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At least 811 records · Page 45Linked to original sources
PubMed1993

Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists.

The decision to perform a renal biopsy on children with asymptomatic hematuria or proteinuria remains a problem for clinicians. To assess the current opinion of 349 pediatric nephrologists on this issue, case summaries of a 9-year-old boy with 20 urinary red blood cells per high power field without proteinuria and a 9-year-old boy with 2+ proteinuria (600 mg/day) without hematuria were distributed to each specialist. Seventy-three percent (n = 256; 3:1, male:female) responded. Five percent would biopsy the child with asymptomatic hematuria. The main reasons were academic interest, parental pressure for a diagnosis/prognosis and concern for future economic impact on the child (i.e., life insurance). The determinations to biopsy for hematuria were not related to age or sex of the nephrologist. In contrast, 38% (n = 96) of the pediatric nephrologists would perform a biopsy on the child with proteinuria. The major reasons for biopsy were academic interest and potential for drug therapy. With a normal history, physical examination and laboratory/radiographic evaluation, the vast majority of pediatric nephrologists in North America support a conservative approach to the child with asymptomatic hematuria or proteinuria.

Adult↗
PubMed2002

Implantable gastric stimulation (IGS) as therapy for human morbid obesity: report from the 2001 IFSO symposium in Crete.

This supplement contains reports from a symposium on a novel approach to treat obesity, gastric myo-electrical stimulation, that was held at the IFSO in Greece in 2001. There were four presentations. Xavier Pi-Sunyer from Columbia University in New York discussed medical risks of obesity. Karl Miller from Austria presented technical aspects of the surgery. Valerio Cigaina from Italy, the originator of the concept, reviewed his 7-year results with this therapy. Finally, Jerome D'Argent from France gave his preliminary results employing higher energy electrical stimulation parameters. Customarily weight loss data are presented as percent excess weight lost (%EWL), an antiquated measurement, e.g. all subjects were purchasing life insurance, the poor and minorities were under-represented and those with heart disease, malignancies or diabetes were excluded. In this supplement weight loss data are presented in a novel manner: percent excess body mass index (BMI) lost %EBL. This innovation merits an explanation and justification. The NIH/NIDDK convened a panel, chaired by Professor Pi-Sunyer, that concluded that for adults a BMI of 25 should be considered the upper limit of normal. Accordingly, we have proposed that BMI units in excess of 25 be considered to represent 100% of the excess weight of an individual. The USA FDA has agreed to accept weight loss data presented as %EBL. The intriguing data presented justify further evaluation of this novel, potentially useful and relatively benign treatment of obesity.

Congresses as Topic↗
PubMed1998

Urinary cotinine as a tobacco-smoke exposure index: a minireview.

A minireview is presented concerning the use of cotinine as a tobacco-smoke exposure index. First, general considerations about methods for the determination of urinary cotinine are presented. Besides pure analytical aspects, this minireview considers major problems encountered in the establishment of threshold values that can be used to distinguish not only smokers from nonsmokers but also nonsmokers exposed or not exposed to environmental tobacco smoke (ETS). In addition, the use of urinary cotinine is illustrated in several situations where smoking status assessment is of interest. Such situations include evaluation of the impact of smoking cessation programs, monitoring of pregnancy and of other groups at risk, assessment of occupational exposure to industrial pollutants, validation of phase I clinical trials, and the control of life insurance candidates. The specific problem of ETS exposure assessment is briefly mentioned.

Biomarkers↗
PubMed2005

Economic outcomes of breast cancer survivorship: CALGB study 79804.

