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[Cancer mortality and incidence in Hungary in relation to international data].

In Hungary mortality caused by malignant tumour diseases is very high. It is the second cause of death showing approximately 25% frequency. Statistics on disability has revealed that during the past 25 years the number of patients become invalid because of cancer has nearly doubled.In comparative international statistics cancer mortality and incidence of the Hungarian male population take the first and that of the female population the second place. The alarming public health problems caused by cancer in Hungary have prompted the authors to identify the causes and search for points of outbreak to stop and reverse these unfavourable tendencies. When analysing the current state of this country authors primarily rely on the studies of the European Cancer Centre, Lyon and those of the Hungarian Central Statistical Office (KSH) and National Cancer Registry. By years 2000-2001 the National Cancer Registry has become a reliable well functioning system. Its activities include the registration of all new cancer patients announced in the previous calendar year. Data processing requires information such as: year of diagnosis, tumour localisation and extension, morphological code and therapeutic interventions. It is a promising sign that the first time over the past 25 years cancer mortality decreased in year 2000. The unfavourable cancer mortality and incidence status in Hungary might be improved by the consistent accomplishment of the project "For a Healthy Nation, A Public Health Project for years 2001-2010".

Europe↗

[Comparison of patterns of drug therapy in Hungary and in developed Western countries for acute coronary syndromes].

Analysis of the data of international multicentric clinical pharmacology trials disclosed that the Hungarian (and Eastern European) patients are more sick, than their western counterparts. The drug prescription habits in Hungary are close to that of international standards. The Hungarian doctors order more nitrates, anticoagulants and ACE inhibitors, but less cholesterol-lowering medication than in other countries. The door-to-needle time in Hungarian patients scheduled for thrombolysis was shorter than the mean. The high price of certain thrombolytic medications prevents Hungarian hospital's doctors to use optimal thrombolytic therapy. The high price of statins in Hungary relative to that of other medications for secondary prevention and to the average per capita income is one of the possible causes that this class of medication is used less frequently in Hungary than in Western Europe. This fact may prevent the decrease of cardiovascular morbidity and mortality on the long-term.

Acute Disease↗

[Correlation of alcohol consumption and pancreatitis in Hungary].

Alcoholic etiology of acute pancreatitis is outstanding high in Hungary. The aim of this retrospective study was to analyse the etiology of patients of 5 years. Between 1990 and 1994 altogether 374 patients were admitted with acute pancreatitis, which is three and half times higher than between 1970 and 1974. From the 374 cases 220 had alcoholic and only 115 had biliary etiology. Altogether in 127 patients developed necrosis, the rate of alcoholic etiology was 80% in this subgroup. During the last two decades the trend of alcohol consumption became one of the most burning question in Hungary. Based on the Jellinek's formula alcohologists estimate the number of alcoholics more than one million. The number of pancreatitis related death multiplied almost four times between 1970 and 1994. The doubling of alcohol consumption was practically simultaneous with the increase of morbidity and mortality of pancreatitis. Hungary shows the most disfavourable distribution of drink varieties among the high-consuming countries in Europe.

Acute Disease↗

[Immigration of physicians and dentists into Hungary in the 1980's and 90's].

Following the fall of the socialist regime in Hungary (1989), it was observed by patients and doctors alike that the number of foreign physicians and dentists significantly increased in the late 1980's and the early 1990's. There was no scientific research so far about these changes. Based on a cross-sectional study in 2001, there are 39,122 registered and professionally active members in the Hungarian Medical Chamber in Hungary. There are 33,915 physicians and 5,207 dentists. At present, the total number of foreign citizens among them amounts to 797, including 517 doctors who studied in Hungarian universities, albeit in English, not in Hungarian. There are also 2,167 doctors with Hungarian citizenship with a medical diploma from abroad. It is likely, that 260-270 people in this group were already Hungarian citizens before entering medical training. Subtracting them from the 2,167 doctors and adding 517 foreigners trained in Hungary, it may be stated that approximately 2,400 doctors work in the Hungarian health care as a result of international migration.

Dentists↗

[Incidence of pediatric brain tumors in Hungary between 1989 and 1999].

