Lege Artis Medicinae

[Fourth-year medical students’ views about informal payment in Hungary]


SEPTEMBER 20, 2011

Lege Artis Medicinae - 2011;21(08-09)

[Introduction - Scientific evaluation from ethical, legal and economical aspects of gratuity (informal) payment in the Hungarian health care system was initiated first in the 1980s and was completed by the end of the 1990s. Since then, there are no unanswered scientific questions regarding the evaluation of this phenomenon; however, theoretical studies did not have any practical consequences. Healthcare policy has been experimenting with indirect initiatives, relying on the changing behaviour of all involved partners. Parallelly, in the past two decades opinion polls were published on the sum and allocation of informal payments as well as empirical surveys on the attitudes of stakeholders. Among these surveys, we consider it particularly important to study the views of medical students who are not yet directly interested in gratuity business but who have already gained some clinical experiences. Material and methods - Our study was conducted among fourth-year medical students at Semmelweis University in the 2009/2010 and 2010/11 academic years. 701 students completed the self-administered questionnaire; the answer rate was 84.5%. Conclusions - We established that students closely follow the debate about gratuity, they have well-defined expectations regarding the policy on physicians’ income policy, and their attitudes do not indicate any encouraging views that would favour the future success of the indirect policy on informal payment.]



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[The primary goals of the treatment of AMI are to rapidly open - either mechanically or by thrombolysis - the blocked blood vessel and to keep it open. Restarting of the blood flow in blocked vessels results in an increased load in volume, pressure and metabolism in the blood vessel's supply area, which triggers the activation of a pathophysiological cascade. Pathophysiological processes accompanying the opening of the blood vessel include activation of catecholamines, RAS and neutrophils and subsequent free radical production, and increases in the levels of proinflammatory citokines and intracellular CA levels, that is, the so called oxygen paradox. The above mentioned processes can be blocked by beta receptor blockers (BRB) as demonstrated by class I, type A evidence. A number of clinical studies have shown their clinical efficiency following PCI. The PAMI, StentPAMI, AirPAMI and CADILLAC studies have proved that BRBs decrease mortality and morbidity after the intervention. The third-generation BRB carvedilol, which acts as a beta and alpha blocker in patients with STEMI successfully treated with PCI, and is also a Ca-channel blocker and a free radical trap, is the firstchoice agent for both theoretical and clinical reasons. Animal studies have shown that carvedilol results in greater reductions in the levels of markers indicating postinfarction reperfusion and ventricular remodeling (MCP1, MMP2, TIMP2) compared with metoprolol. Animal studies have also showed that carvedilol is the most efficient BRB for preventing the damaging of gap junction structure in reperfusion, and for inhibiting the ventricular arrhythmias induced by reperfusion, through restoring connexin 43. The beneficial effect of this drug on the cardiovascular events and mortality following myocardial infarction have been demonstrated in a number of human studies with hard endpoints. The unique efficiency of carvedilol in vascular prevention following PCI has been demonstrated by the short-term and longterm efficiency of carvedilol-filled stents, compared with BMSE-filled stents. Information on the postintervention, long-term (3-year) efficiency of carvedilol in a large (N :7500) patient group is expected to be published in 2015 in the CAPITAL-RCT study coordinated by the University of Kyoto. In summary, the results of experimental and clinical studies on carvedilol have shown that within the BRB group, carvedilol is highly recommended for the prevention of oxygen paradox following successful PCI and preserving the myocardium.]

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