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1.
Br J Nurs ; 29(9): 537-538, 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32407224

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers arrangements for indemnifying nurses returning to practice in the pandemic, and whether nurses might be given immunity from negligence claims.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Imperícia/legislação & jurisprudência , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Medicina Estatal/legislação & jurisprudência , Humanos , Seguro , Papel do Profissional de Enfermagem , Reino Unido/epidemiologia
2.
PLoS One ; 15(4): e0231077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282836

RESUMO

INTRODUCTION: This study aimed to investigate the differences in the Injustice Experience Questionnaire (IEQ) scores during the early period after the diagnosis of Whiplash-associated disorder (WAD) between Japanese and Canadian samples, and the associations between the IEQ scores and treatment terms in Japanese patients with acute WAD. METHODS: We used secondary data for the IEQ scores of Canadian patients with acute WAD. In Japan, we collected data from 85 consecutively enrolled patients with acute WAD, and their treatment terms were collected; these referred to the number of days between the date of injury and the closure date of the insurance claim and the number of treatment visits. Before treatment, the Numeric Rating Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, IEQ, and Euro Quality of Life five-dimensional questionnaire were administered. The variables were subjected to multivariate analysis with each treatment term. RESULTS: The IEQ scores were higher in Japan than in Canada. Through multiple regression analysis, IEQ scores were independently correlated with treatment terms. The optimal cutoff point of the IEQ scores for a prolonged treatment term was 21 and 22 points, respectively. CONCLUSIONS: The IEQ scores were associated with treatment terms in patients with acute WAD in Japan.


Assuntos
Depressão/epidemiologia , Mialgia/epidemiologia , Dor/epidemiologia , Traumatismos em Chicotada/epidemiologia , Canadá/epidemiologia , Depressão/fisiopatologia , Depressão/psicologia , Depressão/terapia , Feminino , Humanos , Seguro , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Mialgia/psicologia , Mialgia/terapia , Dor/fisiopatologia , Dor/psicologia , Manejo da Dor , Análise de Regressão , Inquéritos e Questionários , Traumatismos em Chicotada/fisiopatologia , Traumatismos em Chicotada/psicologia , Traumatismos em Chicotada/terapia
7.
Dig Dis ; 38(1): 46-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31422405

RESUMO

BACKGROUND AND AIMS: Chronic hepatitis C (CHC) viral infection has a major impact on our health care system. The emergence of direct-acting antiviral agents (DAA) has made treatment simple (oral), efficacious, and safe. However, treatment is expensive and access is variable. Despite great treatment outcomes, only a minority of patients with CHC receive antiviral therapy. This study identifies the barriers to treatment in CHC infection. METHODS: Study recruited all hepatitis C antibody-positive patients between 2012 and 2016 from a large academic teaching hospital in New York City. Demographic information, clinical data, and insurance information were reviewed. Statistical analysis performed with OR and p < 0.05 reported. RESULT: A total of 1,548 patients with hepatitis C antibody-positive titer were included in the initial analysis. One thousand and twenty-four patients were forwarded to the final analysis after exclusion of 524 patients (for distant resolved hepatitis C viral [HCV] infection [n = 42], patients cured with interferon-based regimens [n = 94], patients with comorbid conditions [n = 176], and patients with an incomplete medical chart [n = 212]). In the intention to treat cohort of 1,024 patients, 204 patients achieved a sustained virological response after receiving DAAs (n = 204/1,024 - 20%). The majority of patients had not received DAAs (n = 816/1,024 patients - 80%). Multiple factors resulted in hepatitis C viral infection (HCV) patients not receiving DAAs including the following primary factors: (a) lost to follow-up clinic visits and poor adherence to clinic appointments (n = 548 [67%]; p value <0.0001), (b) active substance abuse (alcoholism and IV drug abuse; n = 165 [20%]; p value 0.22), (c) patients with significant psychiatric illness (n = 103 [12.7%]; p value 0.015), and subgroup analysis revealed that 188 (188/1,024 - 12%) patients had human immunodeficiency virus-1 (HIV-1) and HCV coinfection. Majority of HCV/HIV coinfected patients had not received DAAs (n = 176 [97%]; p value <0.0001, OR 4.46). The etiology of nontreatment in coinfected HIV/HCV patients was 73.3% poor adherence, 11.5% active substance abuse including alcohol and IV drug use, and 9% significant psychiatric illness and 6.2% multiple reasons for not receiving HCV treatment. CONCLUSION: Multifactorial barriers are preventing hepatitis C patients from receiving effective DAA therapy. Primary factors include poor compliance, substance abuse, and significant psychiatric illness, with significant overlap between these groups. Subgroup analysis showed a substantial number of high-risk patients with HIV/HCV coinfection did not receive DAA therapy. A multidisciplinary clinic approach with a hepatologist, ID physicians, social worker, and behavioral health psychologist and case manager should provide a solution to improve diagnosis and treatment with DAA.


