To evaluate the knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season.
A questionnaire with 20 questions was ...developed and sent to 232 family physicians in 3 largest Hungarian cities: Budapest, Debrecen, and Miskolc. The study was conducted in December 2009 and January 2010.
A hundred and ninety eight (85%) physicians answered the questionnaire adequately. Respondents believed that the influenza outbreak represented less of a threat to their practices than to Hungary or the world as a whole. They mostly agreed that vaccination was important and were frequently dissatisfied with the support from health authorities. The proportion of vaccinated patients ranged between 2% and 53%, without differences according to geographical region, age, sex, and duration of physicians' employment in family practice. Physicians who were satisfied with the payment for procedures and underwent vaccination themselves were more active in vaccination.
Health authorities should provide clear and evidence-based professional support to family physicians and should encourage them to get vaccinated against pandemic influenza, while insurance funds have to establish appropriate reimbursement system.
Correlations between obesity and asthma control in children: Hungarian primary care pilot study Introduction: Asthma is often associated with overweight and obesity. The aim of this study was to find ...associations between asthma control, obesity and different levels of physical activity. Methods: Using a questionnaire, 117 asthmatic patients between 6-18 years of age were interviewed. Two groups of children, normal vs. overweight, at different levels of physical activity (sport, school-based proper or light activity and full physical exemption) were compared. Asthma control was evaluated in two groups (controlled vs. non or partially controlled). Results: The asthmatic status was generally controlled in 78%; in 81% and 72% of patients with a normal weight and overweight, respectively. Being overweight was more common among girls than boys (43.2% vs. 30.3%). A positive family history of asthma was revealed in many cases; the prevalence of asthma was found at 63% (P=0.0074) among the parents. Weight was significantly higher when the parents themselves were overweight. A lightened workload in physical education lessons at school doubled the risk of obesity (P=0.25), while full exemption increased it by six times (P=0.06). High bodyweight was found in 37% and 31% of children who had received steroid medication and other treatment, respectively (P=0.57). Conclusion: High bodyweight and physical inactivity worsened the chances of effective asthma treatment, while sport improved it. The rates of physical activity among the surveyed patients were lower than recommended. More focus is needed; paediatricians, school-teachers and parents should pay more attention to the issue when establishing a proper family background for healthier lifestyles. PUBLICATION ABSTRACT
Background: The relationship between socioeconomic status and preventive care is an important issue in public health practice in Hungary. Our aim was to investigate the association between the ...socioeconomic status and the present practice of primary allergy prevention in infant feeding in Hajdú-Bihar County, Hungary. Methods: A questionnaire-based cross-sectional survey was performed among 3076 infants aged 0–6 months. We studied how socioeconomic status, type of settlement, allergic background of the family and skin symptoms indicative for allergy were related to primary allergy prevention in infant feeding. Prevalence odds ratios (ORs) were calculated by multiple logistic regression. Results: Independent determinants of breast feeding were age OR corresponding to one month change 0.74; 95% confidence interval (CI) 0.70–0.77, the female gender (OR 1.24; 95% CI 1.06–1.46), the socioeconomic status of the family (OR comparing the worst with the best category 0.63; 95% CI 0.43–0.93), and birth weight (OR comparing <1500 g to >2500 g category 0.17; 95% CI 0.07–0.41). Among supplementary nutrient users independent determinants of the use of hydrolysed infant formulae were the socioeconomic status (OR comparing the worst with the best category 0.06; 95% CI 0.01–0.27), the type of settlement (OR comparing village with town 0.48; 95% CI 0.28–0.80), history of allergy in the family (OR 2.30; 95% CI 1.28–4.11), and skin symptoms indicative of allergy (OR 3.46; 95% CI 1.96–6.14). Conclusion: Socioeconomic status is related to the implementation of primary allergy prevention in infant feeding.
Hypertension is an independent cardiovascular risk factor, therefore continuing care of patients with hypertension is an important task in cardiovascular prevention.
This study was aimed to ...investigate continuing care of hypertension in general practices. Method of the study was a questionnaire survey, and 830 adult patients were involved. Forms contained information about duration of continuing care, associated risk factors, therapy, damages of target organs, and blood pressure values attained. Blood pressure measurement and hypertension grading were performed by the recommendation of the Hungarian Hypertension Society.
