Girls’ and Parents’ Decision-Making About HPV Vaccination Uptake

__Abstract__ In Europe 60,000 women are diagnosed with cervical cancer every year. In the Netherlands, about 700 women are diagnosed with cervical cancer annually and about 200 to 250 women die from the disease [www.rivm.nl]. Cervical cancer can only develop in the presence of infection with a high-risk type of human papillomavirus (HPV). There are two types of HPVs: high-risk (oncogenic) and low-risk. HPV 16 and 18, both high-risk strains, cause approximately 70% of cervical cancers. HPV 16 and 18 can also cause cancer of the vulva, vagina, penis, or anus; and oropharyngeal cancer (cancer in the back of throat). The low-risk strains HPV 6 and 11 cause approximately 90% of genital warts. HPV infections are sexually transmitted, most often during vaginal or anal sex. Condoms may lower the risk of HPV infection, but do not provide complete protection. The estimated lifetime risk of HPV infection is 75% to 80% in Europe and in the US, so it is very common. Most HPV infections are cleared rapidly by the immune system and do not progress into cervical cancer. When the infection persists there is a risk of developing precancerous lesions of the cervix. The precancerous lesions are called cervical intraepithelial neoplasia (CIN) an

The compression of deaths above the mode

Kannisto (2001) has shown that as the frequency distribution of ages at death has shifted to the right, the age distribution of deaths above the modal age has become more compressed. In order to further investigate this old-age mortality compression, we adopt the simple logistic model with two parameters, which is known to fit data on old-age mortality well (Thatcher 1999). Based on the model, we show that three key measures of old-age mortality (the modal age of adult deaths, the life expectancy at the modal age, and the standard deviation of ages at death above the mode) can be estimated fairly accurately from death rates at only two suitably chosen high ages (70 and 90 in this study). The distribution of deaths above the modal age becomes compressed when the logits of death rates fall more at the lower age than at the higher age. Our analysis of mortality time series in six countries, using the logistic model, endorsed Kannisto’s conclusion. Some possible reasons for the compression are discussed.compression of mortality, lexis model, logistic model, modal age of death, oldest old mortality decline, standard deviation

Looking Forward to a General Theory on Population Aging

The main theories on population aging based on recent data on human longevity, life expectancy, morbidity changes, disability trends, and mortality decrease are presented and discussed within their own geographic, cultural, socioeconomic, and medical contexts. The complex interactions between all these components do not facilitate trend forecasting of aging population (healthy aging versus disability pandemic). In the context of population aging, four elements were introduced with their implications: 1) an increase in the survival rates of sick persons, which would explain the expansion of morbidity, 2) a control of the progression of chronic diseases, which would explain a subtle equilibrium between the decrease in mortality and the increase in disability, 3) an improvement of the health status and health behaviors of new cohorts of elderly people, which would explain the compression of morbidity, and eventually 4) an emergence of very old and frail populations, which would explain a new expansion of morbidity. Obviously, all these elements coexist today, and future trend scenarios—expansion or compression of disability—depend on their respective weights leading to the need of elaborating "a general theory on population aging.” This theory has to be based on a world harmonization of functional decline measurements and a periodic "International Aging Survey” to monitor global aging through a sample of carefully selected countrie

International trends in the rate of logistic mortality increase

Meeting Theme: Are sex differences in health expectancy a social issue?BACKGROUND: Thatcher et al. (2010) used the simple logistic model with two parameters, which is known to fit data on old-age mortality well (Thatcher 1999), to investigate the old-age mortality compression and estimated the rate of logistic mortality increase, denoted by b, for ages 70-90. They concluded that if logit m(x) tends to fall faster at younger ages, then the slope b of the logit line will become steeper and mortality compression will occur. In this paper, we aim to estimate the rate of logistic mortality increase, denoted by b, for ages 70-90 in 23 countries with good and acceptable quality of data from Human Mortality Database and examine whether there is a universal trend in b. METHODS: We adopt a special case of the logistic model of mortality, which has only two parameters as does the Lexis model, and it is usually written in the form of model (1) μ(x) = a ebx / (1 + a ebx) (1) RESULTS: Our results show that the rate of logistic increase has steadily risen for females and males from about 0.10 in the 1950s to about 0.13 in recent years for most established market-economy countries in Europe as shown in group A (19 European countries). Among males, the value of parameter b is about 0.02 smaller than that for females and the rate of logistic mortality increase always lags behind females about 20 years. However, for Japanese females, although the increase was similar to the common pattern from 0.10 in 1947 to 0.13 in 1984, then the value of parameter b reached the highest 0.14 and became levelling off in the decade 1984-1995. Afterwards, it reverted to the level of 1984. In Canada, b increased at a relatively slower pace from 0.10 in 1950 to 0.12 in 2006 among females, whereas in the US the value of b tended to stay at 0.10-0.11 throughout the whole period 1921-2006. In Australia, b for females fluctuated around 0.10-0.11 before 1980, then a noticeable increase was observed from 0.12 in 1980 to 0.14 in 2007. CONCLUSIONS: The results show that the rate of logistic increase has steadily risen for females and males from about 0.10 in the 1950s to about 0.13 in recent years for most established market-economy countries. Deviant patterns such as slow increase, plateau and decrease are observed for some periods in Australia, Canada, Denmark, Japan and the USA. Possible reasons for those dominant and deviant trends are discussed.postprin