Showing papers on "Poison control published in 1999"

Food-related illness and death in the United States.

Abstract: To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60,000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.

Perceptual symbol systems.

Abstract: Prior to the twentieth century, theories of knowledge were inherently perceptual. Since then, developments in logic, statis- tics, and programming languages have inspired amodal theories that rest on principles fundamentally different from those underlying perception. In addition, perceptual approaches have become widely viewed as untenable because they are assumed to implement record- ing systems, not conceptual systems. A perceptual theory of knowledge is developed here in the context of current cognitive science and neuroscience. During perceptual experience, association areas in the brain capture bottom-up patterns of activation in sensory-motor areas. Later, in a top-down manner, association areas partially reactivate sensory-motor areas to implement perceptual symbols. The stor- age and reactivation of perceptual symbols operates at the level of perceptual components - not at the level of holistic perceptual expe- riences. Through the use of selective attention, schematic representations of perceptual components are extracted from experience and stored in memory (e.g., individual memories of green, purr, hot). As memories of the same component become organized around a com- mon frame, they implement a simulator that produces limitless simulations of the component (e.g., simulations of purr). Not only do such simulators develop for aspects of sensory experience, they also develop for aspects of proprioception (e.g., lift, run) and introspec- tion (e.g., compare, memory, happy, hungry). Once established, these simulators implement a basic conceptual system that represents types, supports categorization, and produces categorical inferences. These simulators further support productivity, propositions, and ab- stract concepts, thereby implementing a fully functional conceptual system. Productivity results from integrating simulators combinato- rially and recursively to produce complex simulations. Propositions result from binding simulators to perceived individuals to represent type-token relations. Abstract concepts are grounded in complex simulations of combined physical and introspective events. Thus, a per- ceptual theory of knowledge can implement a fully functional conceptual system while avoiding problems associated with amodal sym- bol systems. Implications for cognition, neuroscience, evolution, development, and artificial intelligence are explored.

Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.

Abstract: Background General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. Methods Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. Results Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. Conclusions Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.

Actions of Caffeine in the Brain with Special Reference to Factors That Contribute to Its Widespread Use

Abstract: Caffeine is the most widely consumed behaviorally active substance in the world. Almost all caffeine comes from dietary sources (beverages and food), most of it from coffee and tea. Acute and, especially, chronic caffeine intake appear to have only minor negative consequences on health. For this

Systematic Social Observation of Public Spaces: A New Look at Disorder in Urban Neighborhoods

Abstract: This article assesses the sources and consequences of public disorder. Based on the videotaping and systematic rating of more than 23,000 street segments in Chicago, highly reliable scales of social and physical disorder for 196 neighborhoods are constructed. Census data, police records, and an independent survey of more than 3,500 residents are then integrated to test a theory of collective efficacy and structural constraints. Defined as cohesion among residents combined with shared expectations for the social control of public space, collective efficacy explains lower rates of crime and observed disorder after controlling neighborhood structural characteristics. Collective efficacy is also linked to lower rates of violent crime after accounting for disorder and the reciprocal effects of violence. Contrary to the "broken windows" theory, however, the relationship between public disorder and crime is spurious except perhaps for robbery.

When interventions harm: Peer groups and problem behavior.

Abstract: This article explored developmental and intervention evidence relevant to iatrogenic effects in peer-group interventions. Longitudinal research revealed that "deviancy training" within adolescent friendships predicts increases in delinquency, substance use, violence, and adult maladjustment. Moreover, findings from 2 experimentally controlled intervention studies suggested that peer-group interventions increase adolescent problem behavior and negative life outcomes in adulthood, compared with control youth. The data from both experimental studies suggested that high-risk youth are particularly vulnerable to peer aggregations, compared with low-risk youth. We proposed that peer aggregation during early adolescence, under some circumstances, inadvertently reinforces problem behavior. Two developmental processes are discussed that might account for the powerful iatrogenic effects.

Social Cognitive Theory: An Agentic Perspective

Abstract: ▪ Abstract The capacity to exercise control over the nature and quality of one's life is the essence of humanness. Human agency is characterized by a number of core features that operate through phenomenal and functional consciousness. These include the temporal extension of agency through intentionality and forethought, self-regulation by self-reactive influence, and self-reflectiveness about one's capabilities, quality of functioning, and the meaning and purpose of one's life pursuits. Personal agency operates within a broad network of sociostructural influences. In these agentic transactions, people are producers as well as products of social systems. Social cognitive theory distinguishes among three modes of agency: direct personal agency, proxy agency that relies on others to act on one's behest to secure desired outcomes, and collective agency exercised through socially coordinative and interdependent effort. Growing transnational embeddedness and interdependence are placing a premium on collective ...

