Short- and long-term effects of unemployment on fertility

Scholars have been examining the relationship between fertility and unemployment for more than a century. Most studies find that fertility falls with unemployment in the short run, but it is not known whether these negative effects persist, because women simply may postpone childbearing to better economic times. Using more than 140 million US birth records for the period 1975–2010, we analyze both the short- and long-run effects of unemployment on fertility. We follow fixed cohorts of US-born women defined by their own state and year of birth, and relate their fertility to the unemployment rate experienced by each cohort at different ages. We focus on conceptions that result in a live birth. We find that women in their early 20s are most affected by high unemployment rates in the short run and that the negative effects on fertility grow over time. A one percentage point increase in the average unemployment rate experienced between the ages of 20 and 24 reduces the short-run fertility of women in this age range by six conceptions per 1,000 women. When we follow these women to age 40, we find that a one percentage point increase in the unemployment rate experienced at ages 20–24 leads to an overall loss of 14.2 conceptions. This long-run effect is driven largely by women who remain childless and thus do not have either first births or higher-order births.Demographers have been examining the effect of economic conditions on fertility for more than a century (1–10). Although some find that fertility is countercyclical (8–10), most studies find procyclical fertility; that is, fertility declines in times of rising unemployment (1–7). These fertility reductions may represent mere postponement of fertility to better times (a tempo effect) or persistent long-term effects on completed fertility, i.e., on the total number of children a woman ever bears (a quantum effect).Measuring long-term effects requires the analyst to follow the fertility of fixed cohorts of women over time. Tracking cohorts is feasible at the aggregate level of an entire country, but there are few periods of high unemployment to exploit at this level of aggregation, and strong social trends in fertility that may overshadow long-term effects of past economic fluctuations (11–13). An analysis within countries—for example, at the state level—requires accounting for internal migration and immigration, both of which may be affected by economic conditions. For example, women giving birth to third children in California in 1995 may not be the same women who gave birth to second children in California in earlier years.In this paper, we divide all births to US-born women over the past 35 y into cohorts defined by a mother’s own state and year of birth. Because these mother characteristics are constant over time, we can follow the fertility of these cohorts regardless of where in the United States women subsequently gave birth. This approach provides us with both annual and completed fertility rates at the state level that are not affected by women’s movements or by immigration.^†Using these data, we first analyze short-run fertility responses to economic fluctuations at the national and state levels, and show that they are similar. We also investigate differences in fertility responses by age group. We then investigate the long-run effects of unemployment fluctuations experienced at various ages on women’s completed fertility and on the probability of remaining childless.Our birth data come from the US Vital Statistics natality data, and include ∼140 million individual birth records for all births in the United States from 1975 and 2010. These records provide information about the state and date of the child’s birth, gestation length, the age of the mother, and the mother’s own state of birth. In our sample of all live births to US-born women over this period, we focus on the year of conception rather than on the year of birth, because economic conditions at the time of conception likely are more relevant to the decision to have a child. We also treat multiple births as a single conception (i.e., a single fertility choice). Thus, we are counting conceptions that resulted in a live birth. Cohorts are defined using the mother’s own state and year of birth. To obtain rates, we divide conception counts by population estimates that also are constructed at the level of women’s state and year of birth using data from the decennial US Census.State-level unemployment rates are merged to cohorts’ conception rates at the annual level. Most of our estimates use the weighted average of the unemployment rates in all states in which a cohort gave birth in a given year, with the number of births in each state as weights. Because the number of cohort members giving birth in each state may not be in proportion to the number of cohort members living in each state, we use census data to check on the extent to which the spatial distribution of births reflects a cohort’s overall migration behavior.Another issue is endogenous migration. Because prospective mothers might migrate to states with lower unemployment rates, using the actual locations of cohort members might cause fertility to appear more procyclical than it actually is. An alternative is to use the unemployment rate in the mother’s own state of birth, because most mothers remain in the state in which they were born. However, this estimate will not apply to mothers who have moved, so using it introduces some measurement error. Our preferred specifications use the unemployment rate in a mother’s own state of birth as an instrumental variable for the average unemployment rate in the states where their cohort gave birth at each age.^‡ However, our estimates are quite similar in all three specifications, as discussed further below. Our sample period covers five recessions that vary in strength and timing across states (SI Appendix, Fig. S1), providing us with a rich source of variation in unemployment.     

