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IntroductionSpatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities.AimsWe used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.MethodsA cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).ResultsBroad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.ConclusionAdults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.

ABSTRACTIntroduction Academic motivation (AM), motivation in relation to formal studies that as a construct of the self-determination theory (SDT), is frequently assessed by the Academic Motivation Scale (AMS). However, the scoring of AMS in itself is not fully consistent with the SDT theory as only scores of the subscales can be calculated resulting in seven different score means instead of positioning the individual on the self-determination continuum. There have been few attempts at a person-centered approach to AMS scoring, especially among medical students. Our study aimed to find distinct academic motivation profiles and demonstrate their concurrent criterion validity with mental health variables (psychological distress, life satisfaction) among medical students.Methods The AMS-28 college version, the General Health Questionnaire (GHQ-12), and the Single-Item Measure of Life Satisfaction were administered among medical freshmen. Academic motivation profiles were generated by two methods: 1) two-step cluster analysis, and 2) quantile analysis.Results The sample consisted of 189 participants (mean age = 19.38 ± 2.03 years, 72% females). The cluster analyses revealed three fairly distinct profiles of self-determination: ‘High’ (n = 59; mean im = 5.48 ± 0.60; mean em = 6.07 ± 0.41; mean am = 1.57 ± 0.95), ‘Moderate’ (n = 111; mean im = 4.5 ± 1.06; mean em = 4.41 ± 0.87; mean am = 1.25 ± 0.36), and ‘Low’ (n = 19; mean im = 4.22 ± 1.02; mean em = 4.03 ± 1.16; mean am = 3.07 ± 1.30). The creation of deciles allowed the identification of those who were most intrinsically (n = 14, 7.4%), extrinsically (n = 10, 5.3%), and least motivated (amotivated) (n = 18, 9.5%). ‘Low’ self-determination/amotivation was associated with increased psychological distress and decreased life satisfaction.Conclusion Our results provide means to position medical students on the SDT continuum based on ‘Low’, ‘Moderate’, or ‘High’ levels of self-determination toward their studies. These AM profiles predict the mental health of medical freshmen, which supports the validity of the outcomes and highlight the risks of amotivation for psychological morbidity. The limitations and implications are discussed.

BackgroundRoma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary.MethodsA cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3).ResultsResidents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity.ConclusionThe study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Background: This paper describes the outcomes of an integrated health promotion programme implemented in a Hungarian high school offering health education in the curriculum, daily optional physical education, teacher training in applying a person-centered approach in teaching, and parental involvement in school activities. Methods: The evaluation used mixed methods of which results of the before-6-months-after quantitative survey among pupils is described. The health status and behaviour of students were assessed by applying the Hungarian version of the HBSC questionnaire. Results: Significant improvement was found in the self-rated health of girls (6.6% increase in being of excellent health, p = 0.04), and the consumption of sweets and sugary soft drinks decreased significantly for both genders (boys: −10.2%, p = 0.01; girls: −6.06%, p = 0.04). However, the proportion of physically inactive girls significantly increased (girls: 11.2%, p = 0.01), and substance use did not change significantly. Discussion and conclusions: The intervention had significant positive impacts on subjective health and dietary habits and could counteract the secular trend of increasing tobacco, alcohol, and drug consumption by age among adolescents, but this unfortunately does not include physical inactivity. Offsetting the most widespread health risk behavior, physical inactivity, may require mandatory daily physical education in schools.

Abstract Intoduction Childhood intelligence is an important predictor of later outcomes in life such as socioeconomic status or health. Hence, a deeper understanding of predictors of child intelligence should suggest points of intervention for children facing adversities. Objectives The purpose of this study is to examine the predictive value of demographic, perinatal and neonatal variables after birth and developmental characteristics at age 2 for 4-year intelligence as outcome among low birth weight children. Methods We designed a panel study with a 2-year follow-up with 114 child-mother pairs. The outcome variable was IQ intelligence quotient at 4 years of age of LBW low birth weight children measured by the Wechsler Primary and Preschool Scales of Intelligence. Potential predictors were maternal education, family wealth, ethnic identity; sex, twin pregnancy, gestational age, birth weight, Apgar scores, maternal smoking during pregnancy; diagnosis of intravetricular haemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia after birth and cognitive, language and motor development at age 2 measured by one composite score of the three Bayley Scales of Infant and Toddler Development aggregated. Results Stepwise backward regression was carried out including significant variables from the bivariate analysis. The best model included 4 predictors which accounted for 57% of the variance of the full IQ intelligence at 4-years of age. Maternal higher education was significant positive, below average family wealth and neonatal diagnosis of bronchopulmonary dysplasia were significant negative predictors in the model after birth. 2-year developmental characteristics such as cognitive, motor and language skills were positive predictors of the IQ intelligence at age 4. Conclusion Sociodemographic assessment at birth and developmental assessment at two years of age are of crucial importance to recognize children at high risk for delayed cognitive development. High-risk children should be directed to supportive interventions and their development should be regulary monitored.

