Behaviour does not fully explain the high risk of chronic liver disease in less educated men in Hungary.

BACKGROUND: Hungary has among the highest mortality rates from chronic liver disease (CLD) and cirrhosis in Europe. Usually, conventional behavioural factors are hypothesized as the cause of the high risk of CLD. METHODS: A case-control study was performed with 287 cases and 892 controls to study the relationship between socio-economic and behavioural factors and the risk of CLD. Liver disease was verified by physical examination and blood tests. Blood samples were collected for detecting hepatitis B, C and E virus infection. Information on exposure factors was recorded by the participating physicians and by self-administered questionnaire. Simple regression analysis was used to study the relationship between CLD/cirrhosis and potential risk factors as alcohol intake (amount and source), problem drinking, cigarette smoking, physical activity, viral hepatitis infections, socio-economic factors (education, financial and marital status). Multiple regression analysis was used to identify whether the effect of socio-economic factors is fully mediated by health behaviour (smoking, alcohol consumption, physical activity). RESULTS: The univariate analysis showed that heavy alcohol consumption, problem drinking, former and heavy cigarette smoking, single, separated or divorced marital status, bad or very bad perceived financial status and lower education significantly increased the risk of CLD/cirrhosis. The effect of marital status and of education did not change after adjustment for behavioural factors, but the effect of perceived financial status disappeared. CONCLUSIONS: The effect of low socio-economic status on the risk of CLD/cirrhosis is only partially explained by conventional behavioural risk factors in Hungary.

[Prevention of malignant tumors caused by human papilloma virus (HPV) by vaccination and with the methods of classical gynecologic diagnostics]. / A humán papillomavírus (HPV) okozta rosszindulatú daganatok megelozése védooltással es a klasszikus nogyógyászati diagnosztika módszereivel.

The "gold standard" of the gynecologic examinations is even today the classical clinical examination completed with the digital colposcopy, the Pap smears prepared from transport media and histological examination of biopsy material. Without these classical examinations one cannot evaluate the results of the molecular tests detecting papillomaviruses. The majority (70 to 90%) of the primary clinical symptoms caused by papillomaviruses recovers spontaneously. The recovery can be supported by, "imiquimod" (Aldara) which is an immunostimulant-inducing interferon gamma and the production of interleukins, since papillomavirus infection is able to prevent the production of these mediators through its blocking effect to the innate immunity. Prevention is the main aim of the contemporary public health facilitated by the modern gene technology. The tetravalent vaccine (types 6, 11, 16 and 18) is harmless, since no tumor inducing genes are included. The empty capsids are manufactured in yeast cells and purified to a high degree similar to that of hepatitis B vaccine. The tetravalent vaccine is a preventive vaccine. It will be useful for teenagers, who have not acquired yet the most common papillomavirus types. There is intensive research going on in order to create therapeutic vaccines, that might be effective also in people of older age who had acquired certain virus types before vaccination, and may possess clinical symptoms, too. Men are the source of papillomavirus infection of women. Therefore vaccination of both genders will be indicated. The importance of the classical diagnostic procedures will not be diminished even under the umbrella of vaccination, since the preventive efforts were shown to be fully effective, if the clinical examinations, colposcopy, pap smears and biopsies are regularly performed in the patients with clinical symptoms increasing the rate of recovery above 90%. About 13 to 15 subtypes of human papillomaviruses may induce malignant processes. These are also present and most frequent in Hungary both in sexually transmitted infections and in the cancers of head and neck.

Accident settlement for avian influenza in travel health insurance.

Among those infectious diseases that lead to insurance settlement for damages, we normally list those cases that do not involve person-to-person transmission, but rather those cases wherein the harmful agent enters the body without the intention of the person harmed, and which causes acute infectious disease or food poisoning. This is the way in which, for example, tick-borne encephalitis following an insect bite, rabies caused by animal bites, and acute food poisoning contracted in restaurants or from public catering arise. We can also list among the latter those cases of avian influenza illness, which arise through the involuntary consumption of infected animal meat (not ignoring occupational health and safety regulations). These insurance cases arise particularly when travel to countries with a high level of infection of livestock with avian influenza is involved. In these cases of illness, there is justification for including an accident indemnity payment--in addition to covering the costs related to health care--within the remit of travel health insurance.

Toxoplasmosis surveillance during pregnancy and quality assurance of methods in Hungary.

In Hungary, screening programs have been performed for the early detection of toxoplasmosis in pregnant women in three different counties. The results of a screening program performed in the town of Szeged are discussed in details. The pregnant women are screened by serological and molecular biological methods (anti-Toxoplasma CFT, IgG, IgM, anti-P30 IgA ELISA, IgG avidity test, PCR amplification). The women are first screened within the first 16 weeks of gestation. Seronegative cases are retested for seroconversion in every second month. Appropriate treatment is immediately started both in the mothers suspicious of acute toxoplasmosis and in their offspring. The urine samples of the babies are examined by nested PCR specific to B1 gene of Toxoplasma gondii. No cases of congenital toxoplasmosis have been detected among the screened and treated children so far. Thus, we consider the program as highly successful for screening of congenital toxoplasmosis. To insure the quality of the applied laboratory diagnostic methods, the QualiCont Company organizes two quality control investigations yearly in the laboratories involved.

[Malaria in Hungary: origin, current state and principles of prevention]. / A maláriakérdés Magyarországon: elózmények, aktuális állapot és védekezési elvek.

Malaria was an endemic disease in Hungary for many centuries. A country-wide survey of the epidemiologic situation on malaria started in the year of 1927. That was done by the Department of Parasitology of the Royal State Institute of Hygiene (presently: Johan Béla National Center for Epidemiology). The notification of malaria was made compulsory in 1930. Free of charge laboratory examination of the blood of persons suffering from malaria or suspected of an infection have been carried out. Anti-malarial drugs were also distributed free of charge, together with appropriate medical advise given at the anti-malarial sanitary stations. Between 1933 and 1943, the actual number of malaria cases was estimated as high as 10-100,000 per year. The major breakthrough came in 1949 by the organized antimalarial campaign applying DDT for mosquito eradication. The drastic reduction of the vectors resulted in the rapid decline of malaria cases. Since 1956, there have not been reported any indigenous case in Hungary. In 1963, Hungary entered on the Official Register of the WHO to the areas where malaria eradication has been achieved. During the period of 1963-2001, 169 Hungarians acquired the malaria in abroad and 263 foreigners infected in abroad were registered in Hungary. More than half of the cases (230) were caused by Plasmodium falciparum. Further 178 cases were caused by Plasmodium vivax and 24 cases by other Plasmodium species. During that period, 7 fatal cases were reported (Plasmodium falciparum). The expansion of migration (both the increase of the number of foreigners travelling into Hungary and of Hungarians travelling abroad) favours to the appearance of imported cases. Attention is called of all the persons travelling to malaria endemic countries to the importance of malaria prevention by the International Vaccination Stations located in the National Center for Epidemiology and in the Public Health Institutes of 19 counties and of Budapest. The Johan Béla National Center for Epidemiology issued a protocol in 2001, the title of which is: "Antimalarial defence". This helps the information activity of the International Vaccination Stations. To prevent malaria infections, systemic mosquito eradication is organized and supervised by the Office of the Chief Medical Officer at the touristically important areas in the summer season.