PUBLIC FINANCING OF HEALTHCARE SERVICES

Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ), state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions

Health system responsiveness in the light of the Euro health consumer index

PURPOSE: The paper aims to assign the characteristics of the systems' responsiveness due to patient satisfaction. We base our analysis on the Euro Health Consumer Index (EHCI), including indicators from six categories, i.e. patient rights and information, access to medical services, treatment results, scope and range of medical services offered, prevention of vaccination patients, access to medicines.DESIGN/METHODOLOGY/APPROACH: We investigate data from 2014 to 2018 for thirty-five countries. The studied group of countries is divided into two subgroups - the group of countries with the Bismarck model (group A) and those with Beveridge's model (group B). Ward's method was used as a method of cluster analysis.FINDINGS: (1) The number of clusters is stable over time – both in 2014 and 2018, five clusters are identified; (2) The number of clusters within subgroups A and B is similar and stable over time; (3) The number of clusters created suggests that the responsiveness of health systems is a complex concept perceived by patients in different ways; (4) There are no essential differences between countries with the system of public health and countries where health financing bases on insurance schemes.ORIGINALITY/VALUE: The results suggest that the system's responsiveness cannot be perceived as one-dimensional. While assessing the system's responsiveness, patients take into consideration different factors.peer-reviewe

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Analysis of tissues and organs from mice treated with anti-tumor photodynamic therapy

Photodynamic therapy (PDT) takes an advantage of the activation, in the presence of oxygen, of photosentitizers (PS), that have been preferentially localized in target tissues (Cellular Photodynamic Therapy, CTP) or intravascularly (Vascular Targeted Photodynamic therapy VTP). As a result cytotoxic reactive oxygen species (ROS) are produced. They cause damage of target tissue or vascular damage inducing rapid local thrombus formation, vascular occlusion and tissue hypoxia. Under certain conditions antitumor effects are also mediated by indirect stimulation of inflammatory and immune response, including rapid local infiltration of tumors by neutrophilis and macrophages. This can also lead to adaptive immunity. In the present study we have used Bacteriochlorin-derivative photosentitizer for the treatment of mice C57/black bearing Lewis Lung Carcinoma (LLC) tumors. The aim of the study was to determine the kinetics of an early innate immune response (neutrophil and macrophage infiltration), kinetics of vascular damage, and kinetics of hypoxia in tumor and surrounding tissues after PDT. We compared two protocols, – tumors were illuminated either 15 min (VTP, PDT15) or 72 hours after drug administration (CTP, PDT72). Analysis of host organisms’ organs was also performed. This work is a part of a wider project concerning the physiological and molecular mechanisms of photodynamic therapy with the use of Bacteriochlorin.PDT15 led to a rapid and strong infiltration of neutrophils and macrophages, with maximal infiltration of macrophages 3 h after irradiation for PDT72. Both protocols resulted in decrease in mean vasculature density, but earlier and more persisting for PDT15. In LLC tumors hypoxia pattern is focal (patches). Pilot studies showed that number and size of hypoxic regions is protocol depended. For PDT15 hypoxic regions remain small but numerous while for PDT72 they were larger and few. Oedema was observed for illuminated legs 3 h after the therapy and for PDT72 it was much bigger. Elucidation of the mechanisms of these two protocols of PDT can lead to their modification in order to increase the effectiveness of the outcome.Terapia fotodynamiczna (Photodynamic Therapy, PDT) polega na aktywacji światłem zgromadzonego w tkance docelowej lub w jej unaczynieniu fotouczulacza (Photosentitizer, PS). Warunkiem koniecznym jest obecność tlenu. W efekcie powstają cytotoksyczne reaktywne formy tlenu (Reactive Oxygen Species, ROS), które niszczą tkankę docelową (Cellular Photodynamic Therapy, CTP) lub jej unaczynienie (Vascular Photodynamic Therapy, VTP) poprzez gwałtowne tworzenie skrzeplin, zamykanie światła naczyń lub hipoksję tkanki. W określonych warunkach może też nastąpić pośrednia stymulacja odpowiedzi zapalnej i immunologicznej, co objawia się napływem neutrofili, makrofagów oraz prozapalnych cytokin do leczonej tkanki.Cel pracy stanowiło monitorowanie nieswoistej odpowiedzi immunologicznej w czasie (kinetyka infiltracji neutrofili i makrofagów), kinetyka zmian unaczynienia i hipoksji w guzie mysiego raka płuc LLC oraz przyległej tkance poddanym terapii fotodynamicznej. Jako fotouczulacza użyto difluorosulfonamidowej pochodnej bakteriochloryny. W pracy porównano dwa protokoły terapii różniące się czasem naświetlania od podania fotouczulacza – naświetlanie natychmiast po podaniu PS (VTP, PDT15) oraz 72 godziny po podaniu PS (CTP, PDT72). Przeprowadzono także analizę narządów gospodarza. Projekt ten wpisuje się w badania nad fizjologicznymi i molekularnymi mechanizmami działania terapii fotodynamicznej z zastosowaniem bakteriochloryn.Protokół PDT15 prowadził do natychmiastowej silnej infiltracji neutrofili i makrofagów, podczas gdy maksimum infiltracji makrofagów dla protokołu PDT72 następowało 3h po zakończeniu naświetlania. Obydwa protokoły prowadziły do spadku gęstości naczyń, przy czym protokół PDT15 skutkował wcześniejszym oraz dłużej utrzymującym się spadkiem ilości naczyń. W badanym modelu nowotworu hipoksja występuje w postaci licznych ognisk (łaty). Badania pilotażowe pokazały, że ilość oraz wielkość obszarów hipoksycznych zależy od zastosowanego protokołu. Dla protokołu PDT15 obszary hipoksyczne były małe, ale liczne, a dla protokołu PDT72 duże i mniej liczne. 3h po zakończeniu terapii obserwowano obrzęk naświetlanej nogi z guzem, większy po PDT72. Poznanie mechanizmów działania obydwu protokołów PDT może prowadzić do ich modyfikacji w celu zwiększenia efektywności terapii

Types of cell death and methods of their detection in Saccharomyces cerevisiae.