Assuntos
Hepatite C Crônica/tratamento farmacológico , Anticorpos Antivirais/imunologia , Antivirais/farmacologia , Antivirais/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Feminino , Infecções por HIV/complicações , Infecções por HIV/virologia , Hepacivirus/efeitos dos fármacos , Hepacivirus/imunologia , Hepatite C Crônica/virologia , Humanos , Seguro , Masculino , Pessoa de Meia-Idade , Resposta Viral Sustentada , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-31731634

RESUMO

There are many important factors to consider when creating robust, regional disaster prevention systems. These include rural households' knowledge and reported skills of earthquake disasters, disaster risk perception, awareness of disaster risk reduction, willingness to purchase insurance, and willingness to relocate to avoid disasters. However, few empirical studies have systematically established the theoretical research frameworks to analyze these factors. This study analyzed the data sampled from 241 rural households located in counties affected by the 2008 Wenchuan earthquake. A theoretical model was designed to investigate rural households' disaster risk perception and used path analysis to systematically analyze the mechanism of the factors stated above. The results showed that 53.11% of rural households had a stronger willingness to purchase disease insurance and 72.19% had a stronger willingness to relocate to avoid disasters. Risk perception, knowledge and reported skills, and awareness of disaster risk reduction were significantly correlated with a willingness to purchase disaster insurance. Risk perception and awareness of disaster risk reduction were significantly positively correlated with a willingness to relocate to avoid disasters. Knowledge and reported skills indirectly affected the willingness to purchase insurance and the willingness to relocate to avoid disasters through risk perception and awareness of disaster risk reduction. Risk perception could indirectly affect the willingness to purchase insurance and the willingness to relocate to avoid disasters through awareness of disaster risk reduction.


Assuntos
Desastres , Terremotos , Modelos Teóricos , Percepção , População Rural , Adulto , Idoso , China , Comportamento do Consumidor , Feminino , Humanos , Seguro , Conhecimento , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Medição de Risco
9.
Int J Colorectal Dis ; 34(11): 1865-1870, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31595311

RESUMO

PURPOSE: Hospital discharge after colorectal resection within an Enhanced Recovery After Surgery (ERAS) program occurs earlier compared to standard-care postoperative pathways but often later than what objective criteria of "readiness for discharge" could allow. The aim of this study was to analyse reasons and risk factors of such discharge delay. METHODS: All elective patients admitted for colorectal resection at the regional Hospital of Lugano in 2014 and 2015 were included. The postoperative day on which patients fulfilled consensus agreed criteria (according to Fiore) for readiness for discharge (POD-F) and the effective day of discharge (POD-D) were determined. We analysed the reasons for discharge delay (POD-D>POD-F) and performed univariate and multivariate analysis to determine risk factors. RESULTS: One hundred thirty-eight patients were included in the study. Median POD-F was 5 (2-48) days, POD-D was 6 (3-50) days. In 94 patients, POD-D occurred later than POD-F with a median delay of 1 (1-11) days. Reasons for discharge delay were insufficient social support in 13 (14%), patient's preference in 39 (41%) and medical team preference in 41 (44%). Private insurance (OR 2.61, 95%CI 1.08-6.34, p = 0.034) and patient discharged on a day other than Monday (OR 2.94, 95%CI 1.16-7.14, p = 0.023) were independent predictors for discharge delay. CONCLUSION: Even when objective criteria for readiness for discharge have been fulfilled, patients and/or doctors often do not feel comfortable with hospital discharge at this time point. Length of stay, even within an ERAS program, is still influenced by several non-medical factors and is therefore not a precise surrogate marker of outcomes.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Seguro , Tempo de Internação , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
J Insur Med ; 48(1): 48-51, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609647

