underwriting

New Zealand Anyone? Jobs!

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Life Insurance Underwriters – want a relocation paid move to New Zealand? Currently recruiting intermediate & senior life insurance underwriters. Contact+64 9 354 8122 or andrewbatey@michaelpage.co.nz
Andrew Batey, Financial Services Recruitment Consultant at Michael Page

NEJM Teaching Topic – MCI

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The NEJM Resident e-Bulletin is one of the ways I keep up with medical information.  While it will not be possible for me to reproduce every email that comes from this service, on occasion I will post topics of interest.  Copyright remains vested with the NEJM so don’t try and steal this to make money.

Teaching Topic

Mild Cognitive Impairment

Clinical Practice

Mild Cognitive Impairment

R.C. Petersen

CME Exam   Full Text Audio  Comments

MCI represents an intermediate state of cognitive function between the changes seen in aging and those fulfilling criteria for dementia, often Alzheimer’s disease (AD).

Clinical Pearls

Clinical Pearl  What is the estimated prevalence of MCI?

The estimated prevalence of MCI in population-based studies ranges from 10 to 20%. In the Mayo Clinic Study of Aging, a prospective, population-based study of non-demented persons ages 70 to 89 years at enrollment, the prevalence of amnestic MCI was 11.1% and of nonamnestic MCI, 4.9%.

Clinical Pearl  How can the “worried well” be differentiated from patients with MCI?

Neuropsychological testing may be necessary to corroborate a history of decline in cognition, usually memory. At times, the “worried well” can give a convincing history for memory loss, but neuropsychological testing reveals normal performance.

Figure 1. Diagnostic Algorithm for Amnestic and Nonamnestic Mild Cognitive Impairment.

Morning Report Questions

Q. What factors predict a more rapid progression of cognitive impairment among patients with MCI?

A. As compared with the incidence rate for dementia in the general population of 1 to 2% per year, the incidence of dementia in patients with MCI is significantly increased, with an annual rate of 5 to 10% in community-based populations and 10 to 15% in clinic-based populations. The degree of cognitive impairment at presentation is a clinical predictor of progression; those with greater baseline impairment appear more likely to progress more rapidly. The presence of the apolipoprotein E ε4 allele is also predictive of progression rate. Several MRI measures have also been reported to predict a faster rate of progression, including atrophic hippocampi, dilated ventricles, reduced total brain volume, and the presence of white matter hyperintensities.

Q. How can patients with MCI be managed?

A. Limited data support the potential benefit of cognitive rehabilitation approaches. Several clinical trials that treated persons with MCI with cholinesterase inhibitors used for AD (donepezil, galantamine, and rivastigmine) at standard AD treatment doses for 2 to 4 years have shown no significant reduction in the rates of progression to dementia.

Globalization of Diabetes

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Globalization of Diabetes

Abstract

Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia’s large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the “normal-weight metabolically obese” phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia’s diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority.

© 2011 by the American Diabetes Association.  Reproduced on this blog under a Creative Commons license.  Source attribution is provided via link.

The Non-Mobile Society

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Calculated Risk: Labor Mobility: Starting to Increase

This blog post on CalculatedRisk references an article from the Financial Times.  I am struck by the differences in word choices.  FT uses “picks up sharply” while CalculatedRisk states “starting to increase”.  In conversations with my recruiter friends I’ve become aware of slightly higher activity in job openings.  Some of these openings included paid relocation.  A few years ago employers stopped offering paid relocation.  These changes are not insignificant.  But the job market remains weak.

Starting to increase is a better choice of words.

Have a Plan for Business Continuity

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Missing List in Joplin Tornado Drops to 156 – WSJ.com

“The Joplin Area Chamber of Commerce said Friday that at least 400 businesses and 5,000 jobs were affected by the tornado.”

If you click through and read this WSJ online article, you’ll notice a small video window.  The opening picture of the video is an electric guitar embedded neck first into a wall of a house.  I had never thought of my guitars as deadly weapons, but in the right weather conditions they are.
When I read about the number of businesses affected I silently hoped these businesses had disaster recovery and business continuation plans in place.  Unfortunately, the most likely answer is no and most of these businesses will ultimately fail.
Not many of us think about total destruction from an F-5 tornado.  But if you manage to survive at one point you will have to get back to work.
Time to spend some time revising my own business recovery and continuity plans.