Abstract The potential impact of heavy metal exposure on the progression of diabetic kidney disease (DKD) remains a subject of scientific inquiry. While some studies have hinted at a correlation, definitive evidence is still lacking. It is important to note that certain links, such as the association between cadmium exposure and chronic kidney disease, have been established in prior research. This study seeks to examine the potential link between heavy metal exposure and the risk of DKD. This cross-sectional study included adult type 2 diabetes mellitus (T2DM) patients from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. The study analyzed nine types of urinary heavy metals and three types of blood heavy metals. Survey-weighted logistic regression, restricted cubic spline (RCS) analysis, weighted quantile sum regression (WQS) regression, and Bayesian kernel machine regression (BKMR) model were employed to evaluate the effects of single and mixed heavy metal exposure on DKD. Subgroup analyses were conducted based on age and gender. Mediation analysis was used to assess the mediating effect of the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio. Additionally, a series of sensitivity analyses were performed. The final analysis included 5,124 individuals (2011–2018), of whom 896 (17.49%) were classified as having DKD. Weighted logistic regression indicated that urinary barium (UBa), urinary cobalt (UCo), urinary cesium (UCs), urinary thallium (UTl), blood cadmium (BCd), and blood lead (BPb) were associated with DKD. RCS analysis indicated a nonlinear relationship between UBa, UCo, UCs, UTl, BPb, and DKD. Both WQS regression and BKMR model consistently demonstrated a negative correlation between urinary mixed heavy metal exposure and the risk of DKD, while blood mixed heavy metal exposure was positively correlated with the risk of DKD, identifying UBa as the primary protective contributor and BCd as the primary risk contributor. Subgroup analysis revealed that age and gender could modify the association between heavy metal exposure and the risk of DKD. Finally, mediation analysis revealed that the AST/ALT ratio played a crucial potential mediating role in the association between heavy metal exposure and the prevalence of DKD. Our findings offer a comprehensive perspective on the relationship between heavy metals (particularly protective UBa and risk-associated BCd) and DKD risk, which holds significant implications for environmental control and early prevention of DKD, it is important to note that our cross-sectional design precludes causal inferences. Future longitudinal studies are needed to establish causality and inform intervention strategies.
One of the major indicators in evaluating the performance of hospitals and their managers is the average length of stay of patients; given the importance of this indicator, the present study has examined the factors affecting the length of stay of hospitalized patients. This study was conducted with the aim of identifying the key factors affecting the length of stay of patients and providing practical solutions for improving the management of hospital beds. Data from 26,907 patients were analyzed using clustering models, clustering algorithms (K-Means) and association rules extraction (Apriori). The data consists of 10 numerical and discrete columns. The variables include 10 items, which are respectively: gender, marital status, hospitalization department, physician specialty, insurance, blood transfusion, surgery, type of discharge, age, and length of stay. The findings showed that the variables of surgery and blood transfusion have the greatest impact on the average length of stay in the hospital.
Deepanshu Agrawal, Aarti Heda, Sayantan Ghosh
et al.
Purpose: To assess the knowledge, attitude, and practice patterns (KAPP) of Indian ophthalmologists regarding medicolegal issues using an initial survey. Methods: An online form was circulated among Indian ophthalmologists of all ages over social media and email by the Young Ophthalmologists Society of India (YOSI) and its medicolegal working group. Anonymous responses were obtained and analyzed for each question. The questionnaire comprised questions about demographic details, KAPP of medicolegal issues including how to deal with medicolegal issues (if faced), medical indemnity insurance, deviation from the recommended minimum sum assured (Rs. 1 crore for Indian ophthalmologists), and legal service providers. Results: A total of 109 responses were obtained. The majority of the respondents were male (60, 55%). More than 50% of respondents (58, 53.2%) were younger than 35 years. More than one-fourth of the respondents were private practitioners (29, 27%), and the majority were of senior consultant designation (45, 41%). Around 80% of respondents (89, 81.6%) were aware of professional indemnity insurance; however, only 54% (n = 59) bought the insurance cover. A majority of the respondents (38, 64.4%) had an indemnity cover of a maximum of Rs. 50 lacs. Only 20% of respondents were aware of the expert body at the state/national level that deals with medicolegal cases. Thirty percent of respondents recommended the ideal cover amount to be more than Rs. 1 crore. Conclusion: The current survey highlights the dismally low rate of awareness of medicolegal issues among ophthalmologists. Specifically, a majority of Indian ophthalmologists surveyed did not have recommended minimum insured cover for professional indemnity insurance. Larger studies are needed to further explore KAPP of Indian ophthalmologists in various medicolegal issues.
