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Nemcsik J, Takács J, Pásztor D, Farsang C, Simon A, Páll D, Torzsa P, Dolgos S, Koller A, Habony N, Járai Z. Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry. Blood Press 2024; 33:2337170. [PMID: 38581160 DOI: 10.1080/08037051.2024.2337170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Hypertension is a major public health problem, thus, its timely and appropriate diagnosis and management are crucial for reducing cardiovascular morbidity and mortality. The aim of the new Hungarian Hypertension Registry is to evaluate the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists in outpatient clinics, as well as to assess the seasonal variability of blood pressure. MATERIALS AND METHODS Omron M3 IT devices were used during four-month periods between October 2018 and April 2023 in GP practices and in hypertension clinics. The blood pressure data were then transmitted online from the monitors' cuffs to a central database using the Medistance system of Omron. RESULTS Family physicians (n = 2491), and internists/cardiologists (n = 477) participated in the study. A total of 4804 821 blood pressure measurements were taken during 10 four-month evaluation periods. In the ten periods, the daily average number of measurements was between 3.0 and 5.6. Following ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14, 13.4 and 16.7%, respectively. Altogether 56% of the measurements belonged to stage 1, stage 2 or stage 3 hypertension categories (31.6, 17.1 and 7.4%, respectively). On average, a difference of 5/2 mmHg was observed between winter and summer data in systolic and diastolic blood pressures, respectively. The average systolic blood pressure values were higher in GP practices with more than 2000 patients than in the ones with less than 1500 patients (141.86 mmHg versus 140.02 mmHg, p < 0.05). CONCLUSION In conclusion, the low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians. In GP practices with more patients, blood pressure is usually less well-controlled. These results suggest that the further promotion of home blood pressure monitoring is necessary.
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Affiliation(s)
- János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Johanna Takács
- Department of Social Sciences, Semmelweis University, Budapest, Hungary
| | - Dorottya Pásztor
- Department of Cardiology, South-Buda Center Hospital St, Imre University Teaching Hospital, Budapest, Hungary
| | - Csaba Farsang
- Department of Metabolism, South-Buda Center Hospital St, Imre University Teaching Hospital, Budapest, Hungary
| | - Attila Simon
- State Hospital for Cardiology, Balatonfüred, Hungary
| | - Dénes Páll
- Department of Medical Clinical Pharmacology, University of Debrecen, Debrecen, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | | | - Akos Koller
- Research Center for Sport Physiology, Hungarian University of Sports Science, Budapest, Hungary
- Departments of Morphology & Physiology and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Habony
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Járai
- Department of Cardiology, South-Buda Center Hospital St, Imre University Teaching Hospital, Budapest, Hungary
- Section of Angiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Ares-Blanco S, Guisado-Clavero M, Del Rio LR, Larrondo IG, Fitzgerald L, Murauskienė L, López NP, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Sattler M, Saurek-Aleksandrovska N, Senn O, Seifert B, Serafini A, Sentker T, Ticmane G, Tiili P, Torzsa P, Valtonen K, Vaes B, Vinker S, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Díaz E, Domeyer PR, Feldmane S, Gjorgjievski D, Gómez-Johansson M, de la Fuente ÁG, Hanževački M, Hoffmann K, Ільков О, Ivanna S, Jandrić-Kočić M, Karathanos VT, Üçüncü EK, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Kozlovska L, Nessler K, Gómez-Bravo R, Peña MPA, Lingner H. Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study. Eur J Public Health 2024; 34:402-410. [PMID: 38326993 PMCID: PMC10990533 DOI: 10.1093/eurpub/ckad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary care and Community North Area of Madrid, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member of Royal College of Physician (MRCSI), Dublin, Ireland
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden; Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Goranka Petricek
- Department of Family Medicine “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, Croatia; Health Centre Zagreb West, Croatia
| | | | | | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of General Practice, Prague, Czech Republic
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, Modena, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
| | - Gunta Ticmane
- Department of Family Medicine at Riga Stradiņš University, Riga, Latvia; Member of the board of the Rural Family Doctors’ Association of Latvia, Latvia
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa. University of Helsinki, Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. WONCA Europe President, Israel
| | - Limor Adler
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | | | | | | | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Esperanza Díaz
- Pandemic Center, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway; Norwegian National Institute of Public Health, Bergen, Norway
| | | | - Sabine Feldmane
- Department of Family Medicine, Rīga Stradins University, Riga, Latvia
| | | | | | | | - Miroslav Hanževački
- Department of Family Medicine “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, Croatia; Health Centre Zagreb West, Croatia
| | - Kathryn Hoffmann
- Department of General Practice and Primary Care, Med. University of Vienna, Vienna, Austria
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | | | - Vasilis Trifon Karathanos
- Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina- Greece; GHS, Larnaca, Cyprus
| | - Erva Kirkoç Üçüncü
- Department of Family Medicine, Prof. Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | | | - Milena Kostić
- Health Center “Dr Đorđe Kovačević”, Lazarevac, Belgrade, Serbia
| | | | - Liga Kozlovska
- Department of Family Medicine of Riga Stradins University, Riga, Latvia; President of the Rural Family Doctors' Association of Latvia
| | - Katarzyna Nessler
- Department of Family Medicine UJCM at Uniwersytet Jagielloński - Collegium Medicum, Kraków, Poland
| | - Raquel Gómez-Bravo
- CHNP, Rehaklinik, Ettelbruck, Luxembourg; Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education, and Social Sciences, Luxembourg University, Luxembourg, Luxembourg
| | - María Pilar Astier Peña
- Technical Advisor for Quality and Safety, Territorial Healthcare Quality Unit, Territorial Healthcare Direction of Camp de Tarragona, Healthcare Institut of Catalonia, Health Departament, Generalitat de Catalunya GIBA-IIS-Aragón, Catalunya, Spain; Chair of Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine) and Quality and Safety in Family Medicine of WONCA World (Global Family Doctors), Board Member of WONCA World and SECA (Spanish Society for Healthcare Quality), Spain
| | - Heidrun Lingner
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
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Ungvari Z, Tabák AG, Adany R, Purebl G, Kaposvári C, Fazekas-Pongor V, Csípő T, Szarvas Z, Horváth K, Mukli P, Balog P, Bodizs R, Ujma P, Stauder A, Belsky DW, Kovács I, Yabluchanskiy A, Maier AB, Moizs M, Östlin P, Yon Y, Varga P, Vokó Z, Papp M, Takács I, Vásárhelyi B, Torzsa P, Ferdinandy P, Csiszar A, Benyó Z, Szabó AJ, Dörnyei G, Kivimäki M, Kellermayer M, Merkely B. The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging. GeroScience 2024; 46:191-218. [PMID: 38060158 PMCID: PMC10828351 DOI: 10.1007/s11357-023-01018-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.
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Affiliation(s)
- Zoltan Ungvari
- International Training Program in Geroscience/Healthy Aging Program, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Health Promotion Sciences, The Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Adam G Tabák
- International Training Program in Geroscience/Healthy Aging Program, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- UCL Brain Sciences, University College London, London, UK
- Department of Internal Medicine and Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Roza Adany
- International Training Program in Geroscience/Healthy Aging Program, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- HUN-REN-UD Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Csilla Kaposvári
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Csípő
- International Training Program in Geroscience/Healthy Aging Program, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Szarvas
- International Training Program in Geroscience/Healthy Aging Program, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, The Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztián Horváth
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Mukli
- International Training Program in Geroscience/Healthy Aging Program, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Piroska Balog
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Robert Bodizs
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Ujma
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Adrienne Stauder
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Daniel W Belsky
- Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Illés Kovács
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, The Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea B Maier
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Mariann Moizs
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Ministry of Interior of Hungary, Budapest, Hungary
| | | | - Yongjie Yon
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Péter Varga
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Clinical Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Magor Papp
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - István Takács
- UCL Brain Sciences, University College London, London, UK
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, The Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoltán Benyó
- Department of Translational Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- HUN-REN-SU Cerebrovascular and Neurocognitive Diseases Research Group, Budapest, Hungary
| | - Attila J Szabó
- First Department of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- HUN-REN-SU Pediatrics and Nephrology Research Group, Semmelweis University, Budapest, Hungary
| | - Gabriella Dörnyei
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
| | - Miklos Kellermayer
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Gyöngyösi H, Szőllősi GJ, Csenteri O, Jancsó Z, Móczár C, Torzsa P, Andréka P, Vajer P, Nemcsik J. Differences between SCORE, Framingham Risk Score, and Estimated Pulse Wave Velocity-Based Vascular Age Calculation Methods Based on Data from the Three Generations Health Program in Hungary. J Clin Med 2023; 13:205. [PMID: 38202212 PMCID: PMC10779891 DOI: 10.3390/jcm13010205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Helga Gyöngyösi
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary; (H.G.); (C.M.); (P.T.)
| | - Gergő József Szőllősi
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary; (G.J.S.); (O.C.); (Z.J.); (P.A.)
- Coordination Center for Research in Social Sciences, Faculty of Economics and Business, University of Debrecen, 4032 Debrecen, Hungary
| | - Orsolya Csenteri
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary; (G.J.S.); (O.C.); (Z.J.); (P.A.)
| | - Zoltán Jancsó
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary; (G.J.S.); (O.C.); (Z.J.); (P.A.)
| | - Csaba Móczár
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary; (H.G.); (C.M.); (P.T.)
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary; (H.G.); (C.M.); (P.T.)
| | - Péter Andréka
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary; (G.J.S.); (O.C.); (Z.J.); (P.A.)
| | - Péter Vajer
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary; (G.J.S.); (O.C.); (Z.J.); (P.A.)
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary; (H.G.); (C.M.); (P.T.)
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Fábry S, Rózsa S, Hargittay C, Kristóf P, Szélvári Á, Vörös K, Torzsa P, Németh E, Dornan T, Eőry A. Evaluating real-patient learning in medical education - Hungarian validation of the Manchester Clinical Placement Index. Front Med (Lausanne) 2023; 10:1265804. [PMID: 38162882 PMCID: PMC10756501 DOI: 10.3389/fmed.2023.1265804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The Manchester Clinical Placement Index (MCPI) is an instrument to measure medical undergraduates' real-patient learning in communities of practice both in hospital and in GP placements. Its suitability to evaluate the quality of placement learning environments has been validated in an English-language context; however, there is a lack of evidence for its applicability in other languages. Our aim was to thoroughly explore the factor structure and the key psychometric properties of the Hungarian language version. Methods MCPI is an 8-item, mixed-method instrument which evaluates the quality of clinical placements as represented by the leadership, reception, supportiveness, facilities and organization of the placement (learning environment) as well as instruction, observation and feedback (training) on 7-point Likert scales with options for free-text comments on the strengths and weaknesses of the given placement on any of the items. We collected data online from medical students in their preclinical (1st, 2nd) as well as clinical years (4th, 5th) in a cross-sectional design in the academic years 2019-2020 and 2021-2022, by the end of their clinical placements. Our sample comprises data from 748 medical students. Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. Results Although a bifactor model gave the best model fit (RMSEA = 0.024, CFI = 0.999, and TLI = 0.998), a high explained common variance (ECV = 0.82) and reliability coefficients (ωH = 0.87) for the general factor suggested that the Hungarian version of the MCPI could be considered unidimensional. Individual application of either of the subscales was not supported statistically due to their low reliabilities. Discussion The Hungarian language version of MCPI proved to be a valid unidimensional instrument to measure the quality of undergraduate medical placements. The previously reported subscales were not robust enough, in the Hungarian context, to distinguish, statistically, the quality of learning environments from the training provided within those environments. This does not, however, preclude formative use of the subscales for quality improvement purposes.
