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Partners in life: unmarried couples in Hungary.

"Non-marital cohabitation in Hungary is documented using data from the 1970 and 1980 censuses and the 1984 microcensus. Observed patterns contrast with those in several other countries, particularly those of western and northwestern Europe. Firstly, in Hungary unmarried couples or 'partners in life' are more common, and their proportion is increasing more rapidly, among the previously married than among the single. Secondly, both among the single and the previously married, mothers are more likely than childless women to be cohabiting. Thirdly, although proportions cohabiting are higher in urban than in rural areas, partners in life are concentrated among those with the lowest educational level." (SUMMARY IN FRE)

Developed Countries↗

A detailed study on suicides in Baranya County (Hungary).

Suicidal deaths which occurred in Baranya County, Hungary between 1983 and 1987 were investigated with regard to biodemographical aspects. The number of suicidal deaths for this period was 1056 and the rate for this region was higher in villages than in towns. The male: female ratio was 3:1. The analysis of age groups showed that the rate increased with age and that the most frequent method was by hanging (50-55%). Moreover in 375 cases in-depth interviews were made with the relatives. The analysis of the interviews showed that 20% of elderly males could not cope with their losses and found no way out except through suicide. Suicide was less frequent among persons with intellectual occupations. Severe alcohol abuse was found in 165 cases. In 83% of the 1056 cases studied, pathological disorders of varying severity were observed. Toxicological analysis was performed in 810 cases but 17.9% of these cases should be isolated since they involved acute drug intoxication. Our data showed that most of the suicide victims contacted a doctor and received some treatment immediately before death or not long before. The present health and geriatric care systems in Hungary do not provide a level of psychotherapeutic care which could protect the population at risk from suicide. In our opinion, it would be reasonable to develop the knowledge of practitioners and health care personnel working in this field.

Adult↗

Recent health system development in Poland and Hungary.

Before 1989, the health systems of both Poland and Hungary were fully socialist, with all resources being governmental. The total populations of these countries were entitled to comprehensive health services from regionalized networks of hospitals, polyclinics, and primary health stations. Preventive environmental and epidemiological services were provided through special small facilities. Since the termination of socialism in 1989, the Polish system has been largely unchanged, except for greater emphasis on primary health care. About 5 percent of polyclinics have been privatized. In Hungary, financing has been transferred to a Social Security Fund. Polyclinics have been absorbed by hospital outpatient departments, and patients may use them only on referral by a family doctor. Public health officers have a wider scope of responsibilities in their districts. Both health systems still stress equitable distribution of services to everyone.

Comprehensive Health Care↗

Comparative costing analysis of intensive care services between Hungary and United Kingdom.

OBJECTIVE: The study presents the findings of the first National Intensive Care Cost Block Analysis in Hungary. METHODS: There were 13 Intensive Care Units (ICUs) involved in this study: 5 University Hospitals, 6 District County Hospitals and 2 City Hospitals. The annual costs of ICUs were measured by "top-down" approach based on Cost Block Method. Annual expenditure of 3 cost blocks was collected for year 2000: clinical support, consumables and staff costs. On top of the annual costs, we collected general ICU data and Top 10 drugs of each unit. Our data was compared to National Cost Block data of United Kingdom. RESULTS: There were 9313 patients involved in the study. The median (IQR) ICU occupancy rate was 67% (62-79), mortality was 21% (11-26). The mean cost per bed was 30,990 Euro (SD 12,573) and 144 Euro (SD 63,1) per patient day. Clinical support services were accounted for 9.6% of resources, consumables for 60.6% and staff costs for 29.8%. CONCLUSIONS: Intensive care costs are very low in Hungary compared to other European countries. The difference is explained by the cheaper staff cost, but the lower number of nurses per ICU bed contributes as well.

Costs and Cost Analysis↗

The incidence, prognosis, clinical and histological characteristics, treatment, and outcome of patients with bilateral germ cell testicular cancer in Hungary.

