Demographic science aids in understanding the spread and fatality rates of CO...Wouter de Heij
See also:
https://osf.io/fd4rh/?view_only=c2f00dfe3677493faa421fc2ea38e295
and live-blog:
https://food4innovations.blog/2020/03/16/live-blog-over-de-corona-crisis-covid-19-dagelijkse-beschouwingen-van-wouter-de-heij-food4innovations/
Jim Crow and Premature Mortality Among the US Black and White Poulation, 1960...CookCountyPLACEMATTERS
"...the study results offer compelling evidence of the enduring impact of both Jim Crow and its abolition on premature mortality among the US black population, althought insufficient to eliminate the persistent 2-fold black excess risk evident in both the Jim Crow and non-Jim Crow states from 1960 to 2009." Epidemiology Volume 25, Number 4, July 2014 Digital Object Identifier 10.1097/EDE.
Demographic science aids in understanding the spread and fatality rates of CO...Wouter de Heij
See also:
https://osf.io/fd4rh/?view_only=c2f00dfe3677493faa421fc2ea38e295
and live-blog:
https://food4innovations.blog/2020/03/16/live-blog-over-de-corona-crisis-covid-19-dagelijkse-beschouwingen-van-wouter-de-heij-food4innovations/
Jim Crow and Premature Mortality Among the US Black and White Poulation, 1960...CookCountyPLACEMATTERS
"...the study results offer compelling evidence of the enduring impact of both Jim Crow and its abolition on premature mortality among the US black population, althought insufficient to eliminate the persistent 2-fold black excess risk evident in both the Jim Crow and non-Jim Crow states from 1960 to 2009." Epidemiology Volume 25, Number 4, July 2014 Digital Object Identifier 10.1097/EDE.
Inequalities matter: An investigation into the impact of deprivation on inequ...ILC- UK
Professor Les Mayhew Professor of Statistics, Cass Business School, is presenting the emerging patterns of inequalities and life expectancy and their wider implications for social and economic policy.
An Epidemic of White Death: A Canary in the Coal Mine? An alarming national t...Tony Iton
According to preliminary data from an ongoing new health study, reducing access to health care or weakening the health care safety net could have severe consequences for the Central San Joaquin Valley of California. This is a region that already suffers from high unemployment, deep poverty and skyrocketing drug use…and surprisingly, the white population may be uniquely vulnerable in this region.
Working in partnership with The California Endowment, the Center on Society and Health at Virginia Commonwealth University, reports an unprecedented surge in the death rate for middle-aged whites living in this region (Kern, Fresno, Tulare, and Kings counties). Over the past 20 years across California, death rates among Black, Hispanic, and Asian adults ages 40-64 years have fallen by 16-20 percent. Among California Whites, however, they have decreased by only 5 percent. In this same 20-year period in this four-county region of the Southern San Joaquin Valley, white death rates have actually increased by 11 percent!
This ongoing study comes in the wake of national reports that show a worrying decline in life expectancy in the U.S.
“imagine all the people” is a series of publications produced by
the Boston Redevelopment Authority for the Mayor’s Office of
New Bostonians, that provides a comprehensive profile of Boston’s diverse immigrant communities and their numerous contributions to the city’s social, cultural, and economic landscape. It is part of an ongoing effort to celebrate new Bostonians and gain insight into how our city is shaped by their presence.
Life Expectancy and Mortality Rates in the United States, 1959-2017Jim Bloyd, DrPH, MPH
Importance: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.
Objective: To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.
Evidence: Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.
Findings: Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.
Conclusions and Relevance: US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.
Inequalities matter: An investigation into the impact of deprivation on inequ...ILC- UK
Professor Les Mayhew Professor of Statistics, Cass Business School, is presenting the emerging patterns of inequalities and life expectancy and their wider implications for social and economic policy.
An Epidemic of White Death: A Canary in the Coal Mine? An alarming national t...Tony Iton
According to preliminary data from an ongoing new health study, reducing access to health care or weakening the health care safety net could have severe consequences for the Central San Joaquin Valley of California. This is a region that already suffers from high unemployment, deep poverty and skyrocketing drug use…and surprisingly, the white population may be uniquely vulnerable in this region.
Working in partnership with The California Endowment, the Center on Society and Health at Virginia Commonwealth University, reports an unprecedented surge in the death rate for middle-aged whites living in this region (Kern, Fresno, Tulare, and Kings counties). Over the past 20 years across California, death rates among Black, Hispanic, and Asian adults ages 40-64 years have fallen by 16-20 percent. Among California Whites, however, they have decreased by only 5 percent. In this same 20-year period in this four-county region of the Southern San Joaquin Valley, white death rates have actually increased by 11 percent!
