[Increased financial risks for health insurers: a challenge for providers of mental health care in the Netherlands]. / Zorginkoop en geestelijke gezondheidszorg.

BACKGROUND: As from 2014 Dutch health insurance companies will bear the full financial risk for their clients in mental health care. Over the next years the existing risk settlement shared between insurance companies will gradually be brought to a close. Municipalities and the Ministry of Justice are already responsible for or will soon become responsible for financing health care for adolescents, patients with severe psychiatric disorders and forensic psychiatric patients. As a result, the health insurance companies are beginning to impose ever stricter conditions regarding the care 'product' they are 'buying'. AIM: To study the possible consequences, for mental health care institutions, of the increased risk to be borne by health care insurers. METHOD: Use was made of relevant marketing literature and literature relating to mental health care. RESULTS: Studies of Dutch mental health care literature indicate that in the future the purchasing procedure will no longer consider the immediate treatment outcome as the sole performance indicator but will also take into account additional factors such as long-term improvements in patients' health, customer satisfaction and degree of patient participation, patient empowerment and autonomy. CONCLUSION: In formulating the details of their health products and business strategies, health care providers will now have to take into account not only the efficacy of the treatment they provide but also the purchasing policy and strategy of the health insurance companies.

Peroxisomes and peroxisomal enzymes in the human fetal small intestine.

The appearance and development of peroxisomes and the expression of their enzymes in the human fetal intestine have been investigated between 11 and 22 weeks of gestation. In the youngest samples (11-16 weeks of age), cytochemistry at the ultrastructural level revealed the presence of rare, mostly circular peroxisomes. From 16 weeks of gestation onwards, an increase was noted in the number of peroxisomes. Two peroxisomal types were distinguished: round to oval forms and elongated and/or tailed organelles. Biochemical assays revealed that total and specific intestinal catalase activities increased gradually between 11 and 20 weeks of gestation. The activity of fatty acylCoA oxidase, the first enzyme of the peroxisomal beta-oxidation system, was detectable as early as 11 weeks of gestation. Thereafter, total and specific activities of the enzyme increased steadily. Activities of other peroxisomal oxidases (D-amino acid oxidase, L-alpha-hydroxyacid oxidase) appeared more slowly in the fetal intestine during the period studied. This investigation establishes the presence and the morphological changes that occur in intestinal peroxisomes during human fetal development as well as the developmental patterns of associated enzymes.

Peroxisome through cell differentiation and neoplasia.

Peroxisomes are essential in cellular metabolism as their dysgenesis or defects in single enzymes or impairment of multiple peroxisomal enzymatic functions have been found in several inherited metabolic diseases with serious clinical sequelae. The assembly and formation of these cytoplasmic organelles constitute a major and intriguing research topic. In the present study the biogenesis of peroxisomes and the developmental patterns of their enzymes have been reviewed during embryonic and/or post-embryonic ontogenesis of lower (amphibians) and higher (avians, mammals) vertebrates. In developing vertebrates, epithelial cell differentiation is accompanied by increases in frequency and size of peroxisomes. The tissue-specific expression of peroxisomal enzymes contributes substantially to the biochemical maturation of epithelial cells. The relationship between biogenesis of peroxisomes, expression of peroxisomal enzymes and structural and functional cellular phenotype has also been investigated in differentiating epithelial cells along the crypt-villus axis of the adult rat intestine. Cytochemical studies at the ultrastructural level have provided evidence that peroxisomes are already present in proliferating cells of the intestinal crypt region before they begin to differentiate. Migration and differentiation of intestinal epithelial cells from crypt to villus compartments are marked by significant increases in number and size of catalase-positive structures. Increasing activity gradients from crypt to surface areas are found for the peroxisomal oxidases examined (enzymes of the peroxisomal beta-oxidation system, D-amino acid oxidase and polyamine oxidase). Thus, peroxisomes are more and more involved in oxidative metabolic pathways as intestinal epithelial cells differentiate. Finally, we have analyzed the peroxisomal behaviour in human neoplastic epithelial cells. The presence of peroxisomes has been cytochemically revealed in human breast and colon carcinomas. Peroxisomal enzyme specific activities are significantly lower in human breast and colon carcinomas than in the adjacent healthy mucosa. Furthermore, a relationship is found between the specific activities of some peroxisomal enzymes and the histological tumour grades.

Demonstration by immunocytochemical staining of a somatostatin-28-(1-14)-like peptide in planarians (Plathyhelminthes Turbellaria Tricladida).

A specific polyclonal antiserum directed against the somatostatin-28(1-14) of vertebrates was applied to sections of the planarians Dugesia lugubris and Dendrocoelum lacteum. This made it possible to reveal nerve cells and processes specifically both in cerebral ganglia and in ventral nerve cords. The phylogenetic importance of this demonstration is pointed out.

Development of the vertebrate small intestine and mechanisms of cell differentiation.

