Survey of Raynaud's phenomenon and systemic sclerosis based on a representative study of 10,000 south-Transdanubian Hungarian inhabitants.

OBJECTIVES: To assess the prevalence of Raynaud's phenomenon (RP) and of RP associated systemic sclerosis (SSc) in a large regional representative study. METHODS: Ten thousand individuals aged between 14-65 years participated in face-to-face interviews. The stratified sample of the South-West Hungarian population was representative for age, sex and urban or rural residence. Individuals reporting complaints suggesting the presence of "clinically significant" RP were asked to undergo a clinical investigation. Patients showing complaints provoked by taking something out of the freezer (-20 degrees C) compartment of the refrigerator and/or whether they had experienced digital ulcers were sorted into this category. RESULTS: The overall prevalence of RP was at least 578.9/10,000, and the prevalence of "clinically significant" RP could be calculated as at least 87.7/10,000 inhabitants. In this latter group 17.2% of the cases had either established SSc or anticentromere antibody or scleroderma capillary pattern on nailfold capillaroscopy. SSc with "clinically significant" RP and/or ulcers was identified in a prevalence of 9.1/10.000 individuals, whilst there was a prevalence of 14.7/10,000 of RP with either anticentromere antibody or scleroderma capillary pattern. CONCLUSIONS: "Clinically significant" RP affects almost 1% of the population. We identified cases with early stages of scleroderma spectrum disorder showing either anticentromere autoantibody or scleroderma capillary pattern. The prevalence of SSc was found to be higher than expected. It is reasonable to screen "clinically significant" RP cases for scleroderma-related symptoms because this approach makes it possible to identify patients with both SSc and early scleroderma related symptoms.

A Multisectoral Approach to Prevention of Lead Poisoning in Hungary: Lessons Learned and Potential for Replicability Elsewhere.

Hungarian and American occupational and environmental health professionals are collaborating in a research and demonstration project designed to prevent lead poisoning in Hungary. Using a multisectoral approach, the project has three phases: data collection and review, risk communication, and facilitation of program and policy development. First, the project team reviewed relevant data of many types through a workshop at which commissioned papers were presented, key-informant interviews, and a survey of knowledge, attitudes, and practices. The team then conducted a multifaceted risk-communication program to disseminate information about lead hazards in general and what had been learned about lead exposures and lead poisoning in Hungary. It presented training workshops for workers exposed to lead at work and for groups serving as "mediators" who could affect others' behavior, such as nongovernmental organizations, labor unions, public health nurses, pediatricians, teachers and students, and coordinators of the Hungarian Healthy Cities Project. It also conducted a campaign of "concentrated action," using a variety of communication approaches directed to car owners, pregnant women, mothers of small children, and others, in order to convey knowledge and change attitudes, emphasizing emotional appeals. Project leaders will organize a multisectoral working group to develop, coordinate, and implement an overall activity plan aiming to reduce lead pollution. The approach developed and used in this project provides a model for preventing lead poisoning that may be transferrable or adaptable for use for preventing lead poisoning and other environmental health problems elsewhere.

Environment, occupation and health: a current perspective for the future in Hungary.

Since 1990 directions of various processes in the field of environmental and occupational health and their influence on the state of health of the population have been discussed at annual symposia organised by the Foundation. In this paper, the authors try to present problems arising from the transformation into the market economy and inherited from the previous regime, discussed during the symposium held in 1993. They also emphasise the significance of appropriate legal regulations, better understanding of the environmental and occupational health, the role of the society in the decision-making process and training of both doctors and workers how to protect health and environment.