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 (AD) 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 AD. Digital therapeutics can help with these, and support patients towards a healthier lifestyle to improve their overall QoL.

OBJECTIVE

To test the feasibility of a digital health program tailored for AD through program engagement, retention and acceptability.

METHODS

Adults with AD were recruited in Iceland for a six-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), AD 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 App Usability Questionnaire (MAUQ).

RESULTS

Twenty-one 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 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 AD symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of AD 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 AD, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity was reduced and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with AD, including the tracking and improvement of AD symptoms.

CLINICALTRIAL

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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13555-022-00821-y.

Feasibility of a Digital Therapeutic Program for Cancer Patients During Active Treatment: Analysis of Engagement, Retention and Quality of Life (Preprint)

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.

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.

[Examining health professionals' knowledge and attitudes towards mental disorders]

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.

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]

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.

[In silico diabetology]

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]

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]

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]

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]

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]

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]

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.

Acetyl-L-carnitine and oxaloacetate in post-treatment against LTP impairment in a rat ischemia model. An in vitro electrophysiological study

A high proportion of research relating to cerebral ischemia focuses on neuroprotection. The application of compounds normally present in the organism is popular, because they do not greatly influence the synaptic activity by receptor modulation, and can be administered without serious side effects. Oxaloacetate (OxAc) and acetyl-L-carnitine (ALC) are such favorable endogenous molecules. ALC can exert a protective effect by improving the energy state of the neurons under ischemic conditions. A promising neuroprotective strategy is glutamate scavenging, which can be achieved by the intravenous administration of OxAc. This study involved the possible protective effects of ALC and OxAc in different post-treatment protocols against long-term potentiation (LTP) impairment. Ischemia was induced in rats by 2-vessel occlusion, which led to a decreased LTP relative to the control group. High-dose (200 mg/kg) ALC or OxAc post-treatment resulted in a higher potentiation relative to the 2VO group, but it did not reach the control level, whereas low-dose ALC (100 mg/kg) in combination with OxAc completely restored the LTP function. Many previous studies have concluded that ALC can be protective only as pretreatment. The strategy described here reveals that ALC can also be neuroprotective when utilized as post-treatment against ischemia.

Some issues regarding the Hungarian regulation of traditional Chinese medicine and possible solutions based on examples from the United Kingdom

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. Orv., Hetil., 2014, 155(15), 575–581.

[Assessment of multicultural sensitivity in patient care, based on a survey]

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

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. Orv. Hetil., 2012, 153, 723–731.

From farm to fork follow-up of thermotolerant campylobacters throughout the broiler production chain and in human cases in a Hungarian county during a ten-months period

A study tracking thermotolerant campylobacters from the setting of the broilers throughout the whole rearing period, slaughter and sale of chicken products in five consecutive broiler rotations of the same henhouse as well as in two different other farms was conducted in a well-defined geographic area (Hajdú-Bihar county, Hungary) between March 2006 and Feb 2007. All notified cases of human campylobacteriosis in this area during the study period were also included. One hundred and one, 44, 23 and 282 Campylobacter jejuni and 13, 15, 20 and 60C. coli were isolated from broiler houses, slaughterhouses, retail shops and human samples, respectively. Sixty-two isolates collected from broilers or their environment selected from different flocks (57C. jejuni, 5C. coli), 92 isolates collected from abattoirs and retail shops (72C. jejuni, 20C. coli), as well as 85 randomly selected human isolates (74C. jejuni, 11C. coli) were subjected to PFGE analysis using restriction enzymes KpnI and SmaI. Sixty-six of the isolates produced unique Sma-Kpn profiles; the majority (46) of these were of human origin. The remaining isolates formed PFGE clusters of between 2-25 isolates with 14 (12C. jejuni and 2C. coli) main clusters comprised of five or more isolates with identical KpnI-SmaI patterns. Two genetic clones of C. jejuni (clone A, n=25; clone B, n=20) included 18% of isolates from different sources. Generally, isolates from one cluster were found in 1-3 different flocks, notably, clone B was present in three rotations including those from the two independent farms. Six of the seven investigated flocks had one or two characteristic prevalent clones. Transmission of clones between consecutive flocks was frequently seen. Spread of both C. jejuni and C. coli was traced multiple times along the food chain; eight C. jejuni, but no C. coli clones were detected both in broilers and humans. These data suggest that broilers were the major source for C. jejuni but not for C. coli in the studied area and period. For C. jejuni the carryover of strains between consecutive flocks may be a common event, but the strain is eventually replaced by another and consecutive carryover events seem to be infrequent. The majority of the human disease was due to nonepidemic strains; some clones were transmitted from more than one broiler flocks (including epidemiologically unrelated flocks) to humans multiple times.