This ongoing study comes in the wake of national reports that show a worrying decline in life expectancy in the U.S.
“imagine all the people” is a series of publications produced by
the Boston Redevelopment Authority for the Mayor’s Office of
New Bostonians, that provides a comprehensive profile of Boston’s diverse immigrant communities and their numerous contributions to the city’s social, cultural, and economic landscape. It is part of an ongoing effort to celebrate new Bostonians and gain insight into how our city is shaped by their presence.
Life Expectancy and Mortality Rates in the United States, 1959-2017Jim Bloyd, DrPH, MPH
Importance: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.
Objective: To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.
Evidence: Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.
Findings: Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.
Conclusions and Relevance: US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.
the bmj BMJ 2021;373n1343 doi 10.1136bmj.n1343 1R EGrazynaBroyles24
the bmj | BMJ 2021;373:n1343 | doi: 10.1136/bmj.n1343 1
R E S E A R C H
Effect of the covid-19 pandemic in 2020 on life expectancy
across populations in the USA and other high income countries:
simulations of provisional mortality data
Steven H Woolf,1 Ryan K Masters,2 Laudan Y Aron3
ABSTRACT
OBJECTIVE
To estimate changes in life expectancy in 2010-18
and during the covid-19 pandemic in 2020 across
population groups in the United States and to
compare outcomes with peer nations.
DESIGN
Simulations of provisional mortality data.
SETTING
US and 16 other high income countries in 2010-
18 and 2020, by sex, including an analysis of US
outcomes by race and ethnicity.
POPULATION
Data for the US and for 16 other high income countries
from the National Center for Health Statistics and the
Human Mortality Database, respectively.
MAIN OUTCOME MEASURES
Life expectancy at birth, and at ages 25 and 65,
by sex, and, in the US only, by race and ethnicity.
Analysis excluded 2019 because life table data were
not available for many peer countries. Life expectancy
in 2020 was estimated by simulating life tables from
estimated age specific mortality rates in 2020 and
allowing for 10% random error. Estimates for 2020 are
reported as medians with fifth and 95th centiles.
RESULTS
Between 2010 and 2018, the gap in life expectancy
between the US and the peer country average
increased from 1.88 years (78.66 v 80.54 years,
respectively) to 3.05 years (78.74 v 81.78 years).
Between 2018 and 2020, life expectancy in the US
decreased by 1.87 years (to 76.87 years), 8.5 times
the average decrease in peer countries (0.22 years),
widening the gap to 4.69 years. Life expectancy in
the US decreased disproportionately among racial
and ethnic minority groups between 2018 and
2020, declining by 3.88, 3.25, and 1.36 years in
Hispanic, non-Hispanic Black, and non-Hispanic
White populations, respectively. In Hispanic and
non-Hispanic Black populations, reductions in life
expectancy were 15 and 18 times the average in
peer countries, respectively. Progress since 2010 in
reducing the gap in life expectancy in the US between
Black and White people was erased in 2018-20; life
expectancy in Black men reached its lowest level since
1998 (67.73 years), and the longstanding Hispanic
life expectancy advantage almost disappeared.
CONCLUSIONS
The US had a much larger decrease in life expectancy
between 2018 and 2020 than other high income
nations, with pronounced losses among the Hispanic
and non-Hispanic Black populations. A longstanding
and widening US health disadvantage, high death
rates in 2020, and continued inequitable effects
on racial and ethnic minority groups are likely the
products of longstanding policy choices and systemic
racism.
Introduction
In 2020, covid-19 became the third leading cause of
death in the United States1 and was thus expected to
substantially lower life expectancy for that year (box
1). The US had more deaths fr ...
IMPLEMENTATION OF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CLizbethQuinonez813
IMPLEMENTATION OF PRIMARY CARE EDUCATION TO PROMOTE COLORECTAL CANCER KNOWLEDGE AMONG HISPANICS
by
Capstone Paper submitted in partial fulfillment of the
requirements for the degree of
Doctor of Nursing Practice
June 03, 2021
Signature Faculty Reader Date
Signature Program Director Date
Acknowledgments
Abstract
Start typing here….
