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PubMed2001

HLA alleles and IDDM in children in Hungary: a comparison with Finland.

It has been postulated that variation in the distribution of human leukocyte antigen (HLA)-encoded susceptibility alleles for insulin-dependent diabetes mellitus (IDDM) is the genetic basis for variation in the incidence of the disease between populations. The aim of this study was to characterize HLA-encoded susceptibility to IDDM in Hungary and to identify whether HLA-DRB1/DQ-encoded susceptibility could account for the five times lower incidence of disease in Hungary compared with Finland. The haplotypes DRB1*03-DQA1*05-DQB1*02 (DRB1*03-DQ2) and DRB1*04-DQA1*0301-DQB1*0302 (DRB1*04-DQ8) were significantly associated with disease in both populations. Three genotypes incorporating either or both of these haplotypes accounted for over 70% of the diabetic population in both races. The combined background frequency and the degree of risk as measured by odds ratios of these HLA-DRB1-DQ genotypes were not significantly different in the two countries. Comparison of the DRB1*0401-DQ8 haplotype between the two races suggested a role for HLA-B alleles in susceptibility. These data indicate that the susceptibility associated with high risk DRB1-DQ genotypes alone is insufficient to account for the fivefold variation in incidence of IDDM between Hungary and Finland. Other genetic and/or environmental influences must be involved.

Alleles↗
PubMed2001

Experimental gerontology in Hungary.

Gerontological research has some past and sporadically also some highlights in Hungary, but its present state can be easily deduced from the following data. During the last 12 years and more, well over 10,000 Hungarian scientific papers have been published in well-recognized national or international journals. Altogether approximately 1% of them have been classified as gerontological publications from Hungary. This low figure shows that gerontology has low priority and--unfortunately low support--in Hungary. This statement does not intend to downgrade Hungarian gerontologists, however points out that the Hungarian trends are not far from those of European or world wide interest in aging. Despite the recognition that we have to accept the inevitable fact that industrial societies will have (they already have) an aging population with all the social and medical problems arising, the focus of interest is wide from this significant and interesting (sub)population, which is neglected (sometimes even despised); yet everybody is absolutely eager to join this club. The average of the Hungarian research achievements and publication activities are among the better European achievements. There are some highlights and new trends even initiated by some outstanding Hungarian scientists, yet the overall weight of gerontology research is still an orphan in the Hungarian scientific life. We deal in this short and far from complete summary almost exclusively with experimental gerontology. We have to apologize if we have not included everybody, who also contributed even significantly to this field because the time for the preparation of this overview was short.

Aging↗
PubMed2003

Molecular characterization and sequence analysis of human astroviruses circulating in Hungary.

Human astroviruses (HAstVs) are major pathogens in viral gastroenteritis worldwide. Twenty-five HAstV strains were detected from stool specimens of children hospitalized for acute gastroenteritis in Budapest, Hungary, between 1995 and 1999. Sequence analysis was performed at the 3' end of the capsid gene to determine genotypic diversity of HAstVs circulating in Hungary. Five different genotypes of HAstVs were identified: HAstV-1 was predominant, followed by types 5, 8, 3 and 4. Two different subtypes of HAstV-1 were detected, but only one at a time in the community. This is the first report on the genetic diversity of HAstVs in Hungary and Central/Eastern Europe.

Astroviridae Infections↗
PubMed2004

Issues for countries considering introducing the "fourth hurdle": the case of Hungary.

OBJECTIVES: This study outlines the needs and current development of the "fourth hurdle" (i.e., requirement of effectiveness and cost-effectiveness data for drug coverage policy decisions) in Hungary, describes the legal background and seeks to address some of the most important questions in this field. METHODS: The study draws on international experiences and discusses five issues that a given jurisdiction needs to consider before introducing the "fourth hurdle" for pharmaceuticals. RESULTS: The "fourth hurdle" is very relevant in Hungary because many existing drugs are unevaluated and many new, expensive drugs are becoming available. On the other hand, the existing resources for health technology assessment, including economic evaluation, are quite limited. All the five issues are relevant in the Hungarian setting and were helpful in determining exactly how the "fourth hurdle" should be applied. CONCLUSIONS: The most important issue seems to be that the implementation of the "fourth hurdle" needs to be achieved in a way consistent with the limited resources for HTA in Hungary. Specifically this means that, in setting priorities for drugs to evaluate, additional criteria need to be applied. In particular, priority should be given to assessing drugs that have been evaluated in other countries, because this affords the opportunity to adapt existing studies or models to the Hungarian situation.

