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Primary care is a pivotal part of the health care system. While in the 1990's it was considered a success story, nowadays it is a crisis sector. This paper aims to discover the reasons behind this, evaluating the human resources as well. The age distribution of family physicians is presented and the input and output of residency programmes (vocational training) and elements of the undergraduate education and governmental efforts for improvement are discussed. Based on national data, the components of financing and primary care provision are presented, as well as laboratory and radiological investigations and relevant expenditures are displayed. Fundamental and conceptional changes are needed in the whole health care system. New and innovative structures of primary care provision are required, besides appropriate financing, without uniformity. The problems of human resources could be solved with appropriate financing, wider professional competences and restructuring the undergraduate education. Orv Hetil. 2026; 167(26): 1018-1026. Az egészségügyi rendszer fontos szintje az alapellátás, amelynek működésében hazánkban komoly problémák vannak. Az 1990-es években sikerágazatnak számító terület mára válságágazattá vált. Ennek okait próbálja meg feltárni a kézirat, áttekintve a magyar alapellátás humánerőforrás-helyzetét is. Bemutatja a háziorvosok korösszetételét, az orvoshiány enyhítésére tett kormányzati támogatásokat, a szakorvosképzés adatait és az egyetemi oktatás szakmaspecifikus elemeit. Országos adatok alapján elemzi a háziorvosi finanszírozás összetevőit, a háziorvosi ellátások komponenseit. Bemutatja a háziorvosok által indikált laboratóriumi és képalkotó vizsgálatok számát, költségét. A megoldást az egészségügyi rendszer elkerülhetetlen, koncepcionális átalakításán belül, az alapellátásnak az innovatív elemeket tartalmazó és ezeket finanszírozni képes áttervezésében, nem pedig az uniformizálásában keresi. A humánerőforrás helyzetének javítása sem képzelhető el a finanszírozás és a kompetenciák jelentős bővítése és a képzési rendszer átalakítása nélkül. Orv Hetil. 2026; 167(26): 1018–1026.
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Reactive oxygen species (ROS) play a complex dual role in cancer biology. At physiological levels, ROS act as signaling molecules that drive tumorigenesis, metastasis, and therapy resistance by activating oncogenic pathways, such as NF-κB and PI3K/AKT, and fostering an immunosuppressive microenvironment. Conversely, excessive ROS accumulation overwhelms antioxidant defenses, triggering oxidative stress that can selectively eliminate tumor cells. Consequently, manipulating the delicate redox equilibrium has emerged as a pivotal strategy for cancer treatment. This review systematically examines the multifaceted functions of ROS, bridging the gap between fundamental redox biology and clinical application within the Predictive, Preventive, and Personalized Medicine (3PM) framework. Beyond molecular mechanisms, we evaluated the rationale for utilizing mitochondrial redox signatures as intrinsic biological sensors to identify suboptimal health conditions (SHC) and prevent the health-to-disease transition. We elucidate the regulatory networks governing ROS production and elimination, highlighting their dual function in promoting genomic instability versus inducing distinct cell death modalities, including apoptosis, autophagy, necroptosis, and ferroptosis. Special attention is given to ROS-mediated remodeling of the tumor microenvironment (TME), where oxidative stress facilitates immunosuppression. Importantly, we provide expert recommendations on integrating digital health monitoring and patient stratification into clinical oncology. By emphasizing mitochondrial rejuvenation and individualised protection, this review discusses how proactive interventions can restore homeostasis and improve long-term outcomes, offering a cost-effective alternative to reactive treatments.
