According to the statistical information recently released, the expectation of life of the average Malaysian had increased by 1966 to about 67 years and there was every prospect of the trend being continued. No doubt the sound economy leading to higher living standards and better nutrition and the improved health services in the rural areas account for present day Malaysians being healthier and living longer. The health of children in particular has shown great improvement, the infant deaths having dropped from 75.5 per 1,000 children below the age of one in 1957 to 48 in 1966, and the crude toddler mortality rate from 10.7 to 5.1. Further improvement may be expected, especially in the rural areas with the current malaria eradication programme and the proposal to get the rural health clinic personnel to visit homes in the kampongs to disseminate knowledge on health, nutrition and home economics. It is to be hoped that at the same time, the family planning campaign in the rural areas will begin to produce results so that the economic and other benefits are not spread too thin over a large population. However, almost simultaneously with the release of the information that the life span had increased and that the average Malaysian of 55 may now expect to live for about another 20 years, came the shocking announcement by the government that the compulsory retiring age has been reduced from 60 to 55. Why is the Malaysian considered too old for government service when he reaches the magic age of 55 while there has been new thinking on retirement policies in Western countries? In view of the longer active life expectancy, there has been a fuller recognition in many countries of the contribution that older people can make to the life of the community. In the case of the professional man, this enforced premature retirement from government service may actually prove a blessing in disguise. The doctor, dentist, engineer, etc., may, in fact, welcome the opportunity of being released early so that he can set himself up in private practice or join in partnership with his fellows in the private sector. What happens to the vast majority of government servants who are not so luckily placed? What is he to do when he is thrown out without any training or preparation into a ruthless competitive world of commerce and industry at the age of 55 when he could be usefully employed in the public services for a few more years?
It has been estimated that there are in West Malaysia alone about 800,000 people in the age group of 55 and above. This latter figure will keep increasing with the rising span of life and a population growing steadily at the rate of over three percent per annum. With the better control of infectious and communicable diseases, problems of degenerative diseases are becoming more common. The picture of medical practice in the country has begun to change with more and more people presenting themselves with condition resulting from cardiovascular derangement, neoplasm and mental and senile changes. Traditionally, the old folks in Asia have been housed and cared for by the children but modernization in outlook and urbanization are steadily changing that state of affairs. The old folks are finding themselves more and more dependant on themselves and the poorer ones tend to finish up in overcrowded homes run by charitable organizations with little or no geriatric care. These people, however, should not be penalized because they are too old and cannot earn any more. Most modern countries accept their responsibility to support the aged in dignity and comfort by providing adequate old age pensions and properly run old folks’ homes and do not leave them to the charity of a few benevolent members of society. We would like to see more done for them in this country.
Postharvest treatments of fruits using techniques such as ultraviolet-C have been linked with maintenance of the fruit quality as well as shelf-life extension. However, the effects of this treatment on the quality of fruits on a proteomic level remain unclear. This study was conducted in order to understand the response of mango fruit to postharvest UV-C irradiation.
Volvariella volvacea (Family: Plutaceae), also more commonly known as paddy straw mushroom, is an edible mushroom with high nutritional content. It is usually cultivated using lignocellulosic-based materials for enhanced production. However, V. volvacea is highly perishable and easily deteriorates in terms of quality and appearance after harvest. The present paper thus aimed to provide a critical review on aspects related to the production of V. volvacea using palm oil empty fruit bunch as cultivation substrate. The different stages of V. volvacea development are also highlighted. The present review also provides some information on the preservation techniques and appropriate postharvest management in extending V. volvacea shelf life to further boost the paddy straw mushroom industry
PURPOSE: The proposed Men's Health Index (MHI) aims to provide a practical and systematic framework for comprehensively assessing and stratifying older men with the intention of optimising their health and functional status.
MATERIALS AND METHODS: A literature search was conducted using PubMed from 1980 to 2012. We specifically looked for instruments which: assess men's health, frailty and fitness; predict life expectancy, mortality and morbidities. The instruments were assessed by the researchers who then agreed on the tools to be included in the MHI. When there was disagreements, the researchers discussed and reached a consensus guided by the principle that the MHI could be used in the primary care setting targetting men aged 55-65 years.
RESULTS: The instruments chosen include the Charlson's Combined Comorbidity-Age Index; the International Index of Erectile Function-5; the International Prostate Symptom Score; the Androgen Deficiency in Aging Male; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument; the Sitting-Rising Test; the Senior Fitness Test; the Fitness Assessment Score; and the Depression Anxiety Stress Scale-21. A pilot test on eight men was carried out and showed that the men's health index is viable.
CONCLUSIONS: The concept of assessing, stratifying, and optimizing men's health should be incorporated into routine health care, and this can be implemented by using the MHI. This index is particularly useful to primary care physicians who are in a strategic position to engage men at the peri-retirement age in a conversation about their life goals based on their current and predicted health status.