Cost-Benefit Analysis↗
PubMed2003

Neonatal screening for biotinidase deficiency in Hungary: clinical, biochemical and molecular studies.

From 1989 to 2001, 1,336,145 newborns were screened for biotinidase deficiency in Hungary. Fifty-eight children with the disorder were identified as enzyme-deficient. We have characterized the clinical and biochemical features and mutations of 20 of these children. Eleven children had profound biotinidase deficiency, 7 had partial biotinidase deficiency, and 2 were found to be heterozygous for profound deficiency by mutation analysis. Seventeen different mutations were identified in this population including seven novel mutations. Six of these new mutations are missense, 245C>A, 334G>A, 652G>C, 832C>G, 1253G>C, 1511T>A, and one is a unique allelic double mutation [212T>C;236G>A]. Of five Romanian Gypsies, four were homozygous for the 1595C>T mutation and one was heterozygous for this mutation. Most of the children with profound deficiency have been asymptomatic on therapy; however, four exhibited minimal brain abnormalities, motor delay and abnormal blood chemistries. Compliance with therapy must be questioned in these cases. Of clinical importance, all of the children with partial deficiency exhibited mild symptoms at the time of diagnosis, at several weeks to months of age. These symptoms resolved following biotin therapy. This is in contrast to the experience in the United States, where the children with partial deficiency have been asymptomatic at the time of diagnosis. This finding further indicates that children with partial deficiency should be treated. The incidence of biotinidase deficiency in Hungary is more than twice that observed in a worldwide survey. These results indicate that newborn screening in Hungary is effective and warranted.

Alleles↗
PubMed2000

[DRGs in psychiatric hospital financing exemplified by Hungary. A model for Germany?].

One of the most important provisions incorporated in the reform of the German health sector has been the introduction of a per case prospective payment system for hospitals with the exception of admissions to psychiatric care. The reasons for the exclusion of psychiatric care are unclear, but it is as a result all the more interesting to look at the experience of Hungary, where in-patient psychiatric care has been financed on the basis of diagnosis-related groups (DRGs) for the past seven years. The article describes how in the early 1990's the funding of the Hungarian health service was reorganized from being a state-financed system with a set budget to a system financed by contributions. Parallel to this development, service-related financing was introduced. In the hospital sector this involved DRGs. At the beginning of 1993 the Hungarian DRGs comprised only 437 categories, but this has since increased to 758. Furthermore, other characteristics are listed which, apart from the number of groups, differentiate the Hungarian DRGs from the AP-DRGs. Among other things, service-related financing includes non-typical areas such as psychiatry. In this case, it covers in-patient psychiatric care in an unusual combination of DRGs in the acute case category (50% of all beds in psychiatric units in Hungary are for acute cases) with daily nursing charges in the chronic case category. An analysis is given in the article of 16 homogeneous diagnostic categories in psychiatric care, followed by experiences gathered in conjunction with the application of this approach in this particular sphere, with special reference to three problem areas. These are as follows: the trend towards diagnoses with a relatively high weighting; the practice of charging for psychiatric DRGs in somatic wards; and, finally, the perpetuation of poor service structures and practices through DRGs. In general, evidently the introduction of psychiatric DRGs may also be recommended in Germany because of the danger that otherwise psychiatry might be marginalized and isolated in a corner for chronic medical cases. As the only discipline or specialist sphere with a non-service based budget there is a real threat that funding would be kept low. Thus, under the superior financial conditions in Germany, the disadvantages registered in Hungary would not occur or would become manifest only in a milder form. However, it is important that prior to implementation costing is done with extreme care to determine the relative weighting and duration of treatment for each of the categories and that following introduction of DRGs there is a regular control of coding practices, structure of diagnoses and case-mix changes.

