Factors affecting change in renal function after contrast-enhanced computed tomography in cancer patients

Objectives. Contrast-enhanced computed tomography (CECT) is the most common form of assessing the effectiveness of cancer patient treatment. However, an injection of an iodine-based contrast agent can cause acute kidney damage (AKI). To determine the frequency and factors affecting post-contrast kidney function deterioration during oncological treatment.  Material and methods. Kidney function in cancer patients with solid tumors undergoing a total of 206 CECTs was retrospectively analyzed.  Results. Two hundred and six CECT procedures in 79 patients (age 68.4 ± 10.6 years) were included in the study. The median eGFR before CECT according to the MDRD was 81 mL/min/1.73m2 (IQR 26). The median time between CECT and kidney function examination was 8 (IQR 8) days. In the whole group, the median eGFR change defined as the difference between eGFR after and before CECT was 0.0 (9.0) mL/min/1.73m2 and was not significant. eGFR decreased in 100/206 (48.5%) CECT procedures with the median difference = –5.0 (6.0) mL/min/1.73m2. However, clinically significant deterioration of renal function (an increase in SCr of > 0.3 mg/dL) was found only in two cases (0.9%). The change in eGFR associated with CECT correlated significantly (p < 0.05) with initial creatinine (r = 0.117) and urea (r = 0.158), but not with age and comorbidities. After dividing the analyzed population according to the median GFR, it turned out that in the group of patients with eGFR < 81 mL/min/1.73m2, the median difference in GFR level was 1 (IQR 10), and in the group with a higher eGFR level the median was –1 (IQR 8.5), which was statistically significant (p = 0.03). The multivariate logistic regression analysis in subsequent reduced models confirmed that SCr, uric acid level, and the use of antimetabolites were the factors independently reducing the risk of deterioration of renal function after CECT.  Conclusions. CECT can be responsible for kidney function deterioration; however, it has no impact on oncological treatment

The Extent of Poverty and Tax and Benefit Policy Reforms in 2006-2010

The article aims to identify the impact of changes in tax and benefit regulations-introduced in Poland from 2006 to 2010-on household income distribution. A wide range of legal adjustments in income policy motivated this research agenda. The research method used is based on the decomposition of changes in income distribution and poverty indexes onto those that may be attributed to changes in the distribution of income and those caused by the tax and benefit adjustments. The so-called Shapley values for hypothetical disposable incomes generated by the different regulation systems were calculated in the article. The hypothetical incomes were simulated using the SIMPL tax and benefit microsimulation model. The study confirmed that changes in income distribution have a greater impact on the threat of poverty than those caused by regulatory adjustments. The results of the analysis indicate that in the 2006-2010 period, which was a time of relatively fast economic growth, more care was taken to enhance financial motivation to work than to reduce income inequalities. Despite a strong pro-efficiency policy, regulatory changes effectively protected the poorest households, as shown by changes in the poverty indexes.Celem artykułu jest identyfikacja wpływu zmian w regulacjach podatkowoświadczeniowych wprowadzonych w Polsce w latach 2006-2010 na zróżnicowanie dochodów gospodarstw domowych. Motywacją do podjęcia tego tematu był szeroki zakres zmian prawnych we wspomnianym obszarze prawa przy równoczesnej wysokiej dynamice wzrostu płac. Zastosowana metoda badawcza polegała na dekompozycji zmian wartości indeksów zróżnicowania dochodów (indeks Giniego, indeks Sena oraz indeksy z rodziny FGT) na części wynikające ze zmian w rozkładzie przychodu oraz regulacji podatkowo-świadczeniowych. W tym celu posłużono się wartościami hipotetycznych dochodów do dyspozycji, wygenerowanych za pomocą podatkowo-świadczeniowego modelu SIMPL, które wykorzystano do wyliczenia wartości Shapleya. Przeprowadzone badanie potwierdziło wyrażane wcześniej w literaturze przedmiotu przekonanie o większym wpływie zmian w rozkładzie przychodów niż zmian regulacyjnych na zmiany w skali zagrożenia ubóstwem. Wyniki analiz wskazują, że w okresie względnie dobrej koniunktury, w latach 2006-2010, bardziej dbano o stworzenie warunków umożliwiających poprawę finansowej opłacalności pracy, niż o zmniejszenie zróżnicowania dochodów. Równocześnie, pomimo silnie pro-efektywnościowego nastawienia, zmiany regulacyjne w analizowanym okresie skutecznie osłaniały dochody najbiedniejszych gospodarstw, o czym świadczy ich wpływ na głębokość i dotkliwość ubóstwa

Financial incentives to work in the context of a complex reform package and growing wages: the Polish experience 2005-2011

We examine the consequences of changes in work incentives in Poland between 2005 and 2011 resulting from a complex tax and benefit reform package and substantial real wage growth. While marginal and participation tax rates (PTRs) in the majority of analysed cases fall as a result of the introduced reforms, the conclusions from looking at replacement rates (RRs) for the population eligible for means tested benefits are generally different. These suggest that despite significant tax giveaways incentives on the labour market weakened for families with children and for those eligible to safety net benefits. Yet despite these negative policy implications, we show that work incentives improved substantially over the period due to significant real wage growth. When analysing the effect of the reforms on financial incentives to work, we often find conflicting conclusions when using the PTRs and RRs to reflect financial attractiveness of employment. This is not necessarily surprising, but serves as a note of caution on the use of each of them independently