Repartycyjny i kapitałowy system emerytalny. Synergia czy antagonizm?

Zmiany polegające na przeniesieniu części aktywów ulokowanych w instrumentach dłużnych Skarbu Państwa z OFE do FUS stały się pretekstem do ponownego otwarcia dyskusji o zaletach i wadach modelu kapitałowego i repartycyjnego. Artykuł zawiera analizę polskiej reformy od 1999 r., i jej wpływu na finanse publiczne oraz wskazuje przyczyny, które doprowadziły w ostatnich 2-3 latach do nadmiernego obciążenia budżetu państwa. Analiza została przeprowadzona z uwzględnieniem obecnej i przyszłej sytuacji demograficznej w Polsce, oczekiwanego wzrostu PKB oraz koniunktury na rynkach kapitałowych. Porządek społeczny, stabilność polityczna i poziom konsumpcji w przyszłości w dużej mierze zależeć będą od popularności dobrowolnych systemów oszczędzania na emeryturę, stwierdzają autorzy. Jednak niska popularność IKE, czy też IKZE pokazuje, że upowszechnienie długoterminowego oszczędzania jest wyzwaniem, które należy podjąć jak najszybciej. Tylko ten system ma być podporządkowany interesom obecnych i przyszłych emerytów, a nie ich życiowe sprawy oczekiwaniom rynków finansowych – konkludują autorzy.Zmiany polegające na przeniesieniu części aktywów ulokowanych w instrumentach dłużnych Skarbu Państwa z OFE do FUS stały się pretekstem do ponownego otwarcia dyskusji o zaletach i wadach modelu kapitałowego i repartycyjnego. Artykuł zawiera analizę polskiej reformy od 1999 r., i jej wpływu na finanse publiczne oraz wskazuje przyczyny, które doprowadziły w ostatnich 2-3 latach do nadmiernego obciążenia budżetu państwa. Analiza została przeprowadzona z uwzględnieniem obecnej i przyszłej sytuacji demograficznej w Polsce, oczekiwanego wzrostu PKB oraz koniunktury na rynkach kapitałowych. Porządek społeczny, stabilność polityczna i poziom konsumpcji w przyszłości w dużej mierze zależeć będą od popularności dobrowolnych systemów oszczędzania na emeryturę, stwierdzają autorzy. Jednak niska popularność IKE, czy też IKZE pokazuje, że upowszechnienie długoterminowego oszczędzania jest wyzwaniem, które należy podjąć jak najszybciej. Tylko ten system ma być podporządkowany interesom obecnych i przyszłych emerytów, a nie ich życiowe sprawy oczekiwaniom rynków finansowych – konkludują autorzy

Resynchronization therapy transvenous approach in dextrocardia and congenitally corrected transposition of great arteries

Cardiac resynchronization therapy (CRT) is an acknowledged treatment for advanced heart failure in acquired dilated cardiomyopathy, resistant to pharmacotherapy. Although there are no therapeutic standards regarding heart failure originating from congenital heart defects with systemic right ventricle, a number of CRT implantations by transvenous approach in congenitally corrected transposition of the great arteries (CCTGA) have been reported since 2001, even though none of them expressly referred to a case concomitant with dextrocardia and situs inversus anomaly. We present a 57 year-old patient with dextrocardia and CCTGA, who underwent surgical closure of interatrial and interventricular septal defects at the age of 19, and in whom a VVI pacemaker was subsequently implanted at age 36. A three-lead CRT system was implanted by transvenous approach. Imaging techniques, including multi-slice computed tomography, targeted to pacing system and unusual anatomical relationships were applied. Within a 20-month follow-up, a significant improvement of functional NYHA class, systemic right ventricle ejection fraction and exercise capability were observed. Entirely transvenous CRT system implantation is feasible in patients with dextrocardia and CCTGA, and has substantial potential for long-term benefits. (Cardiol J 2010; 17, 5: 503-508

The Development of eServices in an Enlarged EU: eGovernment and eHealth in Poland

