Eszter Kovács

Do parents and school matter? Protective factors for adolescent substance use.

Protective factors may promote successful development by neutralizing the effects of negative risk factors. This paper is focused on possible protective factors of adolescent substance in a sample of high school students (N=881) in Szeged, Hungary. Data were collected in 2008. Self-administered questionnaires were applied that measured smoking, binge drinking, marijuana use and parental and school-related protective factors. Multiple regression analysis revealed that parental monitoring was a universal protective factor for adolescents. Acceptance and respect of parents values may serve as a protection against binge drinking among adolescents. High academic achievement was a predictor of smoking and binge drinking, talking about problems with teachers and being happy with school were predictors of marijuana use. Future research is needed to clarify the altered role of parent-child relationship in adolescents substance use.

β2-adrenergic receptor gene polymorphisms and pregnancy outcome

Abstract Aims: The association between alleles at two loci of the polymorphic β2-adrenergic receptor (β2AR) gene and pregnancy outcome was determined. Methods: In a case-control study, buccal swabs obtained from 159 mother-infant pairs after a preterm or term birth were analyzed by gene amplification and endonuclease digestion for polymorphisms at codons 16 and 27 of the β2AR gene. Results: Homozygosity for allele A at codon 16 (Arg-16) occurred in 26 (20.5%) of 127 mothers with a term birth and in none of the mothers who had a spontaneous preterm birth (p = 0.002). Conversely, 24 of 32 (75.0%) mothers with a spontaneous preterm birth, as compared to 58 of 127 (45.7%) mothers with term births, were Arg-16/allele G (Gly-16) heterozygotes (p = 0.003). There was no relation between pregnancy outcome and infant genotype at codon 16 or maternal or infant genotypes at codon 27. The alleles at codon 16 and 27 were in linkage disequilibrium and the combinations of Arg-16-Gln-27 homozygosity (p = 0.04) and Arg-16/Gly-16-Gln homozygous (p = 0.01) were associated with a decreased and increased rate of spontaneous preterm birth, respectively. Conclusion: At codon 16 of the β2-AR gene, maternal Arg-16 homozygosity protects against, and Gly-16 predisposes to spontaneous preterm birth.

Dental Status and Oral Health of Patients with Epilepsy: An Epidemiologic Study

Summary:u2003 Purpose: We performed a dental survey of epilepsy patients to examine their oral health by statistical means and to provide a guide for the dental treatment of these patients.

Is emotional dissonance more prevalent in oncology care? Emotion work, burnout and coping.

Objectives: Emotional burden on oncology care workers is considerable. These workers develop confidential relationship with the patient through interpersonal communication, which entails managing their own emotions as well as the emotions displayed by their patients, and it involves a great deal of emotion work. The objectives in our study were to assess the prevalence of burnout and emotional dissonance and to investigate the interrelationship among burnout, emotion work and coping in oncology care.

Religiosity as a Protective Factor Against Substance Use Among Hungarian High School Students

Gender differences in the relationship between religiosity and substance use (lifetime prevalence and current use) were examined among high school students in Szeged, Hungary (N = 881). Experimenting with and consuming tobacco and alcoholic beverages were characteristic in the sample to a great extent, whereas marijuana use was not as frequent. Logistic regression analyses were employed to test how variables of religiosity, that is, denominational affiliation, religiosity, and religious attendance, were related to substance use of youth by gender. Our findings confirmed the importance of the protective role of religious involvement, particularly among females.

Licensing procedures and registration of medical doctors in the European Union

The current proposals to update the European Union (EU) directive on professional qualifications will have potentially important implications for health professions. Yet those discussing it will struggle to find basic information on key issues such as licensing and registration of physicians in different countries. A survey was conducted among national experts in 14 EU member states, supplemented by literature and independent expert review. The questionnaire covered five components of licensing and registration: (1) definitions, (2) regulatory basis, (3) governance, (4) the process of registration and (5) flow and quantity of applications. We identify seven areas of concern: (1) the meaning of terminology, which is inconsistent; (2) the role of language assessments and the responsibility for them; (3) whether approval to practise should be lifelong or time limited, subject to periodic assessment; (4) the need for improved systems to identify those deemed no longer fit to practise in one member state; (5) the complexity of processes for graduates from non-EU/European Economic Area (EAA) countries; (6) public access to registers; and (7) transparency of systems of governance. The systems of licensing and registration of doctors in Europe have developed within specific national contexts and vary widely. This creates inevitable problems in the context of free movement of professionals and increasing mobility.