BACKGROUND: Over 80% of women diagnosed with breast cancer will be survivors. We sought to determine the economic consequences of surviving breast cancer. METHODS: Disease-free survivors who had received adjuvant chemotherapy for stage II breast cancer on CALGB study 8541 participated in a study of long-term outcomes. Survey responses were used to determine the types and frequency of medical resources used in follow-up, annual direct medical costs, and survivor perceptions of the personal economic impact of breast cancer. RESULTS: 245 of 314 (78%) invited breast cancer survivors (median follow-up 12.2 years, range 9.3-16.4) completed the surveys. Eighty-seven percent reported having cancer specialist follow-up in the past year. The following percentages of survivors reported having had, for breast cancer follow-up, at least once in the past year: breast examination 92%, mammogram 88%, bone scan 18%, chest radiograph 59%, tumor marker studies 37%. When follow-up care included a medical oncologist, resources were more likely to be used at least according to published follow-up guidelines, or over-used. Median annual cost of follow-up per survivor was US 630 dollars (range US 0-10,817 dollars) with higher costs associated with medical oncology follow-up, lower income, and younger age. Few women reported a negative impact of breast cancer on employment, but 16% reported being denied life insurance. CONCLUSIONS: Among long-term breast cancer survivors, patient self-report data suggest that over-use of medical resources for follow-up appears common. When follow-up care included a medical oncologist, resources were more likely to be used appropriately, or over-used. Costs of follow-up are higher with medical oncology follow-up, lower income and among younger survivors. The annual cost of follow-up varies widely and may be driven by over-use of follow-up tests.

Adult↗
PubMed2005

Long term follow-up of HNPCC gene mutation carriers: compliance with screening and satisfaction with counseling and screening procedures.

Hereditary non polyposis colorectal cancer (HNPCC) is a hereditary predisposition to colorectal and endometrial cancer, caused by mutations of the mismatch repair (MMR) genes MSH2, MLH1 and MSH6. Regular colonoscopy reduces the incidence of colorectal cancer in mutation carriers dramatically. The aim of this study was to evaluate the use of colonoscopy by proven HNPCC mutation carriers. We also evaluated the satisfaction with the counseling and screening procedures at the long term. A questionnaire survey was performed among 94 proven MMR gene mutation carriers. Data were analyzed using univariate and multivariate analysis. The average time of follow-up was 3,5 years (range 0.5-8.5 years). The response rate was 74%. The proportion of unaffected mutation carriers under colonoscopic screening increased from 31 to 88% upon genetic testing, and for gynecological screening from 17 to 69%. However, more than half of the responders experienced colonoscopy as unpleasant or painful. About 97% felt well informed during counseling, and 88% felt sufficiently supported. Ten percent of the responders reported a high cancer worry that was significantly (P = 0.007) associated with a high perceived cancer risk. Six responders (9%) regretted being tested. Remarkably, of 4 of these 6 a close relative died recently of cancer. Problems with obtaining a disability or life insurance or mortgage were experienced by 4 out 10 healthy carriers opting for these services. In conclusion, genetic testing for HNPCC considerably improves compliance for screening, which will result in a reduction of HNPCC-related cancer morbidity and mortality in mutation carriers. Most HNPCC gene mutation carriers cope well with their cancer susceptibility on the long term.

Adult↗
PubMed1987

Injury as externality: an economic perspective of trauma.

Economists emphasize the costs in dollars or other desirable outcomes of additional safety in contrast to safety experts who remind people to design safe products and operate them safely. Society loses emotionally and financially from traumatic injury. The emotional loss must be balanced against allowing individuals free choice and encouraging them to develop judgment. Individuals are viewed as making their own best safety decisions, although they must have good information and face the correct indentives. Currently, society subsidizes risk taking in many ways, thereby discouraging safety. Health and life insurance ought to be required along with liability insurance, to correct the incentives to drivers. In addition, regulation is required to deal with physical externalities.

Cost-Benefit Analysis↗
PubMed1989

Importance of overweight in studies of left ventricular hypertrophy and diastolic function in mild systemic hypertension.

