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PubMed1992

Thoracic outlet syndrome: reimbursement patterns and patient profiles.

Thoracic outlet syndrome (TOS) is one of the most controversial subjects in clinical medicine. In spite of the increasing skepticism voiced in the medical literature, many patients continue to be diagnosed as having TOS and treated surgically. Colorado is one of the leading states where TOS surgery is performed. We have examined the 1989 data as collected by the Colorado Hospital Association and have defined a patient profile and reimbursement pattern. Of the 174 patients who underwent surgery, women outnumbered men by three to one (132 to 47), even when worker's compensation was the payer. The data show that patients who do not have private insurance or worker's compensation are rarely diagnosed as having TOS. Medicaid patients almost never undergo surgery.

Adult↗
PubMedDate not supplied

Do women simply complain more? National patient injury claims data show gender and age differences.

The Swedish Counties Mutual Insurance (LOF) owns and operates the Swedish Patient Insurance Company, (PSR) a no-blame insurance system that compensates patients for injuries that result from errors in medical practice. We combined malpractice claims data (from PSR) with national hospital discharge registry data (National Board of Health and Welfare-Socialstyrelsen) and determined Swedish inpatient malpractice claims rates for the years 1996-2000. Women have higher claims rates than men, but their claims are adjudicated as valid more often than men's claims. The data are consistent with other lines of evidence suggesting poorer quality of care for women, e.g., heart disease, kidney disease, and cancer. Middle-aged (40- to 59-year-old) patients file malpractice claims at almost twice the national rate, whereas patients younger than 19 years and older than 80 years of age file at significantly below the average rate. Differences in claims rates have major financial and quality of care implications. Further studies are needed.

Adolescent↗
PubMed1997

Asthma in patients with farmer's lung during a five-year follow-up.

OBJECTIVES: This study assessed the incidence of asthma in patients with farmer's lung. METHODS: The study population consisted of 1031 patients who had occupational farmer's lung diagnosed from 1983 to 1988. The cases of farmer's lung were registered in the nationwide Register of Occupational Diseases by the Finnish Institute of Occupational Health, and all the patients in the study had received compensation from the insurance company for an occupational disease. The diagnosis of asthma was based on entitlement to a special refund for asthma medication costs from the national sickness insurance program. RESULTS: Seventy-four cases of asthma were found among farmers with farmer's lung up to the end of the 5 years following the year of the diagnosis for farmer's lung. The prevalence of asthma was 1% in the year preceding the diagnosis. In the year of the diagnosis and during the 5 year of follow-up, asthma was diagnosed in an additional 6% of the patients. CONCLUSIONS: The results of this study confirm previous findings of a low prevalence of asthma before the onset of farmer's lung in small groups of patients. However, the results also indicate that the incidence of asthma increases during the first years after an episode of farmers lung. For example, in the present study, asthma was apparent in 7% of the patients 5 years after the diagnosis of farmer's lung.

Adult↗
PubMed1998

Patients with low back pain not returning to work. A 12-month follow-up study.

STUDY DESIGN: A prospective study of patients treated with a light mobilization program for long-term low back pain. OBJECTIVES: To examine whether medical, psychological, or social factors predict failure to return to work within 12 months in the Scandinavian system of compulsory workers' compensation and social insurance, after a light mobilization program administered 8-12 weeks after initial sick leave. SUMMARY OF BACKGROUND DATA: The relative power of predicting factors varies in previous work, and there are no previous data on prognostic factors for light mobilization programs. METHOD: Patients (n = 260) on sick leave for 8-12 weeks for low back pain were examined with a battery of psychological and medical tests, before entering a light mobilization program. The treatment was given regardless of radiographic or clinical findings. The patients were encouraged to be active participants in the management and prevention of their back pain. Their sick leave status then was checked through registers 12 months after they had entered the treatment program. RESULTS: For those not returning to work within 12 months (23%), only combined models had acceptable predictive power (77%; discriminant analyses). Dominant variables were low Internal Health Locus of Control Score, restricted lateral mobility, and reduced work ability. The predictive value of each set of variables, taken alone, was significant only for medical variables (67% correct prediction). CONCLUSIONS: The final discriminant function may have potential as a brief screening instrument for the number of patients with low back pain who do not benefit from the light mobilization program.

