Presence Of Recommendations Research Articles

Ethical Role of a State in Ancient Jewish Political and Legal Thought

In this article, the author wonders how ancient Judaic legal thought, originally formed at the communal, pre-state level, really justifies the existence of a state, not only in terms of physical security for collective security, but also as a component of the paradigm of moral improvement of society. Based on the analysis of the commandments and attitudes of TaNaHa, the place assigned by Jewish teaching to various human institutions is examined in detail, and an answer is given to the question whether it is possible to preserve the integrity and identity of the people, without the binding and controlling role of the state. In the course of the study, a critical view of this religious and legal theory on the nature of man as a whole is stated, and the presence of recommendations, following which is intended to help correct the shortcomings inherent in humanity, which is «related» to Jewish creed with many other religious and ethical constructions. On the example of the teachings of Judaism, the patterns of the formation of ethical models of social mechanisms are analyzed – from more realistic in the form of a community and a state, to more complex, suggesting a high moral level that allows the community to do without a state apparatus of coercion. It is concluded that religious-traditional teachings can become an example of successful practices for the revival of national social solidarity. Since ethical institutions formulated in religious and legal concepts, taking into account the original characteristics of the peoples to whom they are addressed, the specifics of their traditions, can become the basis for improving the moral background of modern society. In addition, religious-legal theories, which have become the basis for the emergence of other religious teachings, have significant potential for borrowing and using their institutions and concepts in other legal systems, due to the universality of basic principles.

PS-P08-2: FACTORS RELATED TO PARTICIPATION IN HEALTH CHECKUPS AMONG MIDDLE-AGED JAPANESE COMMUNITY RESIDENTS IN THE PRECONTEMPLATION STAGE

Objective: In Japan, all medical insurers are obliged to conduct annual specific health checkups. These checkups are part of the National Health Service system and target all insured people aged 40–74 years and aim to facilitate prevention and early detection of atherosclerosis-related diseases such as hypertension, diabetes, and dyslipidemia. However, the participation rate in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). Additionally, previous studies suggested that those in the precontemplation stage were at higher risk for non-participation in health checkups. Therefore, this study explored the factors related to participation in specific health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage. Design and Method: This cross-sectional mail survey was conducted in 2020 that involved all community residents with municipal NHI aged 40–64 years in five cities in three areas of A Prefecture, Japan. This survey included 33,902 community residents, and 12,446 (36.7%) agreed to participate in the survey. After selecting those without missing data (n = 11,180) and those in the precontemplation stage, the analysis included 2,892 participants. Participants were classified into a participation group and a non-participation group. Those who selected “I underwent a specific health checkup in the past year” were classified as the participation group. The study protocol was approved by the Institutional Review Boards. Informed consent was obtained from all participants who were included in this study. Results: In this study, 994 (34.4%) participants were classified in the participation group, and 1,898 (65.6%) were classified in the non-participation group. Multivariable logistic regression analysis revealed factors related to participation in health checkups among those in the precontemplation stage. The factor with the highest odds ratio (OR) for participation in specific health checkups was recommendations from primary care physicians to participate in specific health checkups [multivariable-adjusted OR 3.19, 95% CI 2.45–4.15, presence of recommendations vs. absence of recommendations], followed by recommendations from public health nurses [multivariable-adjusted OR 2.07, 95% CI 1.26–3.41, presence of recommendations vs. absence of recommendations], and self-reported economic status [multivariable-adjusted OR 1.82, 95% CI 1.48–2.24, good vs. poor]. Conclusions: In particular, recommendations from primary care physicians and public health nurses might be important factors related to participation in health checkups among middle-aged Japanese community residents with NHI in the precontemplation stage.

In the Child's Best Interest: The Contribution of Child and Adolescent Psychiatry

Child and Adolescent Forensic Psychiatry involves a multidisciplinary assessment at the courts' requested to assist them in the process of justice delivery. Retrospective study which included 233 forensic requests to two child and adolescent psychiatrists from Coimbra's HP-CHUC Child and Adolescent Psychiatry Department between 1998 and 2012. Biographic, psychopathology, social and family aspects were analyzed. The response time throughout the process, the origin and nature of the request's and the type of process which originated the request were also assessed. The authors identified the involved professionals and whether they needed to go to court. When there were questions, they evaluated the capacity to answer them, the forensic difficulties and solutions found, and the presence of recommendations. The obtained results met the clinical experience and literature regarding demography and psychopathology. As for the difficulties, there were a number of aspects which could be improved by both parts, aiming to ameliorate the articulation between Health and Justice. With this study it was possible to reflect on the authors forensic practice, in order to develop a closer partnership with the courts to promote the real 'best interests' of children/adolescents and their families.

FACTORS INFLUENCING REIMBURSEMENT OF MEDICAL DEVICES IN FRANCE.

This study aims to analyze the key factors considered for the first application of the National Committee for the Evaluation of Medical Devices (CNEDiMTS) for achieving reimbursement through registration in the list of products and services qualifying for reimbursement (LPPR). All the appraisals studied on medical devices (MD) for first inclusion in the LPPR during 2011 and 2012 were retrieved from the French National Authority for Health or Haute Autorité de santé (HAS) Web site. A list of relevant factors was analyzed for each included opinion, followed by univariate and multivariate analyses to highlight the key factors that impacted the expected benefit (EB) provided by HAS. A total of 151 appraisals were included in the study. Of them, 94 (62 percent) were granted with sufficient EB. The manufacturers were mostly from the United States (36 percent), while most of the applicants were from France (84 percent). After adjusting for other retrieved factors, it was observed that MDs complying with the technical standards, requests supported by opinion(s) from previous generation of MD, and the presence of recommendations or guidelines had more probability to obtain a sufficient EB. A lower probability was related to MDs supported by low-quality studies and with no specific health public benefit. Our results confirmed that manufacturers seeking reimbursement should be aware of the expectations of the health authorities (level of evidence, technical standard, etc.) and foresee their plan of sending requests for funding so that they can provide evidence of good quality.

