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Elméleti háttér: Az orvostanhallgatók kedvezőtlen mentális egészségi állapotára kutatások széle köre mutat rá világszerte. A háttérben álló tényezők és a szükséges beavatkozások megismerése azonban már kevesebb vizsgálatnak került a fókuszába, és különösen kevés a kvalitatív módszert alkalmazó kutatás. Célkitűzés: A Debreceni Egyetem magyar és angol nyelvű orvosképzésében részt vevő hallgatók mentális egészségét kedvezőtlenül befolyásoló egyetemi és egyéni szinten megjelenő tényezők azonosítása, a hallgatók által javasolt beavatkozások megismerése. Módszerek: 26 fő (13 magyar és 13 angol nyelven tanuló), I–VI. éves orvostanhallgatóval készítettünk fókuszcsoportos interjúkat, amelyeket hang-felvételen rögzítettünk. Az interjúk átírását követően az összesen 46 874 szószám terjedelmű anyagon tartalomelemzést végeztünk az NVivo szoftver segítségével, azt manuálisan ellenőrizve. Eredmények: Legfőbb stresszorokként a tananyag mennyiségét, a vizsgáztatás sajátosságait (tisztázatlan követelmények, vizsgáztatói szubjektivitás, észlelt igazságtalanság), az oktatási segédanyagok, valamint a gyakorlati képzés hiányosságait, illetve az egyetemen belüli információáramlás problémáit fogalmazták meg a hallgatók. A magyarok körében kiemelt stresszforrásként jelent meg az évismétlés és az önköltséges képzési formába való átsorolás veszélye. A tananyag nagy mennyisége miatt a hallgatók tanulásmódszertani, időbeosztási készségek fejlesztését célzó intervenciókat szeretnének, továbbá igényük lenne a stresszkezelési és kudarctűrési képességük fejlesztését célzó segítségre is. Sokak szakmai jövőképe bizonytalan, amelyet a hatékony karrier-tanácsadás tudna enyhíteni. Következtetés: Az orvostanhallgatók mentális egészségére számos szervezeti és egyéni tényező jelent kockázatot, amelyeket az egyetem elsősorban rendszerszintű beavatkozásokkal tudna csökkenteni.

Bevezetés: Az egészségműveltség fogalma az elmúlt két évtizedben került az egészségügy fókuszába. Többféle koncepciója ismert, ennek megfelelően mérésére is többféle teszt használható. Hazánkban az elmúlt néhány évben nőtt meg ezen a területen a kutatások száma, ezért a magyar nyelven elérhető publikált kérdőívek és országos felmérések száma is csekély. Kutatásunkban a magyar lakosság egészségműveltségét vizsgáltuk két különböző, külföldi kutatásokban gyakran használt eszköz alkalmazásával. Módszertan: A keresztmetszeti adatgyűjtés 2019-ben, 1 200 fő részvételével a magyar felnőtt lakosságra kor, nem, valamint lakóhely szerint reprezentatív mintán zajlott. Az egészségműveltség mérésére a „Rövid Egészségműveltségi Szűrő Teszt” (Brief Health Literacy Screening Tool, BRIEF) és az „Átlagos Tápérték Teszt” (Newest Vital Sign, NVS) magyar nyelven validált változatait használtuk. A leíró elemzések a nem, kor és lakóhely szerinti súlyozott adatokon történtek a 95%-os megbízhatósági tartományok megadásával. Az egészségműveltség meghatározó elemeit bináris logisztikus regresszió segítségével állapítottuk meg. Eredmények: Az NVS kérdőív kérdéseire adott válaszok alapján a lakosság 17,9%-nak nagy valószínűséggel inadekvát (elégtelen), 28,1%-nak valószínűleg limitált (korlátozott) és 54,0%-nak nagy valószí-nűséggel megfelelő a funkcionális egészségműveltsége. A BRIEF teszt alapján a válaszadók közel egyharmada került az elégtelen, 35,9%-a a marginális (problémás) és 29,8%-a az adekvát (megfelelő) szubjektív egészségműveltségű kategóriába. Az NVS kérdőívvel mért funkcionális egészségműveltség esélyét növelte a magasabb iskolai végzettség, a kedvezőbb egészségi állapot és az erős társas támasz, ugyanakkor a BRIEF teszttel mért szubjektív egészségműveltség megfelelő mértékének esélyét csak a felsőfokú végzettség emelte. A két különböző teszttel mért eredmények pozitív kapcsolatban voltak egymással, azaz a megfelelő szubjektív egészségműveltség növelte a megfelelő funkcionális egészségműveltség esélyét és fordítva. Következtetések: Mindkét teszt eredményei alapján indokoltnak tartható az egészségműveltséget javító beavatkozások tervezése és kivitelezése a hazai népesség körében. Tekintettel arra, hogy az egészségműveltséget befolyásoló tényezők közül csak az iskolai végzettséggel volt egyértelműen kimutatható kapcsolat, így az egészségműveltséget növelő beavatkozások legfontosabb színterei az iskolák lehetnek. Mivel az eredmények szerint a lakosság közel felének nem megfelelő az egészségműveltsége, ajánlott lenne a felnőtteknek szóló, egészséggel kapcsolatos tájékoztatók és betegedukációs anyagok vizsgálata, illetve szükség esetén átdolgozása annak érdekében, hogy azokat az alacsonyabb iskolai végzettségű személyek is megértsék, tartalmukat hasznosítsák. Az eredmények alapján az a megállapítás is felvethető, hogy az egészségműveltség szintje függ attól, hogy milyen eszközt használnak annak mérésére.

