[Organization and significance of insurance medicine in Switzerland].
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Adult↗
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Why a professional corporation?
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Insurance↗
[Treatment of the brain injuries in accident insurance policies].
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Adult↗
[How much harm can be caused by a badly recorded or badly interpreted ECG! (author's transl)].
Two cases are presented which support the sentence of the title. In a 38 years old man a life insurance company proposed an extra charge on the basis of a pseudoischemic ECG due to exceeding pressure of the writing pen on the ECG paper. In a 28 years old asymptomatic female an abnormal ECG was interpreted as due to ischemic heart disease. Physical activity was restricted and three pregnancies were interrupted. 18 years later an angiography showed normal coronary vessels. Some months later an echocardiogram showed an abnormal pericardial pattern, giving a possible explanation for the abnormal ECG.
Adult↗
Plasma lipid and lipoprotein changes in hypertensive patients treated with propranolol and prazosin.
The effects of propranolol and prazosin on plasma lipoproteins in patients with essential hypertension were evaluated according to a crossover protocol of two 8-week periods with a washout of 4 to 6 weeks. Eleven patients with moderate hypertension (greater than 90 but less than or equal to 144 mm Hg, diastolic) and slightly overweight (+10% to +/- +30%, according to Metropolitan Life Insurance tables) were selected. No dietary changes were prescribed. Plasma cholesterol, triglycerides (TG), and lipoprotein changes were monitored at the beginning of each sequence and at 2-, 4- and 8-week intervals. Prazosin, when given first, did not essentially modify any of the metabolic parameters, except for a slight elevation in plasma apoprotein AI levels, i.e., the main protein component of high density lipoprotein (HDL); propranolol caused a significant rise in total TG and very low density lipoprotein TG (VLDL-TG) levels (+37.3% and +23.9%, respectively). Somewhat lower total TG (+19.6%) and vLDL (17.8%) TG elevations were noted when propranolol was given first; plasma glucose was also significantly raised (+12.8%). Triglyceride and glucose levels returned to normal upon changing to prazosin. Total plasma- and lipoprotein-associated cholesterol levels were essentially unchanged with either drug; similarly, no significant changes were detected in total plasma apoprotein B (the main protein component of LDL and also VLDL), a component of apoprotein AI levels. Uric acid levels were slightly raised on propranolol. There was an 8.8% reduction in uric acid levels when the medication changed from propranolol to prazosin.
Apoproteins↗
The relationship of weight loss, locus of control, and social support.
This study investigated the relationship between weight loss, locus of control, and social support. It was hypothesized that internals would be more successful in weight reduction than externals/powerful others or externals/chance; that participants with higher social-support scores would be more successful in weight reduction than participants with lower social support scores; and that social support would contribute more to success in weight reduction in externals/powerful others than in internals or externals/chance. Subjects were 46 female employees of a large life insurance company who had participated in a nutrition and weight control program. They were studied six months later to assess weight change, locus of control (specifically, using a multidimensional health locus of control scale and a modified weight locus of control scale) and social support (using an investigator-developed scale). Study findings did not support the hypotheses. Rather, a significant negative relationship was found between social support and weight reduction in the case of internals. Possible explanations for the findings were discussed, along with recommendations for practice and further research. For example, it was suggested that it may be most desirable for those attempting weight loss to be sufficiently internal that they believe they are capable of bringing their weight under control, yet sufficiently external that they are amenable to the advice of health professionals.
Attitude to Health↗
Evaluation of nutritional status.