PURPOSE: To examine the incidence, prognosis, clinical and histological characteristics, treatment, and outcome of patients with bilateral testicular cancer in the referral center in Hungary, to determine which parameters might predict a second testicular tumor. METHODS: . Clinical parameters-such as time of original surgery, histology of primary tumor, extent of the disease, serum marker concentrations, history of testicular abnormalities, treatment, response to treatment, follow-up period, data on second carcinoma-of bilateral testicular tumors among the 2,386 patients with testicular cancer treated between November 1988 and November 1998 were analyzed. RESULTS: The incidence of patients with synchronous testicular tumor was 0.8% (19 of 2,386 patients). The clinical stages were 8 I/A, 5 I/B, 1 II/A, 2 II/B, 1 III/A, and 2 III/B. Median follow-up time was 93 months and the 5-year overall survival was 84%. The incidence of patients with metachronous testicular cancer (median age 28 years and 35 years at first and second tumor diagnosis) was 2.2% (53 of 2,386 patients) and the median time to second tumor was 76 months (range 18-203 months). The clinical stages at the first and second tumor diagnosis were: 14 I/A, 21 I/B, 15 II/A, 2 II/B, and 1 III/B, and 26 I/A, 16 I/B, 3 II/A, 1 II/B, 7 III/B, respectively. The median follow-up time was 42 months and the 5-year overall survival was 93%. In thirteen patients with metachronous cancers, two family histories of testicular cancer, five cases of undescended testicles, seven cases of testicular atrophy, and one case of azoospermia were detected. There was a non-significant trend to a longer cancer interval after chemotherapy and radiotherapy and a tendency to a greater incidence of asynchronous seminoma after chemotherapy. Clinical stage I tumors were more frequent in the surveyed group than among patients not followed up according to the institutional protocol ( P = 0.01), but the survival rate was good in both groups. Seminoma as a second tumor was diagnosed in an older age group (median 38 years, range 25-49 years) than nonseminoma (median 32 years, range 21-51 years, P < 0.045). The interval till the appearance of a metachronous testicular cancer depended on tumor histology: in seminoma cases it was longer than in nonseminoma cases (median time: 121 months versus 50 months, P = 0.002). CONCLUSIONS: The overall incidence of bilateral testicular cancer in the referral center in Hungary was 3%. We could not identify clinical factors which predicted a higher risk for metachronous testicular cancer. With regular follow-up the early diagnosis of second testicular tumors is probable; therefore education, self-examination of the remaining testicle, and long-term follow-up are important in early detection.

Adult↗

Phylogenetic analysis of rabbit haemorrhagic disease virus (RHDV) strains isolated between 1988 and 2003 in eastern Hungary.

To define the genetic variability of RHDV strains collected in eastern Hungary, liver samples from rabbits that had died of RHD were collected between 1988 and 2003. The phylogenetic analysis of a 528-nucleotide-long portion of the gene encoding the VP60 capsid protein assigned the strains into three genogroups. The first group contained viruses from 1988-1993, and a second group comprised isolates from 1994-2002. A third group comprised all of the tested representatives of the RHDVa subtype and a Hungarian isolate from 2003. These findings were supported by the alignments of the deduced amino acid sequences of the VP60 gene and strongly suggest the presence of the RHDVa subtype in Hungary.

Amino Acid Sequence↗

Enteric caliciviruses in domestic pigs in Hungary.

Caliciviruses closely related to human norovirus and sapovirus were recently detected in domestic pigs, causing discussions about the animal reservoir and the potential for zoonotic transmission to humans. To detect porcine caliciviruses, 17 fecal samples collected on two swine farms in southwestern Hungary were tested by reverse transcription-polymerase chain reaction. Three (17.6%) samples were positive for caliciviruses. This study confirms the presence of caliciviruses, both porcine sapovirus (genus Sapovirus) and porcine norovirus (genus Norovirus), in domestic pigs in Hungary and provides additional information on the viral genetic diversity and relationship to viruses referred to as human caliciviruses.

Animals↗

Variability of the PreS1/PreS2/S regions of hepatitis B virus in Hungary.

Infection with the hepatitis B virus can occur perinatally, parenterally, or sexually, and it can cause acute or chronic liver diseases. Phylogenetic analysis of the virus has led to its classification into eight genotypes (A-H), which show a characteristic worldwide distribution. The aim of this study was to reveal the HBV genotypes present in Hungary and to investigate a nosocomial and an intrafamilial outbreak. The collected samples were tested by nested PCR, and a 650-nucleotide-long segment of the preS1/preS2/S region was sequenced. As no previous genotype data were available from Hungary, sera of 24 HBsAg-positive patients were collected from different regions of the country. They also served as control samples for the molecular epidemiologic study. Nineteen of them carried genotype D of hepatitis B virus, and five of them carried genotype A. Twenty-nine patients from a haemato-oncology unit were affected in a nosocomial outbreak. The patients had haematological and/or oncological diseases, most of them were immunosuppressed. In twenty-eight cases, based on phylogenetic analysis of the viruses, there was presumably a common source of infection, and an epidemiological investigation showed that the infections seemed to be hospital-acquired. In the intrafamilial outbreak, two asymptomatic carrier children infected their foster mother. The three sequences were totally identical.

