Hasil untuk "Insurance"

Wassim J. Aloulou, Nawaf F. Alshohail

This study investigates the impact of Governance, Risk management, and Compliance (GRC) practices on operational efficiency and corporate reputation. Drawing on the Resource-Based View (RBV), Stakeholder Theory, and the signaling perspective, it conceptualizes GRC as a set of organizational capabilities that enhance operational efficiency and company reputation. It also examines the mediating role of operational efficiency in the GRC–reputation relationship, particularly within technologically advanced and regulated sectors. Data were collected through a structured questionnaire distributed to 126 professionals across various Saudi technology-driven organizations, and the analyses combined descriptive statistics, hierarchical regression, and bootstrapped mediation testing using PROCESS to assess direct and indirect effects. The results indicate that operational efficiency partially mediates the effects of governance and compliance on reputation, supporting the argument that strengthened internal processes enhance external stakeholder evaluations; meanwhile, no mediation was found for risk management. Although the study offers meaningful insights, its sample size and sectoral focus limit the generalizability of conclusions, suggesting the need for broader or longitudinal research. This study contributes by advancing the conceptualization of GRC as organizational capabilities and empirically demonstrating their roles in strengthening both efficiency and reputation within technology-driven firms where digital governance and compliance capabilities are increasingly central.

Ine Rahmadiani, Arulita Ika Fibriana, Alfiana Ainun Nisa et al.

Background: Stunting during early childhood is a serious public health concern. In 2022, the prevalence of stunting in Indonesia was 21.6%, still a high prevalence. Low birth weight (LBW) is a major public health issue in low- and middle-income countries. Both play crucial roles in children’s morbidity and mortality. Shreds of evidence show the role of LBW in children’s stunting, however, limited study in Indonesia. This study aimed to determine the relationship between LBW and stunting in Indonesian toddlers. Methods: The study reported a cross-sectional survey using Indonesian Nutrition Status Survey data (Survei Status Gizi Indonesia = SSGI) in 2021, obtained from the National Institute for Health Development Policy, Ministry of Health, Republic of Indonesia, involving 20,808 data. The data were then presented in proportions and analyzed using multiple logistic regression. Results: The results showed children with certain factors were related to the occurrence of stunting, i.e., children with LBW (P < 0.001; aOR = 2.73; 95%CI = 2.420–3.080), aged under-twelve months old (P < 0.001; aOR = 0.38; 95%CI = 0.350–0.417), male (P < 0.001; aOR = 1.44; 95%CI = 1.338–1.547), early starting solid foods (<six months) (P < 0.001; aOR = 0.82; 95%CI = 0.767–0.886), having no health insurance (P = 0.026; aOR = 1.10; 95%CI = 1.011–1.191), low-educated mothers (P < 0.001; OR = 1.33; 95%CI = 1.230–1.436), employed mothers (P = 0.013; aOR = 0.90; 95%CI = 0.834–0.979), low-middle asset ownership (P < 0.001; aOR = 0.82; 95%CI = 0.767-0.886), vulnerable food insecurity (P = 0.037; aOR = 1.08; 95%CI = 1.005–1.167), and living in rural areas (P = 0.001; aOR = 1.14; 95%CI = 1.057–1.231). Conclusions: This study found stunting prevalence was 18.6% and LBW was 6.8%. LBW, male sex, no health insurance, low-educated mothers, low-middle assets, food insecurity, children aged 12 months or over, late-starting solid foods, unemployed mothers, and living in rural areas increased the risk of stunting in toddlers.

Solomiya Pysarevska, Viktoriya Vashchuk, Zinoviy Yaremko

Мета роботи. Оцінити рівень усвідомлення студентами небезпечної поведінки пішоходів, їхнє ставлення до заходів підвищення безпеки дорожнього руху та суб’єктивне сприйняття безпечності різних способів пересування. Метод дослідження. Дослідження базувалося на кількісному методі онлайн-опитування (Google Forms). Участь взяли 410 студентів віком 16–23 років з України (місто Львів). Використано адаптований опитувальник ESRA 2, який включав соціодемографічні питання, оцінку власної поведінки пішоходів та сприйняття безпеки транспорту. Результати дослідження. Виявлено, що найпоширенішими видами ризикованої поведінки були користування телефоном, перехід дороги поза пішохідним переходом і прослуховування музики під час ходьби (95 %, 86 % і 75 % відповідно). Студенти суб’єктивно вважають найбезпечнішим способом пересування – приватний автомобіль, хоча статистично він є найнебезпечнішим видом транспорту. Підтримка заходів безпеки вища для фізичних засобів захисту (шоломи, світловідбивальний одяг), ніж для обмеження використання смартфонів. Стать і місце проживання достовірно впливають на поведінку пішоходів. Теоретична цінність дослідження. Результати підтверджують і розвивають наявні концепції впливу когнітивних та соціальних чинників на ризиковану поведінку пішоходів. Дослідження демонструє значущість цифрових відволікань як незалежного предиктора небезпечної поведінки. Практична цінність дослідження. Отримані дані можуть бути використані для розроблення освітніх програм у закладах вищої освіти, спрямованих на підвищення обізнаності студентів щодо реальних ризиків та ефективних заходів безпеки. Крім того, результати можуть слугувати основою для цільових соціальних кампаній і формування державної полі-тики щодо профілактики дорожньо-транспортних пригод. Цінність дослідження. Робота пропонує комплексний аналіз самодекларованої поведінки українських студентів-пішоходів у контексті сучасної цифрової культури, що до цього часу практично не досліджувалося. Зіставлення суб’єктивної оцінки безпеки транспорту з реальною статистикою дорожньо-транспортних пригод дозволяє виявити суттєві когнітивні викривлення у сприйнятті ризиків. Обмеження дослідження. Обмеженнями дослідження є географічна вибірка (Львів) і самодекларативний характер даних, що можуть супроводжуватися соціально бажаними відповідями. Перспективними напрямками подальших досліджень є експериментальні спостереження за реальною поведінкою пішоходів, а також розширення вибірки на інші регіони України та порівняння з іншими віковими групами.

