EUR/capita. The number of patients who received at least one TKI also increased during that period. Conclusions: After the initial significant improvement in the clinical outcomes for Bulgarian CML patients until 2014, subsequent periods did not bring further benefit in spite of the improved coverage with second- and third-line TKIs. Multiple factors may contribute to these suboptimal outcomes. Therefore, one can propose several additional measures at the country level, which could lead to additional improvement in the OS of Bulgarian CML patients. [ABSTRACT FROM AUTHOR]

The rising incidence of mental health problems significantly affects the well-being of the Indian population, presenting a pressing concern. Lack of sufficient infrastructure and reduced allocated resources hinder the pace of advancements and improvements in the mental health domain. In the current monotonous world, pausing to assess individual well-being seems to be neglected due to the ongoing expectations of life, which makes it important to reflect on one's emotional wellness levels. Evaluating one's wellness levels through a self-reporting emotional wellness test enables one to rethink coping and dealing with stressors, influencing the promotion of healthy living styles. The present constructed test assesses core areas such as time management, self-concept, relationship management, while exploring coping styles among corporate employees and college students. The test was undertaken by 18,951 corporate employees and 32,426 college students. The results show a significant negative correlation between the age and total scores for both corporate employees (-0.191, p<0.001) and college students (-0.022, p<0.001). A one-way ANOVA (F= 548, p<0.001) test confirms a significant difference in the emotional wellness scores based on gender. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) account for one-third of all deaths worldwide. Methods: In this cross-sectional study, we extracted all death records from the Electronic Death Registration System categorized as ischemic heart disease (IHD) based on age, gender, and the year of death according to ICD-10 for this cross-sectional analysis. The Fars province is situated in southern Iran with a population of about 4 million. An analysis of years of life lost (YLL) resulting from premature death from IHD was conducted using the World Health Organization's 2015 YLL framework. The trend of the YLL rates was investigated using joinpoint regression. Results: In the Fars province, IHD was the cause of 46969 deaths throughout a 16-year study period, (2004 to 2019). Among these, 26,503 (56.4%) were men. The crude death rates per 100000 population for men and women were 84.2 and 66.5, respectively. The total YLL due to premature death due to IHD, during the 16-year study period, was 287625 in male, 209665 in female. The joinpoint regression showed a declining trend in the YLL rate associated with premature death. Annual Percent Change (APC) was -0.6% (95% CI -6.9 to 6.1, P=0.851) for males and -1.5% (95% CI -5.2 to 2.2, P=0.418) for females. Conclusion: The trends of the standardized mortality rate, YLL, and crude mortality rate held steady throughout a 16-year period. Planning for comprehensive primary and secondary prevention and increasing public knowledge of IHD are necessary. [ABSTRACT FROM AUTHOR]

Background: For people with limited lifetime expectancy, the benefit of many medications may be outweighed by their potential harms. Despite the relevance of reducing unnecessary medication use, deprescribing is poorly enacted in primary care practice. Aim: This study aims to describe factors, as identified by primary care professionals and patients, that influence deprescribing in the last phase of life. Design: Semi-structured interviews were conducted and analysed using a thematic approach. Setting/participants: This study was performed in primary care settings, including general practices, hospices and community care teams in The Netherlands. Purposefully identified primary care professionals (general practitioners, pharmacists, nurses) and patients with limited lifetime expectancy due to advanced chronic illness or cancer and their caretakers were interviewed. Results: Three themes emerged detailing factors influencing deprescribing in the last phase of life in primary care: (1) non-maleficence, the wish to avoid additional psychological or physical distress; (2) reactive care, the lack of priority and awareness of eligible patients; and (3) discontinuity of care within primary care and between primary care and specialty care. Conclusions: Deprescribing is an incremental process, complicated by the unpredictability of life expectancy and attitudes of patients and health care professionals that associate continued medication use with clinical stability. Opportunities to facilitate the deprescribing process and its acceptance include the routinely systematic identification of patients with limited life expectancy and potentially inappropriate medications, and normalisation of deprescribing as component of regular primary care, occurring for all patients and continuing into end-of-life care. [ABSTRACT FROM AUTHOR]