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Affiliation(s)
- Szabolcs Fábry
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Kristóf
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Szélvári
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Endre Németh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Timothy Dornan
- Centre for Medical Education, Queen’s University Belfast, Belfast, United Kingdom
| | - Ajándék Eőry
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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Guisado-Clavero M, Ares-Blanco S, Serafini A, Del Rio LR, Larrondo IG, Fitzgerald L, Vinker S, van Pottebergh G, Valtonen K, Vaes B, Yilmaz CT, Torzsa P, Tilli P, Sentker T, Seifert B, Saurek-Aleksandrovska N, Sattler M, Petricek G, Petrazzuoli F, Petek D, Perjés Á, López NP, Neves AL, Murauskienė L, Lingner H, Nessler K, Heleno B, Krztoń-Królewiecka A, Kostić M, Korkmaz BÇ, Knežević S, Kirkovski A, Karathanos VT, Jandrić-Kočić M, Ivanna S, Ільков О, Hoffmann K, Hanževački M, Gómez-Johansson M, Gjorgjievski D, Domeyer PRJ, Peña MD, Divjak AĆ, Busneag IC, Brutskaya-Stempkovskaya E, Bayen S, Bakola M, Adler L, Assenova R, Astier-Peña MP, Gómez Bravo R. The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study). Prim Health Care Res Dev 2023; 24:e60. [PMID: 37873623 PMCID: PMC10594530 DOI: 10.1017/s1463423623000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/31/2022] [Accepted: 05/25/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND AIM Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. METHODS Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. RESULTS Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC. CONCLUSION PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.
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Affiliation(s)
- Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Health Care and
Community North Area of Madrid, Madrid,
Spain
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain; Instituto de Investigación Sanitaria Gregorio
Marañón, Madrid, Spain
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena; Laboratorio EduCare,
University of Modena and Reggio Emilia,
Italy
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de
Atención Primaria, Servicio Madrileño de Salud, Madrid,
Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member
of Royal College of Physician (MRCSI), Ireland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv,
Israel; WONCA Europe President
| | - Gijs van Pottebergh
- Department of Public Health and Primary Health Care, KU
Leuven, Leuven, Belgium
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of
Vantaa and University of Helsinki, Helsinki,
Finland
| | - Bert Vaes
- Department of Public Health and Primary Health Care, KU
Leuven, Leuven, Belgium
| | - Canan Tuz Yilmaz
- Lecturer, Bursa Uludağ University, Family
Medicine Department, Turkey
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis
University, Hungary
| | - Paula Tilli
- Communicable Diseases and Infection Control Unit, City of
Vantaa and University of Helsinki, Helsinki,
Finland
| | | | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of
General Practice, Czech Republic
| | | | | | - Goranka Petricek
- Department of Family Medicine “Andrija Stampar” School of Public Health,
School of Medicine, University of Zagreb,
Croatia; Health Centre Zagreb West, Croatia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care
Research, Lund University, Malmö,
Sweden
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine,
University of Ljubljana, Slovenia;
Chairperson of EGPRN
| | - Ábel Perjés
- Department of Family Medicine, University of
Semmelweis, Budapest, Hungary
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg,
Sweden; Department of Pharmacology, Sahlgrenska Academy,
University of Gothenburg, Gothenburg,
Sweden
| | - Ana Luisa Neves
- Imperial College London, United Kingdom;
Faculty of Medicine, University of Porto,
Portugal
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of
Medicine, Vilnius University, Lithuania
| | - Heidrun Lingner
- Medizinische Hochschule Hannover, OE 5430, Carl Neuberg Str. 1,
30625Hannover, Germany
| | - Katarzyna Nessler
- Department of Family Medicine, UJCM at Uniwersytet
Jagielloński – Collegium Medicum, Poland
| | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School,
Universidade Nova de Lisboa; USF das Conchas,
Regional Health Administration Lisbon and Tagus Valley, Lisbon,
Portugal
| | | | - Milena Kostić
- Health Center “Dr Đorđe Kovačević”, Lazarevac,
Belgrade, Serbia
| | | | | | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius
University, Skopje, North Macedonia
| | - Vasilis Trifon Karathanos
- Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of
Health Sciences, University of Ioannina-Greece; Family Doctor,
GHS, Larnaca, Cyprus
| | | | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care,
UZHNU, Medical Faculty 2, Ukraine
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty 2,
Uzhhorod National University, Ukraine
| | - Kathryn Hoffmann
- Associate Professor and Medical Doctor for General Practice and Primary
Care, Medical University of Vienna, Austria
| | - Miroslav Hanževački
- Department of Family Medicine “Andrija Stampar” School of Public Health,
School of Medicine, University of Zagreb,
Croatia; Health Centre Zagreb West, Croatia
| | | | | | | | | | | | - Iliana-Carmen Busneag
- “Spiru Haret” University, Practising Family Doctor, Occupational
Health Expert, Bucharest, Romania
| | | | - Sabine Bayen
- Department of General Practice, University of Lille,
UFR3S, France
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of
Medicine, School of Health Science, University of Ioannina,
Ioannina, Greece
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv,
Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine,
Medical University of Plovdiv, Bulgaria
| | - María Pilar Astier-Peña
- Healthcare Quality Technical Assistant, Territorial Quality Unit, Camp de
Tarragona Healthcare Directorate, Catalan Institute of Health,
Catalonia Government, Spain; Semfyc, Wonca World Executive Board,
University of Zaragoza, GIBA IIS Aragon,
Spain
| | - Raquel Gómez Bravo
- Centre Hospitalier Neuro-Psychiatrique, CHNP,
Rehaklinik, Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health; Institute for Health and
Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities,
Education, and Social Sciences, Luxembourg University,
Luxembourg
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Diószegi J, Rihmer Z, Torzsa P, Pál L, Czifra Á, Gonda X, Sándor J. Psychiatric health care need in Hungary identified by the short screening algorithm of depression and suicide risk used in general medical practices. Sci Rep 2023; 13:14249. [PMID: 37652947 PMCID: PMC10471575 DOI: 10.1038/s41598-023-41437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
Suicides are often related to depression. General medical practices (GMPs) should play a role in screening depression. We aimed to test the screening algorithm of Rihmer and Torzsa for depression and suicide and determine the prevalence and number of patients in the nationwide representative Hungarostudy 2002 population, and to estimate the corresponding extra health care need in an average GMP and in the Hungarian population in addition to patients who are already cared for by specialized care. The short version of the Beck Hopelessness Scale (BHS) and the Hungarian version of the short form of the Beck Depression Inventory (BDI-9) were used to screen for suicide risk and depression. The prevalence of suicidal thoughts and depression was determined and findings were extrapolated to an average GMP of 1,600 adults and to the population over 25 years of age. This screening would generate a considerable extra psychiatric care to organize and implement in an average GMP and throughout the country. Our findings show that with easily administered screening instruments a significant number of patients likely to have depression can be identified at the primary care level, arguing for the establishment of the extra psychiatric care capacity in Hungary.
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Affiliation(s)
- Judit Diószegi
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary.
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Amerikai út 57, Budapest, 1145, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Stáhly u. 7-9, Budapest, 1085, Hungary
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Árpád Czifra
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
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Mourouti N, Mavrogianni C, Mouratidou T, Liatis S, Valve P, Rurik I, Torzsa P, Cardon G, Bazdarska Y, Iotova V, Moreno LA, Makrilakis K, Manios Y. The Association of Lifestyle Patterns with Prediabetes in Adults from Families at High Risk for Type 2 Diabetes in Europe: The Feel4Diabetes Study. Nutrients 2023; 15:3155. [PMID: 37513573 PMCID: PMC10386359 DOI: 10.3390/nu15143155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The increasing prevalence of prediabetes globally does not bode well for the growing epidemic of type 2 diabetes (T2D) and its complications. Yet there is a lack of studies regarding lifestyle patterns (LPs) and their association with prediabetes. The present study aimed to examine the association of different LPs with the existence of prediabetes in adults from families at high risk for T2D in Europe. In total, 2759 adults (66.3% females) from six European countries were included in this cross-sectional analysis using data from the baseline assessment of the Feel4Diabetes study. Anthropometric, sociodemographic, dietary and behavioral data were assessed, and fasting blood glucose measurements were also obtained. LPs were derived via principal component analysis. Two LPs were derived, explaining 32% of the total variation. LP 1 was characterized by breakfast consumption, high consumption of fruits and berries, vegetables and nuts and seeds, and low consumption of salty snacks and soft drinks with sugar, while LP 2 was characterized by high consumption of salty and sweet snacks, soft drinks with sugar and juice with sugar and sedentary behavior. After adjusting for various confounders, LP 2 was positively associated with the existence of prediabetes (odds ratio = 1.02, 95% CI 1.01-1.04), while LP 1 was not significantly associated with prediabetes. Understanding LPs would provide necessary evidence for planning intervention and education strategies for prediabetes and T2D.
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Affiliation(s)
- Niki Mourouti
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300 Sitia, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre (Agro-Health), 71410 Heraklion, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Christina Mavrogianni
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
| | - Theodora Mouratidou
- Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300 Sitia, Greece
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre (Agro-Health), 71410 Heraklion, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Päivi Valve
- Department of Public Health and Welfare, Finnish Institute of Health and Welfare, FI-00271 Helsinki, Finland
| | - Imre Rurik
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yulia Bazdarska
- Department of Pediatrics, Medical University Varna, 9002 Varna, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, 9002 Varna, Bulgaria
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Yannis Manios
- Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre (Agro-Health), 71410 Heraklion, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
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9
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Ares-Blanco S, Guisado-Clavero M, Ramos Del Rio L, Gefaell Larrondo I, Fitzgerald L, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Domeyer PR, Gjorgjievski D, Hoffmann K, Ільков О, Trifon Karathanos V, Kirkovski A, Knežević S, Çimen Korkmaz B, Heleno B, Nessler K, Murauskienė L, Neves AL, Parodi López N, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Seifert B, Serafini A, Sentker T, Tiili P, Torzsa P, Vaes B, van Pottebergh G, Vinker S, Astier-Peña MP, Gómez-Bravo R, Lingner H. Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study. Eur J Gen Pract 2023:2182879. [PMID: 36943232 DOI: 10.1080/13814788.2023.2182879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Louise Fitzgerald
- Irish College of General Practice, MICGP, Royal College of Physician, MRCSI, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | | | | | | | | | - Kathryn Hoffmann
- General Practice and Primary Care, University of Vienna, Vienna, Austria
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine
| | - Vasilis Trifon Karathanos
- Medical Education Uni, Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina, Ioannina, Greece
- GHS, Larnaca, Cyprus
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | | | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School, University Nova de Lisboa, Lisboa, Portugal
- USF das Conchas, Regional Health Administration Lisbon and Tagus Valley, Lisbon, Portugal
| | - Katarzyna Nessler
- Department of Family Medicine UJCM, University Jagielloński, Collegium Medicum, Jagielloński, Poland
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ana Luisa Neves
- Imperial College London, London, UK
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine, University of Semmelweis, Budapest, Hungary
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Goranka Petricek
- Department of Family Medicine "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Health Centre Zagreb West, Zagreb, Croatia
| | - Bohumil Seifert
- First Faculty of Medicine, Institute of General Practice, Charles University, Prague, Czech Republic
| | - Alicia Serafini
- Azienda Unità Sanitaria Locale di Modena, Modena, Italy
- Laboratorio EduCare, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paula Tiili
- Communicable Diseases and Infection Control Unit, City of Vantaa and University of Helsinki, Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - María Pilar Astier-Peña
- Territorial Quality Unit, Territorial Directorate of Camp de Tarragona, Institut Català de la Salut, Health Department, Generalitat de Catalunya, GIBA-IIS-Aragón, Spain
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine) and Quality and Safety in Family Medicine of WONCA World (Global Family Doctors), Catalunya, Spain
| | - Raquel Gómez-Bravo
- CHNP, Rehaklinik, Ettelbruck. Luxembourg
- Research Group Self-Regulation and Health. Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences. Faculty of Humanities, Education, and Social Sciences, Luxembourg University, Luxembourg, Luxembourg
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
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Hargittay C, Vörös K, Eőry A, Márkus B, Szabó G, Rihmer Z, Gonda X, Torzsa P. [The association between diabetes complications and symptoms of depression and anxiety]. Orv Hetil 2023; 164:79-87. [PMID: 36681997 DOI: 10.1556/650.2023.32676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The bidirectional relationship between diabetes and depression results in severe disease burden. Co-occurring depression is associated with a higher rate of diabetes complications. These complications impair quality of life, however, their impact on depressive symptoms is controversial. OBJECTIVE In our cross-sectional study, we aimed to investigate whether the presence of diabetes complications is associated with depressive and anxiety symptoms among patients with type 2 diabetes in general practice. METHOD We obtained patient history, anthropometric, socioeconomic, laboratory parameters. For symptom assessment, the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. We collected data between September 2018 and February 2020. RESULTS We included 338 consecutive patients with type 2 diabetes. The mean age of the sample was 63.98 ± 11.51 (years ± SD), 61.2% of participants were female. We found significant univariate association between diabetes complications and older age, less physical activity, higher body mass index, insulin therapy, higher HbA1c, higher creatinine and carbamide concentrations, worse depressive and anxiety symptoms. In multivariate analysis, diabetes complications and certain socio-demographic factors (female gender, lower education, rural-dwelling) were the determinants of higher BDI and HAM-A scores. CONCLUSION Among primary care patients with type 2 diabetes, the prevalence of depressive and anxiety symptoms was higher and more severe in patients with diabetes complications. The recommended screening for affective disorders among patients with diabetes is especially justified if complications are present. Orv Hetil. 2023; 164(3): 79-87.