Short sleep duration is a known risk to health, but less certain is the impact of longer sleep duration on various measures of health. We investigated the relationship between sleep duration and mental health outcomes in a cross-sectional survey conducted on a homogenous sample of healthy governmental employees (N = 1212). Data on sleep duration, subjective health, psychological stress, sense of coherence, life satisfaction and work ability along with sociodemographic data were collected. Sleep duration was significantly longer, and mental health outcomes and work ability were significantly better among those in at least good subjective health. Fitting mental health outcomes on sleep duration suggested a quadratic or fractional polynomial function, therefore these were tested and the best-fitting models were selected. Longer than 8 h of sleep duration was associated with a decreasing sense of coherence and decreasing work ability. However, psychological stress and life satisfaction were positively impacted by more than 8 h of sleep. Sleep duration likely has an optimum range for health, similar to other variables reflecting homeostatic functions. However, this is difficult to prove due to the left-skewed distribution of sleep duration.

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.

Összefoglaló. Bevezetés: A munkavégzés fontos egészségprotektív tényező, de munkahelyi pszichoszociális kockázatokkal jár, amelyeknek az egészségi állapottal való összefüggéseire az elmúlt évtizedekben derült fény. Célkitűzés: A vizsgálat célja a munkahelyi beosztás és az egészségi állapot közti összefüggés vizsgálata volt olyan, viszonylag homogén mintában, amelynek tagjait közintézmények dolgozói adták. Módszer: Kérdőíves egészségfelmérés történt online adatgyűjtéssel, keresztmetszeti elrendezésben, egy megyeszékhely két közintézményében alkalmazottak körében. A kérdőív demográfiai, az egészségi állapotra, az egészségmagatartásra és a munkavégzésre, köztük a munkahelyi beosztásra vonatkozó, validált kérdéseket tartalmazott. Az adatelemzés beosztási kategóriák szerint két (vezető vs. beosztott), illetve három (vezető, diplomás beosztott, nem diplomás beosztott) rétegben történt. Eredmények: A vizsgált mutatók közül a szubjektív egészség, az élettel való elégedettség, a koherenciaérzés, a túlzott mértékű pszichés stressz, a munkahelyi hiányzás, a munkahelyi és magánéleti társas támogatottság a vezető beosztásban dolgozók körében volt a legkedvezőbb. A vizsgált indikátorok közül csak a munkaképesség nem különbözött beosztás szerint, és csak az alvásidő volt szignifikánsan kedvezőtlenebb (rövidebb) a vezetők körében a beosztottakhoz képest. A háromrétegű elemzés szerint a legkedvezőtlenebb mutatók a nem diplomás beosztottakra voltak jellemzőek. Eredményeink szerint a vezető beosztásban dolgozók egészségi állapota és mentális egészsége kedvezőbb, mint a beosztottaké. Következtetés: A munkahelyi beosztás az egyéni társadalmi-gazdasági helyzet mellett a munkahelyi pszichoszociális stressz mértékével is összefüggésben van, ezért a munkahelyi stressz vizsgálata során érdemes beosztás szerinti elemzést is végezni. A munkahelyi pszichoszociális stressz nyomon követése minden munkahelyen ajánlott, amelynek egyszerű módja az alkalmazási idő és a hiányzott napok számának létszámarányos és beosztásra stratifikált, idősoros nyomon követése. Orv Hetil. 2021; 162(29): 1172–1179. Summary. Introduction: Employment is an important health protective factor but also entails workplace psychosocial risks with multiple impacts on health. Objective: The present study aimed at examining the association between employment position and subjective health in a relatively homogenous sample of public servants with mostly tertiary degrees. Method: Online health survey was conducted among employees of two large public institutes in a large city in Hungary. The questionnaire contained items on demographic data, health status, mental health, health behaviour, and work-related questions including employment position (leadership). Data analysis was carried out by employment position in two (manager, subordinate) and three (manager, subordinate with college degree, subordinate with no college degree) strata. Results: Subjective health, satisfaction with life, sense of coherence, pathological stress, sickness absence, social support in the workplace and private life were most favourable among those in leadership position. Work ability did not differ by employment position, but sleep time was significantly less favourable (shorter) among leaders compared to subordinates. Subordinates with no college degree had the worst measures of health. Conclusion: Employment position is related to individual socioeconomic status and workplace psychosocial stress, therefore research on workplace stress should include employment level as a potential confounder. Psychosocial stress at workplaces should be monitored for which various recommendations are available. The simplest method is to monitor mid- and long-term turnover and sickness absence stratified for employment position and proportionate to the workforce. Orv Hetil. 2021; 162(29): 1172–1179.

