Psychosomatic Diseases Research Articles

Depression among Alopecia Areata Patients: Prevalence and associated factors in a Tunisian sample.

Introduction Alopecia areata (AA) is a common, chronic inflammatory, non-scarring form of hair loss affecting 0.1-0.2% of the population. It is a psychosomatic disease involving a T-cell-mediated immune reaction against hair follicle antigens during the anagen phase. Psychiatric morbidity in dermatological patients can significantly affect their quality of life and disease progression. Identifying and addressing these comorbidities in AA patients is crucial. Aim This study aimed to estimate the prevalence of depression and its associated factors among patients diagnosed with alopecia areata (AA). Methods The present study is a cross-sectional, descriptive, and analytical study conducted at Farhat Hached Hospital in Sousse, Tunisia, during the period from August to December 2019. Participants were recruited from the Dermatology Outpatient Department. The questionnaire covered socio-demographic characteristics, personal and family history, AA history, clinical presentation, disease severity (SALT score), nail involvement, and depression assessment using the Hamilton Depression Scale (validated Arabic version). Results A total of 60 AA patients were enrolled, with a mean age of 37.6 ± 12.9 years. Females exhibited a predominant representation, with a male to female ratio (M/F) of 0.76. According to the Hamilton Depression Scale (HAM-D), 31 cases (51.7%) were depressed, with a mean depression scale score of 11.33 (±6.57 SD). The presence of depression was significantly associated with younger age (p=0.018), the presence of the eyelashes/eyebrows form (p=0.035), nail involvement (p= 0.03), and a poor response to treatment (p=0.004). Conclusion Our research highlights the importance of providing psychological support to alopecia areata patients.

The mediating effects of parental hope and psychological resilience on social support and decision conflict in children with hypospadias

IntroductionThe most common congenital genital abnormality of the urinary system in infants is hypospadias; its frequency is rising to 0.33 percent globally. Surgical reconstruction is the most effective treatment for hypospadias. Parents, as surrogate decision-makers for children, frequently experience decision-making conflicts when making decisions. Stress is neither a straightforward stimulus nor a simple response. However, a stressor (stimulus) caused by life events and influenced by numerous intermediate factors including personality, social support, and psychosomatic symptoms or diseases is a multi-factor process of stress response (response) . The surgical decision conflict of parents of children with hypospadias is a type of stress response, and social support may have an effect on parents' hope, psychological resilience, and decision conflict, with hope and psychological resilience serving as mediators between social support and decision conflict. AimTo investigate the structural relationship between parental social support, hope, psychological resilience, and parents decision conflict in children with hypospadias. Study DesignA cross-sectional design was used to collect the data of 210 parents of children with hypospadias from Department of Urology, Shenzhen Children's Hospital from April 2022 to March 2023. ResultsSocial support indirectly affects decision conflict through hope and psychological resilience, with a total effect of -0.224 (P<0.05), DiscussionDecision conflicts and regret can be reduced if medical professionals provide adequate and clear information, decision assistance, and meet support requirements during the decision-making process. Improving the level of psychological resilience, hope, and social support among parents of children with hypospadias is a crucial strategy for reducing the level of decision conflict they experience. In the process of making surgical decisions for children with hypospadias, the more sufficient social support from relatives, friends, and medical staff can stimulate their hope, boost their belief in the success of surgery, and the greater their psychological resilience, the more effectively decision conflict can be reduced. Some potential limitations of this study should be considered. Firstly, this study was a cross-sectional survey design. It may have some limitations in providing causal relationships between selected variables. Second, the survey investigated only one hospital, which reduces the generalizability of the findings. ConclusionThe data support the proposed model and confirm the structural relationship among the four study variables. This study provides new information on the mediating role of hope and psychological resilience between social support and decision-making conflict.