Cost-Benefit Analysis↗
PubMed2006

Soon, later, or ever? The impact of anomie and social capital on fertility intentions in Bulgaria (2002) and Hungary (2001).

We use survey data from Bulgaria and Hungary to investigate the determinants of whether women intend to have a first or a second child and, if so, whether they intend to have the child within the ensuing 2 years or later. These determinants differ significantly by the order and timing of the intended birth. The variables used include measures of anomie and social capital and these appear to be among the factors that determine both whether to have a child and when. There is some evidence that these measures and economic factors are relatively more important in Bulgaria than in Hungary, and that ideational factors are more important in Hungary, particularly in the case of voluntary childlessness.

Adult↗
PubMed1998

HIV testing for HIV prevention: a comparative analysis of policies in Britain, Hungary and Sweden.

This paper compares policies on named HIV testing in the context of HIV prevention in Britain, Hungary and Sweden, and considers the extent to which these policies are based on evidence of effectiveness or on other, more contextual, factors. In Britain, testing has not featured significantly as a prevention strategy, and named testing has generally been carried out only with the voluntary, informed consent of individuals. In Hungary, testing is central to HIV prevention, and is required by law of certain groups. HIV testing is carried out mainly on a voluntary basis in Sweden, but, unlike in Britain, it has been actively promoted by public health authorities. The paper contrasts the 'right not to know' one's HIV status which is widely respected in Britain, with the 'responsibility to find out' which is more pervasive in Hungary and Sweden. Although policy makers in all three countries appear convinced that their's is the right approach, there appears to be as yet a dearth of convincing evidence to support their arguments.

Communicable Disease Control↗
PubMed2000

Genetic subtypes of HIV type 1 in Hungary.

We examined the diversity of HIV-1 subtypes in 11 adults from Hungary, using the heteroduplex mobility assay (HMA) and DNA sequencing. HMA results showed that HIV-1 gp120 sequences from 10 patients were of subtype B, whereas 1 patient, infected in Africa, carried a subtype C strain. DNA sequencing confirmed the HMA results and revealed a high intrasubtype diversity in the C2V3 region of env in different clade B isolates, which suggests multiple introduction of subtype B to Hungary. This study shows that subtype B is the predominant HIV-1 clade in Hungary.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Marginalized and socially integrated groups of IDUs in Hungary: potential bridges of HIV infection.

The discrepancy in HIV rates among Eastern and central European injecting drug users (IDUs) suggests that, in addition to risk behaviors, social contact patterns also play an important role. We identify two groups of IDUs in Budapest, Hungary, marginalized IDUs (M-IDUs) and socially integrated IDUs (SI-IDUs) and compare their HIV/hepatitis B virus (HBV)/hepatitis C virus (HCV) social and risk network characteristics, risk behaviors, and travel patterns. Between May 2003 and January 2004, 29 nontreatment-recruited young IDUs in Budapest participated in ethnographic interviews and focus groups. The mean age was 23.6 years (SD=3.6); eight were female and two Roma/Gypsy. Most injected heroin (n=23) and/or amphetamines (n=10) in the past 30 days. M-IDUs had no legal employment, injected heroin and sniffed glue, and stopped using drugs in treatment/prison. SI-IDUs had regular jobs or were students, injected heroin and sniffed cocaine, and stopped using drugs before exams/tests. Both M-IDUs and SI-IDUs shared injecting equipment on occasion and used condoms rarely. M-IDUs had a large social network of "buddies" and a small risk network of "friends". SI-IDUs had two separate large social networks of "buddies": a M-IDU and a non-IDU network; and a small risk network of "friends". Both groups reported monogamous sexual relationships. M-IDUs traveled within Hungary, whereas SI-IDUs traveled to Western Europe. If an HIV epidemic among IDUs in Hungary is not prevented, SI-IDUs may form a potential "bridge" of HIV infection between high-risk IDU populations and the low-risk general population, whereas M-IDUs may become cores of infection. Different approaches may be appropriate for M-IDUs and SI-IDUs to prevent HIV.