Key words:
2
Table of Contents
Acknowledgments X
Abstract X
Chapter One: Overview of the Problem of Interest X
Background Information X
Significance of the Problem X
Question Guiding Inquiry (PICO) X
Variables of the PICO question X
Summary X
Chapter Two: Review of the Literature/Evidence X
Methodology X
Sampling strategies X
Inclusion/Exclusion criteria X
Literature Review Findings X
Discussion X
Limitation of literature review. X
Conclusions of findings X
Potential practice change X
Summary X
Chapter Three: Theory and Model for Evidence-based Practice X
Theory X
Application to practice change X
Model for Evidence-Based Practice X
Application to practice change X
Summary X
Chapter Four: Project Management X
Project Purpose X
Project Management X
Organizational Readiness for Change X
Inter-professional Collaboration X
Risk Management Assessment X
Organizational Approval Process X
Use of Information Technology X
Materials Needed for Project X
Plans for Institutional Review Board Approval X
Summary X
Chapter Five: Plan for Project Implementation…………………………………………….X
Planned Project………………………………………………………………………X
High Level Goals for Population Health……………………………………………X
Planned Outcomes…………………………………………………………………..X
Plan for Project Evaluation X
Plan for Demographic Data Collection X
Plan for Outcome Data Collection and Measurement X
Plan for Evaluation Tool X
Plan for Data Analysis X
Plan for Data Management X
Summary……………………………………………………………………………..X
Chapter Six: Actual Implementation Process
Setting X
Participants X
Recruitment X
Implementation Process X
Plan Variation X
Summary X
Chapter Seven: Evaluation and Outcomes of the Practice Change X
Participant Demographicsf X
Table or Figure X X
Table or Figure X X
Outcome Findings X
Outcome One X
Table or Figure X X
Table or Figure X X
Summary X
Chapter Eight: Discussion and Summary………………………………………………….X
Recommendations for Site to Sustain Change X
Plans for Dissemination of Project X
Project Links to Health Promotion/Population Health X
Role of DNP-Prepared Nurse Leader in EBP X
Future Projects Related to Problem X
Implications for Policy and Advocacy at All Levels X
Final Conclusions X
References X
Appendix A: XXXXXX X
Appendix B: XXXXXX X
Appendix C: XXXXXX X
Appendix D: XXXXXX X
Appendix E: XXXXXX X
Appendix F: XXXXXX X
Appendix G: XXXXXX X
Chapter One: Overview of the Problem ...
Marital Status and Survival in Patients with Multiple Myeloma: The Role of Ma...AnonIshanvi
Despite better understanding of Multiple Myeloma (MM) and the development of novel therapeutic strategies which improved overall survival, MM still remain largely incurable. This warrants a better understanding of socio-demographic factors that may influence disease course and outcomes across MM patient
Despite better understanding of Multiple Myeloma (MM) and the development of novel therapeutic
strategies which improved overall survival, MM still remain largely incurable. This warrants a
better understanding of socio-demographic factors that may influence disease course and outcomes
across MM patient. Positive influence of marital status is well established for many solid and liquid
cancers
Marital Status and Survival in Patients with Multiple Myeloma: The Role of Ma...semualkaira
Despite better understanding of Multiple Myeloma (MM) and the development of novel therapeutic strategies which improved overall survival, MM still remain largely incurable. This warrants a better understanding of socio-demographic factors that may influence disease course and outcomes across MM patient...
Marital Status and Survival in Patients with Multiple Myeloma: The Role of Ma...semualkaira
Despite better understanding of Multiple Myeloma (MM) and the development of novel therapeutic strategies which improved overall survival, MM still remain largely incurable. This warrants a better understanding of socio-demographic factors that may influence disease course and outcomes across MM patient...
Dr Yousef Elshrek is One co-authors in this study >>>> Global, regional, and...Univ. of Tripoli
Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
GBD 2013 Mortality and Causes of Death Collaborators*
Dr. Yousef Elshrek is Coauthors in this study
Similar to Relation between income inequality and mortality (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Relation between income inequality and mortality
1. occur, leading to some 34 000 fewer deaths overall
within five years of diagnosis by the year 2010, of which
some 24 000 would be in people aged under 75. This
represents about a quarter of the government’s overall
target “to reduce the death rate from cancer in people
under 75 years by at least a fifth by 2010—saving up to
100 000 lives in total.”1
It is too early to assess the impact on national can-
cer survival rates of the reorganisation of cancer treat-
ment services under way since 1995 (the “Calman-
Hine process”9
), but if inequalities in cancer survival
were substantially reduced by this process, it would
have a major additional impact on avoided deaths. Sur-
vival rates for patients with cancer diagnosed in
England and Wales during 1986-90 and followed up to
the end of 1995 suggest that some 12 700 deaths
within five years of diagnosis would be avoided over
five years if there were no socioeconomic inequalities
in survival.3
Eliminating these inequalities would
greatly improve the chances of achieving the
government’s target of 100 000 fewer deaths in cancer
patients aged under 75 by 2010.
