The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3 6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specificity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62-0.65, 0.59-0.63 and 0.60-0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specificity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specificity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specificity, whereas sensitivity was higher for the GFI and TFI.
The European Journal of Ageing enters the new decade with its seventh volume. By now, the Journal has built up a substantial readership, a wide network of reviewers, and receives a growing stream of submissions from many countries in Europe as well as from many other parts of the world. We as editors are grateful for the active efforts of all contributors. The year 2010 also marks an important event: the Journal will receive an impact factor from Thomson ISI. This first impact factor is calculated for the year 2009, and will be based on citations in 2009 to Journal articles from 2007 to 2008. It is expected to be published by June, 2010. Please watch the Springer website for its release. No doubt, the publication of an impact factor will contribute to the viability of the Journal. Now we have put six years past us, it is time to take stock of the Journal’s development. Did the Journal live up to its mission statement to ‘understand ageing in Europe and the world over’? In other words, from which countries exactly are published articles originating? And to what extent do published articles reflect collaboration between countries? A further part of the mission statement is ‘to publish original articles on the social, behavioural and health-related aspects of ageing and encourage an integrated approach between these aspects.’ This leads to questions such as: To what extent were published articles interdisciplinary in content? Can a development be seen towards more interdisciplinarity? The editors have addressed these questions by building a dataset of all published articles through 2009. In this period, 159 articles were published, including editorials and reports. When the six editorials by the editors-in-chief are disregarded, this makes 153 publications. Excluding other editorials and reports, the article count is 146. Let us first address the origins of the published articles. In Table 1, it can be observed that the first volume was strictly European—which does seem proper for the opening issue of a European journal. This volume in fact consisted of one special issue, with all contributions invited by the editors. However, through the following years, the percentage of contributions from other parts of the world increased, with a maximum of 26% in volume 5. The bottom row of Table 1 shows the percentage of contributions that were co-authored by scholars from countries different from the first author’s. Volume 1 scores highest with 67% cross-national contributions, corresponding to the theme of this special issue: ‘Cross-European research’. It is good to see that in the subsequent volumes, the percentage of cross-national collaborative articles increased to 31 in volume 6. Nevertheless, it is obvious that the majority of publications stem from Northern and Western Europe. Specific countries that contributed most were Germany, Sweden and the United Kingdom with around 20 articles each. From other parts of the world, Hong Kong and Lebanon are worth mentioning as contributors. Two parts of the world that are missing in this list are Eastern Europe and Latin America, although especially Eastern European scholars did co-author some contributions. Table 1 Country of first author (%) from volume 1 (2004) to volume 6 (2009) Turning to the disciplinary content of the contributions, Table 2 shows the number of disciplines, broadly defined as ‘social’, ‘behavioural’, and ‘health’, addressed in published articles. These counts are limited to the original investigations and the reviews, while the editorials and reports are disregarded. Again, volume 1 stands out with the highest percentage of articles addressing all three disciplines, corresponding with its intended profile. In the subsequent volumes, there is considerable fluctuation in content, which seems a normal pattern for a journal that publishes a modest 30 articles yearly. Nevertheless, it is good to see that in total (last column), just over half (52%) of the contributions are based on at least two disciplines. A further observation from Table 2 is that methodological articles are scarce. Table 2 Interdisciplinary content (%) from volume 1 (2004) to volume 6 (2009) Other bits of information can be derived from the article data, such as the facts that EJA published 11 reviews that from the 125 original investigations 3 had a qualitative approach and 3 used mixed methods, and that we had 10 contributions in the section ‘Critical positions in ageing research’. Furthermore, 95 (66%) of the research articles were submitted on the initiative of the author as opposed to recruited by the editors (e.g. for special sections). Finally, nine guest editors were responsible for articles published in special sections. In all, these data provide a profile of the European Journal of Ageing as distinct from other journals. First, it is concentrated on Europe but not exclusively so. Second, it is a forum for a growing number of cross-national collaborative publications. Third, it publishes preferably interdisciplinary research—according to some scholars, the only type of research that leads to proper insight into ageing. The data also show some areas where we could direct more efforts. In the first place, it would be good to encourage submissions of articles with first authors from other parts of the world than Northern and Western Europe, in particular Eastern European articles. As a second point, it also seems good to encourage more submissions using qualitative approaches—exclusively or in combination with quantitative approaches. As a third point, only a small minority of the articles published addressed methodological issues. Elaborating on the latter point, the editors are convinced that research on ageing is still developing further and should be accompanied by methodological advances. We feel that here special encouragement is needed. Therefore, from this seventh volume we launch, as a twin sister to our section on ‘Critical positions in ageing research’, a new section on ‘Methodological issues in ageing research’. This section will provide an option for authors to communicate methodological problems, challenges, solutions, or directions to go that are important to research on ageing, and to cross-European research on ageing in particular. Specific topics may include challenges related to translation doing quantitative or qualitative research, cross-country sampling strategies, rigorous cross-country comparisons using both good theory and good statistics, and measurement instrument development. The format of such articles may deviate from the standard Introduction–Methods–Results–Discussion structure. Perhaps needless to state, contributions submitted for this section will undergo regular review. With this section, EJA aims to further profile itself as a journal that supports the badly needed development of methodological standards of ageing research across Europe and the world over. Let us now turn to the current issue 1 of volume 7. Two of the articles seem to be immediate responses to the points that we concluded need more attention: they are from authors in South Europe (Bilotta et al. 2010; Sousa et al. 2010). One of these is based on qualitative methods and is moreover innovative in that it addresses a common issue of life which has received very little attention from researchers so far: the inheritance process (Sousa et al. 2010). In the other two articles, we recognise the predominance of contributions from Western Europe: one is from Germany, reporting on the highly relevant issue of socioeconomic differences in health (Schollgen et al. 2010) and the other, a review paper, from the Netherlands addressing another highly relevant issue: prevention of disability in frail older persons (Daniels et al. 2010). This collection of articles certainly represents a good start of the new decennium for the EJA.