The assessment of nutritional status has become very popular, especially for patients undergoing stress (surgery) or potential parenteral nutrition. Evaluation of cancer patients is essentially the same as for other patients. Body fat reserves are approximated by subcutaneous skinfold measurements. Somatic protein (skeletal muscle) mass is decreased in marasmus (protein-calorie malnutrition) and is evaluated by anthropometric determinations, based upon age and sex or both. Instead of using relatively inadequate standards such as the 1959 Metropolitan Life Insurance tables for ideal weight, it is advocated to use the population percentiles derived from the Health and Nutritional Examination Survey (HANES) published in 1979. The visceral protein mass is decreased in kwashiorkor and is approximated by study of the liver transport proteins. A mixed-type of protein-calorie malnutrition may exist, e.g., cancer cachexia, with marked decrease of immunocompetence. A prognostic nutritional index, based on biologic measurements rather than true nutritional assessment, can predict the probability of complications and survival in severely ill patients. All such studies should be used to substantiate good clinical judgement, based on adequate history and physical examination with emphasis on the nutritional aspects.
Body Height↗
Reproductive failure in women who practice weight control.
Forty-seven women (29 with unexplained infertility and 18 with menstrual dysfunction) practiced weight control by caloric restriction in order to maintain a fashionable body habitus. All of these women were below ideal body weight (IBW) when compared with Metropolitan Life Insurance Company tables for height and weight. When 36 of these women followed a dietary regimen designed to increase their weight to predicted IBW, 19 of 26 infertile women (73%) conceived spontaneously; 9 of 10 women (90%) with secondary amenorrhea resumed menstruation. Eleven women (23%) would not accept their practice of weight control as the cause of reproductive failure and did not participate in the study. Differences in the serum gonadotropin luteinizing hormone:follicle-stimulating hormone (LH:FSH) ratio were found to be significantly related to differences in the percentage of IBW. The practice of weight control may be a cause of unexplained infertility and menstrual disorders in otherwise healthy women.
Adolescent↗
Cigarette smoking as a confounder of the relationship between relative weight and long-term mortality. The Framingham Heart Study.
Cigarette smoking is a potential confounder of the relationship between obesity and mortality, and statistical control for this factor requires careful consideration. Framingham Heart Study subjects were weighed, their stature measured, and cigarette smoking histories obtained at the first biennial examination starting in 1949. Of men under desirable weight (Metropolitan relative weight [MRW], less than 100%), more than 80% were smokers, while only about 55% of the extremely overweight men were cigarette smokers. When age-, smoking-, and MRW-specific mortalities for 26 years of follow-up were calculated in these men, it was found that smokers had higher mortality than nonsmokers but that in the smokers and nonsmokers, minimum mortalities occurred for subjects who were initially in the "desirable weight" group (MRW, 100% to 109%). Among cigarette smokers, lean men (MRW, less than 100%) experienced considerably elevated mortality, often higher than that in all but the most overweight cigarette smokers. These findings suggest that elevated mortality in low-weight American men results from the mortality risks associated with cigarette smoking and demonstrates the need for controlling for cigarette smoking when considering the relationship between relative weight and mortality. Furthermore, the concept of "desirable weight" developed by the Metropolitan Life Insurance Co in 1959 and subsequently distributed in tabular form is validated by this long-term study. Thus, even those men who were near the average weight (about 20% above "desirable weight") showed appreciably elevated mortality. This finding is contrary to the widely held view that moderate overweight carries no increased risk.
Adult↗
Determination of ideal body weight for drug dosage calculations.
Formulas for ideal body weight (IBW) in men and women were derived from the Metropolitan Life Insurance Company height and weight tables. Regression determinations of median weight versus height were performed for men and women. A program for a minicomputer was developed to generate plots for small, medium, and large frame sizes and for subjects of all frame sizes. Equations for ideal body weight were derived from the resulting data. For men of all frame sizes, IBW = 51.65 kg + 1.85 kg/inch of height greater than 5 feet. For women of all frame sizes, IBW = 48.67 kg + 1.65 kg/inch of height greater than 5 feet. More accurate estimates of IBW by frame size can be obtained using equations derived from the plots for men and women of each frame size. Estimates of IBW obtained by the widely used empirical method probably contain only minor errors. However, formulas derived from actual height and weight data should be used in pharmacokinetic determination of dosage regimens for some drugs.
Body Height↗
The insurance medical. Practical procedures.