Population aging, urbanization, and life expectancy are among the main pillars of sustainable economic, social, and environmental development of the future, as outlined by the Sustainable Development Goals (SDGs) of the United Nations. Globally, the current population structure exhibits an increasing proportion of the elderly along with rising healthcare costs and climate change. Malaysia faces a similar experience, where 14% of its population is expected to account for the elderly by 2030. To achieve the SDGs, attention should be given to their pillars, namely life expectancy, health expenditure, economic development, and carbon emissions. Limited research that addresses these key factors has been conducted, especially in emerging economies, such as Malaysia. Therefore, this study aims to contribute to the existing literature by analyzing the long-term and short-term relationships between carbon emissions, GDP, health expenditure, and life expectancy in Malaysia. The autoregressive distributed lag (ARDL) bounds cointegration test was adopted to determine the long-term and short-term effects on life expectancy from 1997 to 2021. The findings indicate that cointegration existed among the variables, and carbon emissions and health expenditure had a statistically significant relationship with life expectancy in the short run. Hence, greater attention should be paid to these two factors, particularly in the short term, to ensure that Malaysia can maintain the health and well-being of the nation in line with the SDG requirements. [ABSTRACT FROM AUTHOR]

The Human Development Index is a useful measure of a country's overall prosperity and standard of living (HDI). The Human Development Index (HDI) provides data on the social and economic progress of a nation by accounting for variables such as life expectancy, education attainment, and per capita income. This research delves into the intricate correlation of a nation's historical background, policy framework, and advancements on the Human Development Index. The remarkable journey of South Africa, from apartheid to inclusive growth, is an important example. The study uses an average yearly growth rate to examine how changes in political ideologies, ongoing development initiatives, and historical contexts of inequality have shaped South Africa's HDI trajectory. By examining crucial turning points and policy influences, the study aims to reveal the complex relationship of factors affecting human development results. Despite improvement, challenges like unemployment and poverty continue. The study stresses the relevance of understanding historical context and policy changes in shaping HDI outcomes. Ultimately, the study emphasises the need of maintaining a long-term commitment to effective and inclusive human development policies. Understanding the complex relationship of factors influencing South Africa's HDI will help policymakers make better informed decisions that will lead to a more prosperous and fair society for all South Africans. [ABSTRACT FROM AUTHOR]

Recent scientific research has shown that the ketogenic diet may have potential benefits in a variety of medical fields, which has led to the diet receiving a substantial amount of attention. Clinical and experimental research on brain tumors has shown that the ketogenic diet has a satisfactory safety profile. This safety profile has been established in a variety of applications, including the management of obesity and the treatment of drug-resistant epileptic cases. However, in human studies, the impact of ketogenic therapy on the growth of tumors and the life expectancy of patients has not provided results that are well characterized. Consequently, our purpose is to improve the comprehension of these features by succinctly presenting the developments and conclusions that have been gained from the most recent study that pertains to this non-pharmacological technique. According to the findings of our study, patients with brain tumors who stick to a ketogenic diet are more likely to experience improved survival rates. However, it is required to conduct additional research on humans in order to more accurately define the anti-tumor efficiency of this diet as well as the underlying processes that support the therapeutic effects of this dieting regimen. [ABSTRACT FROM AUTHOR]

