EKONOMSKE KRIZE KAO POTICAJ PROMJENA U ZDRAVSTVENOM SUSTAVU – POVIJESNA PERSPEKTIVA S OSVRTOM NA PANDEMIJU COVID-19

Economic crises throughout history have often given an impetus for health and social reforms leading to the introduction of general healthcare systems and social equality in a large number of countries. The aim of this paper is to present the major economic crises and their effect on healthcare and social system chronologically. Bismarck’s and Beveridge’s model, the two most prominent healthcare models, which emerged primarily as a response to major economic crises, constitute the basis for the functioning of most health care systems in the world. An overview of historical events and experiences may be valuable in predicting future developments and potential effects of the crisis on healthcare systems and health in general. An analysis of past crises as well as current health and economic crisis caused by the COVID-19 pandemic and their impact on the healthcare system can facilitate the comprehension of the mechanisms of action and consequences of economic recession. It may also help identify guidelines and changes that might reduce the potential damage caused by future crises. The historical examples presented show that a crisis could trigger changes, which, in their essence, are not necessarily negative. The response of society as a whole determines the direction of these changes, and it is up to society to transform the negative circumstances brought about by the recession into activities that contribute to general well-being and progress.Ekonomske krize tijekom povijesti često su bile poticaj za zdravstvene i socijalne reforme. Rezultat toga bilo je uvođenje sustava opće zdravstvene zaštite i socijalne jednakosti u velikom broju zemalja. Ovim radom željeli smo kronološki prikazati velike gospodarske krize i njihove učinke na zdravstveni i socijalni sustav. Dva najpoznatija modela zdravstvene zaštite, Bismarckov i Beveridgeov, na kojima se temelji funkcioniranje većine zdravstvenih sustava u svijetu, upravo su proizišli iz velikih ekonomskih kriza. Pregled povijesnih događaja i iskustva iz prošlosti mogu biti korisna u predviđanju budućih zbivanja i učinaka krize na zdravstvene sustave i zdravlje. Analiza prijašnjih kriza, kao i trenutačne zdravstvene i gospodarske krize uzrokovane pandemijom bolesti COVID-19, i njihova učinka na sustav zdravstva može pomoći u razumijevanju mehanizama djelovanja i posljedica recesije na zdravlje te određivanju smjernica i promjena kojima bi se umanjile potencijalne štete budućih kriza. Upravo iz iznesenih povijesnih primjera vidi se da kriza može biti poticaj promjena koje u svojoj suštini ne moraju biti negativne. O reakciji društva ovisi koji će biti smjer tih promjena i na samom je društvu da negativne okolnosti koje donosi recesija transformira u aktivnosti koje donose dobrobit i napredak

Eye and Pregnancy

Hormonal, metabolic, hemodynamic, vascular and immunological changes that occur during pregnancy can affect the function of the eye. These changes are commonly transient, but in some cases they may be permanent and have consequences even after childbirth. The ocular effects of pregnancy may be physiological or pathological and can be associated with the development of new ocular pathology or may be modifications of pre-existing conditions. The most common physiological changes are alterations of corneal sensitivity and thickness, decreased tolerance to contact lenses, decreased intraocular pressure, hemeralopia and refractive errors. Possible posterior segment changes include worsening of diabetic retinopathy, central serous chorioretinopathy, increased risk of peripheral vitreochorioretinal dystrophies and retinal detachment. Thus, it should be kept in mind that the presence of any ocular symptoms in a pregnant woman requires ophthalmologic examination and further management

Nejednakosti u financiranju zdravstvene zaštite: komparativna analiza Hrvatske i odabranih zemalja Središnje i Istočne Europe