The relations of Metropolitan Life Insurance Co. Relative Weight values and blood pressure (BP) to minimal forearm vascular resistance, ventricular septal and posterior wall thickness, left ventricular (LV) mass index and cardiac diastolic function were assessed in 31 men, 37 +/- 2 (mean +/- standard error of the mean) years of age. Eighteen patients with untreated mild hypertension were compared with 13 normotensive control subjects of similar age and weight. The hypertensives had higher clinic (137 +/- 3/96 +/- 2 vs 121 +/- 4/81 +/- 3 mm Hg, p less than 0.001/less than 0.001) and home (p less than 0.001) BP. Despite higher BP, the hypertensives did not have significantly greater values than normotensives, respectively, for minimal forearm vascular resistance (2.20 +/- 0.12 vs 2.04 +/- 0.11 U), ventricular septal (9.9 +/- 0.5 vs 10.2 +/- 0.3 mm) and posterior wall thickness (10.2 +/- 0.4 vs 10.0 +/- 0.3 mm) or LV mass index (106 +/- 6 vs 107 +/- 6 g/m2). Furthermore, diastolic peak filling rate, an index of LV diastolic function, was virtually identical in the 2 groups (2.71 +/- 0.14 vs 2.69 +/- 0.07 liters/s, difference not significant). Correlates of peak filling rate included relative weight (r = -0.62, p less than 0.001), posterior wall thickness (r = -0.51, p less than 0.01) and age (r = -0.45, p less than 0.05). Relative weight also correlated significantly with posterior wall (r = 0.59, p less than 0.005), ventricular septal (r = 0.47, p less than 0.005) and LV mass index (r = 0.38, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Indices of relative body weight and ideal weight charts.

Established indices of relative body weight are reviewed and critically evaluated in terms of five criteria: (1) high correlation with obesity, (2) a conceptual interpretation, (3) universality, (4) simplicity of computation, and (5) zero correlation with height. Regression procedures are used to create standard weight charts which are distributed similarly to the body weight of 13,645 Americans, provided by the National Health Survey (NHS), and which have an arithmetic mean equal to the mean of the Metropolitan Life Insurance ( MLI ) table of desirable weights. A similar method is used to create a standard weight table based on body mass index (BMI). Finally, standard body weight charts which are uncorrelated with sex, age, and/or body frame are developed and discussed in terms of their usefulness.

Adolescent↗
PubMed1982

Future forecasting with LEAP.

A rapidly changing business environment has caused numerous firms to adopt some form of environmental assessment as part of their strategic planning process. Extrapolative techniques and trend analysis are useful when forecasting for the short-term and in comparatively stable environments. Futuristic methodologies are appropriate in turbulent environments with long-term planning requirements. The Likelihood of Events Assessment Process (LEAP), a new method of forecasting developed by the author, is explained in detail using examples from a recent study which used top level life insurance executives to predict the relative likelihood of occurrence of planning dates for a set of events in the socio-political environment of business.

Analysis of Variance↗
PubMed1996

Pooling public and private funds in the patient's interest: the case for long-term care insurance.

Although the extent of medical care in France may be thought adequate, the same does not apply to the social medicine sector. The Assurance-maladie paid 87.7% of hospital health expenditure in 1994, whereas direct funding of home assistance amounted to only 9%. In contrast, a recent Legos study (Bungener M. et al. Le bilan économique et financier du secteur médico social, Université de Paris IX, Legos, Janvier 1994) [1] estimated that home assistance costs represent 41-50% of medical-social expenditure. When people are unable to manage because of the high costs of their invalidity, the social security system comes to their assistance, although only under Draconian conditions involving compulsory "family support commitments" and the state's claim on the inheritance of the beneficiary (total costs for hospital admission and boarding and the dual limits of 1000F liabilities and 250,000F net assets for home assistance). The elderly well appreciate the severity of this problem and are deeply distressed by the thought of dependency. Many, however, live under the illusion that the social security system or, to a lesser extent, the mutual funds will come to their assistance, although the problems involved lie partly outside their remits. We therefore need to design new systems to allow the elderly to finance their costs should they become dependant.

Aged↗
PubMedDate not supplied

Association of high density lipoprotein with whole blood-associated acetaldehyde levels.

