I Kriszbacher

The occurrence of acute myocardial infarction in relation to weather conditions

The spatial and temporal changes of weather factors depend on geographical location, seasons and the time of the day. Our study examines the relationships of meteorological factors and the incidence of acute myocardial infarction (AMI). A retrospective analysis of patients diagnosed with AMI between 2000 and 2004 in Hungary (n = 81,956 patients) was carried out. Data were collected by the National Health Insurance Fund Administration (OEP) and the National Meteorology Service (OMSZ). A peak period of the occurrence of AMI was found during spring, while minimum number of events were recorded during summer. Significant difference was observed between the number of events each season (F = 34.741; p < 0.001; N = 81,956). A medium level negative correlation was found between the monthly average temperature and the occurrence of AMI (r = -0.404) during the period examined. A positive correlation was shown between front movements and the number of events per season (r = 0.053). Average barometric pressure changes, the number of front movements and the number of AMI events also showed a nearly similar seasonal deviation. Our findings show that certain meteorological factors may be related to the onset of AMI, however other factors also play an important role.

Permanent stress may be the trigger of an acute myocardial infarction on the first work-day of the week

Numerous studies have reported the weekly variation of an acute myocardial infarction. The Monday peek has been connected with higher rate of physical and mental, work-related stress. We wished to study the weekly variation of an acute myocardial infarction (AMI) in the group of workers and pensioners, and to find out whether National Holidays on the first day of the week could influence the weekly rhythm of an acute myocardial infarction. We carried out the retrospective analysis of patients admitted to Hungarian hospitals with the diagnose of an AMI (n=90,187) between 2002 and 2007. According to the morbidity data of an AMI, the weekly peek was detected on the first work-day of the week, showing a gradually decreasing tendency until the end of the week. Morbidity rates on Mondays being National Holidays were similar to the number of events on Saturdays and Sundays (Z=-24,431; p<0.001). There was a significant difference between the number of events on work-days and weekends (Z=-27,321; p<0.001). No marked difference was found between workers under the age of 65 and pensioners above the age of 65, or between the two sexes. The results of our study reveal that the occurrence of an AMI shows characteristic changes throughout the days of the week, and the first work-days of the week may be related to higher incidence of an acute myocardial infarction.

The time of sunrise and the number of hours with daylight may influence the diurnal rhythm of acute heart attack mortality.

We investigated whether the time of sunrise and the number of daylight hours have an effect on the seasonality, or the daily rhythm of heart attack mortality. We analyzed retrospectively data of patients admitted to hospitals with the diagnosis of heart attack (n=32,329) and patients who deceased of a heart attack (n=5142) between January 1, 2004 and December 31, 2005 in Hungary. Heart attack mortality was highest during winter, while lowest number of events was recorded during summer . The daily peak of diurnality was between 6:00 am and 12:00 pm (33.77%). A positive correlation was found between the time of sunrise, time of sunset and the mortality caused by myocardial infarction (p<0,01). In the analysis of the number of daylight hours and the heart attack mortality we found a negative correlation (r=-0.105, p<0.05). No significant difference was found between sexes and different age-groups in heart attack mortality. Our data suggest, that the occurrence and the mortality of heart attack may be related to the time of sunrise and the number of daylight hours.

Pelvic pain in endometriosis: Painkillers or sport to alleviate symptoms?

To assess potential individual factors influencing quality of life and pain scores of patients suffering from histologically confirmed endometriosis. Study using a questionnaire among patients of reproductive age undergoing laparoscopy with a presumed diagnosis of endometriosis. Details of fertility, previous treatments and quality of life, sexual activity, as well as linear pain scores for several symptoms, were recorded. Details of intraoperative findings were also collected and only those data were used where endometriosis was intraoperatively and histologically proven. A questionnaire before surgery gathered information from women on the following groups of variables: age, marital status, education, reproductive and medical history including previous pregnancies and parity, knowledge of accompanying pelvic disorders, regular sport activity, as well as general quality of life estimates including self-image. Pelvic pain was scored using a visual analogue scale. Data were statistically evaluated. Eighty-one patients complaining about persistent pelvic pain were later intraoperatively and histologically proven to have endometriosis. Thirty-one of them (38.2%) reported regular sport as part of their daily life schedule while 50 of them (61.8%) performed no physical activity at all. Fourteen patients among regular exercisers and 33 patients among those without physical activity reported the effectiveness of painkillers for pelvic pain, corresponding to 45.1% and 66% of these subgroups, respectively (difference statistically significant, p<0.05). Based on our results, we can conclude, that taking painkillers might be less effective among endometriosis patients performing regular daily sport activities, and, thus it might impose them to an unnecessary burden of possible side-effects.

