Journal of insurance medicine (New York, N.Y.)最新文献

Long Covid was first described in 2020. Five years later, progress in disease characterization has been considerable, and definitions continue to evolve. Several disease mechanisms are under study, and evidence for multiple endotypes is accumulating. No clinical biomarker has been identified, nor has an effective therapy been developed. Overlap with other post-infectious syndromes, particularly myalgic encephalomyelitis/chronic fatigue syndrome, is now more evident. For most individuals, symptoms of long Covid progressively disappear over time. Recurrent Covid-19 infections are now an important contributor to the pool of affected individuals. While symptoms limit activity in as many as 20%, inability to work is less common. The anticipated surge of disability claims from insured individuals has not materialized.

What is the survival of a life insurance applicant who is planning to or has previously donated a kidney? The medical director needs to assess short- and long term risk stratification in each scenario. For expectant and immediate post-donor applicants, a waiting period of 3 months is appropriate for insurability. Long-term post-donor applicants are, at best, standard risks due to the absence of renal reserve. For those with accompanying impairments such as hypertension and diabetes, which accelerate renal deterioration, adding debits to the basic rating is appropriate.

Objective.—: This article presents an analysis of mortality data in individuals with a diagnosis of adrenal insufficiency compared to a matched population from a United Kingdom database.

Background.—: Adrenal insufficiency is an easily treated disease, but if undiagnosed and/or glucocorticoid stress dosing is not appropriately implemented at times of illness, then death may occur.

Methods.—: Tabular data on patients with primary and secondary adrenal insufficiency relative to matched controls was generated using the pixel method on the all-cause mortality graph published in the Ngaosuwan et al study.

Results.—: Calculated annual mortality rates, excess death rates, and interval mortality rates were higher for both primary and secondary adrenal insufficiency compared to matched controls. And the increased mortality risk appeared to be greater in those with primary adrenal insufficiency compared to those with secondary adrenal insufficiency.

Conclusion.—: Those with primary and secondary adrenal insufficiency have increased mortality compared to their matched cohort, especially in the early years after their diagnosis.

The legal regulation of healthcare insurance is currently a major challenge for Ukraine in times of war, as the ongoing hostilities have created a pause in the full financing of the healthcare system, including healthcare insurance and ensuring access to healthcare for all citizens. That is why one of the most important issues on Ukraine's agenda is its desire to improve and modernise the existing healthcare system in line with the latest trends in healthcare insurance during the profound transformation of the country in the face of the challenges of war. The purpose of the study is to identify the specific features of legal regulation of medical expense insurance, to make a comparative analysis of international experience, and to provide recommendations on the prospects for the development of medical expense insurance in Ukraine. To achieve this goal, we used the following methods of scientific knowledge: general philosophical method, method of systemic analysis and synthesis, comparative legal method, dialectical method, methods of deduction, and induction. The practically significant conclusions and proposals obtained in the course of the thorough research are aimed at bridging the gap between the best practices implemented in other countries and the current realities of Ukraine. Taken together, this approach will help ensure the sustainability and smoothness of healthcare provision and compliance with the specifics of healthcare insurance.

The study examines the importance of legal regulation of access to health services and insurance programs for persons with mental disorders in Ukraine, taking into account modern challenges, in particular the impact of war on the mental health of the population. In conditions of extraordinary psycho-emotional burden and imperfect regulatory framework, analysis can help to improve legislation using the experience of highly developed countries. This study uses methods of analysis, synthesis, induction, deduction, dialectical, analytical, analogy and generalization. The goal is to develop recommendations for integrating international standards that will provide comprehensive protection of patients' rights and access to effective medical care even in crisis conditions. The conflict in Ukraine has further exacerbated mental health problems, with a growing demand for psychological and psychiatric care due to trauma related to war, displacement, and constant stress. Current legislation does not meet modern psycho-emotional needs. Legislative inconsistencies, funding gaps, and terminological uncertainty impede access to basic medical services and insurance programs. Establishing a unified legal framework aligned with international standards is crucial to ensuring comprehensive health care and protecting patients' rights.

In the past, the chest X-ray (CXR) was a traditional age and amount requirement used to assess potential mortality risk in life insurance applicants. It fell out of favor due to inconvenience to the applicant, cost, and lack of protective value. With the advent of deep learning techniques, can the results of the CXR, as a requirement, now add additional value to underwriting risk analysis?

Background.—: In principle, it is generally accepted that DNA methylation measures can be used to predict mortality. However, as of yet, no epigenetic metric has been successfully incorporated into underwriting procedures. In part, this failure results from the relative incompatibility of many DNA methylation measures with conventional underwriting practices.

Objective.—: To test the ability of previously established epigenetic markers of smoking, drinking and diabetes to standard lipid-based approaches for predicting mortality.

Method.—: We constructed a series of Cox proportional hazards models for mortality using clinical data and DNA methylation data from 4 previously described loci from the Framingham Heart Study.

Results.—: The incorporation of vital signs, standard lipid and diabetes laboratory assessments to a base model consisting of age and sex only modestly increased prediction of mortality from 0.732 to 0.741 area under the curve (AUC). However, the addition of epigenetic marker information for smoking and drinking to the base model markedly increased prediction (AUC=0.787) while the addition of epigenetic marker for diabetes increased prediction even further (AUC=0.792).

Conclusion.—: These results demonstrate the potential of simple interpretable, epigenetic models to predict mortality in a manner compatible with standard underwriting procedures. Potentially, this epigenetic approach using rapid methylation sensitive digital PCR procedures that can utilize saliva or whole blood DNA would increase prediction power even further while facilitating more accurate accelerated underwriting assessments of mortality.