RESUMO

Liquid biopsies hold great promise for the diagnosis and treatment of cancer. Earlier recognition of recurrent and metastatic disease and better treatment choices based on liquid biopsies seem achievable in the near future. However, earlier cancer diagnosis, the most heralded application, will remain the most challenging. The impact of liquid biopsies on life insurance will be positive. The impact on critical illness insurance will be more nuanced. It will depend on 2 factors: the success of liquid biopsies as cancer screening tests and the ability of an insurer to use "genetic information" during risk selection. In jurisdictions where use is prohibited, critical illness insurance, as presently designed, may not be sustainable.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias/diagnóstico , Humanos , Seguro , Biópsia Líquida , Células Neoplásicas Circulantes/patologia
11.
Rev Prat ; 69(4): 454-460, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626506

RESUMO

At the instigation of the Aeras convention -Insuring and borrowing with an aggravated health risk - and the 2014- 2019 Cancer Plan, the Law of 26 January 2016 introduces the « right to be forgotten ¼ for people with cancer. Thus, people wishing to take out an insurance policy for a mortgage or consumer credit do not have to declare their cancer 10 years after the end of the therapeutic protocol, in the absence of relapse. This period is reduced to 5 years for cancers occurring before the age of 18 years. Associated with this right, the « reference grid ¼ identifies situations for which insurance will be granted without surcharge or exclusion of guarantee, or under conditions that are close to standard conditions. This concerns both cancer -breast, thyroid, prostate cancers ...- and noncancer diseases -HIV, hepatitis C, cystic fibrosis ...-. Through his relationship with his patient, the doctor plays a key role in providing the best insight and helping him in his efforts.


Assuntos
Sobreviventes de Câncer , Seguro , Humanos , Recidiva Local de Neoplasia
13.
Prev Vet Med ; 171: 104764, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31494529

RESUMO

Health issues in purebred dogs are currently considered one of the biggest problems in companion animal health. The Labrador retriever (LR) is one of the most popular dog breeds. The aim of this study was to quantify LR breed health in comparison with mixed-breed dogs (MB), by using four different data sources: a veterinary practice management system (appr. 35,000 unique individuals LR + MB), data from two animal insurance companies (appr. 15,500 and 4500 individuals respectively), and a histopathological laboratory (appr. 4000 individuals). After extensive recoding of the data, health parameters utilised to quantify breed health were longevity, frequency of practice visits and insurance expense claims, and diagnostic codes. A Kaplan-Meier univariate and multivariable Cox proportional hazard model were used to evaluate longevity. A negative binomial model was used to analyse the frequency of visits, claims, and diagnostic codes in both sets of insurance data. Logistic regression was used to look into the categorical diagnostic codes in the laboratory data. The median lifespan of the LR was similar (12 years, practice data) or longer (10 versus 8 years, insurance data) than MB for individuals with a known birth and death date. When including censored individuals, survival time in the LR was comparable to MB individuals up to 10 years of age. Above 10 years of age, the LR lived a similar length as MB with a medium to large body size, but shorter than all MB. The LR visited the veterinary practice more often (risk ratio (RR) 1.2, 95% confidence interval 1.2-1.3), and also showed a higher frequency of insurance expense claims (RR 2.2 (2.1-2.3) and RR 1.2 (1.1-1.3) respectively for the two insurance data sets). The largest difference in organ systems between the LR and MB in insurance claims was related to ears (RR 5.3 (4.8-5.8) and RR 2.6 (2.3-3.1)), followed by airways (RR 2.6 (2.4-2.8)), tendons & muscles (RR 2.4 (2.2-2.6) and RR 1.4 (1.1-1.7)), and joints (RR 1.7 (1.3-2.1)), without a difference in median age at diagnosis. The data from the histopathological laboratory suggested a higher disease burden related to oncology for the LR compared to MB (OR 1.2, 95% CI 1.0-1.3). Oncological diagnoses were made at a younger age in the LR (8.8 versus 9.4 years). The disease burden was significantly higher for the LR than MB, but these results may suffer from substantial bias such as selection bias towards the database, and different behaviour of LR versus MB owners with regards to veterinary care. In the future, longer term population data can corroborate these results.