Varieties of impulsivity.

Abstract: The concept of impulsivity covers a wide range of ”actions that are poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable outcomes”. As such it plays an important role in normal behaviour, as well as, in a pathological form, in many kinds of mental illness such as mania, personality disorders, substance abuse disorders and attention deficit/hyperactivity disorder. Although evidence from psychological studies of human personality suggests that impulsivity may be made up of several independent factors, this has not made a major impact on biological studies of impulsivity. This may be because there is little unanimity as to which these factors are. The present review summarises evidence for varieties of impulsivity from several different areas of research: human psychology, psychiatry and animal behaviour. Recently, a series of psychopharmacological studies has been carried out by the present author and colleagues using methods proposed to measure selectively different aspects of impulsivity. The results of these studies suggest that several neurochemical mechanisms can influence impulsivity, and that impulsive behaviour has no unique neurobiological basis. Consideration of impulsivity as the result of several different, independent factors which interact to modulate behaviour may provide better insight into the pathology than current hypotheses based on serotonergic underactivity.

Public conceptions of mental illness: labels, causes, dangerousness, and social distance.

Abstract: OBJECTIVES: The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance. METHODS: Data were derived from a vignette experiment included in the 1996 General Social Survey. Respondents (n = 1444) were randomly assigned to 1 of 5 vignette conditions. Four vignettes described psychiatric disorders meeting diagnostic criteria, and the fifth depicted a "troubled person" with subclinical problems and worries. RESULTS: Results indicate that the majority of the public identifies schizophrenia (88%) and major depression (69%) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors. Results also show, however, that smaller proportions associate alcohol (49%) or drug (44%) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a d...

Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis

Abstract: This article reviews literature on the prevalence of mental health problems among women with a history of intimate partner violence. The weighted mean prevalence of mental health problems among battered women was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. These were typically inconsistent across studies. Weighted mean odds ratios representing associations of these problems with violence ranged from 3.55 to 5.62, and were typically consistent across studies. Variability was accounted for by differences in sampling frames. Dose-response relationships of violence to depression and PTSD were observed. Although research has not addressed many criteria for causal inferences, the existing research is consistent with the hypothesis that intimate partner violence increases risk for mental health problems. The appropriate way to conceptualize these problems deserves careful attention.

Smallpox as a Biological Weapon Medical and Public Health Management

Abstract: Donald A. Henderson, MD, MPHThomas V. Inglesby, MDJohn G. Bartlett, MDMichael S. Ascher, MDEdward Eitzen, MD, MPHPeter B. Jahrling, PhDJerome Hauer, MPHMarcelle Layton, MDJoseph McDade, PhDMichael T. Osterholm, PhD, MPHTara O’Toole, MD, MPHGerald Parker, PhD, DVMTrish Perl, MD, MScPhilip K. Russell, MDKevin Tonat, PhDfor the Working Group onCivilian Biodefense

Traumatic brain injury in the United States: A public health perspective.

Abstract: Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.

Ageing, fitness and neurocognitive function.

Abstract: In the ageing process, neural areas1,2 and cognitive processes3,4 do not degrade uniformly. Executive control processes and the prefrontal and frontal brain regions that support them show large and disproportionate changes with age. Studies of adult animals indicate that metabolic5 and neurochemical6 functions improve with aerobic fitness. We therefore investigated whether greater aerobic fitness in adults would result in selective improvements in executive control processes, such as planning, scheduling, inhibition and working memory. Over a period of six months, we studied 124 previously sedentary adults, 60 to 75 years old, who were randomly assigned to either aerobic (walking) or anaerobic (stretching and toning) exercise. We found that those who received aerobic training showed substantial improvements in performance on tasks requiring executive control compared with anaerobically trained subjects.

Car-following: a historical review

Abstract: In recent years, the topic of car-following has become of increased importance in traffic engineering and safety research. Models of this phenomenon, which describe the interaction between (typically) adjacent vehicles in the same lane, now form the cornerstone for many important areas of research including (a) simulation modelling, where the car-following model (amongst others) controls the motion of the vehicles in the network, and (b) the functional definition of advanced vehicle control and safety systems (AVCSS), which are being introduced as a driver safety aid in an effort to mimic driver behaviour but remove human error. Despite the importance of this area however, no overview of the models availability and validity exists. It is the intent of this paper therefore to briefly assess the range of options available in the choice of car-following model, and assess just how far work has proceeded in our understanding of what, at times, would appear to be a simple process.