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Affiliation(s)
- Csenge Hargittay
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék 1428 Budapest, Pf. 2 Magyarország
| | - Krisztián Vörös
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék 1428 Budapest, Pf. 2 Magyarország
| | - Ajándék Eőry
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék 1428 Budapest, Pf. 2 Magyarország
| | - Bernadett Márkus
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék 1428 Budapest, Pf. 2 Magyarország
| | - Georgina Szabó
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Mentális Egészségtudományok Doktori Iskola Budapest Magyarország
| | - Zoltán Rihmer
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika és Országos Pszichiátriai és Addiktológiai Intézet Budapest Magyarország
| | - Xénia Gonda
- 3 Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika és Országos Pszichiátriai és Addiktológiai Intézet Budapest Magyarország
| | - Péter Torzsa
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék 1428 Budapest, Pf. 2 Magyarország
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Vörös K, Márkus B, Atzél K, Szalay F, Gráf L, Németh D, Masszi T, Torzsa P, Kalabay L. Serum fetuin-A is decreased in cirrhotic patients with Wilson's disease. PLoS One 2023; 18:e0282801. [PMID: 36881584 PMCID: PMC9990947 DOI: 10.1371/journal.pone.0282801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Wilson's disease may lead to cirrhosis, but timely medical treatment could slow down its progression. Clinical markers helping early diagnosis are essential. Decreased fetuin-A concentration has been reported in cirrhosis of different etiologies. The aim of this study was to investigate whether decreased serum fetuin-A concentration could identify patients with Wilson's disease who developed cirrhosis. MATERIALS AND METHODS In this cross-sectional study we determined the serum fetuin-A concentration of 50 patients with Wilson's disease. We analyzed the data of patients with liver involvement, comparing cirrhotic and non-cirrhotic patients. RESULTS Among patients with liver involvement those with cirrhosis had significantly lower fetuin-A and albumin level, white blood cell and platelet count. Fetuin-A negatively correlated with disease duration, bilirubin level, positively with total protein and albumin concentration, but not with copper and ceruloplasmin concentrations or markers of systemic inflammation. In multivariate analysis with fetuin-A and the Nazer score or its parameters only fetuin-A was a significant determinant of having cirrhosis. In receiver operator curve analysis among patients with liver involvement the fetuin-A level of 523 μg/ml was associated with cirrhosis with 82% sensitivity and 87% specificity. The presence of the H1069Q mutation was not associated with alteration in fetuin-A concentration. CONCLUSIONS The serum concentration of fetuin-A is a sensitive marker of liver cirrhosis in Wilson's disease, independently of the H1069Q mutation, ceruloplasmin concentration or systemic inflammation.
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Affiliation(s)
- Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Bernadett Márkus
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Klára Atzél
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Szalay
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - László Gráf
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Dániel Németh
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
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12
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Dibao-Dina C, Oger C, Foley T, Torzsa P, Lazic V, Kreitmayer Peštiae S, Adler L, Kareli A, Mallen C, Heaster C, Dumitra G, Kurpas D, Viegas R, Giezendanner S, Tkachenko V, De Lepeleire J, Falanga R, Missiou A, Jennings A, Petrazzuoli F. Intermediate care in caring for dementia, the point of view of general practitioners: A key informant survey across Europe. Front Med (Lausanne) 2022; 9:1016462. [PMID: 36341273 PMCID: PMC9627031 DOI: 10.3389/fmed.2022.1016462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intermediate care is often defined as healthcare occurring somewhere between traditional primary (community) and secondary (hospital) care settings. High quality intermediate care is important in dementia, may prevent caregiver burnout and also lead to optimal care for people with dementia. However, very little is known about the point of intermediate care for persons with dementia in Europe. Research questions What intermediate care services exist and how are they utilized in the care of people with dementia in Europe? Objective This study aims at describing the point of view of General Practitioners on intermediate care services for people with dementia across Europe. Methods Key informant survey was sent to GPs via a self-developed questionnaire with space for open ended comments. 16 European countries participated to this cross-sectional mixed method study. Given the volunteer nature of the study, no minimum sample size requirements were applied to participation. Convenience sampling technique was used to address variations due to regional variations and regulations within the same country. Descriptive analyses of all intermediate care facilities groups by countries were performed. Qualitative analyses approach was used for the optional-free text to exemplify and/or complete the reasons contained in the closed response categories. Results The questionnaire was sent to 16 European countries. 583 questionnaires were analyzed. The responding physicians were 48 (± 11) years old on average and they had been in practice for an average of 18 (+ /11) years. The types of intermediate care considered were integrated at-home services, respite and relief services, day care centers and nursing homes. Their availability was considered very inhomogeneous by the majority of respondents. The main benefits of intermediate care cited were better medical care for the patient (78%), better quality of life for the caregiver (67%), prevention of the caregiver burden (73%) and a break for the caregiver (59%). The reported difficulties were: accessing these facilities due to limited financial support (76%) and cumbersome administrative procedures (67%). Many other facets of our findings were captured in the qualitative themes that emerged. Conclusion Intermediate care in Europe is diverse and heterogeneous. Major concerns of GPs are about the cost issues and the cumbersome administrative procedures to access them.
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Affiliation(s)
| | - Caroline Oger
- Department of General Practice, University of Tours, Tours, France
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Sanda Kreitmayer Peštiae
- JZNU Dom Zdravlja “Dr. Mustafa Šehoviæ”, Department of General/Family Medicine, Tuzla, Bosnia and Herzegovina
| | - Limor Adler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Kareli
- Georgian Family Medicine Association, Tbilisi State Medical University, Tbilisi, Georgia
| | - Christian Mallen
- Primary, Community and Social Care, Keele University, Keele, United Kingdom
| | - Cindy Heaster
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, Riga, Latvia
| | - Gindrovel Dumitra
- Romanian National Society of Family Medicine, Bucharest, Romania
- Department of Family Medicine, University of Medicine and Pharmacy, Craiova, Romania
| | - Donata Kurpas
- Department of Family Medicine, Wrocław Medical University, Wrocław, Poland
| | - Rita Viegas
- Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | | | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, University of Leuven, Leuven, Belgium
| | - Rosario Falanga
- Department of Primary Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aisling Jennings
- Department of General Practice, University College Cork, Cork, Ireland
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- *Correspondence: Ferdinando Petrazzuoli, ;
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13
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Hargittay C, Eöry A, Márkus B, Mohos A, Ferenci T, Vörös K, Rihmer Z, Gonda X, Torzsa P. Severity of depressive but not anxiety symptoms impacts glucose metabolism among patients with type 2 diabetes in primary care. Front Med (Lausanne) 2022; 9:944047. [PMID: 35966882 PMCID: PMC9366081 DOI: 10.3389/fmed.2022.944047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Data from primary care regarding the prevalence of symptoms of depression and anxiety, and their effect on glycemic control among people with diabetes is lacking in Hungary. The recently introduced Patient Health Record (PHR) requires family doctors to screen for depressive symptoms. Objectives We aimed to investigate the prevalence of depressive and anxiety symptoms among patients with type 2 diabetes in the general practice, and the relationship between these affective disorders and glycated hemoglobin (HbA1c) level. Methods We included 338 consecutive patients with type 2 diabetes from six primary care practices in this cross-sectional study. A self-administered questionnaire (patient history, anthropometric, socioeconomic, laboratory parameters), the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. Results The mean age of the sample was 64.0 ± 11.5 (years ± SD), 61% of participants were female. The prevalence of depressive symptoms was 21%, mainly moderate/severe symptoms (13%). Anxiety symptoms were more common (35%). We found significant univariate association between the depressive symptoms and HbA1c (p = 0.001), suicide attempt (p < 0.001), anxiety (p < 0.001), micro- and macrovascular complication (p = 0.028 and p < 0.001), education (p = 0.001) and place of residence (p = 0.002). In multivariate analysis, however, only BDI score had significant (p = 0.03191) association with glycemic control. Conclusion Among primary care patients with type 2 diabetes, the prevalence of depressive symptoms was less frequent than anxiety symptoms. More severe depressive symptoms were associated with worse glycemic control.
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Affiliation(s)
- Csenge Hargittay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ajándék Eöry
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bernadett Márkus
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - András Mohos
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Ferenci
- Physiological Controls Research Center, Óbuda University John von Neumann Faculty of Informatics, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
| | - Krisztián Vörös
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Samara, Russia
- *Correspondence: Xenia Gonda,
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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14
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Nemcsik-Bencze Z, Kőrösi B, Gyöngyösi H, Batta D, László A, Torzsa P, Kovács I, Rihmer Z, Gonda X, Nemcsik J. Depression and anxiety in different hypertension phenotypes: a cross-sectional study. Ann Gen Psychiatry 2022; 21:23. [PMID: 35761354 PMCID: PMC9235239 DOI: 10.1186/s12991-022-00400-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy controls (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT). METHODS In a cross-sectional study setup 363 patients were included with the following distribution: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A). RESULTS BDI points were higher in WhHT (7 (3-11)) and ResHT (6 (3-11.5)) compared with Cont (3 (1-6), p < 0.05). Similarly, HAM-A points were higher in WhHT (8 (5-15)) and ResHT (10.5 (5.25-18.75)) compared with Cont (4 (1-7), p < 0.05) and also compared with non-ResHT (5 (2-10), p < 0.05). ResHT was independently associated with HAM-A scale equal or above 3 points (Beta = 3.804, 95%CI 1.204-12.015). WhHT was independently associated with HAM-A scale equal or above 2 points (Beta = 7.701, 95%CI 1.165-18.973) and BDI scale equal or above 5 points (Beta = 2.888, 95%CI 1.170-7.126). CONCLUSIONS Our results suggest psychopathological similarities between white-coat hypertension and resistant hypertension. As recently it was demonstrated that white-coat hypertension is not a benign condition, our findings can have relevance for future interventional purposes to improve the outcome of these patients.
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Affiliation(s)
| | - Beáta Kőrösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Helga Gyöngyösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dóra Batta
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | | | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.,Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Xénia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.,Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary.,Neurochemistry Research Group, MTA-SE, Budapest, Hungary
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary. .,Health Service of Zugló (ZESZ), Budapest, Hungary.
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15
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Mohos A, Frese T, Kolozsvári L, Rinfel J, Varga A, Hargittay C, Csatlós D, Torzsa P. Earning opportunities and informal payment as influencing factors in medical students' speciality choice. BMC Fam Pract 2021; 22:258. [PMID: 34969365 PMCID: PMC8716841 DOI: 10.1186/s12875-021-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Background The Hungarian primary care system faces a severe shortage of family physicians. Medical students’ perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students’ knowledge about their future earning opportunities and their attitudes towards informal payment. Methods A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. Results Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = ‘no influence’, 10 = ‘very big influence’) 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. Conclusions Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs – this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.
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Affiliation(s)
- András Mohos
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary.
