Enhanced Pollution Removal with Heat Reclamation in a Small Hungarian Wastewater Treatment Plant

The aim of the research is to outline the possibilities of utilizing waste heat in small municipal wastewater treatment plants. The facility, which was chosen as case-study, accepts about 2,300 m3 of raw sewage daily. In wintertime the wastewater temperature decreases to 10-14 °C which results in lower nitrification capacity based on measurement and validated model results. The excess heat of the wastewater would serve to increase the temperature of the aeration tank in order to enhance the microbiological activity and thus the efficiency of pollutant removal. The amount of reusable waste heat is calculated and with the help of dynamic simulation the effluent quality was determined to compare it with the original results. Increasing the temperature by 6 °C in the aerated tank, ammonium removal could be improved by 61%. This way not only the heat, but the nutrient pollution could be mitigated, too

Hazai kórházi antibiotikum-alkalmazás az elmúlt két évtizedben (1996–2015) | Antibiotic use in the Hungarian hospitals in the last two decades (1996–2015)

Absztrakt Bevezetés: A bakteriális rezisztencia közegészségügyet fenyegető probléma, amely mérsékelhető, lassítható megfelelő antibiotikum-alkalmazással. Célkitűzés: A hazai fekvőbeteg-ellátás szisztémás antibiotikum-felhasználásának bemutatása. Módszer: A kórházi antibiotikum-felhasználási adatokat az Egészségügyi Világszervezet anatómiai-terápiás-kémiai rendszere szerint osztályozták és a Defined Daily Dose metodika szerint kvantifikálták. A standardizálás kórházi betegforgalmi mutatókra, valamint – a nemzetközi összehasonlítás végett – populációra történt. Eredmények: A fekvőbetegszektor antibiotikum-felhasználása az elmúlt 20 évben mennyiségileg kiegyenlített volt (22,4 ± 1,5 DDD/100 ápolási nap), mintázata folyamatos változáson ment keresztül. Megfigyelhettük a parenteralis készítmények alkalmazásának emelkedését (1996-ban 26,4%, 2015-ben 41,6%). Kiemelendő a felhasználás összetételének homogenizálódása az amoxicillin-klavulánsav térnyerése miatt, a fluorokinolon (2,3 vs. 4,2 DDD/100 ápolási nap) és a harmadik generációs cefalosporinfelhasználás (1,0 vs. 2,9 DDD/100 ápolási nap) jelentős emelkedése, valamint a szűk spektrumú penicillinek kiszorulása. Következtetés: A hazai kórházi antibiotikum-felhasználás mennyiségileg alacsony. Ez, illetve a felhasználás mintázatában tapasztalt, nemzetközi mércével is alátámasztott alul- vagy felülreprezentált felhasználás okának és indokoltságának megítélése további vizsgálatot igényel. Orv. Hetil., 2016, 157(46), 1839–l846. | Abstract Introduction: Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. Aim: To quantify systemic antibacterial use in Hungarian hospitals. Method: Consumption data were analysed using the Anatomical-Therapeutic-Chemical – Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. Results: Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. Conclusion: Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839–1846

Dyadic coping in personal projects of romantic partners: assessment and associations with relationship satisfaction

In the present study we describe a context-sensitive, personal-projects-based approach to dyadic coping with stress which adapted the Dyadic Coping Inventory (DCI) for the assessment of dyadic coping strategies in stressful personal projects. In a cross-sectional study, 149 heterosexual Hungarian couples provided evaluations pertaining to their dyadic coping experiences in a stressful everyday project. Explorative factor analyses of personal project-related DCI items provided theoretically meaningful factor structures and the resulting subscales showed excellent reliability. The subscales’ predictive validity was tested in two dyadic analyses using the Actor-Partner Interdependence Model (APIM) whereby positive and negative dyadic coping experiences served as predictors of satisfaction with the dyadic coping process in particular, and with the relationship in general as outcomes. Our results showed that satisfaction with dyadic coping in personal projects is predicted only by the dyadic coping experiences of the respondents (the actor effect), while actor and partner effects proved to be predictive of relationship satisfaction. Negative partner experiences related to dyadic coping predicted lower relationship satisfaction of the female partner, while for males the positive experiences of the partner were found to be more predictive. These results confirm that the contextualized assessment of dyadic coping experiences in specific stressful personal projects is a reliable and valid method. Further methodological and theoretical conclusions are discussed

Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study

The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015–December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, −26.3%), and quinolones (J01M, −36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year’s monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods’ monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged

Gyógyszerrosta: a racionális gyógyszeres terápia meghatározó eleme [Deprescribing: an essential part of rational pharmacotherapy]

A gyógyszerrosta (az angol deprescribing magyar megfelelője) tervezett, szisztematikus gyógyszerleépítési folyamat, amely egészségügyi szakember felügyeletével zajlik, és lényegében a helyes gyógyszerrendelési gyakorlat részének tekintendő. A gyógyszerrosta nemcsak a teljes gyógyszerelhagyást jelentheti, hanem a dóziscsökkentés folyamata is lehet. Megtervezése során létfontosságú figyelembe venni a terápiás célkitűzéseket, valamint a beteg egészségi állapotát, időbeli életkilátását, értékrendjét és igényeit. A gyógyszerrosta célja betegenként változhat, alapvetően azonban prioritásnak tekinthető a beteg számára fontos célok elérése, a beteg életminőségének javítása. Közleményünkben a nemzetközi szakirodalom alapján áttekintjük a gyógyszerrosta folyamatának lehetséges célpontjait: azokat a nagy egészségügyi kockázatú betegcsoportokat, amelyeknél előnyös lehet a gyógyszerleépítés; a gyógyszereket és gyógyszercsoportokat, amelyek szedése esetén szükség lehet a terápia felülvizsgálatára; valamint összefoglaljuk a folyamat lehetséges színtereit. Ezenkívül kitérünk a folyamat általános lépéseire, előnyeire, kockázataira, és ismertetjük a rendelkezésre álló specifikus irányelveket, algoritmusokat. Részletesen tárgyaljuk a folyamatot segítő és hátráltató tényezőket, mind az egészségügyi szakemberek, mind pedig a betegek szemszögéből, végül pedig kitérünk a nemzetközi kezdeményezésekre és a gyógyszerrosta jövőjére is. Orv Hetil. 2023; 164(24): 931–941

Trends in opioid utilization in Hungary, 2006–2020: A nationwide retrospective study with multiple metrics

BACKGROUND: Opioid use is well documented in several countries: some countries struggle with overuse, whereas others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilization in ambulatory care between 2006 and 2020. METHODS: We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15‐year period. We investigated utilization trends, using three volume‐based metrics [defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year]. We stratified data based on administration routes, analgesic potency and reimbursement categories. RESULTS: Total opioid utilization increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (−33% in DID). CONCLUSIONS: Our low utilization numbers might indicate underuse of opioid analgesia, especially for cancer pain. SIGNIFICANCE: This study was one of the recent opioid utilization studies using three volume‐based metrics, covering a long time period. To our knowledge, this was also the first national, population level study describing opioid utilization in Hungary. National opioid utilization data suggested not an overuse but rather an underuse of opioid analgesics in a developed, Central European country

Prescribing Patterns and Variations of Antibiotic Use for Children in Ambulatory Care: A Nationwide Study

The aim of this study was to analyse characteristics of paediatric antibiotic use in ambulatory care in Hungary. Data on antibiotics for systemic use dispensed to children (0–19 years) were retrieved from the National Health Insurance Fund. Prescribers were categorised by age and specialty. Antibiotic use was expressed as the number of prescriptions/100 children/year or month. For quality assessment, the broad per narrow (B/N) ratio was calculated as defined by the European Surveillance of Antimicrobial Consumption (ESAC) network. Paediatric antibiotic exposure was 108.28 antibiotic prescriptions/100 children/year and was the highest in the age group 0–4 years. Sex differences had heterogenous patterns across age groups. The majority of prescriptions were issued by primary care paediatricians (PCP). The use of broad-spectrum agents dominated, co-amoxiclav alone being responsible for almost one-third of paediatric antibiotic use. Elderly physicians tended to prescribe less broad-spectrum agents. Seasonal variation was found to be substantial: antibiotic prescribing peaked in January with 16.6 prescriptions/100 children/month, while it was the lowest in July with 4 prescriptions/100 children/month. Regional variation was prominent with an increasing west to east gradient (max: 175.6, min: 63.8 prescriptions/100 children/year). The identified characteristics of paediatric antibiotic use suggest that prescribing practice should be improved