Short- and long-term effects of ramipril in hypertension

The effect of various doses of ramipril, a new converting enzyme inhibitor, was compared with that of placebo in patients with mild essential hypertension. After a single dose of 2.5 mg blood pressure was not significantly affected, despite a decrease in converting enzyme levels. Single doses of 5 or 10 mg did reduce blood pressure, although complete inhibition of the enzyme was apparent only with the higher dose. Despite partial recovery, both converting enzyme and blood pressure remained reduced for 48 hours. After 1 month of treatment with 10 mg of ramipril, renal vascular resistance had decreased and renal blood flow increased. Continued treatment for 1 year controlled blood pressure in 6 of 10 patients; in the remainder a diuretic needed to be added to maintain control of blood pressure.     

Short- and long-term effects of propafenone in ventricular arrhythmias

The effectiveness of short- (15 days) and long- (12 months) term propafenone treatment was assessed in 53 patients presenting with more than 30 premature ventricular complexes per hour as detected by 24-hour ambulatory Holter monitoring. Thirty-nine patients had no apparent concomitant heart disease while 14 had chronic coronary artery disease. The effects of propafenone were analysed by ambulatory Holter monitoring after 15 days and at 3, 6 and 12 months. The initial dose was 150 mg four times daily and was increased up to 300 mg four times daily when necessary. Favourable short-term effects were obtained in 39 patients (73.6%). After 12 months, 17 patients (32.1%) were still on propafenone treatment with good results. Treatment was discontinued on account of low compliance in 28.3%. This was because treatment was ineffective even at high doses in 15.2%, because of severe side effects in 13.2%, because of proarrhythmic effects in 5.6% and for other causes in 5.6%.     

Short- and long-term effects of calcium entry blockers on the kidney

The renal effects of the calcium entry-blocking drugs diltiazem, nifedipine, nitrendipine, nicardipine and verapamil are reviewed. Although nifedipine may acutely increase plasma renin activity, most of the calcium entry blockers have no sustained effect on any of the components of the renin-angiotensin-aldosterone system. Although all of the calcium entry blockers effectively lower blood pressure, none adversely affects renal function: Glomerular filtration rate and effective renal plasma flow are maintained. Diltiazem may increase glomerular filtration rate via attenuation of the intrarenal effects of angiotensin II or norepinephrine. Although all of the calcium entry blockers acutely increase salt and water excretion, most of the calcium entry blockers have no clinically sustained effect on salt and water excretion; serum electrolytes, urinary sodium and potassium excretion, body fluid composition and body weight are usually unchanged. Calcium entry blockers can be expected to assume a prominent role in the treatment of hypertension because of their ability to lower blood pressure while preserving renal perfusion and function.     

Short- and long-term effects of melatonin on myocardial post-ischemic recovery

Melatonin, the chief secretory product of the pineal gland, has been shown to protect the heart against ischemia-reperfusion injury. This was attributed to its free radical scavenging and broad-spectrum antioxidant properties. The possibility that melatonin may act via its receptor and intracellular signaling, has not yet been addressed in this regard. In all previous studies, only the acute effects of melatonin on the heart, were evaluated. The aims of the present study were to: (i) compare the acute and long-term effects of melatonin on infarct size and functional recovery of the ischemic heart, and (ii) evaluate the role of the melatonin receptor in cardioprotection. For evaluation of the short-term effects of melatonin on contractile recovery and infarct size, the isolated perfused working rat heart was subjected to 20 min global ischemia or 35 min regional ischemia respectively, and melatonin (25-50 microm) administered either before and during reperfusion, or before ischemia or during reperfusion after ischemia. The melatonin receptor was manipulated using luzindole and N-acetyltryptamine. The long-term effects of melatonin were evaluated 24 hr after melatonin administration (2.5 or 5.0 mg/kg, i.p.) or after oral administration for 7 days (20 or 40 microg/mL). Infarct size and mechanical recovery during reperfusion of the working heart were used as endpoints. Melatonin (50 microm), when administered either before and during reperfusion after ischemia or during reperfusion only, significantly improved cardiac output and work performance and reduced infarct size compared with untreated controls. Luzindole (5 microm), a melatonin receptor antagonist, abolished these cardioprotective effects. Long-term administration of melatonin (i.p. or orally for 7 days) caused a significant reduction in infarct size of hearts subjected to 35 min regional ischemia. The cardioprotection persisted for 2-4 days after discontinuation of treatment. In summary, the results obtained suggest that melatonin induces short- as well as long-term protection and that the melatonin receptor is also involved in its cardioprotective actions.     

