52 research outputs found
System controllingu w ochronie zdrowia
Z wprowadzenia: "Szósty rok funkcjonowania reformowanego od 1999 r. systemu opieki zdrowotnej nie
przyniósł oczekiwanych przez autorów reformy rezultatów. Zakładany początkowo
dopływ środków w wysokości 9,1% wartości składki ubezpieczenia społecznego gwarantował
zabezpieczenie świadczeń w zakresie podstawowej i specjalistycznej opieki
zdrowotnej na minimalnym poziomie. Kolejne decyzje, ograniczające napływ środków
do 7,8% stały się jedną z przyczyn zadłużania się samodzielnych ekonomicznie podmiotów
świadczących usługi medyczne. Do reformy systemu opieki zdrowotnej przystąpiono
bez wnikliwej oceny kosztów funkcjonowania wielu placówek ochrony
zdrowia oraz wyceny samych procedur medycznych. W trudnej sytuacji znalazły się
wysoko specjalistyczne jednostki (dawne wojewódzkie szpitale specjalistyczne, instytuty
centralne i resortowe oraz szpitale kliniczne), które zobligowane do świadczenia
procedur na najwyższym poziomie referencyjności lub leczenia chorych, np. z chorobami
nowotworowymi, wobec niedoszacowania tych procedur, stanęły przed koniecznością
zadłużania się lub odmowy leczenia."(...
Development and maturation of the immune system in preterm neonates : results from a whole genome expression study
To expand the knowledge about the consecutive expression of genes involved in the immune system development in preterm neonates and to verify if the environment changes the gene expression after birth we conducted a prospective study that included three cohorts: (A) extremely (gestational age (GA): 23–26 weeks; n=41), (B) very (GA: 27–29 weeks; n=39), and (C) moderately preterm infants (GA: 30–32 weeks; n=33). Blood samples were drawn from the study participants on the 5th and 28th day of life (DOL). The mRNA samples were evaluated for gene expression with the use of GeneChip Human Gene 1.0ST microarrays. Differential expression analysis revealed small subsets of genes that presented positive or negative monotone trends in both the 5th (138 genes) and 28th DOL (308 genes) in the three subgroups of patients. Based on pathway enrichment analysis, we found that most of the pathways that revealed a positive monotone trend were involved in host immunity. The most significantly GA dependent pathways were T-cell receptor signaling pathway and intestinal immune network for IgA production. Overall 4431 genes were differentially expressed between the 5th and 28th DOL. Despite differences in gestational age, patients with the same postconceptional age have a very similar expression of genes
Contemporary Dilemmas of Management
Praca recenzowana / Peer-reviewed paperThe presented publication contains the articles maintaining widely understood
problem of Organization Management. The notion of Management demands nowadays
to undertook the interpretation of many important questions, such as: the
way of influencing inferiors, the values commonly shared by random community,
importance of culture, role of information, communication problems as a source
of ideas concerning possible improvement of enterprise functioning effectiveness
and marketing actions
Mutations in the COL1A1 and COL1A2 genes associated with osteogenesis imperfecta (OI) types I or III
Although over 85% of osteogenesis imperfecta (OI) cases are associated with mutations in the procollagen type I genes (COL1A1 or COL1A2), no hot spots for the mutations were associated with particular clinical phenotypes. Eight patients that were studied here, diagnosed with OI by clinical standards, are from the Polish population with no ethnic background indicated. Previously unpublished mutations were found in six out of those eight patients. Genotypes for polymorphisms (Sp1 - rs1800012 and PvuII - rs412777), linked to bone formation and metabolism were determined. Mutations were found in exons 2, 22, 50 and in introns 13 and 51 of the COL1A1 gene. In COL1A2, one mutation was identified in exon 22. Deletion type mutations in COL1A1 that resulted in OI type I had no effect on collagen type I secretion, nor on its intracellular accumulation. Also, a single base substitution in I13 (c.904-9 G>T) was associated with the OI type I. The OI type III was associated with a single base change in I51 of COL1A1, possibly causing an exon skipping. Also, a missense mutation in COL1A2 changing Gly→Cys in the central part of the triple helical domain of the collagen type I molecule caused OI type III. It affected secretion of the heterotrimeric form of procollagen type I. However, no intracellular accumulation of procollagen chains could be detected. Mutation in COL1A2 affected its incorporation into procollagen type I. The results obtained shall help in genetic counseling of OI patients and provide a rational support for making informed, life important decisions by them and their families