Contributors: MAR and MPC developed the initial idea for
estimating avoided deaths. PB and DS contributed substantially
to the study design and carried out all the analyses. All four
authors wrote the paper. MPC is the guarantor for the study.
Competing interests: None declared.
1 Department of Health. Saving lives: our healthier nation. London: DoH,
1999.
2 Office for National Statistics. Cancer 1971-1997 (CD Rom). London: ONS,
1999.
3 Coleman MP, Babb P, Damiecki P, Grosclaude P, Honjo S, Jones J, et al.
Cancer survival trends in England and Wales 1971-1995: deprivation and
NHS Region. London: Stationery Office, 1999. (Series SMPS No 61.)
4 Carstairs V, Morris R. Deprivation and health in Scotland. Aberdeen: Aber-
deen University Press, 1991.
5 Estève J, Benhamou E, Croasdale M, Raymond L. Relative survival and
the estimation of net survival: elements for further discussion. Stat Med
1990;9:529-38.
6 Beral V, Hermon C, Reeves G, Peto R. Sudden fall in breast cancer death
rates in England and Wales. Lancet 1995;345:1642-3.
7 Stockton D, Davies TW, Day NE, McCann J. Retrospective study of
reasons for improved survival in patients with breast cancer in East
Anglia: earlier diagnosis or better treatment? BMJ 1997;314:472-5.
8 Early Breast Cancer Trialists’ Collaborative Group. Polychemotherapy for
early breast cancer: an overview of the randomised trials. Lancet 1998;
352:930-42.
9 Expert Advisory Group on Cancer. A policy framework for commissioning
cancer services. London: Department of Health, 1995.
(Accepted 3 March 2000)
Relation between income inequality and mortality in
Canada and in the United States: cross sectional
assessment using census data and vital statistics
Nancy A Ross, Michael C Wolfson, James R Dunn, Jean-Marie Berthelot, George A Kaplan,
John W Lynch
Abstract
Objective To compare the relation between mortality
and income inequality in Canada with that in the
United States.
Design The degree of income inequality, defined as
the percentage of total household income received by
the less well off 50% of households, was calculated
and these measures were examined in relation to all
cause mortality, grouped by and adjusted for age.
Setting The 10 Canadian provinces, the 50 US states,
and 53 Canadian and 282 US metropolitan areas.
Results Canadian provinces and metropolitan areas
generally had both lower income inequality and lower
mortality than US states and metropolitan areas. In
age grouped regression models that combined
Canadian and US metropolitan areas, income
inequality was a significant explanatory variable for all
age groupings except for elderly people. The effect
was largest for working age populations, in which a
hypothetical 1% increase in the share of income to
the poorer half of households would reduce mortality
by 21 deaths per 100 000. Within Canada, however,
income inequality was not significantly associated with
mortality.
Conclusions Canada seems to counter the
increasingly noted association at the societal level
between income inequality and mortality. The lack of
a significant association between income inequality
and mortality in Canada may indicate that the effects
of income inequality on health are not automatic and
may be blunted by the different ways in which social
and economic resources are distributed in Canada
and in the United States.
Introduction
A large body of research reports an association
between income distribution and health1–14
and a range
of hypotheses articulates possible mechanisms operat-
What is already known on this topic
Survival is known to be improving for many (but not all) cancers in
England and Wales
There have been no previous estimates of the number of deaths
avoided as a result of improvements in cancer survival
What this study adds
Higher survival rates experienced by patients in England and Wales
with cancer diagnosed during 1986-90 (compared with those for
cancers diagnosed five years earlier) reduced excess mortality by 3%, or
about 17 000 fewer deaths within five years of diagnosis
If recent rates of improvement in cancer survival continue, there
should be some 24 000 fewer deaths in people aged under 75 by 2010,
representing about a quarter of the government’s target of 100 000
fewer cancer deaths in people under 75 by the year 2010
Papers
Statistics Canada,
Ottawa, ON,
Canada K1A 0T6
Nancy A Ross
research analyst,
health analysis and
modelling group
Michael C Wolfson
director general,
analysis and
development branch
Jean-Marie
Berthelot
manager, health
analysis and
modelling group
continued over
BMJ 2000;320:898–902
898 BMJ VOLUME 320 1 APRIL 2000 bmj.com
2. ing between income inequality and poor health
outcomes.15 16
Among American states, mortality is
more weakly correlated with mean or median state
income than it is with various measures of how that
income is shared within a state.5 6
US metropolitan
areas with greater income inequality also have
significantly higher mortality than metropolitan areas
with more equal income distributions, independent of
the median income of the metropolitan area.8
Collectively these studies point to the conclusion
that populations in areas where there is an unequal
income distribution have higher mortality than
populations in more homogeneous areas. While some
have claimed that the relation between income
inequality and mortality is an artefact of the non-linear
relation between income and mortality at the
individual level,17
Wolfson and colleagues18
and others
reporting findings from multilevel analyses19–22
provide
substantial evidence for a non-artefactual explanation.