Abstract Objectives A Primary Care Model Programme had been implemented in Hungary between 2013 and 2017 in which group practices were established that employed—among others—nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme. Methods A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales. Results Positive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-the-job vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence. Conclusions Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for disadvantaged groups, but also improved the mental health of mediators themselves.

Objectives:Physical activity (PA) has a positive effect on life satisfaction (LS) among adolescents, but the moderating effect of gender and level of PA intensity have been equivocal. Our aim was to examine the pattern of physical activity by grade in high school students, and the role of gender and grade on the association between physical activity and life satisfaction.MethodsFour repeated cross-sectional online questionnaire surveys between 2011 and 2013 were carried out among all students in one Hungarian high school (N = 3,450). Health status and behavior was assessed by the Hungarian online version of the health behavior of school-aged children (HBSC) questionnaire. Regression with robust variance estimator was used to identify determinants of life satisfaction.ResultsGood self-reported health as opposed to bad increased life satisfaction by 0.30 standard deviation; having very well or well-off family as opposed to not well-off increased LS by 0.16 standard deviation; and being inactive compared to being vigorously active decreased LS by 0.1 standard deviation.ConclusionsPhysical inactivity has a negative effect on life satisfaction in boys and girls regardless of grade but compounded by low perceived family wealth.

Abstract Background A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. In a country with single-handed practices, four group practices or GP clusters were created in the Programme. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Health mediators were interviewed about their work experiences, motivation, and overall opinion as members of the clusters as part of the Programme evaluation. Methods As part of the Programme evaluation, structured interviews were conducted with all 40 health mediators employed at the time in the Programme. Interviews were transcribed and content analysis was carried out. Results Three themes emerged from the transcripts. The first focused on the health mediators’ personal characteristics such as motivation to join the Programme, the way their job increased their self-esteem, social status and health consciousness. Domains of the second theme of their work included importance of on-the-job training and of their insider knowledge of local communities, as well as their pride to have become members of the primary care team. The third theme covered overall functioning of the Programme of which they had mostly positive opinions, notwithstanding some criticism regarding procurement. Conclusions Health mediators had earlier worked in various European countries specifically to improve access of Roma ethnic groups to health services but the Hungarian Model Programme was globally the first in which health mediators as non-professional workers became equal members of the primary care team as employees. Their contribution and overwhelmingly positive experiences, along with their useful insights for improvement call for the establishment and funding of health mediator positions in primary care especially in areas with large numbers of disadvantaged Roma populations.

Abstract Background A Model Programme of primary care group practices was implemented in Hungary between 2013 and 2017 – where virtually all GPs had worked in single practices – aiming to increase preventive service uptake and reduce inequalities based on a bilateral agreement between the Swiss and Hungarian governments. Group practices employed a wide variety of health professionals as well as support workers called health mediators. Employment of the latter was based on two decades of European experience of health mediators who specifically facilitate access to and use of health services in Roma minority groups. Health mediators had been recruited from local communities, received training on the job, and were tasked to increase uptake of new preventive services provided by the group practices by personal contacts in the local minority populace. The paper describes the contribution of the work of health mediators to the uptake of two new services provided by group practices. Methods Quantitative analysis of depersonalized administrative data mandatorily reported to the Management of the Programme during 43 months of operation was carried out on the employment of health mediators and their contribution to the uptake of two new preventive services (health status assessment and community health promoting programmes). Results 80% of all clients registered with the GPs participated at health status assessment by invitation that was 1.3–1.7 times higher than participation at the most successful national screening programmes in the past 15 years. Both the number of mediator work minutes per client and participation rate at health status assessment, as well as total work time of mediators and participants at community health events showed high correlation. Twice as many Roma minority patients were motivated for service use by health mediators compared to all patients. The very high participation rate reflects the wide impact of health mediators who probably reached not only Roma minority, but vulnerable population groups in general. Conclusion The future of general practices lays in multidisciplinary teams in which health mediators recruited from the serviced communities can be valuable members, especially in deprived areas.

