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The care of people living with mental illness in the Hungarian social care system: The process of deinstitutionalization and the phenomenon of stigmatization 匈牙利社会护理系统中对精神病患者的护理:去机构化进程和污名化现象
Pub Date : 2019-03-01 DOI: 10.1556/2066.2.2019.001
A. Ács, E. Molnár, G. Molnár, Z. Balogh
The aim of this study is to present a situation assessment within the framework of a comprehensive study of the social services for people with mental illness in Hungary. After setting the historical background, we describe in detail the current services, their anomalies, and the ongoing implementation of a strategy to deinstitutionalize them. We reviewed the related academic literature and systematically collected and elaborated upon legal documents, decisions, and data from national databases. We established that a paradigm shift is taking place in the social care of people with mental disorders in Hungary. The lack of human resources, the paternalistic, institution-centered attitude, the mass supply of social services in dilapidated buildings, and the stigmatization of patients are among the greatest problems. Cooperation between the health and social sectors is inadequate and, in the interests of patients, needs to be improved. Hungary needs a complex, integrated, health-and-social-care supply system for people living with mental illness, one that takes into account both personal needs and assistance to recovery. In the continuation of the deinstitutionalization process, emphasis should be placed on social sensitization.
这项研究的目的是在对匈牙利精神疾病患者的社会服务进行全面研究的框架内提出一项情况评估。在设定了历史背景之后,我们详细描述了当前的服务,它们的异常情况,以及正在实施的将它们去机构化的策略。我们查阅了相关的学术文献,并系统地收集和阐述了法律文件、决定和国家数据库中的数据。我们确定,匈牙利对精神障碍患者的社会护理正在发生范式转变。人力资源的缺乏、家长式的、以机构为中心的态度、在破旧的建筑中大量提供社会服务以及对患者的污名化是其中最大的问题。卫生和社会部门之间的合作不足,为了病人的利益,需要加以改进。匈牙利需要为精神病患者建立一个复杂、综合的保健和社会保健供应系统,这个系统既要考虑到个人需要,也要考虑到对康复的帮助。在继续进行非机构化进程时,应强调提高社会敏感性。
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引用次数: 4
Results of CO2 laser-assisted sclerotomy surgery (CLASS procedures) in eyes with primary open-angle glaucoma CO2激光辅助巩膜切开术治疗原发性开角型青光眼的疗效观察
Pub Date : 2018-12-01 DOI: 10.1556/2066.2.2018.20
Z. Nagy, M. Bausz, Kinga Kránitz, Huba J. M. Kiss
This study aimed to examine the effectiveness of CO2 laser-assisted sclerectomy surgery (CLASS) in eyes with primary open-angle glaucoma (POAG) showing progression in spite of maximal local antiglaucomatous therapy. Patients with progressive POAG received CLASS treatment. We performed CLASS on 15 eyes (eight males and seven females). The primary endpoint was the change in the intraocular pressure (IOP), and additionally best spectacle-corrected visual acuity (BSCVA), C/D ratio (cup-to-disc), as well as use of antiglaucomatous drops were also investigated. Following the preoperative assessment, measurements were performed at 6-month follow-up. The average preoperative IOP was 26.13 ± 6.79 mmHg that dropped to 9.57 ± 4.09 mmHg at 1 day. IOP was stable at 1 month, 3 months, and 6 months. The BSCVA decreased to the 1-day and 1-week follow-up but returned to its original value to the 1-month check-up. Preoperatively, all patients were on maximal antiglaucoma drop therapy, after CLASS none of the patients needed antiglaucomatous treatment at 1 month. However, at 3 months, one of them needed antiglaucoma drops. C/D ratio showed non-significant changes. CLASS procedure was found to be effective in decreasing IOP in POAG patients whose IOP was not compensated with maximal antiglaucomatous local therapy; patients needed significantly less local therapy following the CO2 laser surgery.