We hypothesized that while moderate drinking is associated with increasing levels of high density lipoprotein (HDL) levels, excessive drinking of ethanol might, in fact, be associated with lower HDL levels and by implication increased cardiovascular risk. We therefore performed analyses of whole blood-associated acetaldehyde (WBAA) as a measure of drinking behavior and HDL on blood samples from 2780 individuals applying for life insurance. Whole blood-associated acetaldehyde correlated positively with HDL in the entire sample set throughout the range of values (R = 0.101, p = 0.0001). The relationship held for females (N = 477, p = 0.036) but was stronger for males (N = 2277, p = 0.0001). We conclude that ethanol consumption correlates positively with HDL for both males and females and that the relationship persists through higher ranges of ethanol consumption.

Acetaldehyde↗
PubMed1991

Use of relative weight and Body Mass Index for the determination of adiposity.

Relative weight and Body Mass Index (BMI) are commonly used as measures of body fatness in epidemiologic and clinical studies. In order to determine their accuracy, they were compared to body fat measured by underwater weighting and total body water determination in 29 males and 75 females who varied widely in body composition. Relative weights calculated from the Metropolitan Life Insurance Tables correlated so highly with BMI that these measures can be considered to be identical (R2 = 0.992 to 0.999). Linear regression analysis showed a significant correlation between BMI and percentage body fat in men (R2 = 0.68, %fat = 0.99 X BMI -1.32, p less than 0.001) and women (R2 = 0.74, %fat = 0.94 X BMI + 10.77, p less than 0.001). We conclude that relative weight and BMI are nearly identical, and that they are reasonable estimates of body fatness.

Adipose Tissue↗
PubMed1994

Detection of antibody to HIV in saliva: a brief review.

BACKGROUND: The possibility that saliva could be used for HIV screening and diagnosis has been known since 1986. Despite the obvious advantages over venepuncture of ease of collection, safety, compliance and cost, interest in salivary testing has grown relatively slowly. Several studies have demonstrated that salivary anti-HIV testing can be highly accurate, particularly if specimen collection procedure are optimal. OBJECTIVE: To review current knowledge about the detection of anti-HIV in oral fluids, with an emphasis on the identification of optimal procedures. STUDY DESIGN: In the light of existing published data, the factors leading to accurate salivary diagnosis of HIV infection were identified and reviewed. RESULTS: To achieve the best results it is essential to collect oral fluid specimens that are rich in IgG. Most IgG in the oral cavity derives from the crevicular space between the gums and the teeth, and not from salivary glands. Available methods for collecting salivary specimens are discussed. Until these collection methods are fully validated, individual specimens or at least clinical ones found anti-HIV negative should be tested for total IgG before being reported on. There is a lack of proven confirmatory methods for salivary anti-HIV and this problem is reviewed. Salivary anti-HIV testing has been employed mostly for surveillance, but life insurance applicants are increasingly screened in this way and clinical applications are under active consideration. With appropriate safeguards, diagnostic and pre-blood donation salivary testing could be introduced shortly. The necessary technology is also available to develop rapid single-use salivary tests. This would bring anti-HIV testing closer to the patient. CONCLUSIONS: Salivary tests for anti-HIV offer advantages of convenience, economy and safety, and are more acceptable to subjects than blood tests. Further evaluation of the collection devices and assays, the introduction of safeguards against inadequate sampling and the development of suitable confirmatory assays are required. When these deficiencies have been met, salivary tests may supersede tests on serum for HIV and also other infections.

Journal Article↗
PubMed2006

Financial burden of tobacco use: an employer's perspective.

To assist in determining whether employer-sponsored smoking cessation programs can be justified on cost-effectiveness grounds, a review was performed to examine the costs imposed on employers by smoking and the extent to which employers can recover those costs through successful smoking cessation programs. The magnitude of the costs (or cost savings) imposed by employee tobacco use depends on workplace factors, including medical coverage (before and after retirement), disability and life insurance benefits, level of exposure to workplace pollutants associated with smoking-related diseases, employee turnover rate, current smoke-free area policy, smoking breaks policy, cost of providing smoking areas, and type of retirement pension plan.