We compared income inequality and age grouped
mortality in Canada and the United States. We consid-
ered two levels of geographic aggregation: state/
provincial and metropolitan area. The comparison of
states/provinces and US metropolitan areas is compel-
ling in that it has the potential to highlight characteris-
tics and policies specific to particular social contexts
that could affect health. While the product of similar
economic, social, and cultural forces,23
Canada and the
United States also have some major differences,
especially with regard to social policy and racial
divisions. US metropolitan areas differ greatly from
Canadian metropolitan areas in terms of the degree of
economic and social inequality they generate and the
ways in which unequal material circumstances and
social relations are institutionalised through policy and
urban political structure.24 25
While economic segrega-
tion and social polarisation are less pronounced in
Canadian cities, some studies have suggested that they
increased in the last decade of the 20th century.26 27
Incomes at the bottom of the distribution are
higher in Canada than in the United States, and while
inequality in net income rose between 1985 and 1995
in the United States it actually fell slightly in Canada
because of the redistributive effects of Canadian
taxation and transfer policies.28
Furthermore, since the
1980s, pay inequality in Canada has widened much less
than in the United States.28 29
In the United States,
labour market prospects for low skilled workers have
been poor over the past two decades. Hypotheses such
as the growing skill requirements of a global economy,
deindustrialisation, relocations of employers to subur-
ban areas, and racial discrimination have been offered
to explain these trends.30
Methods
Associations between income inequality and mortality
were studied in the 50 US states and the 10 Canadian
provinces, as well as in 282 US and 53 Canadian met-
ropolitan areas with populations greater than 50 000
(as of 1990 in the United States and 1991 in Canada).
All mortalities were age standardised to the Canadian
population in 1991. The associations were examined
separately by the following age and sex groupings for
the states and provinces: infants (less than 1 year), chil-
dren and youth (1 to 24 years), working age men (25 to
64 years), working age women (25 to 64 years), elderly
men (65 years and older), and elderly women (65 years
and older). Age groupings were the same for
metropolitan areas but breakdowns by sex were
unavailable.
Inequality was operationalised as the proportion
of total household income accruing to the less well off
50% of households within an area (that is, the “median
share” of income). In a setting of perfect equality, the
bottom half of the income distribution receives 50% of
the total income and the area then has a median share
value of 0.50. The indicator has recently been used in
similar studies on inequality and mortality,5 8
and thus
allowed for comparability of results. Moreover, tests
with a range of other measures of inequality and
polarisation suggested that this choice did not
substantially affect the results.
US data
Mortality data for the 50 US states came from the
Centers for Disease Control (CDC) Wonder website.
Mortalities by state, sex, and age were averaged over
three years (1989-91) to improve the stability of the
estimates. State median share proportions and the
median income values were generated from the 1990
US census and have appeared in a previous paper by
Kaplan and colleagues.5
Metropolitan area mortalities
and median share proportions were from the work of
Lynch and colleagues.8
Canadian data
The income inequality data for Canada came from a
micro data file of the 1991 census of Canada. The
income definition used in the Canadian calculations,
like that for the United States, included income from
wages and salaries, net income from self employment,
government transfers, and investment income. Cana-
dian mortality data were based on three year averages
(1990-2) by province, sex and age group, and by
metropolitan area and age group.
Model building and general linear testing
Multiple regression analyses were conducted only on
the metropolitan area data because of the small number
of Canadian provinces. Given that the reliability of the
estimated mortality is related to the populations of
metropolitan areas we used weighted regression with
population size as the weight. Use of these weights
ensures that the regression line goes through the mean
mortality of the entire population under study. Further-
more, the use of such a weighted regression allows for
the unobserved differences in mortality between
Canada and the United States, potentially because of
differences in social structure, to be taken into account
through the use of a dummy variable.31
The regression analyses proceeded in four steps.