International Patients on Operation Vacation – Perspectives of Patients Travelling to Hungary for Orthopaedic Treatments

BACKGROUNDnThe importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary.nnnMETHODSnA patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed.nnnRESULTSnThe survey was completed by 115 participants - 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being very satisfied with care received and 41.6% satisfied. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others.nnnCONCLUSIONnBased on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.

Ultrastructure and composition of thrombi in coronary and peripheral artery disease: Correlations with clinical and laboratory findings

INTRODUCTIONnFibrin structure and cellular composition of thrombi profoundly affect the clinical outcomes in ischemic coronary and peripheral artery disease. Our study addressed the interrelations of structural features of thrombi and routinely measured laboratory parameters.nnnMATERIALS AND METHODSnThrombi removed by thromboaspiration following acute myocardial infarction (n=101) or thrombendarterectomy of peripheral arteries (n=50) were processed by scanning electron microscopy and immunostaining for fibrin and platelet antigen GPIIb/IIIa to determine fibrin fibre diameter and relative occupancy by fibrin and cells. Correlations between the structural characteristics and selected clinical parameters (age, sex, vascular localization, blood cell counts, ECG findings, antiplatelet medication, accompanying diseases, smoking) were assessed.nnnRESULTSnWe observed significant differences in mean fibre diameter (122 vs. 135 nm), fibrin content (70.5% vs. 83.9%), fluorescent fibrin/platelet coverage ratio (0.18 vs. 1.06) between coronary and peripheral thrombi. Coronary thrombi from smokers contained more fibrin than non-smokers (78.1% vs. 62.2% mean occupancy). In the initial 24 h, fibrin content of coronary thrombi decreased with time, whereas in peripheral thrombi platelet content increased in the first 7 days. In coronaries, higher platelet content and smaller vessel diameter were associated with thinner fibrin fibres, whereas hematocrit higher than 0.35 correlated with larger intrathrombotic platelet occupancy. Smoking and dyslipidaemia strengthened the dependence of clot platelet content on systemic platelet count (the adjusted determination coefficient increased from 0.33 to 0.43 and 0.65, respectively).nnnCONCLUSIONnEasily accessible clinical parameters could be identified as significant determinants of ultrastructure and composition of coronary and peripheral thrombi.

Bilateral serous retinal detachment as a complication of acquired peripartum thrombotic thrombocytopenic purpura bout

We report a case of a 26‐year‐old primigravid woman, believed to have HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome, which turned out to be a thrombotic thrombocytopenic purpura (TTP) bout. At the 40th gestational week, based on the clinical picture of HELLP syndrome, a cesarean section was performed and a dysmature male newborn was delivered. Afterwards, clinical symptoms and laboratory abnormalities persisted. Severe ADAMTS13 deficiency with the presence of inhibitory anti‐ADAMTS13 antibodies revealed acquired thrombotic thrombocytopenic purpura bout, which was complicated with bilateral vision decrease due to bilateral retinal detachment. At the first ophthalmological examination, ultrasonography and binocular indirect ophthalmoscopy confirmed the diagnosis of the serous retinal detachment. After the diagnosis of acquired TTP bout, the patient was treated with multiple plasmapheresis and intravenous immunoglobulin with rapid improvement of the clinical and laboratory parameters. The ophthalmologic complications disappeared later without sequelae. At the 18‐month examination, substantial visual acuity improvement without serous retinal detachment and full best corrected visual acuity were observed.

Both Freshly Prepared and Frozen-Stored Amniotic Membrane Cells Express the Complement Inhibitor CD59

Amniotic membrane proved to be very effective tool in the treatment of a number of ocular surface diseases. The amniotic membrane, however, has to be stored before its transplantation onto the ocular surface followed by mandatory serologic control in order to exclude the transmission of certain viruses. Therefore it is most important to study if cryopreservation of the membrane affects cell surface expression of the molecules. We measured cell surface expression of CD59, a membrane-bound complement inhibitor on the cells of freshly prepared and cryopreserved amniotic membrane. Cells of amniotic membrane were separated mechanically. Epithelial and mesenchymal cells were identified by the intracellular expression of nanog and the cell surface ICAM1 positivity, respectively. Multicolor flow cytometric immunophenotyping was used for determination of the CD59 expression. CellQuest-Pro software program (Becton Dickinson) was used both for measurements and analysis. CD59-positive cells could be detected in all investigated samples and in all investigated cell types, although the expression level of CD59 differed. CD59 was expressed both on freshly prepared and frozen-stored samples. Higher level of CD59 was detected on ICAM1+ mesenchymal cells than on nanog+ epithelial cells. Our findings indicate that amniotic membranes maintain their complement inhibiting capacity after cryopreservation.