RWD165 Inequities Related to Life Expectancy of Duchenne Muscular Dystrophy in Brazil: An Administrative Database Analysis
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Genetic deficiency of dystrophin leads to disability and premature death in Duchenne muscular dystrophy, affecting the heart as well as skeletal muscle. Here we report that cardiosphere-derived cells (CDCs), which are being tested clinically for the treatment of Duchenne cardiomyopathy, improve cardiac and skeletal myopathy in the mdx mouse model of DMD and in human Duchenne cardiomyocytes. Injection of CDCs into the hearts of mdx mice augments cardiac function, ambulatory capacity and survival. Exosomes secreted by human CDCs reproduce the benefits of CDCs in mdx mice and in human Duchenne cardiomyocytes. The findings further motivate the testing of CDCs in Duchenne patients, while identifying exosomes as next-generation therapeutic candidates.
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CHAPTER 1
Introduction 3
CHAPTER 2
Life Expectancy and Healthy Life Expectancy 11
1. Life Expectancy in Korea 11
2. Methods of Health-Adjusted Life Expectancy 14
3. Health-Related Quality of Life 15
4. Health-Adjusted Life Expectancy in Korea 21
CHAPTER 3
Gains in HALE after Eliminating Stroke
and Risk Factors 29
1. Methods 29
2. Diabetes-eliminated HALE Gains 31
3. Hypertension-eliminated HALE Gains 36
4. Stroke-eliminated HALE Gains 40
CHAPTER 4
Summary and Conclusion 55
1. Differences between Life Expectancy and Health-Adjusted
Life Expectancy 55
2. Policy Implications and Suggestions 59
References 61
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As people live longer, ages at death are becoming more similar. This dual advance over the last two centuries, a central aim of public health policies, is a major achievement of modern civilization. Some recent exceptions to the joint rise of life expectancy and life span equality, however, make it difficult to determine the underlying causes of this relationship. Here, we develop a unifying framework to study life expectancy and life span equality over time, relying on concepts about the pace and shape of aging. We study the dynamic relationship between life expectancy and life span equality with reliable data from the Human Mortality Database for 49 countries and regions with emphasis on the long time series from Sweden. Our results demonstrate that both changes in life expectancy and life span equality are weighted totals of rates of progress in reducing mortality. This finding holds for three different measures of the variability of life spans. The weights evolve over time and indicate the ages at which reductions in mortality increase life expectancy and life span equality: the more progress at the youngest ages, the tighter the relationship. The link between life expectancy and life span equality is especially strong when life expectancy is less than 70 y. In recent decades, life expectancy and life span equality have occasionally moved in opposite directions due to larger improvements in mortality at older ages or a slowdown in declines in midlife mortality. Saving lives at ages below life expectancy is the key to increasing both life expectancy and life span equality.
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This study describes the amount of physical activity and perception of physical activity in boys with Duchenne muscular dystrophy (DMD) compared to healthy boys. A questionnaire described 6 domains of physical activity. Four Duchenne muscular dystrophy subgroups were made: early and late ambulatory, nonambulatory with relative good, or limited arm function. Eighty-four boys with Duchenne muscular dystrophy (15.0 ± 6.4 years) and 198 healthy boys (14.0 ± 4.3 years) participated. Daily activities were more passive for boys with Duchenne muscular dystrophy. Physical activity was less and low demanding compared to healthy boys. It decreased with disease severity ( P < .05), whereas screen time increased ( P < .05). Benefits of physical activity in boys with Duchenne muscular dystrophy were having fun and making friends. Barriers were lack of sport facilities and insufficient health. This study helps to quantify poor engagement in physical activity by boys with Duchenne muscular dystrophy, and demonstrates factors that contribute to it. Suggestions to stimulate physical activity are made.
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Russia is one of the few countries in the world where life expectancy in 2010 was the same as in 1960 or even lower. The leading causes of death are cardiovascular diseases, malignant neoplasm, and external causes. Mortality crisis in Russia is of such magnitude and urgency that the limited available resources can be applied only to the problems of the highest priority in the most cost-effective way. This paper presents results of assessment of life expectancy losses and damage cost from decrease of life expectancy due to different risk factors for 82 federal subjects of Russia. To identify preventable causes of death the difference between Russia and the countries of European Union is considered.
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