Firstly, models specific for age group were fitted for the
282 US metropolitan areas with median share of total
metropolitan area household income as an explana-
tory variable. Secondly, median income for the US
metropolitan areas was added as an explanatory
variable. Thirdly, the 53 Canadian metropolitan areas
were added. In the combined models, metropolitan
median household income for the Canadian cities was
adjusted downwards by a factor of 0.8 (this is Statistics
Canada’s purchasing power parity rate, applied to
Papers
Centre for Health
Services and Policy
Research,
Department of
Health Care and
Epidemiology,
University of British
Columbia,
Vancouver, BC,
Canada V6T 1Z3
James R Dunn
research associate
School of Public
Health, University
of Michigan, Ann
Arbor, MI
48109-2029, USA
George A Kaplan
professor and chair
John W Lynch
assistant professor
Correspondence to:
N Ross
rossnan@statcan.ca
899
BMJ VOLUME 320 1 APRIL 2000 bmj.com
3. personal final expenditure, for 199523
) to achieve
purchasing power parity between the two countries.
We also included a dummy variable to indicate whether
the metropolitan area was Canadian or American to
adjust for the mortality differentials between the two
countries.32
Finally, we tested whether the relation
between income inequality and mortality in Canada
differed significantly from the US relation and whether
the coefficients for median share for Canada differed
significantly from zero. The approach involved specify-
ing full models, including all two way interactions, and
then specifying reduced models with the effect of inter-
est removed (the multicollinearity present in the fully
fitted models made it difficult to assess the slope differ-
ences; the approach comparing the error sum of
squares of the full and reduced models circumvents the
problem). The test statistic entailed a comparison of
the error sum of squares of each model and followed
an F distribution.33
Results
States and provinces
The median share values ranged from 0.17 (least
equal) in Louisiana to 0.23 (most equal) in New
Hampshire for the US states, while the range for the
Canadian provinces was 0.22 (least equal) for
Saskatchewan to 0.24 (most equal) for Prince Edward
Island. The median proportion of income received by
the less well off half was 0.21 for US states, while for
Canadian provinces it was 0.23. There was little overlap
between US states and Canadian provinces in regard
to income inequality with only Wisconsin, Vermont,
Utah, and New Hampshire sharing similar income dis-
tributions to the Canadian provinces.
Median share of income was correlated (P < 0.01)
with infants (r = m-0.69), children/youth (r = − 0.62),
working age men (r = − 0.81), working age women
(r = − 0.81), elderly men (r = − 0.44), elderly women
(r = − 0.42), and all age (r = − 0.68) mortality in
combined US states and Canadian provinces calcula-
tions. Figure 1 shows a weighted linear fit (the areas of
the circles are proportional to the population size)
between income inequality and mortality for working
age men at the state/provincial levels. The strongest
relation with inequality was for working age popula-
tions. The Canadian provinces seem almost like a more
equitable extension of the US data, by having lower
mortality and lower inequality. Within Canada,
however, the slope of the weighted regression line was
in the expected direction but was not significantly
different from zero.
Metropolitan areas
The populations of the 282 metropolitan areas in the
United States ranged from 56 735 (Enid, Oklahoma) to
18 087 251 (New York city) with a median size of
242 847. The populations of the 53 metropolitan areas
in Canada ranged from 50 193 (Saint-Hyacinthe, Que-
bec) to 3 893 046 (Toronto, Ontario) with a median
size of 116 100. The median share values ranged from
0.15 (least equal) in Bryan, Texas, to 0.25 (most equal)
in Jacksonville, North Carolina, for the United States
while the range in Canada was 0.22 (least equal) for
Montreal, Quebec, to 0.26 (most equal) for Barrie,
Ontario. The median proportion of income received
by the less well off half of households for US
metropolitan areas was 0.21 while for the Canadian
metropolitan areas it was 0.23.
There were significant correlations (P < 0.01)
between median share and mortality for infants
(r = − 0.37), children and youth (r = − 0.38), the
working age population (r = − 0.55), the elderly popu-
lation (r = − 0.25), and all ages combined (r = − 0.43)
for the pooled 335 metropolitan areas in the United
States and Canada. Within Canada, however, there was
no statistical relation between inequality and mortality
at the metropolitan area level as evidenced by the
weighted linear fit (dashed line) to the Canadian data
points for working age mortality in figure 2.
In the first set of multiple regression models, the
median share was a significant explanatory variable for
all but the model of mortality in elderly people for the
282 US metropolitan areas (table). The largest effect
was in mortality in working age people, where a 1%
increase in the share of household income to the
poorer half of the income distribution was associated
with a decline in mortality of nearly 22 deaths per
100 000. In general, the size of the effect of the median
share variable changed little with the addition of the
median state income variable, the second set of regres-
sions. The inclusion of the 53 Canadian metropolitan
areas, the third set of regressions, improved the
explanatory significance of the models with, for exam-
ple, the adjusted R2
(squared multiple correction)
increasing from 0.02 to 0.27 for infants and from 0.33
to 0.51 for the working age population. The country
dummy variable was significant in each of the models
and may be interpreted as the difference in mortality
between the two countries after adjustment for the dis-
tribution of household income and median household
income. Thus there were 91 fewer deaths per 100 000
in Canadian metropolitan areas than in US metropoli-
tan areas after adjustment for median share and
median income.