This editorial refers to ‘Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction’† by H. Bueno et al ., on page 1705 Free wall rupture (FWR) is a catastrophic mechanical complication of ST segment elevation myocardial infarction (STEMI), which occurs in up to 8% of patients and is responsible for nearly 20% of all infarction-related deaths. In fact, next to cardiogenic shock due to pump failure, FWR is the most common mechanical cause of death in STEMI patients, occurring eight to 10 times more frequently than rupture of a papillary muscle or rupture of the interventricular septum. Although the vast majority of FWRs occur within the first week following symptom onset, up to half occur within the first 24 h. FWR primarily affects the left ventricle and complicates anterior and inferior infarctions similarly. When FWR occurs, the clinical presentation is dramatic, with the rapid development of hypotension, cardiac tamponade, pulseless electromechanical activity, and death. Unfortunately, the mortality rate is >90%, and few patients can be salvaged by anything other than heroic measures, including emergent pericardiocentesis and surgical repair. Both the choice and the timing of reperfusion therapy for STEMI have been implicated in the development of FWR. Early studies of STEMI patients randomized to fibrinolytic therapy (FT) or placebo showed a paradoxical increase in early mortality in those treated with FT, which could not be explained by an increase in stroke or major bleeding; this early mortality was attributed to the development of FWR. More recently, data from studies comparing primary percutaneous coronary angioplasty (PCI) with FT showed a significantly lower risk of FWR in patients treated with primary PCI.1 Several possible mechanisms have been proposed … *Corresponding author. Tel: +1 214 645 7528; fax: +1 214 645 7501. E-mail address : james.delemos{at}utsouthwestern.edu
2012 as the European Year for Active Ageing and Solidarity between Generations. This action indicates an increased awareness of the urgency to make progress in finding solutions to what some perceive as the ''problems'' of ageing societies. However, ageing societies also present opportunities for Europe. Based on the premise that Europeans are living longer and staying healthier than ever before, the European Commission states that the time has come to realise these opportunities. Hence, the main aims of this year are stated as: maintaining the vitality of older people, enhancing their involvement in society and removing barriers between generations. The emphasis clearly is on employability and workability, given the dramatic demographic shifts in the workforce all over Europe, but also on living independently, health care, social services, adult learning, volunteering, housing, IT services and transport. Under the flag of Europe, a series of initiatives are launched, ranging from conferences and events, information campaigns to exchange of information and best practice. Many national, regional and local authorities as well as social partners and businesses in Europe launch initiatives in parallel. These initiatives should raise awareness, stimulate debate and have a real impact on fostering a sustainable active ageing culture.
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This article is accompanied by the following Invited Commentary: Longrois D, Hoeft A, De Hert S. 2014 European Society of Cardiology/European Society of Anaesthesiology guidelines on non-cardiac surgery: cardiovascular assessment and management. A short explanatory statement from the European Society of Anaesthesiology members who participated in the European Task Force. Eur J Anaesthesiol 2014; 31:513–516. ESC Committee for Practice Guidelines: Jose Luis Zamorano (Chairperson) (Spain), Stephan Achenbach (Germany), Helmut Baumgartner (Germany), Jeroen J. 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Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? 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DiLello, Karen Mulvihill, Jennifer Delli Carpini, Riddhi Shah, Julia Hermanowski, and Damanjeet Chaubey29 October 2018 | Journal of Palliative Medicine, Vol. 21, No. 11Understanding, assessing, and in the spiritual of medical and October 2018 | Theology, Vol. 11, No. and of in Living with October 2018 | Journal of & Social Services, Vol. No. for the spirituality as October 2018 | Revista de Vol. 71, No. An of an aged psychiatry March 2018 | Psychiatry, Vol. 26, No. de de vida de de Vol. 25, No. support and with in Care in the Care A Narrative June | Journal of Care Medicine, Vol. No. Care in Cancer: in the of of Clinical Oncology Educational Vol. 3, No. religion/spirituality in clinical practice: A among social and and October | Journal of Clinical Psychology, Vol. 74, No. Spirituality in Care December | Journal of Religion and Health, Vol. 57, No. of to spiritual care at the of a phenomenological exploration from the of palliative care February 2018 | Journal for the Study of Spirituality, Vol. 8, No. Existential Distress in Pediatric Cancer December and Patient Spiritual in the through October of Spirituality in November Psychological/Psychiatric, Social, and Spiritual Problems and July and End-of-Life Care in Cancer in Oncology Nursing, Vol. No. Care in Hospice and Palliative Journal of Hospice and Palliative Care, Vol. 20, No. and Spirituality: Literature review and Journal of Counseling, Vol. 18, No. of the tool existential communication between and cancer August | European Journal of General Practice, Vol. 23, No. Education and of Christian