The effects of seasonal variations and weather conditions on the occurrence of heart attacks in Hungary between 2000–2004

INTRODUCTION: The onset of acute myocardial infarct shows circadian and seasonal variations, that are influenced by sex, age and the changes of weather conditions as well. AIM: The purpose of our present study is to investigate whether a seasonal variation can be found in the onset of myocardial infarctions during the period under investigation, and whether certain meteorological factors (air temperature, atmospheric pressure, front movements) influence the incidence of myocardial infarction. METHODS: Retrospective analysis has been carried out on patients admitted because of acute myocardial infarct in Hungary between 2000 and 2004 ( n=81.956). Data have been taken from the database of the National Health Insurance Fund Administration based on the International Classification of Diseases (ICD). Weather related data were provided by the National Meteorology Service. RESULTS: Regarding seasonal distribution the peak incidence period of acute myocardial infarct was spring, whereas the lowest number of events was observed during the summer months. There was a marked difference in the number of events per season ( p<0.001). A medium level negative correlation was found between the monthly average temperature and the occurrence of heart attack ( r=-0.404) during the period examined. A positive correlation was shown between front movements and the of number of events per season ( r=0.053). CONCLUSION: Our findings show that certain meteorological factors may be related to the onset of acute myocardial infarct, however, a number of other factors may also play an important role.

Health science research in Hungary

We read with great interest the paper by Judith Hall and associates on interdisciplinary health research in Canada.[1][1] In the 1990s, Canada contributed significantly to the development of education and research in the health sciences in Hungary after the social and political changes that occurred

The effect of climate on heart attack mortality

We have read with great interest the very important letter by George Ntaios et al. about whether there is a geographic variation in the seasonal distribution of acute myocardial infarction and sudden cardiac death [1]. The authors believe that a possible factor causing the differences between Hungarian and Greek results could be that Greece is amajor touristic target, resulting in a large increase of population during the summer.We also consider to analyze the seasonal composition of the population, to determine the extent of contribution of data deriving from cases of nonresident aliens in our results. Another factor causing this deviation between the results of the two countries could be the difference in climate. The climate of Greece is as diverse as its geographical construction. It is also important to note that our study included all patients died following acute myocardial infarction not only cases classified as sudden cardiac deaths. And while the Greek study focused on deaths occurred in the Municipality of Thessaloniki, northern Greece, the Hungarian study covered the whole territory of the country. Several reports have already proved that the number of deaths related to acute myocardial infarction (AMI) shows a seasonal variation, with a peak in winter, and a lowest number of mortality rates during the months of summer [2–4]. The effects of meteorological variables on the human organism have been studied for more than fifty years, and changes in the number of AMI events have been related to both cold or warm temperatures [5–7]. Hungary is a small country in the middle of Europe, laying in the Carpathian basin. Based on our results it may be stated that the annual number of cardiac mortality (N=16.160) in Hungary shows a steadily decreasing tendency between 2000 and 2005, with a seasonal variation regardless of age or sex. The peak period of AMI mortality was during the months of spring, with a lowest value during the summer. There was a significant difference between seasons (F=3.027; pb0.05). The daily average of cardiovascular mortality during each season was the following: 8.48 during spring, 7.23 during the summer, 7.79 during autumn, and 7.76 during winter. The low rate ofAMImortality during themonths of summermay be due to summer holidays in addition to favourable meteorological conditions, nutrition, exercise, or the more wide-spread use of air-conditioners. In addition to these findings, it seems that the changes of weather conditions also influence the mortality of other cardiovascular events. In Hungary the highest average daily temperature is above 29 °C in themonth of July, while the lowest average daily temperature is above 10 °C in December. With consideration to meteorological conditions, our results show, that both the sharp temperature increase during spring, and the similarly significant decrease of temperatures during autumn, both have an increasing effect on heart attack related mortality. Studying the moving average of AMI mortality (k=7), and the relation with the daily average temperature of the preceding 7 days, we have found a medium value negative correlation (r≅−0.466, pb0.001). Categorizing our data according to age groups, the strongest correlation was found in the age group of above 70 (r≅−0.41, pb0.001), with a weaker relation in the age group between 50 and 70 (r≅−0.315, pb0.001), while in the age group below 50 years of age, no correlation was found. Considering the International Journal of Cardiology 139 (2010) 92–104 www.elsevier.com/locate/ijcard

