1,725,228 research outputs found
What can the life course approach contribute to an understanding of longevity risk?
Full text linkLongevity risk means living longer than predicted. Attempts to understand longevity risk to date have concentrated on single diseases, usually coronary heart disease, and sought explanations in terms of risk factor change and medical innovation. In an opening paper, David Blane and colleagues point to evidence that suggests changes in positive health also should be considered; and that a life course approach can do so in a way that is socially and biologically plausible. Applying this approach to UK citizens currently aged 85 years suggests that life course research should give priority to trajectories across the whole life course and to the social and material contexts through which each cohort has passed. Testing these ideas will require inter-disciplinary and international comparative research
Causal inference algorithms can be useful in life course epidemiology
No full textObjectives. Life course epidemiology attempts to unravel causal relationships between variables observed over time. Causal relationships can be represented as directed acyclic graphs. This article explains the theoretical concepts of the search algorithms used for finding such representations, discusses various types of such algorithms, and exemplifies their use in the context of obesity and insulin resistance.
Study Design and Setting. We investigated possible causal relations between gender, birth weight, waist circumference, and blood glucose level of 4,081 adult participants of the Prevention of REnal and Vascular ENd-stage Disease study. The latter two variables were measured at three time points at intervals of about 3 years.
Results. We present the resulting causal graphs, estimate parameters of the corresponding structural equation models, and discuss usefulness and limitations of this methodology.
Conclusion. As an exploratory method, causal graphs and the associated theory can help construct possible causal models underlying observational data. In this way, the causal search algorithms provide a valuable statistical tool for life course epidemiological research.
Keywords: Causality; Causal graphs; Search algorithms; Life course epidemiology; Metabolic syndrome; Cohort studie
Two-Year Course of Quality of Life in Nursing Home Residents with Dementia
Full text linkObjective: To assess the course of quality of life (QoL) in nursing home residents with dementia and to study its predictors. Methods: This longitudinal, multicenter, observational cohort study with a 2-year follow-up looked at 290 residents with dementia, who lived in 14 dementia special care units in nine nursing homes in the Netherlands. QoL was assessed with the Qualidem, providing a total score and QoL profile with nine subscales. Residents were assessed at five assessments: every 6 months during 2 years. A linear mixed model was used for data analysis. Results: No change was found in the Qualidem total score (range: 0-111) over 2 years. However, a significant increase of QoL over time was seen in the subscales "Care relationship," "Negative affect," "Restless tense behavior," "Positive self-image," "Social isolation," and "Feeling at home." A significant decrease of QoL was seen in the subscales "Positive affect," "Social relations," and "Having something to do." Most predictors of the course of Qol were found for the subscales "Positive self-image" (sex, Global Deterioration Scale, Severe Impairment Battery, Activities of Daily Living, and Neuropsychiatric Inventory) and "Having something to do" (Global Deterioration Scale, Severe Impairment Battery, and Activities of Daily Living). Sex and Neuropsychiatric Inventory at baseline were the predictors found most frequently. Conclusion: The total QoL score was stable over a 2-year period. However, QoL subscales showed multidirectional changes. The largest QoL decline in the subscale "Having something to do" suggests that more attention should be given to useful activities in nursing home care
Mechanisms of family formation:an application of Hidden Markov Models to a life course process
Full text linkLife courses consist of complex patterns of correlated events and spells. The nature and strength of these correlations is known to depend on both micro- and macrocovariates. Life-course models such as event-history analysis and sequence analysis are not well equipped to deal with the processual and latent character of the decision- making process. We argue that Hidden Markov Models satisfy the requirements of a life course model. To illustrate their usefulness, this study will use Hidden Markov chains to model trajectories of family formation. We used data from the Generations and Gender Programme to estimate Hidden Markov Models. The results show the potential of this approach to unravel the mechanisms underlying life-course decision making and how these processes differ both by gender and education.</p
Accuracy of general practitioner's prognosis of the 1-year course of depression and generalised anxiety
No full textBackground A prognosis serves important functions for the management of common mental disorders in primary care. Aims To establish the accuracy of the general practitioner's (GP) prognosis. Method The agreement between GP prognosis and observed course was determined for 138 cases of ICD-10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs. Results Modest agreement between GP prognosis and course was found, both for depression (kappa =0.21) and generalised anxiety (kappa =0.11). Better agreement (kappa =0.45 for depression, and kappa =0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs. Conclusions General practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance. Declaration of interest No conflict of interest. Public funding detailed in Acknowledgements
Effects of Parental Cultural and Economic Status on Adolescents’ Life Course Preferences
No full textThis article examines to what extent adolescents’ ideas about their future life course in the professional and family domain are influenced by the cultural and economic status of their parents, and to what extent these influences are mediated by parents’ own preferences for their child’s future life course and the position that the child occupies in the educational system. This issue is studied using data on secondary school students in 60 schools throughout the Netherlands. More than 1,500 adolescents, aged 14–17 years, were surveyed about their future plans, preferences, and ambitions. In addition, their parents also filled out a questionnaire on the future plans of their child. We found that parents’ cultural status generally has a stronger effect on their children’s life plans than parents’ economic status. Furthermore, these effects were mediated both by parents’ own preferences for their children’s future life course and by the child’s level of education. Status effects were found for both the family and the professional domain. Furthermore, only limited gender differences were observed
