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At least 1,153 records · Page 64Linked to original sources
PubMed1996

Long-term follow-up of patients treated surgically for medically intractable epilepsy: results in 291 patients treated at Mayo Clinic Rochester between July 1972 and March 1985.

To assess the long-term outcome in patients who underwent surgical treatment of intractable epilepsy, we retrospectively reviewed the medical records of 291 consecutive Mayo patients treated between July 1972 and March 1985. We also evaluated the responses to a follow-up mailed questionnaire or telephone interview completed in 1992. Of the 291 patients, 245 (94% of the 261 patients known to be alive at the time of the survey) responded to the follow-up questioning. Information on the patients' neurologic status (including frequency of seizures, use of antiepileptic drugs, and self-reported assessment of functional capacity) and their overall satisfaction with the operative procedure and postoperative outcome were evaluated. Two hundred ninety patients survived the operation and were dismissed from the hospital. Of the 245 patients who responded to the follow-up survey, 41% and 58% had been free of seizures since surgical treatment and for 3 years preceding the follow-up survey, respectively. In addition, of the respondent cohort, 36% were successfully weaned off all antiepileptic drugs. Patients reported improvement in their daily functional capacity and quality of life after surgical treatment. For example, in comparison with the preoperative assessment, the patients' ability to obtain a driver's license was significantly increased, and seizure-related driving accidents, falls, and bodily injury significantly decreased. Furthermore, on the basis of current knowledge of the operation and its outcome, 85% reported that they would repeat the operative procedure. Thus, surgical treatment of intractable epilepsy is an effective option that is met with patient satisfaction.

Activities of Daily Living↗
PubMed1997

[Order of mortality, duration of life and annuities in Johann Peter Süssmilch's Göttliche Ordnung].

The government of Providence builds the order which pastor Süssmilch sees in the demographic events and especially the order of mortality. God governs the length of human life and assigns to each person a just balance between fear of death and expectation of life. This authorizes Süssmilch to clarify the notions of probable life and life expectancy with the design to treat of their main application in the field of political arithmetic, that is the computations of Government loans under the form of annuities on lives. So he treats of an important question which concerns the history of actuarial calculation as well as the history of probability, of statistics and demography. We cannot forget also the political and philosophical points of view which the pastor underlines vividly: what sort of contract joins the creature and his God? This study of the contingent but optimal regularities which Providence makes in the world builds an important contribution to the physico-theological current.

Actuarial Analysis↗
PubMed1998

Homocysteinemia: new information about an old risk factor for vascular disease.

OBJECTIVE: To determine the importance of homocysteinemia as a risk factor for atherosclerotic vascular disease. DESIGN: Literature review of published studies homocysteine as risk factor for atherosclerotic vascular disease. METHODS: MEDLINE search from 1969 to 1998 using homocysteine and vascular disease as search terms, from which 13 articles were selected for review. RESULTS: Homocysteine is a sulfur containing amino acid derivative formed during methionine metabolism. Inherited deficiencies of cystathionine B synthase or MTHF reductase result in markedly elevated plasma homocysteine levels and homocystinuria. Although rare, hereditary homocystinuria results in a variety of life threatening vascular complications occurring at a young age. Lesser degrees of homocysteinemia may result from vitamin B12, folate and pyridoxine deficiencies as well as a recently described mutation of the MTHF reductase gene. Homocysteinemia from these causes has been shown to increase the risk of coronary artery disease, peripheral artery disease, stroke, and venous thrombosis. Postulated mechanisms for this association are discussed. CONCLUSION: Homocysteinemia is a risk factor for premature vascular disease. The strength of this association is similar to that due to hyperlipidemia and tobacco use. Although vitamin supplementation with folic acid, B12, and B6 is able to reduce homocysteine levels in many persons, proof of the effectiveness of vitamin treatment in preventing or halting the progression of vascular disease is not yet available.

Aged↗
PubMed2004

Comparative mortality in medically treated aortic regurgitation.