INTRODUCTION: The incidence of primary brain tumors in childhood has increased all over the world in the last decades, so it is the second most frequent tumor after leukaemias. AIMS OF THE STUDY: The aim of this study was to examine the incidence and relative frequency of central nervous system tumors diagnosed under 15 years of age in Hungary. METHODS: The data obtained from the Hungarian Pediatric Oncology Group and the National Neurosurgical Institute between 1989 and 1998, and the reports of the head pediatricians of the counties were used. RESULTS: There were 685 reported cases between 1989 and 1998. The prevalence of cerebral tumors has increased during the last decade in Hungary like that in several developed countries. The increase of the incidence of primary central nervous system tumors in the last ten years was 4.2% per year. In 1998 the incidence of central nervous system tumors was 42.9 cases per million children. The most frequent histological categories were: astrocytoma (30%), medulloblastoma/primitive neuroectodermal tumors (21%), ependymoma (9%) and other tumors (40%). CONCLUSION: The results suggest an increase in the incidence of primary brain tumors in Hungary, similar to those reported in several countries.

Adolescent↗

Hungry for Hungary: examples of tobacco industry's expansionism.

OBJECTIVE: To give an overview of available internal tobacco industry documents on the transnational tobacco companies' (TTCs) efforts to enter the new market of the emerging democracy of Hungary and how it developed allies in its efforts at resisting tobacco control regulations. METHOD: Internal tobacco industry documents relevant to Hungary, available on the World Wide Web, were searched between 26 July and 30 November 2001. Documents on the identification of Central and Eastern Europe (CEE) as a great market potential have been reviewed; another set of reviewed documents are of particular relevance to Hungary, as they indicate who the main partners of the industry are. CONCLUSIONS: TTCs not only invaded the markets of the fragile new CEE democracies by making their product widely available, but also introduced sophisticated lobbying and marketing tactics. TTCs will try to shape the country's regulatory framework in a manner to help increase their profits. The fiercer the reaction of TTCs against a planned regulatory measure is, the more impact on the health of the population could be expected from the introduction and enforcement of that measure.

Democracy↗

[Prescription and safety of dimethindene maleate micropellet capsules in Hungary].

INTRODUCTION: Dimethindene maleate, the active substance of the extended-release Fenistil 24 capsule, is a first-generation histamine receptor antagonist, which is marketed in 10 European countries. In Hungary approximately 200,000 boxes are sold yearly from this product, which is mainly used for treatment of symptoms associated with allergic diseases (urticaria, itch, hay fever) The aim of the present study was to gather information with the help of medical doctors about the indications, efficacy and primarily the safety of use, observed side effects and frequency of adverse events associated with this product. METHOD: During the study 4574 questionnaires were evaluated out of the 5578 filled by 249 doctors. Responses were included into the evaluation only if the address and type of polyclinic of the doctor filling the questionnaire, indication of the use of the product could be precisely identified and the patient returned for control visit at least once. RESULTS: Based on the study results in Hungary in most cases the product is prescribed according to the indications and dosing schedule given in the SPC. In this study participating doctors found the drug to be effective in 95% of cases. Unexpected, new adverse events were not observed during the study. Approximately 22% of patients reported adverse events, tiredness and sleepiness being the most frequent ones. Occurrence of sedative adverse events was more frequent among those who were prone to tiredness (51 vs. 17%). The adverse events most frequently were reported 10-12 hours after intake. The average length of treatment was 4 weeks or less. The medicine is taken usually at night, before going to sleep. CONCLUSIONS: In Hungary in most cases the product is prescribed according to the indications and dosing schedule given in the current approved Summary of Product Characteristics.

Adolescent↗

[Pharmacotherapeutic trends at the beginning of the millennium in Hungary. Pharmacotherapy for bipolar patients, I].