The export of nurses from europe to the united states

We would like to highlight the main conclusion by Polsky et al.1 on the similar qualifications of nurses trained within and outside the United States. The nursing shortage is an important phenomenon not only in the United States but also in Europe.2 Since the fall of socialism in Hungary in 1989, the country has become an important source of well-qualified nurses for Western countries. During Hungary’s economic reforms in the early 1990s, nursing education was elevated from diploma level to degree level to match that of other countries in Western Europe. Until 2005, the development of the bachelor of science in nursing program in Hungarian universities was supported by staff at Case Western Reserve University (Cleveland, Ohio) to make it more compatible with the degrees available in Western countries.3 In 1990 there were no degree-holding nurses in the Hungarian health care system (with the exception of the few nursing director posts); by 2000, 2567 out of 62000 nurses in Hungarian health care institutions (mainly hospitals) held a bachelor of science in nursing. Since the mid-1990s it has been compulsory for each hospital department in Hungary to employ at least 1 nurse with a bachelor’s degree. This requirement has accelerated the acceptance of degree-holding nurses in health care institutions. In 2000 nearly all leading domestic nursing posts were held by degree-holding nurses; in subsequent years, an increase in the migration of nurses (as a result of declining domestic opportunities) was detectable by the number of diploma supplements (a document issued to outline the education received) issued in English.4 Since 2000 the master of science in nursing degree has been available in Hungary in an attempt to make domestic nursing careers more attractive. The focus of this complementary degree is on management, education, and research.5,6 In 2006 the Doctoral School of Health Sciences at the Faculty of Health Sciences, University of Pecs (Pecs, Hungary), was established with the aim of strengthening research in nursing and in health sciences.7 In recent years, the number of new applicants to Hungarian universities who are interested in earning a nursing degree has slightly but steadily declined. If the experienced nursing workforce with bachelor’s or master’s degrees continues to move elsewhere for job opportunities, the Hungarian health care system will be threatened.8 The right of individual nurses to migrate and the ability of nations to keep nurses that are citizens both should be considered in order to find a sustainable balance in migration. Figure 1 Emma Trochez, with Goodwill Industries of South Florida in Miami, trims a US interment flag on March 24, 2003. This South Florida non-profit serves as a major supplier of fatigues for the US military, as well as the licensed maker of the interment flag ...

Aspirin for Stroke Prevention Taken in the Evening? * Response:

To the Editor: We read the article by Yip et al1 with great interest, in which they demonstrated that platelet activation significantly increases in acute ischemic stroke and subtantially decreases thereafter. The lesser long-term pharmacodynamic potency of aspirin relative to clopidogrel raises the prospect of the need for more effective antiplatelet agents or a synergistic combination therapy for stroke prevention in the future.1 Their results are very impressive and raise some ideas, particularly associated with the prevention’s procedures. According to World Health Organization data, in 1996 4.6 million people in the world died because of cerebrovascular manifestation of atherothrombosis.2 In Hungary, nearly 18 000 people suffer stroke every year, half of whom die within a year. In cases of both cardiovascular and cerebrovascular diseases the significant decrease of morbidity/mortality can only be achieved by increasing the effect of prevention. A major form of secondary prevention is the administration of drugs inhibiting the aggregation of platelets. Aspirin is one of the most common, useful, and inexpensive tools for prevention. The effect of aspirin on platelets is irreversible lasting for the duration of the platelet’s life span (≈10 days). Aspirin-mediated inhibition of platelet function occurs within 60 minutes of ingestion.3 The incidence of stroke assessed by onset of clinical symptoms exhibits a marked circadian variation with a peak period during the morning. Stroke usually occurs unexpectedly and more frequently in early morning …

Seasonal variation, weekly and daily rhythm of transient ischemic attack in Hungary.

To the Editor: We read the very important article by Manfredini et al with great interest. Numerous reports have proven that the occurrence of a heart attack, cerebral infarction, or transient ischemic attack (TIA) shows seasonal changes, which may be influenced by prevailing weather conditions as well. Hungary, a small country in the middle of Europe, lies in the Carpathian basin, with similar climate as the mentioned region of Italy, although our results differ. We have performed our study on patients admitted to Neurology wards in Hungary between 2005 and 2007 with the diagnose of TIA (n1⁄412 556, mean age 65.5 + 14.9 years, 42.14% males). Based on our results, the peak period of TIA incidence was during spring, while lowest number of events occurred during autumn (F 1⁄4 13 603, P < .001). The occurrence of TIA in case of females was the highest in April, while in case of males in May, and the lowest was in December in both sexes (F 1⁄4 26 738, P < .001). Furthermore, the time of onset of TIA also showed a weekly variation. The highest morbidity of TIA was found on Monday in case of both sexes (Z 1⁄4 17 982, P < .001). Based on our findings, we may conclude that TIA may be somehow influenced by the internal rhythms of the organism, as well as external factors, such as weather, and also the typical seasonal changes of nutrition and regular workout. The more risk factors one bares, the higher the chance of having TIA.