The high risk of mental health problems among medical students has been compounded by the COVID-19 pandemic, which greatly reduced social contact. The mental health support service of the medical school of one Hungarian university was transferred to the online learning management system and was expanded by self-help materials in three domains: Improving study skills, stress management techniques, and reducing stress related to the COVID-19 pandemic. We wanted to understand the preferences of medical students for psychological self-help techniques by investigating the pattern of access to online self-help materials and the characteristics of the users. Access to the online materials between April 2020 and April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. Of all the students who logged in during the examination period (

Magyarországon 2013-2017 között Alapellátás-fejlesztési Modellprogram működött, melynek célja az egészségügyi alapellátás szolgáltatásainak bővítése, és a lakosság, különösen annak hátrányos helyzetű csoportjai egészségi állapotának javítása volt. A Modellprogramban a családorvosok mellett más szakmákat képviselő munkatársak, valamint úgynevezett segéd-egészségőrök is dolgoztak négy praxisközösségben, amelyek hátrányos helyzetű kistérségekben jöttek létre. A segéd-egészségőrök alkalmazásának célja a helyi lakosság ellátáshoz segítése, vagyis döntően egészségügyi mediáció volt. A jelen kutatás célja a Modellprogram 47 hónapja során foglalkoztatott segéd-egészségőrök működésének vizsgálata volt, alkalmazásuk és munkavégzésük kvantitatív jellemzői alapján, amelyek a Modellprogramot irányító programirodának szolgáltatott jelentésekből származtak. A Program futamideje alatt összesen 58 segéd-egészségőr alkalmazására került sor, akik többsége fiatal-középkorú, gyermekes anya volt, döntően legfeljebb szakiskolai végzettséggel, változó időtartamú alkalmazásban és heti munkaidővel. A praxisközösségekben tevékenykedő segéd-egészségőrök munkájának összehasonlításához különféle mutatókat hoztunk létre, amelyek az ellátottak létszámára, valamint az új szolgáltatásként kínált egészségi állapotfelmérés és közösségi egészségfejlesztési programok résztvevői létszámára vetítették a mediátori munkaórákat. Az egy ellátandó személyre jutó segéd-egészségőr munkapercek száma a Borsodnádasdi PK-ban 2,45-szeres volt a Berettyóújfalui PK-éhoz képest. A négy praxisközösség segéd-egészségőreinek munkaidő-hatékonysága némileg eltért egymástól. A vizsgált mutatókat együttesen tekintve a segédegészségőrök munkaidő-kihasználásának mértéke az ellátottak elérésére a Berettyóújfalui PK-ban volt a legnagyobb, és a Hevesi PK-ban a legkisebb. Az Alapellátás-fejlesztési Modellprogram világviszonylatban is elsőként foglalkoztatott az egészségügyi alapellátásban az ellátást végző csapat teljes jogú tagjaiként mediátori feladatokat ellátó segéd-egészségőröket tartós alkalmazásban. A segéd-egészségőrök vagy mediátorok fontos szereplői lehetnek az egészségügyi alapellátásnak, akik közvetítve az alapellátási szakemberek és a lakosság minden csoportja közt, hatékonyabbá teszik a szakemberek tevékenységét, különösen a leghátrányosabb helyzetű településeken és népességcsoportokban.

Medical students are at increased risk for psychological morbidity but the majority of those with mental health problems do not seek professional care. We aimed to uncover the viewpoints of medical students regarding barriers and facilitators to using university mental health services and their attitudes and preferences towards online counselling. Four semi-structured focus groups were conducted (

Our aim was to investigate the impact of the school psychosocial environment, including students' general attitude towards the school, perception of support from teachers and classmates as well as individual psychosocial factors including self-esteem and loneliness on life satisfaction (LS). Four repeated cross-sectional online questionnaire surveys were carried out between 2011 and 2014, inviting all students in one Hungarian high school. Health status and behaviour were assessed by the Hungarian version of the HBSC questionnaire. Results from the surveys were pooled for analysis (N = 3310 students). Heteroskedastic regression estimating robust variance was used to identify potential determinants of LS. Family wealth perceived to be well-off, self-esteem, and being perceived as a good student were identified to be the most important significant positive contributing factors of LS. Perceived good relations with classmates and teachers and an overall positive attitude to school had smaller but still significant positive effects on LS. Self-esteem was a significant moderator for the effect of perceived difficulty of schoolwork, relation with classmates, and gender. This paper shows that self-esteem is not only an independent factor but also a modifier of some school-related variables on LS. The complex interplay among school-related and individual potential determinants of LS should be taken into account in future research by controlling for their interactions.

BACKGROUND The high risk for mental health problems among medical students has been compounded by the Covid-19 pandemic which greatly reduced formal and informal social contacts. In order to help students, the mental health support service of the medical school of one Hungarian university was not only transferred to the online learning management system but was expanded by self-help materials in three domains: improving study skills, stress management techniques, and reducing stress related to the Covid-19 pandemic. Separate portals were developed for medical students at Hungarian and English courses. OBJECTIVE Our objective was to investigate the pattern of access to the online self-help materials among medical students and the characteristics of those who used the portals. METHODS Access to the online materials between April 2020-April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. RESULTS 15% (n=458) of medical students entered the portal. Women were more likely to visit the site than men among both Hungarian (female: 72%) and international students (female: 59%). Fifth-year students (27%) among Hungarians and first-year students (24%) among internationals comprised the largest proportion of visitors. Of all students who logged in at any time during the examined period, 36.6– 40.4% viewed materials for improving study skills, 23-29% viewed stress management materials of which short-duration techniques in audio format were preferred. The access rate of content targeting coping with mental health effects of Covid-19 was 9.5-24%. CONCLUSIONS The pattern of access can be used for the development of interventions that are of most interest to medical students. Support to improve study skills and brief stress management techniques were the most preferred types of self-help materials.