The segregated colonies (SCs) in Hungary are populated mainly but not exclusively by Roma. Their health care use is restricted in many respects. It has not been studied yet, whether fair COVID-19 vaccination coverage achieved in Hungary is accompanied with fair effectiveness in SCs. Using census data, the vaccination coverage in SCs and the complementary areas (CAs) in the same settlements of the country was determined. To describe the settlement level differences, the vaccination coverage (until June 30, 2021) in SCs were compared to those in CAs by age, sex, and eligibility for exemption certificate standardized measures. Aggregating settlement level data, the level of geographic discrimination in Hungary was also determined. According to nationwide aggregates, crude vaccination coverage was significantly lower in SCs (40.05%, 95% CI 39.87%-40.23%) than in CAs (65.42%, 95% CI 65.37%-65.46%). The relative standardized vaccination coverage was 0.643 (95% CI 0.639-0.647) in SCs. A total of 437 of the 938 investigated settlements showed significant local vaccination disparities. Hungarian citizens living in SCs, mainly of Roma ethnicity, are a distinct high-risk group. Special intervention adapted to SCs is needed to mitigate inequality in vaccination coverage and further consequences of the pandemic.

Background: Health literacy, a recently determined construct plays an important role in how individuals are able to manage their health. A useful approach for the assessment of health literacy is to measure the comprehension of available patient education materials (PEMs).Objective: We aimed at assessing the usefulness of PEMS available in Hungarian by testing comprehension of selected PEMs in different groups of users.Methods: Comprehension of patient education materials in the domain of healthcare was tested by selecting PEMs and creating questions based on their text in 3 dimensions of health literacy: understand, process/appraise, apply/use. Twenty questions were created that could be answered without pre-existing knowledge by reading the appropriate text taken from PEMs. Comprehension was examined in four groups: laypersons, non-professional healthcare workers, 1st year healthcare students, and 5th year medical students. Readability indices were calculated for the same texts to which questions were created.Results: Laypersons answered

Background: The public health relevance of health literacy is highlighted by the fact that its higher levels can improve health outcomes and reduce health inequities. In order to design effective interventions for improving health literacy, the relationship between health literacy and other factors such as sociodemographic variables, subjective health and social support must be understood.Objective: Our aim was to test a socioecological model of the determinants of health literacy with a special focus on the effect of residence. Our study investigated geographical differences regarding the levels of health literacy and its determinants as this was not investigated before in European nationwide surveys.Methods: Data was collected by a polling company in a sample (n = 1,200) of the Hungarian adult population nationally representative by age, gender, and permanent residence in 2019 January. The questionnaire included items on sociodemographic data, subjective well-being, social support, and two health literacy scales. A recursive path model was used to outline the mediating effect of social support between sociodemographic variables and health literacy where both direct and indirect effects of the explanatory variables and multiple relationships among the variables were analyzed simultaneously. Multiple-group analysis was applied to the three pre-set categories of permanent residence (capital city, urban and rural).Results: There was no statistically significant difference by residence regarding levels of health literacy. Social support and educational attainment were the most important determinants of health literacy after adjusting for the effect of other sociodemographic variables. However, the magnitude of effect of social support and educational attainment is different between types of settlements, the strongest being in rural areas.Conclusion: Social support seems to mediate the effect of socioeconomic position on health literacy which could be taken into account when designing interventions to improve health literacy, especially in rural areas. Further studies would be needed especially in rural communities to see whether improvement of social support could be utilized in projects to increase the level of health literacy.

Abstract Background Due to risk and response adapted treatment strategies, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured, and become long-term survivors. However, a high proportion of survivors suffer from treatment-related long-term side effects such as secondary malignancy, organ failure, persistent fatigue and psychological distress. The aim of this study was to evaluate psychological distress and its risk factors among our HL survivors. Methods One hundred sixty-three (50% female) adult HL survivors were contacted between January 1, 2012 and march 31, 2015 in our outpatient centre. The patients were asked to complete a standardized, validated, self-administered Hungarian questionnaire with demographic questions and the following scales: Hospital anxiety and depression scale (HADS14), general health questionnaire (GHQ12), sense of coherence (SOC13) perceived stress scale (PSS4), dysfunctional attitude scale (DAS17). Disease and treatment data were acquired from hospital records. Results Majority of HL survivors are in early adulthood, our most important goal should be to return them to normal life after their lymphoma is cured. The employment status at the time of survey seemed to be crucial so patients were divided into either active (n = 93) or inactive (n = 47) group. Retired survivors (n = 19) were excluded from the subgroup analysis. Psychological distress was significantly lower in active patients. Multiple logistic regression analysis showed significant differences between the inactive and active subgroups, such as age at diagnosis (≥30 years or below, p = 0.001), education level (below college vs. college, p = 0.032) and treatment related long-term side effects (yes vs. no, p

