Association Between Alcohol Consumption and Cardiovascular Risk Based on Data from the Three Generations for Health Program in Hungary.

BACKGROUND Alcohol consumption has a significant effect on cardiovascular health, and risk factors, such as excessive alcohol use, should be avoided. Although alcohol consumption has decreased over the last decade in Hungary, it is still significantly higher than the average across the European Union. The objective of this study was to describe the patterns of alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), with a special focus on cardiovascular risk status (low, moderate, high, or very high). MATERIAL AND METHODS 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 cardiovascular diseases. An ordinal multiple logistic regression analysis was performed with 10 categorical explanatory variables and the outcome was the categorical cardiovascular risk. RESULTS The database consisted of patients aged 40-65 years with a sample size of 11 348. A significant relationship was found between alcohol consumption and cardiovascular risk status; people with high-risk drinking patterns had higher a value of odds ratio (OR=1.306 [1.003-1.701]) for having a more serious cardiovascular status. According to multiple regression analysis, alcohol dependence was associated with cardiovascular risk. CONCLUSIONS From a public health perspective, the results highlight the importance of reducing alcohol consumption with the help of primary care and preventive services in countries with a high cardiovascular risk profile to reduce the cardiovascular disease-related burden.

[Investigating cognitive impairment in communities of practice - lessons learned]. / Kognitív funkcióromlás vizsgálata praxisközösségekben ­ tanulságok.

Background and purpose: In the "Three Generations for Health" programme, general practitioners were responsible for screening for dementia in their practices using mini-COG and Mini Mental State Examination. The aim was to present the screening results of those included, their assessment by the doctor and the further fate of the patients. Methods: After mini-COG test, MMSE test was performed in case of suspected dementia. The examiner categorized the result as abnormal or no abnormal, recorded the referral, and recorded the data in an online interface. Our study is a cross-sectional study; the evolution and distribution of the parameters described in the objectives are described with raw case numbers and proportions. Patients aged 55 years and over were recruited consecutively. Only those cases (29 730) where mini-COG and MMSE test results were available, their assessment by the physician, and referral data to specialist care were analyzed. Results: The Mini-COG test revealed that 64% of the subjects were suspected of cognitive decline. Misclassification occurred in 13 015 cases, with 21% of the Mini-Cog test scores matching cognitive decline and 21% of lesions considered abnormal by GPs. The MMSE test raised the suspicion of dementia in 34% of the sample (10 174 people), with 4 262 (42%) of the participating GPs considering the result abnormal. 11% (2095 people) of people with abnormal Mini-Cog test scores and 17% (1709 people) of people with suspected dementia based on MMSE test scores were referred to specialist care. Conclusion: Our study assessed the practice of detecting cognitive decline in primary health care. The tools adopted for screening for dementia were used by practices, but the assessment of results and referral of suspected cases of dementia to specialist care were below the expected level. There is a need to improve primary care providers' knowledge of dementia detection and treatment and to strengthen links with specialist care.

Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component.

BACKGROUND: Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies. METHODS: Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019. RESULTS: From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention's acceptance in specific or vulnerable population groups. CONCLUSIONS: Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives.

Two-stage, school and community-based population screening successfully identifies individuals and families at high-risk for type 2 diabetes: the Feel4Diabetes-study.

