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

{"title":"New Frontier in Lipids: PCSK9 Inhibitors and Implications for the Life Insurance Industry.","authors":"Alacia J Tarpley","doi":"10.17849/insm-47-4-1-6.1","DOIUrl":"https://doi.org/10.17849/insm-47-4-1-6.1","url":null,"abstract":"<p><p>Since the Framingham Heart Study solidified cholesterol as a causative agent in the development of coronary heart disease there has been an explosion of research in the field of lipidology. Many therapeutic options have come and gone as we have been refining the goals of therapy to match the mortality outcome data of large clinical trials. A new frontier has emerged with the introduction of the PCSK9 inhibitors that are able with monthly injections to lower LDL cholesterol >60% with favorable side effect profiles and recently published favorable mortality data. This ushers in a whole new era of cholesterol management. Life insurance medical directors will need to be informed of how these drugs are being used and for conditions such as homozygous hypercholesterolemia, a condition with a very high mortality risk, and for new genetic analysis of affected patients, who are not as rare as once thought. This article provides the background about the development of these drugs, their expanded indications, how they may slip through the cracks of prescription drug (Rx) database inquiries, and touches on therapies in development beyond this class of medications. Medicine is an evolving field. With the new gene editing CRISPR technology it will truly be transformational for these genetically driven conditions with the potential for curative therapy. If curative therapy comes to pass it will, of course, have favorable implications for our evolving life insurance guidelines.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 4","pages":"230-235"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36986384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does an Absent Left Main Lead to a Main Event?","authors":"Sheila MacDonnell,&nbsp;Lisa M Papazian","doi":"10.17849/insm-47-03-184-186.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-184-186.1","url":null,"abstract":"This is a case report of a 29-year-old, male applicant for life insurance who was discovered to have an absence of the left main coronary artery (LMCA), with the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) each arising directly from the left sinus of Valsalva. A brief review of several types of coronary artery anatomic variants will be presented.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 3","pages":"184-186"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Man (or a Woman) is Known by the Company He/She Keeps.","authors":"Rajesh Wadhwa","doi":"10.17849/insm-47-03-141-142.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-141-142.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 3","pages":"141-142"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal Head CT Imaging in Afghanistan: Empiric Treatment of Abnormal Findings in an Austere Environment.","authors":"David S Williams","doi":"10.17849/insm-47-4-1-4.1","DOIUrl":"https://doi.org/10.17849/insm-47-4-1-4.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 4","pages":"265-268"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37036725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Droplet Digital PCR Assay for Smoking Predicts All-Cause Mortality.","authors":"Allan M Andersen, Philip T Ryan, Fredrick X Gibbons, Ronald L Simons, Jeffrey D Long, Robert A Philibert","doi":"10.17849/insm-47-4-1-10.1","DOIUrl":"10.17849/insm-47-4-1-10.1","url":null,"abstract":"<p><strong>Objectives: </strong>-Determine whether an epigenetic assay for smoking predicts all-cause mortality in adults participating in a longitudinal study of Iowa adoptees.</p><p><strong>Background: </strong>-Improved biomarkers for smoking are needed given its large public health impact and significant limitations of both self-report and current biomarkers, such as cotinine in detecting smoking. In the past 5 years, multiple epigenome-wide association studies of smoking have identified loci suitable for translation as epigenetic biomarkers for smoking, in particular the CpG cg05575921. Digital polymerase chain reaction methods hold promise for the development of this and other epigenetic biomarkers.</p><p><strong>Methods: </strong>-Participants in the Iowa Adoption Studies were interviewed regarding their smoking habits. DNA was prepared from whole blood and bisulfite-converted for methylation analysis and digital droplet polymerase chain reaction assay of methylation at cg05575921 was performed. National Death Index records were requested for 584 study participants, resulting in 24 complete matches, 210 partial matches and 350 non-matching records. Complete matches were coded as deceased while the remainder were coded as alive (ie, censored). In total, methylation data and vital status information were available for a total of N = 193 subjects, including 15 deceased and 178 non-deceased. Cox regression was used to examine the ability of cg05575921 methylation as a continuous value to predict the timing of mortality with and without the inclusion of age, sex, race, BMI, marital status, educational status, socioeconomic status, cardiovascular risk factors, and a history of cancer as covariates.</p><p><strong>Results: </strong>-Methylation at cg05575921 predicted the hazard of mortality as the sole predictor and after accounting for major demographic and clinical risk factors. The fitted model showed the hazard ratio increased by 3.5% for every 1% decrease in methylation.</p><p><strong>Conclusions: </strong>-Decreased methylation at cg05575921, an emerging epigenetic biomarker for smoking, was associated with early mortality in a longitudinal study of adults after accounting for the impact of major demographic and clinical risk factors for all-cause mortality. This approach may be useful in clinical research or actuarial assessments.