KEYWORDS: Health status indicators; Men; Physical fitness; Retirement
A life table for an aboriginal Malaysian population, the Semelai, living in West Malaysia, was constructed using censuses from 1965, 1969, and 1974; and interview data from 1974. The life expectancy at birth for this population, 54.0 years, was compared to that of other Malaysian populations and selected Asian populations. This comparison indicated that the Semelai were at a disadvantage compared to the Malaysian populations, but in a favorable position when compared with the other Asian populations.
BACKGROUND: With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.
METHODS: We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs).
FINDINGS: Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990.
INTERPRETATION: Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.
BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.
METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
FINDINGS: Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death.
INTERPRETATION: At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems.
FUNDING: Bill & Melinda Gates Foundation.
Malaysian collaborators: Southern University College, Skudai, Malaysia (Y J Kim PhD); School of Medical Sciences, University of Science Malaysia, Kubang Kerian, Malaysia (K I Musa MD); Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia (R Sahathevan PhD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD); WorldFish, Penang, Malaysia (A L Thorne-Lyman ScD)
The purpose of this study was to examine the impact of aging on economic growth. The study used dynamic growth model and employed Autoregressive Distributed Lag (ARDL) approach for the period of 1980 to 2011. Three proxies for aging are used namely fertility rate, life expectancy and old dependency ratio. However, only fertility rate is detected to have a long run cointegration. The major finding of this study showed that a reduction of fertility rate lead to higher economic growth. This implied that even though Malaysia will face aging society by 2020, the economic growth is still stable and can increase by investing more on human capital.
Rheumatoid arthritis (RA) is often regarded as benign and not a serious disease. Yet patients with RA have a substantially reduced life expectancy. Patients with RA are particularly at risk of death from cardiovascular disease, infection and renal disease. A few variables are now recognized as important predictive markers, such as disease duration, severity, sex, educational level and treatment., Copyright (C) 2005 Blackwell Publishing Ltd
The growing number of multi-population mortality models in the recent years signifies the mortality improvement in
developed countries. In this case, there exists a narrowing gap of sex-differential in life expectancy between populations;
hence multi-population mortality models are designed to assimilate the correlation between populations. The present
study considers two extensions of the single-population Lee-Carter model, namely the independent model and augmented
common factor model. The independent model incorporates the information between male and female separately
whereas the augmented common factor model incorporates the information between male and female simultaneously.
The methods are demonstrated in two perspectives: First is by applying them to Malaysian mortality data and second
is by comparing the significance of the methods to the annuity pricing. The performances of the two methods are then
compared in which has been found that the augmented common factor model is more superior in terms of historical fit,
forecast performance, and annuity pricing.
Longer lives and extended retirement have created a 'young old age' stage of life. How people spend their "young old age" has become increasingly important. This research aims to investigate the different ageing experiences of Japanese and Malaysian women and the activities they engaged in their "young old age". In-depth interviews were conducted to collect data and an adapted grounded theory approach was used for data analysis. Findings reveal many common characteristics for both groups of research participants. The emerging themes show that Japanese and Malaysian Chinese have different life missions evident in their daily activities, one passing on culture and the other passing on family values and life experience. They also differ in their choice of living arrangement (independent versus dependent/interdependent), attitudes to life (fighting versus accepting) and activities in which to engage (aesthetic pursuits versus family oriented activities).
Matched MeSH terms: Life Expectancy/ethnology; Life Expectancy/trends
The aging man is becoming a major burden to Asian countries because of the current poor health status of Asian men and the aging Asian population. Life expectancy at birth for men is shorter than women by an average of 4 years in Asian countries and major causes of death are cardiovascular disease, cancers, injuries and infections. However, there are considerable variations between Asian countries because of great disparity in socioeconomic status. Male-specific disorders, such as male sexual health and urological conditions, are other major health burdens because they have a great impact on men's quality of life. More importantly, many risk factors to the causes of mortality and morbidities, such as high-risk behavior and smoking, can be improved with health promotion and early intervention. The current evidence suggests that the poor health status of men is the result of their poor health care utilization, negative health-seeking behavior, the adverse social environment for men and gender-insensitive health care delivery. However, much evidence is still needed as Asian countries have great diversity in culture, societal values and men's needs. Asian time-tested wisdom on a balanced healthy lifestyle to longevity should be explored as potential men's health promotional programs. Taking into account Asian men's health-care needs, a gender-streamlined approach and man-friendly health care delivery should be on the national agenda in managing the aging man.
OBJECTIVES: To assess whether delaying risk reduction treatment has a different impact on potential life years lost in younger compared with older patients at the same baseline short-term cardiovascular risk.
DESIGN: Modelling based on population data.
METHODS: Potential years of life lost from a 5-year treatment delay were estimated for patients of different ages but with the same cardiovascular risk (either 5% or 10% 5-year risk). Two models were used: an age-based residual life expectancy model and a Markov simulation model. Age-specific case fatality rates and time preferences were applied to both models, and competing mortality risks were incorporated into the Markov model.