Adult↗
PubMed1988

Progress in treatment of Wilms' tumor in Hungary.

Great improvement in the rate of prolonged survival or cure have occurred in Hungary in recent years. This improvement was the result of organizing a multimodal therapy program. In 1976, the Hungarian Pediatric Oncology Working Group was formed and 10 regional centers were organized. Survival rates for Wilms' tumor in Hungary now approximate the internationally accepted rates for these patients. This report dramatizes the value of a multimodal interdisciplinary therapy program for children with cancer, particularly those with Wilms' tumor. The experience in Hungary should encourage physicians in other underdeveloped areas of the world to organize similar programs for the care of cancer in children.

Child↗
PubMed2004

Rates of electroconvulsive therapy use in Hungary in 2002.

OBJECTIVE: In Hungary there has been no systematic evaluation of ECT use since 1992. Nine years ago, the legal regulation of ECT practice changed. Since 1994, the collaboration of a specialist in anesthesiology is a legal obligation. However, the introduction of the new antipsychotic and antidepressant drugs expanded the possibilities in psychopharmacological treatment. These events basically influenced ECT use. The aim of this study was to obtain an overview of ECT practice in Hungary after these changes. METHODS: A 13-item containing questionnaire was sent to all psychiatric departments. RESULTS: All departments except 1 replied by mail, by phone, or by e-mail. Forty-three departments indicated the use of ECT, but in clinical practice only 34 departments applied ECT in 2002. The average number of treated inpatients was 9 on ECT using departments. Altogether 0,6% of all hospitalized psychiatric inpatients received ECT in 2002. The indication for ECT was schizophrenia in 55.6% of the patients and affective disorder in 40% of the cases. Mostly bitemporal electrode placement was used usually thrice weekly. Most commonly used sleep induction agents were thiopental and propofol. CONCLUSION: The rate of ECT use in Hungary is significantly lower than in the United States, in the United Kingdom, or in the Scandinavian countries and similar than in Hong Kong. The indication of ECT was schizophrenia in 55.6% of the cases.

Depressive Disorder↗
PubMed1999

Burden of human rotavirus-associated hospitalizations in three geographic regions of Hungary.

Data on hospital admissions and laboratory reports were used to estimate the number of hospitalizations of children aged 14 y or less in three geographic regions of Hungary due to group A rotavirus infection. Between January 1993 and December 1996, 9182 hospitalizations for gastroenteritis occurred, of which 1946 (21%) were associated with rotavirus infection. Most (90%) of the rotavirus detections were among children aged 4 y or less. By extrapolation, an estimated 5000 rotavirus-related hospitalizations (8.4/1000 children aged 4 y or less/y) occurred in Hungary during the study period. Marked seasonality of rotavirus infections was observed, with a peak of incidence from December to February. Rotaviruses with "long" RNA electropherotypes predominated each year, but in 1995/1996 20% of electropherotypes in the Budapest area were "short". Effective surveillance is required for all children hospitalized for diarrhoea as part of a rotavirus immunization program in Hungary.

Child, Preschool↗
PubMed1997

Richard Bright in Hungary: a reevaluation.

Richard Bright, the highly respected physician and nephrologist at Guy's Hospital, had a strong liking for travel. In 1815 he traveled in Hungary and made very important observations about the country. His 762-page book, entitled Travels from Vienna through Lower Hungary has detailed, sometimes appreciative, sometimes very critical remarks and comments on Hungarian history, art, archeology, religion, the situation of nationalities, education, social conditions, law, farming, and mining. The Hungarians cherished the memory of Bright's travel in their country as reflected in several papers and on two commemorative tablets recognizing him as a true and sincere friend of Hungary.

