86 research outputs found
Reimbursement of Healthcare Provided to Foreigners in the Czech Republic
No full textPředkládaná kvalifikační doktorská práce popisuje různé režimy úhrady zdravotních služeb čerpaných na území České republiky, a to státními příslušníky/pojištěnci jiných států. Pojednává o režimech úhrady nákladů jak podle českého vnitrostátního práva (zejm. zákona o veřejném zdravotní pojištění, jakož i dalších relevantních zákonů), tak i o režimech, které jsou zaváděny právem mezinárodním, popřípadě právem Evropské unie. Tato kvalifikační práce nepojednává o zdravotní turistice a čerpání zdravotních služeb plánovaných. První část práce se zaměřuje na vymezení základních pojmů, jejichž používání je pro další orientaci v textu důležité. Důraz je také kladen na různá specifika jednotlivých režimů čerpání zdravotních služeb, a to právě i s avizovaným mezinárodním přesahem. Čtenáři je tak postupně představena ucelená řada režimů, které jsou využívány v různých životních situacích cizinců při jejich pobytu či bydlišti1 na území ČR. Tam, kde je to možné, je uvedena i kvantifikace dopadů čerpání zdravotních služeb jednotlivými kategoriemi cizinců. Jako nejvýznamnější je uveden režim úhrady účastí v systému veřejného zdravotního pojištění, který nepokrývá pouze české občany, ale i státní příslušníky jiných států, a to po splnění zákonem předvídaných podmínek (popř. po splnění podmínek předvídaných právem...The presented qualification doctoral thesis describes various regimes of payment for health services provided in the territory of the Czech Republic to nationals of other countries. It describes various cost reimbursement regimes both under Czech national law (especially the Public Health Insurance Act, as well as other relevant legal acts), as well as regimes that are introduced by international law or the law of the European Union. This qualification thesis does not deal with health tourism and the use of planned health services. The first part of the thesis focuses on the definition of basic concepts, the use of which is important for further comprehension of the text. Emphasis is also placed on the various specificities of individual regimes of using health services, even with the above-mentioned international overlap. The reader is presented a comprehensive range of regimes that are used in various life situations of foreigners during their stay or residence1 in the Czech Republic. Where possible, the quantification of the impact of using health services by individual categories of foreigners is also given. The most important regime of payment for health services is being covered by the public health insurance system, which covers not only Czech citizens but also nationals of other states,...Ústav sociálního a posudkového lékařstvíLékařská fakulta v PlzniFaculty of Medicine in Pilse
Reimbursement of Healthcare Provided to Foreigners in the Czech Republic
No full textThe presented qualification doctoral thesis describes various regimes of payment for health services provided in the territory of the Czech Republic to nationals of other countries. It describes various cost reimbursement regimes both under Czech national law (especially the Public Health Insurance Act, as well as other relevant legal acts), as well as regimes that are introduced by international law or the law of the European Union. This qualification thesis does not deal with health tourism and the use of planned health services. The first part of the thesis focuses on the definition of basic concepts, the use of which is important for further comprehension of the text. Emphasis is also placed on the various specificities of individual regimes of using health services, even with the above-mentioned international overlap. The reader is presented a comprehensive range of regimes that are used in various life situations of foreigners during their stay or residence1 in the Czech Republic. Where possible, the quantification of the impact of using health services by individual categories of foreigners is also given. The most important regime of payment for health services is being covered by the public health insurance system, which covers not only Czech citizens but also nationals of other states,..