The insurance medical examination is an integral part of day to day general practice. On a busy day it may develop into a race against the clock with short cuts made despite the handsome remuneration. In this article Dr Breidahl has outlined the disadvantage to our patients of taking these short cuts and in particular the opportunities missed for preventive medicine.
Australia↗
A company-instituted program to improve blood pressure control in primary care.
An occupation-based effort to improve the outcome of antihypertensive therapy provided in the community was instituted by the Massachusetts Mutual Life Insurance Company in 1977. The goal of the program was to utilize the administrative and organizational resources of the company to enhance employee/patient adherence to treatment provided in conventional primary care settings. Key elements of the program were: companywide education and on-site screening, referral to community physicians and company assumption of all patient costs, linked to a monitoring system to permit oversight of care. Initially, 98% of employees were screened, 70% accepted referral for care and 59% fully adhered to program performance criteria. Blood pressure control has risen from 36% at the beginning to 69% at the end of the second year. Fully compliant patients have achieved the greatest lowering of blood pressure and compiled the best work attendance record. Program costs are modest and acceptance by employees and physicians supports the concept that occupation-based, systematic efforts can enhance the impact of primary care.
Adult↗
Average hospital charges for percutaneous transluminal coronary angioplasty, 1993: geographic variations.
Claims to Metropolitan Life Insurance Company by group health insured and their dependents for a percutaneous transluminal coronary angioplasty (PTCA) averaged $21,760 in 1993. The charges varied by as much as 68 percent among the 22 states in which at least 50 PTCAs were performed. The highest average total charges were reported in Colorado and California, where they were 29 and 26 percent, respectively, above the average for the United States as a whole. The lowest average total charge was reported in Ohio, where the PTCA cost $16,770-23 percent lower than the national average. An average of 4.3 days of hospitalization was required for a PTCA. Hospital charges (room and board and ancillary fees) accounted for 78 percent of the total PTCA charges to insurance. The charges for the operating room, laboratory, blood bank, respiratory therapy and other ancillary fees together accounted for 80 percent of the total hospital bill and averaged $13,550 for the country as a whole. Physicians' fees averaged $4,740 across the United States and ranged from a high of $5,930 in Connecticut to a low of $3,730 in Michigan. These PTCA total charges were close to half the charge reported for a coronary artery bypass graft (CABG) in 1992 and the length of stay was also about half that for a CABG.
Angioplasty, Balloon, Coronary↗
Understanding what you need ... when it comes to insuring your practice,your employees, and you.
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Health Benefit Plans, Employee↗
Communities take aim to snuff out smoking.
When the Minnesota Department of Health released a report on smoking in early January, newspapers played up the cost angle. "Smoking's tab up 32 percent in Minnesota," proclaimed a Pioneer Press headline. "Health care costs tied to smoking rise," the Star Tribune reported. Buried beneath the headlines, however, was the real story: Minnesota's anti-smoking efforts have stalled out. Despite intense efforts to curb smoking in the state, our smoking rate has hovered around 22 percent since 1990. A 1991 jump to 23.3 percent placed us above the national average of 23 percent and knocked us out of first place in a Northwestern National Life Insurance Co. ranking of the nation's healthiest states.
Adolescent↗
Doctor's other office, an alternative to the emergency room.
Doctor's Other Office (DOO), a group of ten family physicians, offers after-hours and weekend health care to non-critical patients who might otherwise go to a hospital Emergency Room, even though their medical problems do not require expensive, elaborate facilities of the Emergency Room. Advantages to patients include less expense than the ER, care that is appropriate to their needs, and comprehensive, continuous care through dealing with physicians who will follow through with referral to a regular physician, often the patient's own family physician. DOO physician members enjoy a rational division of after-hours and weekend coverage among colleagues that permits more free time, yet assures that patients receive good quality, continuous care. The methods of operation are discussed, including personnel schedules, consultants, hospital coverage, and finances. The DOO income just meets office expenses, however, life insurance and other fringe benefits that physician members receive through the corporation aid in making this organization more financially attractive.
