Background Identifying the reasons for the Emergency Department (ED) visit of patients with cancer would be essential for possibly decreasing the burden of ED use. The aim of our study was to analyze the distribution of the demographic and clinical parameters of patients with cancer based on the reasons for the ED visits and to identify possible predictive factors for their visits. Methods This retrospective study, carried out at a large, public tertiary hospital in Hungary, involved all patients 18 years or over, who had received a cancer diagnosis latest within five years of their visit to the ED in 2018. Demographic and clinical characteristics were collected partly via automated data collection and partly through the manual chart review by a team of experts, including six emergency physicians and an oncologist. Five main reasons for the ED visit were hypothesized, pilot-tested, then identified, including those with cancer-related ED visits (whose visit was unambiguously related to their cancer illness) and those with non-cancer-related ED visits (whose visit to the ED was in no way associated with their cancer illness.) A descriptive approach was used for data analysis and binary logistic regression was used to determine predictive factors for patients with cancer visiting the ED. Results 23.2% of the altogether 2383 ED visits were directly cancer-related, and these patients had a significantly worse overall survival than patients with non-cancer related ED visits. Age 65 or below (Odds Ratio: 1.51), presence of two more comorbidities (OR: 7.14), dyspnea as chief complaint (OR: 1.52), respiratory cancer (OR: 3.37), any prior chemotherapy (OR: 1.8), any prior immune/biological treatment (OR: 2.21), any prior Best Supportive Care/palliative care (OR: 19.06), or any prior hospice care (OR: 9.43), and hospitalization (OR:2.88) were independent risk factors for the ED visit to be cancer-related. Conclusions Our study is the first to identify independent predictive factors of ED use by patients with cancer based on the chief cause of their visit in the Central and Eastern European region. These results may provide important information for the development of algorithms intended to identify the needs of care of patients with cancer at the ED.

Background West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most human infections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV –infected patients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. Methods We conducted a retrospective chart review of 66 WNV-infected patients from four Hungarian medical centers. Patients’ neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60–90 days and 2nd follow-up, within 150–180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, “moderately severe” and “severe” based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. Results The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patients died. Each day’s increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients’ age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. Conclusions Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infected patients.

Previous studies have shown that indoor environmental quality (IEQ) parameters may have a considerable effect on office employees’ comfort, health and performance. Therefore, we initiated a research program to help occupants identify IEQ parameters they perceive as risk factors for their health in an office and enhance their comfort levels in an office environment. Since we assumed that office employees might have different indoor environmental quality expectations related to their work area and that these differences could be measured, our objective was to develop an office ‘comfort map’ based on occupants’ individual IEQ preferences. Thus, the goal of the comfort map would be to help tailor office spaces to their occupants’ health and comfort expectations. The comfort survey was developed to assess the comfort-related opinions of the occupants, based on IEQ parameters (visual comfort, acoustic comfort, air quality and thermal comfort) of a chosen open-plan office building. The survey also assessed the degree to which the given IEQ parameter was considered a health risk factor by occupants or caused a negative comfort sensation for them. The survey was filled in by 216 occupants. The answers were then analyzed with the help of a frequency table depicting relative frequency. The measurements of IEQ parameters took place in an open-plan office in the chosen office building (a Hungarian subsidiary’s office building belonging to an international company in Budapest). The occupants had different opinions regarding the perceived effects of the IEQ parameters on their health and comfort. Almost two-thirds of the respondents (64.8%) were dissatisfied with the adjustability of the noises and sounds IEQ parameter at their workstation. Furthermore, half of the respondents (50.1%) were dissatisfied with the adjustability of ventilation. Most of the occupants (45.8%) considered noises and sounds as the IEQ parameter that had a negative effect on their health. There were also IEQ differences between different areas of the office space. Based on these results, a comfort map was developed for the office. The comfort map contains information about the IEQ characteristics of each workstation by depicting the thermal comfort, carbon dioxide, visual comfort and acoustic comfort characteristics of a given workstation on a relative scale. Based on the thermal, air, acoustic, and lighting differences between the workstations, occupants can select their preferred workstations when a desk-sharing system works. Although still in its pilot phase, the comfort map could increase the chances for office employees to find the workstation best suited to their IEQ expectations. This could improve occupants’ overall comfort level, which could in turn enhance occupants’ productivity and mental as well as physical health.

Planning for health and creating healthy public policy has been one of the main priorities of the Healthy Cities Project since the early 1990s. The Healthy City Foundation of Pécs (Hungary) - as one of the founding cities of the Healthy Cities Project in Europe - has been involved in all phases of health profiling, health planning and health development planning throughout the years. The experiences of the Healthy Cities Project have strengthened the recognition that the decisions of elected local decision-making bodies are generally based on daily demands and not on long-term plans or concepts. The decision-making process has only one type of filtering system (operated by the city notary), which is for the preliminary legal control of the decisions to be made. Quality of life, health and equity are not considered in the system as a filtering issue. This article reports the experiences of the unique approach of health-orientated planning and decision making in the City of Pécs by using the method of health impact assessment (HIA) as a 'health filter'. It describes the initiative, the success of training and the feasibility of creating a health filter to support the local decision-making process.

IntroductionAcute pancreatitis (AP) is a life-threatening inflammatory disease of the exocrine pancreas which needs acute hospitalisation. Despite its importance, we have significant lack of knowledge whether the lifestyle factors elevate or decrease the risk of AP or influence the disease outcome. So far, no synthetising study has been carried out examining associations between socioeconomic factors, dietary habits, physical activity, chronic stress, sleep quality and AP. Accordingly, LIFESPAN identifies risk factors of acute pancreatitis and helps to prepare preventive recommendations for lifestyle elements.Methods and analysisLIFESPAN is an observational, multicentre international case–control study. Participating subjects will create case and control groups. The study protocol was designed according to the SPIRIT guideline. Patients in the case group (n=1700) have suffered from AP (alcohol-induced, n=500; biliary, n=500; hypertriglyceridemiainduced, n=200; other, n=500); the control group subjects have no AP in their medical history. Our study will have three major control groups (n=2200): hospital-based (n=500), population-based (n=500) and aetiology-based (alcohol, n=500; biliary, n=500 and hypertriglyceridemia, n=200). All of them will be matched to the case group individually by gender, age and location of residence. Aggregately, 3900 subjects will be enrolled into the study. The study participants will complete a complex questionnaire with the help of a clinical research administrator/study nurse. Analysis methods include analysis of the continuous and categorical values.Ethics and disseminationThe study has obtained the relevant ethical approval (54175-2/2018/EKU) and also internationally registered (ISRCTN25940508). After obtaining the final conclusions, we will publish the data to the medical community and will also disseminate our results via open access.Trial registration numberISRCTN25940508; Pre-results.