UNLABELLED: The therapy of bipolar disorders is a challenge for clinicians not only in the acute, but also in the maintenance phase. The choice is hazardous in spite of the many drugs available for this purpose. There are the classical mood stabilizers, antipsychotics, antidepressants, anxiolytics, hypnotics and other medicines that are usable in the treatment, but the resolution of the clinician can significantly influence the actual and prospective condition of the patient. We have evidence based experimental, anecdotal knowledge about the therapy of bipolar disorders, but we do not know the facts of the practice. The aim of the study was to evaluate the current therapeutic trends in Hungary. METHOD: A questionnaire was compiled and sent to psychiatrists working in different regions of Hungary. The questions referred to the institute, the patient (demographic data, actual condition, disorder) and the actual treatment. The study was blind to the investigator: nor the psychiatrists neither the patients were identified. The study covered patients visiting psychiatrists from 25 November to 6 December 2002. RESULTS: 204 questionnaires were evaluated. 82 male and 122 female patients were included, of the average age of 48 years. The distribution of the disorders was as follows: bipolar I: n = 120; bipolar II: n = 66; cyclothym: n = 18; and the actual condition was diagnosed, too. More than half of patients showed a balanced state. 28% of patients took only one, 35% two and 23% three kinds of psychotropic drugs, and 14% four or more simultaneously. 92% of patients was on "classical mood stabilizers" (lithium, carbamazepine, valproate) and the use of the carbamazepine was the most frequent. 54% took some kind of antipsychotic drugs and three quarter among them some atypical form. The use of anxiolytics was excessive: 44% of patients used one of them. 35% was on antidepressants and more than half of them on SSRI. CONCLUSION: The study findings show the current state of the treatment of bipolar disorders in Hungary, and are comparable with the relevant international trends and professional expectation. The results are useful in practice and in the education of physicians.

Adult↗

[Lung harvesting in Hungary--results of the first two years].

OBJECTIVE: Hungarian patients undergo lung transplantation within bilateral cooperation in Vienna, Austria since 1995. Lung harvesting was introduced in 2002 in Hungary. Before 2002 Hungarian patients get 16 donor lungs from abroad, and 4 patients died while being on the waiting list for transplantation. METHODS: Between 15/1/2002 and 31/12/2003 Hungarotransplant offered 164 potential lung donors to the Korányi National Institute for Pulmonology. Donor selection was performed according to international guidelines. All operations were performed as part of multiorgan harvesting. Immediately before cross clamping the aorta 500 microg epoprostenol (Flolan) was administered intravenously for opening the pulmonary vascular bed. The lung was perfused through the main pulmonary trunk with a single flush of 6 litre 4 degrees C extra cellular type low potassium dextran solution (Perfadex). During the perfusion both thoraces were cooled topical by 0.9% saline ice slush. After back table separation the donor lungs was packed and transported with topical cooling. RESULTS: The offer was refused in 27 cases due to donor history, in 31 cases due to allograft pathology. In 57 cases the harvesting was not performed due to logistic reasons. Forty three donor lungs have been transplanted, 6 harvested lungs underwent only histopathology. From 43 harvested lungs 41 bilateral and 3 single lung transplant procedures were performed. The mean cold ischaemic time (=CIT) was 3 75 +/- 50 minutes (range: 230-560 min). Forty two donor lungs showed excellent primary graft function. One allograft underwent down-sizing lobectomy, where the histology of the specimen showed multiple microembolization, and signs of fibrosis, bronchiolitis and anthracosis. In this case the cold ischaemic time was 385 min. The patient needed an extracorporeal membrane oxygenation (ECMO) support immediately postoperatively, and died on the 4th postoperative day. After induction of lung harvesting in Hungary the average waiting time of Hungarian citizens dropped within one year from 14 +/- 8 weeks (range: 2-36 weeks) to 2.6 +/- 1.3 weeks (range: 1-4 weeks). In 2002 3 Hungarian patients died while being on the waiting list, their waiting time was 1, 1, and 7 days. In 2003 the waiting list mortality for Hungarian patients was 0%. CONCLUSIONS: After the introduction of lung harvesting both the waiting time and the waiting list mortality for Hungarian patients decreased. The potential yearly lung donor pool of Hungary is in the range of 5/1 million people.

Adult↗

[The use and safety of butamirate containing drops, syrup and depot tablets in Hungary].