Introduction Nowadays, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured and become long-term survivors due to risk and response-adapted treatment strategies. A well-known side effect is cognitive dysfunction that appears in HL patients after chemotherapy. In the present study, we aimed to measure cognitive dysfunction in our HL patients in this study and to find potential correlations between patient-related factors, the signs and symptoms of their diseases, or therapeutic factors. Methods We carried out a computer-assisted assessment (CANTAB) of cognitive dysfunction in 118 patients. We examined the domains of visual memory, attention, working memory, and planning. Results The median age of 64 females and 54 males at diagnosis was 29 (13–74) and 41 (21–81) years at the completion of CANTAB. Fifty-two percent of all patients showed cognitive impairment. Attention was impaired in 35% of patients, the working memory and planning were impaired in 25%, while visual memory was affected in 22%. All the three functions showed a significant association with inactive employments status. A close correlation was found between visual memory/working memory and planning, higher age at HL diagnosis or the completion of CANTAB test, and disability pensioner status. Discussion Our investigation suggests that patients with inactive employment status and older age require enhanced attention. Their cognitive function and quality of life can be improved if they return to work or, if it is not possible, they receive a cognitive training.

Background: COVID-19 has changed the world and strongly affected the health of the people and the quality of their life. These changes might impact employees’ physical activity (PA) and sedentary behavior (SB). This study aimed to summarize the literature focusing on the COVID-19-caused changes in physical activity and sedentary behavior among the adult working population. Methods: Literature searches were conducted in June 2021 using multiple electronic databases. The following keywords and synonyms were used during the searching process: physical activity, sedentary behavior, COVID-19, employee. After the data cleaning process (duplicates, inclusion criteria), the title and the abstract of all manuscripts from the searches were screened independently by two reviewers. Results: Thirty-nine manuscripts were selected as a result of the searching process. Of these, 5 were SB related, 15 were PA related and 19 addressed both PA and SB. There were longitudinal (10), cross-sectional (28) and a case study (1) in the selected manuscripts. The majority of studies were conducted in the USA (6) and Europe (18), and four studies examined the PA and/or SB in multiple countries. The majority (34 studies) of the studies used subjective, self-reported, but mostly before-validated questionnaires. Objective measures were less common and used only 12.8% of the examined studies. Moreover, 76.4% of the studies described an overall decrease in the amount of PA during the COVID-19 pandemic. In three cases, researchers observed an increase in PA among the workers. Five studies reported no significant changes in the amount of PA during the pandemic. As far as SB is concerned, 18 out of 24 of the studies reported an overall increase in the amount of SB between the two periods. Four manuscripts reported no significant change in the amount of SB, and there was only one manuscript in the examined studies that reported an overall decrease in the SB time before and during the COVID-19 pandemic. Discussion: There is no doubt that the COVID-19 pandemic, including lockdown and work from home (WFH) policies, impaired the PA and SB level of the populations. This period has delivered an important message for the adult working population as well. They should be as active as possible and avoid high levels of SB and uninterrupted sitting time. Therefore, organizations, policies and public health bodies should motivate workers, especially office workers, to be more active and interventions must be developed to mitigate the negative effects of the COVID-19 on PA and SB.

BACKGROUND Patient experiences constitute an independent dimension of health care quality that can be solicited by structured surveys or at dedicated online platforms. Unsolicited spontaneous patient narratives are much less used but potentially valuable means for gauging patient experiences. OBJECTIVE Our aim was to explore patient experiences in spontaneous patient blogs submitted during one decade to an online health forum. METHODS 1662 non-solicited individual blogs on patient experiences posted between 2009 and 2018 on a Hungarian internet forum were randomly sampled. 20% (n=346) of the blogs were used for qualitative content analysis. A coding framework was constructed based on previous research and taxonomies to analyse content, including specific experiences or episodes. Major categories and subcategories were constructed within the three major dimensions (structure, process, outcome) of Donabedian’s framework for health care quality. RESULTS Majority of blogs described a specific experience (94.2%) in healthcare; almost 40% occurred in tertiary care; 29.5% of the blogs even identified a specific hospital or department. 55.2% of the bloggers were patients themselves, and the majority (92.7%) were dissatisfied with the reported experience. Issues were most frequently related to physicians (65.2%). In terms of Donabedian’s dimensions, problems with human resources dominated “Structure” (74.1%) such as not enough or incompetent staff. Waiting time and access to care (69.19%) comprised the most frequent complaints of material resources within “Structure”. Within “Process”, episodes related to examination (42.86%) accounted for most of the complaints. Outcomes were identified in 60% of the blogs, and deterioration, complication, readmission, or death was reported in 62% of these episodes. CONCLUSIONS Donabedian’s model of healthcare quality was appropriate for the categorization of patient experiences. Regular monitoring of spontaneous patient reports is recommended to utilize them for healthcare quality improvement especially if reports provide specific details.