Building blocks toward contemporary trauma theory: Ferenczi 's paradigm shift

In laying down the building blocks of contemporary trauma theory, Ferenczi asserted that trauma is founded on real events and that it occurs in the interpersonal and intersubjective dynamics of object relations. He stressed the significance of the presence or lack of a trusted person in the post-traumatic situation. After the trauma, the loneliness and later the isolation of the victim represent a serious pathogenic source. In the traumatic situation, the victim and the persecutor/aggressor operate differing ego defense mechanisms. Ferenczi was the first to describe the ego defense mechanism of identification with the aggressor. Ferenczi pointed out the characteristic features of the role of analyst/therapist with which (s)he may assist the patient in working through the trauma, among them being the development of a therapeutic atmosphere based on trust, so that the traumatic experiences can be relived, without which effective therapeutic change cannot be achieved. For the analyst, countertransference, as part of authentic communication, is incorporated into the therapeutic process. These are the key building blocks that are laid down by Ferenczi in his writings and appear in later works on trauma theory.

Physical and physiological performances in 10-year-old obese boys

Fatness generally has a negative influence on the performance of a variety of motor and cardiorespiratory fitness tests. The aim of this comparison was to analyse the effects of three grades of obesity on somatic growth, physical performance and oxygen consumption during exercise. Volunteer boys with definitely different grades of obesity were recruited for the comparison. In the group of mildly obese children (G1; n=23) BMI ranged between 24 kg.m -2 and 26 kg.m -2 ; and individual percent body fat was between 33% and 33.5%. In the case of moderate obesity (G2; n=23) BMI ranged between 26.5 kg.m -2 and 28.5 kg.m -2 ; and percent body fat was between 35% and 36%. In the extremely obese group (G3; n=20) BMI was greater than 31 kg.m -2 ; percent body fat was greater than 37.5%. Oxygen consumption during the 1,200 m run-test was measured by VIMEX-ST-type (USA) telemetric equipment.The greatest absolute aerobic power referred to the G3 boys, and the lowest oxygen consumption was characteristic of the mildly obese group. The very high differences between the body mass means resulted in a more marked inter-group variability in mean relative oxygen uptake.The predicted relative fat and high body fat content observed on the trunk, and the elevated level of resting blood pressure may indicate serious risks for the development of cardio-respiratory and metabolic disease. The very low oxygen consumption relative to body mass and poor physical performance are expected consequences of physiologic and environmental influences on the obese population.

[New ways of higher education in nursing: globalisation of nursing leadership and its teaching--dual degree in nursing]

Our paper is presenting a new initiative regarding an international cooperation willing to develop a dual degree program in nursing, the so-called Transatlantic Curriculum in Nursing. The candidates--after successful completion of their studies--will get a European and an American partner diploma in nursing. The objective is to prepare an internationally and culturally competent workforce; develop the practice of nursing students' exchange programs; process the model of dual degree independent of geographical, political or cultural borders; spread the evidence-based nursing standards in the daily practice. The partners in this initiative are Semmelweis University in Budapest, Hungary, Nazareth College of Rochester, NY, USA and Laurea University in Tikkurila, Finland. The planned activities in the framework of the program: mutual student and staff mobility, joint curriculum development and teaching process, determining joint standards. The expected outcomes are: to develop a standardised model for the enhancement and implementation of international educational programs in nursing; to improve institutional work culture; to improve professional terminology and cultural abilities; to create the model of a new type of nursing professional having a high level of cultural and language competence which are indispensable for participating in global programs.

