New botulinum neurotoxin constructs for treatment of chronic pain.

Chronic pain affects one in five people across human societies, with few therapeutic options available. Botulinum neurotoxin (BoNT) can provide long-lasting pain relief by inhibiting local release of neuropeptides and neurotransmitters, but its highly paralytic nature has limited its analgesic potential. Recent advances in protein engineering have raised the possibility of synthesising non-paralysing botulinum molecules for translation to pain sufferers. However, the synthesis of these molecules, via several synthetic steps, has been challenging. Here, we describe a simple platform for safe production of botulinum molecules for treating nerve injury-induced pain. We produced two versions of isopeptide-bonded BoNT from separate botulinum parts using an isopeptide bonding system. Although both molecules cleaved their natural substrate, SNAP25, in sensory neurons, the structurally elongated iBoNT did not cause motor deficit in rats. We show that the non-paralytic elongated iBoNT targets specific cutaneous nerve fibres and provides sustained pain relief in a rat nerve injury model. Our results demonstrate that novel botulinum molecules can be produced in a simple and safe manner and be useful for treating neuropathic pain.

Engagement, Retention, and Acceptability in a Digital Health Program for Atopic Dermatitis: Prospective Interventional Study.

BACKGROUND: Patients with atopic dermatitis can experience chronic eczema with pruritus, skin pain, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of atopic dermatitis. Digital therapeutics can help with these and support patients toward a healthier lifestyle to improve their overall QoL. OBJECTIVE: The aim of the study is to test the feasibility of a digital health program tailored for atopic dermatitis through program engagement, retention, and acceptability. METHODS: Adults with atopic dermatitis were recruited in Iceland for a 6-week digital health program delivered through a smartphone app. Key components of the digital program were disease and trigger education; medication reminders; patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs); atopic dermatitis symptom PROs; guided meditation; and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth (ie, mobile health) App Usability Questionnaire (MAUQ). RESULTS: A total of 21 patients were recruited (17 female, mean age 31 years), 20 (95%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions per day. The education content, medication reminders, and PROs had high user engagement and retention; all users who were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95%) users were continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants, respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90%), but weekly interactions declined. All assigned users completed atopic dermatitis symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of atopic dermatitis symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94%) and 14/17 (82%) users interacted with these at least 3 times in the first and last week of the program, respectively, and all reported improvements over time. User satisfaction was high with a total score of 6.2/7. CONCLUSIONS: We found high overall engagement and retention in a targeted digital health program among patients with atopic dermatitis, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity were reduced, and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with atopic dermatitis, including the tracking and improvement of atopic dermatitis symptoms.

Clinical Efficacy of a Digital Intervention for Patients with Atopic Dermatitis: a Prospective Single-Center Study.

INTRODUCTION: Improving disease awareness and treatment adherence is key for the long-term management of atopic dermatitis (AD). Digital interventions can support patients in disease self-management and adopting a healthier lifestyle through behavioral modifications. We aimed to test the clinical efficacy of a digital program in patients with AD. METHODS: Adults with mild-to-severe AD were recruited for a 6-week feasibility study. The intervention was delivered through a mobile app and consisted of symptom and trigger education, treatment reminders, lifestyle coaching, and healthy lifestyle support. Here we report the secondary outcomes of intervention efficacy on clinical symptoms, as assessed by Scoring Atopic Dermatitis (SCORAD) and Patient-Oriented Eczema Measure (POEM), on health-related quality of life (HR QoL) as assessed by Dermatology Life Quality Index (DLQI), and changes in behaviors related to disease management as assessed by a six-item questionnaire. RESULTS: Twenty of 21 patients (95.2%) completed the program (81% female, mean age 31.4 years, mean time from diagnosis 26.8 years). Clinical symptoms and patient-reported global severity improved by 44% and 46%, respectively, while HR QoL improved by 41% (p < 0.001 for all measures). Adherence to treatments and preventive measures improved from pre- to post-intervention, including skincare, avoidance of triggers, and disease-related knowledge. A significant interaction was observed between increased treatment adherence and clinical improvement, such that larger clinical improvements were observed in patients with higher treatment adherence. CONCLUSION: Patients with AD are open to and can benefit from a digitally delivered targeted intervention, as demonstrated by significant improvements in treatment adherence and related clinical outcomes.

Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study.

BACKGROUND: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. OBJECTIVE: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. METHODS: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. RESULTS: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96%) were still logging their steps, with 19 (68%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89%) were likely to recommend the program, 23 (82%) said the program helped them deal with the disease, and 24 (86%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. CONCLUSIONS: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention.

[Examining health professionals' knowledge and attitudes towards mental disorders]. / Egészségügyi szakdolgozók mentális zavarokkal kapcsolatos ismereteinek és a betegekkel szembeni attitudjének vizsgálata.

Introduction: The stigmatization of mental patients is a priority topic in both domestic and international research. In addition to social prejudices, people living with mental illness must also struggle with the stigmatizing attitude of health professionals. Aim: It was a survey of attitudes of nursing health care professionals towards psychiatric patients and mental illnesses. We also aimed to assess mental health knowledge among the nursing staff. In the light of the results, our aim was to make proposals for the reform of nursing education. Method: We performed the survey among members of the Hungarian Chamber of Health Care Professionals, in 4 sections (paramedics, emergency nurses, psychiatric nurses and adult nurses). We analyzed the results of the online quantitative survey with multiple variables descriptively. Results: 495 of the completed questionnaires were evaluable (n = 495). Psychiatric nurses are characterized by a less stigmatizing attitude towards rescue and emergency carers and other adult nurses. Less stigmatizing attitudes are characterized by BSc and MSc graduates than those who have secondary education. Almost half of all nurses (47%) in the study feel they have a lack of preparedness about mental illnesses. The rate is 49% for rescue and emergency workers, and 55% for members of the adult care section. There is also a relatively high proportion (28%) of psychiatric nurses, who consider their skills to be inadequate. At the same time, of course, this group replied in the highest proportion (37%) that his knowledge is adequate. Conclusion: Psychiatric education should be made more effective at all levels of nursing training. It would also be important to incorporate sensitizing and anti-stigma methods and to develope empathy. Orv Hetil. 2020; 161(2): 56-66.

Psychoanalytic psychotherapy and its supervision via videoconference: experience, questions and dilemmas.

The patient lives in Berlin, the therapist in Lisbon and the supervisor in Budapest. Not long ago, continuous psychotherapy and supervision would have been impossible in such a setting. Nowadays, modern communication technologies via the Internet create new possibilities for patients, therapists, and supervisors. However, when we engage in psychoanalytic practice via modern means of telecommunication, we need to examine if the fundamental tenets of the psychoanalytic process are preserved. We need to think about initial assessment, about how we arrange the setting, how we work with transference and countertransference, what kinds of new forms of resistance we are facing and, indeed, how we can recognize new phenomena and handle inevitable problems. In this clinical paper, we tackle these questions in the context of three-times-a-week psychoanalytic psychotherapy.

Secretion of Mast Cell Inflammatory Mediators Is Enhanced by CADM1-Dependent Adhesion to Sensory Neurons.

Neuroimmune interactions are important in the pathophysiology of many chronic inflammatory diseases, particularly those associated with alterations in sensory processing and pain. Mast cells and sensory neuron nerve endings are found in areas of the body exposed to the external environment, both are specialized to sense potential damage by injury or pathogens and signal to the immune system and nervous system, respectively, to elicit protective responses. Cell adhesion molecule 1 (CADM1), also known as SynCAM1, has previously been identified as an adhesion molecule which may couple mast cells to sensory neurons however, whether this molecule exerts a functional as well as structural role in neuroimmune cross-talk is unknown. Here we show, using a newly developed in vitro co-culture system consisting of murine bone marrow derived mast cells (BMMC) and adult sensory neurons isolated from dorsal root ganglions (DRG), that CADM1 is expressed in mast cells and adult sensory neurons and mediates strong adhesion between the two cell types. Non-neuronal cells in the DRG cultures did not express CADM1, and mast cells did not adhere to them. The interaction of BMMCs with sensory neurons was found to induce mast cell degranulation and IL-6 secretion and to enhance responses to antigen stimulation and activation of FcεRI receptors. Secretion of TNFα in contrast was not affected, nor was secretion evoked by compound 48/80. Co-cultures of BMMCs with HEK 293 cells, which also express CADM1, while also leading to adhesion did not replicate the effects of sensory neurons on mast cells, indicative of a neuron-specific interaction. Application of a CADM1 blocking peptide or knockdown of CADM1 in BMMCs significantly decreased BMMC attachment to sensory neurites and abolished the enhanced secretory responses of mast cells. In conclusion, CADM1 is necessary and sufficient to drive mast cell-sensory neuron adhesion and promote the development of a microenvironment in which neurons enhance mast cell responsiveness to antigen, this interaction could explain why the incidence of painful neuroinflammatory disorders such as irritable bowel syndrome (IBS) are increased in atopic patients.