A Model Programme in primary care group practices (GP clusters) was implemented in 2013 in solo practices in Hungary.1 The practices employed—among others—nonprofessional community workers called “health mediators.” The 5-year program widened the range of primary health care services

Összefoglaló. Bevezetés: A munkavégzés fontos egészségprotektív tényező, de munkahelyi pszichoszociális kockázatokkal jár, amelyeknek az egészségi állapottal való összefüggéseire az elmúlt évtizedekben derült fény. Célkitűzés: A vizsgálat célja a munkahelyi beosztás és az egészségi állapot közti összefüggés vizsgálata volt olyan, viszonylag homogén mintában, amelynek tagjait közintézmények dolgozói adták. Módszer: Kérdőíves egészségfelmérés történt online adatgyűjtéssel, keresztmetszeti elrendezésben, egy megyeszékhely két közintézményében alkalmazottak körében. A kérdőív demográfiai, az egészségi állapotra, az egészségmagatartásra és a munkavégzésre, köztük a munkahelyi beosztásra vonatkozó, validált kérdéseket tartalmazott. Az adatelemzés beosztási kategóriák szerint két (vezető vs. beosztott), illetve három (vezető, diplomás beosztott, nem diplomás beosztott) rétegben történt. Eredmények: A vizsgált mutatók közül a szubjektív egészség, az élettel való elégedettség, a koherenciaérzés, a túlzott mértékű pszichés stressz, a munkahelyi hiányzás, a munkahelyi és magánéleti társas támogatottság a vezető beosztásban dolgozók körében volt a legkedvezőbb. A vizsgált indikátorok közül csak a munkaképesség nem különbözött beosztás szerint, és csak az alvásidő volt szignifikánsan kedvezőtlenebb (rövidebb) a vezetők körében a beosztottakhoz képest. A háromrétegű elemzés szerint a legkedvezőtlenebb mutatók a nem diplomás beosztottakra voltak jellemzőek. Eredményeink szerint a vezető beosztásban dolgozók egészségi állapota és mentális egészsége kedvezőbb, mint a beosztottaké. Következtetés: A munkahelyi beosztás az egyéni társadalmi-gazdasági helyzet mellett a munkahelyi pszichoszociális stressz mértékével is összefüggésben van, ezért a munkahelyi stressz vizsgálata során érdemes beosztás szerinti elemzést is végezni. A munkahelyi pszichoszociális stressz nyomon követése minden munkahelyen ajánlott, amelynek egyszerű módja az alkalmazási idő és a hiányzott napok számának létszámarányos és beosztásra stratifikált, idősoros nyomon követése. Orv Hetil. 2021; 162(29): 1172-1179.Employment is an important health protective factor but also entails workplace psychosocial risks with multiple impacts on health.The present study aimed at examining the association between employment position and subjective health in a relatively homogenous sample of public servants with mostly tertiary degrees.Online health survey was conducted among employees of two large public institutes in a large city in Hungary. The questionnaire contained items on demographic data, health status, mental health, health behaviour, and work-related questions including employment position (leadership). Data analysis was carried out by employment position in two (manager, subordinate) and three (manager, subordinate with college degree, subordinate with no college degree) strata.Subjective health, satisfaction with life, sense of coherence, pathological stress, sickness absence, social support in the workplace and private life were most favourable among those in leadership position. Work ability did not differ by employment position, but sleep time was significantly less favourable (shorter) among leaders compared to subordinates. Subordinates with no college degree had the worst measures of health.Employment position is related to individual socioeconomic status and workplace psychosocial stress, therefore research on workplace stress should include employment level as a potential confounder. Psychosocial stress at workplaces should be monitored for which various recommendations are available. The simplest method is to monitor mid- and long-term turnover and sickness absence stratified for employment position and proportionate to the workforce. Orv Hetil. 2021; 162(29): 1172-1179.

Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create a complex database for comparative and association studies to better understand the background of the very unfavourable health of Roma, especially the high burden of cardiometabolic diseases. A three-pillar (questionnaire-based, physical and laboratory examinations) health survey was carried out on randomly selected samples of the Hungarian general (HG, n = 417) and Roma (HR, n = 415) populations, and a database consisting of more than half a million datapoints was created. Using selected data, the prevalence rates of metabolic syndrome (MetS) and of its components were determined, and to estimate the risk of insulin resistance (IR), surrogate measures (the homeostasis model assessment of insulin resistance index, quantitative insulin sensitivity check index, McAuley and TyG indices and the TG/HDL-C ratio) were calculated. Receiver operating characteristic curve analysis and Youden’s method were used to define the optimal cut-off values of each IR index. The prevalence of MetS was very high in both study populations (HG: 39.8%, HR: 44.0%) with no statistically significant difference between the two groups in females or males. The prevalence of MetS showed a very marked increase in the HR 35–49 years age group. Among surrogate measures, the TyG index showed the greatest power for predicting IR/MetS at a cut-off value of 4.69 (77% sensitivity, 84% specificity) and indicated a 42.3% (HG) and 40.5% (HR) prevalence of IR. The prevalence of MetS and IR is almost equally very unfavourable in both groups; thus, the factors underlying the high premature mortality burden of Roma should be further clarified by investigating the full spectrum of risk factors available in the database, with a special focus on the access of Roma people to preventive and curative health services.