BACKGROUND: The implementation of population screening and early prevention strategies targeting individuals at high-risk for type 2 diabetes (T2D) seems to be a public health priority. The current work aimed to describe the screening procedure applied in the Feel4Diabetes-study and examine its effectiveness in identifying individuals and families at high risk, primarily for T2D and secondarily for hypertension, among vulnerable populations in low to middle-income countries (LMICs) and high-income countries (HICs) across Europe. METHODS: A two-stage screening procedure, using primary schools as the entry-point to the community, was applied in low socioeconomic status (SES) regions in LMICs (Bulgaria-Hungary), HICs (Belgium-Finland) and HICs under austerity measures (Greece-Spain). During the first-stage screening via the school-setting, a total of 20,501 parents (mothers and/or fathers) of schoolchildren from 11,396 families completed the Finnish Diabetes Risk Score (FINDRISC) questionnaire, while their children underwent anthropometric measurements in the school setting. Parents from the identified "high-risk families" (n = 4484) were invited to participate in the second-stage screening, including the measurement of fasting plasma glucose (FPG) and blood pressure (BP). In total, 3153 parents participated in the second-stage screening (mean age 41.1 ± 5.6 years, 65.8% females). RESULTS: Among parents who attended the second-stage screening, the prevalence of prediabetes (as defined by impaired fasting glucose; FPG 100-125 mg/dl) and T2D (FPG > 126 mg/dl) was 23.2 and 3.0% respectively, and it was found to be higher in the higher FINDRISC categories. The percentage of undiagnosed T2D among the participants identified with T2D was 53.5%. The prevalence of high normal BP (systolic BP 130-139 mmHg and/ or diastolic BP 85-89 mmHg) and hypertension (systolic BP ≥ 140 mmHg and/ or diastolic BP ≥ 90 mmHg) was 14 and 18.6% respectively, which was also higher in the higher FINDRISC categories. The percentage of cases not receiving antihypertensive treatment among the participants identified with hypertension was 80.3%. CONCLUSION: The findings of the current study indicate that the two-stage school and community-based screening procedure followed, effectively identified high-risk individuals and families in vulnerable populations across Europe. This approach could be potentially scalable and sustainable and support initiatives for the early prevention of T2D and hypertension. TRIAL REGISTRATION: The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ (NCT02393872; date of trial registration: March 20, 2015).

Intra- and inter- observer reliability of anthropometric measurements and blood pressure in primary schoolchildren and adults: the Feel4Diabetes-study.

BACKGROUND: Feel4Diabetes was a large-scale, multicenter lifestyle intervention aiming to prevent type 2 diabetes among families from vulnerable population groups in six European countries (Belgium, Bulgaria, Finland, Greece, Hungary and Spain). The current study aimed to describe the process that was followed to harmonize and standardize the measurement of anthropometric (weight, height and waist circumference) and blood pressure (systolic and diastolic) indices, as well as to assess the intra- and inter- observer reliability of these measurements. METHODS: A central training workshop was conducted prior to the baseline measurements of the Feel4Diabetes-intervention. One researcher from each intervention country, as well as 12 adults and 12 children (for the anthropometric measurements) and 21 adults (for the blood pressure measurements) participated in this workshop. Technical Error of Measurement (TEM) and reliability (%R) were calculated to assess the reliability of the indices which were assessed to evaluate the outcome of the Feel4Diabetes-intervention. The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ (NCT02393872). RESULTS: Intra-observer reliability was found to be higher than 99.5% for all anthropometric measurements in both children and adults. Inter-observer reliability was found to be higher than 98% regarding the anthropometric measurements, while for blood pressure measurements %R was 76.62 and 91.38% for systolic and diastolic blood pressure measurements, respectively. CONCLUSION: The central training of the Fee4Diabetes-intervention ensured that the data collected for the outcome evaluation of the Feel4Diabetes-intervention in the six European countries at three different time points (baseline, follow-up 1 and follow-up 2) were valid and comparable.

Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement.

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. 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.

Patient-related factors, antibiotic prescribing and antimicrobial resistance of the commensal Staphylococcus aureus and Streptococcus pneumoniae in a healthy population - Hungarian results of the APRES study.

BACKGROUND: Antimicrobial resistance (AMR) is an increasing public health problem worldwide. We studied some patient-related factors that might influence the antimicrobial resistance. and whether the volume of antibiotic prescribing of the primary care physicians correlate with the antibiotic resistance rates of commensal nasal Staphylococcus aureus and Streptococcus pneumoniae. METHODS: The socio-demographic questionnaires, the antibiotic prescription and resistance data of commensal nasal S. aureus and S. pneumoniae were collected in the 20 participating Hungarian practices of the APRES study. Multivariate logistic regression analyses were performed on the patient-related data and the antimicrobial resistance of the S. aureus and S. pneumoniae on individual, patient level. Ecological analyses were performed with Spearman's rank correlations at practice level, the analyses were performed in the whole sample (all practices) and in the cohorts of primary care practices taking care of adults (adult practices) or children (paediatric practices). RESULTS: According to the multivariate model, age of the patients significantly influenced the antimicrobial resistance of the S. aureus (OR = 0.42, p = 0.004) and S. pneumoniae (OR = 0.89, p < 0.001). Living with children significantly increased the AMR of the S. pneumoniae (OR = 1.23, p = 0.019). In the cohorts of adult or paediatric practices, neither the age nor other variables influenced the AMR of the S. aureus and S. pneumoniae. At practice level, the prescribed volume of penicillins significantly correlated with the resistance rates of the S. aureus isolates to penicillin (rho = 0.57, p = 0.008). The volume of prescribed macrolides, lincosamides showed positive significant correlations with the S. pneumoniae resistance rates to clarithromycin and/or clindamycin in all practices (rho = 0.76, p = 0.001) and in the adult practices (rho = 0.63, p = 0.021). CONCLUSIONS: The age is an important influencing factor of antimicrobial resistance. The results also suggest that there may be an association between the antibiotic prescribing of the primary care providers and the antibiotic resistance of the commensal S. aureus and S. pneumoniae. The role of the primary care physicians in the appropriate antibiotic prescribing is very important to avoid the antibiotic resistance.