The saga of psychoanalysis in Eastern Europe: repression and rebirth in Hungary, and in former Czechoslovakia and Yugoslavia.

The paper shortly presents the early roles of Budapest, Prague, and Belgrade in the development of psychoanalytic movement in Central-Europe before the Second World War. Mapping this historical heritage, it suggests how psychoanalysts of former Soviet Bloc countries could restore their own psychoanalytic communities. The study investigates the consequences of these dictatorial and authoritarian regimes for psychoanalysis and for psychoanalysts focusing on similarities and differences in Hungary, in former Czechoslovakia, and Yugoslavia. Furthermore, it emphasizes the contribution of the international professional organizations - the International Psychoanalytic Association, and the European Psychoanalytic Federation - for reintegration of Budapest, Prague, and Belgrade to the international psychoanalytic community.

[The role of environmental factors in managing labour stress]. / A támogató környezet szerepe a szülési stressz kezelésében.

INTRODUCTION: Emotional, cognitive and behavioural aspects of birth and labour stress are strongly associated with the underlying physiological processes. AIM: To study the factors of physical security and social support, the administration of synthetic oxytocin, and how they relate to perceived stress during childbirth. METHOD: Women's experienced physical security, social support and oxytocin administration was measured with targeted questions, and their perceived stress with the short and modified version of the Perceived Stress Scale. RESULTS: A strong negative association was found between perceived stress and physical and social security. The group of women experiencing low physical and social security perceived significantly higher stress, while those given synthetic oxytocin perceived higher stress, and lower physical and social security. CONCLUSIONS: Since physiological, psychological processes and behaviours are strongly intertwined, the support of natural physiological birth without interventions is recommended, which considers not only short-term but long-term health consequences for mother and child. The contribution of calming physical surroundings, minimal interventions and empowering support of caregivers to safe and satisfying birth is demonstrated in a model. Orv Hetil. 2017; 158(29): 1149-1156.

The saga of psychoanalysis in Eastern Europe: repression and rebirth in Hungary, and in former Czechoslovakia and Yugoslavia / A saga da psicoanálise no leste eutopeu: repressão e renascimento na Hungria e nas antigas Tchecoslováquia e Iugoslávia

Abstract The paper shortly presents the early roles of Budapest, Prague, and Belgrade in the development of psychoanalytic movement in Central-Europe before the Second World War. Mapping this historical heritage, it suggests how psychoanalysts of former Soviet Bloc countries could restore their own psychoanalytic communities. The study investigates the consequences of these dictatorial and authoritarian regimes for psychoanalysis and for psychoanalysts focusing on similarities and differences in Hungary, in former Czechoslovakia, and Yugoslavia. Furthermore, it emphasizes the contribution of the international professional organizations - the International Psychoanalytic Association, and the European Psychoanalytic Federation - for reintegration of Budapest, Prague, and Belgrade to the international psychoanalytic community.

Resumo O artigo apresenta brevemente os papéis de Budapeste, Praga e Belgrado no desenvolvimento do movimento psicoanalítico na Europa central antes da Segunda Guerra Mundial. Mapeando essa herança histórica, o artigo sugere como psicanalistas do antigo bloco soviético puderam restaurar suas próprias comunidades psicoanalíticas. O estudo investiga as consequências desses regimes ditatoriais e autoritários para a psicanálise e para os psicanalistas focalizando as semelhanças e diferenças na Hungria e nas antigas Tchecoslováquia e Iugoslávia. Além disso, destaca a contribuição das organizações profissionais internacionais - a International Psychoanalytic Association e a European Psychoanalytic Federation - na reintegração de Budapeste, Praga e Belgrado à comunidade psicoanalítica internacional.

