Home About us Contact
|
Home About us Contact | ||
|
|
||
Remaining Lifetime (remaining + lifetime)
Selected AbstractsCost-effectiveness of primary cytology and HPV DNA cervical screeningINTERNATIONAL JOURNAL OF CANCER, Issue 2 2008Peter Bistoletti Abstract Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3,5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. © 2007 Wiley-Liss, Inc. [source] A Cost-Benefit Analysis of External Hip Protectors in the Nursing Home SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Lisa A. Honkanen MD Objectives: To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. Design: A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and functional status. Costs, transition probabilities between health states, and estimates of hip protectors' effectiveness were derived from published secondary data. Setting: Nursing home facilities in the United States. Participants: Hypothetical cohort of permanent nursing home residents aged 65 and older without a previous hip fracture. Intervention: Program of hip protectors reimbursed by Medicare. Measurements: Number of fractures, life years, and dollars saved. Results: Three pairs of hip protectors replaced annually would result in a weighted average lifetime absolute risk reduction for hip fracture of 8.5%, with net lifetime savings to Medicare of $223 per resident. When the annual cost of hip protectors is less than $151 per person, relative risk of fracture is less than or equal to 0.65 with hip protectors, or adherence is greater than 42%, hip protectors are cost saving to Medicare over a wide range of assumptions. Extrapolating these results to the estimated population of U.S. nursing home residents without a previous hip fracture, Medicare could save $136 million in the first year of a hip-protector reimbursement program. Conclusion: From a Medicare perspective, hip protectors are a cost-saving intervention in the nursing home setting when hip protector effectiveness is less than or equal to 0.65 over the remaining lifetime of subjects. [source] Evidence From Data Searches and Life-Table Analyses for Gender-Related Differences in Absolute Risk of Hip Fracture After Colles' or Spine Fracture: Colles' Fracture as an Early and Sensitive Marker of Skeletal Fragility in White Men,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 12 2004Patrick Haentjens Abstract Based on data searches and life-table analyses, we determined the long-term (remaining lifetime) and short-term (10- and 5-year) absolute risks of hip fracture after sustaining a Colles' or spine fracture and searched for potential gender-related differences. In aging men, Colles' fractures carry a higher absolute risk for hip fracture than spinal fractures in contrast to women. These findings support the concept that forearm fracture is an early and sensitive marker of male skeletal fragility. Introduction: Colles' fracture occurrence has been largely ignored in public health approaches to identify target populations at risk for hip fracture. The aim of this study was to estimate the long-term and short-term absolute risks of hip fracture after sustaining a Colles' or spine fracture and to search for potential gender-related differences in the relationship between fracture history and future fracture risk. Materials and Methods: To determine the long-term (remaining lifetime) and short-term (10- and 5-year) absolute risks of hip fracture, we applied life-table methods using U.S. age- and sex-specific hip fracture incidence rates, U.S. age-specific mortality rates for white women and men, pooled hazard ratios for mortality after Colles' and spine fracture, and pooled relative risks for hip fracture after Colles' and spine fracture, estimated from cohort studies by standard meta-analytic methods. Results: Our results indicate that the estimated remaining lifetime risks are dependent on age in both genders. In women, remaining lifetime risks increase until the age of 80 years, when they start to decline because of the competing probabilities of fracture and death. The same pattern is found in men until the age of 85 years, the increment in lifetime risk being even more pronounced. As expected, the risk of sustaining a hip fracture was found to be higher in postmenopausal women with a previous spine fracture compared with those with a history of Colles' fracture. In men, on the other hand, the prospective association between fracture history and subsequent hip fracture risk seemed to be strongest for Colles' fracture. At the age of 50, for example, the remaining lifetime risk was 13% in women with a previous Colles' fracture compared with 15% in the context of a previous spine fracture and 9% among women of the general population. In men at the age of 50 years, the corresponding risk estimates were 8%, 6%, and 3%, respectively. Similar trends were observed when calculating 5- and 10-year risks. Conclusions: In aging men, Colles' fractures carry a higher absolute risk for hip fracture than spinal fractures in contrast to women. These findings support the concept that forearm fracture is an early and sensitive marker of male skeletal fragility. The gender-related differences reported in this analysis should be taken into account when designing screening and treatment strategies for prevention of hip fracture in men. [source] Prediction of five-year survival for patients admitted to a department