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At least 919 records · Page 51Linked to original sources
PubMed1992

Discrimination as a consequence of genetic testing.

Genetic discrimination refers to discrimination directed against an individual or family based solely on an apparent or perceived genetic variation from the "normal" human genotype. We describe here the results of a case history study designed to assess whether or not genetic discrimination exists. Using the above definition of genetic discrimination and applying stringent criteria for case selection, we find that genetic discrimination exists and is manifested in many social institutions, especially in the health and life insurance industries. Stigmatization, and denial of services or entitlements to individuals who have a genetic diagnosis but who are asymptomatic or who will never become significantly impaired, is noted. Follow-up comprehensive studies on the significance and varieties of genetic discrimination are needed. In order to avoid creating a new social underclass based on genetic discrimination (the "asymptomatic ill"), existing and future genetic testing or screening programs need review by medical, scientific, legal, and social policy experts, as well as the public, and may require modification.

Adult↗
PubMed2005

[Cardiology].

The therapeutic acquisition to be retained for 2004 are: 1. The elderly patients with heart failure also should receive beta blocker treatment. The correction of anaemia, aggravating factor in heart failure, improves symptoms and survival of the patient. 2. It remains to prove that the treatment of sleep apnea, which seems to be an additional factor for mortality in cardiovascular diseases, is able to reduce the risk. 3. The interventions in the endocanabinoïd system which regulates weight and metabolic processes might be a promising new therapeutic acquisition. 4. Prevention of coronary disease with lipid lowering drugs is still a major topic, and the trend goes the lower the better. The problems observed with Rofecoxybe and other drug interactions reminds us to be conscious when prescribing multiple drugs. 5. The implantable defibrillator seems to be a life insurance in the event of ventricular fibrillation. However, it is not so easy to identify the patient who might really benefit.

Cardiovascular Diseases↗
PubMed2005

Pediatric issues in underwriting.

Mortality risk assessment of juvenile life insurance applicants with impairments can be challenging. Advances in neonatal care means more premature infants will survive into childhood and adulthood with attendant respiratory and neurologic disorders. The degree of neonatal lung disease and length of ventilator support are factors that help to separate out more favorable risks. Autism and other developmental disorders have diverse presentations, but in the absence of other neurologic conditions risks are generally limited to accidents. Children with attention deficit hyperactivity disorder without accompanying conduct disorder are less likely to have problems with drug abuse. Impaired pediatric lives mortality patterns depend on whether accidental death predominates.

Humans↗
PubMed2005

PubMed: a brief tutorial for physicians.

This article provides a brief overview of PubMed, an Internet search engine for peer reviewed medical literature. The examples illustrated here are designed for the life insurance medical director, but the examples can be easily modified for other literature searches commonly used by physicians, eg, diagnosis or treatment.

Physicians↗
PubMed1991

[Rehabilitation of patients with malignant germ cell tumor].

The progress achieved in the treatment of the malignant germ cell tumor of the male is based on the introduction of cisplatin in polychemotherapy and of consistent interdisciplinary cooperation (including surgery). Thus more than 70% of testicular cancer patients are now cured long term. Early diagnosis and consistent therapy increase the chances of survival additionally. The chances of successful therapy are markedly higher in early tumor stages (90%) than in late tumor stages (less than 50%), where intensive therapy modalities are being tried (bone marrow transplantation, cytokines). After reaching complete remission, consistent follow up programmes are important in order to detect a relapse (10-15%), and to enable the patient to return to his profession. Psychosocial care is also an important factor. The patient should under no condition be pensioned off, more than 90% of the mainly very young patients (median age 20-35) can return to work after the phase of intensive therapy (3-6 months). In the case of our 222 patients, only 13 had to be pensioned and 7 received new professional training. A disabled pass should be issued, whereby the extent of the disability is reduced from at first 80%-100% to 20% after a period of 5 years. The entry into civil service and a life insurance policy are also usually possible after 5 years. To aid in the consistent and necessary follow up of this group of hopeful and highly curable patients, we have had good experiences in Bavaria with a follow up calendar.

Combined Modality Therapy↗
PubMed2006

Newer cardiac imaging techniques: multidetector CT angiography.

An update of new developments with multidetector computed tomography (MDCT) coronary angiography is presented. Similar to what has occurred with the introduction of other new technologies such as electron beam computed tomography (EBCT), life insurance medical directors are expected to evaluate a technology before there are sufficient data from large clinical trials. Well-performed studies of the performance of MDCT coronary angiography have only recently appeared. MDCT appears to perform well for excluding significant coronary disease, and will perhaps be useful in emergency room "rule-out" situations. Other applications may be for the diagnosis of significant coronary obstruction (> 75% stenosis), as well as for the evaluation of bypass grafts. Limitations include the requirement for radiologic contrast administration and significant radiation exposure. MDCT does not provide information on atheroma morphology. Given these limitations, MDCT coronary angiography utilization will grow, and it will prove to be a useful tool in specific situations.

