Da heterogeneidade à harmonização? : tendências recentes na política de saúde européia

In the European Union (EU), health policy and the institutional reform of health systems have been treated primarily as national affairs, and health care systems within the EU thus differ considerably. However, the health policy field is undergoing a dynamic process of Europeanization. This process is stimulated by the orientation towards a more competitive economy, recently inaugurated and known as the Lisbon Strategy, while the regulatory requirements of the European Economic and Monetary Union are stimulating the Europeanization of health policy. In addition, the so-called open method of coordination, representing a new mode of regulation within the European multi-level system, is applied increasingly to the health policy area. Diverse trends are thus emerging. While the Lisbon Strategy goes along with a strategic upgrading of health policy more generally, health policy is increasingly used to strengthen economic competitiveness. Pressure on Member States is expected to increase to contain costs and promote market-based health care provision.Da heterogeneidade à harmonização? : Tendências recentes na política de saúde européia Na União Européia, as políticas de saúde e a reforma institucional dos sistemas de saúde têm sido tratadas principalmente como questões nacionais, levando a diferenças importantes entre os sistemas dentro da União. Entretanto, o campo da política de saúde está passando por um processo dinâmico de europeização, estimulado pela mudança recente para uma economia mais competitiva, conhecida como a Estratégia de Lisboa, enquanto as exigências regulatórias da União Econômica e Monetária estão promovendo a europeização da política sanitária. Além disso, o método conhecido como coordenação aberta, que representa uma nova modalidade de regulamentação dentro do sistema europeu com múltiplos níveis, é aplicado cada vez mais à área de política sanitária. Enquanto a Estratégia de Lisboa acompanha a melhoria estratégica da política de saúde no sentido mais geral, esta política é utilizada cada vez mais para fortalecer a competitividade econômica. A previsão é de que a pressão crescente sobre os países membros irá conter custos e promover a oferta de serviços de saúde com base no mercado

Growth Mindset and Persistence in Children's Creative Performance

Motivation literature regarding children’s academic achievement is quite extensive and can typically be separated into two mindsets: growth mindset and fixed mindset, which vary on their level of persistence (i.e., effort toward a task, Dweck, 2006). Individuals with a growth mindset find persistence is useful because they believe their abilities can change through hard work. Individuals with a fixed mindset find persistence is not useful because they believe their abilities cannot change with hard work. In the domain of creative achievement there is a lack of research on mindset and persistence during creative performance. Research shows that adults underestimate the value of persisting in their own creative performance (Lucas & Nordgren, 2015). However, this has not been examined in conjunction with mindset or in a younger sample. The aim of this study was to determine if children also show this underestimation of persistence and if children who are more growth minded will value persistence during their own creative performance. Children of all age groups undervalued their persistence in a creativity task, but children who were more creative did a better job in estimating their persistence. Mindset was not related to children’s value of persistence for their own creative performance, nor did mindset interact with age. These results suggest children are doubtful of persistence as a valuable strategy in their own creative performance for creative achievement

Soziale Ungleichheit von Gesundheitschancen : Anmerkungen zum Beitrag der Gesundheitspolitik

Die Privatisierung von Krankheitskosten durch erhöhte Zuzahlungen, informelle Leistungsverweigerungen in der GKV sowie das Nebeneinander von gesetzlicher und privater Krankenversicherung bei einer wachsenden Kluft zwischen beiden Systemen haben die sozialen und die räumlich-zeitlichen Barrieren zur Inanspruchnahme von Gesundheitsleistungen für sozial schwache Gruppen erhöht. Damit wächst die Gefahr, dass die Krankenversorgungspolitik zu einer eigenständigen Ursache für die Verstärkung und Aufrechterhaltung gesundheitlicher Ungleichheit wird. Gleichzeitig werden die Möglichkeiten der gesetzlichen Krankenversicherung, durch verbesserte Prävention zu einer Verringerung gesundheitlicher Ungleichheit beizutragen, nur unzureichend genutzt. So liegt die Teilnahmequote von Personen mit niedrigem Sozialstatus an zahlreichen Maßnahmen der Krankheitsfrüherkennung, insbesondere bei der Krebsvorsorge, nach wie vor deutlich unter dem Durchschnitt. Mit der Novellierung des § 20 SGB V im Jahr 2000 hat zwar auch die Verminderung der sozialen Ungleichheit von Gesundheitschancen Eingang in das Zielsystem der GKV gefunden. Allerdings geht dieses Ziel nur teilweise in die Präventionspraxis der Krankenkassen ein. Nach wie vor existieren zahlreiche Hürden bei der Implementierung von Maßnahmen der kontextgestützten Verhältnisprävention.In recent years, poorer people in Germany are facing new barriers to get access to health care, due to the raising of co-payments and the informal rationing of benefits. Moreover, the persisting segregation and widening gap between social and private health insurance is raising barriers towards the use of health services by the poor. Thus, health care policy is more likely to become a separate cause for maintaining and increasing health inequalities. At the same time, social health insurances do not adequately use existing opportunities to reduce health inequality by improving prevention strategies. Thus, participation rates of people of low socio-economic status in secondary prevention, especially cancer prevention, are mostly far below average. The goal of reducing the social inequality of health chances was included into the social health insurance code by the amendment of para 20 (non-medical primary prevention und health promotion) in 2000. But in practice, this goal has only in part been pursued by the social health insurance organisations. High barriers to implement structural changes in order to prevent illness do still continue to exist