本研究旨在探讨CO2激光辅助巩膜切除术(CLASS)治疗原发性开角型青光眼(POAG)的有效性,尽管进行了最大限度的局部抗青光眼治疗,但仍有进展。进行性POAG患者接受CLASS治疗。我们对15只眼睛(8只雄性和7只雌性)进行了CLASS手术。主要终点是眼压(IOP)的变化,此外还调查了最佳眼镜矫正视力(BSCVA), C/D比(杯盘)以及抗青光眼滴剂的使用情况。术前评估后,随访6个月进行测量。术前平均IOP为26.13±6.79 mmHg, 1 d后降至9.57±4.09 mmHg。IOP在1个月、3个月和6个月时稳定。BSCVA在随访1天1周时有所下降,但在随访1个月时恢复到初始值。术前所有患者均给予最大剂量抗青光眼滴药治疗,CLASS术后1个月无患者需要抗青光眼治疗。然而,在3个月时,其中一人需要抗青光眼滴眼液。C/D比值变化不显著。发现CLASS手术可有效降低POAG患者的IOP,其IOP不能通过最大限度的抗青光眼局部治疗来补偿;患者在CO2激光手术后需要的局部治疗明显减少。
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引用次数: 0
Analysis of subjective experiences of breast cancer patients receiving hypnosis, music, or special attention, during chemotherapy treatment: A content analysis 化疗期间接受催眠、音乐或特别关注的乳腺癌患者的主观体验分析:内容分析
Pub Date : 2018-12-01 DOI: 10.1556/2066.2.2018.19
A. Vargay, Zsuzsa Kaló, O. Zsigmond, E. Józsa, T. Thurzó, G. Kober, É. Bányai
The effectiveness of psychotherapeutic techniques with breast cancer patients has been extensively studied; however, there is limited information available on subjective experiences of patients. The aim of this study was to establish a category system and describe the characteristics of patients’ subjective experiences in three different intervention groups: hypnosis, music, and special attention. Content analysis of short interviews after 21 sessions of intervention was conducted to examine and compare subjective experiences in hypnosis, music, and special attention. Two types of coding system were developed: Characteristics of Involvement (CI) and Intensity of Involvement (II). Based on CI, the most dominant subjective experience of breast cancer patients was the “Pleasant Somatic Experience.” Furthermore, “Visualisation of Symbols” was the most frequent in the hypnosis intervention. Based on II, most common experience of the special attention group was coded as “low intensity.” The frequencies of “low/high intensity” experiences were different between hypnosis and music interventions. “High intensity” was more dominant in hypnosis than music intervention. Both category systems may be reliable tools to examine patients’ subjective experience. Hypnosis as intervention can result in more extended subjective experiences in CI and II.
心理治疗技术对乳腺癌患者的有效性已经得到了广泛的研究;然而,关于患者主观经验的信息有限。本研究旨在建立一个分类系统,描述催眠、音乐和特别注意三种不同干预组患者主观体验的特征。对21期干预后的短访谈进行内容分析,以检验和比较催眠、音乐和特别关注的主观体验。开发了两种编码系统:参与特征(CI)和参与强度(II)。基于CI,乳腺癌患者最主要的主观体验是“愉快的躯体体验”。此外,“符号视觉化”在催眠干预中是最常见的。基于II,特别关注组的大多数常见经验被编码为“低强度”。“低/高强度”体验的频率在催眠和音乐干预之间是不同的。“高强度”在催眠中比音乐干预更占优势。这两种分类系统可能是检查患者主观经验的可靠工具。催眠作为干预可以在CI和II中导致更广泛的主观体验。
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引用次数: 0
The antifungal effect of the biopreparation of Xenorhabdus budapestensis bacteria on some Candida species budapestxenorhabdus budapestensis细菌生物修复剂对部分念珠菌的抑菌作用
Pub Date : 2018-11-13 DOI: 10.1556/2066.2.2018.17
É. Böszörményi, S. Nemeth, A. Fodor, K. Bakó, Dávid Vozik, Z. Csima, I. Barcs
The prevalence of invasive fungal diseases shows an increasing trend. Due to the frequent but unprofessional usage of antifungal medications, the fungi show decreasing susceptibility towards these agents and this trend may lead to the emergence of resistant pathogens. There is a great need to develop antifungal medications with new mechanisms. One of these options is to apply proteins with natural antifungal effects. The objective was to measure the antifungal efficacy of Xenorhabdus budapestensis in vitro on clinical Candida species (Candida albicans, Candida lusitaniae, Candida krusei, Candida kefyr, Candida tropicalis, and Candida glabrata). Materials and methods: We defined the sensitivity of the Candida species towards antibiotics. We conducted agar diffusion tests with the cleaned biopreparation of X. budapestensis (100%) and its dilutions (80%, 60%, 40%, and 20%). Zones of inhibition were measured after 24, 48, and 96 hr. Most of the tested Candida species have shown sensitivity to the biopreparation and its 40% dilution. The area of the zones of inhibition did not decrease after several days. The most sensitive species was C. lusitaniae and the least sensitive was C. krusei. We assume that the proteins produced by X. budapestensis have antifungal effect, as the area of the zones of inhibition did not change.
