Lifestyle and metabolic risk factors, and diabetes mellitus prevalence in European countries from three waves of the European Health Interview Survey.

Population shift towards healthier lifestyles can help reduce the burden of type 2 diabetes mellitus (DM), therefore understanding and monitoring the lifestyle-related risk factors are crucial for setting up effective preventive strategies and disease management. The present study aimed to explore the changes in prevalence of DM and major risk factors including smoking, physical activity, fruit and vegetable consumption, as well as body mass index (BMI) over three waves of European Health Interview Survey, and to investigate the association between risk factors and presence of DM across 11 European Union member states. Poisson regression models were used to evaluate the association between risk factors and DM, adjusted for demographic and socioeconomic variables. The estimated age-standardized prevalence of DM increased from 7.01% in 2009 to 7.96% in 2019, with substantial increase in subgroups with higher BMI and unhealthy lifestyle including physically inactive people, or current smokers. Obesity and overweight and physical inactivity were significantly associated with DM in all survey waves. Our findings underline that obesity prevention and weight loss promotion along with physical activity promotion are the subject of lifestyle interventions to reduce the burden of DM in EU member states.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary.

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

Changes in Antibiotic Redemption Related to Hungarian Dental Care During COVID-19.

INTRODUCTION AND AIMS: Antibiotic resistance is a global health problem that can affect individuals, health systems, and the economy. Our aim was to investigate how the redemption of antibiotics and the associated dental care changed during COVID-19 in Hungary. METHODS: The ICD codes for the infections for which antibiotics should be prescribed in dental care were identified based on the professional recommendation. The database was provided by the National Health Insurance Fund Manager of Hungary. Pearson's chi-squared test with Bonferroni correction was used to compare both the redemption of antibiotics and the associated dental care based on the recommendations in the year 2020 of the COVID-19 and the 2 preceding years. RESULTS: There were fewer antibiotic redemptions and associated dental care in 2020 than in 2018 and 2019. The ratio of professionally relevant and nonrelevant antibiotics redeemed did not change significantly between 2018 and 2019, but the proportion of antibiotics redeemed following recommendations increased significantly during the COVID-19 year of 2020 compared to the previous 2 years. The proportion of all dental care involving antibiotic redemptions increased significantly from 2018 to 2019, and then showed a further increase in 2020. The sex and age of the patient did not affect these findings, while the type of dental care did alter the trends in some cases. CONCLUSIONS: Antibiotics in dentistry are required only for very low proportion of cases, due to the nature of dental care where most infections such as caries and periodontal disease could be managed without resorting to antibiotics. Antibiotic redemptions during COVID-19 pandemic period increased compared to the pre-pandemic period in Hungary. Therefore, Hungarian policy makers need to develop control systems to promote the correct use of antibiotics in dental care. CLINICAL RELEVANCE: It is important to reduce unjustified use of antibiotics so as to curb the emergence of antibiotic resistance organisms.

Genetic Background of Acute Heart Rate Response to Exercise.

The acute heart rate response (AHRR) to physical activity, which refers to the change in heart rate during and after exercise, has been associated with cardiovascular and all-cause mortality. Previous studies have shown that AHRR is significantly determined by genetics in addition to environmental and lifestyle factors. The aim of this study was to investigate the genetic background of AHRR by analysing ten single nucleotide polymorphisms (SNPs) associated with leisure-time physical activity (LTPA) in 620 samples from the Hungarian population. The AHRR can be characterised as the difference between post-exercise and resting heart rate, i.e., the delta heart rate (ΔHR) defined by the YMCA 3 min step test, with a lower value indicating better cardiovascular fitness. The association of SNPs with ΔHR was analysed both separately and in combination using an optimised polygenic score (oPGS). The results showed that five SNPs (rs10252228, rs459465, rs6022999, rs8097348, and rs12405556) had at least nominally significant (p < 0.05) individual associations with ΔHR. After optimizing the PGS, a cumulative effect was observed for eight SNPs (rs6022999, rs12405556, rs459465, rs10252228, rs8097348, rs10887741, rs12612420, and rs7023003) that had a strong and statistically significant association with ΔHR (B = -2.51, 95% CI: -3.46--1.76; p = 2.99 × 10-9). Of the four main domains of physical activity, the oPGS showed a significant positive association only with LTPA (B = 84.60; 95%CI: 25.23-143.98; p = 0.005). In conclusion, our results suggest that the SNPs we investigated influence individual leisure-time physical activity, mediated by their effects on the acute heart rate response.

