Private Medical Centers Research Articles

Некоторые особенности развития миопии у детей школьного возраста

Purpose. To assess the risk factors for the development and progression of myopia in children attending schools in a large city and to determine the possibilities of its prevention on an outpatient basis. Material and Methods. The study includes 106 children attending schools in St. Petersburg (60 boys and 46 girls, 56.6% and 43.4%, respectively). The observation period was 3 years. All examinations were supplemented by questioning the parents of the examined children. Results. Most often, myopia was detected during a routine examination at school (58.5%). Primary visits more often took place in the city diagnostic centre (34%) and in private medical centres (34%). At the same time, families with one child more often visited the district polyclinic (50%), less often – the city diagnostic centre (43.7%), families with two children more often came to private medical centres (50%). When analyzing the questionnaire, it was revealed that a number of questions have prognostic significance for assessing the course of myopia. The subsequent analysis of these questions identified the most significant risk factors for the development and progression of myopia in school-age children. These factors were physical activity of a child and regulated daily routine. The study investigated the incidence of myopia in children with comorbid conditions. Pathology of the musculoskeletal system prevailed (42.3%) in children with mild myopia, while pathology of ENT organs prevailed in children with moderate myopia (33.3%), posture disorders (27.7%) and ARVI (22.2%). An analysis of the prognostic value of risk factors for the development and progression of myopia showed that the only statistically reliable factors were disorders of the child‘s daily routine and the absence of a permanent ophthalmologist. Conclusion. The primary detection of myopia in school children is more frequent (58.5%) during preventive examinations at school. Questionnaires from parents provide additional information on the risk factors for myopia development and progression in their children. Myopia disorders and lack of observation by a «permanent» ophthalmologist have the greatest impact on myopia, which should naturally be taken into account when working with children and their parents. Key words: myopia, progression, risk factors, questionnaires, schoolchildren.

Assessment of diagnostic criteria for the identification of central sensitization in patients with osteoarthritis pain: Results from a Delphi survey.

To assess diagnostic criteria and currently used tools for the identification of central sensitization (CS) in patients with joint pain due to osteoarthritis (OA).Qualitative, cross-sectional and multicenter study based on a 2-round Delphi surveyPublic and private medical centers attending patients with joint pain.A total of 113 specialists in traumatology, physical medicine and rehabilitation, pain management, rheumatology, primary care physicians and geriatrics were enrolled in the study.Participants completed an ad-hoc 26-item questionnaire available from a microsite in Internet.The questionnaire was divided into 6 sections with general data on CS, impact of CS in patients with knee osteoarthritis (KOA), diagnostic criteria for CS, non-pharmacological and pharmacological treatment of CS and usefulness of the concept of CS in the integral management of patients with KOA. Consensus was defined as 75% agreement.Diagnostic criteria included pain of disproportionate intensity to the radiological joint lesion (agreement 86.7%), poor response to usual analgesics (85.8%), progression of pain outside the site of the lesion (76.1%) and concurrent anxiety and depression (76.1%). Based on the opinion of the specialists, about 61% of patients with KOA present moderate-to-severe pain, 50% of them show poor response to conventional analgesics, and 40% poor clinical-radiological correlation. Patients with KOA and CS showed higher functional disability and impairment of quality of life than those without CS (88.5%) and have a poor prognosis of medical, rehabilitation and surgical treatment (86.7%). Early diagnosis and treatment of CS may preserve function and quality of life during all steps of the disease (90.3%).The management of patients with osteoarthritis pain and CS requires the consideration of the intensity of pain related to the joint lesion, response to analgesics, progression of pain to other areas and concurrent anxiety and depression to establish an adequate therapeutic approach based on diagnostic criteria of CS.

