Journal of insurance medicine (New York, N.Y.)
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The preclinical phase of dementia usually precedes the clinical diagnosis by many years. Early detection of dementing conditions during this preclinical phase may provide opportunities for treatments that may slow or mitigate progression. Conventional assessment tools usually can only detect dementia when the symptoms are overt and the disease is well-established. ⋯ The ability to accurately assess the presence of dementia clearly has direct relevance to insurance risk assessment and risk management. As new treatments appear, their role in clinical management of dementia patients will increase as well. In a future issue, the differential diagnosis of dementias related to the findings on these screening tools will be reviewed.
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Frequently an underwriter or medical director will question whether an increase in left ventricular mass represents pathologic left ventricular hypertrophy (LVH) or physiologic changes related to exercise. The LVH condition reflects end-organ damage related to abnormal hemodynamic stresses and confers an increased morbidity and mortality risk. When left ventricular mass is increased because of exercise, measured changes represent a normal, healthy cardiovascular system responding to the demands of that exercise. This article summarizes medical findings that distinguish pathologic LVH from an "athletic heart."
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Randomized Controlled Trial Clinical Trial
Fecal occult blood testing and the incidence of colorectal cancer.
The objective of this abstract is to demonstrate by life table methodology a significant reduction in the mean annual incidence rate of colorectal cancer in randomized groups with annual or biennial screening for fecal occult blood, as compared with the annual incidence rate in the control group. ⋯ Aggregate mean annual incidence rates of colorectal cancer were significantly lower in both screening groups than in the control group, as shown in Table 1. In the source article the same was true for the 18-year cumulative incidence rates, which were also significantly reduced (p < 0.001 for the annual screening group and p = 0.002 for the biennial screening group).
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Many disability claims are based on the subjective symptom of fatigue, which can be caused by a wide spectrum of diagnoses including fibromyalgia, chronic fatigue syndrome and cardiopulmonary diseases. Chronic pain is very often a compounding problem. It is vital for every insurer to have fair and objective criteria to distinguish between invalid claims and those with merit. This review article proposes objective tools and parameters to achieve this goal.