Adolescent storm and stress, reconsidered.

Abstract: G. S. Hall's (1904) view that adolescence is a period of heightened "storm and stress" is reconsidered in light of contemporary research. The author provides a brief history of the storm-and-stress view and examines 3 key aspects of this view: conflict with parents, mood disruptions, and risk behavior. In all 3 areas, evidence supports a modified storm-and-stress view that takes into account individual differences and cultural variations. Not all adolescents experience storm and stress, but storm and stress is more likely during adolescence than at other ages. Adolescent storm and stress tends to be lower in traditional cultures than in the West but may increase as globalization increases individualism. Similar issues apply to minority cultures in American society. Finally, although the general public is sometimes portrayed by scholars as having a stereotypical view of adolescent storm and stress, both scholars and the general public appear to support a modified storm-and-stress view.

The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander.

Abstract: Background and Methods Drowsiness and lack of concentration may contribute to traffic accidents. We conducted a case–control study of the relation between sleep apnea and the risk of traffic accidents. The case patients were 102 drivers who received emergency treatment at hospitals in Burgos or Santander, Spain, after highway traffic accidents between April and December 1995. The controls were 152 patients randomly selected from primary care centers in the same cities and matched with the case patients for age and sex. Respiratory polygraphy was used to screen the patients for sleep apnea at home, and conventional polysomnography was used to confirm the diagnosis. The apnea–hypopnea index (the total number of episodes of apnea and hypopnea divided by the number of hours of sleep) was calculated for each participant. Results The mean age of the participants was 44 years; 77 percent were men. As compared with those without sleep apnea, patients with an apnea–hypopnea index of 10 or higher had an odds ratio ...

A dual-process model of defense against conscious and unconscious death-related thoughts: an extension of terror management theory

Abstract: Distinct defensive processes are activated by conscious and nonconscious but accessible thoughts of death. Proximal defenses, which entail suppressing death-related thoughts or pushing the problem of death into the distant future by denying one's vulnerability, are rational, threat-focused, and activated when thoughts of death are in current focal attention. Distal terror management defenses, which entail maintaining self-esteem and faith in one's cultural worldview, function to control the potential for anxiety that results from knowing that death is inevitable. These defenses are experiential, are not related to the problem of death in any semantic or logical way, and are increasingly activated as the accessibility of death-related thoughts increases, up to the point at which such thoughts enter consciousness and proximal threat-focused defenses are initiated. Experimental evidence for this analysis is presented.

Adverse Childhood Experiences and Smoking During Adolescence and Adulthood

Abstract: ContextIn recent years, smoking among adolescents has increased and the decline of adult smoking has slowed to nearly a halt; new insights into tobacco dependency are needed to correct this situation. Long-term use of nicotine has been linked with self-medicating efforts to cope with negative emotional, neurobiological, and social effects of adverse childhood experiences.ObjectiveTo assess the relationship between adverse childhood experiences and 5 smoking behaviors.DesignThe ACE Study, a retrospective cohort survey including smoking and exposure to 8 categories of adverse childhood experiences (emotional, physical, and sexual abuse; a battered mother; parental separation or divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member), conducted from August to November 1995 and January to March 1996.SettingA primary care clinic for adult members of a large health maintenance organization in San Diego, Calif.ParticipantsA total of 9215 adults (4958 women and 4257 men with mean [SD] ages of 55.3 [15.7] and 58.1 [14.5] years, respectively) who responded to a survey questionnaire, which was mailed to all patients 1 week after a clinic visit.Main Outcome MeasuresSmoking initiation by age 14 years or after age 18 years, and status as ever, current, or heavy smoker.ResultsAt least 1 of 8 categories of adverse childhood experiences was reported by 63% of respondents. After adjusting for age, sex, race, and education, each category showed an increased risk for each smoking behavior, and these risks were comparable for each category of adverse childhood experiences. Compared with those reporting no adverse childhood experiences, persons reporting 5 or more categories had substantially higher risks of early smoking initiation (odds ratio [OR], 5.4; 95% confidence interval [CI], 4.1-7.1), ever smoking (OR, 3.1; 95% CI, 2.6-3.8), current smoking (OR, 2.1; 95% CI, 1.6-2.7), and heavy smoking (OR, 2.8; 95% CI, 1.9-4.2). Each relationship between smoking behavior and the number of adverse childhood experiences was strong and graded (P<.001). For any given number of adverse childhood experiences, recent problems with depressed affect were more common among smokers than among nonsmokers.ConclusionsSmoking was strongly associated with adverse childhood experiences. Primary prevention of adverse childhood experiences and improved treatment of exposed children could reduce smoking among both adolescents and adults.