Group-based intervention program in inflammatory bowel disease patients: effects on quality of life

BACKGROUND: Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) have great impact on patients' health-related quality of life (HRQOL). The aim of this study was to develop an integrated medical and psychological/ psychosocial group-based intervention program for IBD patients and to evaluate if such a program could influence the patients' HRQOL and coping abilities. METHODS: IBD patients in remission or with low disease activity were randomized to intervention or control groups. The intervention comprised nine weekly sessions, alternating lectures, and group therapy sessions. The Inflammatory Bowel Disease Questionnaire (IBDQ) and the Sense of Coherence scale (SOC) were used to measure HRQOL and coping ability at 0, 6, and 12 months. The intervention was evaluated by a visual analog scale (VAS) and written comments by a content analysis. RESULTS: In all, 24 patients were included in the intervention group and 20 in the control group. The mean IBDQ score showed no statistically significant differences before (173.9) or after the intervention at month 6 (175.7) or at month 12 (171.8), or when comparing intervention and controls at month 12. Similarly, there were no statistically significant differences in mean SOC before or after intervention or when comparing groups. The VAS and the content analysis showed that the intervention was well appreciated by the patients. CONCLUSIONS: The group-based intervention program was feasible and highly appreciated. There were no statistically significant differences in average IBDQ or SOC over time or in comparison with controls, although a significant increase was seen in patients with short disease duration.     

Short- and long-term effects of cigarette smoking on heart rate variability

The short- and long-term effects of cigarette smoking on autonomic cardiac regulation were investigated by power spectral analysis of heart rate variability under controlled respiration (15/min). The short-term effects were examined in 9 smokers without evidence of cardiopulmonary disorders after an overnight abstinence from smoking. The heart rate spectral component reflecting the respiratory sinus arrhythmia (0.25 Hz), a quantitative index of vagal cardiac control, decreased 3 minutes after smoking 1 cigarette (p = 0.0061) and the component reflecting Mayer wave sinus arrhythmia (0.04 to 0.15 Hz), which includes sympathetically mediated activity, increased after 10 to 17 minutes (p = 0.0124). The long-term effects were examined in 81 normal subjects comprising 25 nonsmokers, 31 moderate (1 to 24 cigarettes/day) smokers and 25 heavy (greater than 25 cigarettes/day) smokers after an overnight abstinence. Although the magnitude of the Mayer wave component was unaffected by the smoking status, the respiratory component in the supine position was smaller in the young (less than or equal to 30 years) heavy smokers than in the young nonsmokers or moderate smokers (p = 0.0078). Also, postural changes in the components, a decrease in the respiratory component and an increase in the Mayer wave component with standing, were observed in the nonsmokers but not in the heavy smokers. These results suggest that smoking causes an acute and transient decrease in vagal cardiac control, and that heavy smoking causes long-term reduction in vagal cardiac control in young people and blunted postural responses in autonomic cardiac regulation.     