侵袭性真菌病的发病率呈上升趋势。由于频繁但不专业地使用抗真菌药物,真菌对这些药物的敏感性下降,这一趋势可能导致耐药病原体的出现。开发具有新机制的抗真菌药物是非常必要的。其中一个选择是使用具有天然抗真菌作用的蛋白质。目的是测定budapestxenorhabdus budapestensis对临床念珠菌(白色念珠菌、卢西念珠菌、克鲁氏念珠菌、kefyr念珠菌、热带念珠菌和光秃念珠菌)的体外抑菌效果。材料和方法:确定念珠菌对抗生素的敏感性。琼脂扩散试验采用清净的布达巴氏X.(100%)及其稀释液(80%、60%、40%和20%)。24、48和96小时后测定抑制区。大多数被检测的念珠菌对生物制剂及其40%稀释度表现出敏感性。几天后,抑制区面积没有减少。其中最敏感的是卢西塔蝇,最不敏感的是克氏蝇。由于抑制区面积没有发生变化,我们推测布达霉产生的蛋白具有抗真菌作用。
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引用次数: 0
Synthetic cannabinoid and synthetic cathinone use in Hungary: A literature review 合成大麻素和合成卡西酮在匈牙利的使用:文献综述
Pub Date : 2018-11-13 DOI: 10.1556/2066.2.2018.18
M. Kapitány-Fövény, J. Rácz
In the past decade, novel psychoactive substances (NPSs) gained a significant role on the contemporary drug scene. Synthetic cathinones and synthetic cannabinoids are the most common NPSs both in Hungary and worldwide. This study aims to provide a literature review on the Hungarian characteristics related to the use of these NPSs. Available literature regarding synthetic cathinone and cannabinoid use in Hungary was overviewed and structured into (a) epidemiological studies, (b) studies on the subjective and somatic effects, and (c) studies on toxicity and adverse consequences. Published papers between 2007 and 2017 were identified using PubMed and MATARKA search engines. One hundred twenty-six papers were identified and after exclusion, 54 papers remained for in-depth analysis. Most of the reviewed studies were providing epidemiological information regarding the NPSs of our interest. Hungarian prevalence rates were not higher than the European averages. Identified risks of these NPSs consisted of drug-induced psychosis, further severe psychiatric symptoms, and fatal overdose. Injecting of cathinones was also a commonly reported phenomenon, mostly among clients of needle-exchange programs. Based on the reviewed body of research, necessary information is available to plan effective prevention and intervention programs and establishes specific therapeutic guidelines for the treatment of NPS users.
在过去的十年中,新型精神活性物质(nps)在当代毒品领域发挥了重要作用。合成卡西酮和合成大麻素是匈牙利和全世界最常见的nps。本研究的目的是提供一个文献综述有关匈牙利的特点,这些nps的使用。对匈牙利有关合成卡西酮和大麻素使用的现有文献进行了概述,并将其分为(a)流行病学研究,(b)主观和身体影响研究,以及(c)毒性和不良后果研究。使用PubMed和MATARKA搜索引擎确定2007年至2017年发表的论文。共确定了126篇论文,排除后,仍有54篇论文有待深入分析。大多数审查的研究都提供了我们感兴趣的nps的流行病学信息。匈牙利的流行率并不高于欧洲平均水平。已确定的这些nps的风险包括药物性精神病、进一步严重的精神症状和致命的过量用药。注射卡西酮也是一种普遍报道的现象,主要发生在针头交换项目的客户中。根据审查的研究机构,可以获得必要的信息来计划有效的预防和干预方案,并为NPS使用者的治疗制定具体的治疗指南。
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引用次数: 2
III Comparative Health Sciences Symposium: “Ageing in a human way” 三、比较健康科学研讨会:“人类方式的老龄化”
Pub Date : 2018-09-01 DOI: 10.1556/2066.2.2018.16
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引用次数: 0
The structural components of the situation of nurses in Hungary 匈牙利护士状况的结构组成部分
Pub Date : 2018-09-01 DOI: 10.1556/2066.2.2018.15
I. Vingender, N. Szalóczy, M. Pálvölgyi
The purpose of the research is to assess the socioeconomic and sociocultural status of Hungarian nurses. In the research team working at the Department of Social Sciences, the Faculty of Health Sciences, Semmelweis University, by 2015, the idea surfaced that it would be worthwhile to perform a complex socioeconomic and sociocultural study of this social group. We managed to have a sample representative of educational attainment and residence (N = 682). The survey was conducted with a structured questionnaire of 119 questions, 1,195 items, which was filled out in every county by nurses working in three areas: inpatient care, outpatient care, and general practitioner’s office. The analysed data indicate that nurses are recruited from the lower social strata. This background has a definitive impact on their future careers, both in an existential and in a cultural way. Nurses have persistently arrived from the same background in the past decades (Pearson’s R sig = .244), and have attained the same qualifications (Pearson’s R sig = .204). There is a remarkably significant disparity between the perceived real social situation and the desired social situation, which, on the one hand, explains the genesis and nature of social discontent, and on the other hand indicates the difficulties of solving the problem. Only 3.8% of nurses assess their own social prestige similar to that of the doctors’. The social position of the nurses shows multidimensional and multileveled status inconsistency. First and foremost, we can find a relatively low ascribed and an adequately low achieved social position. This is coupled with a social self-image that, alluding to different (mainly work-related) factors, holds a significantly higher social status as desired and acceptable.