The intestinal epithelium represents an attractive biological model of differentiation from stem cells to highly differentiated epithelial cells, not only during particular developmental events depending upon the vertebrate species considered but also throughout adult life. The ontogenic maturation of the intestinal epithelium arises from both a programmed expression of specific genes and epigenetic influences mainly due to epithelial and mesenchymal interactions and hormonal participation. In the present paper we review the structural and functional changes that occur in the amphibian, avian and mammalian intestine during embryonic and/or post-embryonic development. Furthermore, we review the data concerning the mechanisms which control the cytodifferentiation of the intestinal epithelium.

Stage-specific polypeptide and villin expression during thyroid-hormone-induced substitution of the amphibian intestinal epithelium.

Treatment of anuran tadpoles with 5 nM 3,3',5-triiodo-L-thyronine (T3) results in the complete substitution of the intestinal epithelium. We have examined the developmental pattern of protein synthesis in Alytes obstetricans intestinal epithelium using two-dimensional gel electrophoresis. Four different types of changes have been observed. The group I polypeptides (Mr: 41,500; 44,500; 51,500; 55,000 and 101,000) are only synthesized during the first week of hormonal treatment. They are specific of the primary (larval) epithelium. On the other hand, polypeptides referred to as Group II (Mr: 47,000; 48,000; 58,000; 66,500, pl 5.2; 99,500 and 102,000) are not detected until day 8. They are characteristic of the secondary tissue. Polypeptides of Group III (Mr: 42,000, pl 5.15 and 5.25; 42,500, 47,500, pl 5.25 and 5.55) expressed between the 6th and 8th day of T3 treatment, are specific of growing stem cells. During this critical period, Group IV polypeptides (Mr: 63,500; 66,500, pl 6.35; 105,000, pl 5.5 and 5.55) are not synthesized. The protein of Mr 105,000 (pI 5.5 and 5.55) is immunologically related to villin, a core protein of intestinal microvilli. Expression of this protein has been analyzed by immunoreplica and immunocytochemical procedures during differentiation of basal stem cells into secondary absorptive epithelial cells. The results have been compared to that obtained during spontaneous metamorphosis.

Stage-specific polypeptides and villin expression during the intestinal epithelium substitution of the metamorphosing amphibian.

The amphibian intestinal epithelium provides an excellent aid to study the developmental pattern of protein synthesis during cell life. The metamorphosing tissue demonstrates a kaleidoscope of cell degeneration, proliferation and differentiation. These events occur at specific period in a synchronized cell population. Two-dimensional gel electrophoresis, together with histological studies, has been used to examine the changes in the patterns of protein synthesis during intestinal epithelium substitution in metamorphosing Alytes obstetricians larvae. Of the approximately 280 polypeptides detected by this method, 24 show major changes in their patterns of synthesis. Five polypeptides are only synthesized during the larval period and are characteristic of the primary epithelium. Six polypeptides are characteristic of the secondary intestinal epithelium, as they are only detected in the newly-metamorphosed juvenile. Four polypeptides of Mr 81,000, 78,000, 42,000 (pI, 5.1 and 6.2) are characteristic of the epithelium crisis, as they are only detected during climax. They may represent molecular markers of growing stem cells. On the other hand, two polypeptides, of Mr 66,500 and 63,500, are not synthesized during this critical period, but are synthesized before and after metamorphosis. Seven polypeptides show changes in the relative rate of their synthesis during metamorphosis of the intestinal epithelium. Among them, the protein of Mr 105,000 which presents two isoelectric variants (pI 5.5 and 5.55) is immunologically related to villin. Expression of this protein has been studied using immunoblotting of cell extracts onto nitrocellulose and immunodetection in tissue sections. The protein is localized in the brush border of primary and secondary epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Somatostatin-like peptide and regeneration capacities in planarians.

The presence of a neuropeptide immunologically related to somatostatin (SRIF) has been investigated in the neurosecretory cells of two regenerating planarian species (Dugesia lugubris and Dendrocoelum lacteum). A correlation has been shown between the discharge of the SRIF-like-immunoreactive cells during the first hours after amputation and the capacity to regenerate, and between the persistence of numerous positive cells and the lack of regeneration. These results suggest that somatostatin might play a regulatory (inhibitory) role on the cellular proliferation which leads to the blastema edification.

[Demonstration of peptides immunologically related SRIF, neurophysins and angiotensin in the planarian Dugesia lugubris (Platyhelminths,Turbellaria) (author's transl)]. / Mise en évidence de peptides immunologiquement apparentés au SRIF, à l'ACTH, aux neurophysines et à l'angiotensine II chez la planaire Dugesia lugubris (Plathelminthes, Turbellariés).

Several antisera, specific to the neuropeptides of Vertebrates, were applied to frontal sections of the planarian Dugesia lugubris. Five of them enabled to show specific neurones: anti-sera anti-SRIF, anti-neurophysines, anti-ACTH 17-39, anti-ACTH4-10 and anti-angiotensin II. The positive perikarya were situated mainly at the margin of the cerebroïd ganglia and the nerve cords, at all levels of the animal. Nerves processes were detected in the central nervous system and in the surrounding areas.