Background/Aim. Quality of life (QoL) is one of the outcome measures for patients with chronic diseases. Mental health issues often impact the QoL of cancer patients. Cancer patients with a good QoL have a longer life expectancy and are able to lead a more productive and social life. The aim of the study was to determine the association of mental health with the QoL, as well as to determine significant predictors of QoL in patients with breast cancer (BC). Methods. The study included 118 patients treated at the Specialized Breast Cancer Department of the Oncology Clinic of the University Clinical Center Niš, Serbia. The study's inclusion criteria were the presence of early-stage nonmetastatic BC and completed surgical treatment. The following questionnaires were used: the general sociodemographic questionnaire, Hospital Anxiety and Depression Scale (HADS), Buss-Perry Aggression Questionnaire, Early Maladaptive Schema questionnaire - short form (SQ-SF), Flanagan's Quality of Life Scale (QoLS), Holmes and Rahe Stress Scale, Berlin Social Support Scales (BSSS), Health Locus of Control. Results. A statistically significant negative correlation was found with emotional state, i.e., anxiety score, depressiveness score, total stress score, and physical aggression score, while QoL correlated positively with all subscales of the perceived social support (PSS) questionnaire. QoL was significantly different for patients with the following early maladaptive schemas: emotional deprivation, emotional inhibition, and a sense of entitlement/narcissism. Moreover, QoL differed significantly depending on partnership status, the presence of clinically significant anxiety, the presence of hormone-sensitive cancer, the presence of human epidermal growth factor receptor 2 (HER2)-positive cancer, and time since diagnosis. Multiple linear regression was performed, and depression and PSS had the highest share. Conclusion. In our study, the presence of depressiveness and PSS were the best predictors of QoL of BC survivors. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) has become an essential goal of contemporary healthcare and protective psychological resources. Individual life expectancy has increased with improved social progress, healthcare, nutrition and advanced health‐related technologies. However, research often overlooks the significant impact of social change and generational effects on the QoL of the ageing population. As people age, optimising opportunities for health, participation and safety to improve QoL has become crucial for society, policymakers and researchers. This study utilised a cross‐temporal meta‐analysis to investigate changes in the QoL among older adults from 1999 to 2017. Fifty two studies (N = 34,844) that used the Brief Health Status Survey Scale (SF‐36) were analysed. Direct and lagged correlation analyses were performed to examine the relationship between changes in the QoL of older adults and the macro social environment. The findings showed that QoL decreased by 7.94 points (d = −0.50) over the past 18 years. Economic status, social connectedness, and general threats were significant predictors of declining QoL among older adults. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Research indicates that Black communities experienced disproportionately higher numbers of confirmed cases and fatalities throughout the COVID-19 pandemic with Black men experiencing marked reductions in life expectancy. Inequities were further magnified by known COVID-19 such as hypertension, diabetes, obesity, and higher prevalence of cardiovascular disease. The current project aimed to assess the knowledge, attitudes, and behaviors related to COVID-19 among Black men with chronic conditions. Specifically, we sought to determine whether COVID-19-related perspectives and behaviors impacted cross-sectional health outcomes. A national sample of Black men (N = 312) who self-reported at least one chronic disease responded to survey questions about their knowledge, attitude, and preventative behaviors (KAP) related to COVID-19. Analyses suggest that unique latent profiles based on COVID-19-related KAP differentially impacted participants' self-reported health and well-being for those low on KAP items. The discussion includes considerations on viral hygiene interventions, misinformation, stigma, and perceptions of discrimination. [ABSTRACT FROM AUTHOR]

Patients with kidney failure have the option of starting dialysis or continuing medical management. This observational cohort study used a target trial emulation approach to determine the mean survival and number of days at home for adults who start dialysis within 30 days of an eGFR below 12 mL/min/1.73 m 2 compared with those who continue medical management. Visual Abstract. Effect of Starting Dialysis Versus Continuing Medical Management on Survival and Home Time in Older Adults With Kidney Failure: Patients with kidney failure have the option of starting dialysis or continuing medical management. This observational cohort study used a target trial emulation approach to determine the mean survival and number of days at home for adults who start dialysis within 30 days of an eGFR below 12 mL/min/1.73 m 2 compared with those who continue medical management. Background: For older adults with kidney failure who are not referred for transplant, medical management is an alternative to dialysis. Objective: To compare survival and home time between older adults who started dialysis at an estimated glomerular filtration rate (eGFR) less than 12 mL/min/1.73 m 2 and those who continued medical management. Design: Observational cohort study using target trial emulation. Setting: U.S. Department of Veterans Affairs, 2010 to 2018. Participants: Adults aged 65 years or older with chronic kidney failure and eGFR below 12 mL/min/1.73 m 2 who were not referred for transplant. Intervention: Starting dialysis within 30 days versus continuing medical management. Measurements: Mean survival and number of days at home. Results: Among 20 440 adults (mean age, 77.9 years [SD, 8.8]), the median time to dialysis start was 8.0 days in the group starting dialysis and 3.0 years in the group continuing medical management. Over a 3-year horizon, the group starting dialysis survived 770 days and the group continuing medical management survived 761 days (difference, 9.3 days [95% CI, −17.4 to 30.1 days]). Compared with the group continuing medical management, the group starting dialysis had 13.6 fewer days at home (CI, 7.7 to 20.5 fewer days at home). Compared with the group continuing medical management and forgoing dialysis completely, the group starting dialysis had longer survival by 77.6 days (CI, 62.8 to 91.1 days) and 14.7 fewer days at home (CI, 11.2 to 16.5 fewer days at home). Limitation: Potential for unmeasured confounding due to lack of symptom assessments at eligibility; limited generalizability to women and nonveterans. Conclusion: Older adults starting dialysis when their eGFR fell below 12 mL/min/1.73 m 2 who were not referred for transplant had modest gains in life expectancy and less time at home. Primary Funding Source: U.S. Department of Veterans Affairs and National Institutes of Health. [ABSTRACT FROM AUTHOR]