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Chronic kidney disease-mineral and bone disorder is a major contributor to skeletal fragility in patients with chronic kidney disease and after kidney transplantation. Alterations in mineral metabolism begin early during CKD and persist through later stages, leading to a markedly increased fracture risk that may precede renal failure. Bone fragility in CKD arises from the interplay of primary osteoporosis, secondary causes, and CKD-specific disturbances in bone turnover and mineralisation. CKD related bone disease and post-transplant bone loss are characterised not only by reduced bone mineral density but also by impaired bone quality, driven by abnormalities in trabecular and cortical microarchitecture, collagen properties, and mineral composition. Immunosuppressive therapy further exacerbates skeletal vulnerability after kidney transplantation. Recent guidelines have therefore adopted the term CKD-associated osteoporosis to emphasise the need for integrated diagnostic and therapeutic approaches. Diagnosis remains challenging because BMD alone fails to capture alterations in bone turnover and mineralisation that critically influence fracture risk and treatment response. Although bone biopsy remains the reference standard, limited availability has led to increased reliance on bone turnover markers, particularly those not cleared by the kidneys. Combined assessment of parathyroid hormone and BTMs improves discrimination of turnover states and supports individualised clinical decision-making. A pragmatic approach could be based on an integrated evaluation of CKD-MBD parameters, BTM trends, and baseline and follow-up imaging. Therapeutic management becomes increasingly complex in advanced CKD, where fracture risk is high, and evidence for osteoporosis treatments is limited. Antiresorptive, osteoanabolic, and dual-action agents have distinct effects on bone modelling and remodelling, with important implications for efficacy and safety. Despite progress, no consensus exists on optimal treatment strategies. Emerging sequential and combination therapies remain insufficiently studied in advanced CKD and transplant populations, underscoring the need for robust clinical evidence.
This study evaluated the bioaccessibility of essential (Ca, Cu, Fe, K, Mg, Mn, Mo, Na and Zn) and non-essential (Al, Ba, Cr, Sr and V) elements in food supplements (vitamins and/or minerals and botanicals). Extraction using in-vitro methods (Unified BARGE Method-UBM and INFOGEST) was evaluated allowing a comparison of protocols and using inductively coupled plasma optical emission spectrometry (ICP OES). Bioaccessibility values revealed differences among the elements in different types of food supplements. The limits of quantification (LOQs) obtained for some elements were relatively high for both methods due to the composition of the digests, which drastically impaired bioaccessibility assessment. As a result, most elements presented fractions lower than the LOQ, regardless of the sample. This is an important limitation promoted by interferences when analyzing these extracts by ICP-based techniques. A simple extraction using 1 mol L-1 HCl was evaluated, considering that HCl is present in the solutions used in both protocols. Leaching was observed for the same elements using only the HCl solution.
The human microbiome comprises the microorganisms inhabiting the body, with the oral cavity representing the second most densely colonized site after the colon. Periodontal disease-associated oral bacteria are more common in patients with kidney disorders than in the general population. Oral dysbiosis disrupts host-microbiota homeostasis and promotes destructive periodontal inflammation, which has been linked to chronic kidney disease (CKD). However, current interventional evidence, including randomized controlled trials, remains limited by small sample sizes, short follow-up, heterogeneous periodontal interventions, inconsistent renal endpoints, limited blinding, and inadequate adjustment for confounders such as smoking, glycemic control, and medication use. Thus, causality between oral microbiota modulation and CKD progression remains unproven. This review synthesizes current evidence on the mechanisms by which oral microbiota influence various forms of nephropathy, with a particular focus on the impact of periodontitis (PD) on the progression of renal disease.This review summarizes evidence on mechanisms by which oral microbiota and periodontitis may contribute to nephropathy and renal disease progression. Oral dysbiosis may affect CKD through systemic inflammation, endothelial dysfunction, and oxidative stress. It may also promote abnormal IgA1 glycosylation in IgA nephropathy and contribute to immune dysregulation and persistent inflammation in glomerulonephritis. Periodontitis-associated oral dysbiosis may contribute to renal disease pathogenesis and progression. Clarifying these mechanisms could support preventive and therapeutic strategies for patients with nephropathy.
