Lege Artis Medicinae

[Speech by András Kelemen, State Secretary]

MAY 29, 1991

Lege Artis Medicinae - 1991;1(09-10)

[Dear Mr President! Honourable House! The organisation of preventive medicine differs from country to country. But whatever the organisational structure, two basic features are the same everywhere. One is that the whole system is run by national medical officers. The second is that, in addition to public health and epidemiology, health protection is also part of all systems. In Hungary, the medical profession has had a century-old grievance that it was not independent of local authorities and had no authority. The former was helped by the 1936 decree on the medical officers, which nationalised the medical officers but did not give them any authority.]

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Lege Artis Medicinae

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[Asthmatic manifestations can be expected in 20 to 30% of children with allergic rhinitis. Risk factors were searched to predict later bronchial asthma in time. In a prospective study family history, clinical symptoms and laboratory signs, bronchial hyperreactivity (to histamine and to adenosine) and the lymphocyte beta-adrenergic receptor affinity and number were investigated. 31 of 40 patients responded with bronchoconstriction to histamin and 20 to adenosine. In 16 patients both provocation tests were positive. There was no significant difference in lymphocyte beta-adrenergic receptors between the patient group and the controls. It is suggested that children with allergic rhinitis who show bronchial hyperreactivity and a decreased number or affinity of lymphocyte beta-adrenergic receptors are more at risk to asthmatic manifestations. The risk is higher as the number of receptors decreases with age. The prognostic value of the above mentioned methods will be demonstrated by a subsequent retrospective study.]

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[This paper describes a decision support system aimed to assist the day-to-day management of insulin treated diabetic patients based on blood glucose measurements. The therapeutic advices are generated by a multistep procedure involving qualitative reasoning to determine the direction of adjustments and numerical simulation of insulin effect on glycaemia to quantify the extent of control actions to achieve glucose control corresponding to the pre selected targets. The qualitative reasoning module uses meal time oriented glucose balances and distances from the glucose target values to guide the search for appropriate control actions. The simulation module contains a physiologically based glucose-insulin model which generates a 24 hour prediction of the patient's blood glucose profile based on these adjustments which allows the doctor to select the optimal control action from alternatives. The results of a preliminary study to compare the advices given by the system to that of an independent diabetologist are also presented for 11 patients.]

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