Despite their often perceived linearity, the past, present, and future are intricately woven together. Previous experiences shape our perception, nourishing potential scenarios and enriching our evaluations. Sociocultural contexts reinforce this interplay, directing our attention toward various aspects based on our social positions. This scenario forms the context for the present study, which investigates perspectives of young Chilean men from two considerably distinct life conditions: business students and incarcerated individuals. Using semistructured interviews and a phenomenologically inspired analysis, we found that participants (amidst COVID-19) referred to similar pessimistic evaluations for their country but, on the contrary, remarkably converged on optimistic future expectations for their personal lives. Despite their markedly different personal life stories. The conclusions point to the stark experience of individuals "freed" from social structure, nurtured by recent neoliberal Chilean history. [ABSTRACT FROM AUTHOR]

The Silver Generation, the population made up of older adults, in countries like Spain and those in its immediate surroundings, represents a demographic segment in constant growth, as a consequence of the increase in life expectancy, and with an increasingly greater percentage weight on the total population, due to the decrease in the birth rate. The main objective of this work is to know and analyze the characteristics and behaviors of this diverse and heterogeneous demographic profile, which is gradually adapting to the use of new technologies, including their preferences regarding the different channels or media they use, the way they relate to the offering companies and their products and services, as well as their assessment of the effectiveness of current marketing strategies aimed at older people. A quantitative methodology has been used, based on a primary source, a survey carried out on people over 55 years of age residing in Spain. The results reflect the existence of significant discontent regarding advertising campaigns directed towards that generation, since they estimate that they do not use the most appropriate channels and coherent strategies, and they are not developed with respect to their way of being and thinking. It is concluded that personalization in treatment, the generation of trust and improving accessibility to new purchasing systems should allow for solid and lasting commercial relationships between companies and this generation. [ABSTRACT FROM AUTHOR]

The macroeconomic dimensions of health production function in Greece were studied, by linking doctors’ number, per capita health expenditures, population percentage living in material deprivation conditions, pollutant emissions and alcohol consumption with health indicators. Articles were searched, by recording data from databases (Hellenic-European Statistical Service, Organisation for Economic Co-operation and Development [OECD]) and medical personnel number, per capita health expenditures, population segment living in poverty, pollutant emissions (expressed as CO2/capita) and alcohol use variation were correlated with changes in infant mortality, healthy life years and life expectancy. By above methodology, strong negative correlation of doctors’ number with infant mortality (0.90% approximately) (1960–2015) and significantly positive corresponding in life expectancy change (0.94% approximately) (2000–2015) were captured. The strong negative association of per capita health expenditure on infant mortality (84% for years 2000–2015 and 96% for years 1989–2011), 90% negative correlation of people living in material deprivation conditions with healthy life years were highlighted (2008–2015), as well as negative correlation (about 95%) of environmental pollution, expressed as per capita CO2 emitted amount, with life expectancy change (2007–2015) and the 95% approximate connection of alcohol consumption with life expectancy (2005–2014). The studied cases and correlation with longitudinal health indicators’ modification document macroeconomic dimensions of health production function and measures to mitigate negative consequences/enhance beneficial effects on life quality are proposed. [ABSTRACT FROM AUTHOR]

The article examines the state of prostate cancer (PCa) screening in Canada. Topics include the high incidence of PCa in Canadian men and the benefits and risks associated with prostate-specific antigen (PSA) screening; the financial barriers and inequities in screening access, such as Black and Indigenous men, are disproportionately affected; and the need for more context-specific research to address these disparities and improve screening practices.

Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycemia as far as possible and facilitation of glucose management. The International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every four years since 1995, covering more and more topics. For optimal metabolic outcomes, diabetes teams need to follow these current recommendations, adapt them to their clinical practice and provide guidance to people with T1D and their families. In this review, in the light of ISPAD 2018-2022 guidelines and clinical experiences, "10 Key Recommendations", emphasizing the importance of teamwork and the use of technology, current T1D treatment is described for practical applications. [ABSTRACT FROM AUTHOR]

For those affected, infertility is linked to impaired overall health and reduced life expectancy. In particular, infertile individuals bear an increased risk for cardiovascular disease (CVD) and different types of cancer, partially due to lifestyle differences and to genetic alterations that cause both infertility and an increased cancer risk. Genetic variants causing an increased CVD risk are more commonly found in infertile individuals, but their link to infertility remains unclear. Offspring of infertile couples, conceived via medically assisted reproduction, are as likely as their parents to exhibit or develop adiposity, hormonal alterations such as insulin resistance, and infertility. The effects on health of subsequent generations are completely unclear. [ABSTRACT FROM AUTHOR]

The article discusses the need to urgently resolve diverse population and older adult exclusion in clinical trials and research to improve drug evaluation in these groups as of 2024. Topics covered include the consequences of exclusion in trials, the barrier of institutional structures to inclusivity, and the process of trial recruitment and compensation for these people. Also noted are recommendations made for this effort and their implementation.

Background: The landscape of systemic therapies for metastatic hormone‐sensitive (mHSPC) and castration resistant prostate cancer (mCRPC) extensively improved within the last decades resulting in a significantly prolonged overall survival. However, subgroup analyses of phase III trials suggest potentially different overall survival outcomes for older adults. Methods: We relied on our institutional metastatic prostate cancer database to identify mHSPC and subsequently mCRPC patients. Older adults were stratified according to age groups 70–74 versus ≥75–79 versus ≥80 years at metastatic occurrence. Subsequently, uni‐ and multivariable time to mCRPC and overall survival analyses were performed. Results: Of 494 older adults, 217 (44%) were 70–74 versus 180 (36%) 75–79 versus 97 (20%) ≥80 years old. Rates of local prostate cancer treatment differed significantly between all three groups (p < 0.01). Regarding mHSPC treatment, androgen receptor signaling inhibitors (ARSI) were administered in 30–39% of patients and docetaxel with 9% in age group 70–74 years and 6% and 3% in age groups 75–79 years and ≥80 years. Regarding mCRPC treatment, significant differences between treatment proportions were observed (p < 0.01). Most common treatment was ARSI for all three groups. Conversely, chemotherapy was more frequently administered in patients aged 70–74 (16%), relative to 4% and 3% in 75‐79 year and ≥80 year aged patients. In univariable and multivariable time to mCRPC analyses, overall survival in mHSPC and OS in mCRPC analyses, no significant differences between all three age groups were observed (all p ≥ 0.3). Conclusions: Treatment patterns differ significantly between older adults with metastatic prostate cancer. However, these differences may not result in differences of overall life expectancy. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the link between severe mental illness and suboptimal physical health • To enhance your knowledge of the complex and multifaceted causes of diagnostic overshadowing • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). People with severe mental illness (SMI) often have suboptimal physical health and associated outcomes. An important issue for mental health nurses to be aware of is diagnostic overshadowing, which occurs when healthcare professionals misattribute a person’s physical health symptoms to their existing mental illness. This misattribution increases the likelihood of delays in treatment, potentially giving rise to complications that further negatively influence health outcomes. While the causes of diagnostic overshadowing are complex and multifaceted, mental health nurses need to ensure that their practice is not a contributing factor, which requires ongoing self-reflection on their knowledge, skills and attitudes. This article defines diagnostic overshadowing, proposes potential explanations for why it may occur and offers practical strategies to prevent it. Raising awareness of diagnostic overshadowing could help to improve physical health outcomes for people with SMI. [ABSTRACT FROM AUTHOR]