Assuntos
Doenças do Cão/epidemiologia , Nível de Saúde , Longevidade , Animais , Cães , Feminino , Seguro , Laboratórios , Masculino , Países Baixos/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Risco
14.
Artigo em Inglês | MEDLINE | ID: mdl-31480521

RESUMO

Insurance represents one of the main instruments, together with other risk management mechanisms, to face the adverse effects produced by natural calamity that, despite their growing intensity and the enormous costs, are still perceived as "exceptional". Risk management is an important part of farming, and it is a concern for those governments which aim at achieving their agricultural policy targets. In this context, crop insurance can also represent a financial mitigation tool for farmers to face climate change consequences. This study is focused on the Italian case analyzing the evolution of public support and its effect on risk management policy in agriculture. Our research, based on panel data regressions, provides two different levels of analysis. The first one evaluates how the reimbursed value issued by insurance companies in favor of agricultural firms, as recovery from natural adversities, affects farmers' profitability. The second one evaluates how the reimbursed value is used in farm management. The results of the analysis demonstrating the significance of insurance variables and their positive effect on the profitability of the farms, represent a strong advance in the farm risk management field.


Assuntos
Agricultura/economia , Fazendas/economia , Seguro/estatística & dados numéricos , Mudança Climática , Fazendeiros , Humanos , Itália , Gestão de Riscos
15.
Disasters ; 43(4): 906-925, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475731

RESUMO

Flood-related losses in the United States are increasing despite large-scale mitigation efforts. To offset the rising cost of floods, the US Congress passed legislation in 2014 that will augment insurance premiums to make the National Flood Insurance Program more actuarially sound. Consequently, there is interest in lowering flood-related costs to the homeowner, both in terms of premiums and damage. This study addresses the issue by integrating premium savings and damages avoided based on several mitigation scenarios. Specifically, it examines how much policyholders within a watershed near Houston, Texas, could have saved between 1999 and 2009 had their communities introduced specific avoidance-based mitigation activities. The results indicate that homeowners and communities can offset premium rises and a majority of the damage suffered through marginal expansions of such initiatives. However, the costs associated with their implementation could counter some of these savings, and hence they need to be considered in future work.


Assuntos
Inundações/economia , Seguro/economia , Planejamento em Desastres/organização & administração , Programas Governamentais , Humanos , Seguro/legislação & jurisprudência , Texas , Estados Unidos
16.
PLoS One ; 14(8): e0220965, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31442250

RESUMO

We construct two examples of shareholder networks in which shareholders are connected if they have shares in the same company. We do this for the shareholders in Turkish companies and we compare this against the network formed from the shareholdings in Dutch companies. We analyse the properties of these two networks in terms of the different types of shareholder. We create a suitable randomised version of these networks to enable us to find significant features in our networks. For that we find the roles played by different types of shareholder in these networks, and also show how these roles differ in the two countries we study.