Richard Boateng

Introduction: This study explores the ability of sociodemographic and contextual variables, including ethnicity, rural/urban residence, and region, to predict health insurance enrollment among men in Ghana. Methods: This study employs primary data from the Ghana Micro Indicator Cluster Survey (MICS) 2017/2018. The compositional and contextual variables were tested as the main predictors of health insurance coverage in two multivariable ordinal logistic models using odd ratios and p-values after Spearman's rho correlation analysis was conducted. Results: Spearman's rho correlation analysis revealed a positive relationship between age and health insurance coverage and a similar relationship between rural/urban residence and health insurance coverage. Educational level and wealth index quintile were the most significant predictors of health insurance coverage among men in Model 1. Including ethnicity, rural/urban area of residence, and regional location as contextual factors in Model 2 revealed an improved effect of the existing sociodemographic variables except for functional difficulty, which was not statistically significant. Discussion: Low health insurance coverage among men can increase vulnerabilities and gendered tendencies associated with enrolment in health insurance services. The sociodemographic and geo-related context-specific variations depict the differential effects in the predictors of men's health insurance coverage.

Intan Solikhah Indriana, Romi Bhakti Hartarto

Catastrophic expenditure, defined as health care expenditure exceeding 10% of household income, remains prevalent in eastern Indonesia, highlighting the urgent need for targeted health policy and infrastructure interventions. This study investigates the impact of the Community Health Insurance Scheme (Jamkesmas) in reducing catastrophic healthcare expenditure in eastern Indonesia offering a new perspective by focusing on areas with lower Universal Health Coverage (UHC) and higher poverty rates. Using data from the 2012 Eastern Indonesia Family Life Survey covering a sample of 1,105 working-age individuals, logit and probit regression methods were applied. The findings revealed that Jamkesmas significantly reduced the likelihood of catastrophic health care expenditure, with effectiveness 1.8 times higher than that of individuals without health insurance. Exogenous factors such as age, urban residence, male gender, and marital status further supported this reduction. In contrast, barriers such as long distances to health facilities and limited knowledge of public hospitals increased the risk of catastrophic expenditure among workers. These results underscore the importance of expanding access to health services and improving the implementation of Jamkesmas in eastern Indonesia. By addressing disparities in health insurance coverage and healthcare facility distribution, the government can better mitigate catastrophic expenditures, supporting the achievement of the demographic bonus by 2045.

Matthew C. Moccia, James P. Waters, John Dibato et al.

Background: There is a paucity of recent literature investigating the sole effect of income level on the treatment and survival of patients with rectal cancer. Methods: We analyzed all cases of rectal cancer in the Rectal Cancer PUF of the NCDB from 2010 to 2020. We utilized the Median Income Quartiles 2016–2020 to define our income levels. The two lower quartiles were combined to create a lower income group, with the upper two quartiles creating the higher income group. The total cohort included 201,329 patients, with 116,843 and 84,486 in the higher and lower income groups, respectively. Results: Lower income patients were more often black (17 % vs 6 %), lived farther from the nearest hospital (33.5 miles vs 25.7 miles) despite being more likely to live in urban areas (25 % vs 7 %), and had lower levels of private insurance (36 % vs 49 %). They underwent more APRs (17 % vs 14 %) and had a 13 % higher chance of undergoing an open operation (OR 1.13, CI 1.09–1.17). Higher income patients had a 12 % reduction in 90-day (OR 0.88, 95 % CI 0.82–0.96) and overall mortality (OR 0.88, 95 % CI 0.86–0.89). Conclusions: Clinicians should be aware that lower income patients are often faced with unique challenges that may impact care delivery.

Daniel Graf, Stefan Gschwenter, Marina Kuzdas-Sallaberger et al.

Objectives: To examine changes in functional capacity, health-related quality of life and psychological distress in patients with post-COVID-19 condition following a multidisciplinary rehabilitation programme. In addition, to explore whether additional respiratory muscle training for more impaired patients might support their recovery process. Design: Retrospective observational cohort study. Patients: A total of 779 patients with post-COVID-19 condition (47.9% female, mean age 56.6 years). Methods: Measures assessed were: 6-minute walk test (6MWT), 5-level EQ-5D (EQ-5D-5L) including EQ Visual Analogue Scale (EQ-VAS) and Patient Health Questionnaire-4 (PHQ-4). Data were provided pre- and post-rehabilitation from 2 cohorts: (i) patients participating in a regular multidisciplinary rehabilitation programme; and (ii) patients receiving additional respiratory muscle training due to an initially greater level of impairment. Dependent t-tests and general linear mixed models were used for data analysis. Results: A series of dependent t-tests revealed mean overall improvement for both groups in 6-minute walk test distance (6MWD), EQ-5D-5L index, EQ-VAS and PHQ-4 following the rehabilitation programme. General linear mixed models showed significant interaction effects between groups and time for the EQ-5D-5L index and 6MWD. Conclusion: A multidisciplinary rehabilitation programme appears to have a beneficial impact on the recovery process of patients with post-COVID-19 condition.

Jérémy Brühlmann, Ioana Lese, Adriaan O. Grobbelaar et al.

