Cardiovascular risk assessment may help in the identification of symptom-free subjects with high cardiovascular risk.
The author studied the correlation between SCORE and Reynolds risk assessment ...systems based on data from the cardiovascular risk screening program carried out in subjects without cardiovascular disease.
Data obtained from 4462 subjects (1977 men and 2485 women; mean age, 47,4 years) were analysed. The comparison was based on risk categories of the SCORE system.
There was a strong correlation between the two scoring systems in the low risk population (under <2% SCORE risk the Spearman rho = 1, p < 0.001). A weak correlation was found in the medium risk group (between 3-4% the Spearman rho = 0.59-0.49, p < 0.001 and between 10-14% the Spearman rho = 0.42, ns.) and a stronger correlation in the high risk group (>15% the Spearmen rho = 0.8, p = 0.017). When correlations were analysed in gender and age categories, the weakest correlation was detected in medium risk women over 40 years of age. In cases when the differences between the two scoring systems were significant, the hsCRP levels were significantly higher (4.1 vs. 5.67 mg/L, p < 0.001).
Introduction of hsCRP into cardiovascular risk assessments can refine the risk status of symptom-free subjects, especially among intermediate risk middle-age women (two-step risk assessment).
Objective: To compare data of lifelong weight gain of persons, analyzing its correlation with developed metabolic diseases, with special attention to women's weight gain around pregnancy, delivery ...and menopause. Design and method: A retrospective international study was planned and organized to compare selfrecorded data of lifelong weight gain among 60–70 year old patients analyse their correlation with metabolic diseases they developed with special attention to women's weight gain around pregnancy, delivery and menopause in primary care settings in Germany, Hungary, Italy, Slovakia and the Ukraine. People between 60y-70y were asked to fill in a questionnaire on body weights in previous life decades and heights. Recent parameters were measured. Results: Of the recruited 815 participants, 319 men and 496 women presented all the required data. Diabetics of both genders had the highest baseline weight at 20 years of age. The weight and BMI of the whole study population increased steadily until their seventies, but to a lesser extent after their fifties. Compared to the control group, changes over decades were the greatest among diabetics and also greater among patients with hypertension. Weight increase in the first decades (20–30-year-old men and 30–40-yearold women) was a significant risk factor for the development of diabetes (OR = 1.044; p = 0.002; 95 % CI: 1.01–1.07). Among patients with diabetes and hypertension, both diagnoses were set up earlier than among those with a single morbidity. Among females, weight increase around pregnancy and menopause correlated significantly with higher odds for the diagnoses of diabetes and/or hypertension, irrespective of the number of children. Conclusions: During their decade-long relationship with their patients, family physicians are expected to identify the higher weight gain of their patients, especially among younger generation and intervene, if necessary.
Introduction. Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the ...characteristics of individual primary care practices and doctors’ screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings.
Method. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data.
Results. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data.
Conclusion. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.
Uvod. Poleg primarne preventive je presejanje kot sekundarna preventiva pomemben člen pri storitvah osnovnega zdravstvenega varstva. Na uspešnost tovrstnega dela vplivajo značilnosti posameznih splošnih ambulant varstva in pripravljenost zdravnikov za izvajanje presejalnih pregledov kot tudi ureditev procesov presejanja in razpoložljivih finančnih virov. Med leti 1999 in 2009 je bil v Madžarski uveden in izpeljan program vodene oskrbe, ki ga je financirala vlada. Ta finančna podpora in spodbuda je omogočila priložnost za povečanje števila presejalnih pregledov.
Metode. 4462 pacientov iz 40 splošnih ambulant je bilo vključenih v presejalni pregled v sklopu ocene tveganja SCORE. Rezultate presejanja se je primerjalo na podlagi dveh skupin pacientov, in sicer tistih, ki so bili predhodno presejani (metoda predhodnega presejanja) za znane dejavnike tveganja v njihovi zdravstveni anamnezi (kajenje, indeks telesne mase, starost, zgodovina srčno-žilnih obolenj) ter tistih, ki so bili presejani naključno. Avtorji so primerjali tudi podatke sodelujočih splošnih ambulant o smrtnosti z regionalnimi in nacionalnimi podatki.