Ari Nurfikri, Triana Karnadipa, Karin Amelia Safitri
et al.
In submitting conference proceedings to <i>Proceedings</i>, the volume editors of the proceedings certify to the publisher that all papers published in this volume have been subjected to peer review administered by the volume editors [...]
Adena R. Rissman, Ana Fochesatto, Erin B. Lowe
et al.
Perennial grasslands, including prairie and pasture, have declined with tremendous environmental and social costs. This decline reflects unequal policy support for grasslands and managed grazing compared to row crops. To create a resource for community partners and decision-makers, we reviewed and analyzed the policy tools and implementation capacity that supports and constrains grasslands and managed grazing in the U.S. Upper Midwest. Risk reduction subsidies for corn and soybeans far outpace the support for pasture. Some states lost their statewide grazing specialist when the federal Grazing Lands Conservation Initiative lapsed. The United States Department of Agriculture, Natural Resources Conservation Service support for lands with prescribed grazing practices declined after 2005 but remained relatively steady 2010–2020. These results reveal the policy disadvantage for grasslands and managed grazing in comparison with row crop agriculture for milk and meat production. Grassland and grazing policies have an important nexus with water quality, biodiversity, carbon and outdoor recreation policy. Socially just transitions to well-managed, grazed grasslands require equity-oriented interventions that support community needs. We synthesized recommendations for national and state policy that farmers and other grazing professionals assert would support perennial grasslands and grazing, including changes in insurance, conservation programs, supply chains, land access, and fair labor. These policies would provide critical support for grass-based agriculture and prairies that we hope will help build soil, retain nutrients, reduce flooding and enhance biodiversity while providing healthy food, jobs, and communities.
Nutrition. Foods and food supply, Food processing and manufacture
This paper captures advances in prudential regulation and supervision for challenger banks and fintech in the UK. It presents a critical analysis of the prudential supervisory approaches towards fintech. The focus is placed on fast-growing firms (FGFs), building on the review performed by the Prudential Regulation Authority (PRA) of the Bank of England (BoE) in 2019. Specifically, it comprises a critical examination of the underlying regulatory framework in relation to the robustness of stress testing practices, as part of the review of FGF risk management practices and the weakness identified in the Internal Capital Adequacy Assessment Process (ICAAP). The economic analysis of law comprises the underlying methodology, using economic theory to analyse regulation and its effectiveness regarding fintech regulation and supervision. Recommendations for enhancements towards supervisory practices about the prudential governance and management of FGFs and fintech are included, with advances to the underlying regulatory framework in the UK. Overall, this critical legal research examines the supervisory practices of FGFs and fintech in the UK, under the lens of prudential regulation and risk management approaches, focusing on the design, development and implementation of the stress testing tool and scenario practices.
The broadly used pay-as-you-go (PAYG) pension system is intrinsically wrong. The essence of the problem is that the PAYG system distributes the yield of raising children, i.e., of human capital investment (which is essentially the pension contribution), in such a way that it disregards the extent to which individuals have contributed to this, and even whether it has occurred at all. This error can be corrected if we take the pension contribution to be the yield on an investment of human capital, and as such use this to pay back the costs and expenses of the raising of the contribution payer—overall to those who paid these costs and expenses at the time. Accordingly, the central question of my study is whether it is possible to construct a consistent pension system based on the above foundations, and how my ideas may be inserted into the Diamond–Samuelson model. The method of the study was logical analysis and the construction of a theoretical mathematical model. The results of the study show that it is possible to construct a public pension system that operates according to a different logic than today’s system, a system which is free from the effects of demographic fluctuations, which does not motivate the refusal to have children, and which will remain self-sufficient under all circumstances. The study achieves this by presenting a possible pension system of this kind in detail. Via the suitable modification of the Diamond–Samuelson model, I have succeeded in showing that the pension system I am proposing increases the willingness to have children up to the social optimum, in contrast to the fully (but traditionally) funded and PAYG systems. This system currently only exists in theory and may be regarded as a major theoretical innovation, which naturally has certain (although not particularly extensive) antecedents. Its introduction could enable the resolution of the contradictions of existing pension systems and could also provide a solution to the as yet unsolved problem of the increasingly expensive regeneration of human capital, and as such, its potential practical implications are immeasurable.