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle/Saale, Germany
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, 4028 Kassai út 26, Debrecen, Hungary
| | - József Rinfel
- Institute of Primary Care, University of Pécs, 7623 Rákoczi St. 2, Pécs, Hungary
| | - Albert Varga
- Faculty of Medicine, Department Family Medicine, University of Szeged, 6725 Tisza Lajos krt. 109, Szeged, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Dalma Csatlós
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Stáhly u. 9, Budapest, Hungary
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16
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Ungvári Z, Ádány R, Szabó AJ, Dörnyei G, Moizs M, Purebl G, Kalabay L, Varga P, Torzsa P, Kellermayer M, Merkely B. Semmelweis Caring University Model Program Based on the Development of a Center of Preventive Services: Health for All Employees at a University Occupational Setting. Front Public Health 2021; 9:727668. [PMID: 34912767 PMCID: PMC8666717 DOI: 10.3389/fpubh.2021.727668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
The leadership of the Semmelweis University as a leading institution of higher education in Hungary and the Central Eastern European region within the area of medicine and health sciences has decided to reflect on the unfavorable public health situation in the country as well as the deteriorating health behavior and health status indicators in the Hungarian population by the development of an occupational setting-based personalized public health model program targeting its about 8500 employees. Based on its infrastructure and human resources the core element of the program is the establishment of the Center of Preventive Services (CPS) with units providing health risk assessment for each employee, and whenever necessary consultation with medical specialist in preventive medicine and public health, as well as counseling with dietician, physiotherapist and/or health psychologist. The service providers are the staff members of the relevant faculties in collaboration with partner primary and occupational care physicians. The units of the CPS can also serve as practical training sites for students at various levels of medical and health sciences training, and strongly contribute to the development and improvement of their skills to be able for working as a team in service provision. The employees are not only beneficiaries of health risk assessment and screening repeated on a regular basis and adequate interventions at the right time, but they also serve as a sample for a longitudinal cohort study and further ad hoc surveys for defining and implementing interventions to support health protection, disease prevention and healthy aging among them.
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Affiliation(s)
- Zoltán Ungvári
- International Training Program in Geroscience/Healthy Aging Program, Department of Public Health, Semmelweis University, Budapest, Hungary.,Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,Department of Health Promotion Sciences, The Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Róza Ádány
- International Training Program in Geroscience/Healthy Aging Program, Department of Public Health, Semmelweis University, Budapest, Hungary.,MTA-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila J Szabó
- First Department of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary.,MTA-SE Pediatrics and Nephrology Research Group, Semmelweis University, Budapest, Hungary
| | - Gabriella Dörnyei
- Department of Morphology and Physiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Mariann Moizs
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Varga
- Clinical Center, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Miklós Kellermayer
- Department of Biophysics and Radiation Biology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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17
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Békési D, Teker I, Torzsa P, Kalabay L, Rózsa S, Eőry A. To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study. Eur J Gen Pract 2021; 27:277-285. [PMID: 34633272 PMCID: PMC8510612 DOI: 10.1080/13814788.2021.1982889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Responsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease. Objectives We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load. Methods In a mixed-method design, Fava’s clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner’s symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO. Results Data of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p = 0.020). 3–4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5–7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility. Conclusion Under changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.
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Affiliation(s)
- Dóra Békési
- Rácz Károly Clinical Medicine PhD School, Semmelweis University, Budapest, Hungary
| | | | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Washington University, St. Louis, USA.,Károli Gáspár University of the Reformed Church, Budapest, Hungary
| | - Ajándék Eőry
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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18
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Gyöngyösi H, Kőrösi B, Batta D, Nemcsik-Bencze Z, László A, Tislér A, Cseprekál O, Torzsa P, Eörsi D, Nemcsik J. Comparison of Different Cardiovascular Risk Score and Pulse Wave Velocity-Based Methods for Vascular Age Calculation. Heart Lung Circ 2021; 30:1744-1751. [PMID: 34426072 DOI: 10.1016/j.hlc.2021.06.518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The calculation of vascular age can help patients understand the importance of adherence to healthy lifestyle and medications. However, multiple methods are available to calculate vascular age and no comparison data is available yet. Our aim was to evaluate vascular age based on the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE) and carotid-femoral pulse wave velocity (PWV). METHODS Consecutive subjects between the age of 40-65 years, who took part in a screening program in three general practitioner practices were involved. PWV was measured by tonometry and was compared with normal values. Vascular age was defined based on FRS and SCORE according to literature data. RESULTS One hundred and seventy-two (172) patients were involved. The median chronological age was 55.5 (48.8-61.2) years. The median vascular age based on FRS and SCORE were 64 (54-79) years and 55 (44.2-60.7) years, respectively (p<0.05). Based on PWV, FRS and SCORE, 40.1%, 78.5% and 32% of the subjects had increased vascular age compared with chronological age, respectively (PWV+, FRS+, SCORE+, p<0.05). Fifty-eight (58) (84%) of the PWV+ subjects were also FRS+, and this proportion was high in case of SCORE+ patients as well (n=47, 85.4%). However, only moderate overlap was found between PWV+ and SCORE+ subjects as 17 (30.9%) of SCORE+ patients were also PWV+. CONCLUSION The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrants further detailed comparison of different vascular age calculation methods.
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Affiliation(s)
- Helga Gyöngyösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Beáta Kőrösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dóra Batta
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Nemcsik-Bencze
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | | | - András Tislér
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Eörsi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary; Health Service of Zugló (ZESZ), Budapest, Hungary.
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Hargittay C, Gonda X, Márkus B, Sipkovits Z, Vörös K, Kalabay L, Rihmer Z, Torzsa P. The relationship between anxiety and diabetes. Orv Hetil 2021; 162:1226-1232. [PMID: 34333455 DOI: 10.1556/650.2021.32169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A cukorbetegség és a depresszió kapcsolatáról számos tanulmány született. A szorongás és a diabetes közti összefüggést már kevesebben vizsgálták, pedig jelentős szerepük van a szorongásos kórképeknek is, hiszen nagyon gyakori a két betegség együttes előfordulása. A diabetes már önmagában is nagy betegségterhet jelent a betegek számára, a társuló pszichiátriai kórképek pedig tovább rontják a kezelés minőségét, ezért fontos a korai felismerésük és kezelésük. Jelen összefoglaló közleményünk célja a szorongásos kórképek és elsősorban a 2-es típusú cukorbetegség közti összefüggés feltárása. Több elmélet született a köztük lévő kapcsolat magyarázatára. Egyesek szerint szerepet játszhat benne a közös etiológiai háttér, mások szerint a cukorbetegség diagnózisa és a gondozásával kapcsolatos feladatok vezetnek szorongáshoz. Megint mások pedig ellentétes irányból vizsgálva a köztük lévő kapcsolatot, arra a megállapításra jutottak, hogy a szorongás különböző fiziológiai mechanizmusokon keresztül vezethet cukorbetegséghez. A szorongás és a diabetes közti kapcsolat irányától függetlenül javasolt a depresszió mellett a szorongásnak a szűrése és minél korábbi kezelése a cukorbetegek körében, így csökkennének a komorbiditásból származó szövődmények, a kezelési nehézségek, javulna a betegek életminősége és a terápiával való együttműködésük. Orv Hetil. 2021; 162(31): 1226-1232. Summary. The relationship between diabetes and depression has been evaluated in numerous studies. The association between diabetes and anxiety was less investigated, although the importance of anxiety disorders is underlined by its frequent co-occurrence with diabetes. Diabetes alone carries a significant disease burden for patients. Comorbidity with psychiatric disorders deteriorates the quality of care, therefore early treatment and diagnosis of these conditions are essential. The aim of the present review is to outline the relationship between anxiety and mainly type 2 diabetes. There are several theories to explain the relationship between them. Some researchers suggest that common etiological background may play a role in their co-occurrence, some believe that the diagnosis of diabetes and the burden of self-management lead to anxiety, while others - investigating the relationship from the opposite direction - suggest that anxiety leads to diabetes through physiological mechanisms. Independently of the direction of the relationship, screening for anxiety and timely treatment among diabetic patients may decrease the risk of complications, the difficulty in treatment arising from the co-occurrence of these two conditions and may improve patients' quality of life and adherence to therapy. Orv Hetil. 2021; 162(31): 1226-1232.
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Affiliation(s)
- Csenge Hargittay
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Pf. 2, 1428
| | - Xénia Gonda
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika és Országos Pszichiátriai és Addiktológiai Intézet, Budapest
| | - Bernadett Márkus
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Pf. 2, 1428
| | - Zsófia Sipkovits
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Pf. 2, 1428
| | - Krisztián Vörös
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Pf. 2, 1428
| | - László Kalabay
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Pf. 2, 1428
| | - Zoltán Rihmer
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Pszichiátriai és Pszichoterápiás Klinika és Országos Pszichiátriai és Addiktológiai Intézet, Budapest
| | - Péter Torzsa
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Pf. 2, 1428
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20
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Rurik I, Nánási A, Jancsó Z, Kalabay L, Lánczi LI, Móczár C, Semanova C, Schmidt P, Torzsa P, Ungvári T, Kolozsvári LR. Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study. Prim Health Care Res Dev 2021; 22:e36. [PMID: 34193332 PMCID: PMC8278788 DOI: 10.1017/s1463423621000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system. METHODS The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data. FINDINGS Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.
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Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Csaba Móczár
- Irinyi Primary Care Health Center, Kecskemét, Hungary
| | - Csilla Semanova
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Péter Schmidt
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - László Róbert Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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21
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Mohos A, Varga A, Hargittay C, Csatlós D, Kalabay L, Torzsa P. [Examination of the health status and health behaviors of Hungarian family physicians]. Orv Hetil 2021; 162:449-457. [PMID: 33764021 DOI: 10.1556/650.2021.31971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A családorvosok testi, lelki egészségi állapota hatással van a munkavégzésükre, a betegellátás minőségére, ezáltal a társadalom egészségmutatóira is. Az életmód pedig az egyik legjelentősebb, egészségi állapotot befolyásoló tényező. Célkitűzés: A vizsgálat célja a magyar háziorvosok egészségi állapotának és az azt befolyásoló életmódtényezőknek a felmérése. Módszer: Keresztmetszeti vizsgálat. Kvantitatív, papíralapú felmérés családorvosok körében (n = 569, életkor 54 ± 10 év, nők 42%). Eredmények: A háziorvosok 61%-a túlsúlyos vagy elhízott, 88%-ának a vércukorszintje ≤5,5 mmol/l. A résztvevők 50%-a legalább heti rendszerességgel végez testmozgást, 20%-uk egyáltalán nem. A háziorvosok 13%-a dohányzik jelenleg, 5%-a tekinthető nagyivónak. Enyhe fokú depressziós tünetegyüttes 19%-uknál, közepes fokú 6%-uknál, súlyos fokú 5%-uknál fordult elő. A súlyos fokú kiégés mindkét nemben, mindhárom dimenzióban 18–39% volt. Következtetés: A magyar háziorvosok általános egészségi állapota nem mondható jobbnak sem a hazai nem orvos populációénál, sem a külföldi orvoskollégákénál. A magyar háziorvosok dohányzási mutatói kedvezőbbek a lakossági adatoknál, míg az alkoholfogyasztás terén kedvezőtlenebb eredményeket kaptunk. Nemzetközi összehasonlításban, a káros szenvedélyek terén a hazai kollégák eredményei jónak tekinthetők. A depresszió és a kiégés gyakori előfordulása jelentős probléma a háziorvosok körében. Mentális egészségük monitorozása és gondozása a hatékony egészségügyi ellátórendszer kulcskérdése. Orv Hetil. 2021; 162(12): 449–457.
Summary. Introduction: General practitioners’ somatic and mental health status have an impact on their work and the quality of care they provide and thus influence the health indicators of the society. Lifestyle is one of the most important influencing factors of health. Objective: The study aims to assess the health status of Hungarian general practitioners and the lifestyle factors influencing it. Method: Cross-sectional study. Quantitative, paper-based questionnaire among general practitioners (n = 569, age 54 ± 10 years, female 42%). Results: 61% of family physicians are overweight or obese, 88% of them have blood glucose level ≤5.5 mmol/l. 50% of the participants do exercise at least once a week, 20% do not take any exercise at all. 13% currently smoke, 7% are considered heavy drinkers. Mild, moderate and severe depression symptoms occurred in 19%, 6% and 5% of them, respectively. A severe level of burnout syndrome was reported in 18–39% in both sexes, in all three dimensions. Conclusion: The health status of Hungarian general practitioners is not better than that of the non-medical Hungarian population or than that of foreign colleagues. The smoking indicators of Hungarian doctors are more favorable than the Hungarian population data, while we obtained worse results in the field of alcohol consumption. In international comparison, the results of Hungarian colleagues in the field of smoking and alcohol consumption are good. The frequent occurrence of depression and burnout is a significant problem among family physicians. Monitoring and caring for their mental health is a key factor in the effective health care system. Orv Hetil. 2021; 162(12): 449–457.
