Social Learning: A Model for Policy Research

This paper concerns the question of how policy research can be made more useful in practice. Two types of policy research may be distinguished. The first is research on issues in the public realm and not addressed to a specific client. The "consumers" of this type of research -- those whom it stimulates to thought -- are other interested scholars and practitioners, and the arguments proceed from many different quarters and perspectives. Answers given in this context are neither right nor wrong: they merely illuminate an issue of public concern and enhance our understanding of it. In this special sense, policy research resembles, in Cohen and Garet's language, "a discourse about social reality -- a debate about social problems and their solutions". The second type of policy research does have a client and is therefore pitched to an existing social problem that is located within a specific policy environment. Although we recognize that the distinction we are attempting to draw is imprecise, we propose to deal in this paper with only the second type of policy research and further limit ourselves to social policy. Such research is bought and sold, but its results are rarely used in the solution of a problem. Our intention, then, is to find out why and in what circumstances this outcome is highly probable and what, if anything, might be done about it

Persistence with statin therapy in Hungary

Introduction: Persistence with lipid-lowering drug therapy by cardiovascular patients in Hungary has not been studied previously. This study was designed to determine the rate with which Hungarian patients with hyperlipidemia persist in taking lipid-lowering agents, and to compare this with rates reported from other countries. Material and methods: This was a retrospective study that utilized data from the Institutional Database of the National Health Insurance Fund to analyze persistence rates with statins and ezetimibe. The study included data for patients who started lipid-lowering therapy between January 1, 2007, and March 31, 2009. Variables included type of lipid-lowering therapy, year of therapy start, and patient age. Main outcome measures were medians of persistence in months, percentages of patients persisting in therapy for 6 and 12 months, and Kaplan-Meier persistence plots. Results: The percentage of patients who persisted with overall statin therapy was 46% after 1 month, 40.3% after 2 months, 27% after 6 months, and 20.1% after 12 months. Persistence was slightly greater for statin therapy started during 2008 than during 2007. Older patients were more persistent with therapy than younger patients. Persistence with the combination of ezetimibe-statin therapy was greater than with statin or ezetimibe monotherapy. Conclusions: Persistence with statin therapy by patients in Hungary was low compared with other countries. Low persistence may have negated potential clinical benefits of long-term statin therapy

A cukorbeteg-ellátás mutatóinak alakulása Magyarországon 2001–2014 között. Az Országos Egészségbiztosítási Pénztár adatbázis-elemzésének célja és módszertana

In the last couple of years, database analyses have become increasingly popular among clinical-epidemiological investigations. In Hungary, the National Health Insurance Fund serves as central database of all medical attendances in state departments and purchases of drug prescriptions in pharmacies. Data from in- and outpatient departments as well as those from pharmacies are regularly collected in this database which is public and accessible on request. The aim of this retrospective study was to investigate the database of the National Health Insurance Fund in order to analyze the diabetes-associated morbidity and mortality in the period of years 2001-2014. Moreover, data of therapeutic costs, features of hospitalizations and practice of antidiabetic treatment were examined. The authors report now on the method of the database analysis. It is to be hoped that the upcoming results of this investigation will add some new data to recent knowledge about diabetes care in Hungary. Orv. Hetil., 2016, 157(32), 1259-1265

A 2-es típusú diabetes antihyperglykaemiás kezelésének alakulása Magyarországon 2001–2014 között – az Országos Egészségbiztosítási Pénztár adatbázis-elemzésének eredményei

In the last couple of years, significant developments in antidiabetic treatment have influenced the pharmacological treatment of type 2 diabetes mellitus (T2DM). The aim of this study was to analyze the changes in prescribing patterns of glucose-lowering drugs for T2DM patients in Hungary between 2001 and 2014. The number of patients with newly diagnosed T2DM decreased from 75,700 (2001) to 33,700 (2014), while prevalent T2DM cases continuously increased and plateaued in 2014 with a number of registered patients of 727,000. Sulfonylurea-monotherapy decreased from 64% to 35% while metformin-monotherapy increased from 19% to 42% in this period. The most frequently used drug at first treatment initiation was metformin (66%) and sulfonylurea (16%) as monotherapy in 2014. DPP4-inhibitors were newly administered in 20,362 cases while GLP1-mimetics were newly used by 4,996 patients in 2014. Five years later after initiating sulfonylurea therapy between 2010 and 2014, metformin was more frequently used as second drug (39%) than sulfonylurea in patients with previous metformin treatment (22.9%). The prescribing patterns of glucose-lowering drugs have changed over time in accordance with new guidelines. Further changes in prescribing habits can be expected in the near future. Orv Hetil. 2017; 158(20): 770-778

Exploring the link between student placement learning in business organizations and self-employment preparatory behaviours

This study draws on social cognitive career theory to test a moderated mediation model of self-employment preparatory behaviours in university students undertaking placement learning in a business organization (PLBO). Using data from 337 university students undertaking work placement in 123 business organizations, the study hypotheses were tested using PROCESS Macro 3.5. The results revealed that PLBO significantly influenced student self-employment self-efficacy, self-employment outcome expectations and self-employment preparatory behaviours. Also, self-employment self-efficacy and self-employment outcome expectations mediated the relationship between work placement learning and self-employment preparatory behaviours. However, placement supervisor support interacted with PLBO such that greater support from placement supervisors contributed to stronger self-employment preparatory behaviours. The placement learning supervisor support moderated the indirect effect of PLBO on self-employment preparatory behaviours via self-employment self-efficacy and self-employment outcome expectations at all levels (–1SD, Mean and +1SD)

HYPOGLYCAEMIC AND HAEMATINIC PROPERTIES OF ETHANOL LEAF EXTRACT OF ARTOCARPUS HETEROPHYLLUS IN ALLOXAN INDUCED DIABETIC RATS.