Objectives: Endocrine neoplasms, as a general rule, show systemic, neuro-inflammatory and metabolic consequences, known as paraneoplastic syndrome. The comorbidity of thyroid tumors with neurological and autoimmune diseases prompt looking for common neuro-immuno-endocrine mechanisms of these disorders. While most TCs are well described, there is a gap in the literature after the isolation of oncocytic/Hürthle cell carcinoma (HCC), as a unique type due to immunoendocrine and metabolic features (low TSH-receptor expression and radioiodine avidity). The aim of this study was to collect clearly defined reports of HCC (as a separate entity) and to attempt determining common clinical symptoms and the usefulness of various diagnostic techniques (comprehensive critical review). This may be an introduction to modern treatment (patient-centered care) since the main cause of mortality is not local progression or metastases. Results: Until now, due to misnomenclature and data misinterpretation, HCC has been treated according to general standards (with overuse of TSH-ST and RIA). High thyroglobulin level, decreased total thyroxin (with normal FT3 and spontaneous decrease in TSH), hypercalcemia, as well as the "reverse flip-flop" phenomenon, as common symptoms, indicate the neuroendocrine origin of HCC. Sparse, well-documented lymph node metastases are another feature, although from few studies. Most studies omit the N stage. Whole-body 131iodine and 18F-fluorodeoxyglucose scintigraphy may be useful before FNAB. Fine-needle aspiration biopsy (FNAB), as a "gold standard" in early diagnosis of thyroid nodules, delays HCC diagnosis because of the inability to determine a benign/malignant nature. Conclusions: Final HCC outcome may be affected by various overlapping immunoendocrine factors (paraneoplastic effects). Due to very few thyroid function tests performed in HCC, we have proposed a set of basic laboratory analyses, core biopsy in HCC differentiation, and diagnostic chain for standardization. According to the review, adaptation and treatment of HCC based on existing standards for other thyroid cancers seem to be insufficient, and the risks outweigh the benefits. The key recommendations resulting from the 5th edition of the WHO Classification of Endocrine Neoplasms are only the beginning of refuting many myths and biases.
N-ary Knowledge Graphs (NKGs), containing facts with more than two entities, are prevalent in the real world. Link Prediction in NKGs (LPN) is to predict missing elements in facts therein, which helps populate and enrich the NKGs. Existing LPN methods implicitly assume that NKGs remain static. However, real-world NKGs usually grow, frequently introducing new facts over time. When new facts emerge, existing LPN methods need to be fine-tuned with new data or retrained on the entire dataset, often resulting in knowledge forgetting or requiring a lot of training time. Consequently, this paper introduces a new task, i.e., Continual Link Prediction in growing NKGs (CLPN), aiming to predict missing elements in facts in growing NKGs. To conduct CLPN, we propose a Continual N-ary knowledge Reasoner, called ConNR. ConNR includes an embedding generation module to initialize embeddings of the unseen elements, a embedding update module to globally update embeddings of all elements, and a fact decoder that captures the semantics of new facts and predicts missing elements. To evaluate CLPN, we have carefully constructed five datasets with different NKG growth scenarios. Experimental results on all these datasets demonstrate the superior performance of ConNR over existing representative models.
Food pleasure and worry may operate differently across cultural contexts; however, no studies have examined food pleasure or worry and eating-related outcomes among Mexican Americans. This study explored whether: (1) food pleasure/worry were associated with individual-level cultural attributes; (2) food pleasure/worry were associated with eating-related outcomes; and (3) relationships between food pleasure/worry and eating-related outcomes were moderated by cultural attributes. Data were collected with 3,329 Mexican American adults recruited through online panels to complete an online survey between November and December 2022. Participants had unique IP addresses, were aged 18-100, lived in the U.S., were able to read in English or Spanish, and had Mexican heritage. The survey assessed food pleasure, food worry, six cultural attributes (e.g., language use), and five eating-related outcomes believed to be associated with eating pleasure (e.g., sugary drink consumption) or nutrition monitoring (e.g., use of Nutrition Facts labels). Most participants rated food pleasure as important (83.6%) and had no food worry (83.1%). Rating food pleasure as important (vs. not) was associated with more Latino-oriented cultural attributes, higher sugary drink intake, consuming food prepared outside the home, and greater importance of sugary drinks at social gatherings. Having food worry (vs. not) was associated with being foreign-born, lower sugary drink intake, lower importance of sugary drinks at social gatherings, and greater likelihood of using Nutrition Facts labels. There was no strong evidence of moderation by cultural attributes. Food pleasure was associated with more obesogenic behaviors, and food worry was associated with more nutrition monitoring behaviors. More nuanced measurement of these food attitudes is needed to elucidate how food pleasure and worry influence eating behaviors, as well as whether nutrition interventions should target these food attitudes to promote healthy eating among Mexican American adults.