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Affiliation(s)
- András Mohos
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Családorvosi Intézet és Rendelő, Szeged, Székely sor 13/A, 6726
| | - Albert Varga
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Családorvosi Intézet és Rendelő, Szeged, Székely sor 13/A, 6726
| | - Csenge Hargittay
- Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest
| | - Damla Csatlós
- Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest
| | - László Kalabay
- Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest
| | - Péter Torzsa
- Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest
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22
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Jungo KT, Mantelli S, Rozsnyai Z, Missiou A, Kitanovska BG, Weltermann B, Mallen C, Collins C, Bonfim D, Kurpas D, Petrazzuoli F, Dumitra G, Thulesius H, Lingner H, Johansen KL, Wallis K, Hoffmann K, Peremans L, Pilv L, Šter MP, Bleckwenn M, Sattler M, van der Ploeg M, Torzsa P, Kánská PB, Vinker S, Assenova R, Bravo RG, Viegas RPA, Tsopra R, Pestic SK, Gintere S, Koskela TH, Lazic V, Tkachenko V, Reeve E, Luymes C, Poortvliet RKE, Rodondi N, Gussekloo J, Streit S. General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries. BMC Geriatr 2021; 21:19. [PMID: 33413142 PMCID: PMC7792080 DOI: 10.1186/s12877-020-01953-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
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Affiliation(s)
| | - Sophie Mantelli
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Zsofia Rozsnyai
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Biljana Gerasimovska Kitanovska
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia
| | - Birgitta Weltermann
- Institute for General Practice, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Christian Mallen
- Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG,, United Kingdom
| | | | - Daiana Bonfim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wrocław, Poland
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Hans Thulesius
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden.,Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
| | | | - Katharine Wallis
- Primary Care Clinical Unit, the University of Queensland, Brisbane, Australia
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lieve Peremans
- Department of Primary and Interdisciplinary Care, University Antwerp, Antwerp, Belgium.,Department of Nursing and Midwifery, University Antwerp, Antwerp, Belgium
| | - Liina Pilv
- Department of Family Medicine, University of Tartu, Tartu, Estonia
| | - Marija Petek Šter
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg City, Luxembourg
| | - Milly van der Ploeg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Bomberová Kánská
- Department of Social Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Raquel Gomez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg
| | - Rita P A Viegas
- Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006, Paris, France.,Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Sanda Kreitmayer Pestic
- Family Medicine Department, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sandra Gintere
- Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia
| | - Tuomas H Koskela
- Clinical Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Vanja Lazic
- Dom zdravlja Zagreb - Centar, Zagreb, Croatia
| | - Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Clare Luymes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,UWV (Employee Insurance Agency), Leiden, the Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
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23
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Petrazzuoli F, Vinker S, Palmqvist S, Midlöv P, Lepeleire JD, Pirani A, Frese T, Buono N, Ahrensberg J, Asenova R, Boreu QF, Peker GC, Collins C, Hanževački M, Hoffmann K, Iftode C, Koskela TH, Kurpas D, Reste JYL, Lichtwarck B, Petek D, Schrans D, Soler JK, Streit S, Tatsioni A, Torzsa P, Unalan PC, van Marwijk H, Thulesius H. Unburdening dementia - a basic social process grounded theory based on a primary care physician survey from 25 countries. Scand J Prim Health Care 2020; 38:253-264. [PMID: 32720874 PMCID: PMC7470166 DOI: 10.1080/02813432.2020.1794166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To explore dementia management from a primary care physician perspective. DESIGN One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist. SETTING Twenty-five European General Practice Research Network member countries. SUBJECTS Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories. MAIN OUTCOME MEASURES Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines. RESULTS Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories. CONCLUSIONS Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- CONTACT Ferdinando Petrazzuoli Center for Primary Health Care Research, Clinical Research Center, Lund University, Box 50332, Malmö202 13, Sweden
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, University of Leuven, Leuven, Belgium
| | - Alessandro Pirani
- Family and Nursing Home Practice – Memory Clinic, Alzheimer’s Association “Francesco Mazzucca” Onlus, Ferrara, Italy
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Nicola Buono
- SNAMID (National Society of Medical Education in General Practice), Caserta, Italy
| | - Jette Ahrensberg
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Radost Asenova
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Quintí Foguet Boreu
- Institut Universitari d’Investigació en Atenció Primària- IDIAP Jordi Gol, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Gülsen Ceyhun Peker
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | | | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | - Jean Yves Le Reste
- EA 7479 SPURBO. Department of General Practice, Université de Bretagne Occidentale, Brest, France
| | - Bjørn Lichtwarck
- The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Davorina Petek
- Department of Family medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Diego Schrans
- Department of Family Medicine and Primary, Health Care Ghent University, Ghent, Belgium
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Athina Tatsioni
- Department of Internal Medicine, General Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pemra C. Unalan
- Department of Family Medicine, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Hans Thulesius
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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24
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Eőry A, Szabó J, Csik I, Csupor D, Sőti C, Kalabay L, Varsányi P, Komsa I, Eőry A, Torzsa P. Training concept of integrative medicine in Hungary based on international models. Orv Hetil 2020; 161:1122-1130. [PMID: 32564003 DOI: 10.1556/650.2020.31754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022]
Abstract
Integrative medicine is a new approach in the 21st century healthcare system, which integrates conventional medicine and evidence-based, safe and efficient complementary therapies into a unified biomedicine. Medical doctors and complementary therapists work together in partnership with patients to help them recover and live a whole life. Equally important is the maintenance and enhancement of health and well-being in which therapists become role-models. In this article, the authors introduce a proposal for the concept and major elements of a two-year integrative medicine postgraduate training for specialist doctors in Hungary and summarize international progress in the field. Orv Hetil. 2020; 161(27): 1122-1130.
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Affiliation(s)
- Ajándék Eőry
- Általános Orvostudományi Kar, Családorvosi Tanszék, Integratív Medicina Tanszéki Csoport,Semmelweis Egyetem, Budapest, Stáhly u. 9., 1085.,Komplementer Medicina Tanács,Egészségügyi Szakmai Kollégium, Budapest
| | - János Szabó
- Általános Orvostudományi Kar, Családorvosi Tanszék,Semmelweis Egyetem, Budapest.,Háziorvostan Tagozat,Egészségügyi Szakmai Kollégium, Budapest
| | - Ivett Csik
- Általános Orvostudományi Kar, Családorvosi Tanszék, Integratív Medicina Tanszéki Csoport,Semmelweis Egyetem, Budapest, Stáhly u. 9., 1085
| | - Dezső Csupor
- Gyógyszerésztudományi Kar,Szegedi Tudományegyetem, Szeged
| | - Csaba Sőti
- Általános Orvostudományi Kar, Orvosi Vegytani Intézet,Semmelweis Egyetem, Budapest
| | - László Kalabay
- Általános Orvostudományi Kar, Családorvosi Tanszék,Semmelweis Egyetem, Budapest
| | - Péter Varsányi
- Általános Orvostudományi Kar, Családorvosi Tanszék, Integratív Medicina Tanszéki Csoport,Semmelweis Egyetem, Budapest, Stáhly u. 9., 1085
| | - Ildikó Komsa
- Általános Orvostudományi Kar, Családorvosi Tanszék, Integratív Medicina Tanszéki Csoport,Semmelweis Egyetem, Budapest, Stáhly u. 9., 1085
| | - Ajándok Eőry
- Magyar Akupunktúra és Moxaterápiás Egyesület, Budapest.,Komplementer Medicina Tagozat,Egészségügyi Szakmai Kollégium, Budapest
| | - Péter Torzsa
- Általános Orvostudományi Kar, Családorvosi Tanszék,Semmelweis Egyetem, Budapest.,Háziorvostan Tagozat,Egészségügyi Szakmai Kollégium, Budapest
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Jancsó Z, Rurik I, Kolozsvári L, Mester L, Nánási A, Oláh C, Ungvári T, TCs KV, Kalabay L, Torzsa P. Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement. BMC Fam Pract 2020; 21:83. [PMID: 32384878 PMCID: PMC7210674 DOI: 10.1186/s12875-020-01150-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
Abstract
Background Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. studies. Methods Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. Results There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. Conclusions Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.
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Affiliation(s)
- Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Lajos Mester
- Institute of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csaba Oláh
- Central and University Teaching Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Katalin Vraukó TCs
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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Márkus B, Herszényi L, Matyasovszky M, Vörös K, Torzsa P, Rurik I, Tulassay Z, Kalabay L. The Diagnosis and Therapy of Helicobacter pylori Infection in Hungary: Comparison of Strategies Applied by Family Physicians and Internists. Dig Dis 2019; 37:434-443. [PMID: 31067529 DOI: 10.1159/000500243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AIMS Most patients with Helicobacter pylori infection are consulted for the first time by family physicians. We aimed to survey the adherence to the newest guidelines of the management of H. pylori infection in the primary and secondary care settings in Hungary. METHODS From a total of 793 physicians, 94 trainees in family medicine, 334 family physicians without and 195 with board certification in internal medicine, 87 internists, 78 family paediatricians were invited to take part in the study. Diagnostic and therapeutic attitudes towards H. pylori infection were compared by a voluntary and anonymous questionnaire. RESULTS Participants test for H. pylori infection in 92.8% of cases with a family history of peptic ulcer or 76.9% of gastric cancer, 68.9% of dyspepsia and 49.9% of non-specific abdominal complaints, before initiation of non-steroidal anti-inflammatory drug (NSAID; 17.3%) and antiplatelet treatment (14.5%), respectively. They confirm the success of eradication therapy in 88.1% mainly by urea breath test. Most of them initiate eradication therapy by themselves and only 22.4% refer their patients to a gastroenterologist. Clarithromycin-based standard triple therapy is the most preferred (62.1%) and only 3.7% choose quadruple combination with bismuth as first-line and 48.1% as second-line therapy. We found significant differences between groups with respect to the physicians' own infection, localization of practice, and sources of information on H. pylori infection. Internists are more likely to clarify H. pylori status before the initiation of NSAID and antiplatelet therapies, initiate second-line therapies and use bismuth compared to the other groups. Family physicians with board certification in internal medicine are also prone to start eradication therapy and less prone to refer patients to a gastroenterologist. Family paediatricians prefer stool antigen determination, screen family members and prefer gastroenterologist consultation more often, and use bismuth less frequently than the other groups. Family physicians with previous infection check for H. pyloriinfection more frequently before the initiation of NSAID treatment and are more likely to use histology to detect H. pylori. Postgraduate trainings were the most popular source of information. CONCLUSION The adherence to the recent recommendations of current guidelines is moderate. There is a need to increase adherence to current recommendations by family physicians and internists.
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Affiliation(s)
- Bernadett Márkus
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - László Herszényi
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary,
| | | | - Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Imre Rurik
- Department of Family Medicine and Occupational Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Tulassay
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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Torzsa P, Raghavendra D, Tafalla M. [Seroprevalence of Bordetella pertussis antibodies in adults in Hungary: results of an epidemiological cross-sectional study]. Orv Hetil 2018; 159:503-510. [PMID: 29577759 DOI: 10.1556/650.2018.30941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pertussis (whooping cough) is an acute respiratory tract infection caused by Bordetella pertussis that is characterized by a chronic, severe cough. The optimum immunization schedule for pertussis is unclear, so these vary by countries. AIM To estimate the seroprevalence of pertussis in adults in Hungary. METHOD Serum anti-pertussis toxin immunoglobulin G (anti-PT IgG) antibody levels were analyzed using enzyme-linked immunosorbent assay in adults in general practitioners' practices during one year. Sera were classified following manufacturer's instructions as: strongly indicative of current/recent infection (≥1.5 optical density [OD] units); indicative of current/recent infection (≥1.0 OD units); seropositive (>0.3 OD units); or seronegative (≤0.3 OD units). RESULTS 1999 adults (60.6% female; mean age 47.4 ± 17.7 years) were included. 14.8% were seropositive, 1.1% were indicative of current/recent infection, and 0.1% were strongly indicative of current/recent infection. CONCLUSIONS 85.2% of the subjects were seronegative and therefore susceptible to pertussis infection. Approximately 1% was suspicious of current/recent pertussis infection, potentially transmissible to susceptible young infants. Vaccination of adults is a key way to indirectly protect infants. Orv Hetil. 2018; 159(13): 503-510.