Mechanisms of the transition to adulthood: an application of Hidden Markov Models
No full textAn increasing number of studies focuses on understanding the processesunderlying the transition to adulthood. However, the transition to adulthood isa complex process of a series of events that are often interlinked. Even thoughlife courses are greatly varying sequences of roughly the same life course events,the complexity is caused by the fact that these sequences consist of correlatedevents and spells and these correlations depend on gender, social class, cohort and cohort-related macro events. Our previous work demonstrated that the application of stochastic models like the Latent-Class model helps to describe the variation in life courses and its correlation with gender and social class. But the Latent-Class model cannot account for correlated events within life courses nor can it account for switches between latent types during the life course. We argue that (Hidden) Markov models, as a simple generalization of the Latent-Class model, has the ability to account for correlations between events and spells and also allows for switches between latent types or model life courses. Therefore, this study will use (Hidden) Markov models to produce a typology of trajectories of the transition to adulthood. Furthermore, we will test hypotheses on social class- and gender differences in observed life courses and latent types or model-life courses, using data from the Gender and Generation Programme (GGP), which provides full monthly life course sequence data between age 15 to 40
The Course of Quality of Life and Its Predictors in Nursing Home Residents With Young-Onset Dementia
Full text linkObjective: To explore the course of quality of life (QoL) and possible resident-related predictors associated with this course in institutionalized people with young-onset dementia (YOD). Design: An observational longitudinal study. Setting and Participants: A total of 278 residents with YOD were recruited from 13 YOD special care units in the Netherlands. Methods: Secondary analyses were conducted with longitudinal data from the Behavior and Evolution in Young-ONset Dementia (BEYOND)-II study. QoL was assessed with proxy ratings, using the Quality of Life in Dementia (QUALIDEM) questionnaire at 4 assessment points over 18 months. Predictors included age, gender, dementia subtype, length of stay, dementia severity, neuropsychiatric symptoms, and psychotropic drug use at baseline. Multilevel modeling was used to adjust for the correlation of measurements within residents and clustering of residents within nursing homes. Results: The total QUALIDEM score (range: 0-111) decreased over 18 months with a small change of 0.65 (95% confidence interval −1.27, −0.04) points per 6 months. An increase in several domains of QoL regarding care relationship, positive self-image, and feeling at home was seen over time, whereas a decline was observed in the subscales positive affect, social relations, and having something to do. Residents with higher levels of QoL and more advanced dementia at baseline showed a more progressive decline in QoL over time. Sensitivity analyses indicated a more progressive decline in QoL for residents who died during the follow-up. Conclusion and Implications: This study shows that although overall QoL in nursing home residents with YOD was relatively stable over 18 months, there were multidirectional changes in the QoL subscales that could be clinically relevant. Higher levels of QoL and more advanced stages of dementia at baseline predicted a more progressive decline in QoL over time. More longitudinal studies are needed to verify factors influencing QoL in YOD
Predicting the course of disease in recurrent vulvar cancer - A subset analysis of the AGO-CaRE-1 study
Full text linkObjective. In vulvar cancer (VSCC), the course of disease with regard to localization of recurrence and relation of different recurrence sites is poorly described.Methods. The AGO CaRE-1 study is a retrospective survey of treatment patterns and prognostic factors in vulvar cancer. Patients (pts) with primary VSCC, FIGO stage >= 1B treated in Germany from 1998 to 2008 were included in a centralized database (n = 1618). In the current subgroup analysis, different sites of primary recurrence and their impact on disease course and survival were analyzed using multistate and competing risks methods.Results. 1249 pts with surgical groin staging and known lymph-node status (35.8% N+) were included in the analysis. 360 pts (28.8%) developed disease recurrence; thereof 193 (53.6%) at the vulva only, with a cumulative incidence of 12.6% after 2 years. Generally, prognosis after disease depended on recurrence site: Hazard ratios HRs) (95% confidence interval) to die for pts with compared to without recurrence at the same time: vulvar only: 5.9 (4.3-8.2); groins only: 6.0 (3.0-10.2); vulvar and groins: 14.1 (7.6-26.4); pelvic/distant: 21.2 (15.3-29.4). Fifty-eight (30.1%) pts with local recurrence developed second recurrence. 2-year mortality after any recurrence was 56.3%. After vulvar recurrence pts had a 2-year and 5-year overall survival rate of 82.2% and 66.9%.Conclusions. Prognosis after recurrence is highly depending on recurrence site. Pts with isolated vulvar recurrence have an impaired prognosis as many affected pts develop second recurrences. (C) 2019 Elsevier Inc. All rights reserved.</p
The Influence of Parental Education on Timing and Type of Union Formation: Changes Over the Life Course and Over Time in the Netherlands
Full text linkFamily background shapes young adults’ decisions in their transition to adulthood, and the outcomes of these decisions lay the foundation for their subsequent life course. This study examines the influence of parental education on their children’s union formation. We examine the timing of entry into a first union (a married or a cohabiting union), the choice between marriage and cohabitation, and the timing of first marriage. Data from eight nationally representative surveys conducted in the Netherlands are pooled (N = 39,777), with respondents being born between 1930 and 1990, to examine not only the effect of parental education on union formation but also whether this effect changes over birth cohorts, periods, and the life course, and varies by gender. Results from discrete-time hazard analyses show little change in the effect of parental education across cohorts and periods but strong life-course effects. Gender differences in the effect of parental education are relatively small
- …