INTRODUCTION: Butamirate citrate containing medicines are marketed in Hungary since 1991. Every year several hundred thousands of children and adults are treated with these pharmaceutical products. Aim of the study was to compare the prescription habits with the directions provided in the Summary of Product Characteristics and to get an overview on the safety and efficacy of these products. METHODS: The study results are based on the evaluation of 3215 questionnaires provided by 276 general practitioners and pulmonologists having medical practice in many regions and the capital of Hungary. Responses were included into the evaluation only if the name of the physician, the address and type of the practice, the therapeutic indication could be precisely identified and if the patient returned for at least one control visit. RESULTS: The main therapeutic indication of butamirate was cough due to acute lower respiratory tract infections (tracheitis, laryngitis, bronchitis). The treatment interval was usually 1-2 weeks. Depot tablets were prescribed according to the Summary of Product Characteristics. The doses of syrup and drops were frequently and notoriously below the one proposed in the Summary of Product Characteristics. In 14% of the cases the syrup was prescribed for the treatment of children below 3 years of age. All three products were regarded as effective. Adverse events (nausea, vomiting, diarrhoea, skin exanthemas) were reported at 0.5-1% of the patients. CONCLUSIONS: The prescribed average daily doses of drops between the ages 1 month-12 years and the syrup between the ages 6-12 years were 20-30% below the recommended amounts. In Hungary the butamirate citrate containing medicines are regarded to be effective. The adverse events were rare and non-serious.

Administration, Oral↗

[Health status of physicians in Hungary: a representative study].

BACKGROUND: A growing body of evidence in the international literature suggests that the prevalence of psychiatric morbidity including suicide is high among physicians. In addition, data published by Hungarian researchers in the early 1990-ies showed high prevalence of somatic morbidity in this population. Based on these data, it is hypothesised that the prevalence of psychiatric and somatic morbidity is higher among physicians in Hungary compared to the white collar population. AIMS: To assess the psychiatric and somatic health status of physicians as well as the prevalence of role conflict among female physicians in Hungary using a representative sample. METHODS: Data for this epidemiological study were collected from 407 physicians using questionnaires. 1752 white collar female and male workers from a representative survey (Hungarostudy 2002) served as controls. RESULTS: It is found that the prevalence of chronic somatic morbidity among both female and male physicians was significantly higher than that in the respective control groups. The prevalence of malignancies, diabetes, renal impairment, hypertension, myocardial infarction and cardiovascular diseases, and gastrointestinal ulcers was higher among male physicians compared to control. Female physicians exhibited higher prevalence of malignant diseases, hypertension, myocardial infarction, bronchial asthma, other pulmonary and cardiovascular diseases, allergies, gastrointestinal diseases including ulcer, ophthalmologic and gynaecological disorders compared with the normative population. This study is the first in Hungary to report a significantly higher prevalence of maternal reproductive morbidity including miscarriage, therapeutic termination of pregnancy, high-risk pregnancy among female physicians compared to women in the control group. CONCLUSIONS: Correlation analyses confirmed a significant relationship between high prevalence of morbidity and long working hours (> 8 hours), severe anxiety and stress, and role conflict.

Adult↗

[Trends in pharmacotherapy of unipolar depression at the beginning of the century in Hungary].

