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					                                                                     ABC Corp
                                                     Health Screening Report
                                                   October 31-November 1, 2006




                                                       TABLE OF CONTENTS



NUMBER OF PARTICIPANTS.................................................................. 2
SEX OF PARTICIPANTS ........................................................................... 2
AGE OF PARTICIPANTS .......................................................................... 3
CAROTID ARTERY STUDIES .................................................................. 4
AORTA STUDIES ....................................................................................... 6
ANKLE-BRACHIAL INDEX (ABI) STUDIES........................................... 7
ECHOCARDIOGRAM STUDIES............................................................... 7
ECHOCARDIOGRAM STUDIES (CONT.) ............................................... 8
  VALVULAR LEAKAGE.................................................................................................................................................. 8
  HEART ENLARGEMENT ............................................................................................................................................. 9
  MITRAL VALVE PROLAPSE(MVP) ....................................................................................................................... 9
  PERICARDIAL FLUID ............................................................................................................................................... 10
  ARRHYTHMIA .............................................................................................................................................................. 10
  WALL MOTION ABNORMALITIES....................................................................................................................... 10
BONE MINERAL DENSITY STUDIES ................................................... 10
INDIVIDUAL PHYSICIAN CONSULTATIONS ..................................... 11
FINANCIAL ANALYSIS- RETURN ON INVESTMENT(ROI) .............. 12
SUMMARY ............................................................................................... 14
TABLE 1 .................................................................................................... 15
REFERENCES: ......................................................................................... 15



                                                                                                                                                                          1
                                        ABC Corp
                               Health Screening Report
                              October 31-November 1, 2006

Number of Participants

A total of 152 employees, staff, and spouses of employees participated in the health
screenings held on these two designated days. The participation level and enthusiasm of the
company was excellent. All participants completed a health risk appraisal form delineating
specific risks for stroke, heart disease, osteoporosis, diabetes, and peripheral vascular disease.
This data, generated through inquiries about past medical history, family history, and current
symptom complexes formulates the basis for risk assessment, an entity that is used in
conjunction with screening results to formulate a follow-up plan.

Sex of Participants
As most employees of this facility are male, as expected the majority of those screened were
men. A total of 95 males were screened, which comprised 62% of the participants.
Many spouses also participated. A total of 57 women were screened through both days,
comprising 38% of all participants. Please see Figure 1.


                                 Participant Sex




                                                                 38%
                                                                                   Female
                                                                                   Male

            62%




 Figure 1




                                                                                                2
                                        ABC Corp
                               Health Screening Report
                              October 31-November 1, 2006


Age of Participants

Cardiovascular disease, peripheral vascular disease, and osteoporosis are insidious in nature,
accumulating their effects after years of disease development. Identifying the very early
stages of these disease processes is crucial in preventing their progression, and also very
critical in addressing lifestyle change early, and sometimes at a relatively young age.

The age stratification of the ABC Corp participants emphasizes the need to instruct those
with only minimal disease development in lifestyle change and early medical intervention.
The mean average age for the participants was 48.9 years. This relatively young
employee/spouse population precedes actual median age for full disease incidence, but in
doing so provides opportunity to create very early prevention strategies. For instance, a 38
year-old male with even minimal carotid artery plaque formation is at great risk for
significant atherosclerotic plaque build- up in future years, since this finding can signify a red
flag for the plaque development process. Likewise, a normal study for a 66 year-old places
this person at much lower risk, with results being age-adjusted.

The age stratification of all participants can be seen in Figure 2.


                              Age of Participants



                                8%      1%            16%
                                                                                      20-29
                                                                                      30-39
                                                                                      40-49
                                                                                      50-59
              41%                                           34%                       60-69




Figure 2

                                                                                                3
                                        ABC Corp
                              Health Screening Report
                             October 31-November 1, 2006

Carotid Artery Studies

The results of the carotid artery screenings can be seen in Figure 3a. Although the majority of
studies were normal, there were 41(27%) that did show plaque formation. All of these
findings were of the “minimal” plaque category – no study had enough lumen narrowing to
show “velocity change”. This change of velocity can signify more clinically critical
occlusion, and typically can lead to surgical intervention in some cases.

Again, even minimal plaque without velocity change in a young person can indicate the need
for lifestyle change, even though no specific medical intervention is warranted as yet. This
was emphasized in the subsequent physician consultations.



                             Carotid Artery Studies

                                  111

             120

             100

             80
                                                                 41
             60

             40

             20

              0
                          Normal                     Plaque Found

 Figure 3a




                                                                                             4
                                         ABC Corp
                               Health Screening Report
                               October 31-November 1, 2006

The demographics of those found with carotid artery plaque formation can be seen in Figures
3b and 3c.