Mental health and academic performance in university students: Systematic review

Introduction: Mental health is an important part of public health, as its lack leads to a variety of mental disorders that are health problems in societies around the world. Mental health can be affected by biological, psychological, social and economic factors. In the university environment, these factors constitute an aspect that requires special attention, given the negative influence they could exert on the academic performance of students.Objective: Analyze the relationship between mental health and academic performance in university students.Methods: The systematic review of available scientific literature was carried out, using a systematic procedure based on the search, selection, review, interpretation and synthesis of the proven evidence from the years 2006 – 2023. The search was based on the study of the variables: mental health and academic performance.Results: After the analysis of the different articles, three main themes were identified: mental health: generalities; importance of mental health in academic performance and professional support: guarantee of good academic performance in university students.Conclusions: It is concluded that mental health in the university environment affects the student's academic performance. Work must be done on the development of skills to manage emotions and address imbalances that affect the mental health of students, otherwise it will be reflected in the learning process, in the family environment and the social environment, resulting in possible dropouts and the occurrence of psychosomatic diseases in the medium and long term.

Monitoring the psychopathological profile of inflammatory bowel disease patients treated with biological agents: a pilot study.

Biological agents were found to alter the psychopathological profile of a small subgroup of patients treated for a variety of conditions, including inflammatory bowel disease (IBD) and psychiatric disorders. The association between the administration of biological agents and psychopathology needs to be further investigated. In this naturalistic prospective cohort study, patients with IBD were assigned to two treatment groups, i.e., a biological agent (which also included tofacitinib) or conventional therapy. Clinician-administered scales were used to assess psychosomatic symptoms (Hamilton Depression Rating Scale [Ham-D], Hamilton Anxiety Rating Scale [Ham-A], Young Mania Rating Scale [YMRS], and Brief Psychiatric Rating Scale [BPRS]) and disease activity (Mayo Score and Harvey-Bradshaw Index [HBI]) at baseline, after one, three, and six months of treatment. Each group was assessed for the course of their scores during the observation period at each assessment point. Patients on biological drugs who completed three months of treatment (N.=32) and six months of treatment (N.=20) scored significantly lower on the Mayo compared to baseline. Patients on conventional treatment obtained significant drops from baseline on the HBI after one and three months of treatment (N.=30) and also at the six-month endpoint (N.=11). Both groups showed no improvement or worsening on the psychiatric rating scales. In this study, we found no evidence of psychiatric symptom worsening, as some literature would suggest. Our data suggest that the use of biological agents in IBD is safe.

Glymphatic function assessment with diffusion tensor imaging along the perivascular space in patients with major depressive disorder and its relation to cerebral white-matter alteration.

The link between glymphatic system function in the brain and alterations in white-matter microstructure among individuals with major depressive disorder (MDD) remains unclear. This study aimed to examine the assessment of glymphatic system function in patients with MDD using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index and to evaluate its association with cerebral-white-matter abnormalities and neuropsychological scores. From February 2023 to November 2023, this cross-sectional study recruited 35 patients with MDD from the Psychosomatic Diseases Department of the First Affiliated Hospital of Dalian Medical University. In this time period, 23 healthy controls (HCs) were enlisted from the community and matched with the MDD cohort in terms of years of education, gender, and age. All participants underwent magnetic resonance imaging, depression, anxiety, and cognitive assessments. The tract-based spatial statistics (TBSS) analyzed DTI parameters and identified significant clusters. Automated fiber quantification (AFQ) was used to automatically identify fiber bundles with statistical differences. Mann-Whitney tests or two-sample t-tests were used for comparisons. Interobserver consistency of the DTI-ALPS measurements was evaluated using the interclass correlation coefficient (ICC). Partial correlation analyses and linear regression analyses were used to examine relationships. A comparison of the DTI-ALPS index was made between the two groups. Correlations among diffusion characteristics, neuropsychological scores, and the DTI-ALPS index were analyzed. Compared to HCs, patients with MDD exhibited a lower DTI-ALPS score (P=0.001). According to using linear regression analysis, the ALPS index was found to be an independent predictor of the Hamilton Depression Rating Scale [B=-25.32; P=0.001; 95% confidence interval (CI): -40.35 to -11.55], Hamilton Anxiety Rating Scale (B=-33.48; P=0.003; 95% CI: -55.38 to -11.24), and Montreal Cognitive Assessment total score (B=8.59; P=0.008; 95% CI: 2.38 to 14.79). According to the TBSS analysis, there were clusters of increased axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) in patients with MDD as compared to HCs (all P values <0.05). A lower DTI-ALPS score was correlated with higher AD (r=-0.592; P<0.001), MD (cluster 1: r=-0.567, P=0.001; cluster 2: r=-0.581, P<0.001), and RD (r=-0.491; P=0.004) values. AFQ analysis identified the significantly different diffusion indicators in the left cingulum bundle (CB_L), left inferior longitudinal fasciculus (ILF_L), and left uncinate fasciculus (UF_L) between the two groups (all false discovery rate P values <0.05). DTI-ALPS score was negatively correlated with the AD value of CB_L (r=-0.304; P=0.024), ILF_L (r=-0.35; P=0.008), and UF_L (r=-0.354; P=0.008) in AFQ tract-level analysis. In point-wise analysis, the MD value of CB_L at nodes 33 to 36 was negatively correlated with DTI-ALPS score (r ranging from -0.504 to -0.535; P<0.01). Our results indicated a decrease in DTI-ALPS index score in patients with MDD. DTI-ALPS score was associated with depression, anxiety, declined cognitive ability, and white-matter microstructural abnormalities and may thus be a promising biomarker for the partial evaluation of glymphatic system function in patients with MDD.