Nursing, Vol. 34, No. Care Interventions in to and Therapy C. and D. September | Journal of Palliative Medicine, Vol. 20, No. in Patients with A Qualitative September | Journal of Research in Nursing and Vol. 14, No. theory on the and in an exploratory case study September | Vol. 69, No. of the of Spirituality and Palliative Care Research and of Pain and Symptom Management, Vol. No. of a spiritual care training program for staff on November | Palliative and Supportive Care, Vol. 15, No. 4Spiritual distress and spiritual care in advanced heart July | Reviews, Vol. and Spiritual Patient Simulation in Nursing, Vol. No. Vol. 42, No. 4The impact of a spiritual in patients with and and their support December | Vol. 26, No. 3The Importance of a Spiritual History in Healthcare Vol. No. About Substance Use DisordersJournal of Psychosocial Nursing and Mental Health Services, Vol. No. and Spiritual Beliefs of April | Journal of Religion and Health, Vol. No. Care Perceptions of and With of Hospice & Palliative Nursing, Vol. 19, No. in Substance Use What to Know to Practice30 November | in Mental Health Nursing, Vol. 38, No. End-of-Life Care to Religious and Vol. No. of Social Education, Vol. 53, No. Nursing Care and of Christian Nursing, Vol. 34, No. 1The of taking a religious and spiritual July | Psychiatry, Vol. 24, No. religion and spirituality in Vol. No. the role of religious in the at the of of Vol. No. care spiritual March | Supportive Care in Cancer, Vol. 24, No. Spiritual Care and the Role of An Review of Literature and April | Journal of Religion and Health, Vol. No. of the Spiritual Needs of of with Is in the June | Journal of Palliative Medicine, Vol. 19, No. Impact of a Tool for Comprehensive Assessment of Palliative Care on Assessment at and of Pain and Symptom Management, Vol. No. from Healthcare Students to Understand Spiritual Assessment in Clinical Practice29 October | Journal of Religion and Health, Vol. No. Spirituality in January | Journal of Religion and Health, Vol. No. 3Development and of to Assess Nurse Provision of Spiritual August 2014 | Journal of Holistic Nursing, Vol. 34, No. and Validation of the Practice Assessment September 2014 | Research on Social Practice, Vol. 26, No. and the Medical A of July | Journal of Health Care Chaplaincy, Vol. 22, No. history taking in palliative care: A controlled September | Palliative Medicine, Vol. 30, No. Is Is Using A and the Life With American in Spiritual March | Journal of in Mental Health, Vol. 11, No. and spiritual in September | International Journal of and Mental Health, Vol. No. 1The of Hospital to and Patients’ Spiritual A May | Journal for the Study of Spirituality, Vol. No. 1The and to March End-of-Life Spiritual March in Holistic Patient Journal of Nursing, Vol. No. of spiritual assessment for older September 2014 | and Vol. No. und der der Care, Vol. No. Spirituality and A for Holistic January | Journal of Religion and Health, Vol. No. and Belief, in Care spiritual history tool by C. M. Puchalski as an for an interdisciplinary in January | Journal for of and Social Vol. 21, No. the of Spiritual A Pain and Palliative Care Service Quality of Pain and Symptom Management, Vol. No. of Spiritual Assessment in September | Vol. No. the of Christian Nursing, Vol. 32, No. 4Spiritual care: is the assessment tool for palliative Journal of Palliative Nursing, Vol. 21, No. und Spiritualität in der September | Vol. 60, No. of September of spirituality assessment in palliative care patients in November 2014 | Progress in Palliative Care, Vol. 23, No. 4The for Spiritual A Mixed-Methods July | Oncology Nursing Vol. 42, No. 4The Integration of Religion and Spirituality in Social Practice: A May | Social Vol. 60, No. 3The and Educational of a Spiritual Life Review for Patients with and June 2014 | Journal of Cancer Education, Vol. 30, No. in Geriatric Palliative in Geriatric Medicine, Vol. No. An for Spiritual Well-Being May | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 34, No. Spiritual Assessment March | Journal of Health Care Chaplaincy, Vol. 21, No. American on Mental Health, and Help April | and Vol. 60, No. of Christian Nursing, Vol. 32, No. the Spiritual Needs and of Oncology Patients in Nursing Practice, Vol. 29, No. Care Training to Healthcare Professionals: A Systematic April | Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications, Vol. 69, No. analysis of spiritual
Previous article Next article The Limiting Behavior of a One-Dimensional Random Walk in a Random MediumYa. G. SinaiYa. G. Sinaihttps://doi.org/10.1137/1127028PDFBibTexSections ToolsAdd to favoritesExport CitationTrack CitationsEmail SectionsAbout[1] H. Kesten, , M. W. Koslow and , F. Spitzer, A limit law for random walk in a random environment, Compositio Math., 30 (1975), 145–168 52:1895 0388.60069 Google Scholar[2] Fred Solomon, Random walks in a random environment, Ann. Probability, 3 (1975), 1–31 50:14943 0305.60029 CrossrefGoogle Scholar[3] G. Ritter, Masters Thesis, Random walks in a random environment, critical case, thesis, Cornell University, lthaca, NY, 1976 Google Scholar[4] R. A. Minlös and , A. M. Khalfina, A two-dimensional limit theorem for the number of particles and the energy in the grand canonical ensemble, Izv. Akad. Nauk SSSR Ser. Mat., 34 (1970), 1173–1191, (In Russian.) 42:8847 Google Scholar[5] V. V. 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HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. 