Everyone is familiar with the use of family history, especially early death before the age of 60 or 65, as a marker for potential genetic syndromes associated with premature onset of cancer or coro

HIV (Human Immunodeficiency Virus) infection is the cause of the Acquired Immune Deficiency Syndrome, AIDS, which presents with multiple infections and tumours. Since 1996, the efficacy and increased use of treatments associating 3 different classes of drugs — “triple therapy” — has significantly reduced the prevalence of AIDS and the mortality rate in HIV-infected individuals in countries with widespread access to health care.

As early detection and treatment for people with cancer becomes increasingly improved and widespread, more and more cancer survivors are applying for insurance with favorable outcomes—and receiving standard policies.

Researchers have developed a potentially useful list of predictors of atherosclerotic sudden cardiac death (SCD) to help clinicians distinguish patients who are likely to die of a heart attack from those who might survive one. Their ultimate goal is to create a risk stratification score applicable for the general population and provide interventions to prevent development of traits that contribute to SCD.

Areca nut is the seed of fruit oriental palm known as Areca catechu. Many adverse effects of nut chewing have been well documented in the medical literature. As these nuts are mixed with some other substances like tobacco and flavouring agents, it has been hypothesized that it might also cause some dependency symptoms among its users. Therefore, the objective of this study was to investigate dependency syndrome among areca nut users with and without tobacco additives and compare it with dependency associated with cigarette smoking among the male Pakistani population.

Suicide is a leading cause of perinatal maternal deaths in industrialised countries but there has been little research to investigate prevalence or correlates of postpartum suicidality. The Edinburgh Postnatal Depression Scale is widely used in primary and maternity services to screen for perinatal depressive disorders, and includes a question on suicidal ideation (question 10). We aimed to investigate the prevalence, persistence and correlates of suicidal thoughts in postpartum women in the context of a randomised controlled trial of treatments for postnatal depression.

Article appearing in the newsletter of the Australian Life Underwriters and Claims Association. Other articles of interest include:

• What’s going on in Underwriting in the US of A?
• Update on the HIV Working Group
• Chronic (idiopathic) Benign Neutropenia: Not so Benign?
• and Hank's Recent Findings in Laboratory Testings: The Underwriting Perspective

This Gen Re Risk Insights article addresses selected factors affecting underwriting and some shifts in diagnostic testing and treatment.

Chronic obstructive pulmonary disease (COPD) is a disease that requires lifelong adherence to complicated drug therapy regimens. This claims-based analysis of COPD patients, published in Current Medical Research and Opinion, suggests less than optimal compliance with recommended drug therapy treatment for COPD patients based on Chronic Obstructive Lung Disease (GOLD) guidelines. This study further suggests that claims-data analyses provide reasonable aggregate distributions of COPD severity, which can be used by health plans and disease management programs to improve drug therapy management. Link to abstract of article from Informa Health Care.

The measurement of cholesterol in the skin (SC), or "skin sterol," has been put forward as a candidate to eliminate the need for testing blood for lipids and avoiding the inconvenient requirement for examinees to fast prior to the test. This edition of Risk Matters examines the claims for this test and its potential for cardiovascular risk assessment.

As the number of seniors continues to grow, more and more surgical operations are being performed on this segment of the population. Johns Hopkins University reports that approximately half of all operations in this country are performed on patients 65 and older. For patients older than 80, the chance of death during the month following a surgical procedure increases by 26 percent.

Now Johns Hopkins is releasing a study conducted with the American College of Surgeons which assesses the frailty of surgical candidates and attempts to predict the likelihood of post-surgical complications, hospital stay length and need for post-operative nursing care.

Obesity may have an even greater impact on mortality than anticipated, according to a new method of adjusting for confounding.

It is important to know the differences between the different pathologies, as this will help you to assess the risk and offer the most
suitable conditions of acceptance.

SCOR provides an in depth at the pathologies most often encountered in the applications submitted to insurers.

The December 2009 issue covers:

- Mitral Valve Prolapse
- Bicuspid Aortic Valve
- Atrial Fibrillation
- The SCORE Risk Charts - A Critical Assessment
- Heart Disease - Case Examples
- Exceptional Sports in Brief - Shuttlecock and Skiking
- A Look across the Fence - Underwriting in Russia

A new approach to analyzing electrocardiograms--a ubiquitous test of the heart's electrical function--could predict who is most likely to die after a heart attack. Researchers at MIT found that measuring how much the shape of the electrical waveform varies from beat to beat identifies high-risk patients better than existing risk factors. If the findings hold up in further clinical trials, the technology could be used to figure out which heart attack patients need the most aggressive treatment.

A new blood test could improve cancer-screening compliance.

Heritage Labs' newsletter eEnvoy discusses the mortality associated with albumin and globulin. Using our database of insurance applicants and the Social Security Death Master File, we can measure increases in mortality at levels of albumin and globulin that may surprise many of our readers. The risk rises even before the lowest 2.5th percentile which is the traditional level chosen for a “lower limit of normal”.. We also propose a unique formula to help discern the relationship between albumin and globulin better than the current A/G ratio.

Topics covered include:

• Arterial Hypertension - A Major Risk Factor
• Hypertension Management through Physical Exercise
• Blood Pressure and Stress
• A Look across the Fence - Underwriting in France
• An Exceptional Sport: Canoe Polo - A Mixture of Various Sports
• An Exceptional Profession: No False Movement - Sign Language Interpreting
• Hypertension - Case Examples
• Seminar Dates

From the CDC's MMWR.