Mechanism of Mongolian mind-body interactive therapy in regulating essential hypertension through HTR2B: A metabolome- and transcriptome-based study

Essential hypertension is a psychosomatic disease associated with emotions and behaviors. Although Mongolian mind–body interactive therapy can help patients with essential hypertension reduce their systolic blood pressure (SBP), the mechanism is unclear. We assigned patients who underwent Mongolian mind–body interactive therapy to groups that were treated with (DT) or without (NDT) antihypertensive drugs (Clinical registration no: ChiCTR2000034918). We screened differentially expressed genes (DEGs) using targeted metabolic and transcriptomic analyses of blood samples before and after intervention. Sequenced data were analyzed using quantitative polymerase chain reaction (qPCR) and validated using enzyme-linked immunosorbent assays (ELISAs). Small interfering (Si)-RNA interference on key DEGs in human umbilical vein endothelial cells (HUVECs) was experimentally verified. Omics analysis identified 187 DEGS, including human 5-hydroxytryptamine (5-HT) receptor 2B (5-HTR2B), human endothelin receptor type B (EDNRB), and the metabolite N-acetylserotonin. The qPCR and transcriptome sequencing results were consistent. Post-intervention ELISA assays revealed significantly elevated 5-HT in the NDT group after intervention (P < 0.05). Interactions between 5-HTR2B and N-acetylserotonin differed between the groups. The cellular findings showed significantly reduced G protein-coupled receptor 82 (GPR82) and phospholipid phosphatase-related protein type 4 (PLPPR4), and significantly increased S100A2 protein expression in the Si-HTR2B group, compared with the controls (P < 0.05). The biochemical results uncovered significantly decreased nitric oxide (NO) and significantly increased malondialdehyde and NO synthetase concentrations compared with the models (P < 0.05). Mongolian mind–body interactive therapy might affect SBP in patients with essential hypertension by combining 5-HT with 5-HTR2B to mediate NO relaxation.

Discussion on clinical application and regularity of the theory of "mind-regulating" in clinical acupuncture and moxibustion treatment.

The active role of "Shen" (mind) in the process of disease treatment has always been valued by scholars of traditional Chinese medicine (TCM). "Tiaoshen" (mind-regulating) is regarded as the fundamental component of TCM therapy. "Mind-regulating" acupuncture and moxibustion therapy, as a treatment method for both body and mind, is consistent with the present bio-psycho-social medical model. In recent years, a large number of clinical studies have confirmed the exact efficacy of "mind-regulating" acupuncture and moxibustion therapy. This article reviewed the clinical applications of that in psychosomatic diseases, neurological diseases, and digestive diseases over the last decade. This article also summarized the research progress of various "mind-regulating" acupuncture and moxibustion methods, investigated the theoretical connotations of "Tongdu Tiaoshen" (dredging Governor Vessel and regulating mind) acupuncture, "Shugan Tiaoshen" (soothing liver and regulating mind) acupuncture, and the "Tiaoshen needling technique" (mind-regulating needling technique), and generalized the main acupoint selection rules. Lastly, future development directions were provided for the theoretical basis of clinical application of "mind-regulating" acupuncture and moxibustion therapy for further improvement.

Analyzing the Relationship Between Chronic Periodontitis and Psychological Stress in Elderly Patients: A Study Protocol.