Background: Anaemia is known to be associated with diabetes; moreover, with the increasing cases of diabetes there is need for the use of more affordable alternative herbal medicines for the treatment of diabetes and anaemia. The aim of this work was to evaluate the hypoglycaemic and haematinic properties of Artocarpus heteropyllus on diabetic rats. Materials and Methods: Ethanol leaf extract of Artocarpus heteropyllus was screened for phytochemicals and its acute toxicity was tested on mice. Induction of diabetes was done at a dose of 150 mg/kg body weight (b.w) (with exception of the control group). The extract was administered to rats for a period of 7 days at 100, 300 and 500 mg/kg b.w, respectively, following induction. Blood samples of rats were tested for fasting blood sugar (FBS), packed cell volume (PCV), white blood cell (WBC), red blood cell (RBC), haemoglobin, neutrophil lymphocyte and eosinophil counts. Results: The ethanol leaf extract of A. heterophyllus showed no mortality up to a dose of 5000 mg/kg b.w. Administration of the extract to diabetic rats resulted in a decrease in the FBS of diabetic rat, and significant increases (p< 0.05) in RBC, PCV, WBC and haemoglobin levels. Conclusion: The ethanol leaf extract of A. heterophyllus increased the haematological indices of diabetic rats. Our findings support the use of this plant as an herbal alternative in the treatment of diabetes and anaemia associated diabetes

Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic

ObjectiveThe approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database.MethodsThis retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology.ResultsIn total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1–66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011–2012 (28.7% [95% CI: 26.4%–30.9%] vs. 14.45% [95% CI: 13.21%–15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%–25.2%) and 13.37% (95% CI: 11.8%–15.0%) in 2019 and 2011–2012, respectively, the change was statistically significant. Compared to 2011–2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015–2016, 2017–2018, and 2019, respectively (p&lt;0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p&lt;0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020–2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period.Conclusion3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic

Bocepreviralapú hármas kezelés hatékonyságának és biztonságosságának retrospektív elemzése előrehaladott fibrosisstádiumú, hepatitis C-vírus 1-es genotípussal fertőzött, korábban sikertelenül kezelt magyar betegeknél

INTRODUCTION: During 2011 and 2013, 155 Hungarian hepatitis C genotype 1 infected patients, mostly with advanced liver fibrosis, who did not respond to prior peginterferon + ribavirin dual therapy, started boceprevir based triple therapy in an early access program. AIM AND METHOD: Efficacy and safety of the therapy was retrospectively assessed based on sustained virologic responses, as well as on frequency and type of serious adverse events and of those leading to therapy discontinuation. RESULTS: In an intent-to-treat analysis 39.4% patients (61/155) reached sustained virologic response. Amongst pervious relapsers, partial responders and null-responders 59.5%, 41.4 % and 22.9% (p<0.05 compared to the other two categories) reached sustained virologic response, respectively, while amongst non-cirrhotics and cirrhotics 52.5% and 31.3% (p<0.05 compared to the non-cirrhotics) achieved sutained virologic response, respectively. Six out of the 33 most difficult to cure patients (previous null responder and cirrhotic) have reached sustained virologic response (18.2%). Frequency of early discontinuations due to insufficient virologic response was 31.1%, while due to adverse event 10.3%. Reported frequency of serious adverse event was 9.8%. These events represented anemia, diarrhoea, depression, agranulocytosis, elevated aminotransferases, generalized dermatitis and severe gingivitis with loss of teeth, prolonged QT interval on ECG, generalized oedema and severe dyspnoea, uroinfection, exacerbation of Crohn's disease, Campylobacter pylori infection and unacceptable weakness and fatigue. Eight patients received transfusion, 4 patients erythropoietin and 1 granulocyte colony stimulating factor during therapy. No death has been reported. CONCLUSIONS: With boceprevir based triple therapy, one of the bests available in 2011-2013 in Hungary, a relevant proportion of hepatitis C infected patients with advanced liver fibrosis achieved sustained viral response. In this cohort, side-effects resembled those reported in registration studies, and resulted in therapy discontinuation with consequent treatment failure in a relevant number of patients. Efficacy and tolerability of boceprevir-based triple therapy are suboptimal, particularly in the most difficult to cure patient population. Orv. Hetil., 2016, 157(34), 1366-1374

How length of light exposure shapes the development of riverine algal biomass in temperate rivers?

The impact of cumulative daily solar radiation (CDSR) on the biomass of river phytoplankton (Chl-a) in the growing season was studied using a large dataset of rivers in the Carpathian Basin. The amount of solar radiation was cumulated over the range of 1–60 days. The CDSR–Chl-a relationship could be described by linear regression and appeared to be significant for almost all watercourses with the exception of rivers with short water residence time. To determine the most relevant time period of CDSR impacting phytoplankton biomass, the slopes of regressions were plotted against the accumulating number of days of light exposure (1–60). Two characteristic shapes were obtained: unimodal for rhithral rivers with hard substrate and steady increase for lowland potamal rivers with fine substrate. In both cases, there is an increasing tendency in the slope values with water residence time (WRT). It was demonstrated that CDSR has a pronounced impact on river phytoplankton biomass even in cases when WRT was shorter than the cumulated solar radiation period. These results indicate that development of phytoplankton within the river channel is a complex process in which meroplankton dynamics may have significant impacts. Our results have two implications: First, CDSR cannot be neglected in predictive modelling of riverine phytoplankton biomass. Second, climate models forecast increased drought with subsequently increased CDSR in several regions globally, which may trigger a rise in phytoplankton biomass in light-limited rivers with high nutrient concentrations