                            Sex of Clients With Carotid Plaque


                                         32
                     35

                     30

                     25

    Male             20
    Female                                                       9
                     15

                     10

                     5

                     0
                                  Male                   Female

Figure 3b


                          Age Of Participants With Carotid Plaque

  35
                                                  29
  30

  25
                                                                                 30-39
  20                                                                             40-49

  15                                                                             50-59
                                                                                 60-69
  10                               7
                                                                       4
   5
               1
   0
             30-39               40-49           50-59               60-69
                                          Age


Figure 3c


                                                                                         5
                                      ABC Corp
                             Health Screening Report
                            October 31-November 1, 2006

Aorta Studies

Aortic aneurysm rupture is in the majority of cases (>90%) a fatal occurrence. Detection of
the widening of this major blood vessel is paramount in preventing catastrophic
consequences of rupture. The enlargement process typically happens in those with
hypertension (high blood pressure), and occurs over many years. Even slight widening can
mean early stages of the process, and these individuals can be monitored carefully for the
need for elective surgical repair.

The results of the ABC Corp screening are shown in Figure 4. Two individuals were found
to have enlarged aortas, a significant number given the relatively young population set.


                                        Aorta Studies


                                            2
                                            1%

                                                                        Normal


                                                                        Enlarged




                                             150
                                              99%



Figure 4




                                                                                              6
                                         ABC Corp
                             Health Screening Report
                             October 31-November 1, 2006


Ankle-Brachial Index (ABI) Studies

Peripheral vascular disease (PVD) typically occurs in those people with severe hypertension
and diabetes, and most commonly occurs in those over 65 years of age. Given the very low
incidence of diabetes in this particular ABC Corp employee population, it is expected that the
incidence of PVD in this screening would be very low. Indeed, all participants had an ABI of
over 90%. This ratio of ankle blood pressure to brachial (arm) blood pressure is a very
reliable screening for PVD and is a standard used in the vascular community.

Echocardiogram Studies

Of all screenings performed, this particular screen heralded the most complex data set, and
identified numerous abnormalities requiring medical follow-up. The findings for all
echocardiograms performed are summarized in Figure 5a.



                            Echocardiogram Results

   70                  62
   60        51
   50
                                                                                   38
   40
                             27
   30
   20                                      14
                  10                                                  9      10
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 Figure 5a




                                                                                              7
                                      ABC Corp
                             Health Screening Report
                             October 31-November 1, 2006

Echocardiogram Studies (cont.)




                          Figure 5b


       Valvular Leakage

        The predominant finding was one of valvular leakage. In the majority of cases, the
degree of leakage was determined to be a normal physiologic amount of age-related
insufficiency of the valve. In these particular cases, no specific medical follow-up was
warranted. However, some cases did result in a moderate amount of leakage detected, and
follow-up was then recommended. Note the distribution of valvular findings in Figure 5c.


                                    Valvular Leakage
                                        6%    10%           Aortic Valve
                                                            Leakage
                                26%                         Mitral Valve
                                                            Leakage
                                                            Tricuspid Valve
                                                            Leakage
                                                 58%        Pulmonic Valve
                                                            Leakage
                 Figure 5c


                                                                                             8
                                       ABC Corp
                              Health Screening Report
                              October 31-November 1, 2006

Echocardiogram Studies (cont.)
       Heart Enlargement

        Cardiac muscle responds to stress in two ways. It can lengthen its muscle fibers,
resulting in dilation of the heart chambers. Or it can increase the size and density of its
muscle fibers, resulting in thickening of the heart walls, or hypertrophy. These changes can at
times lead to significant reductions in cardiac performance, and hence can be indicators of
not only the processes that cause the enlargement in the first place (hypertension,
atherosclerosis, etc.), but also of some potential symptoms that may ensue. Recognition of
this enlargement is important for gauging effects of diseases on the heart, and can be a
prognosticator of possible future problems.

        All cases of enlargement deserve recommendation for follow-up at the very least.
In the ABC Corp. population, 14 cases of enlargement and 4 cases of left ventricular
hypertrophy were identified. All cases required further discussion for subsequent follow-up
with primary care providers.


       Mitral Valve Prolapse(MVP)




        Mitral valve prolapse is a condition in which the valve leaflets of the mitral valve
project or bow back into the left atrium when the heart beats. Although most people
experience no serious problems with MVP, some common symptoms are :
                    Palpitations
                    Chest pain
                    Dizziness
                    Shortness of breath
       The most important practical implication for this syndrome is the need for
prophylactic antibiotic use before dental and other procedures. People with MVP may
develop infections of their mitral valve if not treated as such.