Median share of income
Rate
per
100
000
population
0.18 0.20 0.22 0.24
300
550
675
MS
AL
SC
FL
MN
BC
SK
QC
MB
NH
NS
NB
ND
PE
ON
AB
CA
TX
LA
800
US states with weighted linear fit (from Kaplan et al, 19955)
Canadian provinces with weighted linear fit (slope not significant)
425
Fig 1 Mortality in working age men by proportion of income belonging to the less well off
half of households, US states (1990) and Canadian provinces (1991). Mortality standardised
to Canadian population in 1991. State abbreviations: LA-Louisiana; MS-Mississippi;
AL-Alabama; SC-South Carolina; FL-Florida; TX-Texas; CA-California; AR-Arkansas; NH-New
Hampshire; MN-Minnesota. Province abbreviations: QC-Quebec; NS-Nova Scotia; NB-New
Brunswick; ND-Newfoundland; PE-Prince Edward Island; ON-Ontario; AB-Alberta; BC-British
Columbia; MB-Manitoba; SK-Saskatchewan
Papers
900 BMJ VOLUME 320 1 APRIL 2000 bmj.com
4. Finally, the general linear testing indicated that the
slope of the relation between median share and
mortality for Canadian metropolitan areas was signifi-
cantly different than the US slope for children and
youth (F1,329 = 5.98, P < 0.05), working age populations
(F1,329 = 8.79, P < 0.01), and all age groups combined
(F1,329 = 6.22, P < 0.05). In all cases, however, after the
three main effects variables (median share, median
income, and the dummy country indicator) and all two
way interactions in the Canada and US models were
accounted for, the slope of the relation between
median share and mortality in Canada was not signifi-
cantly different from zero.
Discussion
Our analysis of data from Canada and the United
States has shown that variations in the equality of the
income distribution are associated with mortality. The
relation was strongest for working age populations but
was much weaker in elderly populations. Other
research has suggested that differential working age
mortality across populations may be a more powerful
measure of relative disadvantage than the traditionally
studied infant mortality differential.20 34 35
As for the
attenuation seen in elderly populations, current house-
hold income may not be a useful measure for this
group given that income levels before retirement or
measures of wealth better reflect their social position.36
There were no significant asociations between
income inequality and mortality in Canada at either
the provincial or metropolitan area levels, whereas
such associations were apparent in the United States.
The absence of an effect within Canada may indicate
that the relation between income inequality and
mortality is non-linear (that is, at higher levels of equal-
ity there is a diminishing effect on health) or that the
relation between income inequality and mortality is
not universal but instead depends on social and politi-
cal characteristics specific to place. The first explana-
tion suggests that reducing income inequality would be
beneficial for population health. The latter explanation
suggests that specific policies can be implemented to
buffer the health effects of income inequality.15
The juxtaposition of Canadian and US policies in
these analyses raises questions about differences in the
social and material conditions of the two countries that
mute (in Canada) and exaggerate (in the United States)
the relation of inequality to mortality. One plausible
difference is the greater degree of economic segrega-
tion in large US cities.20
Such segregation can create a
spatial mismatch between workers and jobs and large
inequalities in provision of public goods and services
(for example, schools, transportation, health care,
policing, housing, etc) because of concentrations of
people with high social needs in municipalities with
low tax bases.37
The population health effects of
inequalities in provision of these public goods and
others like parks, libraries, and recreation facilities
need to be the focus of future research.15 38
Another major difference between the two
countries is the way in which resources such as health
care and high quality education are distributed. In the
United States these resources tend to be distributed by
the marketplace so their utilisation tends to be associ-
ated with ability to pay; in Canada they are publicly
funded and universally available. As a consequence, in
the United States an individual’s income, in both a
relative and absolute sense, is a much stronger
determinant of life chances and, in turn, “health
chances” than in Canada.