COVID-19 specialized diabetes clinic model for excellence in diabetes care: scientific perspective

While diabetes centers are well established by the Ministry of Health, there is no separate specialized diabetes clinics for COVID-19 patients (SDCs). There are several clinical diabetes centers throughout the Kingdom of Saudi Arabia, several of which have been developed through philanthropy funding; nevertheless, it is not obvious what distinguishes SDCs from a therapeutic viewpoint and what the potential would be for such centers. Through this context, we suggest a structure to direct the progress of SDCs. Defining protocols for wider adoption of SDCs as a means to enhance public safety and COVID-19 patient care efficiency (including consistency and satisfaction) and minimize health care expenses becomes increasingly essential when moving towards value-based sales and reimbursements away from service charges. It is wise to introduce innovative financial mechanisms to pay for diabetes that cannot be covered by fiscally limited private and university medical centers. We foresee potential clinical SDCs to be made up of a well-defined framework and six areas or foundations that act as basic guiding principles for the advancement of diabetes treatment skills that can be easily illustrated by stakeholders, including insurance facilities, consumers, payers and government departments.

The medical social characteristic of patients of private stomatological clinics

The article deals with results of anonymous questionnaire survey of patient in private dental clinics "LiderDent" (241 respondents of able-bodied age) and "GelioDent" (419 respondents of able-bodied age). The purpose of the study was to investigate peculiarities of medical and social characteristics. The questionnaire included questions concerning social status of respondents, their financial condition, self-assessment of dental health and its maintenance at the proper level for a number of parameters, as well as evaluation of work of private dental organizations. The assessment of dental health of elderly patients established that 58.1% of respondents rated their dental health as good, 27.8% as satisfactory; and 4.1% of respondents estimated their dental health as bad. The analysis included also evaluation of negative health habits of respondents resulting in dental diseases and afflict damage to teeth and oral cavity. It was found that more than half of respondents had higher education. They consider themselves as financially secure, they did not smoke and had good condition of oral cavity. They choose dentists according recommendation of friends and seek dental care only in case of obvious signs of disease. The analysis of possible reasons for seeking dental professional revealed that 75.5% of respondents seek dental care when there are "obvious signs of disease and deterioration of health", 21.2% "when first signs of disease occurred" and 3.3% "only in critical situation". It is concluded that dental professional of private medical centers should be more widely carried out sanitary and educational work with population in order to increase the medical activity of patient, as well as to increase their awareness of ways and means of maintaining the dental health.

Searching for the optimal population for hepatitis C virus screening in Poland

Aim of the studyThe purpose of the study was to select the optimal target population for a possible national hepatitis C virus (HCV) screening program in Poland, based on the most recent available data.Material and methodsThe analysis included 723,654 participants from different populations screened for anti-HCV. Testing was performed in the whole blood using rapid anti-HCV kits. Presence of HCV RNA was additionally demonstrated in some anti-HCV positive patients with the real-time polymerase chain reaction method.ResultsAltogether 3,548 anti-HCV positive individuals were identified, so the prevalence rate in the whole studied population was 0.5%. The highest percentage (1.2%) was shown by diagnostic laboratories, which offered rapid testing for patients visiting their offices during the HCV awareness campaign. Relatively high anti-HCV prevalence of 0.6-0.7% was noted in hospitals and in private medical centers, as well as during music concerts. Surprisingly, the lowest prevalence (0.2%) was observed in general practitioners’ offices. Among 502 anti-HCV positive individuals tested additionally for HCV RNA, viremic presence was demonstrated in 40%.ConclusionsAnti-HCV testing in Poland should be carried out using rapid anti-HCV kits at the patients’ admission to the hospitals and should also be offered to patients during their visits for any purpose in diagnostic laboratories or private medical centers.

Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants

Umbilical cord milking as an alternative to delayed umbilical cord clamping may provide equivalent benefits to preterm infants, but without delaying resuscitation. To determine whether the rates of death or severe intraventricular hemorrhage differ among preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping. Noninferiority randomized clinical trial of preterm infants (born at 23-31 weeks' gestation) from 9 university and private medical centers in 4 countries were recruited and enrolled between June 2017 and September 2018. Planned enrollment was 750 per group. However, a safety signal comprising an imbalance in the number of severe intraventricular hemorrhage events by study group was observed at the first interim analysis; enrollment was stopped based on recommendations from the data and safety monitoring board. The planned noninferiority analysis could not be conducted and a post hoc comparison was performed instead. Final date of follow-up was December 2018. Participants were randomized to umbilical cord milking (n = 236) or delayed umbilical cord clamping (n = 238). The primary outcome was a composite of death or severe intraventricular hemorrhage to determine noninferiority of umbilical cord milking with a 1% noninferiority margin. Among 540 infants randomized, 474 (88%) were enrolled and completed the trial (mean gestational age of 28 weeks; 46% female). Twelve percent (29/236) of the umbilical cord milking group died or developed severe intraventricular hemorrhage compared with 8% (20/238) of the delayed umbilical cord clamping group (risk difference, 4% [95% CI, -2% to 9%]; P = .16). Although there was no statistically significant difference in death, severe intraventricular hemorrhage was statistically significantly higher in the umbilical cord milking group than in the delayed umbilical cord clamping group (8% [20/236] vs 3% [8/238], respectively; risk difference, 5% [95% CI, 1% to 9%]; P = .02). The test for interaction between gestational age strata and treatment group was significant for severe intraventricular hemorrhage only (P = .003); among infants born at 23 to 27 weeks' gestation, severe intraventricular hemorrhage was statistically significantly higher with umbilical cord milking than with delayed umbilical cord clamping (22% [20/93] vs 6% [5/89], respectively; risk difference, 16% [95% CI, 6% to 26%]; P = .002). In this post hoc analysis of a prematurely terminated randomized clinical trial of umbilical cord milking vs delayed umbilical cord clamping among preterm infants born at less than 32 weeks' gestation, there was no statistically significant difference in the rate of a composite outcome of death or severe intraventricular hemorrhage, but there was a statistically significantly higher rate of severe intraventricular hemorrhage in the umbilical cord milking group. The early study termination and resulting post hoc nature of the analyses preclude definitive conclusions. ClinicalTrials.gov Identifier: NCT03019367.

The Israel National Bariatric Surgery Registry: the inception process.

Obesity rates in Israel are increasing, and so is the popularity of bariatric surgeries, which reached in 2017 a prevalence rate of 1428.7 surgeries per million citizens. However, data regarding patient characteristics and surgery outcomes, including complications, are limited and the procedure requires monitoring. To establish a national bariatric surgery registry with high reliability and validity. All private and public medical centers performing bariatric surgeries in the state of Israel. The Israeli Bariatric Surgery Registry (IBSR) was established in June 2013 by the Israel Center for Disease Control in the Ministry of Health, in collaboration with the Israel Bariatric Surgery Society. An official directive of the Director General of the Ministry of Health as of 2013 made reporting of all bariatric surgeries carried out in Israel mandatory. The bariatric surgery centers relay clinical and surgical information to the IBSR. Presurgery and follow-up outcome information was retrieved from all 4 health maintenance organizations. All 32 certified bariatric units report to the national IBSR. National reporting rates increased from 46.3% in 2013 to 98.7% in 2017. Adherence to bariatric surgery guidelines also increased from 72.8% in 2013 to 98.7% in 2017, and fewer patients not fulfilling the guidelines underwent bariatric surgeries in 2017. Importantly, the considerable annual preregistry increase in surgical procedures has been halted. Registry data regarding obesity-related co-morbidities were validated against hospital files with high Cohen's kappa coefficients for hypertension (r = .8), diabetes (r = .8), and sleep apnea (r = .7). The national IBSR is an identified, validated, mandatory database with access to other national databases, which enables quality assurance of bariatric surgeries in Israel and short- and long-term postoperative follow-up.

A novel model for evaluation Hospital medical care systems based on plithogenic sets.