Assuntos
Administração Financeira/estatística & dados numéricos , Investimentos em Saúde/estatística & dados numéricos , Modelos Teóricos , Comércio/estatística & dados numéricos , Humanos , Seguro/estatística & dados numéricos , Países Baixos , Participação no Risco Financeiro , Turquia
17.
Int J Inj Contr Saf Promot ; 26(4): 399-404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31429368

RESUMO

Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Motocicletas/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Traumatismos Craniocerebrais/epidemiologia , Estudos Transversais , Educação/estatística & dados numéricos , Feminino , Humanos , Seguro/estatística & dados numéricos , Jamaica/epidemiologia , Licenciamento/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Motocicletas/legislação & jurisprudência , Sistema Musculoesquelético/lesões , Adulto Jovem
18.
J Manag Care Spec Pharm ; 25(9): 1026-1027, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456494

RESUMO

DISCLOSURES: No outside funding supported the writing of this letter. Fendrick discloses consulting relationships with AbbVie, Amgen, Centivo, Community Oncology Association, Department of Defense, EmblemHealth, Exact Sciences, Freedman Health, Health at Scale Technologies, Health Management Associates, Lilly, MedZed, Penguin Pay, Risalto, Sempre Health, State of Minnesota, Wellth, and Zansors and also discloses a research relationship with AHRQ, Boehringer-Ingelheim, Gary and Mary West Health Policy Center, Laura & John Arnold Foundation, National Pharmaceutical Council, PCORI, PhRMA, RWJ Foundation, and State of Michigan/CMS. Shrosbree has nothing to disclose.


Assuntos
Assistência à Saúde/economia , Seguro/economia , Análise Custo-Benefício/economia , Custos de Cuidados de Saúde , Humanos , Michigan , Minnesota , Medicamentos sob Prescrição/economia
19.
J Int Bioethique Ethique Sci ; Vol. 30(2): 147-168, 2019 07 02.
Artigo em Francês | MEDLINE | ID: mdl-31460733

RESUMO

Chapter 7. Climate changes and insuranceClimate change challenges insurance, confronting it with uncertainty: risks evolves over time in frequency and intensity, leaving us incapable of measuring the extent of these changes. The following contribution first addresses the way insurance takes into account climate change, from an actuarial and a political point of view. Indeed the principles and the normativity of insurance are solicited. It will then consider the different types of insurance cover, from the most classic, the sustainability of which is threatened by climate change, to the most innovative, which have more to do with finance than insurance.


Assuntos
Mudança Climática , Clima , Desastres/economia , Seguro , Previsões , Efeito Estufa , Humanos
20.
Health Serv Res ; 54(5): 1126-1136, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31385292

RESUMO

OBJECTIVE: To examine the relationship between insurer market structure, health plan quality, and health insurance premiums in the Medicare Advantage (MA) program. DATA SOURCES/STUDY SETTING: Administrative data files from the Centers for Medicare and Medicaid Services, along with other secondary data sources. STUDY DESIGN: Trends in MA market concentration from 2008 to 2017 are presented, alongside logistic and linear regression models examining MA plan quality and premiums as a function of insurer market structure for 2011. DATA COLLECTION/EXTRACTION METHODS: Data are publicly available. PRINCIPAL FINDINGS: MA plans that tend to operate in more concentrated MA markets have a higher predicted probability of receiving a high-quality health plan rating. Operating in more concentrated MA markets was also found to be associated with higher premiums. Among plans that tend to operate in very concentrated MA markets, high-quality MA plans were associated with premiums as much as two times higher than premiums associated with lower-quality plans. CONCLUSIONS: Any policies directed at enhancing insurer competition should consider implications for health plan quality, which may be very different than the implications for enrollee premiums.


Assuntos
Competição Econômica/economia , Competição Econômica/estatística & dados numéricos , Seguro/organização & administração , Seguro/estatística & dados numéricos , Medicare Part C/organização & administração , Medicare Part C/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estados Unidos
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