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Affiliation(s)
- Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
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28
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Vajó P, Gyurján O, Szabó ÁM, Kalabay L, Vajó Z, Torzsa P. [Safety data of the new, reduced-dose influenza vaccine FluArt after its first season on the market]. Orv Hetil 2017; 158:1953-1959. [PMID: 29199437 DOI: 10.1556/650.2017.30877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The currently licensed seasonal influenza vaccines contain split, subunit or whole virions, typically in amounts of 15 µg hemagglutinin per virus strain for adult and up to 60 µg in elderly patients. AIM The present study reports safety data of the newly licensed, reduced dose vaccine with 6 µg of hemagglutinin per strain produced by Fluart (Hungary) after its first season on the market. The main objective of enhanced safety surveillance was to detect a potential increase in reactogenicity and allergic events that is intrinsic to the product in near real-time in the earliest vaccinated cohorts. METHOD The study methods were based on the Interim guidance on enhanced safety surveillance for seasonal influenza vaccines in the EU by the European Medicines Agency. STATISTICS We used the Fisher exact test with 95% confidence intervals. RESULTS We studied 587 patients and detected a total 24 adverse events, all of which have already been known during the licensing studies of the present vaccine. The frequencies of the adverse events were not different from what had been seen with the previously licensed 15 µg vaccine. CONCLUSIONS Based on the results, the authors conclude that the new, reduced dose vaccine FluArt is safe and tolerable. Orv Hetil. 2017; 158(49): 1953-1959.
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Affiliation(s)
- Péter Vajó
- Klinikai Központ, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen
| | | | | | - László Kalabay
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Zoltán Vajó
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
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Abstract
INTRODUCTION The issue of gratuity is one of the most important health policy issues in Hungary. AIM The authors' aim is to investigate the attitude of Hungarian family medicine trainees towards gratitude payment. METHOD Quantitative, paper-based survey among trainees from four Departments of Family Medicine in Hungary (n = 152). RESULTS More than 50 percent of the residents do not approve of accepting gratitude money. Men (p<0.026), and graduating residents accept it significantly more often (p<0.036) while doctors with children tend to accept it more frequently (p<0.051). They think that the reason for this phenomenon is the lack of proper care (65%), vulnerability and the sense of real gratitude patients feel (52%). According to the participants, the least influencing factor was the low salary of physicians (14.4%). They believe that accepting gratuity is a corruption, and it's humiliating for doctors (80-80%). CONCLUSION Family medicine residents approve of gratitude money even less as compared to the results of previous studies, but related to other gratitude payment issues we have found similar opinions. Orv Hetil. 2017; 158(26): 1028-1035.
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Affiliation(s)
- Zsuzsa Győrffy
- Magatartástudományi Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Nagyvárad tér 4., 1089
| | - László Kalabay
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - András Mohos
- Családorvosi Intézet és Rendelő, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Bernadett Márkus
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Anna Nánási
- Családorvosi és Foglalkozás-egészségügyi Tanszék, Debreceni Egyetem, Népegészségügyi Kar Debrecen
| | - József Rinfel
- Alapellátási Intézet, Pécsi Tudományegyetem, Orvostudományi Kar Pécs
| | - Edmond Girasek
- Egészségügyi Menedzserképző Központ, Semmelweis Egyetem, Egészségügyi Közszolgálati Kar Budapest
| | - Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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Torzsa P, Csatlós D, Eőry A, Hargittay C, Horváth F, László A, Márkus B, Mohos A, Kalabay L, Győrffy Z. [Opinions of Hungarian family physicians and residents on vocation and informal payment]. Orv Hetil 2017; 157:1438-44. [PMID: 27596511 DOI: 10.1556/650.2016.30539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The changing of the family medicine can be observed in the New Millennium. Migration, the aging of the healers and informal payment are crucial to the human resource crisis of the health sector. AIM The aim of this study was to investigate the family physicians' and residents' opinions about the vocation and informal payment. METHOD Exploratory, quantitative study was carried out among family physicians (n = 363) and family physician residents (n = 180). The central questions of the study were the vocation, the income and the informal payment. RESULTS The most decisive factors of the carrier choice were altruism, service and responsibility. Residents were significantly rejective (19.7% vs. 38.3%, p<0.001) about informal payment. They would accept smaller amounts of informal payment (14.3% vs. 8.9%, p<0.034), and would spend it on praxis development (1.4% vs.9.4% p<0.023). CONCLUSIONS The attitudes of family physicians and residents are the same in case of the vocation, but on the issue of informal payment, the two generations have different opinions. Orv. Hetil., 2016, 157(36), 1438-1444.
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Affiliation(s)
- Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Dalma Csatlós
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Ajándék Eőry
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Csenge Hargittay
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Ferenc Horváth
- Népegészségtani Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Andrea László
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Bernadett Márkus
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - András Mohos
- Családorvosi Intézet és Rendelő, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Kalabay
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Zsuzsa Győrffy
- Magatartástudományi Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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Kovács Á, Kulcsár A, Kalabay L, Torzsa P. [Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]. Ideggyogy Sz 2017; 70:151-158. [PMID: 29870630 DOI: 10.18071/isz.70.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopharynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially devastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006-2015 every year between 34 and 70 were the numbers of the registered invasive disease because of Neisseria meningitis, the morbidity rate was 0.2-0.7⁰⁄₀₀₀₀. Half of the diseases (50.7%) were caused by B serotype N. meningitidis, 23.2% were C serotype. In this article the authors summarise what you must do and must not do as primary care physician when suddenly meeting a young patients suspected of having meningococcus infection.
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Affiliation(s)
- Ákos Kovács
- Semmelweis Egyetem, Családorvosi Tanszék, Budapest
| | - Andrea Kulcsár
- Egyesített Szt. István és Szt. László Kórház, Központi Gyermek Szakrendelô, Védôoltási Szakrendelô, Budapest
| | | | - Péter Torzsa
- Semmelweis Egyetem, Családorvosi Tanszék, Budapest
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Torzsa P, Devadiga R, Tafalla M. Seroprevalence of Bordetella pertussis antibodies in adults in Hungary: results of an epidemiological cross-sectional study. BMC Infect Dis 2017; 17:242. [PMID: 28376739 PMCID: PMC5379708 DOI: 10.1186/s12879-017-2356-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/28/2017] [Indexed: 01/08/2023] Open
Abstract
Background Pertussis (whooping cough) is well known to be underreported, particularly among adults, who can act as an infectious reservoir, potentially putting susceptible newborns at risk of serious illness. The purpose of this study was to estimate the seroprevalence of pertussis in adults in Hungary. Methods This epidemiological, cross-sectional study was conducted in adults in five general practitioners’ practices in Hungary. Serum anti-pertussis toxin immunoglobulin G (anti-PT IgG) antibody levels were analyzed using enzyme-linked immunosorbent assay. Sera were classified following manufacturer’s instructions as: strongly indicative of current/recent infection (≥1.5 optical density [OD] units); indicative of current/recent infection (≥1.0 OD units); seropositive (>0.3 OD units); or seronegative (≤0.3 OD units). Logistic regression was performed to describe the associations between seroprevalence and various characteristics. Results Between 24th April 2014 and 24th April 2015, 1999 adults (60.6% female; mean age 47.4 ± 17.7 years) were included in the analysis. A total of 14.8% were seropositive for anti-PT IgG, 1.1% had a level indicative of current/recent infection, and 0.1% had a level strongly indicative of current/recent infection. Logistic regression showed significant relationships between increased rates of seropositivity and: age ≥60 years (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.39–2.80; p = .0002) or 18–29 years (OR, 1.67; 95% CI, 1.13–2.46; p = .0094) vs. 45–59 years; former smoker (OR, 1.46; 95% CI, 1.08–1.97; p = .014) or current smoker (OR, 1.38; 95% CI, 1.01–1.89; p = .045) vs. never smoker; and male (OR, 1.30; 95% CI, 1.01–1.68; p = .041) vs. female. Also, between increased rates of probable current/recent infection and current smoker (OR, 7.50; 95% CI, 2.32–24.31; p = .0008) or former smoker (OR, 4.07; 95% CI, 1.21–13.64; p = .023) vs. never smoker. Conclusions Approximately 85% of the adults studied were seronegative and therefore susceptible to pertussis infection. Approximately 1% had anti-PT IgG levels indicative of current/recent pertussis infection, which could potentially be transmitted to susceptible young infants. Vaccination of adults is a key way to indirectly protect infants. Trial registration Clinical Trials.gov NCT02014519. Prospectively registered 12 December 2013.
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Affiliation(s)
- Péter Torzsa
- Faculty of Medicine, Department of Family Medicine, Semmelweis University, Kútvölgyi út 4, Budapest, 1125, Hungary
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Csatlós D, Ferenci T, Kalabay L, László A, Hargittay C, Márkus B, Szakács Z, Torzsa P. [A családorvosok alvási apnoéval kapcsolatos ismeretei és attitűdjei. Megvalósul-e az OSAS szűrése a járművezetők egészségi alkalmasságának vizsgálata során?]. Ideggyogy Sz 2017; 70:105-113. [PMID: 29870615 DOI: 10.18071/isz.70.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background and purpose Obstructive sleep apnea syndrome (OSAS) without treatment can cause serious cardiovascular, cardiorespiratory, neurological and other complications. Family physicians have an important role in recognizing the disease. The aim of the study is to assess the knowledge and attitude of family physicians related to sleep apnea. Whether OSAS screening is realized during the general medical checkup for drivers. Methods In the cross-sectional study we used a validated OSAKA questionnaire in mandatory continuous medical education courses, supplemented with four additional questions. Results 116 family physicians and 103 family medicine residents filled out the questionnaire. Hungarian family physicians, especially male doctors lack the adequate knowledge of sleep apnea. The average score of female physicians was significantly higher than that of males (13.4±1.8 vs. 11.7±2.6, p=0.005). The more specializations the doctor has, the higher the score. Zero or one special examination holders reached 12.5±2.3 points, two special examination holders 12.7±2.2 points. three or four special examination holders reached 14.0±2.1 (p=0.05). Residents' average score was 12.1±2.4 points, which is higher than that of family doctors (p=0.012). Female residents also had higher average points than male residents (12.6±2.0 vs. 11.3±2.7; p=0.008). The size, location and type of the practice or the doctor's age did not show any statistically significant correlation with the number of points achieved. According to our regression analysis, corrected to variables in the model, we found correlation between gender and medical knowledge, but there was no correlation between age, number of specialities, body mass index and the theoretical knowledge of the doctors. In terms of attitude female GPs had higher average scores than male GPs (3.5±0.6 vs. 2.9±0.6, p<0.001). Despite the modification of the 13/1992 regulation only 39% of the practices carried out regularly the required OSAS screening as part of the medical examination for a driving licence. Conclusion Despite the high prevalence and clinical importance of OSAS, GPs often do not recognize sleep apnea and they have difficulty in treating their patients for this problem.
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Affiliation(s)
- Dalma Csatlós
- Semmelweis Egyetem, ÁOK, Családorvosi Tanszék, Budapest
| | - Tamás Ferenci
- Óbudai Egyetem, Neumann János Informatikai Kar, Élettani Szabályozások Csoport, Budapest
| | | | - Andrea László
- Semmelweis Egyetem, ÁOK, Családorvosi Tanszék, Budapest
| | | | | | | | - Péter Torzsa
- Semmelweis Egyetem, ÁOK, Családorvosi Tanszék, Budapest
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Rurik I, Ungvári T, Szidor J, Torzsa P, Móczár C, Jancsó Z, Sándor J. [Obese Hungary. Trend and prevalence of overweight and obesity in Hungary, 2015]. Orv Hetil 2016; 157:1248-55. [PMID: 27476521 DOI: 10.1556/650.2016.30389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prevalence of obesity is growing continuously worldwide, even in Hungary. Since 1988, when the first professional wide-range evaluation was performed, only limited data are available. AIM Authors present the results of the ever largest Hungarian obesity-prevalence surveys, performed by family and occupational physicians. METHOD Data from 0.55% of the population above 18 year were registered in all geographical regions of Hungary (43,287 persons; 17,901 males and 25,386 females), close to the proper national representativeness. Age, body mass index, waist circumference, educational level, presence of hypertension and/or diabetes were analyzed statistically and compared with previous data. RESULTS The overall prevalence rate of overweight and obesity among men was 40% and 32%, respectively, while overweight and obesity occurred in 32% of women. In the different age groups of men, the prevalence of overweight and obesity was: 32.7% and 18.2% in 18-34 years; 40.1% and 34.4% in 35-59 years; 43.5% and 38.8% in over 60 years, respectively. In the same age groups of women, overweight and obesity occurred in 19.6% and 15.7%, 36.8% and 38.7%, and 36.5% and 39.7%, respectively. Body mass index and waist-circumference were presented according to age, by decades and by type of residency as well. The highest ratio of overweight was registered among men with the highest educational level, while highest ratio of obesity among women having the lowest education. Obesity according to Body mass index and abdominal obesity was the highest in the villages, especially among females. Registered metabolic morbidities were strongly correlated with body mass index and both were inversely related to the level of urbanization. CONCLUSIONS Over the previous decades, the ratio of the overweight and even the number of obese persons increased significantly, and it was most prominent among males, mainly in younger generation. Obesity means a serious medical, public health and economic problem, and it requires higher public awareness and political support. Orv. Hetil., 2016, 157(31), 1248-1255.