Adolescent↗
PubMed2002

International comparison of costs of a fatal casualty of road accidents in 1990 and 1999.

The purpose of this study is to assemble information of costs per fatal casualty in traffic accidents, adopted by authorities in different countries. analyse and compare these figures as well as the methods used for estimating these values. A questionnaire was sent to 19 countries from which 11 gave information on cost per fatality and methods of valuation. The costs per fatality, usually defined as direct and indirect costs plus a value of safety per se, are compared both between countries and over time, 1990 and 1999, for each country. The average cost per fatality has increased between 1990 and 1999 (fixed prices) due to both changes in the methodology and changes of valuations. Great Britain, New Zealand, Sweden and the US conduct own willingness-to-pay (WTP) surveys, while the Netherlands and Norway make reviews of these studies. In Finland, the cost per fatality is a combination of the value of lost productivity and the cost of care for an institutionalised disabled person. In Australia, Austria, Germany and Switzerland, the cost per fatality is estimated as a value of lost productivity and an addition of a human cost based on compensation payments or insurance payments. Estimates from recently conducted WTP surveys or meta-analyses are considered in Austria, Finland and Sweden, however, not yet adopted as official values for use in road traffic planning.

Accidents, Traffic↗
PubMed1987

Failed arthroscopic meniscectomy: prognostic factors for repeat arthroscopic examination.

The authors have reviewed 44 patients retrospectively who failed arthroscopic partial meniscectomy. The study attempts to define the chances for success and to identify prognostic factors as these patients return for reoperation. Each patient had a repeat arthroscopic examination from 2 to 60 months after partial meniscectomy (average 19 months). They were reviewed an average of 31 months after reoperation (6 to 60 months), and each completed a subjective questionnaire evaluating the efficacy of their repeat arthroscopic surgery. Seventy-one percent of the patients had improvement with reoperation and were classified as good or excellent. Twelve patients (29%) did not improve and were rated poor. Ten parameters, as recorded before repeat arthroscopic examination, were investigated in an attempt to correlate each with success and to find those that are significant prognostic factors. Age of the patient, number of surgeries on the involved knee, time between arthroscopic examinations, nature of history (acute or chronic), workers' compensation or private insurance status, range of motion on physical examination prior to repeat arthroscopy, and degree of chondromalacia as seen at the first surgery were not found to correlate with the ultimate success of the patient. The presence of mechanical complaints before reoperation was a statistically significant parameter that led to a good or excellent result in 86% of the patients at follow-up. Lateral meniscal pathology seen at first partial meniscectomy gave more favorable results than medial meniscal pathology even if the patient had nonmechanical complaints. A history of reinjury between arthroscopic surgeries is helpful only if positive. In the absence of such a history, no conclusion can be drawn.

Adolescent↗
PubMed2005

[Access to medical records: who asks and why?].

OBJECTIVE: The aim of the survey was to study the characteristics of patients who (or whose families) request access to their medical records, their satisfaction with the handling of their requests, and the reasons for them. METHODS: This prospective study analyzed all the requests for access to medical records sent to two hospitals and collected data from the hospitals at that time (characteristics of the requester, patient and hospitalization) and from the requesters afterwards (opinion survey). RESULTS: The study reviewed 94 requests for medical records. Delays in providing the records exceeded the statutory periods. Most requests were intended to allow continuity of care, to provide information the patient did not receive during hospitalization, or because the patient needed to transmit it to a third party (new doctor, insurance, attorney, worker compensation). The hospitals mailed records to patients by regular mail in 90% of cases. One third of the patients were not satisfied by the handling of their request, complaining about the following difficulties: length of wait for records, complexity of the request procedure, its expense, absence of some documents, and difficulty in understanding the files without medical assistance. CONCLUSION: Improvements are needed, both to decrease the number of requests and to improve the requesters' satisfaction. Specific improvements are suggested.

Adolescent↗
PubMed1999

[Special characteristics of expert assessment of olfactory and taste disorders].

