Telerehabilitació en pacients amb accidents cerebrovascular: revisió bibliogràfica.

L’ ictus és una alteració brusca de la circulació de la sang al cervell, sent la segona causa de mort al món i la primera en discapacitat. Objectius. Examinar si la telerehabilitació i la realitat virtual poden millorar l'estat físic i psíquic dels pacients amb accident cerebrovascular i avaluar l’impacte en les activitats de la vida diària. Conclusió. Els resultats indiquen que la fisioteràpia convencional i un programa combinat de telerehabilitació o realitat virtual amb fisioteràpia, milloren les capacitats físiques dels pacients, no obstant, el tractament combinat obté millores significativament superiors al tractament convencional. La tecnologia en l’àmbit de la rehabilitació pot ser una alternativa segura per promoure la recuperació motora després d'un accident cerebrovascular.

Eficàcia de la imitació, teràpia que activa les neurones mirall, en la rehabilitació de persones que han patit un ACV.

L’objectiu d’aquest projecte és avaluar l’eficàcia de la teràpia d’imitació, basada en l’activació de les neurones mirall, per augmentar la funcionalitat de l’extremitat superior parètica i millorar la qualitat de vida dels pacients que presenten un accident cerebrovascular a través d’un assaig clínic controlat aleatoritzat. Es crea un grup experimental ( teràpia imitació més teràpia fisioteràpia convencional) i un grup control ( teràpia fisioteràpia convencional) que duran a terme un tractament de 13 setmanes. Per a comprovar els resultats es realitzaran sis avaluacions ( primer dia, sis setmanes, tretze setmanes, sis mesos i al cap d’un any) a través de les següents escales: Medical Research Council (MRC) per la força, Action Research Arm test (ARAT) per la motricitat de la mà, l’índex de Barthel per al grau d’independència de les activitats bàsiques de la vida diària, l’índex de Lawton i Brody pel grau d’independència de les activitats instrumentals de la vida diària i el SF-36 per la qualitat de vida.

Influence of the claimant’s behavioural features on motor compensation outcomes

The decision to settle a motor insurance claim by either negotiation or trial is analysed. This decision may depend on how risk and confrontation adverse or pessimistic the claimant is. The extent to which these behavioural features of the claimant might influence the final compensation amount are examined. An empirical analysis, fitting a switching regression model to a Spanish database, is conducted in order to analyze whether the choice of the conflict resolution procedure is endogenous to the compensation outcomes. The results show that compensations awarded by courts are always higher, although 95% of cases are settled by negotiation. We show that this is because claimants are adverse to risk and confrontation, and are pessimistic about their chances at trial. By contrast, insurers are risk - confrontation neutral and more objective in relation to the expected trial compensation. During the negotiation insurers accept to pay the subjective compensation values of claimants, since these values are lower than their estimates of compensations at trial.

Factors affecting hospital admission and recovery stay duration of in-patient motor victims in Spain

Hospital expenses are a major cost driver of healthcare systems in Europe, with motor injuries being the leading mechanism of hospitalizations. This paper investigates the injury characteristics which explain the hospitalization of victims of traffic accidents that took place in Spain. Using a motor insurance database with 16.081 observations a generalized Tobit regression model is applied to analyse the factors that influence both the likelihood of being admitted to hospital after a motor collision and the length of hospital stay in the event of admission. The consistency of Tobit estimates relies on the normality of perturbation terms. Here a semi-parametric regression model was fitted to test the consistency of estimates, concluding that a normal distribution of errors cannot be rejected. Among other results, it was found that older men with fractures and injuries located in the head and lower torso are more likely to be hospitalized after the collision, and that they also have a longer expected length of hospital recovery stay.

Discrete distributions when modeling the disability severity score of motor victims

Many European states apply score systems to evaluate the disability severity of non-fatal motor victims under the law of third-party liability. The score is a non-negative integer with an upper bound at 100 that increases with severity. It may be automatically converted into financial terms and thus also reflects the compensation cost for disability. In this paper, discrete regression models are applied to analyze the factors that influence the disability severity score of victims. Standard and zero-altered regression models are compared from two perspectives: an interpretation of the data generating process and the level of statistical fit. The results have implications for traffic safety policy decisions aimed at reducing accident severity. An application using data from Spain is provided.

