Decreasing suicide mortality in Hungary – What are the main causes?

Introduction

Depression and suicidal behaviour are major public health problems everywhere but particularly in Hungary where until 2000 the suicide rate was among the highest in the world.

Objectives

To analyse the possible causes of declining national suicide rate of Hungary.

Methods

Review of the scientific literature on Hungarian suicide scene published in the last 40 years.

Results

The peak of Hungarian national suicide rate was in 1985 (46/100.000) but due to a steady and continuous, year by year decline, in 2019 it was only 16/100.000, which represents a more than 65% decrease. Rate of unrecognised/untreated mood disorders, availability of health/psychiatric care, antidepressant and lithium prescription, unemployment, smoking and alcohol consumption as well as lithium and arsenic contents of drinking water were the most investigated possible determinants of suicide mortality of the country. More widespread and effective treatment of psychiatric/mood disorder patients, decreased rate of unemployment and smoking as well as the continuously improving living standards were the most important contributors to the great decline of the national suicide rate. However, in 2020 – the first year of the COVID-19 pandemic – the national suicide rate rose by 16%, which was almost totally accounted for by the increase of suicides among males.

Conclusions

Suicidal behaviour is preventable in many cases, but as it is a complex, multicausal phenomenon, its prevention should involve several medical/psychiatric, psychosocial and community interventions.

Disclosure

No significant relationships.

Ms. Noemi Monika Szeifert

Introduction

Working in COVID – 19 Health Care Units – Psychological impacts (PTSD, Depression, Anxiety Disorders) Working in the frontline during COVID-19 has put under extreme psychological and physical pressure the health care workers. The severe psychological symptomps can emerge on short, mid and long term as well. Our research is focusing on the psychological impacts of front line health care workers.

Objectives

In our lecture, we summarize our reserach made in the National Traumatology Center, Budapest, Hungary among health care workers who worked in the front and in the second line during the most severe period of the pandemic in Hungary, and discuss probable risk factors for PTSD and chronic psychological distress related to COVID-19. Furthermore we make an overview on the most frequently used coping skills for dealing with the psychological stress caused by the pandemic among the health care workers. The sample taking was processed in July 2021, after 3 month the 3rd COVID – 19 wave officially ended in Hungary.

Methods

123 health care workers completed the online survey anonimously, included Beck Depression Inventory, Spielberger Anxiety State Inventory, PTSD Checklist, Lazarus Coping Scale.

Results

23% of HCW reported symptomps of depression, nearly 25% dealing with sleeping disorders and 38% with chronic fatigue, 42,50 % HCW suffering from anxiety disorders, 22% HCW experiencing symptomps of PTSD.

Conclusions

With our results we would like to raise awareness of the challenges and severe psychological consequences that these colleagues, our national heroes we can say, are facing after working in COVID-19 Health Care Units.

Disclosure

No significant relationships.

Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center

INTRODUCTION

In patients receiving cardiac resynchronization therapy (CRT), failure rate to implant the left ventricular (LV) lead by the traditional trans-venous approach is 4-8%. Surgical epicardial implantation is considered as an alternative, but this technique is not without morbidity. Evidence from case documentation and from small trial batches demonstrated the viability of endocardial LV lead implantation where surgical epicardial lead placement is not applicable.

MATERIAL AND METHODS

Four patients were implanted with endocardial LV lead using the transseptal atrial approach after unsuccessful transvenous implantation. Implantation of an endocardial active fixation LV leads was successful in all patients with stable electrical parameters immediately after implantation and over the follow-up period. All patients received anticoagulation therapy in order to target the international normalized ratio of 2.5-3.5 and have not experienced any thromboembolic, hemorrhagic events, or infection.

RESULTS

Follow-up echocardiography indicated significant improvement of LV systolic function (24 + 4.9 to 32 + 5.1 %, P = 0.023) with a notable improvement of the functional status.

CONCLUSIONS

Endocardial left ventricular lead implantation can be a valuable and safe alternative technique to enable LV stimulation in high surgical risk patients where standard coronary sinus implant is unsuccessful.

The cardiotonic effects of levosimendan in guinea pig hearts are modulated by beta-adrenergic stimulation

The effects of the Ca2+-sensitiser levosimendan alone or in combination with beta-adrenergic stimulation on the contractile function were studied in various guinea pig cardiac preparations. Echocardiography in narcotised animals indicated that a maximal dose of levosimendan (50 microg x kg(-1)) increased the left ventricular posterior wall movement velocity during systoles and diastoles by 25 +/- 3% (mean +/- S.E.M.) and 17 +/- 2%, respectively. In Langendorff hearts, a saturating concentration of levosimendan (0.3 micromol x l(-1) for 5 min) increased +dP/dt(max) and dP/dt(max) by 28 +/- 3% and 14 +/- 2%, respectively. Further, the Ca2+-sensitising potential of levosimendan in Triton-skinned cardiomyocytes (EC50: 5 +/- 3 nmol x l(-1)) was illustrated by a maximal increase in the isometric force production by 51 +/- 5% (at pCa 6.2). However, following stimulation by isoproterenol, when the level of troponin I phosphorylation was elevated, no significant additional increase in the contractile parameters could be demonstrated upon levosimendan administration. Moreover, the levosimendan-induced increase in force production in isolated skinned myocytes could be prevented by incubation with the catalytic subunit of protein kinase A (100 U x ml(-1) for 40 min). These data indicate that thin filament-targeted Ca2+-sensitisation by levosimendan is modulated by phosphorylation of the contractile filaments, an effect that should be considered during combination therapy with levosimendan.

Crystallization of the haptoglobin-hemoglobin complex

Two orthorhombic forms of crystals of the haptoglobin-hemoglobin complex were obtained using polyethylene glycol as precipitant. These crystals did not diffract well enough for data collection and work on the complex is no longer continued. However, the description of the crystallization conditions may be useful in future endeavors to obtain suitable crystals.

[Pulse oximetry in the study of the viability of the intestines and the microcirculation in intestinal anastomoses (preliminary report)]

The author introduces a new intraoperative procedure suitable to examine the viability of the bowel using pulsoxymetry which has not yet been applied in abdominal surgery, but is widely used in anesthesiological practice. Shortly the writer introduces the importance of the method and its practical measurements. At the moment he is accounting for just six months' experience from the method. The method gives diagnostical assistance to urgent surgical interventions such as destructive and vascular ileus. To obtain accurate measurements the author feels it is necessary to construct a special probe adapted to the bowel. Since pulsoxymeter used to examine decisive parameters of viability--is a part of anesthesiological monitoring system- its application in every surgical theater is a possibility at hand, without any special financial investment.

[Necrosis of the colon and rectum as a complication of aortic reconstruction surgery]

The author reports on two patients operated on for necrosis of left colon after aorta-bifemoral by-pass reconstruction and presents another by whom ischemic rectum necrosis occurred as complication of aorta aneurysm. The paper deals with the symptomatology, diagnostics, anatomic and surgical technical causes of the serious complication. Results may be improved by early recognition of complication and the consequent performance of examinations related to it.