Prevalence and characterization of Salmonella infantis isolates originating from different points of the broiler chicken-human food chain in Hungary

During the 10-month study period Salmonella contamination of broiler houses and the flocks reared in three farms (A, B and C), the slaughter houses where the flocks were slaughtered, as well as the carcass and retail raw meat products originating from them was investigated. In the broiler farm A five consecutive flocks, in the B and C farms one flock was sampled. Environmental samples were taken prior to the introductions. Environmental, drinking water, feed and faecal samples were collected regularly using standard methods. Before and during processing of the flocks, environmental and carcass samples were taken at the abattoirs. Salmonella contamination of the carcass, retail meat, as well as stool samples of farm and abattoir workers and from human illnesses registered in the same period and region were also examined. Isolation, sero-, phage- and antibiotic resistance typing, class 1 integron and plasmid profiling of the strains were performed; their genetic relationship was assessed by PFGE. Although the broiler house and the faecal samples of the 5 flocks of the farm A were negative for Salmonella, S. infantis was isolated from 20-100% of the abattoir carcass samples. The retail raw meat samples were 0-100% S. infantis positive. The environmental samples of farm B were Salmonella negative, but the examined flock was contaminated: S. infantis was identified from 43% of the faecal samples. This serotype was identified in 100% of the carcass and retail raw meat samples. From environmental samples taken before the arrival of the 1-day-old chicks in the broiler house C, S. infantis was cultured. S. infantis prevalence in the faecal samples was 35% and all the carcass and retail raw meat samples were S. infantis contaminated. Altogether 164 S. infantis strains were isolated out of which 145 were further characterized. The vast majority (142/145) of the strains belonged to phage types 217 and 213. All but one were characterized by the nalidixic acid-streptomycin-sulphonamide-tetracycline resistances, had an 885 bp class 1 integron and a large plasmid of > 168 kb in size. The strains showed > or = 88.7% genetic similarity. The results obtained shows that the same multi-drug resistant S. infantis clone was spread from the examined broiler farms contaminating the slaughter and the retail meat and appeared in the human illnesses of the examined region that was earlier detected as the dominant clone characteristic of the broiler and human population of the whole country.

Lifestyle, body composition, and physical fitness changes in Hungarian school boys (1975-2005)

General socioeconomic conditions as well as the physical environment have undergone remarkable changes in Hungary during the past 30 years. Unfortunately, these positive processes have resulted in a reduction of habitual physical activity along with unfavorable changes in dietary habits. Therefore, the purpose of the present study was to compare some selected morphological and functional parameters of 7-14-year-old Hungarian schoolboys living in the middle of the 1970s and at the beginning of the new millennium. It was hypothesized that there would be significant differences in morphological and functional characteristics of the Hungarian schoolboy populations, because they were assessed 30 years apart. Means of height, body mass, body mass index (BMI), the sum of five skinfold tests, percentage of body fat, and two running performance times (400 m and 1,200 m) of the boys (N = 3,672) studied in 1975 were compared to those of the boys (N = 3,758) in 2005. Data were analyzed using two-tailed independent samples t tests (p < .05). We observed significant secular changes in body mass and height. In addition, boys in 2005 had significantly more subcutaneous fat compared to 1975. The running times for the two distances were significantly poorer at the time of the second investigation. The remarkable and unfavorable changes in body composition and cardiorespiratory performance were attributed to the continuously decreasing intensity of habitual physical exercise and a lifestyle that had become more sedentary (watching TV playing computer games, etc.). Radical interventions are necessary to reduce these risks associated with the high prevalence of cardiovascular disease in Hungary, and the challenge to resolve the problem requires combined efforts at the educational, societal, corporate, and governmental levels.

