7. Why Women Don’t Die in Childbirth: Maternal Survivorship in Badakhshan, Tajikistan
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Charnley total hip arthroplasty has been demonstrated to provide good clinical results and a high rate of implant survivorship for twenty years and longer. Most long-term series are not large enough to stratify the many demographic factors that influence implant survivorship. The purpose of this study was to analyze the effects of demographic factors and diagnoses on the long-term survivorship of the acetabular and femoral components used in Charnley total hip arthroplasty.Two thousand primary Charnley total hip arthroplasties (1689 patients) were performed at one institution from 1969 to 1971. Patients were contacted at five-year intervals after the arthroplasty. Twenty-five years after the surgery, 1228 patients had died and 461 patients were living. Hips that had not had a reoperation, revision or removal of a component for any reason, or revision or removal for aseptic loosening were considered to have survived. Survivorship data were calculated with use of the method of Kaplan and Meier. Patients were stratified by age, gender, and underlying diagnosis to determine the influence of these factors on implant survivorship.The twenty-five year rates of survivorship free of reoperation, free of revision or removal of the implant for any reason, and free of revision or removal for aseptic loosening were 77.5%, 80.9% and 86.5%, respectively. The twenty-five-year survivorship free of revision for aseptic loosening was poorer for each decade earlier in life at which the procedure was performed; this survivorship ranged from 68.7% for patients who were less than forty years of age to 100% for patients who were eighty years of age or older. Men had a twofold higher rate of revision for aseptic loosening than did women.Age, gender, and underlying diagnosis all affected the likelihood of long-term survivorship of the acetabular and femoral components used in Charnley total hip arthroplasty.
Aseptic processing
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Survivorship data can be effectively summarized using the shape and scale parameters of the Weibull frequency distribution. The shape parameter controls the rate of change of the age—specific mortality rate and, therefore, the general form of the survivorship curve. Estimates of shape and scale parameters and their confidence intervals can be easily calculated and used to compare survivorship curves of different populations.
Shape parameter
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Every tetraeffective cause of mortality and survivorship negatively and positively affects mortality and negatively and positively affects survivorship. There is previous evidence of tetraeffective causes of mortality and survivorship, and strong rationales suggest that every cause of mortality and survivorship is tetraeffective. Here I elucidate and explain that every tetraeffective cause of mortality and survivorship combines corresponding at least one cause-specific mortacause and at least one cause-specific vitacause; “mortacause” refers here to a cause-specific component that positively affects mortality and negatively affects survivorship, and “vitacause” refers to a cause-specific component that positively affects survivorship and negatively affects mortality. I show tetraeffective causes, mortacauses, and vitacauses in results of multivariable regression analyses of effects of age, lifespan, contemporary aggregate size, lifespan aggregate size, and historical time humans’ and medflies’ mortality and survivorship. In these analyses I specify tetraeffective causes, mortacauses, and vitacauses with sign(β 1 ) = - sign(β 2 ) , where respective corresponding β 1 and β 2 denote respective first and second variable-specific regression coefficients. Thus tetraeffective causes, mortacauses, and vitacauses of mortality and survivorship are hereby defined, identified, named, recognized, elucidated, conceptualized, specified, explained, and demonstrated.
Cancer Survivorship
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Background: The research on fear of childbirth and childbirth self-efficacy of pregnant women in China mainly concentrates on the late pregnancy, and there is a lack of research on the psychology of women during labor. This study aimed to investigate the correlation between fear of childbirth and childbirth self-efficacy during labor. Methods: 378 pregnant women in labor were selected by convenience sampling. They were investigated using a self-designed questionnaire, the Chinese version of Childbirth Attitudes Questionnaire, and the Childbirth Self-Efficacy Inventory. Results: The total score of fear of childbirth during labor was 31.95 ± 9.01, and the total score of childbirth self-efficacy was 212.03 ± 59.64. The total score of fear of childbirth and the score of each dimension were significantly negatively correlated with those of childbirth self-efficacy (R2 = –0.354 to –0.155, p < 0.01). Conclusions: Fear of childbirth during labor should arouse attention of medical staffs. It is necessary to enhance psychological support and childbirth self-efficacy during labor to reduce the fear of childbirth.
Self-Efficacy
Labor pain
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For species of conservation concern, ecologists often need to estimate potential population growth rates with minimal life history data. We use a survivorship database for captive mammals to show that, although survivorship scale (i.e., longevity) varies widely across mammals, survivorship shape (i.e., the age-specific pattern of mortality once survivorship has been scaled to maximum longevity) varies little. Consequently, reasonable estimates of population growth rate can be achieved for diverse taxa using a model of survivorship shape along with an estimate of longevity. In addition, we find that the parameters of survivorship shape are related to taxonomic group, a fact that may be used to further improve estimates of survivorship when full life history data are unavailable. Finally, we compare survivorship shape in captive and wild populations of the same species and find higher adult survivorship in captive populations but no corresponding increase in juvenile survivorship. These differences likely reflect a convolution of true differences in captive vs. wild survivorship and the difficulty of observing juvenile mortality in field studies.
Life History Theory
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Vital rates
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A specification of mortality or survivorship provides respective explicit details about mortality's or survivorship's relationships with one or more other variables (e.g., age, sex, etc.). Previous studies have discovered and analyzed diverse specifications of mortality or survivorship; these discoveries and analyses suggest that additional specifications of mortality or survivorship have yet to be discovered and analyzed. In consistency with previous research, multivariable limited powered polynomials regression analyses of mortality and survivorship of selected humans (Swedes, 1760–2008) and selected insects (caged medflies) show age-specific, historical-time-specific, environmental-context-specific, and sex-specific mortality and survivorship. These analyses also present discoveries of hitherto unknown lifespan-specific, contemporary-aggregate-size-specific, and lifespan-aggregate-size-specific mortality and survivorship. The results of this investigation and results of previous research help identify variables for inclusion in regression models of mortality or survivorship. Moreover, these results and results of previous research strengthen the suggestion that additional specifications of mortality or survivorship have yet to be discovered and analyzed, and they also suggest that specifications of mortality and survivorship indicate corresponding specifications of frailty and vitality. Furthermore, the present analyses reveal the usefulness of a multivariable limited powered polynomials regression model-building approach. This article shows that much has yet to be learned about specifications of mortality or survivorship of diverse kinds of individuals in diverse times and places.
Cancer Survivorship
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Survivorship data by general age-class are reviewed for 30 species of turtles representing nine families. Survivorship varies significantly across age-classes, with mortality generally inversely related to age (type III survivorship). Survivorship also varies significantly across habitat types, with marine and terrestrial turtles exhibiting higher survivorship early in life than freshwater turtles. Marine turtles also tend to have the lowest survivorship as adults. The implications of these findings for the evolution of marine and terrestrial turtles form ancestral freshwater forms are discussed.
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