This research suggests an approach constructed on the connotation of plithogenic theory and VIKOR (VIseKriterijumska Optimizacija I Kompromisno Resenje) technique to come up with a methodical procedure to assess the infirmary serving under a framework of plithogenic theory, where the ambiguity, incomplete information, qualitative information, approximate evaluation, imprecision and uncertainty are addressed with semantic expressions determined by plithogenic numbers and computing of contradiction degrees of attribute values. This research stratifies the plithogenic multi criteria decision making (MCDM) strategy for defining the significant weights of assessing standards, and the VIKOR technique is applied for enhancing the serving efficiency classifications of the possible substitutes. An experimental issue, including 11 assessing standards, 3 private and 2 general hospitals in Zagazig, has been evaluated by 3 assessors from several areas of medical activities, asked to validate the suggested strategy. In this research, we give some definitions of the plithogenic environment, which is more general and comprehensive than fuzzy, intuitionistic fuzzy and neutrosophic ones. The plithogeny is interested in the contradiction degrees between attribute values that help in better calculating the aggregations. We conducted the data analysis and the results showed us that the serving efficiency of private medical centers is superior than that of general medical centers due to the fact that public medical centers are scarcely supported by governmental institutions. The private medical centers have to ward themselves to keep possession of bringing patients or attract patients. We conducted the sensitivity analysis of the achieved results, to verify their validity, and to find out to what extent the different values affect the ranking of available alternatives.

Overview of the current electrophysiology (EP) state of affairs in Russia.

Russia is the largest country in the world based on the landmass, covering more than one-eighth of the earth's inhabited area. Russia faces challenges in electrophysiology (EP) care including insufficient and uneven financing, complicated system for identifying optimal treatment for individual patients, relative paucity of reasonable educational and certification scope for electrophysiologists, suboptimal national statistical data gathering regarding heart rhythm disorders and EP devices in use, and weak networking of medical information. In comparison with the average level of EP utilization in ESC countries, Russia utilizes around 50% in pacemaker; 10% in ICD; 8% in cardiac resynchronization therapy; 55% in ablations; and 45% in AF ablations. As projected, Russia has the biggest unmet demand in EP procedures, so-called developmental potential in the European region. Nearly 37% of implanted single-chamber and 63% dual-chamber devices are manufactured outside of Russia. The price of the Russian devices is slightly (by 10-20%) lower than the one imported and they are readily provided for patients by the Russian Ministry of Health. Based on the analysis of the data available, we suggest some strategies for the improvement of the EP care in Russia. Solutions include the institution of formal EP education and standardization of it, development of international educational, and scientific collaboration; implementation quality-assessment tools for professional knowledge and skills; wide application of national medical databases and collection of heart rhythm disorders' statistics; growth of financial support of electrophysiology and transparent distribution of financing between state/municipal and private medical centers; enhancement of medical care accessibility countrywide; development of technologies for local EP devices production; and collection of data regarding usage and effectiveness of it.

Otologic surgery in private medical centers

One-day otological surgery has become more and more ap­pealing as numerous medical centers with modern diag­nostic and treatment capacity were established. The authors present their 12 years and 8 months of ex­pe­rience in two private medical centers, where they per­formed a variety of surgical procedures involving the ex­ter­nal and middle ear. They present the most frequently ad­dres­sed conditions, the surgical techniques and a few con­clu­sions useful for the wannabe otological surgeons.

Опыт использования методов неконвенциональной медицины в медицинском центре г. Якутска (кейс-стади)

В статье рассматривается опыт использования традиционных медицинских систем (тибетской и китайской медицины) российскими и иностранными специалистами в Якутии на примере одного из специализированных центров в г. Якутске — Центра комплементарной медицины и спа «Канти». Сделан сопоставительный анализ особенностей функционирования неконвенциональной медицины в Якутии и Туве. Материалы статьи подаются в виде ситуации (определенного кейса), которую автор проанализирует с разных точек зрения. Источниковая база: полевые материалы автора, собранные в 2017 г. в г. Якутске. Респондентами выступили руководитель центра и один из его врачей. Привлекаются материалы СМИ, анализируется нормативно-правовая база.Сегодня в Якутске работает 25 частных медицинских клиник и центров, большинство из которых многопрофильные. В центре «Канти» работают 20 штатных сотрудников и 8 совместителей, в том числе 9 врачей и 7 специалистов со средним медицинским образованием. Центр имеет лицензии по 10 видам профессиональной деятельности. Внедряются элементы комплементарной медицины: китайская, тибетская медицина, аюрведа и др., которые пользуются спросом у населения Якутии. Приведены биографии практикующих врачей, описаны методы работы. Популярность интегративных клиник в г. Якутске автор связывает с малой доступностью качественной бесплатной медицинской помощи, рекламой в СМИ, доверием к практике восточной медицины и наличием ее в местных центрах.Предлагаемые услуги неконвенциональной медицины в Якутии ориентированы исключительно на федеральную правовую базу, в отличие от Республики Тыва. В Туве в настоящее время учтены потребности местного населения в использовании традиционной и народной медицины, духовного целительства — введен дополнительный подзаконный акт о применении «народной медицины» (согласно статье 50 Закона об охране здоровья граждан РФ). Такие законодательные уточнения рассматриваются как важные элементы конструирования системы здравоохранения в различных регионах РФ.