Photoredox-Catalyzed α-C-H Monoalkylation of Symmetric Polyols in the Presence of CO2.

Achieving the selective modification of symmetric poly-hydroxylated compounds presents a significant challenge due to the presence of identical active sites. Herein, we address this challenge through the design of a ternary catalytic system that includes a photoredox catalyst, a hydrogen atom transfer promotor and a carbonation catalyst. This catalytic system enables the reversible carbonation of acyclic polyols under CO2 atmosphere, which modulates the reactivity of its distinct C-H bonds toward hydrogen atom transfers. An exquisite selectivity for the monoalkylation is achieved in a variety of unprotected light polyols, yielding valuable building blocks in short reaction times. Mechanistic and computational studies demonstrate that the formation of an intramolecular hydrogen bond between the transient carbonate and the free alcohol is pivotal for the kinetic and thermodynamic activation of a specific alcohol.

Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging.

The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.

Cardiovascular disease and risk factors in adults with diabetes mellitus in Hungary: a population-based study.

Introduction: Diabetes mellitus (DM) and cardiovascular disease (CVD) such as acute myocardial infarction, stroke, and coronary artery disease are highly prevalent conditions that are responsible for significant morbidity and mortality, particularly in Hungary. The conditions are attributed to identical risk factors, and individuals with DM are primarily susceptible to cardiovascular complications, which are the leading causes of death and disability in patients with DM. The objective of this study was to estimate the prevalence of CVD in individuals with DM and to investigate the association between potential risk factors and the presence of CVD among individuals with DM in a population-based sample. Methods: The study was based on data from three waves of the European Health Interview Surveys (EHIS) conducted in Hungary in 2009, 2014, and 2019. Results: The prevalence of CVD among patients with DM decreased during the study period and that socioeconomic factors, cardiometabolic risk factors including high blood pressure and high cholesterol, and depression are major contributors to CVD burden in patients with DM in Hungary. Discussion: Our findings suggest the importance of regular check-up for hypertension and hypercholesterolemia, better focus on socioeconomic status, as well as ongoing monitoring of mental health among patients with diabetes. Further research is needed to understand the potential causes behind the observed decrease in CVD prevalence.

Association of HDL Subfraction Profile with the Progression of Insulin Resistance.

Type 2 diabetes mellitus (T2DM) is a major global public health problem, as it is associated with increased morbidity, mortality, and healthcare costs. Insulin resistance (IR) is a condition characterized by disturbances in carbohydrate and lipid metabolism that precedes T2DM. The aim of the present study was to investigate the association between HDL and its subfraction profile and the progression of IR, as assessed by the Homeostatic Model Assessment for IR (HOMA-IR) index, and to define cut-off values to identify an increased risk of IR. Individuals with a HOMA-IR greater than 3.63 were considered to have IR. The HDL subfractions were separated using the Lipoprint system, which identifies ten subfractions (HDL-1-10) in three subclasses as large (HDL-L), intermediate (HDL-I) and small (HDL-S). Analyses were performed on samples from 240 individuals without IR and 137 with IR from the Hungarian general and Roma populations. The HDL-1 to -6 subfractions and the HDL-L and -I classes showed a significant negative association with the progression and existence of IR. Among them, HDL-2 (B = -40.37, p = 2.08 × 10-11) and HDL-L (B = -14.85, p = 9.52 × 10-10) showed the strongest correlation. The optimal threshold was found to be 0.264 mmol/L for HDL-L and 0.102 mmol/L and above for HDL-2. Individuals with HDL-L levels below the reference value had a 5.1-fold higher risk of IR (p = 2.2 × 10-7), while those with HDL-2 levels had a 4.2-fold higher risk (p = 3.0 × 10-6). This study demonstrates that the HDL subfraction profile (especially the decrease in HDL-2 and -L) may be a useful marker for the early detection and intervention of atherogenic dyslipidemia in subjects with impaired glucose and insulin metabolism.

T cell immune response predicts survival in severely ill COVID-19 patients requiring venovenous extracorporeal membrane oxygenation support.