California↗
Normalization of protein equivalent of nitrogen appearance and dialytic adequacy in CAPD.
Caloric-proteic malnutrition is frequently encountered in peritoneal dialysis and is associated with an increased risk of morbidity and mortality. Our paper aims to assess any greater reliability of protein equivalent of nitrogen appearance (PNA) normalization to desirable body weight (dBW) compared to actual body weight (aBW) and resulting implications for the relationship between dialytic adequacy and protein intake in continuous ambulatory peritoneal dialysis (CAPD). We studied 36 patients on CAPD, 24 male and 12 female (aged 66.6 +/- 10.2 years, 24 +/- 29 months on dialysis), collecting dialysate and urine over 24 hours (126 samples) to calculate the PNA according to Randerson and the total weekly KT/V. The total body muscle mass (TBMM) was calculated by anthropometry and the dBW according to Metropolitan Life Insurance tables. Finally, PNA was normalized to aBW (aPNA, g/kg/day) and to dBW (dPNA, g/kg/day). Average aBW proved to be higher than dBW (66.0 +/- 11.1 vs 59.8 +/- 6.9 kg, p < 0.0001) and aPNA lower than dPNA (0.96 +/- 0.31 vs 1.08 +/- 0.3 g/kg/day, p < 0.005). Compared to aPNA, dPNA correlates better with both blood urea nitrogen (BUN) (R2 = 0.702 vs 0.614) and KT/V (R2 = 0.348 vs 0.306). The TBMM is higher in the group with dPNA > or = 1.0 vs < 1.0 g/kg/day (25.5 +/- 0.6 vs 23.1 +/- 0.7 kg, p < 0.02) while, paradoxically, it is lower in patients with aPNA > or = 1.0 vs < 1.0 g/kg/day (22.8 +/- 0.8 vs 25.4 +/- 0.6 kg, p < 0.01). The KT/V of the patients with dPNA < 0.8, 0.8-1.2 and > 1.2 g/kg/day proved to be different (1.52 +/- 0.06 vs 1.80 +/- 0.03 vs 2.04 +/- 0.04, p < 0.005). On analysis of the linear regression, dPNA = 1.0 and 1.2 g/kg/day corresponds to KT/V values of 1.7 and 2.05, respectively. We consider dPNA to be more suitable then aPNA for the correct assessment of protein intake, and a weekly KT/V of 1.7-2.05 as being sufficient to guarantee satisfactory dPNA.
Adult↗
Hysterectomy charges: geographic variations United States, 1994.
During 1994 Metropolitan Life Insurance Company claims by group health insureds and their dependents for a vaginal hysterectomy averaged $10,500, for an abdominal hysterectomy (laparotomy), $12,440, and for a laparoscopically assisted vaginal hysterectomy (LAVH), $13,840. The distributions of the three surgeries varied by geographic area and state. The East South Central states had the lowest average total charge for each procedure whereas the highest charge for a laparotomy was reported in the Middle Atlantic states; the highest vaginal hysterectomy charge was in the Pacific area, and LAVH average total charge was the highest in New England. Of the three surgeries, the vaginal hysterectomy charges varied the most by state-the average charge in Florida was almost twice that in Oklahoma. Laparotomy charges differed by 59 percent between California and Tennessee, where they were 30 percent above and 19 percent below the U.S. norm, respectively. The total charge for the LAVHs varied by 42 percent and was the highest in California and lowest in North Carolina. Three study states, California, Florida and Illinois, were among the four states with the highest average total charges for each form of hysterectomy. Physicians' fees accounted for 41 percent of vaginal hysterectomy charges, 37 percent of the laparotomy total charges, and 34 percent of the LAVH charges. Of the laparotomies, the physicians' fees differed by 132 percent between the highest in New York and the lowest in Tennessee. For the country as a whole, the average length of stay was 2.17 days for the LAVHs, 2.54 days for a vaginal hysterectomy and 3.43 days for an abdominal hysterectomy.
Adult↗