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Previous article Next article Convergence Conditions for Ascent MethodsPhilip WolfePhilip Wolfehttps://doi.org/10.1137/1011036PDFBibTexSections ToolsAdd to favoritesExport CitationTrack CitationsEmail SectionsAboutAbstractLiberal conditions on the steps of a “descent” method for finding extrema of a function are given; most known results are special cases.[1] Haskell B. Curry, The method of steepest descent for non-linear minimization problems, Quart. Appl. Math., 2 (1944), 258–261 MR0010667 0061.26801 CrossrefGoogle Scholar[2] Augustine Cauchy, Méthode générale pour la résolution des systèmes d'équations simultanées, C.R. Acad. Sci., 25 (1847), 536–538 Google Scholar[3] A. A. Goldstein, Minimizing functionals on normed-linear spaces, SIAM J. Control, 4 (1966), 81–89 10.1137/0304008 MR0196900 0147.12701 LinkGoogle Scholar[4] A. A. Goldstein, Cauchy's method of minimization, Numer. 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SIAM control, 5 (1967), 268–274 10.1137/0305018 0158.18805 LinkGoogle Scholar[14] Philip Wolfe, on the convergence of gradient methods under constraints, Rep., RZ-204, IBM watson research center, yorktown heights, new york, 1966 Google Scholar Previous article Next article FiguresRelatedReferencesCited ByDetails Two efficient modifications of AZPRP conjugate gradient method with sufficient descent propertyJournal of Inequalities and Applications, Vol. 2022, No. 1 | 10 January 2022 Cross Ref Optimal Transport Based Seismic Inversion:Beyond Cycle SkippingCommunications on Pure and Applied Mathematics, Vol. 75, No. 10 | 1 April 2021 Cross Ref A robust BFGS algorithm for unconstrained nonlinear optimization problemsOptimization, Vol. 17 | 19 September 2022 Cross Ref Two Methods for the Implicit Integration of Stiff Reaction SystemsComputational Methods in Applied Mathematics, Vol. 0, No. 0 | 14 September 2022 Cross Ref Simple and fast convergent procedure to estimate recursive path analysis modelBehaviormetrika, Vol. 107 | 6 September 2022 Cross Ref Adaptive three-term PRP algorithms without gradient Lipschitz continuity condition for nonconvex functionsNumerical Algorithms, Vol. 91, No. 1 | 20 January 2022 Cross Ref A Hybrid Stochastic Deterministic Algorithm for Solving Unconstrained Optimization ProblemsMathematics, Vol. 10, No. 17 | 23 August 2022 Cross Ref Pseudospectral methods and iterative solvers for optimization problems from multiscale particle dynamicsBIT Numerical Mathematics, Vol. 48 | 11 August 2022 Cross Ref An outlier-resistant κ -generalized approach for robust physical parameter estimationPhysica A: Statistical Mechanics and its Applications, Vol. 600 | 1 Aug 2022 Cross Ref An Active Set Trust-Region Method for Bound-Constrained OptimizationBulletin of the Iranian Mathematical Society, Vol. 48, No. 4 | 27 July 2021 Cross Ref Advancing Three-Dimensional Coupled Water Quality Model of Marine Ranches: Model Development, Global Sensitivity Analysis, and Optimization Based on Observation SystemJournal of Marine Science and Engineering, Vol. 10, No. 8 | 27 July 2022 Cross Ref Robust regression against heavy heterogeneous contaminationMetrika, Vol. 16 | 1 July 2022 Cross Ref A new class of nonlinear conjugate gradient coefficients for unconstrained optimizationAsian-European Journal of Mathematics, Vol. 15, No. 07 | 14 October 2021 Cross Ref New iterative conjugate gradient method for nonlinear unconstrained optimizationRAIRO - Operations Research, Vol. 56, No. 4 | 29 July 2022 Cross Ref Optimizing Oblique Projections for Nonlinear Systems using TrajectoriesSamuel E. 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OBJECTIVES: To gain an understanding of elderly people's fear of falling by exploring the prevalence and determinants of perceived and physiological fall risk and to understand the role of disparities in perceived and physiological risk in the cause of falls. DESIGN: Prospective cohort study. SETTING: Community sample drawn from eastern Sydney, Australia. PARTICIPANTS: 500 men and women aged 70-90 years. MAIN OUTCOME MEASURES: Baseline assessment of medical, physiological, and neuropsychological measures, with physiological fall risk estimated with the physiological profile assessment, and perceived fall risk estimated with the falls efficacy scale international. Participants were followed up monthly for falls over one year. RESULTS: Multivariate logistic regression analyses showed that perceived and physiological fall risk were both independent predictors of future falls. Classification tree analysis was used to split the sample into four groups (vigorous, anxious, stoic, and aware) based on the disparity between physiological and perceived risk of falling. Perceived fall risk was congruent with physiological fall risk in the vigorous (144 (29%)) and aware (202 (40%)) groups. The anxious group (54 (11%)) had a low physiological risk but high perceived fall risk, which was related to depressive symptoms (P=0.029), neurotic personality traits (P=0.026), and decreased executive functioning (P=0.010). The stoic group (100 (20%)) had a high physiological risk but low perceived fall risk, which was protective for falling and mediated through a positive outlook on life (P=0.001) and maintained physical activity and community participation (P=0.048). CONCLUSION: Many elderly people underestimated or overestimated their risk of falling. Such disparities between perceived and physiological fall risk were primarily associated with psychological measures and strongly influenced the probability of falling. Measures of both physiological and perceived fall risk should be included in fall risk assessments to allow tailoring of interventions for preventing falls in elderly people.