Introduction: There is a critical gap in understanding which SARS-CoV-2 patients would benefit most from venovenous extracorporeal membrane oxygenation (VV-ECMO) support. The potential role of a dysregulated immune response is still unclear in this patient population. Objectives: To assess the potential predictive value of SARS-CoV-2 specific cellular and humoral immune responses for survival in critically ill COVID-19 patients requiring VV-ECMO. Methods: We conducted a prospective single-center observational study of unvaccinated patients requiring VV-ECMO support treated at the intensive care unit of Semmelweis University Heart and Vascular Center between March and December 2021. Peripheral blood samples were collected to measure the humoral and cellular immune statuses of the patients at the VV-ECMO cannulation. Patients were followed until hospital discharge. Results: Overall, 35 COVID-19 patients (63% men, median age 37 years) on VV-ECMO support were included in our study. The time from COVID-19 verification to ECMO support was a median (IQR) of 10 (7-14) days. Of the patients, 9 (26%) were discharged alive and 26 (74%) died during their hospital stay. Immune tests confirmed ongoing SARS-CoV-2 infection in all the patients, showing an increased humoral immune response. SARS-CoV-2-specific cellular immune response was significantly higher among survivors compared to the deceased patients. A higher probability of survival was observed in patients with markers indicating a higher T cell response detected by both QuantiFeron (QF) and flow cytometry (Flow) assays. (Flow S1 CD8+ ≥ 0.15%, Flow S1 CD4+ ≥ 0.02%, QF CD4 ≥ 0.07, QF whole genome ≥ 0.59). In univariate Cox proportional hazard regression analysis BMI, right ventricular (RV) failure, QF whole genome T cell level, and Flow S1 CD8+ T cell level were associated with mortality, and we found that an increased T cell response showed a significant negative association with mortality, independent of BMI and RV failure. Conclusion: Evaluation of SARS-CoV-2 specific T cell response before the cannulation can aid the risk stratification and evaluation of seriously ill COVID-19 patients undergoing VV-ECMO support by predicting survival, potentially changing our clinical practice in the future.

Seasonal patterns in the epidemiology of Bell's palsy in Hungary.

Introduction: Epidemiological data on Bell's palsy are vital for elucidating disease prevalence and enhancing therapeutic options. Our objective was to explore the prevalence and possible risk factors associated with Bell's palsy recurrence in the Clinical Center of the University of Debrecen service area. Secondary data analysis was performed using hospital discharge data, including patient information and comorbidities. Methods: Data was obtained from the Clinical Center of the University of Debrecen, on Bell's palsy patients who were treated at the hospital between January 1, 2015 and December 31, 2021. Multiple logistic regression analysis was used to examine the factors associated with Bell's palsy recurrence. Results: Of the 613 patients analyzed, 5.87% had recurrent paralysis, and the median time interval between episodes was 315 days. Hypertension was significantly associated with Bell's palsy recurrence. Moreover, seasonal distribution analysis revealed that the number of Bell's palsy episodes was higher in colder seasons, with spring and winter having a significantly higher number of episodes than summer and autumn. Discussion: This study provides insights into the prevalence and associated risk factors of Bell's palsy recurrence, which could aid in its management and help reduce the long-term consequences of the disease. Further research is necessary to determine the precise mechanisms underlying these findings.

[Rumination and schizotypal personality traits]. / A rumináció és a szkizotip személyiségvonások összefüggései pszichotikus zavarral élok és sine morbo személyek körében.

Background and purpose:

Although ru­mination and schizotypal traits can be considered transdiagnostic phenomena and can occur within non-clinical population as well, a relatively small number of research has been carried out on the topic involving both patient and non clinical participants. The aim of this study is to examine the rela­tionship between schizotypal traits and rumination using a transdiagnostic approach, involving participants living with psychotic disorders and sine morbo individuals.

We recruited participants living with psychotic disorders (paranoid schizophrenia, hebephrenia, schizoaffective disorder, etc.) (n = 30) and controls who had not been diagnosed with any mental illnesses (n = 67). The connection between rumination and schizotypal traits was examined by self-report questionnaire method in a cross-sectional arrangement. The Oxford-Liverpool Inventory was used to measure schizotypal traits, and the Ruminative Thought Style Questionnaire was used to determine the level of rumination. 

Schizotypal symptoms (β = 0.575; p < 0.001), especially cognitive disorganization (β = 0.459; p < 0.001) and unusual experiences (β = 0.221; p = 0.029) significantly explained the degree of rumination. 

Our results support the hypothesis that the association between rumination and schizotypic traits is due to decreased cognitive inhibitory functions.

Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis.

BACKGROUND: The use of dental care among older people is low compared to other forms of health care, with significant health consequences. However, the evidence on the extent to which countries' welfare systems and socio-economic factors influence the uptake of dental care by older people is limited. This study aimed to describe trends of dental care utilisation, and to compare use of dental care with other types of healthcare services among the elderly, considering different socio-economic factors and welfare systems in European countries. METHODS: Multilevel logistic regression analysis was performed using longitudinal data from four waves (between Wave 5 and 8) of the Survey of Health, Ageing and Retirement in Europe database, with a follow-up period of 7 years. The study sample included 20,803 respondents aged 50 years or older from 14 European countries. RESULTS: The annual dental care attendance was the highest in Scandinavian countries (85.7%), however, improving trends of dental attendance was recognized in Southern and Bismarckian countries (p<0.001). The difference in use of dental care services between socio-economic groups was expanding over time regarding low- and high-income level and residential area. A more marked difference was observed between social groups in dental care utilisation compared to other forms of care. Income level and unemployed status had significant effect on forgoing dental care due to cost and unavailability. CONCLUSION: The observed differences between socioeconomic groups may highlight the health consequences of the different organization and financing of dental care. The elderly population could benefit from adopting policies aiming to reduce the financial barriers to dental care usage, especially in Southern and Eastern European countries.

Association of CETP Gene Polymorphisms and Haplotypes with Cardiovascular Risk.

Cholesteryl ester transfer protein (CETP) is known to influence HDL-C levels, potentially altering the profile of HDL subfractions and consequently cardiovascular risk (CVR). This study aimed to investigate the effect of five single-nucleotide polymorphisms (SNPs; rs1532624, rs5882, rs708272, rs7499892, and rs9989419) and their haplotypes (H) in the CETP gene on 10-year CVR estimated by the Systematic Coronary Risk Evaluation (SCORE), the Framingham Risk Score for Coronary Heart Disease (FRSCHD) and Cardiovascular Disease (FRSCVD) algorithms. Adjusted linear and logistic regression analyses were used to investigate the association of SNPs and 10 haplotypes (H1-H10) on 368 samples from the Hungarian general and Roma populations. The T allele of rs7499892 showed a significant association with increased CVR estimated by FRS. H5, H7, and H8 showed a significant association with increased CVR based on at least one of the algorithms. The impact of H5 was due to its effect on TG and HDL-C levels, while H7 showed a significant association with FRSCHD and H8 with FRSCVD mediated by a mechanism affecting neither TG nor HDL-C levels. Our results suggest that polymorphisms in the CETP gene may have a significant effect on CVR and that this is not mediated exclusively by their effect on TG and HDL-C levels but also by presently unknown mechanisms.

Genetic Determinants of Leisure-Time Physical Activity in the Hungarian General and Roma Populations.

Leisure-time physical activity (LTPA) is one of the modifiable lifestyle factors that play an important role in the prevention of non-communicable (especially cardiovascular) diseases. Certain genetic factors predisposing to LTPA have been previously described, but their effects and applicability on different ethnicities are unknown. Our present study aims to investigate the genetic background of LTPA using seven single nucleotide polymorphisms (SNPs) in a sample of 330 individuals from the Hungarian general (HG) and 314 from the Roma population. The LTPA in general and three intensity categories of it (vigorous, moderate, and walking) were examined as binary outcome variables. Allele frequencies were determined, individual correlations of SNPs to LTPA, in general, were determined, and an optimized polygenetic score (oPGS) was created. Our results showed that the allele frequencies of four SNPs differed significantly between the two study groups. The C allele of rs10887741 showed a significant positive correlation with LTPA in general (OR = 1.48, 95% CI: 1.12-1.97; p = 0.006). Three SNPs (rs10887741, rs6022999, and rs7023003) were identified by the process of PGS optimization, whose cumulative effect shows a strong significant positive association with LTPA in general (OR = 1.40, 95% CI: 1.16-1.70; p < 0.001). The oPGS showed a significantly lower value in the Roma population compared with the HG population (oPGSRoma: 2.19 ± SD: 0.99 vs. oPGSHG: 2.70 ± SD: 1.06; p < 0.001). In conclusion, the coexistence of genetic factors that encourage leisure-time physical activity shows a more unfavorable picture among Roma, which may indirectly contribute to their poor health status.

