Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V
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Versicherungsmedizin · Dec 2002
[So-called trauma criterium (a criterium of DSM-IV) in posttraumatic stress disorder and its significance for social and legal insurance (I)].
Since the diagnosis posttraumatic stress disorder (PTSD) was included in the American diagnosis system DSM-III in 1980, the ongoing scientific discussion has led to a shift in the definition of the so called A-criterion (trauma criterion) away from the general theory that the disease-causing event has to be outside normal human experience towards the point of view that it is more or less determined by the subjective experience of the individual. Without wishing to become involved in the discussion, in the publication the author tries to explain, on the basis of references to basic concepts found in insurance law (accident, initial damage, suitability of event, objectivity, epidemiological considerations), that in social insurance as well as in non-life insurance an objective insured event which has a severe emotional impact on the individual is a prerequisite for payment. The conclusions is that not every mental disorder which occurs after an insured event and which has quite rightly been classified as PTSD (or partial PTSD) on the basis of the symptoms involved in accordance with ICD-10/DSM-IV (criteria B-D) necessarily results in payment under insurance law.
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Versicherungsmedizin · Jun 2002
[Prevention and rehabilitation services in private personal insurance].
Prevention and rehabilitation services within the area of private insurances concerning the inability to work lead to an increased customer orientation, quality assurance and to the reduction of costs. With regard to prevention, different intervention possibilities are pointed out in order to reduce the risk of the event of a performance case. In the case of such the rehabilitation and vocational integration can be optimized by the application of a described procedure. An important component of the procedure represents the analysis of the vocational activity in order to identify the individuality of requirements and thus leading finally to an optimal fit to the abilities of the policyholder.
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Ventricular fibrillation is the main reason for cardiac arrest. The probability for survival decreases by 10% every minute, therefore immediate resuscitation is necessary. ⋯ Thanks to the high reliability of today's automated external defibrillators they can be used by trained first responders without any legal reservations. If a defibrillator is available, a trained first responder is obliged to use it in an emergency.
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The paper describes new forms of specifically organized headache prevention and headache therapy in Germany with the aid of two examples. It provides an overview of the clinical and economic efficiency of facilities with new forms of organization for specialized pain therapy. ⋯ By contrast, patients who do not receive specially organized treatment despite the fact that they need it display either constant suffering or even a worsening of their symptoms and an increased need for financial compensation. In view of this clear situation, specialized headache and pain therapy with a special focus on catering for the needs of chronic headache suffering is called for, both on economic and ethical grounds.
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The application of physical therapy for the treatment of chronic and recurrent pain, above all in the locomotor system, is indeed common, but its importance for pain therapy is often underestimated. The use of physical measures frequently does not follow scientific aspects. Their application without a concept and without regard to the functional and structural alteration as typical of pain in skin, connective tissue and muscles is to be criticized. A survey of the essential physical measures and their therapeutic effects is given and the principles of prescription are discussed.