Rot-grüne Gesundheitspolitik: Eine Zwischenbilanz

Die konservativ-liberale Bundesregierung hatte seit der ersten Hälfte der 90er Jahre darauf gesetzt, die Ausgaben der Gesetzlichen Krankenversicherung durch neue finanzielle Anreize für die Individualakteure im Gesundheitswesen (Krankenkassen, Ärzte, Krankenhäuser, Pati-enten) zu begrenzen. Zu den einschlägigen Steuerungsinstrumenten zählten die Verschärfung des Kassenwettbewerbs durch die Einführung der freien Kassenwahl, die durch die Ausrich-tung des Vergütungssystems auf Budgets und Pauschalen herbeigeführte Verlagerung des Morbiditätsrisikos auf die Leistungserbringer sowie eine durchgreifende Privatisierung von Krankenbehandlungskosten. Rot-grüne Gesundheitspolitik weist im Verhältnis zur Politik der konservativ-liberalen Koali-tion sowohl Kontinuitätselemente als auch neue Akzente auf. Sie hielt am Kassenwettbewerb sowie an Budgets und Pauschalen fest, machte aber einen erheblichen Teil der kurz zuvor ge-troffenen Maßnahmen zur Kostenprivatisierung rückgängig. Statt dessen legte sie ein stärke-res Gewicht auf die Reform von Versorgungsstrukturen. Hervorzuheben sind insbesondere die Bemühungen um die Integration von ambulanter und stationärer Versorgung und um die Stärkung der hausärztlichen Versorgung sowie die finanzielle Unterstützung für die Einfüh-rung strukturierter Behandlungsprogramme für chronisch Kranke. Darüber hinaus wies sie den Krankenkassen erneut Kompetenzen bei der Primärprävention und Gesundheitsförderung zu. Ziel und Leitbild rot-grüner Gesundheitspolitik war es, mit Hilfe von Reformen der Ver-sorgungsstrukturen und Vertragsbeziehungen Wirtschaftlichkeitspotentiale zu erschließen, die es gestatten sollen, das Ziel der Beitragssatzstabilität und das Festhalten an einem einheit-lichen, alles medizinisch Notwendige umfassenden GKV-Leistungskatalog miteinander zu verknüpfen. Allerdings haben sich die skizzierten Reformen bisher kaum im Versorgungsalltag niederge-schlagen. Die Implementationsprobleme sind nicht einfach nur auf die Macht der Verbände im Gesundheitswesen zurückzuführen, sondern - so die hier vertretene These - vor allem auf eine Inkompatibilität von Steuerungszielen und Steuerungsinstrumenten. Insbesondere die Anreize des Kassenwettbewerbs und die sektorale Budgetierung der GKV-Ausgaben erwie-sen sich als Hindernisse für die Implementation wünschenswerter Innovationen in der Ver-sorgungs- und Präventionspolitik. Bisher hat Rot-Grün an den gewachsenen Grundsätzen einer solidarischen Krankenversiche-rung festgehalten und eine weitergehende Privatisierung von Krankenbehandlungskosten ab-gelehnt. Darin besteht der markanteste Unterschied zur Gesundheitspolitik der konservativ-li-beralen Regierungskoalition. Die wieder verstärkt geführte Debatte um die Krise der sozialen Sicherungssysteme deutet allerdings darauf hin, dass diese Prinzipien doch wieder zur Dispo-sition gestellt werden könnten. --