Ratios of men and women participated in the study were 39.8% and 60.2%, respectively. Duration of hypertension care was 10.7 +/- 8.3 year. The care was initiated because of moderate and serious hypertension in 51.4% and 32.7%, respectively. Frequencies of cardiovascular, cerebrovascular and peripheral vascular problems were parallelly increased with severity of hypertension. Frequency of all types of antihypertensive drugs used were also increased with the hypertension grades. The most frequently used drugs were ACE-inhibitors. The target blood pressure of 140/90 Hgmm was reached in 46.4%, and according to blood pressure measured during the last year of continuing care, patients had mild hypertension in 41.5%, moderate in 7.6%, and serious one in 0.9%. Effectiveness of the hypertension care, based on decrease in blood pressure, was associated with severity of hypertension at the time of its diagnosis, the patients' age, but not with their gender.
Summarizing, our results prove that there is a need for intensification of early detection, treatment and continuing care of hypertension.
Both types of diabetes mellitus are conditions with high cardiovascular risk.
This work was aimed to study the frequency of cardiovascular risk factors, macrovascular and microvascular complications ...and to assess the results of continuous diabetes care in an adult population with type 1 and type 2 diabetes. Method of the study was a questionnaire survey, altogether 400 patients, 49 with type 1 and 351 with type 2 diabetes, were enrolled to it.
Frequency of cardiovascular complications, obesity, hypertension and dyslipidemia was higher in type 2 diabetes, smoking and microvascular complications were more frequent in type 1 diabetes. The ratio of conservative intensive and conventional insulin therapy in type 1 diabetes was 70% and 30%, respectively. Treatment methods used in type 2 diabetes were: diet only: 8%, oral antidiabetic therapy: 78%, antidiabetic agent and insulin: 7%, insulin therapy 7%. Ratios of the patients having at least three laboratory results were: fasting blood glucose: 50%, postprandial blood glucose: 30%, haemoglobin A(1C): 10%. Ratios of patients reached the target results were in type 1 and type 2 diabetes were: fasting blood glucose: 27% vs. 14%, postprandial blood glucose: 26% vs. 18%, haemoglobin-A: 29% vs. 34%. Ratios of the patients in micro- and macrovascular risk category were: fasting blood glucose: 59% vs. 68%, postprandial blood glucose: 54% and 53%, haemoglobin-A(1C): 40% vs. 27%.
Frequency of investigations to estimate glycemic control as well as ratio of patients reached target values were rather low, ratio of patients in micro- and macrovascular risk category was high. For these reasons there is a need for a more intensive continuous diabetes care to reach better results.
Cardiovascular diseases are the first in the Hungarian mortality statistics. Numerous factors are known that may be involved as risk factors in the development of these diseases, and the risk is ...multiplied when they occur simultaneously. The recommendations of the European and Hungarian professional societies regard the early exploration of these risk factors and the estimation of cardiovascular risk as extremely important, since the intervention to be introduced depends on the extent of the risk.
The study was aimed to assess, by using a professionally accepted risk estimation method, the extent of cardiovascular risk in the adult population aged between 18 and 60 years and previously not treated for cardiovascular risk(s) or diseases. 48 family doctors' practices of four counties participated in the study; a total of 1320 individuals were enrolled. During the study targeted recording of medical history, physical examination and the determination of certain parameters of carbohydrate and lipid metabolism were performed. Afterwards the participants' cardiovascular risk was calculated for 10 years, based on the parameters obtained (age, sex, smoking habits, systolic blood pressure, total cholesterol level, status of carbohydrate metabolism).
Frequency of high and very high cardiovascular risk was 12.44% in the population (22.59% in men and 4.89% in women, 17.72% in middle-aged and 0.75% in younger patients). Distribution of cardiovascular risk levels was less favourable in men than in woman (p < 0.001), and in middle-aged patients than in younger ones (p < 0.001). The distributions of each risk factors were similar: significant differences were demonstrated in smoking habit, systolic blood pressure and plasma cholesterol between men and women as well as between middle and younger aged patients, however significant difference in alterations of carbohydrate metabolism was found just between middle- and younger aged groups.
Cardiovascular risk is reasonably high in adult population previously not treated with cardiovascular risks or disease. Distribution of risk levels is less favourable in men than in women, and middle-aged patients compared to younger aged patients. These results show that there is a need for the increase of the frequency of patients' preventive visits to physicians, since this can allow the identification of risk factors as early as possible, the recognition of increased cardiovascular risk and the use of the necessary and adequate intervention.