Adult↗
PubMed1990

[Problems of the medicolegal system for unnatural or unexpected deaths in Japan].

Each area in Japan has its own system for postmortem examination of unnatural death or sudden unexpected death. Large cities like Tokyo, Yokohama, Osaka and Kobe have the medical examiner system. In the areas autopsies are performed for the unknown cause of death and for other reasons. Kyoto and Nagoya used to have the system but it was repealed in 1985. In the most part of Japan, the areas without the system, the causes of death are estimated by external examination without autopsy. Medical Examiner's Office, Tokyo Metropolitan Government, examines approximately 7,000 corpses for a year. This number accounts for 15% of total number of death in the area concerned. The author has been a medical examiner since 1969. He has examined 6,084 corpses for 21 years. The 38.4% out of his cases were autopsied. The causes of death suspected at the external medicolegal examinations and the causes determined by autopsies were compared. Not a few diagnoses had serious errors: some extrinsic death was primarily diagnosed as intrinsic diseases, and vice versa. In conclusion, the proportion of cases with serious errors was 15.5% of the total cases of his external examinations. It is extremely difficult to determine the cause of unnatural or unexpected death without autopsy. An error in the postmortem examination infringes on the right of the deceased and his or her family. It still exert a baneful influence upon the public health, social security, life insurance and other related matters. The author insists on the need for medical examiner system all over Japan. This is already asserted by Prof. Kuniyoshi Katayama in 1889. However, it was not until 1946 that the system was applied only to above mentioned areas, and no more than that still now.

Autopsy↗
PubMed1990

Overweight and mortality in Mexican Americans.

The Geriatric Research Center (GRC) table of desirable weights is based on the mortality experience of holders of 4.2 million policies issued by 25 life insurance companies in the USA and Canada. The GRC table defines optimum weight-for-height as the weight range which is associated with below average mortality for a given age and height group. People who fall outside this range, i.e. overweight or underweight, experience above average mortality for their age and height group. We classified 3176 Mexican Americans and 1841 non-Hispanic whites who participated in the San Antonio Heart Study according to the GRC table and found that Mexican Americans were less likely than non-Hispanic whites to be underweight and more likely to be overweight. The two effects did not offset one another, however, and fewer Mexican Americans were found to be in the 'just right' range. If the mortality experience of the population which generated the GRC table (largely non-Hispanic) applied to Mexican Americans, these results imply that Mexican Americans should have higher mortality rates than non-Hispanic whites. Vital statistics data from the state of Texas for the years 1979-81, however, fail to corroborate this prediction. Beyond age 45 years, an age range in which obesity and obesity-related disorders would be expected to exert an important influence on mortality, age-specific and age-adjusted all cause mortality was at last as good if not better in Mexican Americans than in non-Hispanic whites. These results could not be explained by ethnic differences in body fat distribution, since fat was less favorably distributed in Mexican Americans.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Modified radical mastectomies: average charges, 1988.

Average charge of $6,160 was billed to Metropolitan Life Insurance Company for 807 modified radical mastectomies during 1988. The average physicians' fees were $2,090. Length of hospital stay averaged 4.3 days across the country. The charges varied by as much as 92 percent between states. Among the 19 states included in the study, New York and California reported the highest average total charges ($7,870 and $7,290) and Iowa and Minnesota reported the lowest average charges ($4,100 and $4,620). On average, hospital expense comprised 66 percent of the total charges and ancillary fees accounted for almost three-fourths of the hospital bill.

Adult↗
PubMed1990

[Danger in cave diving].

A diving accident fatal for two divers, that occurred in the Blautopf-cave near Ulm, FRG, is reported. The circumstances fundamental in precipitating the fatal outcome are discussed. As a consequence accident- or life insurance coverage has become one of the prerequisites to obtain the official permit to dive in this cave.

Adult↗
PubMedDate not supplied

Cardiac catheterizations: regional variations in average hospital charges.

The number of cardiac catheterizations performed in the United States increased from 299,000 in 1979 to over 900,000 in 1988. Analyses of Metropolitan Life Insurance Company claims experience for 2,788 in-hospital, diagnostic cardiac catheterizations during 1988 revealed an average total charge of $4,820 and a length of stay of 2.8 days. Substantial geographic variation in charges existed, with California reporting the highest average charge ($7,990) and Wisconsin the lowest ($3,210). As the technology, professional experience and patient outcomes improve, the proportion of uncomplicated cardiac catheterizations being performed on an outpatient basis is also increasing. This development should result in major decreases in some of the costs associated with the diagnosis of heart disease.

