Search PubMed⌕ Search

Biomedical subjects

J R Iacovino

Publications and source records attributed to J R Iacovino.

At least 19 recordsLinked to original sources
PubMed2001

Peripartum cardiomyopathy: mortality outcomes.

Mortality estimates of peripartum cardiomyopathy have been reported to be between 18 and 56% without reference to time frames. Although this is an unusual impairment, medical directors need accurate information to meet the gold standard of underwriting: decisions must be based on sound underwriting and actuarial principles reasonably related to actual or anticipated loss experience. In an insurance purchasing population, the excess mortality in peripartum cardiomyopathy can be nearly eliminated by not insuring those with the impairment within the first 6 months postpartum or until all abnormal physiologic parameters have resolved. Thereafter, the risk is probably negligible. This abstract illustrates the challenge to determine expected mortality when the study population exhibits strong racial diversity and when available expected life tables contain raw data of only alive and dead at each yearly interval.

Adolescent↗
PubMed2001

Mortality outcomes after osteoporotic fractures in men and women.

BACKGROUND: Underwriting the elderly will challenge the skills of the medical director. Factors not typically reflecting an increased mortality risk in younger applicants assume major importance in the elderly. This article demonstrates osteoporotic fractures in the elderly can be predictive of adverse mortality. MATERIALS AND METHODS: In a 5-year prospective community study, all residents age 60 and over were screened for low-impact fractures, defined as those from a standing height or less. Two fracture groups were analyzed: proximal femur (hip) and combined vertebral and other major fractures. Those with predisposing underlying disease were excluded. Follow-up was nearly 100%. Age- and sex-specific mortality for expected and those with each fracture group were calculated. Through an abridged life table analysis technique, the authors were able to create a 25-year cumulative survival analysis. RESULTS: There were more deaths among fracture patients in both groups than in the expected general population. Females with vertebral and other major fractures had a mortality ratio of 188% and excess death rate of 7. For hip fractures, values were 500% and 32. Males exhibited more adverse mortality, with a mortality ratio of 330% and excess death rate of 30 for vertebral and other major fractures and 540% and excess death rate of 57 for hip fractures. CONCLUSION: Osteoporotic fractures are risk factors for increased mortality in both males and females age 60 and older. The fractures contribute directly to mortality but more importantly appear to be a marker for comorbid conditions.

Aged↗
PubMed1999

Mortality of atrial fibrillation in a population selected to be free of major cardiovascular impairments.

The magnitude of additional mortality produced by the development of atrial fibrillation not associated with major cardiovascular risk factors is demonstrated. In a community-based population followed for 10 years, men aged 55-74 years had a mortality ratio of 260% and an excess death rate of 57. Women in the same age group had a mortality ratio of 335% and an excess death rate of 59. Were one to use an industry expected life table instead of the author's selected community population, the mortality ratios and excess death rates would be higher. Charging an extra premium for individuals with atrial fibrillation is supported by this increased mortality risk.

Aged↗
PubMed1998

Additional mortality produced by co-existent cerebral and peripheral atherosclerosis in a population with coronary artery disease.

The effect on survival of cerebral and lower extremity atherosclerosis was investigated in a cohort of individuals with known coronary artery disease. Those with cerebral and lower extremity atherosclerosis each had mortality ratios about 220% and extra death rates about 27. With the co-existence of both impairments the mortality ratio nearly doubled to 410% and the extra death rate increased to 71. In a group of individuals with known coronary artery disease, cerebral and lower extremity atherosclerosis have a major additional mortality impact.

Arteriosclerosis↗
PubMed1997

Life table mortality analysis of parkinsonian signs in a community population of older people.

BACKGROUND: A community based mortality review of individuals with parkinsonism is evaluated by a comparative life table analysis. RESULTS: Individuals with parkinsonism had an increased mortality over a nine year follow up. The presence of a gait disturbance is an additional mortality factor. However, the absence of gait disturbance is a far stronger factor for improved survival in parkinsonism than is the adverse factor of a gait disturbance being present. Bradykinesia, tremor and rigidity had no significant additional mortality effect. CONCLUSIONS: Careful risk selection should lead to a favorable mortality result. Credits can be given to those without gait disturbances and extra debits assessed to those with gait disorders.

Aged↗
PubMed1997

Mortality analysis of complete right and left bundle branch block in a selected community population.

A twenty year follow up of a selected, community population with complete right and left bundle branch block is reviewed by comparative mortality analysis. In this population, where cases and controls were free of hypertension and heart disease at entry, the presence of complete right bundle branch block does not have excess mortality. Complete left bundle branch block exhibits excess total and cardiac mortality.

Adult↗
PubMed1996

The non mortality of hypertrophic cardiomyopathy in an unselected, community diagnosed and treated population.

Hypertrophic Cardiomyopathy (HC) is portrayed in past literature as having an ominous prognosis. However, most studies emanated from medical centers and suffered from potential referral bias. A population based, community diagnosed and treated survival study is analyzed by the life table method. Despite potential causes for both underestimation of the observed mortality as well as for overestimation of expected mortality, the study appears to reveal a more favorable prognosis for HC in this population.

Adult↗
PubMed1994

Mycosis fungoides--an underwriting prospective with emphasis on staging and risk selection.

Mycosis Fungoides is a T-cell lymphoma having a broad clinical spectrum ranging from localized cutaneous to rapidly fatal systemic disease. Early clinical presentation is non specific, delaying correct diagnosis. Compared to clinical, the insurable spectrum is narrow. Staging for skin, lymph node and other organ manifestations is presented. Factors which influence mortality within each stage are elucidated. The survival curves of stages and stage groupings are illustrated and discussed to facilitate risk classification. Cutaneous (T) and lymph node (LN) stages are the most important prognosticators. Substages T1/T2, LN1/LN2 without associated palpable adenopathy, eosinophilia, visceral and blood positive findings are insurable. It would be most appropriate to place them in a tumor class of mild/moderate risk after the initial excessive mortality period ends. Higher T and LN substages, adenopathy and visceral disease have highly adverse mortality. These ultimately reveal a flattening of survival curves at 8-10 years. Although numerous treatment modalities have been used, none appear to consistently prolong life expectancy except in the earliest stage skin disease.

Actuarial Analysis↗
PubMed1976

Fatal pulmonary reaction from low doses of bleomycin. An idiosyncratic tissue response.

There were two cases of fatal interstitial pneumonia secondary to bleomycin sulfate administration. Although bleomycin pulmonary toxicity is generally thought to be dose-related and occurs infrequently with a total cummulative dose less than 300 to 400 units, the two reactions reported here occurred with doses of 105 and 165 units. Fatal bleomycin-induced pneumonia has been previously reported at these low dosages, and physicians should be aware that this toxic reaction may occur as an idiosyncratic response. Previous thoracic irradiation may be a predisposing factor. Patients receiving bleomycin should be meticulously monitored by interrogation for cough, dyspnea, and chest pain; by auscultation for rales; by serial chest roentgenograms; and by determinations of vital capacity and single-breath carbon monoxide diffusing capacity.

Adenocarcinoma↗