Rezultati. Povprečen rezultat je bil bistveno višji v predhodno presejani skupini pacientov, ne glede na to, ali so bili dejavniki tveganja upoštevani posamično ali v kombinaciji. Smrtnost je bila bistveno nižja pri sodelujočih splošnih ambulantah, kot je bilo pričakovati na podlagi nacionalnih podatkov o smrtnosti.
Zaključek. Ta program, ki ga je financirala država, je pomenil velik korak naprej k ustanovitvi ustrezne metode presejanja znotraj madžarskega sistema osnovne zdravstvene oskrbe. Izvajanje presejanja za ogroženost srčnožilnega sistema pri izbrani skupini je očitno bolj primerno od naključnih pregledov. Obe metodi sta vidno prispevali k izboljšanju regionalnih podatkov o smrtnosti, čeprav je precej verjetno, da se s predhodnim presejanjem doseže bolj stroškovno učinkovita izbira presejanj.
Prevention program including lifestyle changes was initiated with the participation of obese and overweight subjects recruited from the practices of 29 family doctors.
The aim of the author was to ...analyse changes of non-HDL-cholesterol levels, especially when triglyceride levels were above 2.26 mmol/l, and when non-HDL cholesterol levels were high in association with low HDL-cholesterol levels in overweight or obese subjects who had no cardiovascular disease and diabetes mellitus.
Data obtained from 1192 subjects (424 men and 768 women) before and 12 month after inclusion into the prevention program was analysed.
The average level of non-HDL-cholesterol in the whole group of subjects decreased from 4.74 to 4.64 mmol/l, but the change was not significant. However, the average concentration of non-HDL-cholesterol was reduced significantly from 4.87 to 4.4 mmol/l in men, whereas no significant change was detected in women. In cases when triglyceride levels were higher than 2.26 mmol/l, the non-HDL-cholesterol level was reduced by 0.65 mmol/l. In cases when the non-HDL-cholesterol level was high in association with low HDL-cholesterol level, the non-HDL-cholesterol was significantly decreased from 5.22 to 4.48 mmol/l. In addition, in cases when HDL-cholesterol levels were low, the average level of the HDL-cholesterol significantly increased from 0.84 to 1.3 mmol/l.
Lifestyle changes decrease the level of atherogenic lipid fractions, particularly in men with high triglyceride levels. Improvement of the atherogenic lipid profile in response to lifestyle changes is related not only to the reduction of atherogenic lipid fractions, but also to the increase of HDL-cholesterol level.
Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different ...methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved in a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on the SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10-90%, and >90% ePWV values for the participants. In total, 99,231 subjects were involved in the study, and among them, 49,191 patients had hypertension (HT) and 15,921 patients had diabetes (DM). The chronological age of the total population was 54.0 (48.0-60.0) years, while the SCORE and FRS vascular ages were 59.0 (51.0-66.0) and 64.0 (51-80) years, respectively. In the HT patients, the chronological, SCORE, and FRS vascular ages were 57.0 (51.0-62.0), 63.0 (56.0-68.0), and 79.0 (64.0-80.0) years, respectively. In the DM patients, the chronological, SCORE, and FRS vascular ages were 58.0 (52.0-62.0), 63.0 (56.0-68.0), and 80.0 (76.0-80.0) years, respectively. Based on ePWV, the FRS identified patients with an elevated vascular age with high sensitivity (97.3%), while in the case of the SCORE, the sensitivity was much lower (13.3%). In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation in CV preventive strategies requires further studies.