Monica Violeta Achim, Viorela Ligia Văidean, Sorin Nicolae Borlea
et al.
Economic and financial crime is closely related to the changes and the development of societies. In this paper, we question whether the types of economic and financial crimes change as the society develops or not. For our purpose, we use the sample of 27 European Union member countries, for the 2005–2020 time period, which forms an unbalanced panel dataset. The main econometric method is represented by the Pooled OLS method for panel data. Our findings highlight that higher economic and sustainable development determines a reduction in the levels of corruption, shadow economy, and cybercrime. Additionally, we find that increased economic and sustainable development is related to higher levels of money laundering. These findings help governments to understand the way in which various types of economic and financial crimes unfold within different contexts of economic development, in order to implement specific policies for reducing the general level of crimes.
Informal employment takes place in labor markets as a gray area between unemployment and employment. It effectively continues to exist as a temporary shelter for the unemployed in countries with higher unemployment rates. Although Turkey’s informal employment rate has decreased in recent years, it remains above the OECD average. Examining the relationship between informal employment and education in Turkey, this study also attempts to identify how small businesses that loom large in the Turkish labor market affect informal employment. The TURKSTAT 2018 Household Labor Force Survey micro data setis used for this purpose. A binary logistic regression model is applied as the method of analysis. Conclusions reveal that the probability of informal employment is much higher for female wage earners, industrial workers, part-time workers, and those with temporary employment contracts. Additionally, the positive relationship between the number of employees in enterprises and formality is another finding of this study. A strongly positive education-formal employment relationship is also identified, and the effect of education on the probability of formal employment is found to be higher for women in particular.
Industrial relations, Social insurance. Social security. Pension
Two models were developed to estimate Lyme borreliosis (LB) cases. One was based on the seroprevalence of Borrelia infections in human samples. This model used corrections for false negative and false positive results from published test sensitivity and specificity measures. A second model based on Borrelia infections in sentinel dogs was used to quantify the prevalence of Lyme disease Borrelia infections in humans; the reference baseline for this model was human and canine infections in Germany. A comparison of the two models is shown and differences discussed. The relationships between incidence, prevalence and total infection burden for LB were derived from published data and these were used in both models to calculate annual incidence, prevalence and total LB infections. The modelling was conservative and based on medical insurance records coded for erythema migrans. Linear model growth rates were used in place of the commonly adopted exponential growth. The mean of the two models was used to create estimates for various countries and continents. Examples from the analyses for LB estimated for 2018 include: incidence – USA 473,000/year, Germany 471,000/year, France 434,000/year and UK 132,000/year; prevalence – USA 2.4 million, Germany 2.4 million, France 2.2 million and UK 667,000; total infections – USA 10.1 million, Germany 10.0 million, France 9.3 million and UK 2.8 million. Estimates for the world for 2018 are: incidence 12.3 million/year; prevalence 62.1 million; and total infection burden 262.0 million. These figures are far higher than officially published data and reflect not only the underestimation of diagnosed cases, which is acknowledged by health agencies, but also undiagnosed and misdiagnosed cases.