[In silico diabetology]. / In silico diabetológia.

INTRODUCTION: Simulation models can contribute substantially to our understanding and ability to control the dynamic processes underlying impaired glucose metabolism in diabetic patients. AIM: The aim of this paper is to outline a new comprehensive, physiologically-based dynamic model of glucose homeostasis incorporating up-to-date quantitative knowledge about glucose metabolism and its control by insulin and glucagon. METHOD: The model is composed of three submodels for glucose, insulin, and glucagon. RESULTS: The glucose submodel specifies the dynamics of glucose absorption following meals, hepatic glucose production and uptake, peripheral glucose uptake, kidney excretion, and insulin-independent uptake of glucose in the brain and red blood cells. The insulin submodel includes equations for insulin absorption, pancreatic insulin release and insulin clearance. The glucagon model specifies the hormone secretion and elimination kinetics. Algebraic equations are used to specify (i) how the hormones affect glucose production and utilisation in various compartments such as liver, muscle and fat tissues, and (ii) how glucose levels modify insulin and glucagon release from the pancreas. Setting the values of various model parameters is used to generate virtual individual patients. CONCLUSIONS: The model allows the simulation of 24-hour blood glucose profiles for both insulin-dependent non-insulin dependent diabetic patients.

[Most common skin disorders caused by excessive exposure to sunlight]. / Napsugárzás által okozott leggyakoribb borártalmak.

The healing properties of sunlight has been known for millennia, however the gradual deterioration of the ozone layer and the increased use of sun tanning beds in recent decades are causing an increase in skin damaging ultraviolet exposure. In this article the most common photodermatoses and the principles of their treatments are reviewed.

[Objective assessment of transfusion-related knowledge of nurses using modern test theory]. / Modern tesztelméleti eszközök alkalmazása az ápolók transzfúziós ismereteinek objektív mérésében.

INTRODUCTION: Clinical practice requires knowledge of health professionals for the application of problem solving of different tasks in various clinical settings. Therefore, a set of reliable measurement tools is required to assess various components of the professional knowledge including factual knowledge, skills and competence as outcomes of nursing education and training. Traditional questionnaires and test methods do not allow the measurement of these characteristics properly, as these tools typically provide overall scores without relevant insight into areas in which nurses perform well, and those where their knowledge and/or skills should be improved substantially. AIM: The aim of this nationwide survey conducted among nurses between November 2014 and February 2015 was to determine how the teaching/training objectives have been achieved in the nurses' transfusion practice. The authors attempted to exceed the capabilities of classical test theory and acquire a detailed picture about what the nurses know about transfusion therapy and how they are involved and behave in routine clinical practice. METHOD: The knowledge and skills of 657 participants were assessed using a validated instrument consisting of a set of questions covering every aspects of transfusion therapy. The answers to these items were evaluated on a binary (good or bad) scale. Recorded answers of the participants were analysed using hierarchical cluster analysis and item response theory tools such as the one-parametric Rasch model suitable for dichotomous data. Data analysis was performed with the SPSS program and the ltm module of the R statistical program. RESULTS: The paper presents the distribution of correct and incorrect answers to various questions about transfusion therapy along with the corresponding logit values and odds ratios, respectively. The characteristic curves of each item were determined on the basis of the number of correct answers that have been recorded. These curves highlight which questions were answered easily and which items were found harder to answer by the nurses who participated in the survey. In addition to the separate analysis of individual questions, a set of response patterns is also presented which shows how frequently the nurses responded correctly to different combinations (sub-sets) of questions. On the whole, nurses exhibited medium level performance in terms of knowledge and skills required for efficient and safe transfusion practice. CONCLUSIONS: Objective and reliable measurement of the level of acquired knowledge is a key requirement in nursing education. This paper, which demonstrates the use of cluster analysis and item response theory for the assessment of transfusion-related knowledge of nurses, focuses on this issue for the first time in nursing research. The results of this survey have revealed substantial limitations and deficiencies both in knowledge and skills of nurses which need to be addressed by training in order to improve the efficiency and safety of transfusion therapy.

