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One thousand unselected patients with bronchial asthma have been followed up for an average period of 11 years, with extremes of 33 years and three years. The average period from the first symptoms to the date of follow-up was 20.6 years in the 562 males and 22.3 years in the 438 females, with extremes of 72 years and three years. Since throughout the analysis no differences were found between the sexes, they have been grouped together. Terms used, such as asthma, chronic bronchitis, childhood bronchitis, age of onset, etc., have been carefully defined, as have the descriptions of intermittent and continuous asthma. The present state of the patients has been classified as A (good), B (fair), C (poor), and D (dead). Early age of onset (before 16) and intermittent asthma were associated and had a more favourable prognosis, while the childhood bronchitic had a better outlook than the adult bronchitic. Intermittent and continuous asthma have been compared. The incidence of bronchitis initially was higher in the continuous group, and the tendency to develop bronchitis over the years (present in all asthmatics) was also greater in the continuous group. Those with bronchitis were in much poorer health on follow-up than those without.
The year in which this first number of "Annals of Life Insurance Medicine" goes to press happens to be the Fiftieth Anniversary of the Swiss Reinsurance Com pany's activity in the field of underwriting and reassuring those risks which later became known as "substandard lives". In retrospect, it is a far cry from the old days when life assurance proposals were either accepted or rejected on medical grounds to the modern principles and methods of rating substandard cases both medically and actuarially. It can be assumed that in the course of the last few decades solutions, or at least approxi mate solutions sufficiently accurate for practical purposes, have been found to most of the numerous and often rather tricky actuarial problems relating to substandard policies, adequate premiums and reserves. No Life Assurer to-day however can fail to recognize that actuarial skill may only be applied to of medical assessment. Even the lay under substandard life risks on the basis writer certainly realizes that the medical and statistical problems inherent in the underwriting of substandard risks are infinitely more complex than any actuarial consequences of a calculated or assumed extramortality. It is primarily this basic fact which has stimulated the Swiss Reinsurance Company's plans to intensify and develop its research work in the field of the medical assessment of substandard lives.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
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Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
In the preface to Volume 1 of the 'Annals of Life Insurance Medicine' Dr. MAX E. EISENRING described the goal of this publication as follows: "Any project which aims at contributing substantially to the modern science of medical underwriting can do so only if the many people preoccupied with these problems throughout the world join forces to the ultimate benefit of those most in need of life assurance." In an endeavour to keep the life insurance medical directors all over the world informed of the developments in the field of life insurance medicine, we have decided to publish the papers which were presented at the 11 th International Congress of Life Assurance Medicine in Mexico in 1973 in Volume 5 of the 'Annals'. We are most grateful to Dr. J. REN06N, President of the Organizing Commit tee of the Congress in Mexico for having consented to our publishing the proceed ings of the Congress in a special edition of the 'Annals'. It is a source of great satisfaction to us that in this way a much larger circle of life insurance medical directors can be reached than would have been the case if only the participants themselves were to receive the proceedings of the Congress. Dissemination of the results of medical research on an international basis, in particular those findings that have a bearing on life insurance medicine, is one of our foremost aims.
European public health was a playing field for deeply contradictory impulses throughout the twentieth century. In the 1920s, international agencies were established with great fanfare and postwar optimism to serve as the watchtower of health the world over. Within less than a decade, local-level institutions began to emerge as seats of innovation, initiative, and expertise. But there was continual counterpressure from nation-states that jealously guarded their policymaking prerogatives in the face of the push for cross-national standardization and the emergence of original initiatives from below. In contrast to histories of twentieth-century public health that focus exclusively on the local, national, or international levels, Shifting Boundaries explores the connections or "zones of contact" between the three levels. The interpretive essays, written by distinguished historians of public health and medicine, focus on four topics: the oscillation between governmental and nongovernmental agencies as sites of responsibility for addressing public health problems; the harmonization of nation-states' agendas with those of international agencies; the development by public health experts of knowledge that is both placeless and respectful of place; and the transportability of model solutions across borders. The volume breaks new ground in its treatment of public health as a political endeavor by highlighting strategies to prevent or alleviate disease as a matter not simply of medical techniques but political values and commitments. Contributors: Peter Baldwin, Iris Borowy, James A. Gillespie, Graham Mooney, Lion Murard, Dorothy Porter, Sabine Schleiermacher, Susan Gross Solomon, Paul Weindling, and Patrick Zylberman. Susan Gross Solomon is professor of political science at the University of Toronto. Lion Murard and Patrick Zylberman are both senior researchers at CERMES (Centre de Recherche Médecine, Sciences, Santé et Société), CNRS-EHESS-INSERM, Paris.