An appraisal: how notifiable infectious diseases are reported by Hungarian family physicians.

BACKGROUND: Within the frame of National Epidemiological Surveillance System, family physicians have an obligation to report infections and suspicions cases. The aim of this study was to evaluate the knowledge, attitudes, daily practice and the reporting activities of Hungarian family physicians regarding to infectious diseases. METHODS: A self-administered survey was developed, validated and used. The survey was completed by family physicians who had taken part in continuous medical educational programmes of all Hungarian medical faculties. The questionnaire, consisting demographic questions and 10 statements about their reporting habits were completed by 347 doctors, 8% of the total number of family physicians. The data were processed in a cross-sectional design with general linear model. RESULTS: According to the majority of responders, the current reporting system works efficiently. Rural physicians were mainly agreed, that reporting is not a simply obligation, it is a professional task as well. They were less hindered in daily work by reporting activities, waited less for laboratory confirmation before reporting, reported suspicious cases more frequently. Practitioner's based in urban settlements preferred to await laboratory tests before reporting and were hindered less by failures of the electronic reporting system. Older physicians trusted more in the recent system and they wished to increase the number of reports. Female physicians have higher consciousness in epidemiology. They were mostly in agreement that even severe infectious diseases can be diagnosed at primary care level and their daily practices were less burdened by reporting duties. CONCLUSIONS: Both the epidemiological knowledge of general practitioners' and the electronic surveillance systems should be improved. There is a need to develope the electronic infrastructure of primary care. More and regular control is also expected by the health care authorities, beside the synthesis of professional and governmental expectations and regulations.

[Primary care of refugees and migrants. Lesson learnt from the EUR-HUMAN project]. / Menekültek, migránsok az alapellátásban. Mit tanulhattunk az EUR-HUMAN projekt eredményeibol?

In 2015, local wars, starvation and misery in some Middle Eastern, Asian and African countries forced millions of people to leave their homelands. Many of these people migrated toward Europe, reaching Hungary as well. The refugee crisis created significant challenges for all national healthcare systems across Europe. Limited attention has been given to the extent to which health service provision for refugees and migrants has become a task for primary health care (PHC), which has been unprepared as a profession and pressured by the enormous workload. Hungarian primary care was involved only to an extent in the refugees' health care, as most of the migrants entering Hungary wanted to move forward to other countries. The need for evidence-based patient-centred interventions to assess refugee healthcare needs, and for training programmes for rapid capacity-building for integrated PHC was addressed by the EUropean Refugees - HUman Movement and Advisory Network (EUR-HUMAN) project, which 7 European countries developed together. The overall aim of the EUR-HUMAN project is to enhance the knowledge and expertise of European member states who accept refugees and migrants in addressing their health needs, safeguarding them from risks, while at the same time to minimize cross-border health risks. This initiative focuses on addressing the early arrival period, transition and longer-term settlement of refugees in European host countries. A primary objective of this project is to identify, design and assess interventions to improve PHC delivery for refugees and migrants with a focus on vulnerable groups. The structure, the main focus and outputs of the project are described and summarized in this paper, providing relevant information and access to educational materials for Hungarian (primary care) physicians. The EUR-HUMAN project was operated in 2016 under the auspices of the European Commission and funded by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). Orv Hetil. 2018; 159(35): 1414-1422.

[Obese Hungary. Trend and prevalence of overweight and obesity in Hungary, 2015]. / Elhízó Magyarország. A túlsúly és az elhízás trendje és prevalenciája Magyarországon, 2015.