of internal medicineJOURNAL OF INTERNAL MEDICINE, Issue 5 2001B. O. Eriksen Abstract.,Eriksen BO, Kristiansen IS, Pape JFr (University Hospital of Tromsø and University of Tromsø, Tromsø, Norway). Prediction of five-year survival for patients admitted to a department of internal medicine. J Intern Med 2001; 250: 435,440. Objective.,The effect of many common forms of therapy, as medication for mild hypertension or hypercholesterolaemia, only reaches clinical significance after years of treatment. The meaningful application of such therapy presupposes that physicians can, at least to some extent, predict the remaining lifetime of patients. We investigated whether clinicians from different disciplines were able to predict the 5-year survival of patients admitted to a department of internal medicine. Design.,The members of two groups, each consisting of an internist, a surgeon and a general practitioner, made individual predictions of the expected remaining lifetime of discharged patients from written summaries of clinical information. Each patient was randomized to be assessed by the members of either of the two groups. The predictions were compared with actual 5-year survival. Setting.,Department of internal medicine at a university hospital. Subjects.,Patients admitted consecutively during a 6-week period. Main outcome measures.,Sensitivity, specificity, positive and negative predictive values and areas under the receiver operating characteristic (ROC) curves for predictions of 5-y ear survival for each of the six experts. Results.,A total of 402 patients were included. Five-year survival was 0.63. The sensitivity of the predictions ranged from 0.81 to 0.95, the specificity from 0.61 to 0.77, the positive predictive value from 0.78 to 0.87 and the negative predictive value from 0.68 to 0.87. The areas under the ROC curves ranged from 0.84 to 0.91. Conclusion.,The quality of predictions of 5-year survival made by experienced clinicians should permit the rational use of treatments with long-term effects. [source] Demography and reproductive strategies of a polycarpic perennial, Trillium apetalon (Trilliaceae)PLANT SPECIES BIOLOGY, Issue 3 2001MASASHI OHARA Abstract To investigate the connection between demographic strategies and reproductive strategies of a polycarpic perennial herb, Trillium apetalon Makino, we conducted three studies. First, we monitored the fate of individuals and the flowering behavior of T. apetalon for 12 years and used a transition matrix model to analyze the demography of the population. The analysis revealed that it takes a long time for individuals to go through one-leaf stage in juveniles. Elasticity analysis showed that the survival of flowering individuals was a decisive factor in the dynamics of the population. Furthermore, we found that the average remaining lifetime of flowering individuals was high relative to the other three stages. Second, to elucidate the demographic consequences of organ preformation, we investigated the development of flower buds for future years. We observed three to six flower buds per rhizome, suggesting that flower buds for the next 3,6 years were ready in advance in this plant. Third, the results of breeding experiments clarified that although this species appears to have a substantial capacity for both inbreeding and outbreeding, inbreeding plays an important role in seed production, and that crossing experiments (direct cross-pollination and self pollination) yielded similar seed-ovule ratios to those obtained from open-pollinated individuals. Our three studies suggest that the adult survival and continuous flowering strategies of T. apetalon obtained from demographic analysis are closely interlinked with breeding systems and preformation of flower buds. [source] Grundlagen des Lebensdauermanagements im KraftwerksbauBETON- UND STAHLBETONBAU, Issue 7 2010Tobias Pfister Dr.-Ing. Allgemeines; Bauwerkserhaltung/Sanierung; Bauwerksüberwachung Abstract Der Begriff des "Lebensdauermanagements" rückt im Kraftwerksbau auch bei der Planung von Neubauten verstärkt in das Blickfeld der Betreiber. Darüber hinaus werden für Bestandsbauwerke unter dem Einfluss von Laufzeitverlängerungen Maßnahmen erforderlich, die die Restlebensdauer zuverlässig bewerten und sicherstellen können. Der vorliegende Beitrag zeichnet die rechtlichen Rahmenbedingungen nach, aus denen sich das Erfordernis eines aktiven Lebensdauermanagements ergibt und stellt die Vorgehensweise und grundlegenden Elemente einer derartigen begleitenden Überwachungsstrategie dar. Fundamentals of Lifetime Management in Power Plants The concept of "lifetime management" moves more and more into the focus of power plant owners, also in the context of new constructions. Additionally, for existing buildings there is a demand for methods, which are able to estimate the remaining lifetime in a reliable way. The present contribution collocates the legal general conditions, which lead to a requirement of an active lifetime management, and presents the procedure and basic elements of such an accompanying inspection strategy. [source] Zur Beurteilung des Ankündigungsverhaltens von Spannbetonbrücken nach dem Riss-vor-Bruch-Kriterium.BETON- UND STAHLBETONBAU, Issue 9 2007Vorschläge zur Vorgehensweise bei gefährdeten Brücken Bei Spannbetonbrücken steigt mit zunehmender Nutzungsdauer die Bedeutung der Dauerhaftigkeit. Mit numerischen