         One ABC Corp individual was found to have mitral valve prolapse and was referred
for follow- up.


                                                                                               9
                                        ABC Corp
                               Health Screening Report
                              October 31-November 1, 2006

Echocardiogram Studies (cont.)
       Pericardial Fluid

         The presence of fluid in the sac around the heart, called the pericardium, is abnormal
in all cases. The causes of this fluid are varied, and fairly complex, and include forms of
inflammatory conditions, infections, cancers, and other etiologies. This entity always
warrants follow-up. Two ABC Copr participants were found to have fluid in their
pericardium, and were referred to their primary care provider.

       Arrhythmia

         Many times rhythm disturbances can be detected while echocardiograms are
performed. These rhythm problems can be simple non-threatening events such as premature
atrial contractions (simple extra beats), to more life-threatening rhythms such as atrial
fibrillation, and need to be further identified by event monitors. ABC Corp had 9 individuals
with rhythm disturbances identified via echocardiogram. All 9 people were referred to their
primary care providers for further delineation of rhythms as required.

       Wall Motion Abnormalities

        Disturbances in the movement of any of the walls of the heart as can be visualized via
echocardiography can signify diseases of the heart from past and present conditions. A
person suffering a previous known or silent heart attack will many times have a segment of
the heart that is not beating as well as the rest of the heart muscle. This is critical to identify
since further interventions may be warranted to prevent future events.

      Out of the 152 heart echocardiograms, 10 (6.6%) were shown to have wall motion
abnormalities, and were referred to their primary care providers.

Bone Mineral Density Studies

        Osteoporosis is a condition whereby bone becomes abnormally thin, resulting in
fractures of the hip, spine, wrist, and other places, as well as the potential for dramatic
changes in quality of life. A simple ultrasound test to screen for osteoporosis at the heel was
employed in the ABC Corp screening event.




                                                                                                 10
                                      ABC Corp
                              Health Screening Report
                              October 31-November 1, 2006

      A total of 43 bone density screens were performed, all of whom were females except
two males. Figure 6 delineates these results.


                                   Bone Density Results


                                       3%
                        24%
                                                                          Normal
                                                                          Osteopenia
                                                                          Osteoporosis


                                                         73%




               Figure 6

       Discussion of results during consultation entails assessing risk factors for
osteoporosis and utilizing this information in conjunction with bone density screening results
to formulate a plan for further follow- up and possible more DXA bone density testing.
Certainly all post- menopausal women with at least one risk factor with T-scores below -1.5
were referred for further follow-up and possible testing, and all women with no risk factors
with T-Scores below -2.0 were referred as well. Beginning early therapy is crucial to
avoiding major bone loss and its consequences.


Individual Physician Consultations

All 152 ABC Corp participants were given private consultations to review results, discuss
risk factors, and plan a strategy for future interventions and changes. Risk factor
modification, through lifestyle change and medical intervention was discussed. In addition,
all individuals in whom specific follow- up with their primary care provider was warranted
were instructed to do so in a timely fashion.

In-depth discussions regarding hypertension control, diet manipulation, diabetes
management, exercise regimens, nutrition supplementation, stress management and other
issues were carried out. Three individuals were found to have blood pressure readings in
excess of allowable levels, and were encouraged to seek follow- up very soon.

                                                                                              11
                                       ABC Corp
                              Health Screening Report
                             October 31-November 1, 2006

Financial Analysis- Return on Investment(ROI)

It has been shown through numerous studies, incorporating both peer-review and meta-
analyses, that well-crafted health promotion programs attain returns on investment averaging
from $3.48 to $5.82 per $1 spent on such programs. These figures take into account worker
health, enhanced productivity, and reduced health care expenditures1 . Aldana et al reviewed
72 health promotion research articles and through meta-analysis found this to be a consistent
finding. In addition to immediate cost reduction, other spin-offs of these programs like that of
Advanced Screening’s include greater productivity, intellectual capacity, and reductions in
disability and absenteeism2 . They also promote favorable perceptions of the company and
improved worker morale, providing yet further non-health benefits of these programs.