"The person in power told me to"-European PhD students' perspectives on guest authorship and good authorship practice.

Questionable authorship practices in scientific publishing are detrimental to research quality and management. The existing literature dealing with the prevalence, and perceptions, of such practices has focused on the medical sciences, and on experienced researchers. In contrast, this study investigated how younger researchers (PhD students) from across the faculties view fair authorship attribution, their experience with granting guest authorships to more powerful researchers and their reasons for doing so. Data for the study were collected in a survey of European PhD students. The final dataset included 1,336 participants from five European countries (Denmark, Hungary, Ireland, Portugal, and Switzerland) representing all major disciplines. Approximately three in ten reported that they had granted at least one guest authorship to "a person in power". Half of these indicated that they had done so because they had been told to do so by the person in power. Participants from the medical, natural and technical sciences were much more likely to state that they had granted a guest authorship than those from other faculties. We identified four general views about what is sufficient for co-authorship. There were two dominant views. The first (inclusive view) considered a broad range of contributions to merit co-authorship. The second (strongly writing-oriented) emphasised that co-authors must have written a piece of the manuscript text. The inclusive view dominated in the natural, technical, and medical sciences. Participants from other faculties were more evenly distributed between the inclusive and writing oriented view. Those with an inclusive view were most likely to indicate that they have granted a guest authorship. According to the experiences of our participants, questionable authorship practices are prevalent among early-career researchers, and they appear to be reinforced through a combination of coercive power relations and dominant norms in some research cultures, particularly in the natural, technical, and medical sciences.

Health and economic gain attributable to the introduction of the World Health Organization's drinking water standard on arsenic level in Hungary: A nationwide retrospective study on cancer occurrence and ischemic heart disease mortality.

The World Health Organization (WHO) estimates that 140 million individuals are at risk from consumption of drinking water containing arsenic at concentrations above the WHO guideline value of 10 µg/l. Arsenic mitigation is considered to be the most effective way to prevent arsenic related diseases. After joining the European Union, Hungary implemented a Drinking Water Quality Improvement Programme (DWQIP) to reduce levels of arsenic in drinking water below the WHO guideline value. But what impact did this have on health? We estimated the change in lifetime excess skin, lung, and bladder cancer risks and mortality from ischaemic heart disease (IHD) associated with chronic arsenic intake among those exposed before (2004-2007) and after (2014-2017) the implementation of DWQIP. A population-based risk assessment approach was used to assess lifetime excess cancer risk applying two scenarios for lung and bladder cancers. The economic benefits of the DWQIP were estimated by the combination of cost of illness and value per statistical life methods. Compared to the period before the DWQIP, its implementation was associated with a significant reduction in arsenic in drinking water [median: 3.0 µg/l interquartile range (IQR): 1.5-12.0 µg/l to median: 2.15 µg/l IQR: 1.0-5.79 µg/l]. The two scenarios were estimated to be associated with 225.2 and 35.9 fewer cancer cases each year. The number of annually prevented IHD deaths was estimated to be 88.9. It was estimated that the benefits of the DWQIP will outweigh its costs. We conclude that reducing arsenic levels in drinking water to 10.0 µg/l resulted in significant health and economic benefits. Our study goes beyond the existing research, offering both new insights into the impact of arsenic mitigation and providing a methodological template for similar studies in the many parts of the world that have yet to reduce arsenic exposure.

Physical Activity Pattern Characterized by Domains and Dimensions of the Roma Population in Comparison with That of the General Population in Northeast Hungary.

Our study focuses on examining physical activity, as one of the most influential health determinants by domains and dimensions among Roma, the largest vulnerable ethnic minority in Europe. The study was carried out on a sample representative of the Hungarian Roma (HR) population (n = 350) living in segregated colonies in Northeast Hungary in comparison with the Hungarian general (HG) population sample (n = 343) from the same region. Data were collected using the International Physical Activity Questionnaire (IPAQ) long-form and physical activity was quantified as MET-min/week. Scores were calculated for walking, moderate and vigorous-intensity activities for each domain (work, transport, domestic and gardening, leisure) and as an overall total. The HR population­similarly to the HG­is characterized by moderate or high physical activity; however, this level is achieved by work and housework/gardening instead of leisure time activities, which is worryingly low among HR females, but its prevalence is significantly (p < 0.001) lower in both sexes than among the HG population in the vigorous activity category. HR men move (walk and cycle) significantly more during transport than HG men. Our results may direct the attention of decision-makers to improve the health of Roma by increasing leisure-time physical activity.