Az elmúlt három évtizedben folyamatosan nőtt a nemzetközi érdeklődés a populációk mentális egészsége iránt, amit a témakörben nagy számban végzett tudományos kutatások és nemzetközi szakmai dokumentumok bizonyítanak. A téma iránti érdeklődéshez és elkötelezettséghez képest azonban a szakirodalomban igen alacsony a populációs adatokat szolgáltató, pontosan dokumentált, jól tervezett, és nemzetközi összehasonlításra is alkalmas vizsgálatok száma. Ez különösen igaz a hazai népesség mentális egészségével kapcsolatos kutatásokra, ami jelentős akadálya annak, hogy a mentális problémákkal küzdő hazai népesség különféle csoportjait célzottan segíteni képes, bizonyítékokon alapuló beavatkozásokat kínáló, több mint egy évtizede tervezett lelki egészség-stratégia elfogadásra kerüljön. E helyzet megoldásához kíván hozzájárulni a közlemény azáltal, hogy áttekintést ad a mentális állapot populációs mérésének konceptuális kérdéseiről, beleértve a mentális egészség átfogó témaköreit; valamint számba veszi a mentális zavarok, a generikus mentális állapot, és a mentális egészség, illetve a szubjektív jóllét vizsgálatára alkalmas, populációs vizsgálatokban leggyakrabban használt mérőeszközöket. A mentális egészség kérdéskörének jelentőségét és a magyar népesség mentális problémáira fókuszálva szükséges, a rendelkezésre álló széleskörű nemzetközi tapasztalatokat figyelembe véve pedig lehetséges a hazai népesség mentális állapotát az eddiginél átfogóbb, rendszeres, és nemzetközi összehasonlításra alkalmas eredményeket nyújtó módon vizsgálni, amely megalapozza a lelki egészség javítását hatékonyan szolgáló, bizonyítékokra alapozott országos stratégia megtervezését és eredményeinek nyomon követését. [ABSTRACT FROM AUTHOR]

Abstract Streptococcus pyogenes (Spy) Cas9 has potential as a component of gene therapeutics for incurable diseases. One of its limitations is its large size, which impedes its formulation and delivery in therapeutic applications. Smaller Cas9s are an alternative, but lack robust activity or specificity and frequently recognize longer PAMs. Here, we investigated four uncharacterized, smaller Cas9s and found three employing a “GG” dinucleotide PAM similar to SpyCas9. Protein engineering generated synthetic RNA-guided nucleases (sRGNs) with editing efficiencies and specificities exceeding even SpyCas9 in vitro and in human cell lines on disease-relevant targets. sRGN mRNA lipid nanoparticles displayed manufacturing advantages and high in vivo editing efficiency in the mouse liver. Finally, sRGNs, but not SpyCas9, could be packaged into all-in-one AAV particles with a gRNA and effected robust in vivo editing of non-human primate (NHP) retina photoreceptors. Human gene therapy efforts are expected to benefit from these improved alternatives to existing CRISPR nucleases.

Mortality caused by non-communicable diseases has been extremely high in Hungary which can largely be attributed to not performed preventive examinations (PE) at the level of primary health care (PHC). Both structures and financial incentives are lacking which could support the provision of legally defined PEs.A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs.A sample of 4320 adults representative for Hungary by age and gender was surveyed. 12 PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not perfomed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund.The rate of service use varied between 16.7% to 70.2%. There was no correlation between the unit price of examinations and service use (r=0.356; p=0.267). The rate of not performedPEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million EUROs saved by not paying for PEs, the largest share was not spent on those in the lowest educational category.New preventive services offered in the reoriented PHC model programme include systematic and scheduled health examination health promotion programmes at community settings; risk assessment followed by individual or group care, and/or referral and chronic care.The Model Programme has created a pressure for collaborative work, consultation and engagement at each level, from the GPs and health mediators up to the decision making level. It channeled the population into preventive health services shown by the fact that more than 80% of the population in the intervention area has already participated in the health status assessment.