In 2005, IPTS launched a project which aimed to assess the developments in eGoverment, eHealth and eLearning in the 10 New Member States at national, and at cross-country level. At that time, the 10 New Member States were Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovenia and Slovakia. A report for each country was produced, describing its government and health systems and the role played by eGovernment and eHealth within these systems. Each report then analyzes, on the basis of desk research and expert interviews, the major achievements, shortcomings, drivers and barriers in the development of eGovernment and eHealth in one of the countries in question. This analysis provides the basis for the identification and discussion of national policy options to address the major challenges and to suggest R&D issues relevant to the needs of each country ¿ in this case, Poland. In addition to national monographs, the project has delivered a synthesis report, which offers an integrated view of the developments of each application domain in the New Member States. Furthermore, a prospective report looking across and beyond the development of the eGoverment, eHealth and eLearning areas has been developed to summarize policy challenges and options for the development of eServices and the Information Society towards the goals of Lisbon and i2010.JRC.J.4-Information Societ

Noninvasive assessment of liver status in adult patients after the Fontan procedure

A hemodynamic derangement in Fontan circulation causes liver pathology known as Fontan‑associated liver disease. Although liver biopsy is a standard for diagnosis of liver fibrosis, noninvasive methods are being developed, including shear wave elastography (SWE). We aimed to evaluate the degree of liver stiffness (LS) using SWE in patients with Fontan circulation in a long‑term follow‑up and to investigate a relationship between patient characteristics and LS. The study included 59 patients after the Fontan procedure. Clinical examinations and laboratory tests were performed. According to the stage of LS, patients were divided into 2 subgroups: group 1 (METAVIR stages F1 and F2) and group 2 (METAVIR stages F3 and F4). The ratio of aspartate transaminase to alanine transaminase, aspartate transaminase‑to‑platelet ratio index (APRI), fibrosis‑4 (FIB‑4) score, and Forns index were assessed. The median LS was 9.1 kPa (interquartile range, 3.9–18.5 kPa). Five patients (9%) demonstrated LS in stage F1; 14 (26%), F2; 28 (52%), F3; and 7 (13%), F4. Group 2 had significantly higher aspartate transaminase and γ‑glutamyltranspeptidase levels, APRI, FIB‑4, and Forns index, and lower platelet count than group 1. A canonical correlation analysis indicated that LS and thrombocytopenia were related to time from the Fontan procedure, age at procedure, and single ventricular ejection fraction. We showed that adult patients after the Fontan procedure develop liver dysfunction. Time from surgery, age at procedure, and single ventricular ejection fraction are related to the degree of LS assessed by SWE. Finally, SWE, APRI, Forns index, and FIB‑4 score may help assess the degree of liver fibrosis

Clinical classification of rare cardiac arrhythmogenic and conduction disorders, and rare arrhythmias

Rare cardiovascular diseases and disorders (RCDDs) constitute an important clinical problem, and their proper classification is crucial for expanding knowledge in the field of RCDDs. The aim of this paper is to provide an updated classification of rare arrhythmogenic and conduction disorders, and rare arrhythmias (RACDRAs). We performed a search for RACDRAs using the Orphanet inventory of rare diseases, which includes diseases with a prevalence of no more than 5 per 10 000 in the general population. We supplemented this with a search of PubMed and Scopus databases according to a wider definition proposed by the European Parliament and the Council of the European Union. RACDRAs are categorized into 2 groups, primary electrical disorders of the heart and arrhythmias in specific clinical settings. The first group is further divided into subgroups of major clinical presentation: disorders predisposing to supraventricular tachyarrhythmias, ventricular tachyarrhythmias, bradyarrhythmias, and others. The second group includes iatrogenic arrhythmias or heart rhythm disturbances related to medical treatment, arrhythmias associated with metabolic disorders, and others. We provide a classification of RACDRAs and supplement them with respective RCDDs codes. The clinical classification of RACDRAs may form a basis to facilitate research and progress in clinical practice, both in diagnostic and therapeutic approaches