[Use of high-fidelity patient simulators for the assessment of students' performance]. / Valósághu páciensszimulátorok alkalmazázsa a hallgatói teljesítmény értékelésében.

INTRODUCTION: The authors started to use high-fidelity simulators at Semmelweis University, Faculty of Health Sciences in September, 2007. AIM: The aim of this study was to evaluate the students' performance in order to determine their knowledge after each simulation course. METHOD: The Creighton Simulation Evaluation Instrument (C-SEI) was used to evaluate midwifery students' performance during examinations. 67 midwifery students were evaluated after the "Clinical simulation" course and 58 midwifery students after the "Case studies in simulation" course. RESULTS: The average total scores were significantly higher than the desired level of 75 (p<0.01); after the "Clinical simulation" 88.8±9,14, and after the "Case studies in simulation" courses 86.6±14.87. Among subscales the lowest average total score was found in critical thinking in each of the course. Statistically significant correlation was found between the results of "General nursing care" and the results of "Case studies in simulation" courses (r = 0.34; p<0.01). CONCLUSIONS: The use of high-fidelity simulators with valid tools simultaneously might be a suitable method for students' evaluation.

[Transfusiology knowledge and competence of nurses in light of a national survey]. / Ápolók transzfuziológiai ismeretei és kompetenciái egy országos felmérés tükrében.

INTRODUCTION: International literature data clearly show that the role of nurses in transfusion therapy, which needs professional knowledge and skills, continues to increase. AIM: The aim of the authors was to perform a national-level mapping of the practice of transfusion therapy including transfusion therapy-related knowledge of nurses and their knowledge about their competence. Further aim was to identify similarities and differences as referred to the requirements of the transfusion regulations (2008), which was valid at the time of the survey in Hungary. METHOD: The nationwide survey took place between November 19, 2014 and February 20, 2015. Data were collected using paper-form and web-based anonymous, self-administered questionnaire. 657 nurses who were involved in transfusion therapy with changing regularity in adult in-patient wards took part in the survey. Data were processed using descriptive statistical methods. RESULTS: It was found that the transfusion therapy related knowledge of nurses was very incomplete (50.72%), and only about half of the nurses (52.3%) systematized the nursing functions correctly. Significant differences were also found in the practice of transfusion therapy. The vast majority of the institutions had their own protocol, but responsible nurses assigned for transfusion care were present only in 23.9% of the wards. CONCLUSIONS: The authors conclude that the identified problems can be resolved by improving professional responsibility of nurses, increasing supervision by nursing leaders and appropriate transfusiology training and regular retrainings.

[Intelligent interpretation of home monitoring blood glucose data]. / Vércukor-önellenorzési adatok intelligens értelmezése.

Self monitoring of blood glucose is the cornerstone of diabetes management. However, the data obtained by self monitoring of blood glucose have rarely been used with the highest advantage. Few physicians routinely download data from memory-equipped glucose meters and analyse these data systematically at the time of patient visits. There is a need for improved methods for the display and analysis of blood glucose data along with a modular approach for identification of clinical problems. The authors present a systematic methodology for the analysis and interpretation of self monitoring blood glucose data in order to assist the management of patients with diabetes. This approach utilizes the followings 1) overall quality of glycemic control; 2) severity and timing of hypoglycemia and hyperglycemia; 3) variability of blood glucose readings; 4) various temporal patterns extracted from recorded data and 5) adequacy of self monitoring blood glucose data. Based on reliable measures of the quality of glycaemic control and glucose variability, a prioritized problem list is derived along with the probable causes of the detected problems. Finally, problems and their interpretation are used to guide clinicians to choose therapeutic actions and/or recommend behaviour change in order to solve the problems that have been identified.

[Professional knowledge and practice mapping among nurses regarding transfusion therapy. A pilot study on reliability and validity testing]. / Ápolók szakmai ismereteinek és gyakorlatának feltérképezése a transzfúziós terápiát illetoen. Megelozo tanulmány: megbízhatóság- és érvényességvizsgálat.