BACKGROUND: A marked increase in bariatric surgery has led to higher numbers of patients with contour deformities after massive weight loss seeking plastic surgical correction. Insurance coverage for these post-bariatric interventions is highly subjective and a common set of objective criteria has not yet been established. AIM: The aim was to evaluate the factors influencing insurance coverage for post-bariatric surgery, focusing on finding objective, reproducible criteria. METHODS: This was a retrospective single centre chart review of all post-bariatric patients with redundant skin requesting body contouring surgery from 2013 to 2018. Demographic, bariatric and surgical, as well as insurance information were collected. A logistic regression model was used to identify predictors of successful insurance coverage. RESULTS: 116 Patients were included in the study. Insurance approval for post-bariatric body contouring surgery was obtained for only 47 patients (41%). Mentioning the term “medical indication” in the application letter was associated with a 15.2 times higher rate of receiving a positive answer (p <0.001), whereas mentioning “mental suffering” was associated with 82.3% lower chance of getting a positive response (p <0.001). A high body mass index (BMI) (p <0.009) before the bariatric operation as well as a high BMI reduction (p <0.021) were associated with a higher approval rate by insurance companies . An additional application letter to the insurance company (p <0.024) as well as mentioning mechanical restriction (p <0.022) were associated with a positive response from the insurance companies. CONCLUSIONS: We were able to establish certain objective predictive criteria for insurance coverage of post-bariatric surgery. However, it appears that the decisions of insurance companies for this condition are still rather randomly taken. Therefore, the establishment of objective criteria for insurance coverage may allow fairer treatment for this growing patient population.