Background: Unsafe sex is recognized as an important risk factor for cervical cancer (CC). Understanding the global disease burden of CC attributable to unsafe sex can assist policymakers in allocating healthcare resources. Methods: Data were obtained from the 2019 global burden of disease database (GBD). We examined global, regional, and national levels of CC mortality, disability‐adjusted life years (DALYs), and age‐standardized rates (ASRs) caused by unsafe sex. ASRs were evaluated using estimated annual percentage changes (EAPCs). Results: Attributable to unsafe sex, there were 280,479 CC‐related deaths in 2019 and 8,955,013 CC‐related DALYs. In the period 1990–2019, the global ASRs of CC due to unsafe sex decreased around the world; for age‐standardized mortality rate (ASMR) and age‐standardized DALY rate (ASDR), the EAPCs were −0.93 and −0.95. The highest ASMRs and ASDRs were found in central sub‐Saharan Africa and the lowest in Australasia. Conclusion: In the past few decades, the ASMR and ASDR of CC caused by unsafe sexual practices have decreased over time, with significant variations observed among different countries and regions. Increased focus is needed on spreading awareness about sexual health and promoting CC prevention and screening, particularly in low‐ and middle‐income nations. [ABSTRACT FROM AUTHOR]

Objective: Health inequalities are universal, but their magnitude and determinants vary according to geographic areas, and understanding variations is essential to designing and implementing preventive and corrective policies. Our objective was to evaluate health inequalities in the Maresme region (Catalonia, Spain) and the relationship with socioeconomic indicators. Design: Cross‐sectional ecological study (2017). Site: Maresme region. Participants: Population assigned to any of the Maresme's 21 basic health areas (BHAs). Measures: Sociodemographic, socioeconomic, health, and health resource use indicators published by the Catalan Health Service's Information and Knowledge Unit. Results: Differences observed between BHAs were 49% in mortality, 266% in diabetes incidence, 348% in stroke incidence, and 89% in hospitalizations. In the most compared to the least disadvantaged BHAs, socioeconomic deprivation, as measured by the socioeconomic index (SEI), was 4.6 times greater and the percentage population with low educational attainment (EA) was 3.7 times higher. Greater deprivation was associated with greater prevalence of diabetes, chronic obstructive pulmonary disease, and high blood pressure, and greater incidence of diabetes, ischemic heart disease, and cancer. Likewise, a greater percentage population with low EA was associated with higher premature mortality and avoidable hospitalizations. Conclusion: Great variation exists in socioeconomic, health, and health resource use between the different Maresme BHAs. Socioeconomic deprivation is strongly correlated with the prevalence and incidence of certain chronic diseases, and low EA is correlated with premature mortality and avoidable hospitalizations. Our findings point to the urgency of taking health inequalities into account in designing and implementing healthcare strategies, programs, and policies. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the current status and spatial distribution differences of elderly care service resources supply and demand in China. Methods: Semi‐structured qualitative interviews were utilized to gather participants' insights into the current demands for elderly care services, the status of resource allocation, and related indicators. The entropy weight method was employed to determine indicator weights, yielding objective demand and allocation indices for elderly care service resources. Kernel density estimation was used to illustrate the distribution characteristics of the demand and allocation indices. The coupling coordination degree model was applied to measure the coupling coordination level of China's elderly care service resource supply and demand system in 2020. Results: The demand index ranks highest in Beijing (0.3291), Shanghai (0.2941), and Tianjin (0.2563), while the lowest are found in Tibet (0.1673), Guangxi (0.1727), and Guizhou (0.1737). Kernel density estimation shows that the demand index is concentrated in the range of 0.1800 to 0.2000. The top three regions for allocation index are Shanghai (184.0007), Qinghai (129.8177), and Beijing (109.5941), with the lowest in Liaoning (34.8558), Hainan (35.3168), and Yunnan (36.6366). Kernel density estimation indicates that the allocation index is concentrated in the range of 25–75. Calculations of coupling coordination degree show that Shanghai has high coordination quality (0.9368), Beijing has good coordination (0.8392), while Hainan and Yunnan experience severe imbalances (0.1990, 0.1831). Conclusions: There is a significant lack of coordination between the demand for elderly care services and the allocation of resources in Hainan and Yunnan provinces in China. Most provinces, with the exception of Beijing and Shanghai, exhibit some degree of misalignment. The Chinese government should address the varying needs of the elderly population in different regions, pay timely attention to regional disparities, enhance regional cooperation, and dynamically allocate elderly care resources in a rational manner. [ABSTRACT FROM AUTHOR]

