The paper highlights the milestones in the development of the UN idea of the Society for All Ages, originally announced as a motto of the International Year of Old Persons and later accepted as a central concept of the Madrid International Plan of Action on Aging (MIPA). In accord with MIPA building of the Society for All Ages will be a major issue in policies and programmes on aging in the XXI century. According to the UN experts opinion demographic tendencies may produce considerable impact on economy, social sphere and safety of Russia. The issues of aging are far from being completely and rapidly included into national development strategies on priority basis.
Life-history theory predicts a tradeoff between reproductive effort and lifespan. It has been suggested that this tradeoff is a result of reproductive costs accelerating senescence of the immune system, leading to earlier death. Longevity costs of reproduction are suggested for some human populations, but whether high reproductive effort leads to impaired immune function is unknown. We examined how reproductive effort affected postreproductive survival and the probability of dying of an infectious disease in women born in preindustrial Finland between 1702 and 1859. We found that mothers delivering twins had reduced postreproductive survival after age 65. This effect arose because mothers of twins had a higher probability of succumbing to an infectious disease (mainly tuberculosis) than mothers delivering singletons. The risk among mothers of twins of dying of an infectious disease was further elevated if mothers had started reproducing early. In contrast, neither female postreproductive survival nor the risk of succumbing to an infectious disease was influenced by the total number of offspring produced. Our results provide evidence of a long-term survival cost of twinning in humans and indicate that the mechanism mediating this cost might have been accelerated immunosenescence.
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This paper reviews Russia's health crisis, financing, and organization and public health reform needs.
The structure, policy, supply of services, and health status indicators of Russia's health system are examined.
Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic.
The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.
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Human development reportedly includes critical and sensitive periods during which environmental stressors can affect traits that persist throughout life. Controversy remains over which of these periods provides an opportunity for such stressors to affect health and longevity. The elaboration of reproductive biology and its behavioral sequelae during adolescence suggests such a sensitive period, particularly among males. We test the hypothesis that life expectancy at age 20 among males exposed to life-threatening stressors during early adolescence will fall below that among other males. We apply time-series methods to cohort mortality data in France between 1816 and 1919, England and Wales between 1841 and 1919, and Sweden between 1861 and 1919. Our results indicate an inverse association between cohort death rates at ages 10-14 and cohort life expectancy at age 20. Our findings imply that better-informed and more strategic management of the stressors encountered by early adolescents may improve population health.
Intensive care is advanced and highly technical, and it is essential that, despite this, patient care remains safe and of high quality. Adverse events (AEs) are supposed to be reported to internal quality control systems by health-care providers, but many are never reported. Patients on the intensive care unit (ICU) are at special risk for AEs. Our aim was to identify the incidence and characteristics of AEs in patients who died on the ICU during a 2-year period.
A structured record review according to the Global Trigger Tool (GTT) was used to review charts from patients cared for at the ICU of a middle-sized Swedish hospital during 2007 and 2008 and who died during or immediately after ICU care. All identified AEs were scored according to severity and preventability.
We reviewed 128 records, and 41 different AEs were identified in 25 patients (19.5%). Health care-associated infections, hypoglycaemia, pressure sores and procedural complications were the most common harmful events. Twenty two (54%) of the AEs were classified as being avoidable. Two of the 41 AEs were reported as complications according to the Swedish Intensive Care Registry, and one AE had been reported in the internal AE-reporting system.
Almost one fifth of the patients who died on the ICU were subjected to harmful events. GTT has the advantage of identifying more patient injuries caused by AEs than the traditional AE-reporting systems used on many ICUs.
Apolipoprotein C-III (apoC-III) is the major component of triglyceride-rich lipoproteins. One of six identified polymorphisms in the apoC-III 5'-untranslated region (T-455C) is located within a functional insulin-response element. In a group of 137 elderly individuals (70-106 years old), the allele distribution was analyzed using restriction fragment length polymorphisms. Statistical analysis of allele frequencies was performed on subgroups selected by age and in elderly patients with arterial hypertension or ischemic heart disease. A greater frequency of the apoC-III -455C allele was demonstrated with aging (p
We identified age-dependent post-translational modifications of skeletal muscle glycogen phosphorylase b (Ph-b), isolated from F1 hybrids of Fisher 344 x Brown Norway rats. Ph-b isolated from 34 months old rats showed a statistically significant decrease in specific activity compared to 6 months old animals: 13.8+/-0.7 vs. 20.6+/-0.8 U mg(-1) protein, respectively. Western blot analysis of the purified Ph-b with anti-3-NT antibodies revealed an age-dependent accumulation of 3-nitrotyrosine (3-NT), quantified by reverse-phase HPLC-UV analysis to increase from 0.05+/-0.03 to 0.34+/-0.11 (mol 3-NT/mol Ph-b) for 6 vs. 34 months old rats, respectively. HPLC-nanoelectrospray ionization-tandem mass spectrometry revealed the accumulation of 3-NT on Tyr113, Tyr161 and Tyr573. While nitration of Tyr113 was detected for both young and old rats, 3-NT at positions 161 and 573 was identified only for Ph-b isolated from 34 months old rats. The sequence of the rat muscle Ph-b was corrected based on our protein sequence mapping and a custom rat PHS2 sequence containing 17 differently located amino acid residues was used instead of the database sequence. The in vitro reaction of peroxynitrite with Ph-b resulted in the nitration of multiple Tyr residues at positions 51, 52, 113, 155, 185, 203, 262, 280, 404, 473, 731, and 732. Thus, the in vitro nitration conditions only mimic the nitration of a single Tyr residue observed in vivo suggesting alternative pathways controlling the accumulation of 3-NT in vivo. Our data show a correlation of age-dependent 3-NT accumulation with Ph-b inactivation.
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.