OBJECTIVE: To present and discuss in this article a table of comparative mortality of medically treated patients with aortic regurgitation, derived from data presented in the source article. BACKGROUND: Although there is abundant information on the follow-up (FU) of patients after surgical replacement of a leaking aortic valve, FU studies of patients with aortic regurgitation prior to valve replacement give discordant and confusing results for a number of reasons. The aim of the source study was to confine the results to patients who had been and continued to be on medical treatment only. METHODS: In this article, the triple decrement approach to life table analysis has been emphasized (death, withdrawal due to surgery, and withdrawal due to end of FU). Data in the source article were used to calculate exposures and to prepare a life table incorporating exposures, observed and expected deaths, to derive observed, expected, and excess death rates and mortality ratios. RESULTS: There was no significant excess mortality above that in the age/sex-matched US population in the NYHA class I group. In NYHA class II group, the excess death rate (EDR) averaged 28 per 1000 per year over 0-10 years. In NYHA class III and IV groups, the EDR was very high, averaging 205 per 1000 per year over 0-5 years, with a mortality ratio (MR) of 1100%. CONCLUSION: Based on data presented in the source article, there was no excess mortality in medically treated aortic regurgitation patients with no functional impairment (NYHA class I), compared to the control population. However, the long-term outlook for the AR patients with good NYHA functional classification includes a high incidence of heart failure and valve surgery. Excess mortality was significant in NYHA class II patients, and was very high in patients with NYHA class III and IV impairments. In the source study, exposure to risk of medically managed aortic regurgitation was greatly curtailed by the performance of aortic valve surgery soon after initial diagnosis, most within the first year of FU.

Age Distribution↗
PubMed2002

Cost of illness of Crohn's disease.

Crohn's disease is a chronic inflammatory bowel disease of unknown aetiology which affects around 35,000 people in the UK (population 56.8 million). The potential for onset in early adult life, disease chronicity and a need for hospitalisation and surgery mean that the disease can be associated with substantial healthcare costs. Cost-of-illness studies focusing on direct medical costs have identified that over half the average costs associated with the disease relate to hospital costs. Estimates of the contribution of drug costs to the total direct economic burden have varied between 4.6 and 25%. Figures for average annual direct costs per patient in the US have been put at between US dollars 6561 (1990 values) and US dollars 12,417 (1994 values), whereas European studies have given much lower cost estimates (US dollars 655, 1994 values). However, all studies have highlighted that much of the total cost of illness relates to extensive interventions required by a small proportion of severely affected individuals. Indirect costs associated with reduced productivity in Crohn's disease can be high, with long periods of absenteeism and early disability. However, most patients (90%) remain in the workforce and life expectancy is relatively normal. A variety of drugs are employed for the treatment of Crohn's disease, both in an attempt to induce clinical remission in active disease and to maintain remission once this has been achieved. Comparative data on cost effectiveness is lacking, though crude estimates based on randomised trials suggest that the frequently prescribed aminosalicylates, which have only modest efficacy, are a relatively costly drug option. The costs associated with adverse drug effects, particularly for corticosteroids, have not been formally quantified. Despite high costs, new drug therapies for more severe disease, such as anti-tumour necrosis factor (TNF-alpha) antibodies, may prove a cost-effective option if the need for hospitalisation is reduced. In a modelling exercise, a US group estimated that if a theoretical new drug was introduced which was capable of reducing non-drug costs (including hospitalisation) by a fifth despite doubling the overall drugs bill, there would still be a reduction in the overall costs of Crohn's disease by 13%. Although surgical therapy is costly, there may be prolonged post-surgical remission following resection of localised disease and early surgery may represent a cost-effective option for selected patients. Without formal cost-effectiveness analyses, or (better still) clinical trials incorporating cost data, decisions about the relative efficiency of treatment alternatives for Crohn's disease remain subjective and more research is clearly required in this area.

Cost of Illness↗
PubMed1994

Alpha 1-antitrypsin deficiency. Impact of genetic discovery on medicine and society.

An increasing body of molecular information resulting from advances in basic research is being incorporated into clinical practice by medical genetics. The process by which these research advances progress from the laboratory to the bedside and their medical, social, and legal impact is a topic of intense current interest. Some authors have claimed that new genetic information may lead to discrimination in insurance and employment; change the way courts allocate responsibility for injury and resultant damages; and be inappropriately interpreted by the medical profession. To address some of these issues, we chose, as a model, to review alpha 1-antitrypsin deficiency, described over 30 years ago. At this time, such concerns with respect to alpha 1-antitrypsin deficiency have not yet been realized, perhaps for the following reasons: (1) knowledge of alpha 1-antitrypsin deficiency, while common among geneticists and pulmonologists, has not been well disseminated in the medical community; (2) insurers, employers, lawyers, and judges are not generally aware of the deficiency and its implications; (3) insurers, if they are aware of the deficiency, have not found it cost-effective to screen for the condition; and (4) in the legal context, case law involving other types of preexisting conditions is being applied to genetic predispositions.

Biomedical Research↗
PubMed1988

Assuming the risks: occupational disease in the years before workers' compensation.