Today, nurse leaders in most developed countries are confronting the reality of a nursing workforce that is rapidly ageing at a time when healthcare demands are increasing. McIntosh et al. (2010) suggest that the shift toward an aging nursing workforce has significant implications. Organisations will need to consider ways to build supportive cultures, teach the workforce about generational diversity, rethink the way that work is done and pay closer attention to ergonomics and job engineering. Yet, Hill (2011) points out that myths persist about ageing and that research and evidence-based practices are noticeably absent from the nursing literature. Finding solutions to complex workforce problems requires that nurse leaders adopt more of a worldview as they look for best practices and creative strategies (Clark 2011). This issue of the Journal of Nursing Management is very timely. Nurse experts and researchers with a special interest in the ageing nursing workforce have contributed evidence-based work and innovative ideas to support nurse leaders in their strategic planning. There are currently 57 countries considered by the World Health Organization to be in a crisis relative to their work force (WHO, 2010). It is widely understood and accepted that across developed countries, health care systems are also facing major challenges due to changes in ageing demographics. An ageing population and the consequent rise in chronic and long-term conditions will be key drivers of change increasing demand for health services and requiring new forms of treatment and delivery systems tailored to the needs of older persons. At the same time, the graying of the nursing workforce mirrors the trend towards population ageing. Although many countries are considering workforce policy changes that could delay the retirement of nurses, it is unlikely that these policies will take effect early enough to substantively change the current projected losses. A recent RN4CAST project (Filkins 2011) funded by the European commission projected a shortage of 600 000 nurses across Europe by 2020. Large numbers of nurses are expected to leave the workforce in developed countries during the next two decades, just when geriatric competence will be in higher demand due to unprecedented acceleration in population ageing (EU Commission, 2012). Indeed, the scarcity of qualified health personnel including nurses has been highlighted as one of the biggest obstacles globally to achieving health system effectiveness and this problem is expected to intensify over time (Buchan & Aiken 2008). In developed countries, a primary force behind population ageing has been the transition from high to low fertility rates. Falling fertility and increases in life expectancy have serious implications for the labor force. In most Organization for Economic Co-operation and Development (OECD) member countries, a declining ratio of young and working-age people to retirees will place significant stress on public budgets and pension systems. The OECD estimates that by 2015, the number of people retiring will outnumber entrants to the workforce (Warmuth 2008). The problem is equally serious in the United States where the average age of a nurse is 47 (U.S. Department of Health & Human Services, HRSA 2010). Future workforce projections indicate that there could be a shortage of up to 250 000 nurses by 2025 (Buerhaus et al. 2009). Although the recent economic downturn has postponed the early retirement of many nurses, more than one third of the RN workforce are between the ages of 50 and 64 (Buerhaus et al. 2013). Confronting these problems will require strong nursing leadership but this group is also ageing, and succession planning is proving to be challenging. Westphal (2012) analysed the ages of nurse leaders as reported in the US National Nursing Sample from 1992–2008 and found a progressive increase in age over time. Wendler et al. (2009) have predicted that up to 75% of the nurse leaders in the United States workforce will retire by 2020. Their loss threatens the smooth continuity of healthcare delivery. Traditional methods to address the nursing shortages such as increasing educational capacity, improving RN productivity and international recruitment may not be adequate considering the long-term prospects of a declining population with fewer entrants into the workforce. To minimize workforce shortages and meet the increasing demands for healthcare of an ageing population, employers will be required to develop new employment strategies to induce older nurses to extend their working life. The challenges involved with leading an ageing nursing workforce require careful strategic planning. The articles in this issue address three key issues. These include retaining the ageing nurse in the workforce, building healthy environments to accommodate an ageing workforce and succession planning for the future. Though it is clear that proactive initiatives are needed to build a future workforce, there is also a need to focus on retaining nurses longer in the workforce so their expertise can be shared and their knowledge transferred. Some organisations have already begun the work of making changes which may encourage the older nurse to stay. In the United States AARP (N.D) annually awards those organisations recognized to be the top 50 best employers for employees over the age of 50. Healthcare organisations such as Atlantic Health System, Mercy Health System, Massachusetts General Hospital and Kaiser Permanente, as well as others qualified for this honor in 2011. Common threads in the selection of these organisations include evidence of considerable respect for their employees, active recruitment of employees over the age of 50, recognition of employee work, encouraging voice in decision making and providing meaningful feedback. There are tools that can be helpful in planning. The Older Worker Lure Scale (OWL) (McIntosh et al. 2010) can be utilised to assess priorities and employee needs so realistic interventions can be planned. The OWL asks employees about their interest in continuous development, career opportunities, formal career ladder, succession planning, tuition reimbursement, in-service education support, age diversity training and recruitment of older nurses. It also allows the employees to rate their organisation's efforts in the implementation of best practices to accommodate an ageing workforce. The scale provides good direction for strategic planning but many of the factors such as flexibility of hours and shifts continue to be problematic in today's healthcare environment and impact retention. Ageing nurses frequently complain about leadership rigidity in shift scheduling. In the United States, it is not uncommon for nurses to be given no option but to work 12 hour tours. Any discussion of their elimination or reduction evokes passionate arguments on both sides of the issue. Yet the evidence for the negative impact of 12 hour tours which includes staff fatigue, medical errors and patient dissatisfaction continues to grow (Stimpfel et al. 2012, Geiger-Brown & Trinkoff 2010). In this issue, authors Clendon and Walker (pp. 903–913) explore the impact of shiftwork in their research with nurses in New Zealand. They found that nurses report a decreasing tolerance for working night shift as they age and poor scheduling practices that did not allow for adequate rest were particularly detrimental to older nurses. Letvak, Gupta and Ruhm (pp. 914–921) were interested in whether there were differences between older and younger nurses in their overall health, productivity and quality of care delivered. Their research includes an analysis of data from over 1000 nurses working in North Carolina. They found no differences in the quality of care; but that nurses over 50 had higher BMIs (body mass index), better mental health scores yet reported higher pain scores