本研究的目的是评估匈牙利护士的社会经济和社会文化地位。Semmelweis大学健康科学学院社会科学系的研究团队在2015年提出了一个想法,即对这一社会群体进行复杂的社会经济和社会文化研究是值得的。我们设法获得了具有教育程度和居住地代表性的样本(N = 682)。该调查采用一份包含119个问题、1195个项目的结构化问卷,由在住院、门诊和全科医生办公室三个领域工作的护士填写。分析的数据表明,护士是从较低的社会阶层招聘的。这种背景对他们未来的职业生涯产生了决定性的影响,无论是在存在主义方面还是在文化方面。在过去的几十年里,护士一直来自相同的背景(Pearson的R值= .244),并且获得了相同的资格(Pearson的R值= .204)。感知到的真实社会状况与期望的社会状况之间存在着显著的差异,这一方面解释了社会不满的成因和性质,另一方面也表明了解决问题的难度。只有3.8%的护士评估自己的社会声望与医生相似。护士的社会地位表现出多维度、多层次的地位不一致。首先,我们可以找到一个相对较低的归属和足够低的社会地位。这与社会自我形象相结合,暗示了不同的(主要是与工作有关的)因素,在期望和可接受的情况下拥有更高的社会地位。
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引用次数: 1
Stigma of substance use in healthcare: A research on contact hypothesis 医疗保健中物质使用的污名化:接触假说的研究
Pub Date : 2018-09-01 DOI: 10.1556/2066.2.2018.14
K. Pfitzner, M. Kapitány-Fövény
Patients suffering from mental disorders and especially substance-use disorders (SUDs) are often stigmatized by both lay individuals and health professionals, which may lead to poorer treatment outcomes. The purpose of this study was to assess the level of stigma against alcohol and drug users among lay respondents and actors of healthcare. An online questionnaire was filled out by a total of 148 participants from three subgroups: (a) 25 addictology professionals, (b) 55 emergency care professionals, and (c) 68 lay individuals outside healthcare. The questionnaire contained standardized scales measuring the severity of substance use, authoritarianism, and own items assessing demographics, attitude towards substance users, and substance-related knowledge. A more accepting attitude towards drug users was explained by the respondents’ own substance use (β = 4.52, p < .01) and knowledge in addictology (β = 2.22, p = .05). Repeated encounters with substance users only showed connection with destigmatization in case of positive experiences. Emergency care professionals were characterized by the most stigmatizing attitude towards substance users. Our results partially support Allport’s contact hypothesis. We emphasize the need of a continuous sensitizing program targeting emergency care professionals in order to change their attitude towards SUD patients.