Ambulatory Care↗
PubMed1989

[Is gambling a disease in the sense of section 169 of the federal insurance law?].

The socalled gambling addiction expresses itself as an exaggerated form of the gambling passion. The act of becoming fixed on or addicted to this (or another) behaviour pattern is always proceded by tentative situations man is succumbing to. The stimulant becomes increasingly more attractive. Regarding such a process, there is not criterion to determine a point when the addiction (which is not linked to a certain matter) becomes a disease. At all events, it is a legal matter to decide whether an extremely defective development that has obviously resulted into social ruin is to be regarded as a disease. The whole range of medical and educational requirements, however, has to be dealt with separately.

Gambling↗
PubMed1988

AIDS and South Africa--towards a comprehensive strategy. Part II. Screening and control.

In this, the second of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider controversies relating to screening for HIV, the indications for and desirability of mandatory testing of certain groups at risk, and the place of voluntary testing in the control of HIV transmission and infection. Key recommendations are that mandatory testing of donors of blood and other vital tissues, patients on haemodialysis and haemodialysis unit staff is justified, and that children put up for adoption may require testing. We make further recommendations regarding HIV testing as a prerequisite for life insurance and recommend that voluntary testing be offered, supported by adequate pre- and post-test counselling. We consider that all health care workers should accept as their moral obligation the care and management of HIV-infected individuals, and that they should be adequately educated and skilled in such work. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Proportionate mortality study of workers in the grain industry.

The proportionate mortality experience and proportionate cancer mortality experience were examined for 1,114 white male members of the American Federation of Grain Millers' life insurance plan. Mortality was significantly elevated for accidents and cancers of the lymphatic and hematopoietic systems, particularly from lymphosarcoma and reticulum cell sarcoma, other neoplasms of lymphoid tissue (i.e., giant follicular lymphoma and other primary malignant neoplasms of lymphoid tissue), and multiple myeloma. No increased mortality was seen for cancer of the respiratory tract, and nonmalignant diseases of the digestive tract were significantly lower than expected. Employees of grain mills showed higher mortality ratios of lymphatic and hematopoietic cancers as compared to other grain industry categories. A preliminary survey of pesticide usage suggested that grain mills were generally associated with greater use of pesticides than other industrial categories with considerable variation among the many facilities encompassed in this study.

Aged↗
PubMed1986

Obese, overweight, desirable, ideal: where to draw the line in 1986?

In February 1985, the National Institutes of Health sponsored the Consensus Development Conference on the Health Implications of Obesity. The panel of experts concluded that height and weight tables based on mortality data and the body mass index (BMI) are helpful measures to determine the presence of obesity and the need for treatment. For the dietitian, however, practical concerns arise regarding which index to select. The usefulness of the BMI in patient education and contradictions between the 1959 and 1983 Metropolitan Life Insurance height-weight tables are discussed. A temporary solution is offered in light of the need for further investigation into morbidity experience at weights recommended in the 1983 table.

Body Composition↗
PubMed1985

Examples of early mortality follow-up studies.

Numerous mortality studies may be found in publications of the life insurance industry dating back about a century. Examples presented include mortality in asthma history (1903), overweight (1844-1905), and hypertension (1907-11). The favorable effect of underwriting selection on mortality was recognized early, and standard insurance mortality tables in North America have always distinguished between select and ultimate mortality rates. The mortality ratio has been the traditional measure of excess mortality in insurance follow-up studies. Similar mortality studies in the medical literature before 1920 are extremely difficult for investigators to locate. One important exception with regard to methodology and completeness of comparative mortality and survival results was a 20-year follow-up of pulmonary tuberculosis patients after discharge that was reported in 1908.

Actuarial Analysis↗
PubMed1985

Persistent proteinuria in asymptomatic individuals: renal biopsy studies.

The usefulness of renal biopsy in investigating persistent asymptomatic proteinuria was assessed by a study of 87 out 1245 adults referred for pre-employment medical examination and individuals proposing to take life insurance policies. Out of these 87 persons with initial proteinuria on dipstik test, 25 were found to have persistent asymptomatic proteinuria. Unequivocal abnormalities were seen on light microscopy in 15 of the 25 specimens of renal tissues examined. Focal proliferative glomerulonephritis was the commonest abnormality, being present in 7 out of 15 renal tissues. Overall, 12 persons subsequently developed hypertension. Glomerulonephritis as a cause of asymptomatic proteinuria in the tropics has not been studied in detail; this study suggests that it may be an important cause of renal hypertension. Renal biopsy is an important procedure in evaluating glomerular disease in asymptomatic proteinuria which may subsequently cause hypertensive renal disease.

Adult↗