Parental attitudes towards mandatory vaccination of children
No full textDiplomová práce pojednává o problematice postojů rodičů k povinnému očkování dětí. Cílem práce byla analýza současných postojů rodičů k přijímání či odmítání povinného očkování dětí v České republice. Součástí praktické části diplomové práce bylo nastavené dotazníkové šetření, kterého se zúčastnilo 463 rodičů z ČR. Výsledky ukazují, že 90 % rodičů testovaného souboru očkuje své děti dle platného očkovacího kalendáře. Nízké procento rodičů a zákonných zástupců vyjádřilo svůj nesouhlas s očkováním. Rodiče své děti očkují především z důvodu obavy nákazy infekčním onemocněním. Bylo potvrzeno, že pozitivní vztah rodičů s pediatry má vliv na rozhodnutí rodičů o očkování svých dětí. Zároveň bylo zjištěno, že úroveň vzdělání nemá vliv na rozhodnutí o očkování dítěte povinnými vakcínami. Práce přispívá k lepšímu porozumění postojů rodičů k povinnému okování dětí a může najít své uplatnění v oblasti prevence jako podklad pro diskusi rodičů o důležitosti očkování a o významu komunikace mezi rodiči a pediatry.The thesis deals with the issue of parental attitudes towards mandatory vaccination of children. The aim of the study was to analyze current attitudes of parents towards accepting or refusing mandatory vaccination in the Czech Republic. The practical part of the thesis involved a questionnaire survey with the participation of 463 parents from Czech Republic. The results show that 90 % of the parents in the sample vaccinated their children according to the current vaccination schedule. A low percentage of parents expressed their disagreement with vaccination. Parent primarily vaccinate their children due to the fear of infectious diseases. It was confirmed that a positive relationship between parents and pediatricians influences parents’ decisions regarding vaccination. Furthermore, it was found that the level of education does not affect the decision to vaccinate a child with mandatory vaccines. The thesis contributes to a better understanding of parental attitudes towards mandatory vaccination of children and can be applied in the field of prevention as a basis for discussions among parents about the importance of vaccination and the significance of communication between parents and pediatricians
A phase 2 randomized controlled trial of a multicomponent meningococcal serogroup B vaccine (I): efects of prophylactic paracetamol on immunogenicity and reactogenicity of routine infant vaccines and 4CMenB
No full textThe novel meningococcal serogroup B vaccine (4CMenB, Bexsero®), recently approved in Europe and Australia, may soon be included in routine infant immunization schedules, subject to guidance from national or regional recommending bodies. In the development of 4CMenB and consistent with other newly introduced vaccines, clinical studies have shown concomitant administration with routine infant vaccines induces an incremental increase in some reactions, including fever. As this may hinder acceptability, we examined the impact of prophylactic paracetamol on the occurrence of fever and other solicited reactions, as well as the immune responses to study vaccines, in a prospectively designed study. 4CMenB was administered as a 4-dose series at 2, 3, 4, and 12 months of age concomitantly with routine infant vaccines: DTaP-HBV-IPV/Hib and PCV7, with or without prophylactic paracetamol; a third group received MenC vaccine. Immune responses to 4CMenB were not decreased by the use of paracetamol prophylaxis and there were no clinically relevant effects on immune responses to routine vaccines. Occurrence of fever was higher in infants co-administered with 4CMenB compared with those given MenC vaccine, but was significantly decreased by prophylactic paracetamol, as were other solicited reactions to vaccination, both local and systemic. Co-administration of 4CMenB had an acceptable tolerability profile, with no withdrawals due to vaccination-related adverse events. Inclusion of 4CMenB in routine infant immunization schedules will be a major advance in the control of meningococcal disease, and our study indicates that by using paracetamol prophylaxis, post-vaccination reactions are reduced without clinically relevant negative consequences on vaccine immunogenicity
The severity of influenza in the context of acute respiratory infections and climate
No full textDepartment of Epidemiology and Biostatistics 3FM CUÚstav epidemiologie a biostatistiky 3. LF UK3. lékařská fakultaThird Faculty of Medicin