These comments underscore the point that
observations of contexts in which income inequality
has health consequences and those in which it does not
provide opportunities to examine the role of variations
in economic and social policy which structure the
availability of resources and demands placed on
individuals. Collectively, these resources and demands
Median share of income
Rate
per
100
000
population
0.15 0.19 0.23 0.27
200
400
500
600
Florence, SC
Augusta, GA
Pine Bluff, AR
New Orleans, LA
US cities (n=282) with weighted linear fit (from Lynch et al, 19988)
Canadian cities (n=53) with weighted linear fit (slope not significant)
300
New York, NY
Monroe, LA
Bryan, TX
Mcallen, TX
Los Angeles, CA
Shawinigan, QC
Shawinigan, QC
Shawinigan, QC
Montreal, QC
Vancouver, BC
Toronto, ON
Appleton, WI
Oshawa, ON
Barrie, ON
Sioux City, IA
Portsmouth, NH
Fig 2 Mortality in all working age people by proportion of income belonging to the less well off
half of households, US (1990) and Canadian metropolitan areas (1991). Mortality standardised
to Canadian population in 1991. State abbreviations: LA-Louisiana; GA-Georgia; AR-Arkansas;
SC-South Carolina; NY-New York; TX-Texas; CA-California; IA-Iowa; NH-New Hampshire;
WI-Wisconsin. Province abbreviations: QC-Quebec; ON-Ontario; BC-British Columbia
Metropolitan area regression results for US only models (n=282) and combined Canada
and US models (n=335)
Age group and model Intercept
Median share
(%)
Median income
(USr1000)
Country
dummy
Adjusted
R2
*
Infants
US only 1341† −19.73† — — 0.03
US only with income 1386† −19.35† −1.6 — 0.02
US-Canada with dummy 1358† −18.18† −1.5 −280† 0.27
Child/youth
US only 110† −2.49† — — 0.11
US only with income 116† −2.43† −0.20† — 0.11
US-Canada with dummy 113† −2.26† −0.30† −18† 0.35
Working age
US only 848† −21.71† — — 0.33
US only with income 838† −21.80† 0.40 — 0.34
US-Canada with dummy 826† −20.92† 0.20 −67† 0.51
Elderly
US only 5255† −20.58 — — 0.01
US only with income 5547† −18.03 −10.50† — 0.03
US-Canada with dummy 5490† −14.16 −11.20† −399† 0.16
All ages
US only 1110† −15.09† — — 0.13
US only with income 1141† −14.82† −1.10 — 0.12
US-Canada with dummy 1127† −13.84† −1.30† −91† 0.34
*Squared multiple correction.
†P<0.05.
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BMJ VOLUME 320 1 APRIL 2000 bmj.com
5. modify the day to day experiences of individuals
thereby creating different patterns of health and
disease in different places.
Contributors: NAR performed the analyses and wrote most of
the paper. MCW had the original idea for the research and
helped to write the paper. JRD developed some of the concep-
tual arguments around the differences between Canada and the
United States and participated in the writing of the paper. J-MB
provided statistical expertise and helped to write the paper.
GAK and JWL inspired the analysis and participated in the
design and writing of the final version of the paper. NAR and
MCW are guarantors.
Funding: Statistics Canada, Canadian Population Health
Initiative, Social Sciences and Humanities Research Council of
Canada (postdoctoral fellowship No 756-98-0194), University of
Michigan Initiative on Inequalities in Health.
Competing interests: None declared.
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(Accepted 20 January 2000)
What is already known on this topic
Income inequality has been shown to be associated with mortality when
countries, US states, and US metropolitan areas have been compared
What this study adds
Data from Canada have been added to the research on the relation
between income inequality and mortality, thus providing a more
complete picture for North America
Income inequality is strongly associated with mortality in the United
States and in North America as a whole, but there is no relation within
Canada at either the province or metropolitan area level
Overall, the comparison between Canada and the United States
suggests that policies directed toward evening out the income
distribution may reduce the effects of inequality on health
A useful radiology report
Like all specialists, I was taught never to trust an x ray report.
There are times when a specialist report is invaluable.
I was asked to see an elderly patient on a medical ward. The
patient clearly had marked impairment of cognitive and memory
functions. But how long was the history? The only child was away;
the GP had not had much contact. The usual psychodetective
work of searching for clues began.
I looked through the medical notes: a radiology report of
unusual length, with some normal, and in this context, some
unimportant findings. Then a second paragraph: “Mr X had a
rather fraught time leaving the hospital escorted by radiologist as
he could not remember who had given him a lift, in what car and
at which entrance he had been deposited. It took an hour and a
half before his lift could be located during which time he walked
further than I think was good for him.”
This was dated some 18 months before my visit. So the history
of memory problems was at least that long.
Unfortunately, this aspect of the report did not lead to any
action by the requesting doctor.
I thank Dr C P Robinson for the helpful report.
Adam Moliver consultant in old age psychiatry, Cheltenham
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