Air Pollution, Indoor↗
PubMed2004

Expanding criteria for the use of living donors: what are the limits?

The cadaver organ shortage has pushed the transplant community to extend the boundaries beyond the traditional criteria used for living donor transplantation. This new liberal policy involves: (1) the type of donor, such as emotionally related individuals, the direct or indirect interchange of donors, anonymous as well as rewarded donation; (2) challenging immunological criteria, using incompatible ABO blood types and or transplantation across a positive cross-match; (3) relaxing clinical criteria related to elderly, hypertensive, or obese donors, or patients with nephrolithiasis, fibromuscular renal artery disease, hematuria, or renal cell carcinomas. However, these practices may be dangerous. They must be clearly validated to promote a liberal policy of donor acceptance since it may carry a risk for both the donor and the recipient as well as for society. It is crucial to ensure the physical integrity of the donor as well as to provide guarantees, for instance a 1-year policy of life insurance, an indefinite long-term medical follow-up and the assurance of going to the top of the waiting list if the donor becomes uremic in the future.

Bioethics↗
PubMed2006

Dietary fat, coronary heart disease, and cancer: a historical review.

OBJECTIVES: This report describes the historical development of medical theories and research concerning the relationship between dietary fat intake and breast and colorectal cancer and coronary heart disease (CHD). METHOD: The historical and medical literature on this topic was analyzed with special reference to the Woman's Health Initiative (WHI) studies. RESULTS: After 1900, changes in clothing fashions and life insurance mortality studies created strong preferences for slimness and emphasized reduced dietary fat intake as the preferred method of weight control. After midcentury, ecological correlations of countries found that national average dietary fat intake was related to national breast cancer and CHD rates. These relationships were not found in longitudinal studies of the same countries or in studies of dietary fat intake of individuals, including the WHI study. Dietary fat intake was found to affect colorectal cancer in some studies of individuals, although not the WHI. The WHI, like other intervention studies of dietary fat reduction, used unrepresentative samples and costly lifestyle change techniques that are not economically feasible in the community. CONCLUSION: The WHI concurred with many other studies in finding that dietary fat intake is not a significant risk factor for CHD or breast cancer.

Biomedical Research↗
PubMed1986

Marfan's syndrome. A personal perspective.

Marfan's patients share the same problems as anyone with a lifelong, progressive, hereditary condition. The more knowledgeable an individual is about his disease and the more willing he is to accept the responsibility for his own well-being, the more control he has over his life. Medical and life insurance is not a luxury, but an absolute must. The need for stable insurance coverage impacts career decisions. Medication is a lifelong necessity; the patient must know what medications he takes, for what purpose, and the side effects. For patients with a cardiac prosthesis, most physicians recommend a regimen of prophylactic antibiotics before dental work or any invasive procedure. It is the responsibility of the patient to do this. Craig has cancelled dental appointments because he has forgotten to take antibiotics. Craig also takes an anticoagulant because of his prosthetic valve and fears being in a major accident and bleeding to death. Because of human body contains large amounts of connective tissue, a Marfan's patient will continue to develop problems; hernias, eye problems, joint problems, and further cardiovascular complications are all possibilities. Being realistic and maintaining a positive attitude are important in effective planning and dealing with continued adversity.

Aneurysm↗
PubMed1997

Storage of newborn stem cells for future use.

Human placental cord blood contains a large number of hematopoietic progenitor cells, which could be used as a source of stem cells for the treatment of hematologic disorders and malignancies. Advantages of cord blood use include noninvasive collection, low risk for viral infection, and immunologic naivete. Cord blood may be used as stem-cell rescue in all applications of bone marrow transplantation, including gene therapy. Given this potential utility, questions are raised regarding the regulation of cord-blood collection, storage, and use. Should the prospective parent(s) donate the infant's cord blood for treatment of unrelated recipients, or should they invest in cord-blood storage as biologic "life insurance" for the child's later use? This issue presents many conflicts for families and their health care providers.

Blood Preservation↗