Although stress is the body's physiological response to challenging life events, chronic exposure to a stressor may not cause stress. In such cases, stress negatively impacts some physiological functions, which can lead to psychosomatic diseases. According to research, inadequate coping mechanisms and long-term stress are factors that moderate the risk and progression of periodontitis. As a result, theories explaining how stress affects the periodontium have been put forth. The clinical examination comprised measurements of the probing pocket depth (PPD), clinical attachment level, number of teeth present, and plaque index. The current study uses a questionnaire to examine how psychosocial stress affects periodontium. A written consent form will be obtained after each patient has received an extensive description of the study's objectives. The instrument for diagnosis and natural illumination will be used during the patient's examination. PPD and clinical attachment loss will be compared with a questionnaire. Patients who are under stress should receive additional periodontal care to prevent periodontal disease from emerging or, if the issue already exists, from progressing to a more critical stage. Stress here deserves special attention because it is a natural part of people's life experiences with various intensities.Prejudice suggests that psychological stress and anxiety have a role in the advancement of periodontitis, which is consistent with the findings.

Psychosomatic Diseases and Gut Microbiome Connections

Recent research has illuminated the intricate relationship between psychosomatic diseases and the gut microbiome, emphasizing the bi-directional communication between the central nervous system and the gastrointestinal tract, known as the gut-brain axis. Psychosomatic diseases, which are physical illnesses influenced or exacerbated by mental factors, have been shown to correlate with alterations in the gut microbiome composition. Dysbiosis, an imbalance in the microbial community, has been linked to various psychosomatic conditions, including irritable bowel syndrome (IBS), depression, and anxiety. Mechanistically, the gut microbiome influences brain function and behavior through several pathways, including the production of neuroactive compounds, modulation of the immune system, and the vagus nerve. Studies indicate that certain microbial metabolites, such as short-chain fatty acids (SCFAs) and tryptophan metabolites, can impact neurotransmitter systems, contributing to the pathophysiology of psychosomatic diseases. Furthermore, interventions such as probiotics, prebiotics, and dietary modifications have shown promise in modulating the gut microbiota and alleviating symptoms of these conditions. Understanding the gut-brain connection offers potential for novel therapeutic approaches targeting the microbiome to treat psychosomatic diseases, underscoring the need for continued research in this interdisciplinary field.

STUDYING ATTITUDES TO DEPRESSION AMONG STUDENTS

Depression is a serious mental illness, when it occurs, the ability to work is sharply reduced and motor problems arise lethargy, impaired thinking, decreased mood. Depression is accompanied by low self-esteem, loss of taste to life, interest in usual activities. Being a mental disorder, depression manifests itself as pathological affect. It is perceived by people and patients as a manifestation of laziness, bad character, selfishness and pessimism. It should be noted that a depressive state is not just a bad mood, but a psychosomatic disease in which specialist intervention required. Overthinking or intrusive thoughts depression or anxiety or any mental problem isn't just a disorder, it can happen to us because of various reasons.

Comparing the effectiveness of group mindfulness-based cognitive therapy with emotion-focused therapy on anxiety sensitivity in patients with peptic ulcer

Introduction: Peptic ulcer is known as a psychosomatic disease that is closely related to anxiety and stress. This research aimed to compare the effectiveness of mindfulness-based cognitive therapy and emotion-oriented therapy on anxiety sensitivity in patients with peptic ulcers. Method: This semi-experimental study was conducted based on a pre-test-post-test-follow-up design and a control group. In total, 45 peptic ulcer patients who had referred to specialized and sub-specialized gastroenterology clinics in Mashhad, Iran in 2023 were enrolled in the study. The participants were selected by available sampling method and randomly replaced in two experimental groups and one control group (n=15). The experimental groups received intervention in the form of eight 90-minute sessions of emotion-focused therapy and mindfulness-based cognitive therapy. The control group did not receive training during the research. Participants completed the Taylor and Cox (1998) Anxiety Sensitivity Questionnaire before, immediately after, and three months after the interventions. The obtained data were analyzed by repeated measure ANOVA in SPSS software. Results: The findings showed that emotion-focused therapy and mindfulness-based cognitive therapy were effective on the anxiety sensitivity of patients with peptic ulcer (P&lt;0.001). However, no significant difference was observed between the effectiveness of the two treatment approaches (P=0.78). Conclusion: The results showed that emotion-focused therapy and mindfulness-based cognitive therapy can be used to improve anxiety-related factors among patients with peptic ulcers.