This article utilizes the Panel Study of Income Dynamics to demonstrate how disadvantages in healthy life expectancies accumulated across generations create disparate kin structures among African American families in the United States. The analysis quantifies the overlap in parents' healthy years with their adult children's healthy life expectancies and examines how much the overlap coincides with the adult children's childrearing years. Non-Hispanic Black adults experienced parental illness and death sooner than non-Hispanic White adults, and their parents' poor health coincided longer with their own health declines. Non-Hispanic White adults, on the other hand, enjoyed more years in good health with two healthy parents. The intergenerational accumulation of unequal healthy life expectancies directly translated into unequal kin structures for the subsequent third generation. Race inequities in the intergenerational kin structure and health were greater among women than among men, and non-Hispanic Black women spent the most years raising children in poor health with unhealthy or deceased parents. Disparities in the intergenerational tempos of fertility, mortality, and morbidity are building profound structural racial inequities within a fundamental social institution—the family. [ABSTRACT FROM AUTHOR]

Background: Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. Objective: We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. Design: Qualitative study based on semi-structured telephone interviews. Participants: Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. Approach: We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. Key Results: PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. Conclusions: Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS. [ABSTRACT FROM AUTHOR]

This study aimed to assess the burden of early-onset gastrointestinal (GI) cancers in China over three decades. A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Data on early-onset GI cancers in 2020 and from 1990 to 2019 were extracted from GLOBOCAN 2020 database and GBD 2019, respectively. The average annual percent change (AAPC) was calculated to analyze the temporal trends using the Joinpoint Regression Program. The Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2030. In China, there were 185,980 incident cases and 119,116 deaths of early-onset GI cancer in 2020, with the highest incidence and mortality observed in liver cancer (new cases: 71,662; deaths: 62,412). The spectrum of early-onset GI cancers in China has transitioned over the last 30 years. The age-standardized rates of incidence, mortality, and disability-adjusted life years for colorectal and pancreatic cancers exhibited rapid increases (AAPC >0, P ≤ 0.001). The fastest-growing incidence rate was found in colorectal cancer (AAPC: 3.06, P < 0.001). Despite the decreases in liver, gastric, and esophageal cancers, these trends have been reversed or flattened in recent years. High body mass index was found to be the fastest-growing risk factor for early-onset GI cancers (estimated annual percentage change: 2.75–4.19, P < 0.05). Projection analyses showed an increasing trend in age-standardized incidence rates for almost all early-onset GI cancers during 2020–2030. The transitioning pattern of early-onset GI cancers in China emphasizes the urgency of addressing this public health challenge. [ABSTRACT FROM AUTHOR]