Cell therapy of a patient with type III "Osteogenesis imperfecta" caused by mutation in COL1A2 gene and unstable collagen type I
Relationship between stereoscopic vision, visual perception, and microstructure changes of corpus callosum and occipital white matter in the 4-year-old very low birth weight children
Aim. To assess the relationship between stereoscopic vision, visual perception, and microstructure of the corpus callosum (CC) and occipital white matter, 61 children born with a mean birth weight of 1024 g (SD 270 g) were subjected to detailed ophthalmologic evaluation, Developmental Test of Visual Perception (DTVP-3), and diffusion tensor imaging (DTI) at the age of 4. Results. Abnormal stereoscopic vision was detected in 16 children. Children with abnormal stereoscopic vision had smaller CC (CC length: 53±6 mm versus 61±4 mm; p<0.01; estimated CC area: 314±106 mm2 versus 446±79 mm2; p<0.01) and lower fractional anisotropy (FA) values in CC (FA value of rostrum/genu: 0.7±0.09 versus 0.79±0.07; p<0.01; FA value of CC body: 0.74±0.13 versus 0.82±0.09; p=0.03). We found a significant correlation between DTVP-3 scores, CC size, and FA values in rostrum and body. This correlation was unrelated to retinopathy of prematurity. Conclusions. Visual perceptive dysfunction in ex-preterm children without major sequelae of prematurity depends on more subtle changes in the brain microstructure, including CC. Role of interhemispheric connections in visual perception might be more complex than previously anticipated
Comparative two time-point proteome analysis of the plasma from preterm infants with and without bronchopulmonary dysplasia
Background: In this study, we aimed to analyze differences in plasma protein abundances between infants with
and without bronchopulmonary dysplasia (BPD), to add new insights into a better understanding of the pathogenesis
of this disease.
Methods: Cord and peripheral blood of neonates (≤ 30 weeks gestational age) was drawn at birth and at the 36th
postmenstrual week (36 PMA), respectively. Blood samples were retrospectively subdivided into BPD(+) and BPD(−)
groups, according to the development of BPD.
Results: Children with BPD were characterized by decreased afamin, gelsolin and carboxypeptidase N subunit 2 levels
in cord blood, and decreased galectin-3 binding protein and hemoglobin subunit gamma-1 levels, as well as an
increased serotransferrin abundance in plasma at the 36 PMA.
Conclusions: BPD development is associated with the plasma proteome changes in preterm infants, adding further
evidence for the possible involvement of disturbances in vitamin E availability and impaired immunological processes
in the progression of prematurity pulmonary complications. Moreover, it also points to the differences in proteins
related to infection resistance and maintaining an adequate level of hematocrit in infants diagnosed with BPD
Assessment of long-term renal complications in extremely low birth weight children
We assessed the long-term renal complications in a regional cohort of extremely low birth weight (ELBW) children born in 2002–2004. The study group, comprising 78 children born as ELBW infants (88% of the available cohort), was evaluated with measurement of serum cystatin C, urinary albumin excretion, renal ultrasound, and 24-h ambulatory blood pressure measurements. The control group included 38 children born full-term selected from one general practice in the district. Study patients were evaluated at a mean age of 6.7 years, and had a median birthweight of 890 g (25th–75th percentile: 760–950 g) and a median gestational age of 27 weeks (25th–75th percentile: 26–29 weeks). Mean serum cystatin C levels were significantly higher (0.64 vs. 0.59 mg/l; p = 0.01) in the ELBW group. Hypertension was diagnosed in 8/78 ELBW and 2/38 of the control children (p = 0.5). Microalbuminuria (>20 mg/g of creatinine) was detected only in five ELBW children (p = 0.17). The mean renal volume was significantly lower in the ELBW group (absolute kidney volume 81 ml vs. 113 ml; p < 0.001, relative kidney volume 85 vs. 97%; p < 0.001). Abnormally small kidneys (<2/3 of predicted size) were detected in 19 ELBW and four control children (p = 0.08). Multivariate logistic regression revealed that the only independent risk factor for renal complications was weight gained during neonatal hospitalization (odds ratio: 0.67; 95% confidence interval: 0.39–0.94). Serum cystatin C and kidney volume are significantly lower in school-age ELBW children. It is important to include systematic renal evaluation in the follow-up programs of ELBW infants
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