The past few decades have been marked by a substantial increase in health spending in Central and Eastern European countries. At the same time, healthcare systems have experienced significant changes, as a consequence of economic and political transformation processes that these countries have undergone after the fall of communism. The aim of this paper was to briefly present current situation and trends in healthcare financing in Central and Eastern European countries. Our approach is based on an analysis of a number of healthcare expenditures indicators which are connected to healthcare spending patterns in each of these countries. Comparative research of these countries aims to demonstrate a degree of similarities or variations in the structure and finances in health systems. According to results, public involvement in health financing is still dominant in the majority of countries, but it has recorded a downward trend. On the other hand, private spending has been increasing mostly due to increase in out-of-pocket payments.Posljednjih nekoliko desetljeća obilježeno je znatnim porastom izdataka za zdravstvo u zemljama Središnje i Istočne Europe. Istovremeno, sustavi zdravstvene skrbi iskusili su značajne promjene uslijed procesa gospodarske i političke transformacije koje su te zemlje prošle nakon pada komunizma. Cilj je ovoga rada ukratko prikazati trenutnu situaciju i trendove u financiranju zdravstvene skrbi u zemljama Središnje i Istočne Europe. Naš se pristup temelji na analizi niza pokazatelja izdataka za zdravstvenu skrb koji su povezani s uzorcima za izdatke za zdravstvenu skrb u svakoj od tih zemalja. Komparativno istraživanje tih zemalja nastoji ukazati na stupanj sličnosti ili varijacija u strukturi i financijama sustava zdravstvene skrbi. Prema rezultatima, javno financiranje zdravstva još je uvijek dominantno u većini zemalja, ali bilježi trend opadanja. S druge strane, privatno trošenje se povećava uglavnom zbog povećanja neposrednih plaćanja

Inflammatory and angiogenic biomarkers in diabetic retinopathy

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus (DM) and a leading cause of blindness in working- age adults in developed countries. Numerous investigations have recognised inflammation and angiogenesis as important factors in the development of this complication of diabetes. Current methods of DR treatment are predominantly used at advanced stages of the disease and could be associated with serious side effects. Therefore, new diagnostic methods are needed in order to identify the initial stages of DR as well as monitoring the effects of applied therapy. Biochemical biomarkers are molecules found in blood or other biological fluid and tissue that indicate the existence of an abnormal condition or disease. They could be a valuable tool in detecting early stages of DR, identifying patients most susceptible to retinopathy progression and monitoring treatment outcomes. Biomarkers related to DR can be measured in the blood, retina, vitreous, aqueous humour and recently in tears. As the retina represents a small part of total body mass, a circulating biomarker for DR needs to be highly specific. Local biomarkers are more reliable as indicators of the retinal pathology; however, obtaining a sample of aqueous humour, vitreous or retina is an invasive procedure with potential serious complications. As a non-invasive novel method, tear analysis offers a promising direction in further research for DR biomarker detection. The aim of this paper is to review systemic and local inflammatory and angiogenic biomarkers relevant to this sight threatening diabetic complication

Maternal immune system adaptation to pregnancy - a potential influence on the course of diabetic retinopathy