Kalina Kamenova, Hazar Haidar

INTRODUCTION The possibility of using genetic technologies to engineer the perfect baby has long haunted the public imagination. While some techno-utopians have openly advocated for human genetic enhancement, many critics have warned that advances in DNA technology come with myriads of ethical dilemmas and potentially dangerous social consequences. Literary and cinematic works have offered dystopian visions of our genetic futures—from Aldous Huxley’s powerful socio-political fantasy in his book Brave New World (1932) to cult classics of sci-fi cinema, such as Blade Runner (1982) and Gattaca (1997), there has been no shortage of ominous predictions that genetic engineering would lead to a new form of eugenics, which would ultimately create new social hierarchies grounded on genetic discrimination. Moreover, concerns about the use of genetic and genomic technologies for social control have been entangled with deep philosophical questions about personal autonomy, the right of the child to an open future, and the morality of changing, improving, or redesigning human nature.1 The perennial debate on human enhancement was recently reignited with a new controversy over the use of pre-implantation screening of embryos using polygenic risk scores.2 While the profiling of IVF embryos to detect hereditary, monogenetic diseases has been widely accepted, some companies are now pushing the envelope with unrealistic promises of tests that can predict genetic possibilities for desirable traits such as a child’s intelligence, athletic ability, and physical appearance. One event that prompted a public outcry in late 2021 was news about the birth of the first baby from an embryo selected through polygenic testing, a girl named Aurea.3 Although the embryo screening in Aurea’s case was used to decrease the likelihood for certain health conditions, many commentators believed that it signaled a real possibility of embryo selection for non-medical reasons becoming a commercial procedure in the foreseeable future, especially in the largely unregulated US fertility market.4 In the past, there have been discrepancies in how ethical and policy issues arising from advances in reproductive medicine have been viewed by experts (e.g., bioethicists, philosophers, legal scholars) and presented in the news. Like other advances in medical genetics, gene editing and screening technologies have been frequently characterized by exaggeration, sensationalism, and hype around clinical possibilities.5 Moreover, news media have often amplified the anticipated health benefits of genetic testing while overlooking uncertainty associated with its clinical validity and emerging ethical concerns, as shown in a recent study of the media portrayal of non-invasive prenatal testing (NIPT).6 The issue of polygenic embryo screening (PES) initially gained traction in the media in 2017 when the New Jersey biotech startup Genomic Prediction made headlines with claims that its testing technology could identify and avoid implanting embryos with very low IQs.7 The company also claimed that it had the capability to identify embryos with high IQs, although it committed not to offer that procedure for ethical reasons.8 The media coverage of polygenic risk scoring of human embryos between 2017 and 2019 was previously analyzed in a study published in BMC Medical Ethics in September 2021.9 This media content analysis has established that while most news articles were neutral towards the technology, one of the most significant critiques raised by science reporters was the absence of solid scientific evidence for the technology’s predictive accuracy and its practical value in IVF settings. It has also identified five major ethical concerns articulated by science reporters that have also been addressed in the academic discourse and within broader policy debates on reproductive technologies: a slippery slope towards designer babies, well-being of the child and parents, impact on society, deliberate choice, and societal readiness. In this article, we examine the discourse on PES in bioethics blogs, opinion articles, and news stories published in 2021, with a specific focus on reactions to the birth of the first polygenic risk score baby. We compare the perspectives of experts and science reporters to establish their attitudes towards PES, the main ethical themes in press coverage, and the key issues highlighted for a future policy debate. We also juxtapose our findings to the previous study of media coverage to establish if the case of baby Aurea has raised any new issues and pressing ethical concerns. I. Polygenic Embryo Screening in Reproductive Medicine While complex diseases and human traits result from a combination of genetic, lifestyle, and environmental factors, genomic medicine is quickly gaining momentum, and demands for genetic tests in clinical practice have significantly increased. Scans and analyses of genomes from various populations, a research area known as genome-wide association studies, have enabled scientists and researchers to identify genetic differences or variants associated with a particular trait or medical condition. These variants can be combined into a polygenic risk score that predicts an individual’s traits or increased risk for a certain disease. For instance, PES have been used to predict a range of diverse common conditions, from diabetes and cancer to attention deficit issues10 and, in some cases, well-being in general.11 This testing modality relies on the probabilistic susceptibility of individuals to certain diseases to offer personalized medical treatments and inform therapeutic interventions. Polygenic embryo screening uses polygenic risk scores to assess an embryo’s statistical risks of developing diseases (e.g., cardiovascular diseases) and potentially traits (e.g., intelligence, athletic ability, among others) and is performed in an IVF setting. It is currently marketed by several US companies such as MyOme, OrchidHealth, and Genomic Prediction to prospective parents as a method to screen pre-implantation embryos for health and non-health related conditions and is accessible to those who can afford to pay for it. As stated in a recent report on companies bringing PES into reproductive medicine, Genomic Prediction has already made their test for polygenic disorders, LifeView, available to couples. In contrast, Orchid Health has only recently invited couples to an early-access program for their testing technology, and MyOme is still in the process of launching its own test.12 In September 2021, Bloomberg first reported the birth of baby Aurea using screening conducted by Genomic Prediction. She was born after her parents used IVF and subsequently PES to select from 33 candidate pre-implantation embryos in 2020.13 Aurea’s embryo was deemed to have the best genetic odds of avoiding conditions such as breast cancer, diabetes, heart disease, and schizophrenia in adulthood. It is worth noting that Genomic Prediction made the announcement almost one year following Aurea’s birth, thus delaying the media’s reaction to this development and the ensuing bioethical and policy debates. II. Ethical, Social, and Policy Implications Some important ethical, social, and regulatory considerations regarding the development and clinical use of PES have been raised within the academic community. The bioethics literature on the issue, however, appears rather thin, which is not surprising given that prior to 2021, the possibility of using this screening method in clinical practice was largely hypothetical. Other genomic technologies that have enabled polygenic embryo selection, such as whole-genome sequencing and pre-implantation genetic diagnosis, have received more attention from bioethicists, legal scholars, and Ethical, Legal, and Social Implications (ELSI) researchers. Our analysis of the emerging literature has shown that some proponents of PES advocate its current use and go as far as to suggest a permissive regulatory environment for the purpose of outpacing the ethical concerns and potential restrictions once the technology becomes widely available. This approach suggests that embryo selection should be allowed for or against any trait associated with higher odds for better health and well-being in general, often without further discussion of what accounts for wellbeing.14 Scholars applying the principle of procreative beneficence to defend the use of PES have also argued for regulation that addresses issues of justice and equality and expands access to the procedure for those who are currently unable to afford it. By contrast, opponents have argued that the clinical utility of this embryo selection method is yet to be proven, and its current use may create unrealistic expectations in parents, making it an unethical practice to offer the procedure as part of IVF treatments.15 They state that predictive models from PRS have been developed with data from genomes of adult populations. Therefore, extrapolating results for embryo screening, along with the absence of a research protocol to validate its diagnostic effectiveness, is dangerous and misleading.16 Another layer of complexity is added because PRS already faces many translational hurdles that would undermine its predictive value assessment for certain traits or diseases. Scientists have noted that PRS take into consideration the genetic component of a particular trait putting aside the effects of other non-genetic factors, such as lifestyle and environment, which might interfere and influence the calculation of these scores.17 Discussions on the ethics and societal implications of PES in the bioethics literature can be grouped into three distinct categories: 1) relational issues between parents and the future child (e.g., selection