Amino Acid Sequence↗

Pulmonary Mycobacterium xenopi infection in AIDS patients treated with HAART in Hungary.

Reported here are three cases of pulmonary Mycobacterium xenopi infection that occurred in AIDS patients in Hungary shortly after starting highly active antiretroviral therapy. In this country, Mycobacterium xenopi is the most common nontuberculous mycobacterial species causing pulmonary mycobacterial infections. Cases of pulmonary Mycobacterium xenopi disease have been described in patients infected with the human immunodeficiency virus infection and in patients with other immunodeficiencies; however, only limited information is currently available concerning the connection between nontuberculous Mycobacterium infection and AIDS in Hungary. This report thus adds useful information regarding the diagnosis, clinical course, and treatment regimens of Mycobacterium xenopi infections in AIDS patients.

AIDS-Related Opportunistic Infections↗

Occurrence and regional distribution of SHV-type extended-spectrum beta-lactamases in Hungary.

In order to determine the presence and geographical distribution of SHV-type extended-spectrum beta-lactamase genes among Enterobacteriaceae strains in Hungary, isolates from 25 microbiology laboratories throughout the country were collected between January 2002 and August 2003 and examined. Sequencing of the genes showed that SHV-5 and SHV-2a are the dominant SHV-types in extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in this country. The SHV-2 gene, which is prevalent in many European countries, was not detected, but one isolate carried the SHV-12 gene. The results show that these genes are circulating among Enterobacteriaceae strains in Hungary and indicate that strict infection control measures are warranted in order to prevent their spread.

Cross Infection↗

The cost-effectiveness of fluvastatin in Hungary following successful percutaneous coronary intervention.

BACKGROUND: The Lescol Intervention Prevention Study (LIPS) showed substantial gains in health outcomes from statins following PCI. That study was a randomized double-blind placebo-controlled trial undertaken in 77 centres, predominantly in Europe, of patients with moderate hypercholesterolemia who had undergone their first PCI. The evidence on cost-effectiveness has been established for the UK, USA and the Netherlands, but due to different health system cost structures, the results may not be applicable to other European countries. The aim of this study was to estimate the cost-effectiveness of fluvastatin used following first PCI in Hungary. MATERIALS AND METHODS: A deterministic Markov model was used to estimate the incremental costs per quality-adjusted life year gained, with cost data drawn from the Hungarian National Health Insurance Fund. Effectiveness data on fluvastatin was derived directly from LIPS and utility weights from previous studies on heart disease. Sensitivity analyses were conducted around key parameters and analyses were conducted for subgroups identified in LIPS. RESULTS: Treatment with fluvastatin cost an additional 1,704 euro and resulted in an additional 0.107 QALYs per patient discounted over 10-years compared with controls. The incremental cost per quality-adjusted life year gained was 15,910 euro. The key determinants of cost-effectiveness were the effectiveness of fluvastatin, utility weights, cost of fluvastatin, and the time horizon evaluated. Fluvastatin was substantially more cost-effective in patients with diabetes, renal disease, multi-vessel disease or LDL-cholesterol >3.4 mmol/l. CONCLUSIONS: Fluvastatin is an economically efficient pharmaceutical for reducing heart disease in Hungary and other European countries in patients following PCI.

Angioplasty, Balloon, Coronary↗

Antidiabetic drug utilization in hungary.

OBJECTIVE: To evaluate the utilization trends of antidiabetics in Hungary. METHOD: The analysis includes the drugs of antidiabetic therapy which were registered between 1998 and 2002 in Hungary. The consumption of antidiabetic drugs was analyzed by the ATC/Defined Daily Dose (DDD) method. The data used in this study were derived from the National Health Insurance and from MIS Consulting Company. RESULTS: Between 1998 and 2002, the total consumption of antidiabetics increased by 41.8%, and reached 47.59 DDD/1000 inhabitants/day in 2002. The consumption of oral antidiabetics (OAD) increased by 33.41% (33.86 DDD/1000 inhabitants/d ay in 2002), while in the case of insulin the increase was 67.8% (13.74 DDD/1000 inhabitants/day). Sulphonylureas were the most frequently used class (21.11 DDD/1000 inhabitants/day in 2002). Glibenclamide was the most frequently used antidiabetic drug (12.63 DDD/1000 inhabitants/day in 2002). CONCLUSION: The insulin class had greater emphasis in therapy. Among OAD, the consumption rate of sulphonylureas decreased and the consumption rate of Biguanides and acarbose increased. By 2002 metformin replaced 90% of the buformin in use. The limited effect of therapeutic recommendations could explain these changes, although the out-of-date buformin and the non-micronized glibenclamide were still in use in 2002.