UCSF scientists have discovered commonly inherited genetic risks for the deadliest types of brain tumors, marking the first time such a link has been definitively established.

To examine the relationship between alcohol and suicide among racial/ethnic populations, CDC analyzed data from the National Violent Death Reporting System (NVDRS) for the 2-year period 2005--2006 (the most recent data available).

Weekly update on seasonal influenza. For H1N1 related news, visit http://www.cdc.gov/swineflu/.

The latest issue of Risk Matters takes a timely look at the possible impact of the current flu outbreak.

With the flowering of “financial services,” life insurers are now seriously questioning the appropriateness of cumbersome, time-consuming and blatantly customer-unfriendly screening tests.

Presentation by Transamerica Reinsurance's David Wylde at the 2009 MUD Group meeting.

From the Morbidity and Mortality Weekly Review.

From the March 2009 issue of Gen Re's Risk Insights.

Presentation at 2009 MUD Group meeting.

This new article by Hank George lays waste to the so-called "advantages" of treadmill stress tests and shows why their use should end NOW. They welcome all comments!

Check out these articles on:

• Calibrating Mortality Estimates From Insurance Applicants Linked To Mortality Data: How Do We Measure Up?
• Lipemia, Hemolysis And Things That Go Bump In The Lab
• A1C And Mortality Implications
• Results Reported From Plasma

A small chunk of DNA linked to schizophrenia, mental retardation, and autism may change the way we think about disease.

Heritage Labs recently had an inquiry concerning the hepatitis B tests offered as part of their reflex panel and the apparent discrepancy with the requirements of certain reinsurers. The case involves a female applicant, age 27, with normal transaminases, and a positive result for hepatitis B surface antigen. Before getting into detail on this case, this technical bulletin recaps the nomenclature for several of the common hepatitis B markers.

In this issue, Munich Re´s Centre of Competence for Biosciences (CoCB) focuses on the development of genetic testing for common diseases and talks to renowned geneticist Prof. Dr. Jens Reich about the predictability and prevention of common diseases. Our doctors also take critical look at other current developments such as the threat of an influenza pandemic. And finally they report on a common neurological disorder that Munich Re has now included in MIRA.

From the CDC's Morbidity and Mortality Weekly Report.

Recent articles in mainstream publications have raised questions on some quarters regarding the use of Rx (pharmacy) profiles in underwriting.

Does this work to the detriment of the best interests of insurance seekers? The short answer is absolutely not, says Hank George.

Presentation by Hank George at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

At the recent AHOU in Miami, Heritage received both a comment and a question. One inquiring mind made the statement that he had “seen a rash of early duration deaths due to pancreatic cancer. Physicians use a particular test to rule pancreatic cancer in or out; had this test been investigated by Heritage Labs for use as a screening tool?” Danny Perkins responds.

From the September 2008 Heritage Labs eNews by David Winsemius, MD, MPH.

Published in May, this newsletter contains articles on:

• Tumor Markers
• New Tools To Predict CHD Risk
• Optimizing Laboratory Test Performance

...and more.

Presentation by J. Carl Holowaty M.D. at the MUD Group meeting in January, 2008.

Presentation at the MUD Group meeting in January 2008 by Laura Vecchione, MD, Second Vice President and Medical Director, Gen Re LifeHealth.

November 2008 GenRe Underwriting Focus looks at:
Gastrointestinal System - Stomach Disorders: Gastric and Duodenal Ulcer Disease / The ABC of Gastritis / Functional (Nonulcer) Dyspepsia / A Look Across the Fence - Underwriting in Singapore / An Exceptional Sport: Speedflying / An Exceptional Occupational Profile: Freefall Photography / Certified Medical Underwriting Specialist (CII) - Graduation 2008 / Seminar Dates / Stomach Disorders - Case Examples.

By Richard Rougeau, M.D., VP and Chief Medical Officer, Generali USA.

http://www.genre.com/sharedfile/pdf/Topics16_Warstat-en.pdf

Recaps some key findings from evidence based underwriting research Gen Re has completed into multiple sclerosis.

180 million people suffer from diabetes mellitus at the present time. And there will be 300 million by the year 2025, according to World Health Organization estimates. This dramatic increase will also be reflected in the application portfolio of the insurer. It is therefore all the more important to be able to assess the different types of disease and also the early forms of metabolic disorder with respect to the real associated risk. Diabetic complications, HbA1c and urinalysis findings provide reliable information about the long-term prognosis.

Changes in longevity, biological perspectives, mortality trends and more.

Presentation by Angelique Ramirez, MD.

Some researchers now believe that certain diseases can be postponed simply by slowing down the aging process, says this piece in Contingencies.

This is the first of a Transamerica Reinsurance series of articles on the laboratory and examination components of age and amount requirements. Topics will be chosen on the basis of current interest, whether new tests or simply old tests that are being reconsidered. Sidebars will introduce the mathematical tools that are commonly used to evaluate tests and testing programs.

Handouts from the Living to 100: Survival to Advanced Ages International Symposium for sessions such as:

• Distinguishing Health Status For Advanced Ages - Faye S. Albert, John M. Bragg, James C. Brooks, Dr. Bob Gleeson, Steven K. Holland, Ashely Thomas
• Demographic Implications of Aging Populations Internationally - Robert L. Brown, Roberto Ham–Chande, Steven G. Prus, N. V. Subramanyan
• Quality of Life of Elderly - Beverly J. Orth, Anna M. Rappaport,Eric Stallard
  

http://www.genre.com/sharedfile/pdf/ClaimsFocus20081-en.pdf