Assessment of emotional intelligence in medical university staff in Ardabil: Northwest of Iran

Background: Emotional intelligence is one of the most important factors for the job and social success of individuals that is necessary for effective performance of all employees working in different governmental and private sectors, medical centers, factories and others. The aim of this study was to investigate the Emotional Intelligence (EI) in Ardabil University staff.Methods: This cross-sectional descriptive study was done on 150 staff employed in Ardabil University of Medical Sciences which selected randomly. Data collected by Goleman EI questionnaire and analysed by statistical descriptive methods in SPSS.19.Results: The mean age of samples was 7.6±40.8 and 56% of samples were male. 93.3% of samples had university degree. The EI of most of employees with 68% were in moderate level.Conclusions: Conducting appropriate and effective training courses on emotional intelligence can be very effective in promoting job success, social success, and better interaction between staff and people.

International telecytology: Current applications and future potential.

International telecytology can improve patient care by increasing access to regional and international expertise in cytopathology. The majority of international telecytology studies published to date have been based on static telepathology platforms. Overall concordance rates for these studies ranged from 71% to 93%. This is comparable to the concordance rates published for other studies comparing diagnoses made by digital still images to reference glass slides, which vary from 80% to 95%. Static telepathology systems are relatively cheap and easy to use, and have the potential to increase access to international experts in developing countries with limited resources. In contrast, resource-rich academic and private medical centers can use whole slide digital imaging (WSI) for telecytology consultation, though few studies have been published addressing this topic. International telepathology consultation services with digital whole slide image capabilities have been established at several academic medical centers including the University of Pittsburgh Medical Center (UPMC) and the University of California at Los Angeles (UCLA), through the UCLA Center for Telepathology and Digital Pathology. In a small series of 20 telecytology cases submitted to UCLA from 2014 to 2017 (10 gynecologic and 10 fine needle aspiration cases), a meaningful diagnosis was rendered for 100% of cases, with 100% concordance between the submitting institution, versus consultation diagnosis provided by UCLA. These limited results are promising, and in the future both WSI and static telecytology consultation may have a place serving clinical needs in different practice settings.

Incidence and Risk Factors for Mortality Following Bariatric Surgery: a Nationwide Registry Study.

Although bariatric surgery (BS) is considered safe, concern remains regarding severe post-operative adverse events and mortality. Using a national BS registry, the aim of this study was to assess the incidence, etiologies, and risk factors for mortality following BS. Prospective data from the National Registry of Bariatric Surgery in Israel (NRBS) including age, gender, BMI, comorbidities, and surgical procedure information were collected for all patients who underwent BS in Israel between June 2013 and June 2016. The primary study outcome was the 3.5-year post-BS mortality rate, obtained by cross-referencing with the Israel population registry. Of the 28,755 patients analyzed (67.3% females, mean age 42.0 ± 12.5years, and preoperative BMI 42.14 ± 5.21kg/m2), 76% underwent sleeve gastrectomy (SG), 99.1% of the surgeries were performed laparoscopically, and 50.8% of the surgeries were performed in private medical centers. Overall, 95 deaths occurred during the study period (146.9/100,000 person years). The 30-day rate of post-operative mortality was 0.04% (n= 12). Male gender (HR = 1.94, 95%CI 1.16-3.25), age (HR = 1.06, 95%CI 1.04-1.09), BMI (HR = 1.08, 95%CI 1.05-1.11), and depression (HR = 2.38, 95%CI 1.25-4.52) were independently associated with an increased risk of all-cause 3.5-year mortality, while married status (HR = 0.43, 95%CI 0.26-0.71) was associated with a decreased risk. Mortality after BS is low. Nevertheless, a variety of risk factors including male gender, advanced age, unmarried status, higher BMI, and preoperative depressive disorder were associated with higher mortality rates. Special attention should be given to these "at-risk" BS patients.