Impact of adult day services on behavioral and psychological symptoms of dementia

PURPOSE: This study explored whether adult day service (ADS) use was associated with reductions in behavioral and psychological symptoms of dementia (BPSD) in individuals with dementia. DESIGN AND METHODS: We used a quasi-experimental design to compare a group of 133 persons with dementia (PWDs) who initially enrolled in an ADS program to a control group not using these services (n = 68). Caregivers used a 24-hour log on multiple, consecutive days to report on five domains of BPSD. RESULTS: We used growth-mixture modeling techniques to model change in the BPSD domains over a 2-month period as well as to handle the preponderance of zeros that were inherent in the data. Results showed a relationship between ADS use and caregivers' report of fewer nighttime sleep-related problems for their PWDs. We found trends for other domains, specifically depressive symptoms and agitated behavior, but no significant group differences emerged for these and the other domains. IMPLICATIONS: The findings of ADS use on PWDs' duration of nighttime sleep problems provide some evidence of the benefits of ADS; the findings also support its utility as part of the continuum of care for PWDs and their caregivers. For other behavior domains, enhanced or more targeted behavioral strategies coupled with ADS might offer caregivers and their PWDs the best possible combination for ameliorating BPSD.     

Short- and long-term effects of transcatheter ablation of the coronary sinus by radiofrequency energy

Catheter ablation of left-sided atrioventricular accessory pathways through the coronary sinus by direct-current shock may be complicated by rupture and thrombosis of the coronary sinus and injury to the coronary arteries. This study examined short and long-term effects of radiofrequency catheter ablation of the coronary sinus in 20 closed-chest dogs to determine whether this technique is feasible for potential interruption of left-sided accessory pathways. Single-pulsed radiofrequency energy (750 kHz, 85-293 J) was delivered to three sites in the distal and middle coronary sinus between the distal (1) or the proximal electrodes (2 or 3) of a standard 6 French quadripolar catheter and a chest-wall patch electrode. Single-pulsed radiofrequency energy (78-293 J) was also applied to two sites near the ostium of the coronary sinus with the proximal (4) or the distal (1) electrode of the same catheter. Coronary artery and levophase coronary sinus angiograms obtained before and immediately after ablation, as well as before killing, showed intact vascular structures in all dogs. Right atrial, pulmonary arterial, and aortic pressures measured in three dogs did not change significantly at the time of energy delivery. No significant changes were found in atrioventricular nodal refractoriness and conduction. None of the dogs had significant rhythm disturbances during and after ablation as evaluated by ambulatory electrocardiographic monitoring and periodic rhythm strips at follow-up. Ten dogs were killed 1-7 days after ablation, three dogs were killed at 4 weeks, three dogs at 6 weeks, two dogs at 8 weeks, and two dogs at 12 weeks. Discrete lesions ranging in size from 3 x 3 to 8 x 10 mm2 in surface area and 0.5-4.5 mm in depth were found in the coronary sinus with most of the lesions extending to the left atrial and left ventricular myocardium. There was neither rupture of the coronary sinus nor occlusion of the coronary arteries. Mural thrombus was found in the coronary sinus on five acute lesions in two dogs, but none was noted on the chronic lesions, which was characterized by chronic granulation tissue and fibrosis. Two dogs in the study during chronic conditions had damage to branches of the underlying coronary artery that showed necrotizing arteritis and arterial sclerosis. Conduction system studies in four dogs showed some chronic inflammatory and fibrotic changes. Similar discrete lesions were found in situ in the coronary sinus of four postmortem human hearts with radiofrequency catheter ablation.(ABSTRACT TRUNCATED AT 400 WORDS)     

Short- and long-term effects of rituximab for the treatment of thrombotic thrombocytopenic purpura: four case reports

We report four cases of thrombotic thrombocytopenic purpura (TTP) successfully treated with rituximab in combination with plasma exchange and other immunosuppressive agents. All four cases fulfilled the diagnostic criteria of TTP with severe deficiencies in ADAMTS13 activity and a detectable anti-ADAMTS13 inhibitor. Four weekly doses of 375?mg/m² rituximab were initiated on day 3?C29 of presentation as a salvage treatment for relapsing/refractory disease in three patients and as a first-line treatment in one. Resolution of clinical symptoms and hematological abnormalities occurred as early as the second dose and, after the completion of treatment, all four patients achieved complete response (CR). They are currently free from relapse and the duration of CR has been 13?C72?months. During the treatment course, the level of ADAMTS13 activity and the titer of the inhibitor correlated well with resolution or exacerbation of the disease. This report suggests that rituximab exhibits short- and long-term favorable effects for the treatment of TTP and that a severe ADAMTS13 deficiency and ADAMTS13 inhibitor positivity may support early administration of rituximab in both acute/refractory and relapsing cases.     