UNLABELLED: At the first glance the treatment of depression not seems to be a difficult task for the physicians. However, prescribing an effective drug, determining the right dose and choosing a suitable adjunctive therapy are all important factors requiring up-to-date knowledge and experience by the physicians. The results of evidence based studies, experimental facts, and anecdotal knowledge are taken into practice by the physicians so it is of vital importance to gain information about the actual pharmacotherapeutic trends they use in everyday practice. Since these facts are rarely revealed, the aim of my study was to give an overview of the therapeutic trends of depression in Hungary. METHOD: A questionnaire constructed by the author was filled in by psychiatrists working in outpatient clinics in different regions of Hungary for each patient turned to them in the period between 1 and 11 June, 2004. The inclusion criteria was the diagnosis of unipolar major depression and the exclusion criteria was the existing comorbid psychiatric disorder both based on the judgement of the clinician. Since neither the physician, nor the patient was identified the study was blind to the investigator. RESULTS: By evaluating 170 questionnaires 20,6% of the patients were found to take one, 46,5% two, 24,7% three, and only 8,2% four or more kinds of psychotropic drugs simultaneously. Only 4 patients were not given any antidepressants at all and 19 (13,5%) were on two antidepressants. 64,1% of the patients took some SSRI (citalopram>sertraline>paroxetine), 22,4% some dual action (mirtazapine>venlafaxine), and 22,4 other antidepressants (tianeptine, moclobemid etc). Not any kind of classical TCS was given. 71,8% of the patients found to be on anxiolytic, 7,7% on mood stabilizer, 4,2 on antipsychotic and 16,5% on hypnotic drug. The doses used by clinicians did not show any deviation from the guidelines. 95 patients (55,9%) could be kept balanced with the therapy above and only 8 patients (4,7%) were in serious condition. More than half of the patients (54,1%) was given the same antidepressant for one year and the long term use of anxiolytics was found to be typical. CONCLUSION: The results show the current trends in the pharmacological treatment of depression. Only psychiatrists participated in the study because mostly they have the responsibility for the correct diagnosis, assessment and therapeutic choice up to the present in Hungary. These data can be compared with the international trends, professional expectation, or the future results of trials and also can be used in education.

Antidepressive Agents↗

[Lung diseases caused by non-tuberculous mycobacteria in East Germany and Hungary].

Despite the decrease of new cases of pulmonary tuberculosis also between 1982 and 1986 an increase in nontuberculous mycobacteriosis can be seen especially in the GDR and also in Hungary. In 1986 the ratio of recognized lung diseases caused by nontuberculous mycobacteria to all newly diagnosed bacillary cases was 4.1% in the GDR and 2.2% in Hungary. In Hungary, M. xenopi was the most important potential pathogenic species of nontuberculous mycobacteria during the whole period, followed by M. kansasii. In the GDR at the beginning most cases of nontuberculous mycobacteriosis were caused by M. kansasii later, M. xenopi was most frequent. Most of the patients with nontuberculous mycobacteriosis were men older than 50 years of age.

Cross-Sectional Studies↗

Incidence of non-cholera vibrios in Hungary.

In the period 1971 to 1976, 200 non-cholera vibrio (NCV) strains were isolated in Hungary; 18 of the cultures were derived from 34 729 faecal and 182 from 237 surface water samples. Ninety-two strains belonged to the Heiberg-Smith group I and 108 to group II. Two strains failed to give the string test and 3 were pteridine resistant. The strains were classified into 48 serotypes according to Smith's system. Faecal NCV strains belonged to serotypes 46 and 328; these serotypes did not occur in water. Of the 18 faecal strains 13 were isolated from 18 048 persons who had travelled in cholera-infected areas, and 5 strains from persons who had never left Hungary (2 from 4559 patients with diarrhoea and 3 from 6061 healthy individuals). These data indicate that although NCV are present in the environment, they play an insignificant role in enteric infections in Hungary.

Bacterial Toxins↗

[Epidemiology of Helicobacter pylori infection in Hungary (comparative sero-epidemiologic study)].

In the last decade pathogenetical role of Helicobacter pylori infection has been proved in development of gastroduodenal alterations. DNA-RNA hybridisation and protein profile studies proved that Helicobacter pylori is an organism distinct from other bacteria. Therefore serology became a useful method to study the epidemiology of Helicobacter pylori infection in various populations. In Hungary sera were collected from adults aged 20-60 in blood banks (Military Hospital, Tolna County Hospital) in 1993. The samples were classified in 5 year increment groups and questionnaires were filled out. Anti-H. pylori IgG were tested using Cobas Core kit (Roche Diagnostic). The overall rate of seropositivity was 63.3%. The prevalence according to age was the following: 20-24 yrs = 44%, 25-29 yrs = 40%, 30-34 yrs = 52%, 35-39 yrs = 64%, 40-44 yrs = 75%, 45-49 yrs = 73%, 50-54 yrs = 77%, 55-59 yrs = 83%. There were no statistical difference between gender, living in urban or rural areas at the time of collection or in childhood, between the level of education, type of labour or social status. However we found statistical correlation between anti-H. pylori seropositivity and epigastric symptoms. The same characteristics of Helicobacter pylori infection were found in Hungary as well as in other countries. In groups between 20 and 30 years has been proved lower prevalence in Hungary than in Poland, Bulgaria.