In Poland, we have approx. 10,000 fuel stations and fuel depots. Approximately 27 million vehicles registered in Poland and several million vehicles transiting through Poland use the petrol stations. Petrol and LPG stations are very dangerous places with flammable materials. Hence, an important element is the civil liability of employees of petrol stations and fuel and LPG depots. The article presents the scale and types of threats that may occur during the operation of these facilities, and the security elements of this type of place are also discussed. The final part of the article presents the basic elements of liability insurance for petrol operators. The basic elements of this insurance are indicated, such as the scope of the liability, the contribution, the guarantee sum and the problems with settling claims.
The objective of this study was to examine the role of social security in fighting poverty in Metlaoui, Tunisia, using survey data collected between July 2012 and January 2014, covering 200 poor households. We used questionnaire data, which gave a thorough analysis of the reactions, behavior, and strategies adopted by poor households as a result of various forms of risk. Social security has an effect on a number of different areas, including health, education, housing, and income. Our methodology explored both complete and partial risk-sharing, to investigate the impact of social security schemes on the strategies adopted by households to cope with economic shocks. The estimation results of different models showed that social security could help social security-covered households choose less costly strategies to cope with risks. However, the role of social security remains insufficient, given that covered households had less confidence in its services and they adopted strategies of self-insurance or income smoothing. Overall, the results showed that social security plays an important role in Metlaoui, but it remains insufficient, especially for households that are not covered by social security and are suffering from heavy health expenditures.
An intersection–union test for supporting the hypothesis that a given investment strategy is optimal among a set of alternatives is presented. It compares the Sharpe ratio of the benchmark with that of each other strategy. The intersection–union test takes serial dependence into account and does not presume that asset returns are multivariate normally distributed. An empirical study based on the G–7 countries demonstrates that it is hard to find significant results due to the lack of data, which confirms a general observation in empirical finance.
Abstract Background There is evidence that uric acid may have antioxidant and neuroprotective effects and might therefore alter the risk for neurodegenerative diseases such as dementia. So far, the relation between serum uric acid (SUA) levels or hyperuricemia and dementia remains elusive. Most studies focused on the disease or SUA levels. Effects of anti-hyperuricemic treatment have not been considered yet. This study investigated the association between hyperuricemia and dementia taking into account anti-hyperuricemic treatment. Methods We used longitudinal German public health insurance data and analyzed the association between hyperuricemia with and without different treatment options and dementia in a case-control design. Applying logistic regression the analysis was adjusted for several potential confounders including various comorbidities and polypharmacy. Results We identified 27,528 cases and 110,112 matched controls of which 22% had a diagnosis of hyperuricemia or gout and 17% received anti-hyperuricemic drugs. For patients with a diagnosis of hyperuricemia we found a slightly reduced risk for dementia (adjusted odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98). The risk reduction was more pronounced for patients treated with anti-hyperuricemic drugs (adjusted OR 0.89, 95% CI 0.85 to 0.94, for regular treatment). Conclusions Our results showed a slight reduction for dementia risk in patients with hyperuricemia, both with and without anti-hyperuricemic treatment.
The article explores the theoretical basis for the formation of an effective investment strategy of the insurance company. It was determined that, depending on the insurer’s conduct and risk factor and yield of funds, investment strategy can be aggressive, moderate and conservative. The main factors that characterize conservative, aggressive and moderately conservative investment strategy are defined. The characteristic of the structure of the investment portfolio of domestic insurance companies is determined. There are insurance companies which conduct an aggressive, conservative and moderately conservative investment strategy. In the article defined the main directions of investments of insurance companies in Ukraine which include bank deposits, government securities and shares. Determined that majority of insurance companies in the insurance market of Ukraine followed a conservative investment strategy which is the least risky. It is noted that in view of difficult economic situation in Ukraine, insurance companies need to develop an effective investment strategy to ensure their ability to pay.