Background: The prevalence of postpartum anxiety is high and its negative consequences are significant. Most research studies have aimed at exploring the demographic and psychosocial risk factors while neglecting factors of intrapsychic vulnerability. The aim of our study is to examine postpartum anxiety from this aspect, that is, uncovering the early relational experiences of mothers, specifically regarding their early maladaptive schemas. Methods: 125 women participated in online data collection in the first year after giving birth. Maternal anxiety was measured with the postpartum version of STAI-S, while early maladaptive schemas were assessed with the Schema Questionnaire. Results: In terms of demographics, most of the mothers in our sample had middle-class characteristics, but 21.6% had clinical, and 34.4% had subclinical levels of anxiety. Our results confirmed a significant, direct effect of maladaptive schemas on postpartum anxiety in case of 13 of the 15 measured schemas. Discussion: This study draws attention to the intrapsychic vulnerability of mothers as a highly neglected etiological aspect of postpartum anxiety. Further research of intrapsychic and, especially, attachment-related vulnerability should be carried out to identify at-risk women and treat postpartum anxiety more adequately. Limitations: The sample consisted of highly educated, married women with planned children, so the results are not representative for mothers in general.

Abstract: Introduction: Monitoring the health status of populations is essential for good health policy decisions. This is particularly true in maternal and child health where targeted and timely interventions may have long-term consequences. Aim: Our objective was to describe changes in the health status of pregnant women at the national and county level during the period of 1997–2012. Method: Data were extracted from the mandatory annual reports of district nurses responsible for primary maternal care. Information on the smoking status of expecting mothers, special care during pregnancy, pregnant women entering into maternity care after 28 weeks of pregnancy, borne woman without district nurse care were analysed using Microsoft Excel and STATA 13.0. Results: The mean prevalence of smoking was 13.8% among pregnant women during the investigation period. The ratio of smoking pregnant women was higher (p

Mental health problems are common among students in higher education all over the world, so identifying those who are at higher risk would allow the targeted provision of help. Our goal was to develop an assessment tool to identify students at risk for vulnerable mental health status. This tool was created from the 12-item General Health Questionnaire and Antonovsky’s abbreviated sense of coherence scale and was tested to distinguish between those with high or low mental resilience. Predictive ability was characterized by likelihood ratios taking the Beck Depression Inventory and perceived health as references. One-quarter (95% CI 21.1% to 29.7%) of the students had been in vulnerable mental health characterized by low sense of coherence and high distress, whereas 28.4% (95% CI 24.2% to 33.1%) seemed resilient, having high sense of coherence and low distress. The high negative predictive value of the assessment tool reliably identified resilient students in comparison with both the Beck Depression Inventory (98.6%) and perceived health status (83.9%). Use of the assessment tool is recommended for students to distinguish between those at decreased and increased risk in terms of mental health. Mental health services should be offered to students at higher risk.

Monitoring the health status of populations is essential for good health policy decisions. This is particularly true in maternal and child health where targeted and timely interventions may have long-term consequences.Our objective was to describe changes in the health status of pregnant women at the national and county level during the period of 1997-2012.Data were extracted from the mandatory annual reports of district nurses responsible for primary maternal care. Information on the smoking status of expecting mothers, special care during pregnancy, pregnant women entering into maternity care after 28 weeks of pregnancy, borne woman without district nurse care were analysed using Microsoft Excel and STATA 13.0.The mean prevalence of smoking was 13.8% among pregnant women during the investigation period. The ratio of smoking pregnant women was higher (p0.01) in Borsod-Abaúj-Zemplén, Nógrád, Heves, Szabolcs-Szatmár-Bereg, and Somogy counties. The ratio of pregnants requiring special care was higher (p0.01) than the national average in Somogy, Szabolcs-Szatmár-Bereg, Borsod-Abaúj-Zemplén and Nógrád counties. More, than 1% of the pregnant women entered into care only after the 28th week of the pregnancy. Women who were registered by district nurses and gave birth less than 1% did not participate in pregnant nursing.National data hide significant regional disparities within the country which should be amended by targeted interventions, taking into account the large regional inequalities in the country. Orv Hetil. 2017; 158(29): 1131-1142.

SUMMARY A social cognitive intervention was developed and delivered as a credit course to improve mental distress of university students, based on findings in a previous health survey showing notable mental distress among future teachers in Hungary in 2007. The intervention included increasing information on psychoactive substances used for stress reduction; skills development in stress reduction methods; improving skills in communication and problem-solving. All students who participated in the previous health survey were targeted. Mental status of the participants was assessed by a questionnaire before (n: 128, 22% male, mean age 23.21 years) and after (n: 148, 30% male, mean age 23.54 years) the intervention. Specifically, self-efficacy as outcome was approximated by a trait measure (sense of coherence); psychological distress was measured by the 12-item General Health Questionnaire (Goldberg et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191‐197) after the intervention compared with that before. After the intervention, psychological distress was reduced among the participants (p: 0.013). Nonsignificant improvement occurred in the mean score for sense of coherence (from a mean 60.8 points before to 61.4 points after, p: 0.688). The intervention produced a modest but significant decrease in psychological distress in students at a cost of 54 US$ per 1 point improvement in mental distress. The intervention, a first example of the translation of the social cognitive theory into practice among students in higher education can be integrated into the curriculum as a standardized optional course.