Cellular and molecular mechanisms of allergic asthma.

Asthma is a chronic disease of the airways, which affects more than 350 million people worldwide. It is the most common chronic disease in children, affecting at least 30 million children and young adults in Europe. Asthma is a complex, partially heritable disease with a marked heterogeneity. Its development is influenced both by genetic and environmental factors. The most common, as well as the most well characterized subtype of asthma is allergic eosinophilic asthma, which is characterized by a type 2 airway inflammation. The prevalence of asthma has substantially increased in industrialized countries during the last 60 years. The mechanisms underpinning this phenomenon are incompletely understood, however increased exposure to various environmental pollutants probably plays a role. Disease inception is thought to be enabled by a disadvantageous shift in the balance between protective and harmful lifestyle and environmental factors, including exposure to protective commensal microbes versus infection with pathogens, collectively leading to airway epithelial cell damage and disrupted barrier integrity. Epithelial cell-derived cytokines are one of the main drivers of the type 2 immune response against innocuous allergens, ultimately leading to infiltration of lung tissue with type 2 T helper (TH2) cells, type 2 innate lymphoid cells (ILC2s), M2 macrophages and eosinophils. This review outlines the mechanisms responsible for the orchestration of type 2 inflammation and summarizes the novel findings, including but not limited to dysregulated epithelial barrier integrity, alarmin release and innate lymphoid cell stimulation.

Diabetes Mellitus and Associated Factors in Slovakia: Results from the European Health Interview Survey 2009, 2014, and 2019.

Diabetes mellitus (DM) is a high-risk non-communicable disease with an emerging burden for the European Union (EU) member states in the past decades. The unfavorable trend of the burden is striking compared to the declining disease burden due to cardiovascular diseases or stagnation of neoplasms. The goal of this study is to describe the temporal changes of diabetes in the adult population of Slovakia through the three European Health Interview Survey (EHIS) waves and to assess the association between DM and socioeconomic and/or lifestyle characteristics. These cross-sectional studies were carried out using microdata derived from Slovakia's EHISs conducted in the years 2009 (n = 4972), 2014 (n = 5490), and 2019 (n = 5527). The DM variable was compared to the independent variables such as sociodemographic and lifestyle characteristics including dietary patterns and physical activity. DM prevalence for the EHIS in 2009, 2014, and 2019 were 6.1%, 8.2%, and 9.8%, respectively. In bivariate analysis, the relationship between DM and age, education level, job status, BMI, walking for at least 10 min, and physical activity was significant in the three EHISs. In 2014 and 2019, there was an inverse association between the risk of DM and walking regularly. There was no association between the frequency of eating fruits or vegetables and DM, with the exception of 2009, where a negative association between eating vegetables one to six times a week and DM was observed. Present health policies and activities in Slovakia were unable to reverse the increasing DM burden, indicating that a more systematic approach is needed. Complex policy strategies and legislative measures must be developed and implemented at both the national and EU levels.

Inequalities in the Global Burden of Chronic Kidney Disease Due to Type 2 Diabetes Mellitus: An Analysis of Trends from 1990 to 2019.

The prevalence of type 2 diabetes mellitus (T2DM) and the burden of complications are increasing worldwide. Chronic kidney disease (CKD) is one serious complication. Our aim was to investigate the trends and inequalities of the burden of CKD due to T2DM between 1990 and 2019. Data were obtained from the Global Health Data Exchange database. Age-standardized incidence, mortality, and DALYs rates of CKD were used to estimate the disease burden across the Human Development Index (HDI). Joinpoint regression was performed to assess changes in trend, and the Gini coefficient was used to assess health inequality. A higher incidence was observed in more developed countries (p < 0.001), while higher mortality and DALYs rates were experienced in low and middle HDI countries in 2019 (p < 0.001). The trend of incidence has increased since 1990 (AAPC: 0.9-1.5%), while slight decrease was observed in low HDI countries in mortality (APC: -0.1%) and DALYs (APC: -0.2%). The Gini coefficients of CKD incidence decreased from 0.25 in 2006 to 0.23 in 2019. The socioeconomic development was associated with disease burden. Our findings indicate that awareness of complications should be improved in countries with high incidence, and cost-effective preventive, diagnostic, and therapeutic tools are necessary to implement in less developed regions.