and a 12% higher prevalence of having health problems that resulted in lost productivity. They ask intriguing questions about whether the complex patients care assignments often given to older nurses should be reconsidered to retain them in the workforce. Finally, Frank (pp. 922–926) explores another dimension of the ageing workforce, the ageing of nursing faculty. Her commentary is about her own experience in a phased retirement program which could be a promising solution for educational institutions confronting faculty shortages. There is growing evidence in the nursing literature about the positive impact of healthy work environments on staff satisfaction, retention, improved patient outcomes and organisational performance. Building on work begun by the American Association of Critical-Care Nurses (2005), many organisations have launched efforts to improve their work environments in an effort to retain staff. Magnet designation which has now been achieved by more than 390 hospitals globally (ANCC, 2013) is an example of an important initiative for organisations that seek to build professional practice environments that are healthy and support the work of nurses. In a review of research looking at the nursing shortage and intent to leave, Chan et al. (2013) identified that work environment, culture, commitment, work demands and social support were key organisational predictive factors. There has been little written in the literature that specifically addresses older nurses and retention. In this issue, our authors present some creative strategies to retain the ageing workforce which include initiatives such as improving work engagement, reducing bullying, and environmental design to better accommodate older nurses. Havens, Warshawsky and Vasey (pp. 927–940) report on their research done in five rural US hospitals where they found no statistically significant differences in the level of engagement across generations but confirmed that professional practice environments are associated with higher levels of work engagement in all generational groups. Bishop (pp. 941–949) presents promising program evaluation research on a caring-based initiative that was specifically designed to re-engage staff by revitalizing the internal motivation and self-reward that brought them into nursing. Longo tackles the important issue of bullying. Most of the nursing literature on bullying explores the impact on new graduates. Longo (pp. 950–955) points out that nurses of all ages can be bullied and it does impact the retention of older nurses. Finally, Stichler (pp. 956–964) did a synthesis of the current literature and describes the physical challenges that ageing nurses experience and how facility design features can help to reduce these challenges. She makes a strong case that design features that promote healthier work environments can motivate nurses to continue working. The looming retirements of significant numbers of baby-boomer nurses and nurse leaders during the next 10 years is usually presented in the literature within the context of anticipated nursing shortage vacancies and replacement costs. Less discussed is what the impact of lost knowledge that these nurses have gained through years of experience and will take with them could have on patient care, healthcare organisations and the profession of nursing. Hatcher et al. (2006) authors of the Robert Wood Johnson Foundation report on Wisdom at Work observed that while the retention of older nurses in the workforce for as long as possible is an important goal, inevitably they will begin to retire. They are concerned that with a large number of retirements occurring in a short period of time, younger nurses are likely to get pushed into jobs that they are not prepared to do in a very complex healthcare environment. The knowledge and expertise of nurses can be difficult to articulate because it is often abstract and dynamic and reflects a set of complex interdependencies and experiences. Patricia Benner (2000) recognised this in her work on how nurses move from being novices to experts. Benner's model is widely used in nursing today as a framework for understanding how the knowledge, skills and abilities that nurses developed over time in their work impacts their practice. In this issue, Cathcart and Greenspan (pp. 964–970) beautifully illustrate one creative way to capture this wisdom in their work with nurse managers using narratives. This is why succession planning at all levels of the organisation is important. Titzer, Phillips, Tooley, Hall and Shirey (pp. 971–979) present a comprehensive synthesis of the evidence on nurse manager succession planning. Based on their review, they recommend that nurse manager succession planning needs to be deliberate because new managers take months to adapt to their new positions. Trepanier and Crenshaw (pp. 980–985) examine succession planning in acute care hospital settings. They present a business case for the importance of succession planning and provide practical strategies for nurse executives to consider in designing programs. There are no easy answers to this global challenge confronting nurse leaders. The editors would like to thank all of the authors for their thoughtful work on this important topic. We hope the readers will find these articles both thought provoking and helpful in designing strategies to proactively manage the global challenge of the ageing nursing workforce.
The hepatitis C virus (HCV) epidemic affects about 2.35% of the worldwide population, i.e. an estimated 160 million individuals (1). The limitations of current estimates, largely based on outdated sources or surveys on samples that are poorly representative of the general population, have been emphasized recently (1). Further difficulties arise when attempting to quantify the HCV-associated liver disease burden, for which estimates are partially available and only for selected, resource-rich countries. The picture is complicated if one considers that, because of ageing of the currently HCV-infected population, the burden of hepatitis C is expected to increase in the medium term. A study from USA (2) has shown that ageing of the HCV-infected population has already resulted in a significant increase in the prevalence of cirrhosis and hepatocellular carcinoma (HCC) cases reported in that country during the period 1996–2006. According to another work from the same country (3), the number of HCV-related cirrhosis cases is estimated to increase by 24% and that of decompensated cirrhosis cases by 50%. Unfortunately, similar accurate studies from other areas of the globe are lacking. It must be added that a synergistic effect on morbidity and mortality is anticipated because of the overlapping worldwide epidemics of HCV and the metabolic syndrome and therefore, the above estimates should be considered as conservative. Clearly, better data to estimate the baseline and trends of the HCV epidemic are urgently needed in order to plan effective prevention and management strategies. Here, we present a series of manuscripts relating a systematic analysis of the HCV epidemiology literature, including an entire series of non-indexed sources that may constitute a framework for a better and more detailed appreciation of the global HCV epidemic. The last comprehensive global overview of HCV epidemiology was completed by WHO in 1999. Our goal was to develop an updated global analysis using sentinel countries in three regions, i.e. America, Europe and Asia/Australia (Fig. 1). In addition, we wanted to create a comprehensive reference for researchers working in this field. Thus, we were sure to include studies that we reviewed. Our decision to select countries was driven by two factors: the country had to provide adequate representations of the region and there had to be some HCV epidemiology studies available. Over 27 000 articles and documents from