Effects of 3 hours a week of physical activity on body fat and cardio-respiratory parameters in obese boys

The prevalence of overweight or fat children and adolescents has markedly increased in Hungary during the past three decades. Among the possible factors insufficient physical activity and a relative or absolute excess of calorie intake associated to it can be regarded as the most important ones. The aim of the study was to analyse the effects of a 20-week aerobic exercise on body composition and on the exercise tested cardio-respiratory functions in 10-year-old obese boys. Obesity was defined by a BMI greater than the cut-off value reported by Cole and co-workers (5) and a relative body fat content above 30% (13). Of the study group 21 volunteer children completed the program; the contrast group contained 28 obese boys. Mean calendar age was 10.03 +/- 0.26 in the study group (S) and 9.88 +/- 0.29 in the control group (C). The members of group S had two curricular physical education (PE) classes a week and three extracurricular aerobic physical activity sessions of 60 min net time in the afternoon, on Mondays (swimming and water games), Wednesdays (folk dance) and Fridays (soccer). Group C had only 2 PE classes a week. Anthropometric and spiroergometric data were collected in the middle of January and June of 2004. Relative body fat content and BMI did not increase during the observation period in contrast to the significant increase of both in the control group. Peak minute ventilation, aerobic power, oxygen pulse, and running distance (performed on a treadmill) increased in group S, and did not change in group C. The program was considered successful despite that the changes in the observed physiological and physical indicators appeared to be slight. However, the 5-month elevated level of physical activity brought about such development in the physical status of the obese subjects that might be an appropriate basis for regular training. Fortunately, the cardio-respiratory functions of the investigated boys were not affected yet by obesity, consequently the really dramatic change in their further lifestyle exclusively depends on their decision.

Overweight and obesity in 7 to 10-year-old Hungarian boys. Short communication

Increasing prevalence of overweight and obesity is a serious social and health problem both in the economically developed and developing countries. Despite this fact the nation-wide growth studies completed in Hungary during the past 30 years had not categorised the children either by body fat content or nutritional status. The aim of the study was to estimate the prevalence of overweight and obese boys in the country at the beginning of the new millennium. Height, body mass and four skinfold thicknesses were measured in 7173 volunteer boys aged between 7 and 10 and living in various urban and rural settlements of Hungary between 2003 and 2005. Nutritional status was qualified by the BMI and relative body fat content. The significantly increasing prevalence with age of overweight and obesity ranged between 10.3 and 23.4%. The results showed the joint effects of a secular trend of growth and of a remarkably changed lifestyle. Of these the consequences of the lifestyle are the more important ones. The high and possibly further increasing prevalence of child-age overweight and obesity reminds one of the observations of Kopp and associates (5), namely that of the increased prevalence of chronic childhood diseases during the past 15 years. More intense habitual physical activity and dramatic changes in dietary habits still promise some solution. No one should reckon, however, with the efficiency of physical education at the schools with its very few classes.

Could Balint have done more for Ferenczi?

After Ferenczi's death of pernicious anemia in 1933 at the age of 59, Michael Balint became the greatest advocate of his late analyst, teacher, colleague, and friend. He was faced with widespread avoidance, a conspiracy of silence against Ferenczi in the psychoanalytic movement. Ernest Jones, in particular, an analysand of Ferenczi and fellow member of the Secret Committee founded by Freud before World War I, seriously attacked Ferenczi. In the third volume of the Freud biography, Jones alleged that in the last years of his life Ferenczi suffered mental deterioration caused by the pernicious anemia, and that this mental decline was the real cause of Ferenczi's technical experimentations, thereby belittling the importance of Ferenczi's independent work in the last phase of his life. This article answers whether Michael Balint, who later became the literary executor of Ferenczi, was devoted enough in countering the charges that lead to a fifty-year silence on Ferenczi's eminent place in psychoanalysis. Correspondence between Balint and Jones is cited, as are reports of Ferenczi's contemporaries; Balint's efforts are placed within the context of the psychoanalytic rivalries after Freud's death.