Programmed cell death (PCD) for long time was supposed to not exist in unicellular organisms. However, there is a growing body of evidence showing PCDs presence in unicellular organisms, including yeasts and bacteria. In baker’s yeast Sacharomyces cerevisiae following types of death: apoptosis, necrosis and macroautophagy were reported. Moreover, many yeast’s homologs of important molecules in cellular death were already found, but some like Hsp70 remain unknown. Due to that, overall mechanisms of these processes have not been fully elucidated yet. Methods that are used for detection of cell death type in yeast include fluorescence microscopy, electron microscopy, flow cytometry, fluorogenic assays, TUNEL assay and clonogenity test. –The aim of this review is to present the newest published data in PCDs in model organism of yeast Sacharomyces cerevisiae and objective discussion.Występowanie programowanej śmierci komórkowej (ang. programmed cell death, PCD) u organizmów jednokomórkowych jest kontrowersyjnym tematem wzbudzającym duże zainteresowanie naukowców. Świadczy o tym rosnąca liczba prac teoretycznych i eksperymentalnych, szukających odpowiedzi na pytania o przyczyny powstania i adaptacyjne znaczenie PCD u jednokomórkowców. Znajdowane są ewolucyjnie konserwatywne geny i szlaki metaboliczne, które potwierdzają istnienie PCD u drożdży i bakterii. U drożdży Sacharomyces cerevisiae wyróżnia się obecnie co najmniej trzy główne rodzaje śmierci, w tym: apoptozę, nekrozę oraz autofagię. Odkryto wiele drożdżowych homologów ważnych molekuł biorących udział w śmierci u wyższych Eukaryota. Jednak wiele ważnych, np. Hsp70 pozostaje dalej niezidentyfikowanych. Metody wykorzystywane wcześniej do detekcji rodzajów śmierci komórkowej wyższych Eukaryota takie jak: mikroskopia fluorescencyjna, mikroskopia elektronowa, cytometria przepływowa, testy fluorymetryczne na aktywność kaspaz, metoda TUNEL, zostały obecnie opracowane na potrzeby analizy komórek drożdży. Niniejszy przegląd teoretyczny ma na celu przedstawienie najnowszych publikacji i obiektywne przedyskutowanie opisanego tematu na przykładzie modelowego organizmu jednokomórkowego Saccharomyces cerevisiae

The role of local governments in entrepreneurship stimulation

Artykuł przedstawia zjawisko przedsiębiorczości oraz możliwości podejmowania przez władze lokalne działań na rzecz jej wspierania. Dokonano oceny dotychczasowej aktywności władz lokalnych w sferze inicjowania działań wspierających inicjatywy gospodarcze. Wskazano potencjalne obszary zmian i usprawnień w lokalnej polityce wsparcia. Propozycje usprawnień odniesiono do obiektywnych ograniczeń wyznaczanych przez obowiązujące ramy prawne.The article presents the role of territorial units in enterprise stimulation, discusses the factors that encourage local authorities to promote entrepreneurship or discourage them from using supporting instruments. The authors assess the current activity of local governments in the domain and they suggest potential changes in local policy regarding entrepreneurship stimulation. The article points out areas where improvement is possible despite the obstacles due to the existing legal framewor

Aktywność fizyczna determinantą zdrowia populacji

 Physical activity as a determinant of population’s hea lth statusIn this paper we verified and analysed the relationship between: 1 cycling in minutes and doing another sports, in a typical week, and social determinants of health; 2 moving on foot in public space and social determinants of health; 3 physical activity associated with the performance of work and the social determinants of health; 4 physical activity and health assessment, long-term health problems, diseases and chronic ailments, and athleticism. We constructed three research hypotheses: H1 residents of densely populated areas large cities are physically active; H2 the longer the time average intensity of physical activity, the healthier the population; H3 the healthiest group are people physically active. The first hypothesis was positively verified — inhabitants of large cities often spend a lot of time at work, are stressed and need some physical activity. The second hypothesis was confirmed only partially: Chi square = 1692,469; Yul φ = 0,322; Q-Kendalla = 0,297 indicate that there is a statistically significant relationship between the amount of time spent on sports and health. The longer time spent on sport, the better health. The third hypothesis was also confirmed — active physical enjoy better health. Physical activity as a determinant of population’s hea lth statusIn this paper we verified and analysed the relationship between: 1 cycling in minutes and doing another sports, in a typical week, and social determinants of health; 2 moving on foot in public space and social determinants of health; 3 physical activity associated with the performance of work and the social determinants of health; 4 physical activity and health assessment, long-term health problems, diseases and chronic ailments, and athleticism. We constructed three research hypotheses: H1 residents of densely populated areas large cities are physically active; H2 the longer the time average intensity of physical activity, the healthier the population; H3 the healthiest group are people physically active. The first hypothesis was positively verified — inhabitants of large cities often spend a lot of time at work, are stressed and need some physical activity. The second hypothesis was confirmed only partially: Chi square = 1692,469; Yul φ = 0,322; Q-Kendalla = 0,297 indicate that there is a statistically significant relationship between the amount of time spent on sports and health. The longer time spent on sport, the better health. The third hypothesis was also confirmed — active physical enjoy better health

Outsourcing as a concept of management of health care institutions–selected aspects

Ucieklak-Jeź, P.; Bem, A. Outsourcing as a concept of management of health care institutions – selected aspect