Background: Evidence on type 2 diabetes onset age and duration on mortality risk has been limited by short follow‐up, inadequate control for confounding, missing repeated measurements, and inability to cover the full range of onset age, duration, and major causes of death. Moreover, scarce data dissect how type 2 diabetes onset age and duration shape life expectancy. Methods: We evaluate prospectively these topics based on 270,075 eligible participants in the Nurses' Health Studies and Health Professionals Follow‐up Study, leveraging repeated measurements throughout up to 40 years of follow‐up. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: In fully adjusted analyses, incident early onset type 2 diabetes (diagnosed <40 years of age) was associated with significantly higher mortality from all‐causes (HR, 95% CI was 3.16, 2.64–3.79; vs. individuals without type 2 diabetes), cardiovascular disease (6.56, 4.27–10.1), respiratory disease (3.43, 1.38–8.51), neurodegenerative disease (5.13, 2.09–12.6), and kidney disease (8.55, 1.98–36.9). The relative risk elevations declined dramatically with each higher decade of age at diagnosis for deaths from most of these causes, though the absolute risk difference increased continuously. A substantially higher cumulative incidence of mortality and a greater loss in life expectancy were associated with younger age at type 2 diabetes diagnosis. Longer disease duration was associated with generally higher relative and absolute risk of mortality. Conclusion: Early onset of type 2 diabetes and longer disease duration are associated with substantially increased risk of all‐cause and cause‐specific mortality and greater loss in life expectancy. [ABSTRACT FROM AUTHOR]

Canine mammary tumours (CMT) have histological, clinicopathological and molecular resemblances to human breast cancer (HBC), positioning them as viable models for studying the human disease. CMT initiation and progression occur spontaneously in immune‐competent animals, which challenge the suggested limitations of genetically modified mice, also enabling the evaluation of immunotherapies in canine patients. Dogs have shorter life expectancy compared to humans, and cancer advances more rapidly in this species. This makes it possible to perform studies about the clinical efficacy of new therapeutic modalities in a much shorter time than in human patients. The identification of biomarkers for tumour subtypes, progression and treatment response paves the way for the development of novel therapeutic and diagnostic approaches. This review addresses the similarities between CMT and HBC and the molecular signatures identified in CMT samples that have been explored to date. We proposed a detailed molecular exploration of the CMT stroma using state‐of‐the‐art methods in transcriptomics and proteomics. Using CMT as an analog for HBC not only helps to understand the complexities of the disease, but also to advance comparative oncology to the next level to prove the claim of dogs as a valid translational model. [ABSTRACT FROM AUTHOR]

The life expectancy of people with multiple sclerosis (MS) has increased, yet we have noted that development of a typical Alzheimer disease dementia syndrome is uncommon. We hypothesized that Alzheimer disease pathology is uncommon in MS patients. In 100 MS patients, the rate of amyloid‐β plasma biomarker positivity was approximately half the rate in 300 non‐MS controls matched on age, sex, apolipoprotein E proteotype, and cognitive status. Interestingly, most MS patients who did have amyloid‐β pathology had features atypical for MS at diagnosis. These results support that MS is associated with reduced Alzheimer disease risk, and suggest new avenues of research. ANN NEUROL 2024;96:453–459 [ABSTRACT FROM AUTHOR]

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65–91 years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60 years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea. [ABSTRACT FROM AUTHOR]

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The therapeutic armamentarium of chronic myeloid leukemia (CML) has dramatically improved after small molecule tyrosine kinase inhibitors (TKIs) targeting BCR::ABL1 became available, with a life expectancy now close to that of the general population. Although highly effective, these drugs also have a toxicity profile that is often mild to moderate, but sometimes severe. Indeed, long‐term treatment with TKIs can lead to chronic adverse events that can negatively affect patients' quality of life and can promote significant morbidity and mortality, particularly in the case of second‐ or third‐generation TKIs. Treatment discontinuation has therefore become an emerging goal for CML patients and numerous studies have evaluated in off‐TKI subjects what requirements are appropriate for an attempt at treatment‐free remission (TFR). TFR eligibility is currently limited to a small population of subjects with both deep and sustained molecular responses to TKIs. For those attempting TFR, average success rates are promising, with 25%–30% of patients experiencing prolonged TFR. In case of failure to maintain sustained TFR, safety results to date are reassuring, with almost all patients responding successfully to resumption of TKIs, and advanced‐phase disease progression representing a very rare event. The purpose of this review is to discuss guidelines for TKI discontinuation, clinical advances from clinical trials and real‐life experiences, and describe areas of research, particularly regarding the biological factors capable of predicting the success of TFR. [ABSTRACT FROM AUTHOR]