Preexisting medical conditions in adult day services: an examination of nonmetropolitan and metropolitan admissions.

BACKGROUND: It is not known what health conditions are being managed by day services staff because, to date, there is virtually no research on the types of preexisting medical conditions that clients bring to these community-based settings. Furthermore, it is not known whether or how nonmetropolitan clients differ from their metropolitan counterparts. METHODS: Census data for 1,448 individuals who were admitted to adult day services in Maryland during 1993 were examined. Variables were included for client characteristics, medical diagnoses at admission (based upon ICD-9-CM categories), and adult day center location (metropolitan vs. nonmetropolitan). RESULTS: Persons admitted to nonmetropolitan centers were more likely than those entering metropolitan centers to be diagnosed as having musculoskeletal, respiratory, cardiovascular, and endocrine conditions and as having a malignant neoplasm. Admissions to metropolitan centers were significantly more likely to be diagnosed with Alzheimer's disease. After using multiple logistic regression to control for a number of client characteristics, location of the facility remained significantly associated with all listed admission diagnoses except musculoskeletal conditions. CONCLUSION: Nonmetropolitan centers are caring for a distinctly different type of long-term care client than metropolitan centers, perhaps because few other long-term care options are available to families in sparsely populated settings. The differences in the medical conditions of their clients should affect most aspects of the day services program, including budgets for appropriate professional staff, staff qualifications, resources for client/family education and counseling, and expected outcomes.     

Short- and long-term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy

Background

Trimetazidine (TMZ) has been shown to partially inhibit free fatty acid oxidation by shifting substrate utilization from fatty acid to glucose. The aim of this study was to assess the effects of TMZ in patients with diabetes and ischemic cardiomyopathy.

Methods

Sixteen patients with diabetes and ischemic hypokinetic cardiomyopathy (all males) on conventional therapy were randomized to receive either placebo or TMZ (20 mg 3 times per day), each arm lasting 15 days, and then again to receive either placebo or TMZ for 2 additional 6-month periods, according to a double-blind, crossover design. At the end of each period, all patients underwent exercise testing, 2-dimensional echocardiography, and hyperinsulinemic/euglycemic clamp. Among the others, New York Heart Association class, ejection fraction, exercise time, fasting blood glucose, end-clamp M value (index of total body glucose disposal) and endothelin-1 levels were evaluated.

Results

Both in the short and long term (completed by 13 patients), on TMZ compared to placebo, ejection fraction (47 ± 7 vs 41 ± 9 and 45 ± 8 vs 36 ± 8%, P < .001 for both) and M value (4.0 ± 1.8 vs 3.3 ± 1.6, P = .003, and 3.5 ± 1.5 vs 2.7 ± 1.6 mg/kg body weight/min, P < .01) increased, while fasting blood glucose (121 ± 30 vs 136 ± 40, P = .02 and 125 ± 36 vs 140 ± 43, P = .19) and endothelin-1 (8.8 ± 3.8 vs 10.9 ± 3.8, P < .001 and 6.2 ± 2.4 vs 9.2 ± 4.3 pg/mL, P = .03) decreased. In the short term, 10 patients decreased 1 class on the NYHA scale during treatment with TMZ (P = .019 vs placebo). Eight patients decreased 1 NYHA class while on long-term TMZ treatment, while on placebo 1 patient increased 1 NYHA class and none improved (P = .018 vs placebo).

Conclusions

In a short series of patients with diabetes and ischemic cardiomyopathy, TMZ improved left ventricular function, symptoms, glucose metabolism, and endothelial function. Shifting energy substrate preference away from fatty acid metabolism and toward glucose metabolism by TMZ appears an effective adjunctive treatment in patients with diabetes with postischemic cardiomyopathy.     