RESULTS: Younger patients had more potential life years to lose if untreated, but the maximum difference between 35 and 85 years was <1 year, when models were unadjusted for time preferences or competing risk. When these adjusters were included, the maximum difference fell to about 1 month, although the direction was reversed with older people having more to lose.
CONCLUSIONS: Surprisingly, age at onset of treatment has little impact on the likely benefits of interventions that reduce cardiovascular risk because of the opposing effects of life expectancy, case fatality, time preferences and competing risks. These findings challenge the appropriateness of recommendations to use lower risk-based treatment thresholds in younger patients.
Epidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18-50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young adult patients with stroke is unknown. They are usually not included in trials, and specific subanalyses limited to young adult patients with stroke are usually not done, owing to lower incidence of stroke and lower prevalence of vascular risk factors in young adults. Progress has been made in identifying patients with a considerable risk of stroke occurrence, such as those with patent foramen ovale. Future prevention studies might result in a decrease in the incidence of stroke and its sequelae in young adults. The development of guidelines specifically devoted to the management of stroke in young adults will be an important step in achieving this aim.
The improvement of health care support has greatly extended the average life expectancy over the last 50 years, which
has increased the rate of cognitive decline consequently. The avoidance of risk factors such as toxins, stress and somatic
diseases can be protective against the reduction of cognitive function in the elderly. This study aimed to determine the
effects of socio-demographic factors, constipation and renal failure on cognitive status among 2322 samples who were
the non-institutionalized Malaysian elderly. The multiple logistic regression analysis was applied to estimate the risk of
such factors on cognitive decline in subjects. Approximately, 77.54% of samples experienced cognitive impairment. The
results showed that advanced age (odds ratio (OR) = 1.03), Malay ethnic (OR = 2.15), constipation (OR = 3.31) and renal
failure (OR= 4.42), significantly increased the risk of cognitive impairment in subjects (p<0.05). In addition, education
(OR = 0.38) significantly reduced the risk. However, we concluded that age, Malay ethnic, constipation and renal failure
increased the risk of cognitive impairment in subjects but education reduced the risk.
Patients who are entering the last phase of their illness and for whom life expectancy is short, have health needs that require particular expertise and multidisciplinary care. A combination of a rapidly changing clinical situation and considerable psychosocial and spiritual demands pose challenges that can only be met with competence, commitment and human compassion. This article is concerned with the definition of suffering, recognition of the terminal phase and application of the biopsychosocial-spiritual model of care where family physicians play an important role in the community. Key words: biopsychosocial-spiritual care, dying, family medicine, good death, palliative care, suffering.
BACKGROUND: We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries.
METHODS: Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy.
RESULTS: All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy.
CONCLUSIONS: We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density.
This paper analyses the effect of income and education on life expectancy and mortality rates among the elderly in 33 countries for the period 1960-92 and assesses how that relationship has changed over time as a result of technical progress. Our outcome variables are life expectancy at age 60 and the probability of dying between age 60 and age 80 for both males and females. The data are from vital-registration based life tables published by national statistical offices for several years during this period. We estimate regressions with determinants that include GDP per capita (adjusted for purchasing power), education and time (as a proxy for technical progress). As the available measure of education failed to account for variation in life expectancy or mortality at age 60, our reported analyses focus on a simplified model with only income and time as predictors. The results indicate that, controlling for income, mortality rates among the elderly have declined considerably over the past three decades. We also find that poverty (as measured by low average income levels) explains some of the variation in both life expectancy at age 60 and mortality rates among the elderly across the countries in the sample. The explained amount of variation is more substantial for females than for males. While poverty does adversely affect mortality rates among the elderly (and the strength of this effect is estimated to be increasing over time), technical progress appears far more important in the period following 1960. Predicted female life expectancy (at age 60) in 1960 at the mean income level in 1960 was, for example 18.8 years; income growth to 1992 increased this by an estimated 0.7 years, whereas technical progress increased it by 2.0 years. We then use the estimated regression results to compare country performance on life expectancy of the elderly, controlling for levels of poverty (or income), and to assess how performance has varied over time. High performing countries, on female life expectancy at age 60, for the period around 1990, included Chile (1.0 years longer life expectancy), China (1.7 years longer), France (2.0 years longer), Japan (1.9 years longer), and Switzerland (1.3 years longer). Poorly performing countries included Denmark (1.1 years shorter life expectancy than predicted from income), Hungary (1.4 years shorter), Iceland (1.2 years shorter), Malaysia (1.6 years shorter), and Trinidad and Tobago (3.9 years shorter). Chile and Switzerland registered major improvements in relative performance over this period; Norway, Taiwan and the USA, in contrast showed major declines in performance between 1980 and the early 1990s.