A phase II randomized controlled trial of a multicomponent meningococcal serogroup B vaccine, 4CMenB, in infants (II) : effects of variations of the OMV and protein content on immunogenicity and reactogenicity
No full textThe licensed meningococcal serogroup B vaccine, 4CMenB (Bexsero(®)), contains recombinant membrane proteins (rMenB) and outer membrane vesicles (OMV) of the New Zealand serogroup B strain. We investigated whether reducing the OMV and/or protein content influences 4CMenB immunogenicity and reactogenicity in healthy two month-old infants. Six formulations were studied: 4CMenB, rMenB with 0, 1⁄4 or 1⁄2 the OMV dose in 4CMenB, a half-dose of 4CMenB or a prelicensure formulation of 4CMenB, as a 4-dose primary/booster series, concomitantly with routine vaccines (DTaP-HBV-IPV/Hib and 7-valent pneumococcal conjugate) at 2, 3, 4 and 12 months of age. Immunogenicity was assessed as serum bactericidal activity measured with human complement (hSBA) against indicator strains for Men B vaccine antigens before and after the 2,3,4-month series and 12-month dose. Parents recorded solicited reactions for 7 days after each vaccination, and any adverse events throughout the study period. All formulations elicited robust immune response against rMenB components at 5 months, there was some evidence of OMV and protein dose-dependence for Men B indicator strains tested. Titers waned up to the 12-month dose, which elicited further strong responses, which were still OMV and protein dose-dependent. Groups with no, or low-dose OMV displayed slightly lower reactogenicity profiles, but all formulations were generally well-tolerated, high fever was rare and transient, and only three transient SAEs were considered possibly vaccine-related. Decreasing or removing the OMV content reduced reactogenicity of 4CMenB to a certain extent, but had an unacceptable negative impact on the immunogenicity profile. Trial: Clinicaltrials.gov NCT00937521
Approaches to ensuring the quality of health care: management simulations for decision support
No full textProcesní management představuje v současnosti moderní přístup umožňující rozhodování na základě přesně stanovených indikátorů. Vhodným nástrojem k modelování procesů jsou pak zjednodušené explicitní modely vytvořené na základě metod systémové dynamiky. Tzv. SD-modely dokážou efektivně pracovat s entitami procházejícími daným systémem (např. pacienty) a spotřebovávajícími zdroje, které má systém k dispozici (finance, personál, zdravotnická technika, lůžka), přičemž lze využít různých specifických metodik pro správu front, sdílení zdrojů a práci se zpožděním. Vlastní problematika zajištění kvality zdravotní péče je komplexní téma a kombinuje celou řadu přístupů (strukturální, procesní, výsledkový, atd.) a to na makro úrovni zdravotnického systému i v rámci zdravotnických zařízení. Nicméně většina modelů sledování kvality ve zdravotnictví je založena na pragmatickém strukturálním přístupu sledování kvality, přičemž primárním cílem v dlouhodobém časovém horizontu zůstává bezpochyby zlepšení zdravotního stavu populace prostřednictvím dostupné a kvalitní zdravotní péče. Grossmanův model poptávky po zdraví představuje od doby svého publikování přijatelnou aproximaci chování jedince ve vztahu k formování poptávky po zdravotnických službách, nicméně zůstává ve své podstatě dynamickou optimalizační úlohou. Vysoká míra neurčitosti, komplexity a heterogenity prostředí zdravotnického systému bohužel nedovolila úspěšný převod modelu do rámce systémové dynamiky a vyžaduje celou řadu významných zjednodušení. Nicméně přes svá omezení zůstávají nejdůležitější implikace Grossmanova modelu v identifikaci významu celé řady faktorů na poptávku po zdraví a potažmo na celkový zdravotní stav jedince v platnosti. Z manažerského hlediska se přijatelnější variantou jeví paralelní aplikace modelů heterogenních, které využívají specifické výrazové techniky pro různé typy modelových situací nebo režimů, avšak v rámci jediného modelu. Dizertační práce představuje ve svém výsledku syntézu znalostí a přístupů z individuálních oblastí zdravotnické ekonomiky, kvality zdravotní péče a aplikované systémové dynamiky v podobě rámce pro manažerské rozhodování v oblasti zdravotnického managementu.Assuring the quality of healthcare is a very complex subject combining a variety of approaches (structural, process, result, etc.) on the macro-level of the health system as part of national health policy and even on micro-level in healthcare facilities. However, majority