INTRODUCTION: All people involved in transfusion therapy have professional, legal and ethical responsibility for their own actions. AIM: The aims of the authors were to evaluate competencies, knowledge and practice of nurses about transfusion therapy. METHOD: Descriptive statistical approach using observation, questionnaire survey and interview was applied. Reliability and validity of the self-made questionnaire were examined with statistical methods. Variance, standard deviation, Cronbach's alpha and Pearson correlations were calculated. RESULTS: Transfusiology-related knowledge of nurses regarding current transfusion regulations was almost 90%, and 56.2% of nurses systematized the nursing functions correctly. Significant differences were found among different institutions in transfusion therapy, transfusion practice and the use of relevant documentation. 75-77% of the institutions examined had their own protocol, and assigned transfusion care nurses worked in more than 20% of the wards. CONCLUSIONS: The authors propose a better supervision by leaders in nursing aspects of transfusion therapy, and an increased professional responsibility.

[Some issues regarding the Hungarian regulation of traditional Chinese medicine and possible solutions based on examples from the United Kingdom]. / A hagyományos kínai orvoslás magyarországi szabályozásának egyes problémái és lehetséges megoldásai az Egyesült Királyság példáján keresztül.

This paper aims to present factual information and to suggest possible solutions regarding some of the recent questions which have arisen regarding the regulation of traditional Chinese medicine in Hungary. According to current legislation "traditional Chinese doctors", who are the most highly trained professionals in this field, are not allowed to practice Chinese medicine and acupuncture in Hungary. This situation cannot be explained by their educational background, as they receive thorough training in both Chinese medicine and modern medical sciences. Furthermore, this legislation is not supported by any EU standard: Traditional Chinese medicine professionals can practice Chinese medicine and acupuncture in a number of European countries within a legal and regulated framework. Different kinds of healthcare professionals may practice Chinese medicine and acupuncture in the UK - this could be a good example for Hungarian regulation. The five-year bachelor level traditional Chinese medicine training at the Faculty of Health Sciences, Semmelweis University and the increasing number of locally trained traditional Chinese medicine professionals could be a good basis for laying the groundwork of the new system.

[Assessment of multicultural sensitivity in patient care, based on a survey]. / Az interkulturalitás megítélése az ápolásban egy felmérés tapasztalatai alapján.

INTRODUCTION: The internationalization of societies and the processes of globalization raise new challenges towards health provision systems, including professional, ethical, social, cultural and communicational references of nursing and nursing education. AIMS: In this study the authors wanted to answer the following question: To what extent are health care professionals aware of and able to respond to the new challenges? METHODS: As an investigation method, the authors used a questionnaire and made a comparative analysis of answers related to the knowledge, skills and attitude of BSc nurses and other health professionals who possess a secondary qualification. The questionnaire was compiled based on the internationally accepted and validated Transcultural Self Efficacy Test. With the permission of the authors of the test, some questions were adapted to the national conditions. The responses were evaluated by statistical methods. RESULTS: There were better results in the components of skills and attitude of BSc nurses but there was a very high number of professionals in both groups who either failed to have or could not meet the requirements and phenomena related to intercultural skills. CONCLUSIONS: The survey performed among nurses proved that there is a real demand for intercultural skills and knowledge related to expectations of the society. In order to improve the quality of health care, the development of these skills is necessary.

[Traditional Chinese medicine: theoretical background and its use in China]. / A hagyományos kínai orvoslás elméleti háttere és alkalmazása Kínában.

This paper aims to define the concept of traditional Chinese medicine. Chinese medicine has its own unique system of knowledge, which fundamentally defines all of its therapeutic procedures (acupuncture, manual therapy, and Chinese herbal medicine). The authors offer a detailed description of the theoretical basics of Chinese medicine: classification of the normal and pathological processes of the human body based on functional models and a high degree of therapeutic individualization. The authors describe the current practice of Chinese medicine based on the Chinese model, without which modern Chinese medicine cannot exist. This concept pervades the education, clinical practice and research of Chinese medicine. If we hope to adequately satisfy scientific inquiry about Chinese medicine, we must first define its theoretical background and get acquainted with its scope of usage in modern China. The clarification of these basic issues will be beneficial to scientific research and legislative procedures.