Acarbose↗

The underuse of women's health care services in hungary. A preliminary study.

In order to collect baseline data for a 2-year Women's Health Program in Hungary, a survey was conducted of 369 women residing in one community setting. The purpose of this descriptive exploratory study was to gather preliminary data that would help identify perceptions of inhibitors to utilization of women's health services. An additional purpose was to identify perceived health needs in the study setting and to make recommendations for changes in the existing services. The survey results indicated that women were satisfied overall with their health care. Equivocal responses suggested, however, that patient-provider interactions and lack of understanding regarding preventive health care may contribute to the underuse of services. The authors suggest that public feedback that includes women's opinions and perceived needs is essential in health program planning and evaluation. In order to accomplish this, standardized Hungary-specific research instruments must be developed.

Adolescent↗

Suicide rates in Hungary correlate negatively with reported rates of depression.

Regional variations across Hungary in suicide rate and in rate of treated depression were examined. Regional differences in suicide rate as well as psychiatric morbidity were consistent over the 3 years examined (1985, 1986 and 1987). The suicide rate showed a significant negative correlation with the rate of treated depression in each of the 3 years, and weaker negative correlations with perinatal mortality and divorce rate. No correlation between suicide rate and rate of schizophrenia was found. The results suggest that underdiagnosis of depression may contribute to Hungary's very high suicide rate. The implications of this for medical education and psychiatric practice are discussed.

Bipolar Disorder↗

Immunological alterations in anti-HTLV-III negative haemophiliacs and homosexual men in Hungary.

Hungary can be considered as a low risk area for AIDS since no patient with full-blown AIDS or AIDS-related complex has been found in the country. A complex clinical and immunological (T cell subsets, DNCB sensitization test, circulating immune complexes, acid-labile alpha interferon) investigation was performed between November, 1983 and June, 1984 in order to study whether alterations found in symptom-free homosexuals and haemophiliacs in the risk areas for AIDS can be observed in Hungary as well. 38 patients with mild haemophilia, 35 patients with severe haemophilia and 40 homosexual men were investigated in parallel to 37 heterosexual blood donors as controls. Anti-HTLV-III antibodies were measured later in the stored serum aliquots from the same subjects by the indirect membrane immunofluorescence assay. Although specific anti-HTLV-III antibodies were not detected in the haemophiliacs or homosexuals, immunological alterations characteristic for the members of AIDS risk groups in the high risk areas (decrease in the percentage of OKT4 cells and/or decrease of the OKT4/8 ratio) were found in one-third of the homosexuals and haemophiliacs tested. In addition, a significant part of these subjects did not develop delayed type hypersensitivity skin reaction on DNCB rechallenge. These findings indicate that an immunodeficiency independent of HTLV-III infection can be present in two major AIDS risk groups, in homosexual men and haemophiliacs.

Acquired Immunodeficiency Syndrome↗

How immunology was won in Hungary.

To mark the occasion of the 8th International Congress of Immunology, this special issue surveys the latest findings from Hungarian immunology. Here, János Gergely, president of the Congress, traces the origins and development of immunology in Hungary and describes the joys and sorrows of being an immunologist in Hungary today.

Allergy and Immunology↗

HIV in Hungary.

HIV infection in Hungary has not reached the frightening proportions that are currently ravaging other parts of the world. Given this relatively fortunate position and the now clear understanding of the ways in which HIV is transmitted, vigorous public education programmes have been undertaken to minimize the spread of the virus. Here, George Füst outlines these efforts, discusses diagnosis and monitoring of infected patients, and describes HIV research in Hungary.

Acquired Immunodeficiency Syndrome↗

Neuroblastoma in hungary.

In a cohort study we investigated the incidence and distribution of the age and stage of neuroblastoma at diagnosis, and the outcome, in children aged 0-14 years during 1988-1998 in Hungary. The proportion of neuroblastoma in age groups of 0 year old, 1-4 year old, 5-9 year old and 10-14 year old children was 30%, 53%, 12% and 5%, respectively. The proportion of stage 1-2, stage 3-4 and stage 4s cases was 30%, 65% and 3%, respectively. Hungarian data were compared with data reported for other Western European countries. The distribution of age at diagnosis of Hungarian cases was significantly different from France and Germany (p < 0.05), but not different from that of the United Kingdom (UK). However, the proportion of stage 1-2 neuroblastoma was higher in Hungarian children (30%) than that reported in French, German and UK children. The incidence and survival of neuroblastoma in Hungary is broadly comparable to that reported elsewhere in Europe.

Adolescent↗