Modelling the disability severity score in motor insurance claims: an application to the Spanish case

Bodily injury claims have the greatest impact on the claim costs of motor insurance companies. The disability severity of motor claims is assessed in numerous European countries by means of score systems. In this paper a zero inflated generalized Poisson regression model is implemented to estimate the disability severity score of victims in-volved in motor accidents on Spanish roads. We show that the injury severity estimates may be automatically converted into financial terms by insurers at any point of the claim handling process. As such, the methodology described may be used by motor insurers operating in the Spanish market to monitor the size of bodily injury claims. By using insurance data, various applications are presented in which the score estimate of disability severity is of value to insurers, either for computing the claim compensation or for claim reserve purposes.

Atenció a l'ictus agut: comparació del sistema català amb el sistema finlandès

L’ictus és un problema de salut pública on les malalties cerebrovasculars representen la tercera causa de mort del nostre país, la primera causa de discapacitat física en adults i la segona de demència. Segons la OMS es preveu que la malaltia cerebrovascular s’ incrementi un 27% en relació a l’envelliment de la població entre els anys 2000 i 2025Objectius: Conèixer i comparar l’atenció i la organització de les persones afectades per ictus a Catalunya i a Finlàndia, específicament a l’Hospital Universitari Doctor Josep Trueta (Girona) i a l’Hospital Universitari de Kuopio (Finlàndia) Metodologia: Estudi observacional quantitatiu i qualitatiu que compara les diferents atencions a la fase pre-hospitalària, hospitalària i sub-aguda a Girona (Catalunya) i a Kuopio (Finlàndia). S’han estudiat variables relacionades amb l’atenció pre-hospitalària, hospitalària i post-hospitalària específicament, s’han estudiat variables relacionades amb cures d’infermeria. S’han realitzat tècniques qualitatives utilitzant la observació directa en els dos centres estudiats, i tècniques quantitatives mitjançant un qüestionari als responsables d’infermeria

Determinants of the decision to appeal against motor bodily injury settlements awarded by Spanish trial courts

Automobile bodily injury disputes represent one of the main causes of litigation faced by Spanish Courts. In this paper a multinomial model is implemented to analyse which factors determine the decision to appeal against the verdicts of trial courts. Use of a dataset of motor insurance claims revealed differences between the determinants of a claimant’s decision to appeal and those of insurers. Among other results it is shown that discrepancies regarding the permanent disability sustained affect the insurer’s decision to appeal. In contrast, the claimant pays more attention to differences in the stated temporary disability. Conclusions are drawn regarding which factors could reduce the percentage of appealed cases.

Forecasting the maximum compensation offer in the automobile BI claims negotiation process

Most motor bodily injury (BI) claims are settled by negotiation, with fewer than 5% of cases going to court. A well-defined negotiation strategy is thus very useful for insurance companies. In this paper we assume that the monetary compensation awarded in court is the upper amount to be offered by the insurer in the negotiation process. Using a real database, a log-linear model is implemented to estimate the maximal offer. Non-spherical disturbances are detected. Correlation occurs when various claims are settled in the same judicial verdict. Group wise heteroscedasticity is due to the influence of the forensic valuation on the final compensation amount. An alternative approximation based on generalized inference theory is applied to estimate confidence intervals on variance components, since classical interval estimates may be unreliable for datasets with unbalanced structures.

Prediction of individual automobile RBNS claim reserves in the context of Solvency II

Automobile bodily injury (BI) claims remain unsettled for a long time after the accident. The estimation of an accurate reserve for Reported But Not Settled (RBNS) claims is therefore vital for insurers. In accordance with the recommendation included in the Solvency II project (CEIOPS, 2007) a statistical model is here implemented for RBNS reserve estimation. Lognormality on empirical compensation cost data is observed for different levels of BI severity. The individual claim provision is estimated by allocating the expected mean compensation for the predicted severity of the victim’s injury, for which the upper bound is also computed. The BI severity is predicted by means of a heteroscedastic multiple choice model, because empirical evidence has found that the variability in the latent severity of injured individuals travelling by car is not constant. It is shown that this methodology can improve the accuracy of RBNS reserve estimation at all stages, as compared to the subjective assessment that has traditionally been made by practitioners.