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‡SUMMARY The Commission on Social Determinants of Health (CSDH) formulated recommendations along which health inequalities can be successfully tackled anywhere in the world. The situation of the Roma minority in Europe provides countless opportunities for the translation of these guidelines into action that should be guided by coherent and evidence-based strategies integrating lessons learned in smaller-scale field projects. Our paper describes the longterm evaluation of a locally initiated housing project in Hungary carried out more than a decade after implementation, which highlights the salience of the CSDH’s recommendations and critical factors for success and sustainability. The project provides evidence for the longterm positive impact on education of the social housing project implemented by an empowered community through delegating decision making to a board of representatives of the beneficiaries in all decisions, including financial ones. Educational level greatly improved, and all houses – inhabited by 17 out of 20 families who initially entered the project—remained in good condition, properly equipped and decorated after 13 years of implementation, in spite of an increase of unemployment during the same period which led to reduced income and deterioration of the families’ economic situation. Better housing conditions for vulnerable people can be sustained and result in increased educational level if incremental improvement is aimed for and coupled with the redistribution of power at the local level.

A questionnaire survey on health among students of higher education was planned. To produce a response rate high enough for the analysis in a cost-effective manner, a pilot study was carried out to test various methods of data collection. Electronic invitation by the university messaging system to fill a Web-based questionnaire, invitation by the same means to fill paper-based questionnaires at a predefined place and time with or without conditional incentives yielded response rates below 10%. Therefore, a combination of postal and Internet-based questionnaires was used for data collection enhanced with a small up-front gift and conditional incentives suggested by a student focus group. This modality resulted in a 68.6% response rate (65.2% after data cleaning). Those who responded through the Web were more likely to be males and residing in larger settlements. However, no statistically significant differences were observed on the primary health status variables with respect to modality. Use of Web-based questionnaires is recommended in combination with other data collection methods and incentives.

A leendő orvosok vélemény- és attitűdformáló hatása, példaképszerepe az egészséggel kapcsolatos ismeretek és szemlélet formálásában nemcsak a betegek, hanem rajtuk keresztül a hozzátartozók, a tágabb népesség körében is érvényesül. Azért fontos megismerni már tanulmányaik során egészségmagatartásukat és az arra ható tényezőket, hogy azt szükség esetén formálni lehessen. Célkitűzések és módszer: A jelen vizsgálat az orvostanhallgatók egészségi állapotának és egészségmagatartásának felmérése céljából történt a Debreceni Egyetem Orvos- és Egészségtudományi Centruma Általános Orvostudományi Karának I–V. évfolyamain magyar nyelven tanuló orvostanhallgatók körében, kérdőíves adatfelvétellel. A kérdőív a demográfiai adatokon túl az egészségi állapotra és az egészségmagatartásra vonatkozó kérdéseket tartalmazott. Eredmények: A debreceni orvostanhallgatók közel háromnegyede jónak, illetve nagyon jónak ítéli egészségi állapotát; csaknem mindannyian úgy vélekednek, hogy sokat, illetve nagyon sokat tehetnek az egészségükért. A hallgatók csaknem kétharmada soha nem dohányzott; 15%-uk napi rendszerességgel szív cigarettát. Alkoholt a hallgatók több mint négyötöde fogyaszt, de leginkább csak alkalmanként. Egynegyedük kipróbált már valamilyen kábítószert, a leggyakrabban marihuánát, illetve altatót és nyugtatót orvosi javaslat nélkül. A debreceni orvostanhallgatók adatait az átlagnépesség azonos korosztályával összehasonlítva elmondható, hogy az orvostanhallgatók közül kevesebben dohányoznak, és a naponta dohányzók aránya is kisebb; közel 50% a heti rendszerességgel italozók aránya. Következtetések: Az orvostanhallgatók közt korábban történt felmérések és a jelen vizsgálat eredményeit összehasonlítva a szerhasználat gyakorisága nem emelkedett lényegesen. Aggasztó azonban, hogy a hallgatók körében szignifikánsan magasabb a lelki egészség zavarára utaló pontszám átlaga, mint a hasonló korú átlagnépesség körében.

Background: During implementation of a community development project involving a severely disadvantaged Roma community, the community was threatened with eviction. Two scenarios, eviction with placement on the waiting list for social housing versus a replacement housing development, were identified and specified. A health impact assessment (HIA) was carried out to inform subsequent negotiations. Aims: To assess the health effects of eviction in comparison with that of a housing project for a Roma community; to make recommendations on short-term and long-term benefits of the two scenarios in order to inform the local government; and to develop a demonstration HIA that can act as a model for other disadvantaged Roma populations. Method: A prospective assessment, based on a broad model of health, was carried out to assess health effects of a housing project compared with eviction. By design, it ensured full involvement of members of the community, local decision makers and relevant stakeholders. Results and conclusion: This HIA identified numerous positive and some probable negative health effects of a housing project. Despite the uncertainty around some of its predicted effects, the overall health benefit of a housing project clearly outweighed that of eviction. Although the immediate financial advantages of eviction for the municipal government are clear, this example provides further evidence to support the adoption of a statutory requirement to assess both economic and health outcomes. It also provides an example that other Roma communities can emulate.