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.

A public health threat in Hungary: obesity, 2013.

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.

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.

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.

[Trends and current questions of cardiovascular prevention in primary health care]. / A cardiovascularis prevenció irányai és aktuális kérdései a háziorvoslásban.

Although an impressive progress has been achieved in the treatment of cardiovascular diseases, they are at the top of the mortality statistics in Hungary. Prevention of these diseases is an essential task of the primary health care. Cardiovascular prevention is carried out at primary, secondary and tertiary levels using risk group and population preventive strategies. The two main tasks of primary cardiovascular prevention are health promotion and cardiovascular disease prevention, and its main programs are ensuring healthy nutrition, improving physical training and accomplishing an anti-smoking program. The essential form of secondary prevention is the screening activity of the primary health care. The majority of cardiovascular risk factors can be discovered during the doctor-patient consultation, but laboratory screening is needed for assessing metabolic risks. The official screening rules of the cardiovascular risk factors and diseases are based on diagnostic criteria of the metabolic syndrome; however, nowadays revealing of global cardiometabolic risks is also necessary. In patients without cardiovascular diseases but with risk factors, a cardiovascular risk estimation has to be performed. In primary care, there is a possibility for long term follow-up and continuous care of patients with chronic diseases, which is the main form of the tertiary prevention. In patients with cardiovascular diseases, ranking to cardiovascular risk groups is a very important task since target values of continuous care depend on which risk group they belong to. The methods used during continuous care are lifestyle therapy, specific pharmacotherapy and organ protection with drugs. Combined health education and counselling is the next element of the primary health care prevention; it is a tool that helps primary, secondary and tertiary prevention. Changes needed for improving cardiovascular prevention in primary care are the following: appropriate evaluation of primary prevention, health education and counselling, renewal of the cardiovascular screening system based on the notion of global cardiometabolic risk, creating a unified cardiovascular prevention guideline, and operating primary care cardiovascular prevention within the framework of an integrated prevention system.

Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2.

OBJECTIVE: Cardiovascular risk estimation is an essential step to reduce the onset of adverse cardiovascular events. For this purpose, the Systematic Coronary Risk Evaluation (SCORE) risk chart method was used in Europe. In 2021, the SCORE2 algorithm was released, bringing changes in the calculation methodology. This study assessed and compared the level of cardiovascular risk in a population aged 40-65 years using the SCORE and SCORE2 methodologies. METHODS: This cross-sectional study included a total of 85 802 patients in Hungary. Cardiovascular risk levels were determined using the SCORE and SCORE2 risk estimation methods. RESULTS: Using SCORE, 97.7% of men aged 40-50 years were classified as low-moderate risk, which decreased to 32.4% using SCORE2. Using SCORE, 100% of women aged 40-50 years were classified as low-moderate risk, compared with 75.6% using SCORE2. Using SCORE, 36.8% of men aged 50-65 years were classified as high risk and 14.8% as very high risk, and 5.4% of women aged 50-65 years were classified as high risk and 0.5% as very high risk. In this age group, using SCORE2, 50% of men were classified as high risk and 25.8% as very high risk, and 38.8% of women were classified as high risk and 11.9% as very high risk. CONCLUSIONS: When the SCORE2 method was used instead of SCORE 43.91% of the whole population were classified with a higher level of risk, which represents a radical increase in the number of patients with high or very high cardiovascular risk.

Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary.

BACKGROUND: The management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors' target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40-65 years and the success of achieving risk factors' target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies. METHODS: We conducted a cross-sectional study involving 37,778 patients aged 40-65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics). RESULTS: For 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%. CONCLUSIONS: The success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.

Expectations, values, preferences and experiences of Hungarian primary care population when accessing services: Evaluation of the patient's questionnaires of the international QUALICOPC study.

