Privatisation and profitisation in health care. A comparative study of Sweden and the Netherlands

Κατά τα τελευταία 20 χρόνια, η ιδιωτικοποίησηαναδείχθηκε σε σημαντικό ζήτημα στον τομέα τηςυγείας. Η νεο-φιλελεύθερη ιδέα της αγοράς υποσχέθηκε να αυξήσει την αποτελεσματικότητα καιτην ανταπόκριση, μειώνοντας συγχρόνως την επιβάρυνση των δημόσιων προϋπολογισμών. Διάφορες Ευρωπαϊκές χώρες έχουν εισάγει όλα τα είδητων εργαλείων της αγοράς, τα οποία κυμαίνονταιαπό την εφαρμογή εσωτερικών αγορών, μέχρι τιςΟμοιογενείς Διαγνωστικές Κατηγορίες (DRGs) καιτην αύξηση των συν-πληρωμών. Ωστόσο, η υφιστάμενη βιβλιογραφία για το κράτος πρόνοιαςδεν διαθέτει μια αναλυτική επεξήγηση αυτών τωνμεταρρυθμίσεων. Όλα τα συστήματα φροντίδαςυγείας στην Ευρωπαϊκή Ένωση αντιμετωπίζουνπαρόμοια προβλήματα: δημογραφική αλλαγή, αύξηση της ζήτησης, ιατρο-τεχνολογικές καινοτομίεςκαι υπηρεσίες έντασης εργασίας. Παρ ‘όλα αυτά,ο βαθμός και η μορφή ιδιωτικοποίησης διαφέρειπολύ. Η παρούσα εργασία μελετά τη δύναμη τωνιδεών στο πλαίσιο των πιέσεων για διαρθρωτικέςμεταρρυθμίσεις και υπό την οπτική της θεωρίας τηςθεσμικής εξάρτησης. Οι αιτίες για τις μεταρρυθμι-στικές διαδικασίες ιδιωτικοποίησης εξετάζονταισε δύο χώρες που εκπροσωπούν τις δύο ιδεατούςτύπους συστημάτων υγείας: την Ολλανδία η οποίαέχει σύστημα κοινωνικής ασφάλισης υγείας και τηΣουηδία η οποία διαθέτει Εθνικό Σύστημα Υγείας.During the last 20 years, privatizationbecame an issue in health care. The neoliberalmarket idea promised to increaseefficiency and responsiveness, while at thesame time relieving public budgets. Europeancountries have introduced all kind of marketinstruments, reaching from internal markets,over DRGs, to increased co-payments.However, the welfare state literaturecurrently lacks a detailed explanation ofthese different reforms.All health care systems in the EuropeanUnion are affected by the same problempattern: demographic change, raisingdemand, medical-technical innovations andlabour intensive services. Nonetheless, thedegree and form of privatization varies a lot.This paper studies the power of ideas withinthe framework of structural reform pressureand institutional path-dependency. Thecauses for privatization reforms are studiedin two countries representing the two idealtypes: the Netherlands for Social HealthInsurance and Sweden for the NationalHealth Service

Role of Protein Kinase C, PI3-kinase and Tyrosine Kinase in Activation of MAP Kinase by Glucose and Agonists of G-protein Coupled Receptors in INS-1 Cells