Attention and executive deficits in Alzheimer's disease: A critical review

Abstract: In this review we summarize the progress that has been made in the research on attentional and executive deficits in Alzheimer's disease. Like memory, attention is now recognized as consisting of subtypes that differ in their function and anatomical basis. We base our review upon a classification of three subtypes of attention: selective, sustained and divided. This model derives from lesion studies, animal electrophysiological recordings and functional imaging. We examine how these subcomponents of attention can be reconciled with neuropsychological models of attentional control, particularly the Supervisory Attentional System and the Central Executive System of Shallice and Baddeley, respectively. We also discuss the relationship of attention to the concept of executive function. Current evidence suggests that after an initial amnesic stage in Alzheimer's disease, attention is the first non-memory domain to be affected, before deficits in language and visuospatial functions. This is consistent with the possibility that difficulties with activities of daily living, which occur in even mildly demented patients, may be related to attentional deficits. It appears that divided attention and aspects of selective attention, such as set-shifting and response selection, are particularly vulnerable while sustained attention is relatively preserved in the early stages. The phenomenon of cognitive slowing in Alzheimer's disease and normal ageing emphasizes the need to discriminate quantitative changes in attention dysfunction from qualitative changes which may be specifically related to the disease process. The neuropathological basis of these attentional deficits remains unsettled, with two competing hypotheses: spread of pathology from the medial temporal to basal forebrain structures versus corticocortical tract disconnection. Finally we discuss the difficulties of comparing evidence across studies and look at the implications for the design of future studies and future directions that may be fruitful in the research on attention in Alzheimer's disease.

Occult economies and the violence of abstraction: notes from the South African postcolony

Abstract: Postcolonial South Africa, like other postrevolutionary societies, appears to have witnessed a dramatic rise in occult economies: in the deployment, real or imagined, of magical means for material ends. These embrace a wide range of phenomena, from "ritual murder," the sale of body parts, and the putative production of zombies to pyramid schemes and other financial scams. And they have led, in many places, to violent reactions against people accused of illicit accumulation. In the struggles that have ensued, the major lines of opposition have been not race or class but generation—mediated by gender. Why is all this occurring with such intensity, right now? An answer to the question, and to the more general problem of making sense of the enchantments of modernity, is sought in the encounter of rural South Africa with the contradictory effects of millennial capitalism and the culture of neoliberalism. This encounter, goes the argument, brings "the global" and "the local"— treated here as analytic constructs rather than explanatory terms or empirical realities—into a dialectical interplay. It also has implications for the practice of anthropology, challenging us to do ethnography on an "awkward" scale, on planes that transect the here and now, then and there,

The evolution of Crew Resource Management training in commercial aviation.

Abstract: In this study, we describe changes in the nature of Crew Resource Management (CRM) training in commercial aviation, including its shift from cockpit to crew resource management. Validation of the impact of CRM is discussed. Limitations of CRM, including lack of cross-cultural generality are considered. An overarching framework that stresses error management to increase acceptance of CRM concepts is presented. The error management approach defines behavioral strategies taught in CRM as error countermeasures that are employed to avoid error, to trap errors committed, and to mitigate the consequences of error.

Identifying and mapping community vulnerability.

Abstract: Disaster vulnerability is socially constructed, i.e., it arises out of the social and economic circumstances of everyday living. Most often discussed from the perspective of developing nations, this article extends the argument using American demographic trends. Examples from recent disasters, Hurricane Andrew in particular, illustrate how certain categories of people, such as the poor, the elderly, women-headed households and recent residents, are at greater risk throughout the disaster response process. Knowledge of where these groups are concentrated within communities and the general nature of their circumstances is an important step towards effective emergency management. Emergency planners, policy-makers and responding organisations are encouraged to identify and locate high-risk sectors on Community Vulnerability Maps, integrating this information into GIS systems where feasible. Effective disaster management calls for aggressively involving these neighbourhoods and groups at all levels of planning and response, as well as mitigation efforts that address the root causes of vulnerability.