Aim To evaluate the knowledge, motivation, and attitudes
of Hungarian family physicians toward pandemic influenza
vaccination in the 2009/10 influenza season.
Method A questionnaire with 20 questions ...was developed and sent to 232 family physicians in 3 largest Hungarian cities: Budapest, Debrecen, and Miskolc. The study
was conducted in December 2009 and January 2010.
Results A hundred and ninety eight (85%) physicians answered the questionnaire adequately. Respondents believed that the influenza outbreak represented less of a
threat to their practices than to Hungary or the world as
a whole. They mostly agreed that vaccination was important and were frequently dissatisfied with the support from
health authorities. The proportion of vaccinated patients
ranged between 2% and 53%, without differences according to geographical region, age, sex, and duration of physicians’ employment in family practice. Physicians who were
satisfied with the payment for procedures and underwent
vaccination themselves were more active in vaccination.
Conclusion Health authorities should provide clear and
evidence-based professional support to family physicians
and should encourage them to get vaccinated against
pandemic influenza, while insurance funds have to establish appropriate reimbursement system.
In various team sports, such as handball, referees work on the court by continuously moving with the players. Therefore, their physical fitness also has an impact on their reaction time, which could ...affect their professional decisions. The cardiorespiratory fitness status of healthy Hungarian elite handball referees was examined via body composition analysis and vita maxima cardiopulmonary exercise testing with lactate measurements. One hundred referees were examined (age: 29.0 ± 7.9 years; male: 64.0%; training: 4.3 ± 2.0 hours/week; ratio of former elite handball players: 39.0%; 51.0% first and 49.0% second division referees of the Hungarian National Handball Leagues). A resting heart rate (HR) of 79.0 ± 12.6 BPM was measured. On the basis of the body composition analysis the fat-free mass index proved to be 19.9 ± 2.6 kg/m.sup.2 . The referees achieved a maximal oxygen uptake (VÌO.sub.2max) of 44.6 ± 6.1 ml/kg/min, with a maximal HR of 187.2 ± 11.1 BPM (which was 98.1 ± 4.6% of their calculated maximal HR) and a peak lactate of 9.2 ± 3.2 mmol/l at 557.1 ± 168.3 sec on our continuous speed, increasing slope treadmill protocol. Second division referees were younger, on a weekly average they trained more, achieved higher treadmill exercise time (respectively, 463.8 ± 131.9 vs 658.4 ± 143.9 sec, p < 0.001) and anaerobic threshold time (respectively, 265.8 ± 100.9 vs 348.2 ± 117.1 sec, p < 0.001), while the two different divisional referees had similar VÌO.sub.2max values. Regarding our physical fitness measurements, huge individual differences were observed between the referees (exercise time range: 259.0-939.0 sec, VÌO.sub.2max range: 25.3-62.4 ml/kg/min). Since it can affect their performance as referees, individual training planning, regular physical fitness measurements, and strict selection methods are suggested.
Background The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We ...aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Methods Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18-29, Group B: 30-39, Group C: 40-49, Group D: >50 years). The calculated parameters were indexed to body surface area (i). Results The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Conclusions Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.
The relationship between smoking and human health has been investigated mostly in adults, despite the fact that the chemicals originating from sustained maternal smoking disrupt the carefully ...orchestrated regulatory cascades in the developing fetus. In this study, we followed molecular alterations in the umbilical cord (UC) vessels and fetal red blood cells (RBCs), which faithfully reflect the in vivo status of the fetus. We showed evidence for the decreased level of DNA-PKcs-positive nuclei in samples with smoking origin, which is associated with the impaired DNA repair system. Furthermore, we pointed out the altered ratio of MMP-9 metalloproteinase and its endogenous inhibitor TIMP-1, which might be a possible explanation for the morphological abnormalities in the UC vessels. The presented in vivo dataset emphasizes the higher vulnerability of the veins, as the primary target for the toxic materials unfiltered by the placenta. All these events become amplified by the functionally impaired fetal RBC population via a crosstalk mechanism between the vessel endothelium and the circulating RBCs. In our ex vivo approach, we looked for the molecular explanation of metal-exposure-induced alterations, where expressions of the selected genes were upregulated in the control group, while samples with smoking origin showed a lack of response, indicative of prior long-term in utero exposure.
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