as identity-determining, concerns about the instrumentalization of children and the child’s right to an open future); 2) concerns about social justice and equality (e.g., fears about a new eugenics that establishes new social hierarchy, limited access to the technology due to its cost); and 3) implementation and regulatory concerns (e.g., lack of professional guidelines and advertising of PES by private companies). An important ethical implication of PES relates to the well-being of the future child and the way that selecting children based on their genetic make-up might negatively affect the parent-child relationship. This is in line with previously raised ethical concerns in the literature around cloning and pre-implantation genetic diagnosis that by choosing a child’s genetic predisposition, we are limiting to and, in some cases, denying their right to an open future. For instance, the future child’s options would be restricted if parents chose a genetic predisposition to musicality that might interfere with the child’s ability to make certain life choices.18 On a societal level, there are concerns PES may alter social perceptions of what is “normal” and “healthy,” resulting in discrimination and stigmatization of certain conditions.19 Related to this are fears about encouraging eugenic attitudes that can exacerbate discrimination against people with disabilities. Furthermore, one of the main ethical concerns raised is that the growing use of PES might exacerbate societal pressure to use this technology, influencing parents’ decisions to select the embryo with the “best” genetics giving rise to a generation of “designer babies.” 20 Finally, direct-to-consumer marketing and clinical introduction of the technology prior to the publication of professional guidelines and in the absence of scientific validity for its use, as well as without appropriate regulatory oversight, is seen as a premature step that might erode public trust.21 III. News Stories and Expert Commentary on Polygenic Embryo Screening in 2021 We conducted searches on google news using keywords such as “polygenic embryo screening,” “polygenic risk scores,” “baby Aurea,” and “embryo selection” and selected blogs and articles from major news sources (e.g., Washington Post, New York Times, Wall Street Journal, LA Times, Guardian, The Times, etc.). An additional effort was made to collect all relevant articles from prominent bioethics blogs such as the Hastings Center Bioethics Forum, Impact Ethics, Bioethics.net, Biopolitical Times (Center for Genetics and Society), among others. The time period for the study was one year, from January 1 to December 31, 2021. While most coverage occurred after the Bloomberg report on the birth of the first baby using PES, there were a number of news stories and blogs in response to a special report on embryo selection based on polygenic risk scores published in the New England Journal of Medicine on July 1, 2020.22 This report, which has received significant attention in the press, warns that companies that offer genetic services can create unrealistic expectations in health providers and prospective parents through their marketing practices. It has further emphasized the scientific uncertainty around the predictive results of PRS in the context of embryo selection. In general, our search has established that the news media coverage on PES over the past year has revolved around these two events – the NEJM Report and the announcement about the first baby born after PES. In total, we collected 29 publications, of which 12 were blog posts and 17 publications under the general category of “news,” including ten news articles, three opinion pieces/perspective articles, two press releases, and one radio broadcast transcript (see Supplementary Material). IV. Methods for content analysis We utilized an inductive-deductive process to develop coding categories for a systematic content analysis of the blogs and new articles. The first author undertook a close reading of the entire dataset to derive inductively recurrent themes and ethical arguments in the media representations of PES. Based on this preliminary analysis, both authors agreed on the categories for textual analysis. The coding book was further refined by using a deductive approach that incorporates themes that have been previously articulated in the scholarly literature on the issue, particularly questions about the perceived attributes of the test, ethical concerns, and emerging policy considerations. The following categories were used to analyze key issues and attitudes towards PES expressed by experts and science journalists: a. Claims that PES is unethical because it violates the future child’s autonomy. b. Concerns about PES as a step towards eugenics and/or genetic discrimination. c. Defenses of PES with arguments that parents have a duty to give the child the healthiest possible start in life (and reduce public health burden). d. Claims that the science behind PRS-based diagnostics is uncertain, and it will take some time to prove its clinical validity. e. Concerns about the equality of access to PES. f. Arguments that PES can exacerbate ethnic and racial inequality (e.g., that most polygenic scores are created using DNA samples from individuals of European ancestries and predictions may not be accurate in other populations). g. Arguments that PES provides health benefits and can help overcome genetic and health inequalities. h. Concerns about the negative impact that PES may have on the child-parent relationship. i. Arguments about the need for better regulatory oversight of PES. j. Suggestions that there is an urgent need for deliberation and debate on the societal and ethical implications of PES. k. Concerns that patients and clinicians may get the impression that the procedure is more effective and less risky than it is. l. Assessment of whether the article’s perspective towards the use of PES is positive, negative, or neutral. We used yes/no questions to detect the frequencies of mentions in each category, except on the last question, which required a more nuanced, qualitative assessment of the overall tone of the articles. We coded articles as “positive” when the authors viewed the technology favorably and emphasized its potential health benefits over its negative implications. Articles that did not condone the current use of PES and expressed strong concerns about the predictive accuracy of this testing method, its readiness for clinical use, and highlighted its controversial ethical and social implications were coded as “negative.” Finally, articles that simply presented information about the topic and quoted experts on the advantages and disadvantages of using PRS for embryo selection without taking a side or expressing value judgments were coded as “neutral.” Acknowledging the complex polysemic nature of media texts, we took into consideration that support or disapproval of PES may be implicit and expressed by giving credence to some experts’ opinions over others. Therefore, we coded articles that mostly cited expert opinion favorable to PES, or alternatively, presented such views as more credible, as “positive”, while we coded articles that emphasized critical perspectives as “negative.” V. Media Discourse and Expert Opinion On PES We found out that perspectives and opinions by experts were prominently featured in both news (17 articles) and blogs (12 articles). The blog posts in our dataset were written by university professors in bioethics (four articles), academics from other disciplines such as medicine, political science, psychology, human genetics, and neurobiology (four articles), and science journalists and editors (four articles). Furthermore, three of the news articles in influential newspapers and magazines such as The Wall Street Journal, The Washington Post, and The Scientific American were opinion articles or commentaries contributed by academics (e.g., a psychology professor, specializing in personality, individual differences, and behavior genetics, a sociology professor, and a director of research in a graduate program in human genetics). The remaining 14 news articles in our dataset were written by science reporters, editors, or other staff writers. Altogether, experts contributed 38 percent of the media coverage (11 articles) on the issue of PES and its wider societal implications. Experts’ comments were also heavily featured in the 18 articles written by science reporters and other media professionals, which accounted for 68 percent of the dataset. Of these articles, 17 extensively cited experts with academic and research backgrounds (professors and research scientists), seven articles quoted industry representatives (e.g., CEOs and spokespersons of Genomic Prediction and Orchid, other commercial developers), and four articles included opinions by parents seeking PES, particularly Aurea’s father, North Carolina neurologist Rafal Smigrodzki, who argued that a parent’s duty is to prevent disease in their child.23 The overall perspective towards the use of PES was mostly negative – 59 percent (17 articles) expressed negative attitudes, while 24 percent (seven articles) were positive and 17% (five articles) were neutral in tone and did not advance arguments in favor or against the technology and its adoption. However, we did not establish significant differences in negativity and positivity between experts and science reporters. For instance, 49 percent of the articles with negative attitudes were written by experts, while 53 percent were authored by science reports. Similarly, the articles by experts with positive perspectives on PES accounted for 13 percent of the dataset, while science reporters contributed 11 percent of the positive articles. VI. Major Themes and Issues The most