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Affiliation(s)
- Imre Rurik
- Családorvosi és Foglalkozás-egészségügyi Tanszék, Debreceni Egyetem, Népegészségügyi Kar Debrecen, Móricz Zs. krt. 22., 4032
| | - Tímea Ungvári
- Családorvosi és Foglalkozás-egészségügyi Tanszék, Debreceni Egyetem, Népegészségügyi Kar Debrecen, Móricz Zs. krt. 22., 4032
| | - Judit Szidor
- Családorvosi és Foglalkozás-egészségügyi Tanszék, Debreceni Egyetem, Népegészségügyi Kar Debrecen, Móricz Zs. krt. 22., 4032
| | - Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | | | - Zoltán Jancsó
- Családorvosi és Foglalkozás-egészségügyi Tanszék, Debreceni Egyetem, Népegészségügyi Kar Debrecen, Móricz Zs. krt. 22., 4032
| | - János Sándor
- Megelőző Orvostani Intézet, Epidemiológiai és Biostatisztikai Tanszék, Debreceni Egyetem, Népegészségügyi Kar Debrecen
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László A, Tabák Á, Kőrösi B, Eörsi D, Torzsa P, Cseprekál O, Tislér A, Reusz G, Nemcsik-Bencze Z, Gonda X, Rihmer Z, Nemcsik J. Association of affective temperaments with blood pressure and arterial stiffness in hypertensive patients: a cross-sectional study. BMC Cardiovasc Disord 2016; 16:158. [PMID: 27503108 PMCID: PMC4977892 DOI: 10.1186/s12872-016-0337-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/29/2016] [Indexed: 01/31/2023] Open
Abstract
Background Affective temperaments (anxious, depressive, cyclothymic, irritable and hyperthymic) measure subclinical manifestations of major mood disorders. Furthermore, cumulating evidence suggests their involvement in somatic disorders as well. We aimed to assess associations between affective temperament scores and blood pressure and arterial stiffness parameters in hypertensive patients. Methods In this cross-sectional study, 173 patients with well-controlled or grade 1 chronic hypertension, with no history of depression, completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Scale (HAM-A) questionnaires in three GP practices. Arterial stiffness was measured with tonometry (PulsePen). Results According to multiple linear regression analysis, cyclothymic temperament score was positively associated with brachial systolic blood pressure independently of age, sex, total cholesterol, brachial diastolic blood pressure, BDI, HAM-A and the use of alprazolam (β = 0.529, p = 0.042), while hyperthymic temperament score was negatively related to augmentation index independent of age, sex, smoking, heart rate, BDI, HAM-A and the use of alprazolam (β = -0.612, p = 0.013). A significant interaction was found between cyclothymic temperament score and sex in predicting brachial systolic blood pressure (p = 0.025), between irritable and anxious temperament scores and sex in predicting pulse wave velocity (p = 0.021, p = 0.023, respectively) and an interaction with borderline significance between hyperthymic temperament score and sex in predicting augmentation index (p = 0.052). Conclusions The present findings highlight elevated blood pressure among subjects with high cyclothymic temperament as well as an increased level of arterial stiffening in subjects with low hyperthymic scores suggesting that affective temperaments may play a role in the development of hypertension and arterial stiffening and may thus represent markers of cardiovascular risk. Sex differences were also present in these associations.
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Affiliation(s)
- Andrea László
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Ádám Tabák
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.,Department of Epidemiology and Public Health, University College, London, UK
| | - Beáta Kőrösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Eörsi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - András Tislér
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - György Reusz
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Zsófia Nemcsik-Bencze
- Magnetic Resonance Imaging Research Center, Semmelweis University, Budapest, Hungary
| | - Xénia Gonda
- Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary. .,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary. .,MTA-SE Neurochemistry Research Group, Budapest, Hungary.
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary.,Health Service of Zugló (ZESZ), Budapest, Hungary
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Szakács Z, Ádám Á, Annus JK, Csatlós D, László A, Kalabay L, Torzsa P. [Hungarian Society for Sleep Medicine guideline for detecting drivers with obstructive sleep apnea syndrome]. Orv Hetil 2016; 157:892-900. [PMID: 27233832 DOI: 10.1556/650.2016.30451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea is the most frequent sleep-disordered breathing. The prevalence of sleep apnea in the general population is 2-4% and the main characteristics of the disease are the intermittent cessation or substantial reduction of airflow during sleep, which is caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. Untreated patients are 4-6 times more likely to cause traffic accidents than their healthy counterparts. The aims of the obstructive sleep apnea screening are to prevent and reduce the incidence of serious car accidents, which are often caused by one of the most dangerous sleep disorders. Since April 1, 2015 a modification of the 13/1992 regulation has been in force in Hungary which orders screening of obstructive sleep apnea during medical checkup of drivers. The Hungarian Society for Sleep Medicine made a guideline according to the regulation which was adapted to national circumstances and family doctors, occupational health specialists can more easily screen obstructive sleep apnea in suspected patients. In sleep ambulances the disease can be diagnosed and effective treatment can be started. Patients receiving appropriate treatment and with appropriate compliance can get their driving licence under regular care and control.
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Affiliation(s)
| | - Ágnes Ádám
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | | | - Dalma Csatlós
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Andrea László
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - László Kalabay
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
| | - Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125
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Lakos A, Torzsa P, Ferenci T. [Bexsero, a novel vaccine against meningococcus]. Orv Hetil 2016; 157:242-6. [PMID: 26853725 DOI: 10.1556/650.2016.30333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Meningococcus B is the most prevalent Neisseria meningitidis serogroup isolated in Hungary. Bexsero is one of the vaccines developed against it, which has been available in Hungary since the summer of 2014. The authors summarize the most important issues and open questions concerning the disease and the vaccine based on literature review. Based on immunological evidence, it is expected that Bexsero provides protection against this rare but very serious infection. However, the vaccine is extremely expensive, the clinical effectiveness has not yet been proven and it frequently causes fever, especially in infants where the vaccine is most needed. According to the opinion of the authors, the formulation of a Hungarian guideline concerning the application of Bexsero should be postponed until the accumulating international experience makes it possible to better judge the vaccine's benefits, risks and cost-effectiveness. For patients with asplenia, complement defect or other immunological defect, or in case of markedly increased individual risk of contracting the disease, the vaccination is already justified.
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Affiliation(s)
- András Lakos
- Kullancsbetegségek Ambulanciája Budapest, Visegrádi u. 14., 1132
| | - Péter Torzsa
- Családorvosi Tanszék, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Tamás Ferenci
- Élettani Szabályozások Csoport, Óbudai Egyetem, Neumann János Informatikai Kar Budapest
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Nemcsik J, László A, Lénárt L, Eörsi D, Torzsa P, Kőrösi B, Cseprekál O, Tislér A, Tabák Á, Gonda X, Rihmer Z, Hodrea J, Nemcsik-Bencze Z, Fekete A. Hyperthymic affective temperament and hypertension are independent determinants of serum brain-derived neurotrophic factor level. Ann Gen Psychiatry 2016; 15:17. [PMID: 27478486 PMCID: PMC4966794 DOI: 10.1186/s12991-016-0104-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/30/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) has neuroprotective, proangiogenic and myogenic effects and, therefore, possibly acts as a psychosomatic mediator. Here, we measured serum BDNF (seBDNF) level in hypertensive patients (HT) and healthy controls (CONT) and its relation to affective temperaments, depression and anxiety scales, and arterial stiffness parameters. METHODS In this cross-sectional study, affective temperaments, anxiety, and depression were studied with questionnaires (TEMPS-A, HAM-A, and BDI, respectively). SeBDNF level and routine laboratory parameters were measured as well. Arterial stiffness was evaluated with a tonometric method. RESULTS Allover, 151 HT, and 32 CONT subjects were involved in the study. SeBDNF level was significantly higher in HT compared to CONT (24880 ± 8279 vs 21202.6 ± 6045.5 pg/mL, p < 0.05). In the final model of regression analysis, hyperthymic temperament score (Beta = 405.8, p = 0.004) and the presence of hypertension (Beta = 6121.2, p = 0.001) were independent determinants of seBDNF. In interaction analysis, it was found that in HT, a unit increase in hyperthymic score was associated with a 533.3 (95 %CI 241.3-825.3) pg/mL higher seBDNF. This interaction was missing in CONT. CONCLUSIONS Our results suggest a complex psychosomatic involvement of BDNF in the pathophysiology of hypertension, where hyperthymic affective temperament may have a protective role. BDNF is not likely to have an effect on large arteries.
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Affiliation(s)
- János Nemcsik
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary.,Health Service of Zugló (ZESZ), Budapest, Hungary
| | - Andrea László
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Lilla Lénárt
- Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary.,MTA-SE "Lendület" Diabetes Research Group Budapest, Budapest, Hungary
| | - Dániel Eörsi
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Beáta Kőrösi
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - András Tislér
- Ist Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Ádám Tabák
- Ist Department of Internal Medicine, Semmelweis University, Budapest, Hungary.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Xenia Gonda
- Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.,National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.,National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Judit Hodrea
- Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary.,MTA-SE "Lendület" Diabetes Research Group Budapest, Budapest, Hungary
| | - Zsófia Nemcsik-Bencze
- Magnetic Resonance Imaging Research Center, Semmelweis University, Budapest, Hungary
| | - Andrea Fekete
- Ist Department of Pediatrics, Semmelweis University, Budapest, Hungary.,MTA-SE "Lendület" Diabetes Research Group Budapest, Budapest, Hungary
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Brodszky V, Péntek M, Komoly S, Bereczki D, Embey-Isztin D, Torzsa P, Gulácsi L. QUALITY OF LIFE OF PATIENTS WITH NON-DIABETIC PERIPHERAL NEUROPATHIC PAIN; RESULTS FROM A CROSS-SECTIONAL SURVEY IN GENERAL PRACTICES IN HUNGARY. Ideggyogy Sz 2015; 68:325-330. [PMID: 26665494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND PURPOSE There is a lack of data on the impact on health related quality of life of peripheral neuropathic pain in Hungary. The main aims of the study were to assess the health related quality of life of non-diabetic PeNP patients identified in general practices through screening, and to assess the relationship between condition specific pain scores and health state utilities. METHODS Non-diabetic patients aged 30 years were recruited in 10 general practices in Hungary. At first, patients filled in the PainDETECT Questionnaire (PD-Q) and those who have achieved > or =13 PD-Q score (unclear or possible neuropathic pain) were further assessed by the DN4 questionnaire. Patients with PD-Q score >18 or DN4 score 4 were considered to have PeNP and they completed the EQ-5D health questionnaire. RESULTS Among the 111 patients identified as non-diabetic PeNP patients the mean age was 62 (SD=14) years, 69% were women. Average EQ-5D score was 44% lower than the gender and age matched Hungarian norm (0.42 vs. 0.75, p<0.001) and it worsened with increasing pain intensity. The pain/discomfort and anxiety/depression were the most affected EQ-5D dimensions. Strong relationship was demonstrated between the PD-Q and EQ- 5D score. Most of the PeNP patients (86%) were undiagnosed. CONCLUSIONS Non-diabetic PeNP pain has a huge negative impact on health related quality of life. Although PeNP is a serious chronic condition, the disease burden is seriously underestimated, both on the level of individuals and society, due to the fact that patients are rarely identified.