In the late 19th and early 20th centuries, new knowledge of work-related illness became part of discourses in several institutional spheres on the relationship between aspects of the economy and workers' health. Appeals courts and state legislatures invoked this knowledge in their deliberations on legislation to ease the coercive aspects of the employment relationship. Insurers used the knowledge to help determine what types of coverage would be available to different occupational groups. In the courts, a narrow compensation remedy evolved for illness caused by employers' failure to warn of latent risks. This small, legal zone of protection of workers' health was separated out from the massive amount of uncompensated, preventable work-related illness.

History, 19th Century↗
PubMedDate not supplied

Arresting evidence.

Explore the source record for details and available documents.

Criminal Law↗
PubMed1994

Extremes in body mass index: probability of healthcare expenditures.

BACKGROUND: This study was conducted as a first initiative to investigate the relationship between body mass index [BMI, weight(kg)/height(m)2] and healthcare expenditures by third party providers for lifestyle-related diseases and disorders. METHOD: Data were analyzed for 383 individuals who were continuously employed and covered by the same comprehensive health insurance plan during a 2-year baseline period followed by a 5-year observation period. A multiple logistic regression analysis that adjusted for covariates was used to ascertain whether BMI and baseline expenditure status separately or in combination influenced the probability of healthcare expenditures during the observation period. RESULTS: After controlling for age, gender, and smoking status, probability of healthcare expenditures for lifestyle-related medical problems was significantly (P < 0.04) greater during the observation period for adults with high as well as low BMIs plus baseline expenditures and lowest for subjects whose BMIs were in the midrange regardless of their baseline expenditures. Odds of expenditures increased significantly (P = 0.0079) with age of nonsmokers, but was approximately constant and high for smokers at all ages. The absence of any significant interaction of either smoking status or age with BMI indicated that the relationship between BMI and the log odds of expenditures was consistent across age and smoking categories. CONCLUSIONS: The analyses support the conclusion that the highest probability of expenditures occurs with the combination of baseline insurance expenditures and BMI extremes and the lowest probability occurs when BMIs are near 26 or 27 (approximately 19% above the ideal of 22). The findings also provide further justification for focusing on extremes in body weight as health priorities.

Adult↗
PubMed1992

A cohort study of tobacco use, diet, occupation, and lung cancer mortality.

In 1966, a cohort of White males aged 35 or over, who were policy-holders with the Lutheran Brotherhood Insurance Society (United States), completed a mail questionnaire on tobacco use, diet, and demographic characteristics. During the 20 years of follow-up, 219 lung cancer deaths occurred. Besides the strong relationship with cigarette smoking, we observed an effect on lung cancer risk among current users of cigars or pipes who were nonsmokers of cigarettes (relative risk [RR] = 3.5, 95 percent confidence interval [CI] = 1.0-12.6) or who were past/occasional users of cigarettes (RR = 2.7, CI = 1.4-5.3). In addition, elevated risks (from 1.5 to 2.6) of lung cancer were found among craftsmen and laborers, with the highest risks among subjects who worked in the mining or manufacturing industry. No association between current (as of 1966) use of beer or hard liquor and lung cancer was observed, although past users were at elevated risk. An inverse association between lung cancer and intake of fruits was observed, and risks of lung cancer were lower among persons in the highest dietary intake quintiles of vitamins A and C. Except for oranges, however, none of the inverse associations with fruits or dietary nutrients had statistically significant trends. The findings from this cohort study add to the evidence of an adverse effect of cigar/pipe smoking and possibly protective effect of dietary factors on lung cancer risk.

Ascorbic Acid↗
PubMed2003

Insurance companies' access to genetic information: why regulation alone is not enough.

The background of this paper is the ongoing dismantling of the social insurance systems in favour of commercialisation and privatisation of insurances needed for illness, old age and premature death. This combined with the increased possibility of using genetic testing for differentiating personal insurance premiums has the potentiality of creating a 'genetic proletariat'--an uninsurable high-risk population. The common way of handling this problem in Sweden, and many other developed countries around the North Atlantic, has been to regulate insurance companies' right to ask for and use genetic information in various ways. There is a distinction between partial regulation (that allows insurance companies access to genetic information from genetic tests already made, sometimes only above a specified amount, but not to demand new tests) and total regulation (that forbids insurance companies to ask for or use any genetic information). I will argue that these forms of regulation probably will have adverse consequences given the dismantling of collective social insurance systems. If this is convincing, a better way to solve the problem of an uninsurable high-risk population (and other problems) is to resurrect the collective, obligatory insurance systems in which the individual risk profile does not constitute a basis for premium determination. Both arguments cast in terms of consequences and justice render support for this conclusion.

Genetic Predisposition to Disease↗