discussed issue in media coverage was the prediction accuracy of polygenic risk scores and the uncertainties regarding the utility of these tests in embryo screening. Our analysis has established that 72 percent of the articles (21 out of 29) argued that the science behind PES-based diagnostics is uncertain, and it will take some time to prove its clinical validity. The second most frequently mentioned issue was the potential of PES to lead to a eugenic future of human reproduction. More than half of the articles (59 percent or 17 out of 29) raised concerns that PES could become a step towards a new form of eugenics that could eventually normalize the discrimination of people based on their genetics. Despite concerns about the accuracy of PES testing, many articles gave extensive attention to problems concerning equality of access to PES and related diagnostic services, with 49 percent of the articles (13 out of 29) expressing concerns that the procedure is currently offered at a high cost, it is not covered by health insurance plans, and people of lower socioeconomic status cannot afford it. Furthermore, 41 percent of the articles (12 out of 29) raise concern that the current use of PES reflects the existing ethnic and racial inequalities since most PES are created using DNA samples from individuals of European ancestries, and predictions may not be accurate in other populations. Although it has been reported that Genomic Prediction considers offering the procedure to parents of non-European ancestries, their messaging has suggested it would take a significant time to provide them with predictive models that are as relevant as those for European populations.24 The health benefits of this testing technology, its regulation, and the need for a wider debate on how to realize its promise in a responsible manner were also addressed, albeit to a lesser extent. The potential to overcome genetic and health inequalities by selecting healthy embryos with the best odds against diseases and chronic conditions was emphasized in 41 percent of the articles (12 out of 29). The regulation was a topic covered in 38 percent of the articles (11 out of 29), in which the authors argued that better regulatory oversight of PES is needed, especially in the present condition of an unregulated US market for genetic testing. Additionally, 38 percent suggested that there is an urgent need for deliberation and public debate on the societal and ethical implications of PES. Finally, the issue that patients and clinicians may get the wrong impression that the procedure is more effective and less risky was addressed in 31 percent (nine out of 29). We have established that critical issues about how PES may affect the well-being of the future child and the child-parent relationship have received less attention. For instance, only 17 percent of the articles (five out of 29) supported the clinical use of PES with arguments that parents have a moral obligation to give the child the healthiest possible start in life, a line of thought that is prominent in the bioethics literature on procreative beneficence and procreative autonomy.25 These authors also maintained that the technology has the potential to provide benefits to individuals and reduce the burden of disease and public health expenditure. Similarly, just 10 percent of the articles (three out of 29) expressed concerns about the negative impact that PES may have on the child-parent relationship by causing relational asymmetries between generations and limiting the autonomy of the future child. CONCLUSION Our content analysis has shown that the media discourse on PES and the birth of baby Aurea has been highly influenced by expert opinion. In fact, leading experts from bioethics and a range of other academic disciplines contributed 38 percent of the content in the form of blogs, opinion articles, and commentaries, published on prestigious bioethics fora and in the popular press. Furthermore, as our analysis has shown, science reporters have heavily relied on expert opinion in writing stories about the ethical challenges and societal implications of PES. One important finding of our study is the prevalence of negative attitudes towards the technology, as opposed to past media representations of PES, which had been neutral towards the technology.26 This change in attitudes is likely caused by the amplified voices of bioethics experts reacting to the first clinical use of the technology, which made hypothetical ethical dilemmas a very real possibility. As far as the thematic focus of media representations is concerned, the birth of the first baby using PES has raised ethical concerns similar to those highlighted in the literature on PES and embryo selection through pre-implantation genetic diagnosis, with the most prominent issue being the absence of robust scientific evidence for the predictive accuracy of PRS modeling and its practical value in IVF settings. Although the critical nature of media discourse can contribute to raising public awareness about the ethical acceptability of the technology, bioethicists should also examine the effect of economic forces and societal pressures to have a perfect child that may be driving prospective parents to seek such unproven genetic interventions. PES is an emerging niche in a large, unregulated market for genetic testing services that has the potential to shape the future of reproductive medicine, and there is an urgent need for a policy debate on how it can be developed responsibly and ethically. 1 J. Habermas, "The Debate on the Ethical self-Understanding of the Species," The Future of Human Nature (Oxford, UK: Blackwell Publishing, 2003): p. 16-100. 2 Polygenic risk scores (PRS) are used in personalized medicine to predict disease risk in different human populations, not necessarily for risk modelling in embryos. Polygenic embryo screening (PES), on the other hand, involves the clinical use of PRS modelling from genome-wide association studies of adult populations for selecting embryos with the lowest probability of developing certain health conditions in adulthood. It could potentially be used to select embryos with a higher probability for inheritance of certain physical traits or complex characteristics. 3 C. Goldberg, "Picking Embryos With Best Health Odds Sparks New DNA Debate," Bloomberg September 17, 2021. 4 D. Conley, "A new age of genetic screening is coming — and we don’t have any rules for it," The Washington Post June 14, 2021. 5 K. Kamenova, A. Reshef, and T. Caulfield, "Angelina Jolie's faulty gene: newspaper coverage of a celebrity's preventive bilateral mastectomy in Canada, the United States, and the United Kingdom," Genetics in Medicine 16, no. 7 (2014): 522-28. 6 K. Kamenova et al., "Media portrayal of non-invasive prenatal testing: a missing ethical dimension," Journals of Science Communication 15, no. 2 (2016): 1-19. 7 B. Talat, Choosing the "Smartest" Embryo: Embryo Profiling and the Future of Reproductive Technology, (Canadian Institute for Genomics and Society, March 14, 2019), https://www.genomicsandsociety.com/post/choosing-the-smartest-embryo-embryo-profiling-and-the-future-of-reproductive-technology 8 E. Parens, S. P. Applebaum, and W. Chung, "Embryo editing for higher IQ is a fantasy. Embryo profiling for it is almost here.," Statnews, February 12, 2019. 9 T. Pagnaer et al., "Polygenic risk scoring of human embryos: a qualitative study of media coverage," BMC Medical Ethics 22, no. 1 (2021): 1-8. 10 E. L. de Zeeuw et al., "Polygenic scores associated with educational attainment in adults predict educational achievement and ADHD symptoms in children," American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 165b, no. 6 (2014): 51020. 11 A. Okbay et al., "Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses," Nature Genetics 48, no. 6 (2016): 624-33. 12 F. Ray, "Embryo Selection From Polygenic Risk Scores Enters Market as Clinical Value Remains Unproven," (December 22, 2021). https://www.genomeweb.com/sequencing/embryo-selection-polygenic-risk-scores-enters-market-clinical-value-remainsunproven#.YeVWzvhOk2w 13 J. Savulescu, "The moral case for eugenics?," IAI News, September 28, 2021, https://iai.tv/articles/the-moral-case-for-eugenicsauid-1916. 14 S. Munday and J. Savulescu, "Three models for the regulation of polygenic scores in reproduction," Journal of Medical Ethics 47, no. 12 (2021): 1-9. 15 F. Forzano et al., "The use of polygenic risk scores in pre-implantation genetic testing: an unproven, unethical practice," European Journal of Human Genetics (2021). 16 Forzano et al., 1-3.; P. Turley et al., "Problems with Using Polygenic Scores to Select Embryos," The New England Jourmal of Medicine 385, no. 1 (2021): 78-86. 17 N. J. Wald and R. Old, "The illusion of polygenic disease risk prediction," Genetics in Medicine 21, no. 8 (2019): 1705-7. 18 M. J. Sandel, "The case against perfection: what's wrong with designer children, bionic athletes, and genetic engineering," Atlantic Monthly 292, no. 3 (2004): 50-4, 56-60, 62. 19 H. Haidar, "Polygenic Risk Scores to Select Embryos: A Need for Societal Debate," Impact Ethics (blog), November 3, 2021, https://impactethics.ca/2021/11/03/polygenic-risk-scores-to-select-embryos-a-need-for-societal-debate/. 20 Pagnaer et al., " 1-8. 21 Forzano et al., 1-8. 22 Turley et al., 78-86. 23 P. Ball, "Polygenic screening of embryos is here, but is it ethical?," The Guardian, October 17, 2021. 24 W. K. Davis, "A New Kind of Embryo Genetics Screening Makes Big Promises on Little Evidence," Slate, July 23, 2021, https://slate.com/technology/2021/07/prs-model-snp-genetic-screening-counseling.html. 25 J. Savulescu, "Procreative beneficence: why we should select the best children," Bioethics 15, no. 5-6 (2001): 413-26. 26 Pagnaer et al., 1-8.