Malpractice insurance of medical staff is probably the oldest professional liability insurance underwritten in the insurance market in Romania. The aim of our research is to theoretically examine in a qualitative inquiry the usefulness of insurance completion by the practitioners from the Romanian health system at both state and private, in order to improve a best practice medical insurance. The medical profession is practiced in Romania under the Code of Medical Ethics 30 March 2012 prepared in code that complies with international standards contained in the Geneva Declaration of 1948, as amended by the World Medical Association and the International Code of Medical Ethics. The forms of medical liability are: disciplinary, administrative, civil and criminal and only the civil liability can be taken into insurance because only it meets the conditions of insurability. Once we explain in general and the insurance liability in particular we show articles of the Romanian Civil Code which
establishes the obligation the one that caused an injury to a third person for the repair or indemnify and conditions provided by the Civil Code as an act to be considered liability. Then we refer to situations where the patient may be damaged through the fault of the doctor or the doctor unit operates. The object of malpractice insurance is loss of money that the insured would have to pay a patient whom he caused injury as a result of acts or deeds of negligence committed to, during and in relation to professional activity. Risks taken in the insurance are personal injury, illness or death of the patient and / or moral damages. Regarding the excluded risks we have presented an overview of the more common contracts underwritten by Romanian insurance companies. We show the way of underwriting, the insured sums of the standard insurance and the additional one which subscribes moral damages, to companies in Romania agreed by bodies which organize and supervise the Romanian medical system. The current procedure
for determining the guilt of a doctor and his patient complained of the amount of damages is a long and difficult. The procedure for determining the guilt of a doctor reported by his patient and the amount of compensation is a long and arduous one. In conclusions we have shown that along with the reform and reorganization of the Romanian medical system, the civil liability insurance of the medical staff, the way of contracting, the way of establishing the guilt of the applicant and the amount of compensation need to be reformed.
Barbara P Yawn,1 Suzanne Madison,1 Susan Bertram,1 Wilson D Pace,2 Anne Fuhlbrigge,3 Elliot Israel,3 Dawn Littlefield,1 Margary Kurland,1 Michael E Wechsler41Olmsted Medical Center, Department of Research, Rochester, MN, 2UCDHSC, Department of Family Medicine, University of Colorado Health Science Centre, Aurora, CO, 3Brigham and Women&#39;s Hospital, Pulmonary and Critical Care Division, Boston, MA, 4National Jewish Medical Center, Division of Pulmonology, Denver, CO, USABackground: Published reports and studies related to patient compensation for clinical trials focus primarily on the ethical issues related to appropriate amounts to reimburse for patient&#39;s time and risk burden. Little has been published regarding the method of payment for patient participation. As clinical trials move into widely dispersed community practices and more complex designs, the method of payment also becomes more complex. Here we review the decision process and payment method selected for a primary care-based randomized clinical trial of asthma management in Black Americans.Methods: The method selected is a credit card system designed specifically for clinical trials that allows both fixed and variable real-time payments. We operationalized the study design by providing each patient with two cards, one for reimbursement for study visits and one for payment of medication costs directly to the pharmacies.Results: Of the 1015 patients enrolled, only two refused use of the ClinCard, requesting cash payments for visits and only rarely a weekend or fill-in pharmacist refused to use the card system for payment directly to the pharmacy. Overall, the system has been well accepted by patients and local study teams. The ClinCard administrative system facilitates the fiscal accounting and medication adherence record-keeping by the central teams. Monthly fees are modest, and all 12 study institutional review boards approved use of the system without concern for patient confidentiality after reviewing all regulatory documents provided by ClinCard.Conclusion: This system works well for studies that recruit patients from widely dispersed practices and for studies that require flexibility in the amount of payments required, eg, the cost of eight different study medications across varying insurance and pharmacy systems.Keywords: clinical trial payment, clinical trials, ClinCard
Treatment services constitute one of the five priority actions to face the global crisis due to noncommunicable diseases (NCDs). It is important to formulate standard treatment guidelines (STGs) for an effective management, particularly at the primary and secondary levels of health care. Dissemination and implementation of STGs for NCDs on a country-wide scale involves difficult and complex issues. The management of NCDs and the associated costs are highly variable and huge. Besides the educational strategies for promotion of STGs, the scientific and administrative sanctions and sanctity are important for purposes of reimbursements, insurance, availability of facilities, and legal protection. An effective and functional referral- system needs to be built to ensure availability of appropriate care at all levels of health- services. The patient-friendly "to and fro" referral system will help to distribute the burden, lower the costs, and maintain the sustainability of services.