Body composition and peak aerobic power in male international level Hungarian athletes

Body size, physique, body composition and physiological performance of elite athletes are independent aspects, have aroused the interest of exercise scientists, but studies that combine these aspects in elite athletes are scarcely available. The aim of the present study was to describe the selected anthropometric and exercise physiological characteristics of some Hungarian top athletes. The investigated subjects were qualified Hungarian water polo players (n=25), paddlers (n=24) and modem pentathlonists (n=20), all of whom had been medalists at several continental and intercontinental competitions. The athletes' body composition was estimated by the Drinkwater-Ross (45) body mass fractionation technique. Peak physiological performance was estimated by graded exhausting spiroergometric treadmill exercise. Intergroup differences in mean height, body mass and body composition characteristics were significant at the 5% level of random error. By the results of spiroergometry, all the three groups compared could be qualified as physically excellently trained. The greatest oxygen uptake relative to body mass was found in the modern pentathlonists (73.22 ml x kg(-1) x min(-1)) and the lowest one (59.79) in the water polo players. The authors do not disregard the favourable effects of regular and adequate trainings in the development of the studied characteristics, but in their opinion the process of proper selection has been the most important factor that explains the observed significant intergroup differences.

[Experience in treating acromegalic patients with long-acting octreotide]

The authors report clinical observations in 12 acromegalic patients treated with long-acting octreotide (Sandostatin LAR, Novartis, 20 mg intramuscular injection per 28 days administered for 6-36 months). Clinically and hormonally active acromegaly was evidenced in all patients by the presence of typical clinical symptoms, increased serum growth hormone and insulin-like growth factor I concentrations, and by non-suppressible serum growth hormone levels after oral glucose administration. In all patients previous treatments (transsphenoidal surgery, pituitary irradiation and bromocriptine therapy) were uneffective or contraindicated, or they were refused by the patients. Octreotide test (Sandostatin, Novartis, 100 g subcutaneously) performed in all patients before treatment precisely predicted the hormonal effectiveness of long-acting octreotide treatment. Three-six months after therapy serum growth hormone levels decreased from 13.6 +/- 3.9 ng/ml (mean +/- SD) to 3.4 +/- 1.7 ng/ml, while insulin-like growth factor I concentrations decreased from 483 +/- 127 ng/ml to 248 +/- ng/ml. Of the 12 patients 7 (58%) had serum growth hormone levels considered as safe values (< 2.5 ng/ml), whereas in 9 patients (75%) serum insulin-like growth factor I concentrations returned to age- and sex-matched normals. Repeat pituitary magnetic resonance imaging performed in 8 patients treated longer than 1 year revealed a decrease of tumor size in 3 patients (37%). There was a considerable clinical improvement during treatment: severe headache, which was present in most patients, as well as perspiration, joint pain, swelling of extremities, and weakness markedly decreased or disappeared. These results indicate that long-acting octreotide offers a very effective treatment of choice in acromegalic patients in whom other previous therapies were ineffective, contraindicated, or refused.

Book reviews

Karl-Heinz Waldmann and Michael Wendt (editors), Klaus Bickhardt, Karl Heinritzi, Karl Heinz Lahrmann, Hans Plonait†, Karl-Heinz Waldman, Michael Wendt and Werner Zimmermann (co-authors):Lehrbuch der Schweinekrankheiten (Textbook of Swine Diseases). Parey Buchverlag, Berlin, 2001. 3rd revised edition. 626 pages with 318 figures and 63 tables. Format 17 × 24 cm. ISBN 3-8263-3373-X. Price: € 89.95.  Roy Mack, Bettina Mikhail and Michel Mikhail:Dictionary of Veterinary Medicine and Biosciences / Wörterbuch der Veterinärmedizin und Biowissenschaften / Dictionnaire de médecine vétérinaire et des sciences biologiques (English-German-French). 3rd, revised and expanded edition, 2002. Parey Buchverlag, Berlin. 1692 pages. 17 × 24 cm. ISBN 3-8263-3405-1. Price: € 94.95.  Környezet- és Természetvédelmi Lexikon (Encyclopaedia of Environmental Protection and Nature Conservation) (in Hungarian language). 2nd, revised and expanded edition. Akadémiai Kiadó, Budapest, 2002. Hardcover, two volumes (664 and 588 pages).