باباعمي الحاج أحمد

In this intervention, we address the various aspects of legislative interference in the content of the insurance agreement, as a fertile model for the switch of the agreement from freedom of negotiation to compliance and modeling, which led to the need for legislative intervention in the different phases of the agreement, in order to protect the weak insured, as well as the attempts of the legislator to preserve general economic and social order, considering the significant role that insurance plays economically (achieving development) and socially ( prompt and effective compensation). We will further explain the aspects of legislative intervention under the Insurance Law No. 95-07, and the extent to which the simple insured’s signature on the agreement is an evidence against him, despite his inability to negotiate and comprehend the content of the conditions.

Ersan OKATAN, Ali Hakan IŞIK

Prediction of health care cost has a big importance for general budget planning and accurate pricing of institutions which are in insurance sector. In particular, insurance companies need to make accurate analysis for competitive bidding and for increasing profitability. In this study, decision tree which is one of the data mining methods is used to make prediction of health care cost and results are analyzed. The values age, sex, number of child, bmi, region, smoker which taken from the data set given in open access Kaggle data mining data storage platform is input attributes. Health care cost is the label attribute depends on these attributes. Analysis of the decision tree method was performed in this prediction which is made by using these values. Performance results will hope to be helpful for planners on health budget, the insurance companies and researchers on those areas.

Hae-Dong Jang, Jin-Sung Park, Dae Woong Kim et al.

Among a variety of comorbidities of ankylosing spondylitis (AS), the association between dementia and AS by using an extensive dataset from the Korean National Health Insurance System was evaluated in this study. We extracted 15,547 newly diagnosed AS subjects among the entire Korean population and excluded wash-out patients (n = 162) and patients that were inappropriate for cohort match (n = 1192). Finally, 14,193 subjects were chosen as the AS group, and through 1:5 age- and sex-stratified matching, 70,965 subjects were chosen as the control group. We evaluated patient demographics, household incomes, and comorbidities, including hypertension, diabetes, and dyslipidemia. The prevalence of overall dementia (1.37%) and Alzheimer's dementia (AD) (0.99%) in the AS group was significantly higher than in the control group (0.87% and 0.63%), respectively. The adjusted hazard ratio of the AS group for overall dementia (1.758) and AD (1.782) showed statistical significance also. On the other hand, the prevalence of vascular dementia did not differ significantly between the two groups. Subgroup analyses revealed the following risk factors for dementia in the AS group: male gender, greater than 65 years in age, fair income (household income greater than 20% of the median), urban residency, no diabetes, and no hypertension. From the nationwide, population-based, retrospective, longitudinal cohort study, AS patients showed a significantly higher prevalence of overall dementia and Alzheimer's dementia. Comprehensive patient assessment using our subgroup analysis could help to prevent dementia in patients suffering from AS.

Dayalaxmi T Shedole, Panchsheela S Reshmi, Sidramappa S Reshmi et al.

Background: In many developing countries, a large proportion of the money spent on health care comes from the out-of-pocket expenditure of patients or their families. In India, Bangladesh and Nepal, for example, this proportion has been estimated to be 48–69%. Information on healthcare expenditure at the family or household level is important for the planning and management of health services. It is particularly relevant for health insurance agencies to estimate the amount of premium for initiating a universal health insurance system. Methodology: A Retrospective cross sectional community based study was conducted for a period of three months in UFPA of KBNIMS, Kalaburagi, Karnataka. The data on disease episodes and the health expenditure incurred was collected by household survey using a pre designed pre tested structured proforma by interview method. Results: A total of 2295 episodes of illness were recorded giving an overall prevalence of disease episodes as 99.6%. The mean expenditure per episode among all socio demographic factors was found to be Rs 563.8 with standard deviation of 43.15. Conclusion: The mean per episode expenditure on health is high in our study, so there is need for systems such as health insurance to protect the poor from high medical costs.

Andreas Hermes, Stanislaus Maier-Paape

In this paper, the multivariate fractional trading ansatz of money management from Vince (Vince 1990) is discussed. In particular, we prove existence and uniqueness of an “optimal f” of the respective optimization problem under reasonable assumptions on the trade return matrix. This result generalizes a similar result for the univariate fractional trading ansatz. Furthermore, our result guarantees that the multivariate optimal f solutions can always be found numerically by steepest ascent methods.