Clinical efficacy of implementing Bio Immune(G)ene MEDicine in the treatment of chronic asthma with the objective of reducing or removing effectively corticosteroid therapy: A novel approach and promising results.

Asthma is one of the diseases that demonstrates a wide range of variation in its clinical expression, in addition to an important heterogeneity in the pathophysiological mechanisms present in each case. The ever-increasing knowledge of the molecular signalling routes and the development of the Bio Immune(G)ene Medicine [BI(G)MED] therapy in line with this knowledge has revealed a whole novel potential set of self-regulation biological molecules, that may be used to promote the physiological immunogenic self-regulation mechanisms and re-establish the homeostatic balance at a genomic, proteomic and cellular level. The aim of the present study is to demonstrate that the sublingual use of a therapeutic protocol based on BI(G)MED regulatory BIMUREGs in the treatment of chronic asthma may reduce or suppress corticosteroid therapy and avoid its harmful side effects which some patients suffer when using this treatment on a long-term basis. The clinical efficacy of BI(G)MED for chronic asthma was evaluated through a multi-centre study carried out in 2016 implementing a 6-month BI(G)MED treatment protocol for Bronchial Asthma. A total of 61 patients from private medical centres and of European countries including Germany, Austria, France, Belgium and Spain participated. The manuscript describes in detail the clinical efficacy of Bio Immune(G)ene regulatory BI(G)MED treatment protocol that allows the reduction or total removal of the corticosteroid dose in patients with chronic asthma. No adverse reactions were observed. The BI(G)MED regulatory therapy brings novel therapeutic possibilities as an effective and safe treatment of chronic asthma. BI(G)MED was demonstrated to significantly reduce asthma severity when parameter compositions were all analysed by categorical outcomes. Therefore, it is considered a good therapeutic alternative for patients who respond poorly to steroids.

“Kyrgyz Clinics” in Moscow: Medical Centers for Central Asian Migrants

ABSTRACTSocial isolation limits migrants’ access to health care, providing the context for the emergence of migrants’ own medical infrastructure. In this article, we explore the so-called Kyrgyz clinics, private medical centers in Moscow founded by doctors from Kyrgyzstan and targeted specifically for labor migrants from Central Asian countries, particularly Kyrgyzstan, Uzbekistan, and Tajikistan. These Kyrgyz clinics both provide affordable medical services and enable migrant doctors to guide migrant patients through Russia’s medical infrastructure, in the context of limited resources, lack of health insurance, low awareness of available services, and other barriers to care.

Clinical Diabetes Centers of Excellence: A Model for Future Adult Diabetes Care.

Although diabetes research centers are well defined by National Institutes of Health, there is no clear definition for clinical Diabetes Centers of Excellence (DCOEs). There are multiple clinical diabetes centers across the United States, some established with philanthropic funding; however, it is not clear what defines a DCOE from a clinical perspective and what the future will be for these centers. In this Perspective we propose a framework to guide advancement for DCOEs. With the shift toward value-based purchasing and reimbursement and away from fee for service, defining the procedures for broader implementation of DCOEs as a way to improve population health and patient care experience (including quality and satisfaction) and reduce health care costs becomes critically important. It is prudent to implement new financial systems for compensating diabetes care that may not be provided by fiscally constrained private and academic medical centers. We envision that future clinical DCOEs would be composed of a well-defined infrastructure and six domains or pillars serving as the general guiding principles for developing expertise in diabetes care that can be readily demonstrated to stakeholders, including health care providers, patients, payers, and government agencies.