MAP (mitogen-activated protein) kinase (also called Erk 1/2) plays a crucial role in cell proliferation and differentiation. Its impact on secretory events is less well established. The interplay of protein kinase C (PKC), PI3-kinase nd cellular tyrosine kinase with MAP kinase activity using inhibitors and compounds such as glucose, phorbol 12-myristate 13-acetate (PMA) and agonists of G-protein coupled receptors like gastrin releasing peptide (GRP), oxytocin (OT) and glucose-dependent insulinotropic peptide (GIP) was investigated in INS-1 cells, an insulin secreting cell line. MAP kinase activity was determined by using a peptide derived from the EGF receptor as a MAP kinase substrate and [ P 32 ]ATP. Glucose as well as GRP, OT and GIP exhibited a time-dependent increase in MAP kinase activity with a maximum at time point 2.5 min. All further experiments were performed using 2.5 min incubations. The flavone PD 098059 is known to bind to the inactive forms of MEK1 (MAPK/ERK-Kinase) thus preventing activation by upstream activators. 20 μM PD 098059 ( IC 50 =51 μM) inhibited MAP kinase stimulated by either glucose, GRP, OT, GIP or PMA. Inhibiton (“downregulation”) of PKC by a long term (22h) pretreatment with 1 μM PMA did not influence MAP kinase activity when augmented by either of the above mentioned compound. To investigate whether PI3-kinase and cellular tyrosine kinase are involved in G-protein mediated effects on MAP kinase, inhibitors were used: 100 nM wortmannin (PI3-kinase inhibitor) reduced the effects of GRP, OT and GIP but not that of PMA; 100 μM genistein (tyrosine kinase inhibitor) inhibited the stimulatory effect of either above mentioned compound on MAP kinase activation. Inhibition of MAP kinase by 20 μM PD 098059 did not influence insulin secretion modulated by either compound (glucose, GRP, OT or GIP). [ H 3 ]Thymidine incorporation, however, was severely inhibited by PD 098059. Thus MAP kinase is important for INS-1 cell proliferation but not for its insulin secretory response with respect to major initiators and modulators of insulin release. The data indicate that MAP kinase is active and under the control of MAP kinase. PKC is upstream of a genisteinsensitive tyrosine kinase and probably downstream of a PI3-kinase in INS-1 cells

The FK506 binding protein 13 kDa (FKBP13) interacts with the C-chain of complement C1q

BACKGROUND: The pharmacological action of specific immunosuppressants is mediated by immunophilins. While cyclosporin A binds to cyclophilins, FK506/tacrolimus, rapamycin, and others bind to FK506 binding proteins (FKBPs). Different physiological actions of immunophilins were described but their genuine function, however, remains elusive and is still under investigation. A yeast two-hybrid screen was performed using the FK506 binding protein 13 kDa (FKBP13) as a bait and a fetal liver expression library as a prey. RESULTS: The C-chain of complement C1q (C1q-C) was detected to interact with FKBP13 in the yeast two-hybrid system and in a protein complementation assay. Neither FKBP12, FKBP25, FKBP52 nor the unrelated immunophilin CypA did react with C1q-C in the yeast system stressing the specificity of the interaction. Binding of C1q-C to FKBP13 could not be prevented in the presence of FK506, demonstrating that possibly other regions than the binding pocket of the drug are responsible for the interaction of the two proteins. CONCLUSION: It is concluded that exclusively FKBP13 but no other FKBPs tested so far interact with the C-chain of complement C1q in the two different assays and further work will be initiated to investigate the physiological relevance of the interaction

Sustainability in German development cooperation: Meta-evaluation

This meta-evaluation ‘Sustainability in German development cooperation’ is part of DEval’s thematic focus on sustainability. The meta-evaluationis complemented by an accompanying evaluation synthesis. Linked by an integrated evaluation design, the two reports share a common database and pursue complementary objectives

Sustainability in German development cooperation: Evaluation synthesis

This evaluation synthesis 'Sustainability in German development cooperation' is part of DEval’s thematic focus on sustainability. The evaluation synthesis is supported by an accompanying meta-evaluation. Linked by an integrated evaluation design, the two reports share a common database and pursue complementary objectives

High-glutathione producing yeasts obtained by genetic improvement strategies: a focus on adaptive evolution approaches for novel wine strains

Glutathione (GSH) is the most abundant non-protein thiol in living organisms. Due to its important antioxidant role, it is widely used in medicine, as a food additive, and in the cosmetic industry. Recently, GSH has received growing attention in winemaking because of its ability to control oxidative spoilage damage and to protect various aromatic compounds. Indeed, GSH concentration in wine is highly variable and several factors are involved in its regulation, ranging from grape must to yeast fermentation activity. This short review aims at highlighting the common genetic strategies, useful for obtaining wine yeasts with enhanced GSH production, paying particular attention to the adaptive evolution approaches. Moreover, other strategies, such as random mutagenesis, metabolic engineering and hybridization have been briefly reviewed with a stress on both their strengths and weaknesses in terms of actual feasibility and acceptance by wine consumers