of models for monitoring the quality of health care is still based on a pragmatic approach to structural quality monitoring, with the primary aim to improve the health status of the population through affordable and quality healthcare in the long term. Michael Grossman's 1972 Grossman's concept on the health capital and the demand for health has been extremely influential in the field of healthcare economics. The model is based on human capital theory and is being introducing some novelty distinctive features, such as assumption that health can be seen as lasting over time periods - it depreciates and can therefore be analyzed as a capital good and of course that the demand for health care is a derived from the demand for health consists of two elements: consumption effect and investment effect. Unfortunately the high degree of uncertainty, complexity and environmental heterogeneity associated with health system unfortunately did not allow a smooth transfer of Grossmans model into the system dynamics frameworks. The use of management simulators in practice leads to higher rationality in decision making. Introduction of new methods, especially including methods based on system dynamics, helps in the way of shifting the empirical-intuitive decision to scientific decision-making. Heterogeneous multi-agent models of healthcare system allow realistic modeling of system environment and the interactions of entities operating on the healthcare market. These models can be also continuously "cultivated" using external data (demographic, economic, epidemiological, public-health, etc.) and consequently applied to solve alternative problems or scenarios. The thesis/dissertation presents its results as the synthesis of knowledge and approaches from individual areas of health economics, health care quality assurance and applied system dynamics as a framework -- or maybe a paradigm - for competent managerial decision making in health care management
Corrigendum to "Persistence of bactericidal antibodies following booster vaccination with 4CMenB at 12, 18 or 24months and immunogenicity of a fifth dose administered at 4years of age-a phase 3 extension to a randomised controlled trial" [Vaccine 35 (2017) 395-402].
No full text[no abstract
Persistence of bactericidal antibodies following booster vaccination with 4CMenB at 12, 18 or 24 months and immunogenicity of a fifth dose administered at 4 years of age-a phase 3 extension to a randomised controlled trial
No full textBackground4CMenB is immunogenic in infants and toddlers. We assessed persistence of human complement serum bactericidal activity (hSBA) following a fourth dose administered at 12, 18 or 24 months and characterised the antibody response to a fifth dose administered at 4 years of age.MethodsA phase 3, open label, multi-centre extension to a randomised controlled trial conducted in four countries (number of centres): Czech Republic (nineteen), Italy (four), Spain (four) and the United Kingdom (four). Four-year-old children who were either 4CMenB-naïve or had previously received a variety of 3-dose infant priming schedules and a booster vaccine as toddlers (follow-on group) were recruited. Venous blood samples were obtained to determine hSBA against four reference strains; acting as targets to assess immunity to each of the vaccine antigens, NadA (5/99), fHbp (H44/76), PorA (NZ98/254), and NHBA (M10713) at baseline (prior to vaccination, all participants) and one month following a dose of 4CMenB for all vaccine-naïve and follow-on participants primed with the 2, 3, 4 schedule, and a third of follow-on participants primed with a 2, 4, 6 month schedule.ResultsAt baseline (prior to vaccination), the proportion of participants (n = 468) with hSBA titers ⩾ 5 was similar across all followon groups: 89–100% against 5/99; 12–35% for H44/76; 8–12% for NZ98/254 and 53–80% for M10713 compared with 5%, 0%, 0%; and 60% respectively, for the vaccine-naïve controls (n = 206). Following a dose of 4CMenB at 4 years of age, this increased to 100% (5/99), 97–100% (H44/76), 80–95 % (NZ98/254) and 84–100% (M10713) (n = 210), compared with 89%, 70%, 24%, and 76% respectively for vaccine-naïve controls (n = 192).ConclusionWaning of protective antibodies occurred 12–36 months after toddler booster regardless of age at boost. This was least marked against target strains 5/99 and M10713. A robust memory response occurred after a booster dose given at 4 years of age
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