患有精神障碍,特别是物质使用障碍(sud)的患者往往受到非专业人士和卫生专业人员的侮辱,这可能导致较差的治疗结果。本研究的目的是评估非专业受访者和医疗保健行为者对酒精和药物使用者的污名化程度。来自三个亚组的148名参与者填写了一份在线问卷:(a) 25名成瘾学专业人员,(b) 55名急诊护理专业人员,(c) 68名医疗保健以外的非专业人员。问卷包含测量药物使用严重程度、专制主义的标准化量表,以及评估人口统计、对药物使用者的态度和药物相关知识的自己的项目。被调查者对吸毒者的接受态度与自身物质使用情况(β = 4.52, p < 0.01)和成瘾学知识(β = 2.22, p = 0.05)有关。与药物使用者的反复接触只在积极体验的情况下显示出与去污名化的联系。急诊护理专业人员对药物使用者的态度最具侮辱性。我们的结果部分支持了Allport的接触假说。我们强调需要针对急诊护理专业人员进行持续的致敏计划,以改变他们对SUD患者的态度。
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引用次数: 3
Does level of training predetermine the success rate of prehospital sepsis assessment? A prospective survey on early recognition 培训水平是否预先决定院前败血症评估的成功率?早期识别的前瞻性调查
Pub Date : 2018-07-20 DOI: 10.1556/2066.2.2018.12
P. Kanizsai, G. Molnár, R. Sztudva, T. Berényi, I. Hornyák
Sepsis is a challenge for health professionals. The increasing number of cases emphasizes the importance of early recognition resulting in better survival. Questionnaires were spread focusing on the prehospital recognition, treatment, and care pathway of septic patients. After presenting an initial scenario, other sepsis-like diseases were given as diagnosis of choice and the answers were registered. After redefining the situation, the same potential diagnoses were given and the difference in correct answers was detected. The number of responders was 120. Among them, 33% of responders chose hypovolaemia, 10% allergic reaction, 2.5% endocrine disease, 30.8% systemic inflammatory response syndrome/sepsis, 0.83% internal bleeding, 0.83% drug effect, 2.5% pulmonary embolism, and 19.17% metabolic disorder as primary diagnosis with a significantly higher number of trained paramedics highlighting the correct answer. After redefining the scenario, 63% changed the diagnosis, while 37% did not change (p < .001). Further management was correctly chosen by the majority of responders. The small number of correct answers from non-paramedics highlights the need for more education in identifying the pitfalls of early recognition and therapy of those who attend patients first. Trained paramedics recognize the sepsis better than other representatives, necessitating the introduction of new guidelines.
败血症是卫生专业人员面临的挑战。越来越多的病例强调了早期识别对提高生存率的重要性。针对脓毒症患者院前认知、治疗和护理途径进行问卷调查。在给出一个初始场景后,其他败血症样疾病作为诊断选择,并记录答案。在重新定义情况后,给出相同的潜在诊断,并检测正确答案的差异。应答者人数为120人。其中,33%的应答者选择低血容量、10%的过敏反应、2.5%的内分泌疾病、30.8%的全身炎症反应综合征/败血症、0.83%的内出血、0.83%的药物作用、2.5%的肺栓塞、19.17%的代谢紊乱作为主要诊断,其中训练有素的护理人员中强调正确答案的人数显著高于其他诊断。在重新定义情景后,63%的人改变了诊断,而37%的人没有改变(p < 0.001)。大多数应答者正确地选择了进一步的治疗。来自非护理人员的少量正确答案突出了需要更多的教育,以识别早期识别和治疗那些首先照顾病人的陷阱。训练有素的护理人员比其他代表更能识别败血症,因此有必要引入新的指导方针。
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引用次数: 0
Methodological approach to follow the effectiveness of a hand hygiene peer education training programme at Hungarian schools 跟踪匈牙利学校手部卫生同伴教育培训方案有效性的方法学方法
Pub Date : 2018-07-20 DOI: 10.1556/2066.2.2018.13
H. J. Feith, Á. Lehotsky, Ágnes J. Lukács, E. Gradvohl, R. Füzi, S. D. Mészárosné, I. K. Bihariné, ZS Karacs, ZS Kiss Soósné, András Falus
The authors intended to develop a novel procedure and research method that follows the effectiveness of the peer-educational approach in handwashing among school children. To ask the children about their sociodemographic background, health behaviour, hand hygiene knowledge, and health attitudes, and questionnaires were applied. The education on proper handwashing procedures was followed by a test with a mobile UV-light detection system (Semmelweis Scanner, http://www.handinscan.com/), and the scans were evaluated through an intrinsic computer software. Our newly developed questionnaire-based research method and the hand-rubbing technique followed by a test with a mobile UV-light detection system may become a reliable and valid scientific measurement of the effectiveness of hand hygiene training programmes. The Hand-in-Scan technology and questionnaire-based research method provide proper tools for evaluating the successful peer education method. It can significantly elevate the level of children’s compliance, which leads to a better hygienic consciousness.
作者打算开发一种新的程序和研究方法,遵循同侪教育方法在学龄儿童洗手中的有效性。采用问卷调查的方式了解儿童的社会人口背景、健康行为、手卫生知识和健康态度。在正确洗手程序的教育之后,使用移动紫外线检测系统(Semmelweis扫描仪,http://www.handinscan.com/)进行测试,并通过内置的计算机软件对扫描结果进行评估。我们新开发的以问卷为基础的研究方法和用移动紫外线检测系统进行测试的搓手技术可能成为一种可靠和有效的科学衡量手卫生培训计划有效性的方法。手把手扫描技术和基于问卷的研究方法为评估同伴教育方法的成功提供了适当的工具。可以显著提高儿童的依从性水平,从而提高儿童的卫生意识。
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引用次数: 3
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