Knowledge of past cultures relies heavily on surviving written material. Over the centuries, texts were copied, altered, and often lost, leaving scholars to reconstruct partial genealogies-stemmata-from shared innovations between surviving copies. Yet, a general understanding of the processes shaping textual transmission remains elusive. Within the broader topic of cultural evolution, text transmission provides a favorable context for integrating formal modeling with empirical evidence: explicitly identified items (texts), transmitted through deliberate manual replication, have left tangible artifacts (manuscripts)-traces of a dynamical, cultural, and historical process. Rethinking textual transmission through a complexity science approach, this study combines stochastic models and simulations, informed by historical scholarship, with empirical data from a corpus of circa 2,000 medieval manuscripts spanning four centuries. Our framework quantifies how variation in copying and destruction rates influences survival or extinction, and reproduces key stylized facts observed empirically in reconstructed stemmata, such as imbalance, a feature debated for over a century. Further, this approach provides broad trends estimates suggesting that up to 60%; of texts and more than 95%; of manuscripts may have been lost. Our findings highlight the role of drift in cultural transmission, while providing a formal basis to integrate drivers such as cultural selection and historical contingencies (eg the Black Death). It bridges philology and cultural evolution approaches, while providing a theoretical and empirical framework applicable to numerous other traditions-eg Classical literature, legal and scientific texts, religious canons-where replication and loss also shape what endures.
Global labor mobility has intensified, positioning Indonesia as one of Japan's fastest-growing sources of migrant workers under the Technical Intern Training and Specified Skilled Worker schemes. However, the transition of health surveillance mechanisms - particularly Japan's Notebook of Personal Health Record (nPHR) - remains challenging once workers return home. We examined Indonesia's readiness to adopt a standardized returning health checkup system aligned with Japan's nPHR framework. In addition, we summarized the available resources and hospital data and analyzed policy, infrastructure, and resource preparedness across health facilities, identifying facts in standardization, financing, and specialist availability. We propose integrated digital health solutions for returning migrant workers.
This research demonstrates that citing scientific sources to correct disinformation can be ineffective or even counterproductive, and offers a potential remedy. Three experiments simulated a WhatsApp conversation about COVID-19 vaccine disinformation, examining corrections in the high-uncertainty context of the early 2021 stage of the pandemic (Studies 1 and 2) and among vaccine skeptics in 2024 (Study 3). A science-based correction backfired during the pandemic and was ineffective among skeptics in 2024. However, a brief, content-agnostic intervention, comprising three simple prompts directing attention to facts and experts, consistently attenuated these patterns. The intervention specifically enhanced the effectiveness of science-based corrections, but not corrections without a source, and it worked even for skeptics who typically distrust science, suggesting it acts by increasing the salience of evidence and expertise. These findings indicate that for science to be an effective antidote to disinformation, individuals may first need a cognitive nudge toward an evidence-oriented mindset.
The currently known favorable properties of soybean have become the target of fraud in meat production. The use of plant-based raw materials in the adulteration of meat products is increasingly recognized by consumers, manufacturers, and researchers. However, the toxicity of soybeans has not been addressed. This article aimed to focus on the following: detection, quantification of soybean adulteration in meat products, analyzing how other adulterants could impact cholesterol levels in the products, and discussing how soybean adulteration could cause conditions such as allergies and toxicity. Utilizing immunohistochemical techniques, 450 different meat product samples were analyzed. Highlighting the confirmed soybean adulteration by analyzing cholesterol levels using HPLC. Results showed that, across all tested cases, soybean toxic doses ranged from 62% to 85%. Meanwhile, there were no indications on their respective nutritional facts labels. Surprisingly, the cholesterol levels were lower than those reported by previous investigators.