English

This study was carried out to describe the male or female original causes of infertility among couples and the semen quality among men attending fertility clinics. A descriptive cross-sectional study was conducted with a retrospective data collection from 2003 to 2012. From 14 to 18th January, 6 982 patients were included and analyzed 6642 patients’ data from 15 private and public medical centres in Ouagadougou, Burkina Faso. The mean age was 36.4 (95% CI: 35.3, 37.6), 30.0 (95% CI: 29.6, 30.4) and 29.6 (95% CI: 29.4, 29.8) for men, infertile and fertile women, respectively. The origin of the infertility was related to female or male factor in 25.1 and 7.7% of the cases, respectively while unexplained infertility represented 62.5% of the cases. The trend of the male infertility had a slight but steady increase over the last years of the study. Regarding semen quality, the male-factor infertility was more associated with the sperm quality (morphology, motility and vitality) than the spermatozoa count or the volume. Our findings tended to confirm that male infertility is increasing. Prospective studies are needed to investigate the specificities of infertility in Burkina Faso as well as the different partners’ contribution to this. Key words: Infertility, semen quality, prevalence, sub-Sahara Africa, Burkina Faso.

The healthcare system and the provision of oral healthcare in European Union Member States. Part 6: Poland.

Poland is one of the largest European countries in terms of area and population. The country's economic situation does not allow for the allocation of sufficient public funds for healthcare in general and oral healthcare in particular. The health policy of the state focuses primarily on prophylaxis and treatment of diseases, directly threatening the health and lives of the inhabitants. Currently, expenditure on oral health accounts for only 2.7% of the public funds allocated to healthcare. In this context, providing oral care financed from public funds at an appropriate level constitutes a challenge for state institutions, centres providing medical and dental services and private practices. Despite difficult financial conditions in Poland, therapeutic and prophylactic programmes are implemented, aimed at improving the oral health of the society, especially children and adolescents, pregnant women and patients with disabilities or developmental disorders such as cleft palate. In Poland, apart from the oral care system financed by the state, there is also an extremely well developed system of private practices and clinics providing clinical services on a commercial basis. In 2014, oral services, financed by the state, were utilised by about 30% of the population of children and youths aged 0-18 years (2,212,792 patients) and about 15% of the adult population (5,026,383 patients). Training of Polish dentists is conducted in ten state-owned universities, from which 700 graduate each year. Dentists work mainly in private practices or medical centres, some of which provide services guaranteed by the public insurer - the National Health Fund. The other dentists find employment in state clinics, hospitals, and universities and their associated clinics. In Poland dentistry is a predominantly female profession and 75% of the just over 40,000 Polish dentists are female. Accession of Poland to the European Union meant that some Polish dentists have taken up employment abroad. It is estimated that the most common destination is the United Kingdom (UK), where 803 Polish dentists were registered, according to the General Dental Council in 2015.

A Randomized Controlled Multicenter US Food and Drug Administration Trial of the Safety and Efficacy of the Minerva Endometrial Ablation System: One-Year Follow-Up Results

Study ObjectiveTo assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatment of heavy menstrual bleeding in premenopausal women. DesignMulticenter, randomized, controlled, international study (Canadian Task Force classification I). SettingThirteen academic and private medical centers. PatientsPremenopausal women (n = 153) suffering from heavy menstrual bleeding (PALM-COEIN: E, O). InterventionPatients were treated using the Minerva Endometrial Ablation System or rollerball ablation. Measurements and Main ResultsAt 1-year post-treatment, study success (alkaline hematin ≤80 mL) was observed in 93.1% of Minerva subjects and 80.4% of rollerball subjects with amenorrhea reported by 71.6% and 49% of subjects, respectively. The mean procedure times were 3.1 minutes for Minerva and 17.2 minutes for rollerball. There were no intraoperative adverse events and/or complications reported. ConclusionThe results of this multicenter randomized controlled trial demonstrate that at the 12-month follow-up, the Minerva procedure produces statistically significantly higher rates of success, amenorrhea, and patient satisfaction as well as a shorter procedure time when compared with the historic criterion standard of rollerball ablation. Safety results were excellent and similar for both procedures.