Short- and long-term effects of CPAP on upper airway anatomy and collapsibility in OSAH

Rationale and aim  In obstructive sleep apnea hypopnea (OSAH) patients, an increase of upper airway (UA) collapsibility has been described together with a reduced UA caliber due to inflammation, edema, and fat accumulation in pharyngeal walls. CPAP is the main treatment of OSAH and acts mechanically by increasing pressure inside UA. The aim of this study was to assess the short- and long-term effects of CPAP on UA caliber and collapsibility in severe OSAH patients. Patients and methods  Ten obese patients (nine male, age 55± 9 yr, BMI 35.1 ± 6.1, Epworth sleepiness scale 12.3 ± 3.6 point, AHI 58.8 ± 27.1) had measurements of oropharingeal junction area (OPJ), mean pharyngeal area (APmean), maximal pharyngeal area (APmax) by acoustic pharyngometry and determination of expired volume in the first 0.5 s after the application at the mouth of −5 cmH₂O negative expiratory pressure (V,NEP_0.5) during wakefulness in the supine position under basal conditions (baseline) and after 1 week and 6 months of CPAP treatment. Results  OPJ was 0.74 ± 0.28 cm² at baseline, 0.90 ± 0.24 cm² after 1 week and 1.05 ± 0.31 cm² after 6 months (1 week and 6 months vs baseline p < 0.05). APmax was 2.28 ± 0.74 cm² at baseline, 2.79 ± 0.90 cm² after 1 week and 2.94 ± 0.33 cm² after 6 months (1 week and 6 months vs baseline p < 0.05). APmean was 1.43 ± 0.46 cm² at baseline, 1.82 ± 0.45 cm² after 1 week and 1.94 ± 0.35 cm² after 6 months (1 week vs baseline p < 0.01; 6 months vs baseline; p < 0.05). V,NEP_0.5 was 290 ± 73 mL at baseline, 291 ± 65 mL after 1 week and 338 ± 67 mL after 6 months (6 months vs baseline p < 0.05; 1 week vs 6 months p < 0.01). Conclusions  Our data suggest that CPAP treatment might be effective in OSAH patients not only by causing a mechanical splint of UA but also by inducing an improvement on anatomical (early) and functional (later on) aspects of UA that can be observed during wakefulness.     

Sensory impairment, use of community support services, and quality of life in aged care clients

OBJECTIVE: To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients. METHOD: The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits. RESULTS: After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0-7.8). CONCLUSION: Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.     

Concurrent and long-term predictors of older adults' use of community-based long-term care services: the Caregiver Health Effects Study

Objective: This study examined concurrent and long-term associations between caregiver-related characteristics and the use of community long-term care services in a sample of 186 older adults caring for a disabled spouse. Method: We used two waves of data from the Caregiver Health Effects Study, an ancillary study of the Cardiovascular Health Study. Caregiver-related need variables as predictors of service use were of primary interest and included caregiving demands, caregiver mental and physical health, and mastery. Their contribution to service use was examined after controlling for known predictors of service use. Results: At Time 1, more caregiver depressive symptoms predicted greater service use; at Time 2, more caregiver activity restriction and depressive symptoms predicted greater formal service use; increases in caregiver activity restriction and depressive symptomatology over time predicted increases in service use. Discussion: Caregiver-related need variables play a significant role in defining utilization patterns of community-based long-term care services among older adults.     

Work stressors and the quality of life in long-term care units

PURPOSE: The purpose of this work was to examine how structural factors, residents' needs for physical and psychosocial assistance, and the work stressors experienced by employees are related to the quality of life of elderly residents in long-term care. DESIGN AND METHODS: Cross-sectional survey data were collected from 1,194 employees and 1,079 relatives of residents in 107 residential-home units and health-center bed wards. Data were analyzed using multilevel modeling. RESULTS: The majority of differences in both employees' and relatives' perceptions of residents' quality of life across units could be explained by work stressors such as time pressure. Large unit size was related to both increased time pressure among employees and reduced quality of life of residents. IMPLICATIONS: Long-term care units are encouraged to review their practices so that employee well-being is supported. Attention also should be focused on unit size, as small units appear better able to help employees cope with work stress, resulting in better quality of life for residents.