<p>Abstract</p> <p>Background</p> <p>Progression of diabetic retinopathy occurs at least temporarily during pregnancy. Although the cause of this progression is not entirely understood, the immune phenomenon and chronic inflammation may play a significant role. During pregnancy in order to avoid fetus rejection, certain components of the immune system that are knowingly implicated in the pathogenesis of diabetic retinopathy are activated including generalized leukocyte activation and an increase in certain cytokine plasma levels. Activated leukocytes with up regulated adhesion molecules have an increased potential to bind to the endothelium cells of blood vessels. Leukocyte-endothelial interaction and the consequent leukostasis with capillary occlusion, ischemia and vascular leakage have a substantial role in the development of diabetic retinopathy. Furthermore, certain increased cytokines are known to cause blood-retinal-barrier breakdown whilst others promote angiogenic and fibrovascular proliferation and thereby can also be implicated in the pathogenesis of this diabetic complication.</p> <p>Presentation of the hypothesis</p> <p>We hypothesized that the activation of the immune system during gestation may have an influence on the course of retinopathy in pregnant diabetic women.</p> <p>Testing the hypothesis</p> <p>We suggest two prospective follow up studies conducted on women with type 1 diabetes mellitus. The first study would include a group of non-pregnant women and a group of diabetic women undergoing normal pregnancy matched for age and duration of diabetes. In the second study pregnant women would be divided into two groups: one with normal pregnancy and the other with preeclampsia. The procedure and data collection in both studies will be identical: a complete ophthalmological examination, glycaemic control, blood pressure measurement and venous blood samples for the determination of plasma levels of cytokines (TNF-alpha, IL-1beta, IL-6, IL-8) and adhesion molecules (ICAM-1, VCAM-1).</p> <p>Implications of the hypothesis</p> <p>Considering the present assumption, the gestational immune activation could be suggested as a potential risk factor for the development and progression of retinopathy in diabetic women. A better understanding of immunomodulatory effects of pregnancy on diabetic retinopathy pave the way for further investigations of the mechanism of its pathogenesis and could be essential for novel approaches to the treatment of this serious sight threatening complication of diabetes mellitus.</p

Corneal collagen crosslinking: from basic research to clinical application

Corneal collagen crosslinking is a promising new treatment of progressive corneal ectasia. Its clinical use has been rapidly increasing since it was originally introduced in 1997 as the first treatment that can improve biomechanical stability of theweakened cornea. The method is based on the combined action of photosensitizer riboflavin (vitamin B2) and ultraviolet A light, which induce the formation of new covalent bonds between the collagen fibers. Our systematic search of literature in English has yielded only eight prospective trials with the efficiency and safety data published to date. However, all of the published studies reveal a halt in the progression or a slight improvement of corneal ectasia with the low complication and failure rates after the treatment. In this review we are highlighting the method’s history, scientific basis and its current clinical application in order to provide clinicians with the recent data on its benefits and potential risks

How to Prevent and Treat Anysometropic-Amblyopic Child by Contact Lenses

Anisometropy as a first step on a way forward future amblyopic child, can be prevent and treat if this condition is recognased on time. Second step is wisdom, right contact lens fit on bothes eyes. As follow, some ortoptic-pleoptic procedures depending on (objective, subjective squinting angle, state of fusion, visus on bothes eyes and separatly each eay and condition of nervus opticus (VEP), normal or absent retinal corespondence, are recomended. There is no limit how old a child is, but best choice and best compliance is age between five and twelve. Contact lens materiales, different fit procedures, right diagnosys and tips allabout are discussed

DRY EYE IN CONTACT LENS WEARERS AS A GROWING PUBLIC HEALTH PROBLEM

Background: The aim of this study is to analyze the relationship between the self-reported symptoms and objective signs of dry eye disease in long-term rigid gas-permeable (RGP) or soft contact lens (SCL) wearers. Subjects and methods: The study included 84 eyes of Caucasian RGP and SCL wearers between the age of 15 and 71 who wore contact lenses on a continuous daily basis for more than 1 year. Symptoms were assessed according to the Ocular Surface Disease Index (OSDI). Clinical assessments included corneal fluorescein staining according to the National Eye Institute (NEI) staining grid and tear film break-up time (TBUT). Results: There were more female (76.19%) than male (23.81%) persons with a higher proportion of RGP wearers among the females (88.89% vs. 11.11%). The mean duration of daily lens wear was 7.71±2.72 hours. No RGP wearer in this study had a NEI corneal staining grid score higher than 2. A weak negative correlation was found between daily lens wear duration and TBUT (Pearson’s coefficient, r=-0.1467). A strong negative correlation was found between TBUT and OSDI values (r=-0.844). Conclusion: The results of the study emphasize the importance of early and accurate diagnosis of dry eye disease for successful long term RGP and SCL contact lens wear. This will hopefully motivate future larger scale investigations on dry eye related problems in contact lens wearers