The Prospects of the Baby Boomers: Methodological Challenges in Projecting the Lives of an Aging Cohort

In most industrialized countries, the work and family patterns of the baby boomers characterized by more heterogeneous working careers and less stable family lives set them apart from preceding cohorts. Thus, it is of crucial importance to understand how these different work and family lives are linked to the boomers' prospective material well-being as they retire. This paper presents a new and unique matching-based approach for the projection of the life courses of German baby boomers, called the LAW-Life Projection Model. Basis for the projection are data from 27 waves of the German Socio-Economic Panel linked with administrative pension records from the German Statutory Pension In-surance that cover lifecycle pension-relevant earnings. Unlike model-based micro simula-tions that age the data year by year our matching-based projection uses sequences from older birth cohorts to complete the life-courses of statistically similar baby boomers through to retirement. An advantage of this approach is to coherently project the work-life and family trajectories as well as lifecycle earnings. The authors present a benchmark anal-ysis to assess the validity and accuracy of the projection. For this purpose, they cut a signif-icant portion of already lived lives and test different combinations of matching algorithms and donor pool specifications to identify the combination that produces the best fit be-tween previously cut but observed and projected life-course information. Exploiting the advantages of the projected data, the authors compare the returns to education - measured in terms of pension entitlements - across cohorts. The results indicate that within cohorts, differences between individuals with low and high educational attainment increase over time for men and women in East and West Germany. East German boomer women with low educational attainment face the most substantial losses in pension entitlements that put them at a high risk of being poor as they retire

Sonospirometry: A new method for noninvasive estimation of mean right atrial pressure based on two-dimensional echographic measurements of the inferior vena cava during measured inspiration

AbstractA noninvasive method of estimating mean right atrial pressure would be useful in evaluating hemodynamics and calculating pulmonary pressures by Deppler echocardiography. An electronic pressure gauge was built and tested for measurement of inspiratory pressures during two-dimensional echocardiography to quantitate the diameter of the inferior vena cava. Thirty-one studies were made in 27 alert, informed, consenting patients with an in-place pulmonary artery catheter having right atrial ports. Inferior vena cava diameter was measured in successive 10 mm segments distal to the right atrial-inferior vena cava junction on images obtained while the patient suspended breathing at full inspiration and during each 4 mm Hg increment of a calibrated inspiratory maneuver.Results show that the segment between 5 and 30 mm distal to the right atrial-inferior vena cava junction was the region most responsive to increasing inspiratory pressure. In this segment, the inspiratory pressure required to decrease the inferior vena cava diameter to ≥85% of the difference between its maximal (suspended full inspiration) and minimal (over the entire inspiratory maneuver) values was similar or equal to the mean right atrial pressure (measured from the pulmonary artery catheter) (r = 0.87, SEE = 2.9 mm Hg). Minimal inferior vena cava diameter was directly related to mean right atrial pressure (r = 0.56); the minimal to maximal inferior vena cava diameter ratio was inversely related to mean right atrial pressure (r = −0.57). Maximal inferior vena cava diameter and the absolute (measured) amount of inferior vena cava diameter decrease correlated weakly with mean right atrial pressure. This method appears to be useful for noninvasive estimation of mean right atrial pressure

Validation of Two Methods of Data Collection of Self-Reported Medicine Use Among the Elderly

The accuracy of medicine use information was compared for a telephone interview and mail questionnaire, using an in-home medicine check as the standard of assessment The validity of medicine use information varied by data source, level of specificity of data, and respondent characteristics. The mail questionnaire was the more valid source of overall medicine use information. Implications for both service providers and researchers are provided

Selection of patients for programmed ventricular stimulation: A clinical decision-marking model based on multivariate analysis of clinical variables

AbstractObjective. This study was conducted to assess the utility of clinical variables in predicting the inducibility of sustained ventricular arrhythmias in a heterogeneous group of patients undergoing programmed ventricular stimulation.Methods. Variables were considered in a simulated chronologic order to determine the incremental information added by the signal-averaged electrocardiogram (ECG) and left ventricular ejection fraction. All patients undergoing baseline programmed ventricular stimulation for induction of ventricular tachyarrhythmia during a 30-month period were included in the study. Fourteen historical, ECG, signal-averaged ECG and left ventricular wall motion variables were evaluated for their ability in predicting inducibility of a sustained ventricular arrhythmia, a “positive” event, at programmed ventricular stimulation.Results. On univariate analysis of the clinical variables, comparison between patients with positive or negative results showed significant differences in 10 of the 14 clinical variables: major cardiac diagnosis, history of ventricular tachycardia, myocardial infarction by history or ECG, all five signal-averaged ECG variables; left ventricular ejection fraction and presence of left ventricular aneurysm. On multivariate analysis, five independent variables were determined to be important: history of ventricular tachycardia, historical or ECG evidence of myocardial infarction, history of loss of consciousness, filtered QRS duration on the signal-averaged ECG and left ventricular ejection fraction. However, with sequential multivariate analysis, a model based only on historical and conventional ECG data was found to do as well as a model that included signal-averaged ECG and left ventricular ejection fraction data.Conclusions. Routinely available noninvasive historical, ECG, signal-averaged ECG and left ventricular wall motion variables can be used to accurately predict the outcome of programmed ventricular stimulation. The majority of the predictive power was obtained with the routine model, using only historical and ECG data. The signal-averaged ECG and left ventricular wall motion analysis added no significant incremental information

Cardiac consequences of renal transplantation: Changes in left ventricular morphology and function

AbstractTo characterize changes in left ventricular morphology and function associated with renal transplantation, noninvasive cardiac evaluations were performed in 41 adults at the time of surgery and at follow-up. At the time of transplantation, 36 patients had undergone hemodialysis through a fistula for 2.3 ± 2.5 years (mean ± SD); their hematocrit level was 26 ± 6% and systolic blood pressure was 151 ± 19 mm Hg. Perioperatively, left ventricular hypertrophy was present in 93% of patients by echocardiography, but in only 37% by electrocardiography. Abnormal left ventricular diastolic function was present in 67% of patients and indicated a high risk for perioperative pulmonary edema.At follow-up (1.5 ± 14 years), mean hematocrit level increased to 39 ± 7%, systolic blood pressure decreased to 132 ± 14 mm Hg and spontaneous closure of the fistula occurred in 13 patients. Left ventricular mass by echocardiography decreased from 237 ± 66 to 182 ± 47 g (p < 0.001), a decrease of 23%. Left ventricular volumes and cardiac index also decreased significantly, reflecting the rapid resolution of a pretransplant high output state. Despite proportionate regression of left ventricular hypertrophy within months of transplantation, diastolic function did not improve. The significant regression of left ventricular hypertrophy that occurs after renal transplantation may help explain the improved cardiovascular survival of patients with a renal transplant over that of patients on long-term dialysis