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

Mental health disorders are harder to evaluate for life insurance because their diagnoses can be subjective. To make fair decisions, insurance medical directors use research from trusted sources to calculate risk based on survival data. This article reviews a study conducted on patients in the UK with a diagnosis of attention-deficit and hyperactivity disorder (ADHD).

In the United States, ovarian cancer is the second most common form of gynecologic cancer and the second leading cause of gynecologic cancer death. It is a heterogeneous disease with many different types and subtypes. The most common variety (70%-80%) is the high-grade serous epithelial tumor. A positive family history and/or the presence of susceptibility genes (BRCA1, BRCA2, and mismatch repair genes) increase the risk for developing the disease. Due to the lack of effective screening tools, even in those with known increased risk, most ovarian cancers are diagnosed at advanced stages. Diagnosis and accurate staging usually require tissue sampling and extensive debulking surgery performed by a surgeon who specializes in gynecologic oncology. Combination chemotherapy, before or after surgery, or as primary treatment for advanced disease is commonly needed. Mortality rates vary by stage, grade, and type of tumor. For the most common histotypes, due to the presence of advanced disease at presentation in most individuals, overall death rates remain high. Survival is better with some of the less common subtypes including sex cord stromal, germ cell and borderline epithelial ovarian tumors.

Objective.—: To compare the alcohol biomarkers phosphatidylethanol (PEth) and carbohydrate-deficient transferrin (CDT) in a convenience sample of life insurance applicants.

Background.—: PEth is a direct measure of alcohol consumption, which may have some advantages in the detection of problematic alcohol use when compared to CDT.

Methods.—: A total of 619 life insurance applicants were tested for both PEth and CDT. Linear models were constructed to assess the relationship between these two markers and other laboratory values. Classification and regression tree (CART) models were also constructed to identify clusters of individuals with high levels of either marker.

Results.—: The correlation between PEth and CDT was 0.52. PEth was positive in 23% of the sample at a threshold of 200 ng/ml, while CDT was positive in 11% at a threshold of 1.5%. CART models showed that GGT and AST were the most important predictors of PEth positivity, while HDL and AST were the most important predictors of CDT positivity.

Conclusion.—: PEth may be a more sensitive marker of alcohol intake than CDT, and may be useful as a reflex test from other laboratory values in both the clinical and life insurance setting.

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.