Factor V Leiden: to test or not to test, that is the debate.

The first reference to factor V Leiden (FVL) is in a letter to the journal Nature by Bertina and colleagues1 from the University of Leiden in the Netherlands. This is now a citation classic, having been cited a remarkable 3,279 times (Google Scholar - accessed 14 May 2012). The paper followed the key discovery by Dahlback of an autosomal dominantly inherited form of activated protein C resistance which was associated with a predisposition to venous thrombosis2. A point mutation in the factor V gene that causes a missense mutation in the protein (Arg506Gln, factor V Leiden) renders the molecule less susceptible to inactivation by activated protein C. The mutation is found in 3–7% of the healthy Caucasian population and is associated with a sevenfold increase in the risk of thrombosis3. The presence of the FVL defect is associated with venous thromboembolism as well as with recurrent miscarriage and other pregnancy complications such as severe preeclampsia, growth retardation and stillbirth. Testing for FVL is fairly straightforward because in practise it is usually associated with a single mutation3. Just because a test is easy to perform however, does not mean that there is value in performing it, unless knowledge of the result alters the management of the affected individual. It is sometimes assumed that identification of a positive result is always going to be helpful but positive patients frequently suffer from psychological anxiety as a result of knowing they have a genetic disease, may suffer higher insurance premiums, and there is an actual monetary cost associated with performance of the test. In this issue of Blood Transfusion, Franchini4 and, Favaloro and McDonald5 debate the utility of FVL testing. The clinical utility of a test is its ability to influence or alter a clinical outcome. Franchini describes the background to the development of the FVL test and supports the recommendations of the American College of Medical Genetics in selecting categories where testing for FVL is justified, but also argues for the addition of blood donors to these categories4,6. With the aim of improving blood donor safety, the Italian authorities recommend avoidance of donors who are homozygous for FVL or who have combined thrombophilia but the reference is in Italian and we do not know the precise reasoning behind this recommendation. Even if it is accepted that these thrombophilic individuals are at some risk, it must be questionable whether it is justified to screen blood donors to identify these individuals especially since the prevalence of homozygous FVL in the population would be expected to be around 1 in 1,000. In discussing the futility of FVL testing, Favaloro and McDonald take the opposite view5. The authors observed a dramatic year on year increase in the number of requests for FVL testing in their laboratory service which was accompanied by a concomitant reduction in the number of positive tests, suggesting that tests were being requested inappropriately. Thus, despite the presence of recommendations on who to test for FVL, clinicians are not following these and continue to request the test unselectively. The authors conclude that in the majority of cases FVL testing will actually have a negative impact on identified individuals and their relatives, and clinicians should be discouraged from testing on the basis of theoretical benefits. The issue of thrombophilia testing in general has been tackled by a number of publications including recently the British Committee for Standards in Haematology7. A common finding of many guidelines is, that although testing will identify cases, the evidence that knowledge that an individual is a carrier of a thrombophilic defect rarely influences management. Ultimately the decision of whether to test or not comes from the definition of the term “utility”, if knowing the result will affect your management you should test, but unfortunately this is rarely followed when referring to FVL.

Abdominal and pelvic computed tomography (CT) interpretation: discrepancy rates among experienced radiologists

To assess the discrepancy rate for the interpretation of abdominal and pelvic computed tomography (CT) examinations among experienced radiologists. Ninety abdominal and pelvic CT examinations reported by three experienced radiologists who specialize in abdominal imaging were randomly selected from the radiological database. The same radiologists, blinded to previous interpretation, were asked to re-interpret 60 examinations: 30 of their previous interpretations and 30 interpreted by others. All reports were assessed for the degree of discrepancy between initial and repeat interpretations according to a three-level scoring system: no discrepancy, minor, or major discrepancy. Inter- and intrareader discrepancy rates and causes were evaluated. CT examinations included in the investigation were performed on 90 patients (43 men, mean age 59 years, SD 14, range 19-88) for the following indications: follow-up/evaluation of malignancy (69/90, 77%), pancreatitis (5/90, 6%), urinary tract stone (4/90, 4%) or other (12/90, 13%). Interobserver and intraobserver major discrepancy rates were 26 and 32%, respectively. Major discrepancies were due to missed findings, different opinions regarding interval change of clinically significant findings, and the presence of recommendation. Major discrepancy of between 26 and 32% was observed in the interpretation of abdominal and pelvic CT examinations.

Eco-labeling and information asymmetry: a comparison of five eco-labels in the Netherlands

Eco-labels have become commonplace instruments of self-regulation. This paper analyzes five food labels with respect to the reliability of their information. A new method to analyze reliability is developed. For each label, four aspects are examined: (1) mention of biodiversity; (2) reference to rule of law to assure buyers’ confidence; (3) notification of farmers’ compliance; and (4) information on ecological impact. The analysis reveals that eco-labels fail to communicate adequately; they do not diminish the information gap between seller and buyer. The main shortcomings of the eco-labels were found in their ambiguity about environmental themes, their failure to assure the buyer about the product's ecological impact, the insufficient information about producers’ compliance, and presence of recommendations.