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Hodrea J, Nemcsik J, László A, Torzsa P, Eőry A, Kalabay L, Cseprekál O, Tislér A, Gonda X, Rihmer Z, Lenart L, Szabo AJ, Fekete A. FP107ASSOCIATION OF BRAIN-DERIVED NEUROTROPHIC FACTOR WITH PSYCHOSOMATIC DISORDERS IN HYPERTENESIVE PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv169.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
INTRODUCTION The prevalence of invasive pneumococcal disease, which is depending on risk factors and comorbidities, is increasing over the age of 50 years. Most developed countries have recommendations but vaccination rates remain low. AIM To assess the general practitioners' daily practice in relation to pneumococcal vaccination and analyse the effect of informing the subjects about the importance of pneumococcal vaccination on vaccination routine. METHOD Subjects over 50 years of age vaccinated against influenza during the 2012/2013 campaign were informed about the importance of pneumococcal vaccination and asked to fill in a questionnaire. RESULTS Of the 4000 subjects, 576 asked for a prescription of pneumococcal vaccine (16.5% of females and 11.6% of males, OR 1.67 CI 95% 1.37-2.04, p<0.001) and 310 were vaccinated. The mean age of females and males was 70.95 and 69.8 years, respectively (OR 1.01; CI 95% 1.00-1.02; p<0.05). Information given by physicians resulted in 33,6% prescription rate, while in case it was 8% when nurses provided information (OR 6.33; CI 95% 5.23-7.67; p<0.001). As an effect of this study the vaccination rate was 6.3 times higher than in the previous year campaign (p<0.001). CONCLUSIONS General practitioners are more effective in informing subjects about the importance of vaccination than nurses. Campaign can raise the vaccination rate significantly.
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Affiliation(s)
- Péter Vajer
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Ferenc Tamás
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - Róbert Urbán
- Eötvös Loránd Tudományegyetem, PPK Személyiség- és Egészségpszichológiai Tanszék Budapest
| | - Péter Torzsa
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
| | - László Kalabay
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest Kútvölgyi út 4. 1125
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Brodszky V, Péntek M, Komoly S, Bereczki D, Embey-Isztin D, Torzsa P, Gulácsi L. Nem diabeteses perifériás neuropathiás betegek életminőségének mérése magyarországi háziorvosi praxisokban végzett keresztmetszeti vizsgálat eredményei alapján. Ideggyogy Sz 2015. [DOI: 10.18071/isz.68.0325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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László A, Babos L, Kis-Igari Z, Pálfy A, Torzsa P, Eőry A, Kalabay L, Gonda X, Rihmer Z, Cseprekál O, Tislér A, Hodrea J, Lénárt L, Fekete A, Nemcsik J. Identification of hypertensive patients with dominant affective temperaments might improve the psychopathological and cardiovascular risk stratification: a pilot, case-control study. Ann Gen Psychiatry 2015; 14:33. [PMID: 26512294 PMCID: PMC4623904 DOI: 10.1186/s12991-015-0072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/14/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although mood disorders and cardiovascular diseases have widely studied psychosomatic connections, data concerning the influence of the psychopathologically important affective temperaments in hypertension are scarce. To define a possibly higher cardiovascular risk subpopulation we investigated in well-treated hypertensive patients with dominant affective temperaments (DOM) and in well-treated hypertensive patients without dominant temperaments the level of depression and anxiety, arterial stiffness and serum Brain-derived Neurotrophic Factor (seBDNF). METHODS 175 hypertensive patients, free of the history of psychiatric diseases, completed the TEMPS-A, Beck Depression Inventory and Hamilton Anxiety Scale questionnaires in two primary care practices. Of those 175 patients, 24 DOM patients and 24 hypertensive controls (matched in age, sex and the presence of diabetes) were selected for measurements of arterial stiffness and seBDNF level. RESULTS Beck and Hamilton scores in DOM patients were higher compared with controls. Pulse wave velocity and augmentation index did not differ between the groups while in the DOM patients decreased brachial systolic and diastolic and central diastolic blood pressures were found compared with controls. SeBDNF was lower in the DOM group than in the controls (22.4 ± 7.2 vs. 27.3 ± 7.8 ng/mL, p < 0.05). CONCLUSIONS Although similar arterial stiffness parameters were found in DOM patients, their increased depression and anxiety scores, the decreased brachial and central diastolic blood pressures as well as the decreased seBDNF might refer to their higher vulnerability regarding the development not only of major mood disorders, but also of cardiovascular complications. These data suggest that the evaluation of affective temperaments should get more attention both with regard to psychopathology and cardiovascular health management.
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Affiliation(s)
- Andrea László
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Levente Babos
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Zsóka Kis-Igari
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Adrienn Pálfy
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Ajándék Eőry
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Xenia Gonda
- Department of Pharmacodynamics, Semmelweis University Budapest, Budapest, Hungary ; Department of Clinical and Theoretical Mental Health, Semmelweis University Budapest, Budapest, Hungary ; MTA-SE Neurochemistry Research Group, Budapest, Hungary
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, Semmelweis University Budapest, Budapest, Hungary
| | | | - András Tislér
- Ist Department of Internal Medicine, Budapest, Hungary
| | - Judit Hodrea
- MTA-SE "Lendület" Diabetes Research Group Budapest, Budapest, Hungary
| | - Lilla Lénárt
- MTA-SE "Lendület" Diabetes Research Group Budapest, Budapest, Hungary
| | - Andrea Fekete
- MTA-SE "Lendület" Diabetes Research Group Budapest, Budapest, Hungary
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University Budapest, Budapest, Hungary ; Health Service of Zugló (ZESZ), Budapest, Hungary
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Rurik I, Torzsa P, Szidor J, Móczár C, Iski G, Albók E, Ungvári T, Jancsó Z, Sándor J. A public health threat in Hungary: obesity, 2013. BMC Public Health 2014; 14:798. [PMID: 25096526 PMCID: PMC4143555 DOI: 10.1186/1471-2458-14-798] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022] Open
Abstract
Background In Hungary, the last wide-range evaluation about nutritional status of the population was completed in 1988. Since then, only limited data were available. Our aim was to collect, analyze and present updated prevalence data. Methods Anthropometric, educational and morbidity data of persons above 18 y were registered in all geographical regions of Hungary, at primary care encounters and within community settings. Results Data (BMI, waist circumference, educational level) of 40,331 individuals (16,544 men, 23,787 women) were analyzed. Overall prevalence for overweight was 40.4% among men, 31.3% among women, while for obesity 32.0% and 31.5%, respectively. Abdominal obesity was 37.1% in males, 60.9% in females. Among men, the prevalence of overweight-obesity was: under 35 y = 32.5%-16.2%, between 35-60 y = 40.6%-34.7%, over 60 y = 44.3%-36.7%. Among women, in the same age categories were: 17.8%-13.8%, 29.7%-29.0%, and 36.9%-39.0%. Data were presented according to age by decades as well. The highest odds ratio of overweight (OR: 1.079; 95% CI [1.026-1.135]) was registered by middle educational level, the lowest odds ratio of obesity (OR: 0.500; 95% CI [0.463-0.539]) by the highest educational level. The highest proportion of obese people lived in villages (35.4%) and in Budapest (28.9%). Distribution of overweighed persons were: Budapest (37.1%), other cities (35.8%), villages (33.8%). Registered metabolic morbidities were strongly correlated with BMIs and both were inversely related to the level of urbanization. Over the previous decades, there has been a shift in the distribution of population toward being overweight and moreover obese, it was most prominent among males, mainly in younger generation. Conclusions Evaluation covered 0.53% of the total population over 18 y and could be very close to the proper national representativeness. The threat of obesity and related morbidities require higher public awareness and interventions.
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Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Móricz Zs, krt,22, 4032 Debrecen, Hungary.
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Kender Z, Fleming T, Kopf S, Torzsa P, Grolmusz V, Herzig S, Schleicher E, Rácz K, Reismann P, Nawroth P. Effect of Metformin on Methylglyoxal Metabolism in Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2014; 122:316-9. [DOI: 10.1055/s-0034-1371818] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Z. Kender
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - T. Fleming
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - S. Kopf
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - P. Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - V. Grolmusz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - S. Herzig
- Joint Research Division, Molecular Metabolic Control, German Cancer Research Center DKFZ, Network Aging Research, ZMBH, Heidelberg, Germany
| | - E. Schleicher
- Division of Clinical Chemistry/Central Laboratory, Department of Internal Medicine, University of Tubingen, Tubingen, Germany
| | - K. Rácz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P. Reismann
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P. Nawroth
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
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Eory A, Gonda X, Torzsa P, Kalman J, Kalabay L, Rihmer Z. EPA-1314 - Affective temperaments in the background of acute cardiac complications in primary hypertension. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nemcsik J, László A, Babos L, Kis-Igari Z, Pálfy A, Torzsa P, Eőry A, Kalabay L, Cseprekál O, Tislér A, Gonda X, Rihmer Z. P1.9 EVALUATION OF AFFECTIVE TEMPERAMENTS AND ARTERIAL STIFFNESS IN TREATED HYPERTENSIVE PATIENTS. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rurik I, Torzsa P, Ilyés I, Szigethy E, Halmy E, Iski G, Kolozsvári LR, Mester L, Móczár C, Rinfel J, Nagy L, Kalabay L. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians. BMC Fam Pract 2013; 14:156. [PMID: 24138355 PMCID: PMC3853764 DOI: 10.1186/1471-2296-14-156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/15/2013] [Indexed: 12/02/2022]
Abstract
Background Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. Methods The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. Results The knowledge about multimorbidity, a main consequence of obesity was balanced. Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue. There were wider differences regarding attitudes and practice, influenced by the the doctors’ age, gender, known BMI, previous qualification, less by working location. GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients’ waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors. Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for patients significantly more frequently (65% vs 52%). Most of the younger doctors agreed that obesity management was a primary care issue. Doctors in the normal BMI range were unanimous that they should be a model for their patients (94% vs 81%). Conclusion More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary.
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Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, Medical and Health Science Center, University of Debrecen, Nagyerdei krt, 98, 4032, Debrecen, Hungary.
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Studinger P, Tabák ÁG, Chen CH, Salvi P, Othmane TE, Torzsa P, Kapocsi J, Fekete BC, Tislér A. The Effect of Low-Dose Carvedilol, Nebivolol, and Metoprolol on Central Arterial Pressure and Its Determinants: A Randomized Clinical Trial. J Clin Hypertens (Greenwich) 2013; 15:910-7. [DOI: 10.1111/jch.12210] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/24/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Péter Studinger
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Ádám G. Tabák
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
- Department of Epidemiology and Public Health; University College London; London UK
| | - Chen-Huan Chen
- Department of Public Health; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medical Research and Education; Taipei Veterans General Hospital; Taipei Taiwan
| | - Paolo Salvi
- Department of Cardiology; Istituto Auxologico Italiano; Milan Italy
| | - Taha E.H. Othmane
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Péter Torzsa
- Department of Family Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Judit Kapocsi
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Bertalan C. Fekete
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - András Tislér
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
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Györffy Z, Torzsa P, Sándor I, Csoboth C, Kopp M. [Sleep disorders and physical abuse: a nation-wide representative study in Hungary]. Psychiatr Hung 2013; 28:281-290. [PMID: 24142294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Violence against women has been declared a major public health concern. The relationship between physical abuse and physical and psychological symptoms is well-known, however data regarding the association between physical abuse and sleep disorders are limited. Our aim is to document the prevalence of reported abuse and investigate the association between physical abuse and insomnia among females. METHODS Cross-sectional analyses were conducted on the female sample (N=6987) of the Hungarostudy 2002, a nationwide representative survey. The survey contained sociodemographic questions and a Hungarian version of Athen Insomnia Scale (AIS). RESULTS We found higher (>10) AIS scores and all of the items of AIS reported higher prevalence among abused women's group than non-abused women. Physical abuse was found to be associated with sleep disturbances (OR=1,707), problems with staying asleep (OR=1,552) and decrease of daytime performance (OR=2,024) after controlling the potential risk factors. CONCLUSION Women experiencing physical abuse have a significantly higher risk of sleep disorders. The relationship between physical abuse and insomnia deserves further investigation in order to determine the possible pathways of this association.
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Affiliation(s)
- Zsuzsa Györffy
- Semmelweis Egyetem, Magatartastudomanyi Intezet, Budapest, Hungary, E-mail:
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