PSYCHOSOMATİCS: PSYCHOLOGİCAL CAUSES OF SOMATİC DİSEASES

There is always a balance between the physical and spiritual world of a person. When symmetry is broken in their joint activity, psychological problems arise, which are covered by the name of psychosomatics. In the article, the author considers these issues and notes that the problem of psychosomatics is one of the most pressing and complex problems of our time. The history of psychosomatics is ancient. The humoral theory of temperament of Hippocrates is considered the basis of psychosomatics. The author notes that the term psychosomatics was first used in 1818 by the German physician Heinroth. He analyzed various sources and grouped the causes of psychosomatic diseases and showed that the treatment of somatic diseases is carried out through long-term psychotherapy.

THE MAIN PECULIARITIES OF THE CREATION OF A SYSTEM OF PSYCHOLOGICAL TECHNOLOGIES FOR THE PRIMARY PREVENTION OF PSYCHOSOMATIC DISEASES OF STUDENT AND YOUNG PUPIL’S

The article analyzes the process and relevance of studying the psychological problems of individuals and social groups, including psychosomatic problems of students and students. Moreover, the analysis of the research of scientists who conducted research within the framework of this problem makes it possible to establish a number of psychological problems inherent in certain social groups. The article also identifies the relationship between these problems and the occurrence and incidence of psychosomatic disorders among members of the social group. The result, on the other hand, allows us to conclude that in order to prevent psychosomatic diseases, it is necessary to solve these psychological problems. In addition, these psychological problems studied and solved by existing technologies of existing approaches in medical psychology.

Alopecia and Emotional Aspects Related to Hair

Introduction: Alopecia is a dermatological condition where hair loss occurs suddenly or gradually in one or more areas of the body, most commonly on the scalp. Studies focusing on the psychosocial and emotional aspects highlight the influence of traumatic situations and stress-related events on the progression of diseases, considered as triggering factors for alopecia. In this context, this study is justified by its aim to describe the disorder, outline the research, and address some issues of concern to researchers and professionals. It highlights that so-called psychosomatic diseases, disorders with an emotional origin, can be factors leading to physical problems that may affect hair, skin, and nails. Methodology: This paper aims to describe the approach for making a diagnosis, outline the emotional aspects in response to the disease, and detail the treatments tried and described in the consulted literature. It is a qualitative literature review conducted during November and December 2021, using databases such as Lilac’s, Medline, Pubmed, and Scielo. Results and Conclusion: Many studies suggest examining the role of coping and social support, the latter being seriously affected by changes in the appearance of individuals with alopecia.

A Review on Chittodvega w.s.r to Generalized Anxiety Disorder and its Management

With the advent of modern science, human life has become much faster and more stressful. Psychiatric disorders are therefore expanding today, A wide range of psychiatric conditions have been described in Ayurveda. Ayurveda follows psychosomatic approach of health. Chittodvega is a Manasavikara mentioned by Charaka which is considered as a perfect word for highlighting the status of anxiety, Generalized Anxiety Disorder. Chittodvega can exists as a separate disease or can be an etiological factor for other psychic and psychosomatic diseases. Generalized anxiety disorder (GAD) is a mental health disorder that produces fear worry and a constant feeling of being overwhelmed. This on-going worry and tension may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle tension or problems sleeping. Being an alarming disease, it requires effective management. In recent years several synthetic drugs have been introduced for the treatment of anxiety disorders. Clinical trials have shown that anxiolytic drugs alone have limited long term efficacy and one cannot avoid major side effects such as drug dependence, drug resistance, sedation etc. Ayurveda follows psychosomatic approach of health. Acharya Charaka explains three types of therapies of physical and mental disorders Daivavyapasraya, Yuktivyapasrya, Satvajaya Chikitsa. So the present study deals with systemic review of Chittodvega from all the classics of Ayurveda and its management.