Nisreen Mahasneh

No general Doctrine of Substitution (Holol) within Civil Code has been provided for by Jordanian Legislature, rather only some particular applications for such a doctrine were provided for explicitly sometimes, such as in Article 309 concerning the settlement of other’s debt, Article 926 concerning insurance or Articles 1355 and 1363 concerning the recourse by the holder of a mortgaged property against the debtor, or implicitly on other occasions, as with Article 980 concerning the recourse of the guarantor against the debtor. Further, Contractual Substitution is unknown under Jordanian Civil Law. The said approach by Jordanian Legislature is against the relevant approaches of most Arab Legislatures, particularly the Egyptian, whereby both forms of Substitution, Legal and Contractual, are known and dealt with in detail under the Egyptian Civil Law. Despite this fact, most of Jordanian jurists still insist to expand the applications of Substitution under Jordanian Civil Law to include such applications provided for under the General Substitution Doctrine within the Civil Law of Egypt, without any legal proxy to support their argument. This study has revealed that Substitution does not take place in the case of the recourse of the Joint Debtor against other Debtors, neither in the case of undividable debt, being unknown concept under Jordanian law, nor in the case of the settlement of debt by a second creditor to a first creditor in mortgage. Substitution of the creditor by the payee of a debt cannot be here presumed, as Substitution is deemed the exception from the general notion in the law that recourse by creditor is based on a personal lawsuit, and so there is no “Substitution without a Provision”. When Subrogation is compared with Contractual Substation under Jordanian Civil Law, it has appeared that both are different systems, albeit some similarity among them exists. Substitution is a consequence of Subrogation (Hewaleh), but not a replacement thereof.

О. Zaletov

In the article the essence of investment insurance company. The role and importance of investment of insurance companies on formation of investment resources in the economy. The essence of the definition of "investment potential of insurance companies" and its relationship with the definition of "financial strength of insurance companies' insurance and potential insurance companies." By analyzing the structure and dynamics of aggregate investment portfolio of insurance organizations of Ukraine in 2008-2015 years defined contribution insurance sector in the formation of investment resources. The problems and prospects of the investment potential of the insurance market of Ukraine. Directions of improvement of state regulation of investment of insurance companies in Ukraine.

Fei-Yuan Hsiao, Li-Ning Peng, Yu-Wen Wen et al.

To explore the healthcare resource utilization, psychotropic drug use and mortality of older people with dementia.A nationwide propensity score-matched cohort study.National Health Insurance Research database.A total of 32,649 elderly people with dementia and their propensity-score matched controls (n=32,649).Outpatient visits, inpatient care, psychotropic drug use, in-hospital mortality and all-cause mortality at 90 and 365 days.Compared to the non-dementia group, a higher proportion of patients with dementia used inpatient services (1 year after index date: 20.91% vs. 9.55%), and the dementia group had more outpatient visits (median [standard deviation]: 7.00 [8.87] vs. 3.00 [8.30]). Furthermore, dementia cases with acute admission had the highest psychotropic drug utilization both at baseline and at the post-index dates (difference-in-differences: all <0.001). Dementia was associated with an increased risk of all-cause mortality (90 days, Odds ratio (OR)=1.85 [95%CI 1.67-2.05], p<0.001; 365 days, OR=1.59 [1.50-1.69], p<0.001) and in-hospital mortality (90 days, OR=1.97 [1.71-2.27], p<0.001; 365 days, OR=1.82 [1.61-2.05], p<0.001) compared to matched controls.When older people with dementia are admitted for acute illnesses, they may increase their use of psychotropic agents and their risk of death, particularly in-hospital mortality.

Xian-hua ZHOU, Yun-bo WANG, Hua-dong ZHANG et al.

This study investigates the optimal reinsurance for crop insurance in China in an insurer's perspective using the data from Inner Mongolia, Jilin, and Liaoning, China. On the basis of the loss ratio distributions modeled by AnHua Crop Risk Evaluation System, we use the empirical model developed by Tan and Weng (2014) to study the optimal reinsurance design for crop insurance in China. We find that, when the primary insurer's loss function, the principle of the reinsurance premium calculation, and the risk measure are given, the level of risk tolerance of the primary insurer, the safety loading coefficient of the reinsurer, and the constraint on reinsurance premium budget affect the optimal reinsurance design. When a strict constraint on reinsurance premium budget is implemented, which often occurs in reality, the limited stop loss reinsurance is optimal, consistent with the common practice in reality. This study provides suggestions for decision making regarding the crop reinsurance in China. It also provides empirical evidence for the literature on optimal reinsurance from the insurance market of China. This evidence undoubtedly has an important practical significance for the development of China's crop insurance.

Mostafa Mablaghi, Elham Danesh

The present research was carried out with the goal of examining the indexes which affect organizational culture for improving the culture and organizational productivity based on Denison Model in Iran Export Guarantee Fund in 2013. The research is of descriptive-correlation type and the measurement tool is Denison's sixty-question questionnaire of organizational culture. Denison Model evaluates the organizational culture based on the four dimensions, getting involved in work, compatibility, adaptation and mission, and for evaluating each of the four mentioned dimensions, 3 indexes have been defined. Analyzing the data has been done by using T tests and Pearson’s correlation coefficient. The statistical population in this research includes all the organization personnel, 102 of whom have answered the questions. Finally after collecting and analyzing the acquired data by using SPSS software ,the picture of organizational culture of Iran Export  Guarantee Fund was  formed and the results showed that "empowerment“ index with %64 has the most and “improvement of capabilities” index with %55 has the least importance among the organizational culture indexes of  Iran Export  Guarantee Fund ,and among the four dimensions, "adaptability" dimension with the least percent needs more improvement  than the other dimensions.

Ewa Wanda MARUSZEWSKA

ERP systems integrate all processes and software users in one computerized environment reshaping organization to fit into system’s functionalities. ERP system implementation is a complex process with technical and socio‐organizational issues. As ERP system encompass financial data and management decision modules, accountants are important actors of the system both during implementation and after go‐live stage.