indexed journals and other non-indexed sources were screened. About 2600 items were selected based on relevance. When multiple data sources were available for any given key assumption, a systematic process using multi-objective decision analysis was used to select the most appropriate sources (4–7). When data were missing, analogues were used. The analysis focused on data relating to incidence and prevalence, major modalities of transmission, diagnosis rates and the relative proportion of HCV genotypes and subtypes. In addition, a patient flow model was developed to estimate treatment uptake and future trends. Hepatitis C virus prevalence among adults and genotype distribution. When evaluating the HCV epidemiology, we realized that there were inherent limitations to our analysis, making comparison across countries difficult. The total number of HCV infections was not consistently analysed from country to country. In some countries, for example Australia, great care was taken to estimate the size of high-risk populations (e.g. injection drug users) and include them in the overall prevalence rate. In other countries, including USA and western European countries like France and Germany, the overall HCV prevalence was based on general population studies, which likely excluded many drug users and institutionalized individuals, thus leading to an underestimation of the true prevalence rate. For example, a study by Chak et al. (8) showed that the prevalence in USA is 27% higher if HCV infection among under-represented populations was added to NHANES estimates. In other countries, like Switzerland and India, the best estimate for the overall prevalence was derived from blood bank and/or pregnant women studies, which also underestimated the true infection rate. Although the inconsistencies made direct comparison of one country vs another difficult, it did highlight the fact that the true prevalence of HCV infection was likely to be higher than what is reported here and in other reports. Across the board, there were no good data sources for the number of new infections. This is a major gap that makes efforts to eradicate the disease difficult. When data were reported, the distinction between acute and chronic cases was not always clear. In a report by Rantala and ECDCP, countries that had a robust registry (e.g. Sweden) appeared to have a much higher rate of new infections (9). In reality, the reported numbers were actually newly diagnosed cases, which included both acute and chronic infections. Thus, countries with a good surveillance system may sometimes appear to have a higher incidence. In the first manuscript, Kershenobich et al. (10) describe a tool that was developed to predict the future prevalence of the disease in different countries and, more importantly, to understand the cause and effect relationship between key assumptions and future trends. It was applied to the US HCV-infected population, where the prevalence was estimated to decline 24% from 3.15 million in 2005 to 2.47 million in 2021, while the HCV-associated disease burden increased as the surviving infected population aged. During the same period, the mortality rate was forecasted to increase from 2.1 to 3.1%. The diagnosed population was 50% of the total infections, while the treatment uptake was <2% of the infected population. Using US data as a model, these authors built a framework to analyse the baseline and trends of HCV-infected populations in other countries around the world. Applying this framework to Argentina, Brazil, Mexico and Puerto Rico showed that the number of HCV-infected individuals in this region is steady or increasing (11). It is evident that Latin American countries have been very active in screening blood supplies, thus minimizing the risk of transmission through transfusion. However, as in most western countries, other risk factors are currently playing a major role in accounting for new infections. The number of diagnosed and treated patients is low or very low, thus increasing the burden of complications such as cirrhosis or HCC in the near and medium term. The following manuscript relates the epidemiology of HCV in most European countries, plus Canada and Israel (12). Here, HCV prevalence was generally low, ranging between ≤0.5% (northern European countries) and ≥3% (Romania, rural areas in Greece, Italy and Russia). Differences in prevalence were explained by local variability in transmission routes or public health measures. The main risk for HCV transmission in countries with well-established HCV screening programmes and lower HCV prevalence was injection drug use. In other regions, however, it seems as if contaminated glass syringes and nosocomial infections continue to play an important role in transmission. Interestingly, in this relatively resource-rich region, immigration from endemic countries was sometimes a major factor impacting the total number of HCV-infected persons: approximately 70% of cases in Israel, 37% in Germany and 33% in Switzerland were not born in the country. These data underline the high heterogeneity of HCV epidemic across Europe, Canada and Israel. Although the HCV pandemic has been systematically studied and characterized in North America and Europe, it has not received equivalent attention in other regions. The objective of the last manuscript was to characterize HCV epidemiology in selected countries of Asia, Australia and Egypt, i.e. in a geographical area inhabited by over 40% of the global population (13). Thus, a substantial proportion of the global HCV health burden lives in these regions; China alone has more HCV infections than all of Europe or the Americas. While most countries had prevalence rates from 1 to 2%, several of the countries presented relatively high prevalence rates, such as Egypt (15%), Pakistan (4.7%) and Taiwan (4.4%). Nosocomial infections and injection drug use are major risk factors in the region, and in some countries blood donors are still not universally screened. The implementation of surveillance systems to guide effective public health policy that may lead to the effective control of HCV spread is urgently warranted in these countries. In conclusion, this Supplement of Liver International aims at providing an extensive coverage of the literature on the epidemiology of HCV. The major feature of this work is the collection and review of an unprecedented amount of data sources, most notably non-indexed, i.e. sources that are not available in scientific databases, such as websites and bulletins of government agencies and manuscripts that appeared in local non-English journals. We believe that this amount of information and the analysis thereof will be helpful to guide strategies to tackle the HCV epidemic globally and to identify gaps in the current knowledge of the HCV spread in selected areas. As such, this work should be considered as a starting point to buttress further research in the field. This study was completed through the International Conquer C Coalition (I-C3) organization, an international, interdisciplinary group of physicians involved in the treatment and care of patients infected with HCV, aiming at increasing the understanding of the epidemiology, diagnosis, side effect management and treatment options for hepatitis C. The IC-3 initiative has been led by Drs N. Afdhal and S. Zeuzem. Funding for this programme was provided through an educational grant provided by Merck & Co. Inc. and support from the Center for Disease Analysis. The Liver International supplement was funded by the Center for Disease Analysis, a division of Kromite. We are indebted to all I-C3 and Regional Conquer C Coalitions (R-C3) members for their contributions and comments. Disclosures: FN Advisor: Schering-Plough, Roche, Novartis, Abbott and Gilead. AA Consultant: Roche, Gilead, Novartis, BMS, J&J, Merck, Schering-Plough. Grants: Gilead, Merck and BMS.
