Place-Based Drivers of Mortality: Evidence from Migration

We estimate the effect of current location on elderly mortality by analyzing outcomes of movers in the Medicare population. We control for movers’ origin locations as well as a rich vector of pre-move health measures. We also develop a novel strategy to adjust for remaining unobservables, using the correlation of residual mortality with movers’ origins to gauge the importance of omitted variables. We estimate substantial effects of current location. Moving from a tenth to a ninetieth percentile location would increase life expectancy at age 65 by 1.1 years, and equalizing location effects would reduce cross-sectional variation in life expectancy by 15 percent. Places with favorable life expectancy effects tend to have higher quality and quantity of health care, less extreme climates, lower crime rates, and higher socioeconomic status. (JEL H51, I1, I11)

Medical and social aspects of the problem life expectancy (literature review)

The current demographic situation is characterized by a significant increase in the aging of the population. The aging process is accompanied by the inclusion of certain active mechanisms that contribute to the disruption of the life of the human body. The complex of these mechanisms fits into the concept of metabolic syndrome. The presented materials convincingly prove that the problem of metabolic syndrome is largely a gerontological problem. Its development contributes to premature aging of the body and shortening the life span of the population of the planet. The development and widespread implementation of special dispensary Programs, as well as complex targeted therapy of various pathogenic manifestations of this syndrome, will significantly improve public health and increase life expectancy.

A chemogenomic approach seems indispensable for effective treatment of amyotrophic lateral sclerosis

ALS is a fatal untreatable disease involving degeneration of motor neurons. Μultiple causative genes encoding proteins with versatile functions have been identified indicating that diverse biological pathways lead to ALS. Gene and stem cell-based therapies are not expected to enter clinical practice anytime soon. Thus, chemical entities represent a promising choice to delay ALS progression, attenuate symptoms and/or increase life expectancy. Various compounds proved effective in transgenic models overexpressing distinct ALS causative genes but showed no efficacy in clinical trials. Notably, while animal models provide a uniform genetic background for preclinical testing, ALS patients are not stratified, and the distinct genetic forms of ALS are treated as a unique group which could explain the discrepancy between treating genetically homogeneous mice and quite heterogeneous patient cohorts. We suggest that chemical entity-genotype correlation should be exploited to guide patient stratification for therapy.

“Health For All”. The Medical System in Wallachia Under Protomedicus Nicolae Gussi 1848-1859

The main objective of this study is to provide an overview of the evolution of the medical system in Wallachia between 1840 and 1860 and the very important role of physician Nicolae Gussi (1802-1869), protomedicus of Wallachia between 1840 and 1859, to transform medicine into a modern public service, accessible to the entire population. Particularly, we will refer to the medical reform project of 1853, which Gussi implemented during the time he headed the medical-sanitary administration. We will insist on the details of the project because it was designed to create a network of county hospitals that would improve the health of the population and, in the medium and long term, would reduce mortality and increase life expectancy. Another dimension of the study aims at the tenure of physicians in county hospitals and describes the medical services they provided to patients, particularly from the poor population.

THE ROLE OF COMPREHENSIVE GERIATRIC ASSESSMENT IN THE TREATMENT OF CANCER PATIENTS IN ELDERLY AND SENILE AGE

Современные подходы к организации диагностики и лечения больных пожилого и старческого возраста со злокачественными новообразованиями позволяют улучшать качество жизни и увеличивать продолжительность жизни. Оценка гериатрического статуса в онкологии позволяет прогнозировать осложнения в процессе комплексного лечения, в том числе лекарственного, модифицировать терапию для уменьшения факторов риска неблагоприятных исходов, осуществлять отбор пациентов на специализированное лечение с использованием стандартных схем. Таким образом, своевременная оценка гериатрических синдромов и их коррекция способна расширить показания к специализированному лечению больных пожилого и старческого возраста. Modern approaches to the organization of diagnosis and treatment of elderly and senile patients with malignant tumors allow to maintain the necessary level of health, improve the quality of life and increase life expectancy. Assessment of geriatric status in Oncology allows: to predict complications during the complex treatment, including drug treatment; to modify treatment to reduce the risk factors of adverse outcomes; to select patients for specialized treatment using standard schemes. So, timely assessment of geriatric syndromes and their correction can expand the indications for specialized treatment of elderly and senile patients.

General Practitioners’ Autonomy in the Management of Non-Communicable Diseases (NCDs) in the JKN Era: Is It Feasible?

Demographic, epidemiological, and nutritional transitions increase life expectancy, changes in lifestyles and behaviors of Indonesian people. These changes are resulting in a growing contribution of non-communicable diseases (NCDs) to morbidity and mortality, especially metabolic disorders, such as type 2 diabetes mellitus (DM), hypertension, and dyslipidemia. Approximately 10.9% of the Indonesian population above 15 years old suffers from type 2 DM (21.2 million) and 34.1% have hypertension (66.3 million) in 2018. These figures increase significantly from 2013 figure; 6.9% and 25.8% respectively1. The metabolic disorders, which in turn, are responsible for vascular problems such as renal failure, stroke, and heart attack. Not surprisingly, then, 60% of Indonesian national health insurance (JKN) funds are spent on the NCDs. This condition causes a deficit and threatens the sustainability of the JKN program.