Berechnungen und Bauwerksprüfungen gemäß DIN 1076 wird versucht, ein mögliches Versagen der Bauwerke rechtzeitig erkennen und verhindern zu können sowie das Restrisiko für den Bauherrn zu minimieren. Besonders ältere Spannbetonbrücken mit spannungsrisskorrosionsgefährdetem Spannstahl sind hinsichtlich ihres Ankündigungsverhaltens nach dem Riss-vor-Bruch-Kriterium rechnerisch zu untersuchen und zu bewerten. Ausgehend von diesen numerischen Ergebnissen und ergänzenden Berechnungen lässt sich das bestehende Restrisiko für den Bauherrn hinsichtlich eines Bauwerksversagens beurteilen. Die konstruktive Durchbildung betreffender Bauwerke wird diskutiert. Aufgrund der durchgeführten Untersuchungen werden Vorschläge zur weiteren Vorgehensweise bei älteren gefährdeten Brücken und zur Eingrenzung des Restrisikos erarbeitet. Bei jüngeren Brücken stellt der Nachweis nach dem Riss-vor-Bruch-Kriterium ein Maß für eine ausreichende Robustheit dar. Interpretation of the Preannouncement Behaviour of Prestressed Concrete Bridges by applying the "Crack-before-Collapse-Criterion" Proposals for further Proceeding with Critical Bridges Due to extending lifetimes of prestressed concrete bridges the importance of the durability increases. With numerical calculations and investigations of structures according to DIN 1076 it is intended to recognize and prevent possible failure of the structures in time and to minimize the risk for the owner during the remaining lifetime. Especially older prestressed concrete bridges with tension wires endangered to stress-corrosion-cracking need to be numerically investigated and judged concerning their preannouncement behaviour according to the "crack-before-collapse-criterion". According to the numerical results of the "crack-before-collapse-criterion" and supplemental calculations it is possible to evaluate the existing risk for the owner concerning failure of the structures. The design of the concerned structures will be discussed. Based on results of performed investigations proposals for further proceeding with older critical bridges will be given along with recommendations how to limit the remaining risks. For newer bridges the analysis according to the "crack-before-collapse-criterion" is a measure of a sufficient sturdiness. [source] Time-Varying Functional Regression for Predicting Remaining Lifetime Distributions from Longitudinal TrajectoriesBIOMETRICS, Issue 4 2005Hans-Georg Müller Summary A recurring objective in longitudinal studies on aging and longevity has been the investigation of the relationship between age-at-death and current values of a longitudinal covariate trajectory that quantifies reproductive or other behavioral activity. We propose a novel technique for predicting age-at-death distributions for situations where an entire covariate history is included in the predictor. The predictor trajectories up to current time are represented by time-varying functional principal component scores, which are continuously updated as time progresses and are considered to be time-varying predictor variables that are entered into a class of time-varying functional regression models that we propose. We demonstrate for biodemographic data how these methods can be applied to obtain predictions for age-at-death and estimates of remaining lifetime distributions, including estimates of quantiles and of prediction intervals for remaining lifetime. Estimates and predictions are obtained for individual subjects, based on their observed behavioral trajectories, and include a dimension-reduction step that is implemented by projecting on a single index. The proposed techniques are illustrated with data on longitudinal daily egg-laying for female medflies, predicting remaining lifetime and age-at-death distributions from individual event histories observed up to current time. [source] Immediate versus delayed sequential bilateral cataract surgery: an analysis of costs and patient valueACTA OPHTHALMOLOGICA, Issue 1 2009Mats Lundström Abstract. Purpose:, To compare resource utilization of two different strategies for bilateral cataract surgery: immediate sequential cataract surgery (ISCS) versus delayed sequential cataract surgery (DSCS). The purpose was also to analyse the value for the patient of undergoing ISCS versus DSCS. Methods:, Differences in routines and resource utilization between ISCS (n = 17) and DSCS (n = 80) were studied in a cohort of cataract surgery patients at our clinic in Karlskrona, Sweden. Costs were extracted from an earlier publication by the same clinic. The value for the patient was studied using the capability index, based on published data on the benefit to the patient of ISCS or DSCS using the Catquest questionnaire. Results:, Operating both eyes of a patient was 1.14 times more expensive with DSCS than with ISCS including all surgical costs. The value to the patient of undergoing ISCS depended on the time between first- and second-eye surgery in DSCS and the remaining lifetime after both-eye surgery. A long waiting time for second-eye surgery and a short remaining lifetime decreased the patient value of DSCS compared to ISCS. Conclusion:, DSCS is 14% more expensive than ISCS. The value for the patient of ISCS compared to DSCS depends on how long the period will be between first- and second-eye surgery in DSCS and also on the patient's survival time after surgery. [source] | ||||||||||