Type 2 diabetes mellitus (T2DM) is a common comorbidity among patients with heart failure (HF). This study aims to describe how T2DM relates to HF hospitalization patterns across demographic groups and HF subtypes. We conducted a population-based retrospective cohort study using 19 years of clinical data from Cerner Health Facts®, a nationwide electronic health record (EHR) database. Adult patients hospitalized with HF were identified using ICD-9/ICD-10 diagnosis codes and HF-related medications and were stratified by T2DM status. Measures included HF-related hospitalization count, length of first HF hospitalization, and age at first HF hospitalization. Comparisons were examined across HF subtypes (historically termed systolic, diastolic, other). Additionally, sensitivity analyses were conducted using alternative inclusion criteria to assess the robustness of the findings. We identified 137,785 HF patients from the EHR database, among whom 29.5% had T2DM. Overall HF hospitalization was more common in men than in women; however, diastolic HF was more prevalent among women and presented at older ages whereas systolic HF was more prevalent among men. Compared with patients without T2DM, patients with T2DM experienced higher HF hospitalization count (mean: 2.81 vs. 2.42, p < 0.001), and both longer stay (mean: 7.03 vs. 6.85 days, p < 0.001) and earlier age (mean: 68.9 vs. 70.4 years, p < 0.001) of initial HF hospitalization. Across HF subtypes, T2DM was more prevalent among patients with diastolic HF (31.4% diastolic vs. 29.5% systolic vs. 28.7% other), and patients with T2DM were younger at first HF hospitalization than those without T2DM, with the largest difference observed for diastolic HF (mean: 70.4 vs. 73.1 years, p < 0.001). In this large nationwide EHR cohort, T2DM was associated with more intensive HF hospitalization patterns and was more prevalent in the diastolic HF subtype. These findings highlight the relevance of diabetes status and HF subtype, in addition to demographic factors, in shaping HF-related healthcare utilization.
Sexual self-determination for people with disabilities remains a marginalised topic in the context of the discourse on participation. Narratives and facts that define the (sexual) realities of life for the target group clearly show that the realisation of sexual self-determination is primarily shaped by disabling social attitudes, structural challenges and paternalistic everyday practices. These are mostly at odds with sexual human rights. The ReWiKs research project has developed a comprehensive topic-specific media package, conducted training courses for professionals and designed participation-oriented discussion formats (Freiraum-Gruppen) for people with disabilities. The empirical findings from these activities indicate significant competence developments among professionals, while also revealing considerable structural and institutional challenges in the development and implementation of sex-positive institutional cultures. The participatory discussion formats for people with disabilities create spaces for resonance, exchange, recognition and sexual education. The findings of the project have multidimensional consequences for participation issues in the context of self-determined sexuality. Sexuelle Selbstbestimmung von Menschen mit Behinderung ist weiterhin ein marginalisiertes Themenfeld im Kontext des Teilhabediskurses. Narrative und Fakten, die die (sexuellen) Lebenswirklichkeiten der Zielgruppe bestimmen, zeigen deutlich, dass die Realisierung sexueller Selbstbestimmung primär von behindernden gesellschaftlichen Vorstellungen, strukturellen Herausforderungen und paternalistischen Alltagspraktiken geprägt ist. Diese stehen zumeist im Widerspruch zu sexuellen Menschenrechten. Das Forschungsprojekt ReWiKs hat ein umfangreiches themenspezifisches Medienpaket entwickelt, Fortbildungen für Fachkräfte durchgeführt und partizipationsorientierte Gesprächsformate (Freiraum-Gruppen) für Menschen mit Behinderung konzipiert. Die empirischen Resultate dieser Aktivitäten zeigen bedeutsame Kompetenzentwicklungen der Fachkräfte, jedoch auch erhebliche strukturell und institutionell bedingte Herausforderungen in der Entwicklung und Umsetzung sexualfreundlicher Einrichtungskulturen. Die partizipativ konzipierten Gesprächsformate für Menschen mit Behinderung eröffnen Räume für Resonanz, Austausch, Anerkennung und sexuelle Bildung. Aus den Erkenntnissen des Projekts werden multidimensionale Konsequenzen für Teilhabefragen im Kontext selbstbestimmter Sexualität abgeleitet.