BACKGROUND: Preferences and wishes of patients is an important indicator of primary health care provision, although there are differences between national primary care systems. AIM: The aim of this paper is to describe and evaluate the preferences and values of Hungarian primary care (PC) patients before accessing and to analyse their experiences after attending PC services. METHODS: In the Hungarian arm of the European QUALICOPC Study, in 2013-2014, information was collected with questionnaires; the Patient Values contained 19 and the Patient Experiences had 41 multiple-choice questions. FINDINGS: The questionnaires were filled by 2149 (840 men, 1309 women) using PC services, aged 49.1 (SD ± 16.7) years, 73% of them having chronic morbidities. Women preferred to be accompanied and rated their own health better. Patients in the lowest educational category and women visited their GPs more often, and they are consulted more frequently by other doctors as well. Men, older and secondary educated people reported more frequently chronic morbidities. Longer opening hours were preferred by patients with higher education. The most preferred expectations were availability and polite communication of doctors, not pressures on consultation time, clear instructions provided during consultations, shared decisions about treatments and options for consultations, the knowledge of the doctors concerning the living conditions, social and cultural backgrounds of patients, updated medical records, short waiting times, options for home visits, wide scope of professional competences and trust in the doctor. CONCLUSION: Wishes, preferences of patients and fulfilment were similar than described in other participating countries of the study. Although there are room to improve PC services, most of the questioned population were satisfied with the provision.

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.

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.

Nutritional counseling for diabetic patients: a pilot study in hungarian primary care.

Although nutritional advice and counseling are an important part of diabetes care, current Hungarian health care regulations make it available only in the secondary (specialist) care. Authors planned and implemented a self-financed nutritional counseling in primary care setting. For 67 of 108 diagnosed diabetic patients of a primary care practice in Budapest, a free of charge educational service was offered. The 47 patients (45 type 2 and 2 type 1) who accepted the invitation were educated in two consecutive group sessions. Only 24 of them were ready to take part in three further individual consultations. Fasting blood glucose and glycated hemoglobin were measured before and after the sessions and 1 year later. Comparison was made between genders (31 men, 16 women) and patients who took part in the group and the individual nutritional counseling, respectively. Patients with a higher educational level, males and persons with shorter duration of diabetes were more likely to participate in the consultation. All glycemic parameters improved after counseling in both groups, but this was significant only in men and for the group consultation. After 1 year, a further improvement was seen in women and in patients of the individually counseled group. In turn, fasting blood glucose and glycated hemoglobin concentrations of men and group-consulted patients increased again, reaching almost the baseline level before consultations. Nutritional counseling in the primary care offers more comfort and help for diabetics but requires changes in insurance regulation, and reimbursement system together with increase in resources.

Primary care behind the former "Iron Curtain": changes and development of primary healthcare provision in the Eastern part of the European Union.

BACKGROUND: The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations' expectation. Celebrating the 40th year's anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe. AIM: To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former 'Soviet bloc' countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries. METHOD: Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed. RESULTS: Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former 'Soviet bloc' countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries. CONCLUSION: Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.

[Continuing care of patients with cardiovascular risk in general practice: patients with hypertension and their care]. / Cardiovascularis kockázattal rendelkezo betegek gondozása háziorvosi praxisokban: hypertoniás páciensek es gondozásuk.

INTRODUCTION: Hypertension is an independent cardiovascular risk factor, therefore continuing care of patients with hypertension is an important task in cardiovascular prevention. AIM: This study was aimed to investigate continuing care of hypertension in general practices. Method of the study was a questionnaire survey, and 830 adult patients were involved. Forms contained information about duration of continuing care, associated risk factors, therapy, damages of target organs, and blood pressure values attained. Blood pressure measurement and hypertension grading were performed by the recommendation of the Hungarian Hypertension Society. RESULTS: Ratios of men and women participated in the study were 39.8% and 60.2%, respectively. Duration of hypertension care was 10.7 +/- 8.3 year. The care was initiated because of moderate and serious hypertension in 51.4% and 32.7%, respectively. Frequencies of cardiovascular, cerebrovascular and peripheral vascular problems were parallelly increased with severity of hypertension. Frequency of all types of antihypertensive drugs used were also increased with the hypertension grades. The most frequently used drugs were ACE-inhibitors. The target blood pressure of 140/90 Hgmm was reached in 46.4%, and according to blood pressure measured during the last year of continuing care, patients had mild hypertension in 41.5%, moderate in 7.6%, and serious one in 0.9%. Effectiveness of the hypertension care, based on decrease in blood pressure, was associated with severity of hypertension at the time of its diagnosis, the patients' age, but not with their gender. CONCLUSION: Summarizing, our results prove that there is a need for intensification of early detection, treatment and continuing care of hypertension.