Mechanisms underlying delayed afterdepolarizations in hypertrophied left ventricular myocytes of rats

Cardiac hypertrophy was induced in rats by daily injection of isoproterenol (5 mg/kg ip) for 7 days. Membrane voltage and currents were recorded using the whole cell patch-clamp technique in left ventricular myocytes from control and hypertrophied hearts. Ryanodine-sensitive delayed afterdepolarizations (DADs) and transient inward current (I(ti)) appeared in hypertrophied cells more often and were of larger amplitude than in control cells. DADs and I(ti) are carried principally by Na/Ca exchange with smaller contributions from a nonselective cation channel and from a Cl- channel. The latter is expressed only in hypertrophied myocytes. In hypertrophy, the density of caffeine-induced Na/Ca exchange current (I(Na/Ca)) was increased by 26%, sarcoplasmic reticulum (SR) Ca2+ content as assessed from the integral of I(Na/Ca) was increased by 30%, the density of Na-pump current (I(pump)) was reduced by 40%, and the intracellular Na+ content, measured by Na+-selective microelectrodes was increased by 55%. The results indicate that DADs and I(ti) are generated by spontaneous Ca2+ release from an overloaded SR caused by a downregulated Na pump and an upregulated Na/Ca exchange. These findings may explain the propensity for arrhythmias seen in this model of hypertrophy.

Pathological and immunological study of an in ovo complex vaccine against infectious bursal disease

The appearance of very virulent strains of infectious bursal disease (IBD) virus at the end of the 1980s made it necessary to develop more effective immunization procedures. To facilitate this, the immunogenicity and the immunosuppressive effect of a mild (G-87), an intermediate (LIBD) and an intermediate-plus (IBDV 2512) IBDV strain were tested after the in ovo inoculation of 18-day-old SPF and broiler chicken embryos. It was established that no noteworthy difference existed between the immunized and the control embryos in hatching rate and hatching weight. The higher the virulence of the vaccine virus strain, the more severe damage it caused to the lymphocytes of the bursa of Fabricius. In SPF chickens, the haemagglutination inhibition (HI) titres induced by a Newcastle disease (ND) vaccine administered at day old decreased in inverse ratio to the virulence of the IBD vaccine strain, while in broiler chickens this was not observed. Despite the decrease of the HI titre, the level of protection did not decline, or did so only after the use of the 'hot' strain. SPF chickens immunized in ovo with a complex vaccine prepared from strain IBDV 2512 and IBD antibody showed the same protection against Newcastle disease as the broilers. In broiler chicken embryos immunized in ovo, only strain IBDV 2512 induced antibody production, and such chickens were protected against IBD at 3 weeks of age. The complex vaccine administered in ovo has been used successfully at farm hatcheries as well.

Functional restoration of the bursa of Fabricius following in ovo infectious bursal disease vaccination

The primary role of the avian bursa of Fabricius is to provide an essential microenvironment for B-lymphocytes to diversify their immunoglobulin genes by gene hyperconversion. Infectious bursal disease (IBD) vaccination using intermediate plus vaccine strains can temporarily deplete the bursal follicles and interrupt the normal B-cell development, which is generally followed by B-cell repopulation and histological regeneration. To find evidence that functional restoration of the bursa of Fabricius occurs in addition to the histological regeneration, we have analysed the chB1 gene expression, which indicates active bursal B-lymphocytes, and also the surface expression of a carbohydrate structure Lewis(x), a marker which identifies those bursal B-lymphocytes that are undergoing gene hyperconversion. In ovo vaccination with an immune complex vaccine (IBDV-BDA) caused transient bursal destruction in both the SPF and the maternally protected broiler groups with differences evident in the starting time, the severity and the duration of the effect. After the depletion phase, signs of histological regeneration appeared together with chB1- and Lewis(x) expression indicating that B-lymphocytes were functionally active and the bursa of Fabricius was serving again as an efficient primary lymphoid organ providing an appropriate microenvironment for B-cell development.