Chapman reviewed 42 studies on Worksite Health Promotion Economic Return3 . He found
that these worksite programs on average produced:

           Decrease in absenteeism                     28.3%
           Decrease in health cost                     26.1%
           Decrease in worker’s comp/disability        30.1%
           Cost/Benefit Ratio                         + 5.93

Advanced Screening’s program institutes some key unique features not offered in other
programs:
                  On-site comprehensive physician-directed seminars with
                    question/discussion sessions – excellent primer for entire program.
                    Initiates buzz and interest
                  On-site American Vascular Association protocol stroke risk
                    identification
                  Vascular screening for atherosclerosis and indirectly inferring
                    coronary risk
                  Ultrasonic aortic aneurysm risk assessment
                  Osteoporosis risk assessment and bone densitometry measurement
                  Personalized, individual physician consultation and real- time
                    discussion of results, methods for risk and lifestyle modification,
                    medical interventions, and follow-up

Cost savings alone for one prevented stroke equate to approximately $147,000 as shown by
Lavenson.4 In this 2-day event, through the identification of the 42 individuals with even
minimal carotid plaque, some very young, as well as the benefits of on-site consultation and


                                                                                               12
                                      ABC Corp
                              Health Screening Report
                             October 31-November 1, 2006



Financial Analysis- Return on Investment(cont.)
risk modification instruction, it could be estimated that the program may well exceed in the
long-term the reported 0.5% yield attained in the Asymptomatic Carotid Arteriosclerotic
Study, in saved strokes per number of screens performed. Thus one saved stroke alone
provides a cost benefit ratio of +5.4.

Cost savings due to osteoporosis education, osteoporosis detection, consultation, follow-up
and therapy can be realized with the number of expected hip fra ctures that would be averted
with such a comprehensive program. The cost of one hip fracture = $38,000. With 11
individuals identified, and using the typical hip fracture reduction rate of 50% shown by
Cummings, et al, if bisphosphonates are instituted (ie. Fosamax, Actonel, Boniva) – as many
as 5 ABC Corp staff may have avoided hip fractures due to appropriate intervention5 . This
equates to a savings of a potential $190,000.

Total potential savings with reduced health costs alone from stroke and hip fracture reduction
= $147,000 + $190,000 = $337,000. This places the total cost benefit ratio at +12.5, a
figure seen in some studies to be achievable.

These figures do not take into account 1) aneurysms identified and treated 2) heart disease
identified and intervened on 3) decreased absenteeism, disability/worker’s compensation,
improved productivity, morale, company perception.




                                                                                               13
                                      ABC Corp
                              Health Screening Report
                             October 31-November 1, 2006

                                         Summary

        The screening event held at ABC Corp was realized because of the commitment of
the administration to corporate health and well-being. The state of a company is directly
related to the health and happiness of its employees.

The employees at ABC Corp reacted favorably to this screening offering and made this event
a true success. From the initial quality and quantity of questions at the September educational
seminar, to the interest and inquiries regarding results and health topics during the
screenings, it was evident that this particular group was dedicated to achieving preventive
health wellness. Those individuals with abnormal results gave every indication that they
would be compliant in attaining follow- up if directed to do so.

Many gains in addition to employee health can be realized with this program, not the least of
which is financial return exceeding 5x the cost of the investment. This concept is well
established by innumerable studies throughout the past 10 years. Non-health related benefits
are not taken lightly, since the true health of the co mpany rests on the morale of its staff.

Ongoing education, seminars, inte raction and follow-up from Advanced Screening is
available and would offer added benefit to the program already instituted.

Table 1 provides a summary of screens performed, and those that were found to be abnormal.




*Advanced Screening appreciates this opportunity to provide our services to ABC Corp.




                                                                                             14
                                                ABC Corp
                                      Health Screening Report
                                     October 31-November 1, 2006


                                                       Table 1

                                            Screen                               Age in years                             Sex
                                                                           20-    30-      40-   50-      60-
                        Carotid     Aorta     Echo      ABI       BD       29     39       49    59       69       Male      Female


TOTAL
SCREENS                    152       152      152       152       43        2     24       51    63       12       95           57


Normal screens             111       150       51       152       31         -         -     -        -        -    -           -

Abnormal
screens                    41          2      101        0        12         -         -     -        -        -    -           -




                                                    References:
1
    Aldana SG. American Journal of Health Promotion 2001; 15(5): 296-320.

2
    Serxner S, Go ld D, Anderson D, Williams D. J Occup Environ Med. 2001; 43(1): 25-29.
3
 Chapman L. Meta-evaluation of worksite health pro motion economic return studies. The American Journal of
Health Promotion 2003; 6(6) 1-17.
4
    Lavenson GS, Sharma D. Cost savings of carotid endarterectomy: value of one vascular surgeon in one year.
    Perspect Vasc Surg. 1994; 7: 1-20.
5
    Cummings, SR, et. a l., Effect of alendronate on risk of fracture in wo men with low bone density but without
    vertebral fractures: results fro m the Fracture Intervention Trial(FIT). JAMA 1998; 280:2077-82.




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