Psychosomatic Disorder

Abstract: The word psychosomatics comes from the Greek word “psyche (mind) and “soma” (body) psychosomatic illness is on illness that affects the mind And body in some case mentl and emotions disorders can increases many studies have shown that chronic diseases . mouth burns etc. Psychosomatic disorder include physical and mental disorders. The physical symptoms of the diseases are caused by mental or emotional problems if often lead to stress , anixiety ,and depression when menatal disorder are not recognized ,physical pain wil occure due to hystriea although oral and paraoral patterns indicate psychosomatic disorders . The term psychosomatic diseases ,oral diseases , stress etc .relevent articles were selected and filtrated from the database using .

Mode of Psychosomatic Medical Integration: Exploring the Pathogenesis of Heart, Brain-body Interaction

At present, the methods of neuroscience research have been widely used in the field of psychosomatic medical research, and now the mainstream medicine has developed a strong interest in integration, which is also a necessary prerequisite for the greater development of psychosomatic medicine. Explore multidisciplinary, multimodal, the integration of medical treatment, is expected to make patients with psychosomatic disorder treatment effect of progress, so that the causal mechanism of psychosomatic disease in new areas, compared with previous physical and mental medical research, now the neuroscience research results have stronger credibility, nerve medical research will be more psychosomatic medical research mode brings new inspiration, bring new ideas to psychosomatic disease diagnosis and treatment. Based on this, the paper proposed the integration model of mind and physical medicine, and respectively discussed the mechanism of mental and body interaction, body and body interaction, multiple and multiple interaction between mind and body, hoping to provide reference for related work.

Research progress in psychosomatic medicine in 2023: An overview

Psychosomatic medicine focuses on exploring the interactions of biological, psychological, and social factors in regulating the balance between health and disease. Recent shifts in disease spectra and medical models have contributed to the heightened prevalence and burden of psychosomatic diseases, posing new challenges to the contemporary health-care system. Consequently, there has been an imperative drive toward intensified research in psychosomatic medicine. Neuroscience methodologies have been widely applied in the research of psychosomatic diseases, facilitating the exploration of underlying causal mechanisms of psychosomatic diseases and the examination of correlations between brain function, specific organ systems, and clinical manifestations. This article offers a review of the contemporary research developments in 2023 regarding the pathogenesis, diagnosis, treatment, and intervention strategies for psychosomatic diseases, approached from various systemic perspectives. Drawing upon these insights, it offers an outlook on the future of psychosomatic medicine, aiming to enhance the integration of body&amp;ndash;mind to clinical practice for the management of psychosomatic diseases.

Pedagogical Work with Children with Increased Anxiety: Educational Approach in Transactional Analysis

This article discusses the problem of increased anxiety in children and options for pedagogical work with them. Anxiety, being the personal basis for the systematic reactions of a child with emotional and physiological stress to family and school situations, can cause the formation of various psychosomatic diseases, therefore, the prevention of anxiety reactions, the creation of a comfortable learning and personal development environment are also a means of preventing diseases and preserving the health of the nation. The author examines the possible causes of increased anxiety in children and gives specific recommendations for teachers and parents on how to support a child in difficult situations and stabilize his or her emotional state.

Investigating LGBTQ affirmative attitudes and needs for better practice among Hungarian healthcare professionals

AbstractIntroduction: LGBTQ (lesbian, gay, bisexual, transgender, queer) people often do not seek health care and do not identify as LGBTQ people because of fear of judgment, stereotyping, and discrimination by health professionals. All of this is a particularly worrying phenomenon, because various mental difficulties, risky behaviors, and certain types of somatic and psychosomatic diseases may appear in a higher proportion among them.Objectives Attitudes related to LGBTQ people were examined in several areas in Hungary. Most of our data comes from psychologists, however, a comprehensive examination of health professionals’ attitudes towards LGBTQ people has not yet been carried out.MethodsIn a cross-sectional online survey, we ask healthcare professionals (medical doctors, nurses, other graduate healthcare professionals and medical university students) to fill out our questionnaire. The participants complete the Modern Homonegativity Scale and the Lesbian, Gay, Bisexual and Transgender Clinical Skills Development Scale.Results We assume that the majority of Hungarian healthcare professionals have a neutral or positive attitude towards LGBTQ people, but they struggle with a significant lack of affirmative skills. We will present our results in detail in the presentation of the symposium.ConclusionsThere is an urgent need to provide the appropriate affirmative knowledge material to Hungarian healthcare workers.Disclosure of InterestNone Declared