BACKGROUND: The number of medical expert opinions dealing with smell and taste disorders has continuously increased in recent years. However, an overview of the specific problems and results of those expert opinions has not been published until now. INDIVIDUALS AND METHODS: Olfaction was assessed by multiple subjective tests in 145 individuals with chemosensory dysfunction caused by trauma or occupational and environmental exposures. Additionally, a gustatory test, nasal endoscopy, anterior rhinomanometry, and radiography of the paranasal sinuses were performed. Malignering was diagnosed on a trial of multiple symptoms. Retronasal olfaction was tested using the Güttich gustatory olfaction test. RESULTS: Most of the medical expert opinions have been ordered by professional associations (42%) and insurance companies (28%). Compensation for olfactory dysfunction was claimed after trauma (64%), occupational exposure (23%) rhinosurgical procedures (8%), and laryngectomy (5%). Anosmia or hyposmia was claimed by 66% and 24% of all individuals, respectively. According to the results of the chemosensory tests, 41% of patients suffered from anosmia and 40% had hyposmia. Malignering was registered in 14%. CONCLUSIONS: The study shows that the "characteristic case" is a male in the late fourties, complaining of anosmia initially noticed after an occipital or frontobasal head trauma. The assessment of olfactory deficits related to toxic or chemical occupational exposure is difficult when a latency between the occupational exposure and the onset of chemosensory dysfunction is present. Moreover, interactions between the occupational exposure and nicotine or alcohol abuse must be taken into consideration. Claims for medical liability arose in 3% of the study group after septoplasty and sinus surgery.

Adolescent↗
PubMed2002

A descriptive study of women injured by hand-arm vibration.

The aim of this study was to describe the symptoms and the prognosis of vibration injuries in women. The investigation was based on a study of 374 women who had reported an injury due to hand-arm vibration to the Social Insurance Office or had received financial compensation from the Swedish Labor Market Insurance scheme during 1988-1997. Information on, for example, self-rated health symptoms and vibration exposure was collected by means of a questionnaire. On average, the first symptoms started after 7 yr of exposure and the first visit to a doctor took place after 11 yr. Neurological symptoms developed after a shorter period of exposure compared to vascular symptoms, 6.8 and 9.2 yr, respectively. The prevalence of numbness at the time of reporting the injury was 91% and the prevalence of white fingers was reported by 54%. The occupational group with the highest prevalence of vibration injuries was dental technicians. Two thirds of the women had stopped using vibrating machines in their work. Among the women who suffered from white fingers when they reported the injury, 50% declared impairment or no improvement of the symptoms. One woman in five was retired and the same number of women had retrained due to the occupational injury.

Adult↗
PubMed2003

Household food insufficiency is associated with poorer health.

The purposes of this study were to estimate the prevalence of household food insufficiency in Canada, to identify sociodemographic characteristics of households most likely to report food insufficiency and to examine the relationship between food insufficiency and physical, mental and social health. These objectives were achieved through an analysis of data from the 1996/1997 National Population Health Survey. An estimated 4% of Canadians, 1.1 million people, were found to be living in food-insufficient households. Single-parent families, households reporting their major source of income as welfare, unemployment insurance or workers' compensation, those who did not own their own homes and households in Western Canada were more likely to report food insufficiency. The likelihood of reporting food insufficiency increased dramatically as income adequacy deteriorated. Individuals from food-insufficient households had significantly higher odds of reporting poor/fair health, of having poor functional health, restricted activity and multiple chronic conditions, of suffering from major depression and distress, and of having poor social support. Individuals in food-insufficient households were also more likely to report heart disease, diabetes, high blood pressure and food allergies. Men in food-insufficient households were less likely to be overweight; after adjusting for potentially confounding variables, no other associations were found between food insufficiency and body mass index. These findings suggest that food insufficiency is one dimension of a more pervasive vulnerability to a range of physical, mental and social health problems among households struggling with economic constraints.

Adult↗
PubMed1987

Dental injuries among Norwegian soccer players.

The incidence and type of dental injuries among Norwegian soccer players were assessed according to the files of the Norwegian Soccer Association. In 1979-83 a total of 7319 injuries were reported. Approximately 20% (1267) were dental injuries. In every fifth case the expenses for necessary dental treatment exceeded the maximum compensation from the insurance company. The majority of the injuries occurred among male players (96.5%). Also the relative frequency of dental injuries was higher in men than in women. The prevalence of dental injuries was highest in the top division, and decreased gradually down through the divisions. Goalkeepers seemed to be more susceptible to injuries than did the other players. Uncomplicated crown fracture of maxillary front teeth was common and accounted for 45% of all dental injuries.