BACKGROUND: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING: Bill & Melinda Gates Foundation.
BACKGROUND: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING: Bill & Melinda Gates Foundation.
The term Silver Economy encompasses a vast range of concepts and areas of interest related to both the challenges and opportunities that the ageing population represents. Social Infrastructure is a subset of the infrastructure sector and typically includes assets that accommodate social services and support networks. Housing and utilities with the added value of 850 billion EUR per year represent the highest share of European Silver economy. Investments in housing and age-friendly built environment should be made with the criterion to accommodate declining functional capacities of ageing residents. Their functional capacities are decreasing and require the development of specialised housing stock for independent living in a community. The structure of housing stock and the development of supply networks and services for older adults, including nursing and social care, do not follow the dynamics of population ageing. Based on the literature review we present the dynamics of publications for the most frequently discussed types of dwellings in connection with ‘older adults’ in the journals indexed by Web of Science (WoS). In this article, we present a literature review of specialized housing solutions and other dwellings for older adults and further research agenda to develop optimization and control theory models supporting optimal planning, operations and control of services for older adults based on ambient intelligence, some of them based also on the geographic information technology and model to measure and forecast the demand for specialized housing stock and services in ageing society for which even the documents of the European Commission state that has not been developed yet. Industrial engineering and production research has the potential to significantly improve the efficiency of supply networks for older adults and mitigate the rising expenditure for health care and long-term care in ageing societies.
The first edition of Applied Health Economics did an expert job of showing how the availability of large scale data sets and the rapid advancement of advanced econometric techniques can help health economists and health professionals make sense of information better than ever before. This second edition has been revised and updated throughout and includes a new chapter on the description and modelling of individual health care costs, thus broadening the book’s readership to those working on risk adjustment and health technology appraisal. The text also fully reflects the very latest advances in the health economics field and the key journal literature. Large-scale survey datasets, in particular complex survey designs such as panel data, provide a rich source of information for health economists. They offer the scope to control for individual heterogeneity and to model the dynamics of individual behaviour. However, the measures of outcome used in health economics are often qualitative or categorical. These create special problems for estimating econometric models. The dramatic growth in computing power over recent years has been accompanied by the development of methods that help to solve these problems. The purpose of this book is to provide a practical guide to the skills required to put these techniques into practice. Practical applications of the methods are illustrated using data on health from the British Health and Lifestyle Survey (HALS), the British Household Panel Survey (BHPS), the European Community Household Panel (ECHP), the US Medical Expenditure Panel Survey (MEPS) and Survey of Health, Ageing and Retirement in Europe (SHARE). There is a strong emphasis on applied work, illustrating the use of relevant computer software with code provided for Stata. Familiarity with the basic syntax and structure of Stata is assumed. The Stata code and extracts from the statistical output are embedded directly in the main text and explained at regular intervals. The book is built around empirical case studies, rather than general theory, and the emphasis is on learning by example. It presents a detailed dissection of methods and results of some recent research papers written by the authors and their colleagues. Relevant methods are presented alongside the Stata code that can be used to implement them and the empirical results are discussed at each stage. This text brings together the theory and application of health economics and econometrics, and will be a valuable reference for applied economists and students of health economics and applied econometrics.
Cerami A. Ageing and the politics of pension reforms in Central Europe, South-Eastern Europe and the Baltic States Int J Soc Welfare 2011: 20: 331–343 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article investigates ageing and the politics of pension reforms in Central Europe, South-Eastern Europe and the Baltic States. It emphasises the importance of historical legacies, presence of veto points, trade unions' power, electoral rules and country-specific patterns of political competition, but it also highlights the central role in institutional change played by other concomitant factors, such as those associated with the communicative actions of national and international actors. The role played by power politics, class conflicts and strategic use of social policies is also emphasised. The main argument put forward in this article is that pressures for reforms in the pension systems have not only been the response of demographic, economic and financial pressures but have also been the result of a new consensus found on new economic ideas and discourses that saw in the privatisation of the economy a new modernisation paradigm.
Today, 8.5% of the world's population is 65 and over, and this statistic will reach 17% by 2050 (He et al., U.S. Census Bureau, international population reports, P95/16-1, An ageing world: 2015, U.S., 2016). They are the people who, with increasing age, will find themselves more closely interfacing with the national health system, which in many countries shows strong imbalances between rural and urban areas. In this context, a fundamental role is played by the relatives who find themselves becoming informal caregivers to compensate for lack of services. To date, however, little has been done to help these people. In this article, we want to identify the nature and extent of research evidence that had its objective to help informal caregivers in rural, hard to reach areas (Grant & Booth, Health Information & Libraries Journal, 2009, 26, 91). Following the approach set out by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19), we conducted a scoping review in May 2018 and closed the review with an update in September 2018. We identified 14 studies published from 2012, the European Year of Active Ageing, promoted by the European Commission, which had three domains of implementation: emotional support to decrease the emotional burden of caregivers, educational support to increase their skills, and organisational support to improve the mobility of caregivers and carereceivers. Although informal caregivers play a fundamental role in many countries, the studies that have been involved in alleviating their caring burden are few; nevertheless, they provide interesting indications. This lack of attention confirms how this portion of the population is still neglected by scientific research and risks having unequal access to health and social care. Future research is needed, not only to create and improve services to caregivers in rural, hard to reach areas, but also to evaluate and focus on the participation and the engagement of caregivers in the co-design of these services.