England↗
PubMed1986

Social visions and social control: the evolution of medical thought in postwar Hungary.

After nearly two decades of rigid adherence to the Soviet model of social and economic development, Hungary initiated a series of reforms in the 1960s that emphasize decentralization and market economic mechanisms. Internal repression and surveillance have diminished concurrently. Shaped by these broader social trends, three explanations of disease causation have successively emerged in Hungary since World War II: social medicine, a lifestyle model, and a psychosocial model. Although each model attempts to offer the best explanation for prevailing patterns of morbidity and mortality, each also reflects an underlying world view and the political priorities that derive from it. Social medicine and the lifestyle model have served largely to consolidate the power of ruling elites. The psychosocial model, on the other hand, has the potential to challenge the social order. The current popularity of the lifestyle model seems rooted in a widespread cynicism about social change which in turn is a product of contemporary social conditions in Hungary.

Hungary↗
PubMedDate not supplied

Childhood leukemia and statistical characteristics in 0- to 18-year-old patients in Hungary, diagnosed between 1988 and 1992.

A population-based cancer registry for childhood leukemia was started in Hungary in 1971. Data processing and analysis have been done at the Second Department of Pediatrics, Semmelweis University Medical School in Budapest, which is the main center for the treatment of childhood malignancies in Hungary. In 1992 a new computerized database structure was created in collaboration with Kansas University Medical Center, Kansas City, Kansas, United States. This work presents childhood leukemia frequency distribution and treatment results between 1988 and 1992 in Hungary. The number of patients diagnosed with leukemia under 18 years of age fluctuates between 69 and 82 cases per year. We present the main causes of death and outline our future objectives to improve the survival rate and quality of life.

Adolescent↗
PubMed1992

Drug use by the members of youth subcultures in Hungary.

In our survey we tape recorded sociological interviews with 234 members of youth subcultures in Hungary. Further, we conducted participant observations. This is the first survey of the kind in Hungary. In this study we present findings concerning the familial, sociodemographical characteristics of the persons and also the data related to their course of life and their career in the subculture. We compare the drug-user youths in the subculture groups and the ones in the same groups who are not drug users. The differences are above all due to the course of life and the special features of their careers in the subculture. The findings allow the subculture drug scene in Hungary to be mapped and therefore made better known.

Adolescent↗
PubMed2005

NOD2/CARD15 gene polymorphism in patients with inflammatory bowel disease: is Hungary different?

AIM: To analyse the impact of NOD2/CARD15 mutations on the clinical course of Crohn's disease patients from an eastern European country (Hungary). METHODS: We investigated the prevalence of the three common NOD2/CARD15 mutations (Arg702Trp, Gly908Arg, 1007finsC) in 148 patients with Crohn's disease, 128 patients with ulcerative colitis and 208 controls recruited from the University of Szeged, Hungary. In patients with Crohn's disease, the prevalence of NOD2/CARD15 mutations was correlated to the demographical and clinical parameters. RESULTS: In total, 32.4% of Crohn's disease patients carried at least one mutant allele within NOD2/CARD15 compared to 13.2% of patients with ulcerative colitis (P = 0.0002) and to 11.5% of controls (P<0.0001). In Crohn's disease patients, the allele frequencies for Arg702Trp, Gly908Arg and 1007finsC were 7.1%, 3.0% and 10.8% respectively. Interestingly, only the 1007finsC mutation was associated with a distinct clinical phenotype. The patients positive for the 1007finsC mutation suffered more frequently from stenotic disease behaviour (P = 0.008). Furthermore, 51.9% of patients positive for the 1007finsC mutation underwent a surgical resection within the ileum compared to only 17.4% of patients without the 1007finsC mutation (P = 0.001). With respect to the other two mutations (Arg702Trp and Gly908Arg), no associations were found with all investigated clinical parameters. CONCLUSION: NOD2/CARD15 mutations are frequently found in Crohn's disease patients from Hungary. The 1007finsC mutation is associated with stenotic disease behaviour and frequent ileal resections.

Adolescent↗