The Medial Extended Amygdala in Male Reproductive Behavior A Node in the Mammalian Social Behavior Network

Abstract: Hormonal and chemosensory signals regulate social behaviors in a wide variety of mammals. In the male Syrian hamster, these signals are integrated in nuclei of the medial extended amygdala, where olfactory and vomeronasal system transmission is modulated by populations of androgen- and estrogen-sensitive neurons. Evidence from behavioral changes following lesions and from immediate early gene expression supports the hypothesis that the medial extended amygdala and medial preoptic area belong to a circuit that functions selectively in male sexual behavior. However, accumulated behavioral, neuroanatomical, and neuroendocrine data in hamsters, other rodents, and other mammals indicate that this circuit is embedded in a larger integrated network that controls not only male mating behavior, but female sexual behavior, parental behavior, and various forms of aggression. In this context, perhaps an individual animal's social responses can be more easily understood as a repertoire of closely interrelated, hormone-regulated behaviors, shaped by development and experience and modulated acutely by the environmental signals and the hormonal milieu of the brain.

Level of automation effects on performance, situation awareness and workload in a dynamic control task

Abstract: Various levels of automation (LOA) designating the degree of human operator and computer control were explored within the context of a dynamic control task as a means of improving overall human/machine performance. Automated systems have traditionally been explored as binary function allocations; either the human or the machine is assigned to a given task. More recently, intermediary levels of automation have been discussed as a means of maintaining operator involvement in system performance, leading to improvements in situation awareness and reductions in out-of-the-loop performance problems. A LOA taxonomy applicable to a wide range of psychomotor and cognitive tasks is presented here. The taxonomy comprises various schemes of generic control system function allocations. The functions allocated to a human operator and/or computer included monitoring displays, generating processing options, selecting an 'optimal' option and implementing that option. The impact of the LOA taxonomy was assessed within a dynamic and complex cognitive control task by measuring its effect on human/system performance, situation awareness and workload. Thirty subjects performed simulation trials involving various levels of automation. Several automation failures occurred and out-of-the-loop performance decrements were assessed. Results suggest that, in terms of performance, human operators benefit most from automation of the implementation portion of the task, but only under normal operating conditions; in contrast, removal of the operator from task implementation is detrimental to performance recovery if the automated system fails. Joint human/system option generation significantly degraded performance in comparison to human or automated option generation alone. Lower operator workload and higher situation awareness were observed under automation of the decision making portion of the task (i.e. selection of options), although human/system performance was only slightly improved. The implications of these findings for the design of automated systems are discussed.

Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence

Abstract: A randomized clinical trial was conducted to evaluate whether Dialectical Behavior Therapy (DBT), an effective cognitive-behavioral treatment for suicidal individuals with borderline personality disorder (BPD), would also be effective for drug-dependent women with BPD when compared with treatment-as-usual (TAU) in the community. Subjects were randomly assigned to either DBT or TAU for a year of treatment. Subjects were assessed at 4, 8, and 12 months, and at a 16-month follow-up. Subjects assigned to DBT had significantly greater reductions in drug abuse measured both by structured interviews and urinalyses throughout the treatment year and at follow-up than did subjects assigned to TAU. DBT also maintained subjects in treatment better than did TAU, and subjects assigned to DBT had significantly greater gains in global and social adjustment at follow-up than did those assigned to TAU. DBT has been shown to be more effective than treatment-as-usual in treating drug abuse in this study, providing more support for DBT as an effective treatment for severely dysfunctional BPD patients across a range of presenting problems.

Population based study of social and productive activities as predictors of survival among elderly Americans

Abstract: Objectives: To examine any association between social, productive, and physical activity and 13 year survival in older people. Design: Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants9 homes Proportional hazards models were used to model survival from time of initial interview. Setting: City of New Haven, Connecticut, United States. Participants: 2761 men and women from a random population sample of 2812 people aged 65 and older. Main outcome measure: Mortality from all causes during 13 years of follow up. Results: All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. Conclusions: Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people. Key messages Little is known about predictors of survival among elderly people Physical activity is clearly good for health, but the potential benefits of social activities have not been studied Social and productive activities are as effective as fitness activities in lowering the risk of death Enhanced social activities may help to increase the quality and length of life