A systematic review of methods to measure menstrual blood loss

Background Since the publication over 50 years ago of the alkaline hematin method for quantifying menstrual blood loss (MBL) many new approaches have been developed to assess MBL. The aim of this systematic review is to determine for methods of measuring MBL: ability to distinguish between normal and heavy menstrual bleeding (HMB); practicalities and limitations in the research setting; and suitability for diagnosing HMB in routine clinical practice. Methods Embase®™, MEDLINE®, and ClinicalTrials.gov were screened for studies on the development/validation of MBL assessment methods in women with self-perceived HMB, actual HMB or uterine fibroids, or patients undergoing treatment for HMB. Studies using simulated menstrual fluid and those that included women with normal MBL as controls were also eligible for inclusion. Extracted data included study population, results of validation, and advantages/disadvantages of the technique. Results Seventy-one studies fulfilled the inclusion criteria. The sensitivity and/or specificity of diagnosing HMB were calculated in 16 studies of methods involving self-perception of MBL (11 pictorial), and in one analysis of the menstrual-fluid-loss (MFL) method; in 13 of these studies the comparator was the gold standard alkaline hematin technique. Sensitivity and specificity values by method were, respectively: MFL model, 89, 98%; pictorial blood loss assessment chart (PBAC), 58–99%, 7.5–89%; menstrual pictogram, 82–96%, 88–94%; models/questionnaires, 59–87%, 62–86%, and complaint of HMB, 74, 74%. The power of methods to identify HMB was also assessed using other analyses such as comparison of average measurements: statistical significance was reported for the PBAC, MFL, subjective complaint, and six questionnaires. In addition, PBAC scores, menstrual pictogram volumes, MFL, pad/tampon count, iron loss, and output from three questionnaires correlated significantly with values from a reference method in at least one study. In general, pictorial methods have been more comprehensively validated than questionnaires and models. Conclusions Every method to assess MBL has limitations. Pictorial methods strike a good balance between ease of use and validated accuracy of MBL determination, and could complement assessment of HMB using quality of life (QoL) in the clinical and research setting

A nyaki dissectiók onkológiai hozamának maximalizálása a sebészi morbiditás egyidejű minimalizálása mellett | Maximizing nodal yield while minimizing surgical morbidity: the appropriate neck dissection

Absztrakt A regionális nyaki lymphadenectomia – elterjedt nevén nyaki dissectio – a fej-nyaki tumorsebészet fontos alapműtéte. Ezen műtét 110 éves evolúciója során a különböző iskolák, nevezéktanok és műtéti technikák keveredése nyomán olyan mértékű zavar alakult ki az irodalomban és a mindennapi szakmai életben, amely szinte lehetetlenné teszi a sebészi és onkológiai eredmények standardizálását és objektív összehasonlítását. Ezt a helyzetet kísérlik meg a szerzők jelen összefoglaló munkájukban közérthetően tisztázni, a multidiszciplináris fej-nyaki terápiás döntésekben részt vevő kollégák kommunikációját megkönnyítendő annak érdekében, hogy a fej-nyaki tumoros betegek számára minden esetben optimális terápiás döntés szülessék. A közlemény történeti és irodalmi áttekintést ad, valamint ismerteti a két legelterjedtebb műtéti technika eredményeinek statisztikai összehasonlítását. A műtéti technika megválasztása szignifikáns hatással van az onkológiai hozamra. A megfelelő sebészi koncepció az onkológiai haszon maximalizálása mellett a betegek életminőségét a lehető legkisebb mértékben befolyásolja, egyrészt a primer sebészi terápiás morbiditás csökkentése, másrészt az adjuváns indikációk optimalizálása révén. Orv. Hetil., 2016, 157(47), 1871–1879. | Abstract Cervical regional lymphadenectomy, also known as neck dissection, is a fundamental procedure in head and neck surgery. Its evolution over 110 years resulted in a great deal of confusion in the literature and in clinical practice, due to the heterogenicity in training, classification and surgical techniques, which makes outcomes comparability virtually impossible. The authors aim to clarify this situation in a structured manner, in order to facilitate communication among all specialists involved in multidisciplinary head and neck cancer care. The ultimate goal is to make sure that each and every head and neck cancer patient receives their optimal treatment. Review of the history and literature with statistical comparison of the two mainstraim methods regarding their nodal yield results. The applied surgical technique has a significant impact on nodal yield. An appropriate surgical concept achieves maximum oncologic benefit, minimum surgical morbidity with optimized adjuvant indications. Orv. Hetil., 2016, 157(47), 1871–1879