Objective: Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but ...different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved into a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). Design and method: The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10-90% and >90% ePWV values of the participants. Results: 99 231 subjects were involved in the study and among them 49 191 patients had hypertension (HT) and 15 921 patients had diabetes (DM). Chronological age of the total population was 54.0 (48.0 – 60-0) years, while SCORE and FRS vascular ages were 59.0 (51.0 – 66.0) and 64.0 (51-80) years, respectively. In HT patients chronological, SCORE and FRS vascular ages were 57.0 (51.0 – 62.0), 63.0 (56.0 – 68.0) and 79.0 (64.0 – 80.0) years, respectively. In DM patients chronological, SCORE and FRS vascular ages were 58.0 (52.0 – 62.0), 63.0 (56.0 – 68.0) and 80.0 (76.0 – 80.0) years, respectively. Based on ePWV, FRS identified patients with elevated vascular age with high sensitivity (97.3%), while in case of SCORE, the sensitivity was much lower (13.3%). Conclusions: In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation into CV preventive strategies requires further studies.
In Hungary, since 1990, each government has tried to transform and rationalize the structure of health care. One of the reforms was the Care Managing Organization (CMO) programme introduced in 1999.
...The aim of this paper is to describe the regional, environmental, structural and preliminary health related outcomes of the CMO in Bács-Kiskun County (Central-Eastern Hungary).
First, cardiovascular screening programmes were organized for pre-screened and randomly selected populations of a total of 4462 persons. Seven years after completing the programmes, regional mortality data were analysed and compared. Second, nutritional and lifestyle counselling programmes with increased physical activity were organized for 2489 overweight or obese patients from the participating primary care practices. Anthropometric and laboratory data were examined after one and two years.
First, for persons with higher cardiovascular risk, appropriate medical treatment was introduced, and after seven years, their mortality rates proved better than the regional and national data. Second, almost all measured anthropometric parameters improved (body mass index, body weight decrease) after the first year and this trend lasted till the end of the second year.
According to the data of the National Health Insurance Fund, the average savings rate for all CMOs for the fiscal years 1999-2007 was 4.94%. The highest rates of savings were realized in chronic and acute inpatient care and medical devices. In the end of 2008, by which time 14 CMOs had already covered 2.1million people, the programme was discontinued by the government, without a comprehensive evaluation of the experience and outcomes.
Az alapellátás átalakításának első lépéseként – a kompetenciák, az eszközpark, az alapellátás által nyújtott szolgáltatások bővítésének lehetőségét keresve – létrejöttek az első praxisközösségek. ...Ennek struktúrája már nem hasonlít a háziorvosi ellátási modell korábbi jellemzőire, az egymástól elszigetelten dolgozó, két-három orvoskollégából álló csapatra. Az új forma a közösségbe szerveződő praxisok hálózata. A hypertoniás beteg ellátása, gondozása tipikus területe a praxisközösségi munkának. A szerzők cikkükben a praxisközösségek szerepét igyekeznek bemutatni a hypertoniás betegek ellátása és gondozása során.
Az egészségügyi ellátás során óriási mennyiségû adat keletkezik, ugyanakkor az elmúlt években a nagy adatbázisok feldolgozása terén is óriási elôrelépés történt a mesterséges intelligencia ...technológiai fejlôdésével. A mesterséges intelligencia gyakorlati alkalmazásai egyre inkább megjelennek az egészségügy területén, ezen be lül a családorvosi ellátásban is. Ez a tanulmány nemzetközi irodalmi áttekintéssel mutatja be a mesterséges intelligencia alkalmazását a családorvoslásban. Egyelôre komplex, összefüggô rendszerek nem léteznek, leginkább egyes betegségek (például idült veseelégtelenség, diabetes mellitus, dementia stb.) predikciója, az adminisztratív feladatok segítése, és a döntési mechanizmusok támogatása azok a területek, ahol a mesterséges intelligencia különbözô módszerei vizsgáznak, kísérleti jelleggel. A technológiai fejlôdés üteme óriási, de a lehetôségek adta lelkesedés mellett azért tisztában kell lenni a technológia lehetséges veszélyeivel is.
PDF