Adolescent↗
PubMed1999

[Complementary medicine and health legislation].

This review begins by explaining the meaning and purpose of health law in general. While legal regulations pertinent to mainstream medicine are functioning well, this project focuses on the legal situation that developed in Switzerland as a consequence of the increasing availability and use of services in complementary medicine. There are obvious gaps and deficits in our legislation concerning medical and paramedical providers of services in complementary medicine. Main emphasis of this project, therefore, was placed on the regulations dealing with health professionals in complementary medicine, in particular on standards of training, on licenses to practice, and on the compensation by health insurance funds. The project achieved a comprehensive stock-taking of the great variety of the Swiss federal and the 26 cantonal laws and regulations. It also drew conclusions on the necessity to formulate generally applicable rules and regulations for the field of complementary medicine and finally submitted a list of practical recommendations.

Complementary Therapies↗
PubMed1995

Persistent medical problems and permanent impairment five years after occupational injury.

In a comprehensive, one year material of 1,785 occupational injuries in the township of Umeå, Sweden. 1985-04-01/1986-03-31, the proportion of persons with persistent medical problems, two years after the event, was 39%. These were investigated again in 1990, five years after the event, and the proportion of persons with persistent medical problems had dropped to 23%. Around 4% of the injured had a definable permanent medical impairment, most often caused by a fracture, luxation or amputation of an upper extremity. Back injuries, however, were the most frequent cause for persistent medical problems, mostly in the form of ache and pain. Persons in health care, social and nursing occupations had a twice as high proportion of persistent problems as the average in the material. Of the persons that reported persistent medical problems when interviewed in 1990, one in three had changed his leisure time activities, one in five had changed jobs, and one in ten had retired early or was on long term sick leave. The group of early retired and persons on long term sick leave had a large proportion of young females and old males. The reader is reminded that conclusions and comparisons must be made with reference to the assessment and benefit structure in the particular systems of social insurance and workers' compensation.

Adult↗
PubMed1999

The involvement of the agriculture industry and government in animal disease emergencies and the funding of compensation in western Europe.

In Western Europe, the control and eradication of contagious animal diseases have always been subject to government legislation. In the event of an outbreak, the principal policy is 'stamping-out' (depopulation) of the infected herd. The owner of the herd is usually awarded financial compensation. The authors provide an overview of the involvement of the agriculture industry and government in animal disease emergencies and the funding of compensation in Western Europe. In particular, developments within the European Union are described, as illustrated by a case study in the Netherlands. The economic consequences of a widespread epidemic of classical swine fever (hog cholera) in the Netherlands in 1997 are described. Evaluation of the epidemic demonstrated that special emphasis needs to be placed on factors such as the high-risk period, animal movement, the attitude of farmers towards risk and the structure of compensation. Epidemic disease insurance schemes are considered to be a possible alternative in alleviating certain financial losses caused by disease outbreaks.

Agriculture↗
PubMedDate not supplied

[The detection of possible cases of simulation after a traumatic brain injury].

OBJECTIVE: To show the degree of detection of simulation, defined as the conscious, intentional production of false or exaggerated physical and psychological symptoms, motivated by external rewards such as payments by insurance companies and compensations. DEVELOPMENT: In forensic circles, a major problem is under consideration, namely recognition of the existence and nature of cognitive alterations after mild head injury (HI), since it is estimated that in 5-10% of the cases of mild HI there may be simulation of cognitive and emotional deficit, with further difficulty of differential diagnosis between simulation and the post-concussion syndrome. CONCLUSIONS: The forensic assessment of cognitive alterations following HI should include a clinical interview and neuropsychological evaluation. The former helps to determine the causal relationship between the traumatic accident and the resulting damage, continuance of symptoms and the existence or not of a premorbid pathological state. Although there is still not completely reliable, valid marker which permits one to be completely certain that the person is a simulator, neuropsychological evaluation permits suspicion of it in three aspects: 1. General indicators showing lack of internal consistence in the results of the person evaluated. 2. Specific tests to detect possible cases of simulation. 3. Profiles of responses which characterize possible simulators and neuropsychological evaluation tests.

Affective Symptoms↗