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 4","pages":"220-229"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518325/pdf/nihms-1628375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36915820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Irregular Rhythm with Missing P Waves.","authors":"Ross MacKenzie","doi":"10.17849/insm-47-03-187-190.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-187-190.1","url":null,"abstract":"<p><p>An electrocardiogram on a life insurance applicant with a history of surgically repaired congenital heart disease displays an irregular rhythm with occasional missing P waves.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 3","pages":"187-190"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Takotsubo Syndrome - Case Review.","authors":"Tea Mamaladze","doi":"10.17849/insm-47-03-176-183.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-176-183.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 3","pages":"176-183"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbid Illness, Injuries and Health Insurance Subscription Among Self-Reported Mentally Disabled Subjects of Tamil Nadu, India.","authors":"A M Anusa,&nbsp;C Ramasubramaniam,&nbsp;Thavarajah Rooban","doi":"10.17849/insm-47-04-1-11.1","DOIUrl":"https://doi.org/10.17849/insm-47-04-1-11.1","url":null,"abstract":"<p><strong>Background: </strong>-Mentally Disabled (MD) subjects often have multiple co-morbidities and also experience injuries, acute and chronic illness like the general population. Details of such episodes and the impact of health insurance have not been described for Tamil Nadu, an Indian state population. This manuscript intends to report on this experience.</p><p><strong>Materials and method: </strong>-Secondary Data Analysis of District Level Household and Facility survey-4 (2012-13) were employed for this study. Comparison of MD with the normal population was performed. Demographic characteristics along with injury (in preceding year), acute illness (within past 15 days) and the experience of chronic illness (requiring treatment for 1 month), treatment seeking behavior and health insurance coverage formed the variables. Descriptive statistics, chi-square and odds ratio are presented. P≤0.005 was considered as statistical significance.</p><p><strong>Result: </strong>-Of the 179381 surveyed, 565(0.3%) had some form of MD and 169938 (94.7%) had no disabilities. The two groups varied in age, gender, and marital status. MD population had nearly 4 times the incidence of injury (P = 0.000) in the past 1 year, more commonly requiring in-patient treatment. Epilepsy was more common among individuals with MD with odds ratio of 7.159 [P = 0.015]. Health insurance cover and its influence on treatment seeking behavior are presented.</p><p><strong>Discussion: </strong>-The experience of injuries, acute and chronic illness by individuals with MD, to the best of our knowledge has been described for the first time in Tamil Nadu. Individuals with MD and without health insurance often do not take treatment. The absence of health insurance with the resulting increased cost of out-of-pocket expense for chronic illness may force them to neglect their health. These factors are discussed along with recommendations for policy makers.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 4","pages":"249-259"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36979409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JIM Reading List.","authors":"","doi":"10.17849/insm-47-03-194-200.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-194-200.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 3 1","pages":"194-200"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67475728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Cancer: 20-Year Comparative Mortality and Survival Analysis of Six Thyroid Cancer Histologic Subtypes by Age, Sex, Race, Stage, Cohort Entry Time-Period and Disease Duration (SEER*Stat 8.3.2) A Systematic Review of 145,457 Cases for Diagnosis Years 1993-2013.","authors":"Anthony F Milano","doi":"10.17849/insm-47-03-143-158.1","DOIUrl":"https://doi.org/10.17849/insm-47-03-143-158.1","url":null,"abstract":"<p><strong>Background: </strong>-Incidence and prognosis of cancers of the endocrine glands vary greatly by stage and histologic type, and, thyroid cancer accounts for most (92%) of the cancers of the endocrine glands. It is the 8^th most common of cancers and has been rising in incidence since 1975. It remains a formidable health threat in the United States in 2016 with estimated cases of 64,300 and 1980 deaths.</p><p><strong>Objective: </strong>-Provide 20-year comparative mortality analysis of thyroid cancer in a recent group of 145,457 staged cases (97.5%) of a total of 149,202 patients during the 1993-2013 entry time-period in six histologic subtypes by age, sex, race, stage and disease duration.</p><p><strong>Methods: </strong>-Population-based data from SEER registries, ¹ 1973-2013, (SEER*Stat 8.3.2.) were analyzed.</p><p><strong>Results: </strong>- Tables 1 - 8 provide basic SEER epidemiologic, demographic, case-statistics, and comparative mortality follow-up data of 4 principal and 2 supplementary thyroid cancer oncotypes by age, sex, race, stage and disease duration of patients in the 1993-2013 time-period. [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] [Table: see text] Conclusions.-Thyroid cancer when localized has a very good prognosis, with no significant excess mortality after diagnosis in papillary and papillary follicular variant cancers (PFV). Because nearly two thirds of thyroid cancers are localized, and excess death rate (EDR) is small in patients with regional cancer under age 50, overall excess mortality for all ages also virtually disappeared after 10 years in papillary and follicular cancer. Overall, the 5-year survival rate is greater than 90% for papillary and follicular carcinomas. Nevertheless, because of the marked predominance of papillary carcinoma, the continued increase in its relative frequency and annual projected deaths, thyroid carcinoma remains a significant health concern in the current era.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"47 3","pages":"143-158"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36471298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}