Spatial and temporal diversity in genomic instability processes defines lung cancer evolution

PMCID: PMC4636050.-- et al.Spatial and temporal dissection of the genomic changes occurring during the evolution of human non-small cell lung cancer (NSCLC) may help elucidate the basis for its dismal prognosis.We sequenced 25 spatially distinct regions from seven operable NSCLCs and found evidence of branched evolution, with driver mutations arising before and after subclonal diversification. There was pronounced intratumor heterogeneity in copy number alterations, translocations, and mutations associated with APOBEC cytidine deaminase activity. Despite maintained carcinogen exposure, tumors from smokers showed a relative decrease in smoking-related mutations over time, accompanied by an increase in APOBEC-associated mutations. In tumors from former smokers, genome-doubling occurred within a smoking-signature context before subclonal diversification, which suggested that a long period of tumor latency had preceded clinical detection. The regionally separated driver mutations, coupled with the relentless and heterogeneous nature of the genome instability processes, are likely to confound treatment success in NSCLC.E.B. is a Rosetrees Trust fellow; M.J.H. has a Cancer Research UK fellowship; N.Mu. received funding from the Rosetrees Trust; M.G. is funded by the UK Medical Research Council; I.V. is funded by Spanish Ministerio de Economía y Competitividad subprograma Ramón y Cajal; R.C.R. and D.M.R. are partly funded by the Cambridge Biomedical Research Centre and Cancer Research UK Cancer Centre; P.V.L. is a postdoctoral researcher of the Research Foundation—Flanders (FWO); S.M.J. is a Wellcome Senior Fellow in Clinical Science; and C.S. is a senior Cancer Research UK clinical research fellow and is funded by Cancer Research UK, the Rosetrees Trust, European Union Framework Programme 7 (projects PREDICT and RESPONSIFY, ID:259303), the Prostate Cancer Foundation, the European Research Council and the Breast Cancer Research Foundation. This research is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.Peer Reviewe

Miscellanea. Folyóirat-referátumok. Beszámoló. Könyvismertetés. OH-KVÍZ

Folyóirat-referátumok. Kardiológia Serelaxin hatása a megtartott bal kamrai ejekciós frakció mellett kifejlődő heveny szívelégtelenségben szenvedő betegek nehézlégzésére: RELAX-AHF tanulmány (Serelaxin in acute heart failure patients with preserved left ventricular ejection fraction: results from the RELAX-AHF trial) Filippatos, G., Teerlink, J. R., Farmakis, D., et al. (Heart Failure Unit, Department of Cardiology, Attikon University Hospital, 1 Rimini St, 12461, Haidari, Athén, Görögország; e-mail: [email protected]): Eur. Heart J., 2014, 35 (16), 1041–1050. | Onkológia Fizikai aktivitás és a rákbetegek túlélése: bonyolult terület egyszerű váza (Physical acitivity and cancer survivorship: a simple framework for a complex field) Courneya, K. S. (University of Alberta, E-488 Van Vliet Center, Edmonton, Alberta, Canada T6G 2H9; e-mail: [email protected]): Exerc. Sport Sci. Rev., 2014, 42 (3), 102–109. | Beszámoló. „Markusovszky Sitz” Abbáziában | Húgyúti fertőzések klinikuma, mikrobiológiai diagnosztikája és célzott antibiotikus kezelése Győr, 2014. szeptember 13. | Könyvismertetés. Gaál Csaba: Egy életút gondolatai Sebészfi lozófi a – Nézeteim Semmelweis Kiadó, Budapest, 2013 | Hirschberg Jenő, Hacki Tamás, Mészáros Krisztina (szerk.): Foniátria és társtudományok, I. és II. kötet A hangképzés, a beszéd és a nyelv, a hallás és a nyelés élettana, kór- tana, diagnosztikája és terápiája ELTE Eötvös Kiadó, Budapest, 2014, I. kötet: A foniátria tárgya, története és a logopédiával való kapcsolata; Társtu- dományok: akusztika, nyelvészet-fone- tika, neurológia-pszichológia, genetika, információelmélet; a beszéd- és ének- hangképzés, hangképzési zavar, II. kötet: A beszéd kialakulása, fejlődé- se, beszéd- és nyelvi zavarok; A hallás és gyermekkori zavarai; A nyelés, nyelésza- varok, Foniátriai feladatok a komplex rehabilitáció keretében | OH-KVÍ