Adult↗

[Psychological status of Croatian refugees in Hungary].

This presentation addresses the capability of Croatian refugees from Baranja to acclimatize themselves in the Republic of Hungary. The authors assessed the mental health of 100 refugees through a psychiatric interview using a questionnaire, specifically designed for the purpose of this research. Their ages ranged from 10 to 82 years, average age 38 years. The assessment of mental health of the refugees was conducted 6 weeks following their placement in a camp (social institution) of a small town (Maria Jüd) in Hungary. The authors found that refugees fled their homes and homeland in front of barbarous combined forces of local Serbs whom they identified as terrorists and Yugoslav Federal Army. Leaving homes and country was sudden and unexpected, but by their own will. The departure was accompanied by fear, anxiety, disbelief, despair, anger and rarely by panic behaviour. Fear for children's safety was on the first place, than fear from exposure to violent injury--torture and crippling, while threat for ones own life and life of relatives as well as loss of property were of milder intensity. Among the most dominant feelings refugees manifested during an interview were: home--and homeland sickness and uncertainty about the future. In 61% of the examinees, these feelings prevailed. Forty-two per cent of the subjects experienced emotional and psychosomatic disorders, primarily Beard's "neurasthenic syndrome". Only 5% of the refugees needed psychiatric help, mainly those who had psychic problems before they fled their homes. The authors conclude that Croats from Baranja who took refuge in Hungary had acclimatizational problems even 6 weeks after displacement, which were manifested as emotional and psychosomatic reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗

Precipitating antibodies to Crimean haemorrhagic fever virus in human sera collected in Hungary.

Agar-gel diffusion precipitation test was carried out with Crimean Haemorrhagic Fever (CHF) virus as antigen in serum samples collected in four areas of Hungary from 587 persons working in contact with animals, and in 169 animal sera collected in Hajdu-Bihar county, Hungary. Antibody was found in 17 human sera. All these but one, originating from a slaughterhouse worker in Budapest, had been collected from Hajdú-Bihar county. The highest titre was 1:16. All the animal sera proved to be negative. It is suggested that the CHF virus or a closely related virus is present, and may cause human infections in Hungary.

Abattoirs↗

[The bone-marrow transplantation program in Hungary: report from the period 1990-1995].

The article summarises the statistical data of bone marrow transplantation (BMT) carried out in Hungary between 1990-1995 in yearly distribution. Since the first BMT up to the end of 1995, 168 BMT were performed. The number of transplantations since 1990 to our days was gradually increasing. As a result of this activity in the three transplantation centers (National Institute of Haematology and Immunology, St. László Hospital and County Hospital in Miskolc) 36 allogeneic and 12 autologous BMT were performed in 1995. Out of the allogeneic BMT cases, 14% of them were completed with unrelated, donors in the last three years. The most frequent indications for allogenic BMT are: chronic myeloid leukaemia (CML), acute lymphoid leukaemia (ALL), acute myeloid leukaemia (AML), myelodysplasia, severe aplastic anaemia. Child allogenic BMTs are carried out on pediatric patients in St. László Hospital in leukaemia, severe aplastic anaemia cases and children born with immunodeficiency. Autologous BMTs started in an organised way in 1995 for adult patients in cases of non-Hodgkin lymphoma, Hodgkin lymphoma and for children with solid tumour indication in the Miskolc Centre. BMT activity in Hungary compared with international data, especially within Europe, shows a significant drop behind. To calculate for ten million inhabitants, the optimal BMT activity should be between 100-200 transplantations (allogeneic and autologous BMT together) in 1994. Among the Central European countries Hungary and Poland fall most behind. Autologous BMTs in most countries of Europe are above of allogeneic BMTs in numbers as indication in cases of lymphoma and solid tumours (first of all mamma carcinoma) comes into focus. This summary emphasises the most important difficulties in connection with the development of the National BMT program.

Adolescent↗