Determining the cost of obesity and its common comorbidities from a commercial claims database.

What is already known about this subject Obesity is highly prevalent and costly in the US. Obesity often leads to other comorbid conditions, including diabetes and hypertension. Obesity prevention efforts can reduce healthcare costs. What this study adds Obesity combined with other comorbidities significantly increases healthcare costs per patient visit. The combination of obesity and depression exacerbates costs. The most expensive series of chronic conditions in this study included obesity, diabetes, hypertension and depression. Our objectives were to determine payments made by commercial healthcare providers in the US for adults diagnosed with obesity, and those comorbid with any combination of selected chronic conditions. Using a commercial claims and encounters database (n = 3,562,717), we evaluated an adult study population that had at least one in-patient visit, outpatient visit or emergency department visit, and received a primary or secondary diagnosis of obesity. Persons were categorized by one or more comorbid diagnoses for diabetes mellitus, hypertension, depression or congestive heart failure. We adjusted for age and gender, and calculated the mean total net expenditures (in 2012, $US) for each combination of comorbid conditions based on individual visits to an in-patient, outpatient or emergency department setting. Among 50,717 claims with diagnosis of obesity, the mean net expenditure for in-patient and outpatient services was $ 1907 per patient per visit. Persons diagnosed with obesity and other comorbidities observed an increase in total net expenditures. Obesity and congestive heart failure observed the highest increase among single comorbidities at $ 5275. For persons with obesity and two other comorbidities, diabetes mellitus and depression was the highest at $ 15,226. The most expensive condition was obesity, diabetes mellitus, hypertension and depression at $ 15,733. Compared with average medical claims, persons diagnosed with obesity and other common chronic conditions experience significant increases in medical costs. These costs are often driven higher by time spent as in-patients. By controlling and reducing the prevalence of obesity, we may see significant decreases in medical expenditures.

Post trauma vision syndrome and visual midline shift syndrome.

Following a neurological event such as a traumatic brain injury (TBI), cerebrovascular accident (CVA), multiple sclerosis (MS), etc. Vision imbalances can occur between affecting the focal and ambient visual process that can affect balance, posture, ambulation, reading, attention, concentration and cognitive function in general. Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS) can be the cause of these difficulties. This paper discusses the symptoms and characteristics of these syndromes as well as methods of treatment.

Visual rehabilitation in low vision patients with aging macular degeneration.

Using optical visual aids, visual rehabilitation was performed in 14 cases (25 eyes) for low-vision patients with aging macular degeneration (AMD). With distance aids, visual acuity improvements were recorded for 24 eyes (95 percent) out of 25 eyes. Twelve eyes (48 percent) achieved vision equal to or better than 0.4. Utilizing near visual aids, the near visual acuity for all eyes (100 percent) were improved. Thirteen eyes (52 percent) received near vision equal to or better than 0.5. Ten patients were able to read No. 5 equal to or better than 0.5. Ten patients were able to read No. 5 Chinese print (corresponding visual angle is 0.67 at 30 cm of reading distance). The reading success rate was 71.4 percent. The results suggest that the application of visual aids is an effective method to improve the distance and near visual acuity of low vision patients with AMD.

Visual evoked potentials (VEP) evaluating treatment for post-trauma vision syndrome (PTVS) in patients with traumatic brain injuries (TBI)

Post-trauma vision syndrome (PTVS), which is characterized by binocular function problems, may be caused by dysfunction of the ambient visual process which is part of the sensory-motor feedback loop rather than specific oculomotor disturbance. Clinically, PTVS frequently presents with symptoms of diplopia, blur, seeing movement in the spatial environment, vertigo, and hallucination-like experiences. Visual evoked potentials (P100) were used to evaluate an experimental group (n = 10) of subjects who suffered a traumatic brain injury, and a control group (n = 10). A new treatment using prisms and bi-nasal occluders which affected amplitude responses of the VEP was evaluated. The results demonstrate the amplitude of the VEP is a function of cortical binocular integration, and that this is influenced by dysfunction of the ambient visual process. The results also demonstrate that base-in prism and bi-nasal occluders are an effective means to treat ambient vision disturbances resulting from head trauma which causes PTVS.

Federal low vision services reimbursement mechanisms.

This paper is a synopsis of the present federal legislative programs that offer reimbursement for low vision services. The programs are reviewed with specific attention given to 1) The Social Security Act, 2) the Education of the Handicapped Act, 3) the Rehabilitation Act, and 4) the Veteran's and Uniformed Services Act. A comparison of these programs is presented along with a brief discussion about the effectiveness of these programs to meet our present and future needs.