There are important disparities in health outcomes between racial/ethnic minorities and majorities in all countries where minority health has been investigated. This holds true for the largest minority population of Europe, the Roma, although research data related to Roma are scarcer and more contested than for other minorities. We discuss major obstacles that hinder or prevent the collection of reliable data in Roma and other minorities. The definitions and classification systems on race/ethnicity vary widely, pointing to the social construction of both race and ethnicity. Imprecision in taxonomy and definition of target groups is compounded by challenges in data collection, analysis, and interpretation, along with ethnocentricity that shapes the perspectives and approaches of the researchers. However, administrative data collection on race/ethnicity serves legitimate purposes although such data must comply with less-stringent quality requirements as opposed to data meant for scientific analysis. Research on minorities should consider race/ethnicity as proxy indicators of complex health determinants, and should aim at dissecting these determinants into separate items. Careful documentation of methodology and active involvement of the minorities themselves can increase trust between the investigators and the research subjects, which can in turn improve research on minority health.

Objective The present study, taking a resource-oriented approach to mental health, aimed at investigating mental resilience and its determinants among undergraduate physiotherapy students using quantitative and qualitative tools. Design A questionnaire-based cross-sectional survey supplemented by 2 focus groups. Setting One university in Hungary. Participants 130 physiotherapy students at years 1, 2, and 3. Main outcome measures Sense of coherence, a measure of dynamic self-esteem, as well as social support from family and peers were used to assess mental well-being. A screening instrument for psychological morbidity and perceived stress were used as deficiency-oriented approaches. Student opinions were gathered on positive and negative determinants of mental health. Results Resilience was lower [mean difference 4.8 (95% CI −3.4; 13.1)], and the occurrence of psychological morbidity (32.5% vs. 0%) was higher among female compared to male students. However, the proportion of students fully supported by their peers was higher among females (63% vs. 37.5%). Female students, unlike their male counterparts, experienced higher stress compared to their peers in the general population. Social support declined as students progressed in their studies though this proved to be the most important protective factor for their mental well-being. Conclusions Results were fed back to the course organizers recommending the implementation of an evidence-based method to improve social support as delineated by the Guide to Community Preventive Services of the US the outcomes of which are to be seen in the future.

The field of vitamin A research has witnessed a remarkable surge in interest since the late 1980's, when the retinoid receptors were discovered and their genes cloned. Heterodimeric interactions between the retinoid X receptors (RXRs α, β, and γ), which bind 9-cis-retinoic acid, and other hormone receptors, including the retinoic acid receptors (RARs α, β, and γ), the thyroid hormone receptor (TR), the vitamin D receptor (VDR), the peroxisomal proliferator activated receptor (PPAR), and others make hormone action dependent on retinoid homeostasis. Retinoid response elements (RAREs) are present in the promoter and/or enhancer regions of several genes, including some of the homeobox genes, which control development and differentiation. The interaction between hormones and retinoids is added additional orders of complexity by the diversity of the RAREs including the spacer length, their 5′ or 3′ position, and their coexistence in composite sequences with other hormone response elements (e.g., an estrogen response element in the lactablbumin gene promoter, see Table 2). Control of normal epithelial differentiation is a fundamental function of retinoids. The histogenesis of squamous metaplasia caused by vitamin A deficiency is a stepwise process, which permits the gradual transition of phenotypes from simple-columnar, typical of the endocervical epithelium, to pseudostratified, to stratified-squamous and, eventually, to keratinizing. Conversely, the maintenance of the squamous keratinizing differentiation in the ectocervix and vagina requires estrogen. In the absence of this hormone, the squamous stratified ectocervical epithelium retrogrades to a simpler, two or three cell layer morphology, with the topmost layer expressing keratin K8, typical of the endocervical epithelium and mucous cells. Retinoid and estrogen receptor transcript expression is governed by dietary retinoid status and by estrogen availability, with squamous cells mostly expressing RARγ and estrogen receptor transcripts, and columnar cells mostly expressing RARβ. RXR transcripts appear mostly expressed in proliferating cells. The relevance of the retinoid receptors to carcinogenesis is highlighted in the work on acute promyelocytic leukemia. This work has demonstrated that the fusion gene PML-RARα, resulting from the t(15;17) chromosomal translocation, is etiologically connected with the disease and with complete remission after oral retinoid administration. Developments in retinoid metabolism, including the cloning of the cytochrome P450RAI and the connection between RA metabolism and cell growth inhibition, have recently taken place. Recent work has also shown that pharmacological dietary retinoic acid specifically inhibits malignant conversion in the mouse two-stage carcinogenesis system. Because RA upregulates retinoid receptor expression, it seems that retinoid receptors function as tumor suppressors. p]This field should serve as a paradigm for things to come for other essential nutrients, and spells out the notion that nutritional sciences are indeed fundamentally important, because they can contribute significantly to our understanding of different diseases and provide effective therapeutic approaches.

In contrast to most other systems, TPA induced TGc activity and protein in SW620 human colon carcinoma cells. This induction was accompanied by cell growth inhibition and increased apoptosis. The general protein kinase-C inhibitor GF-109203X blocked the induction of TGc by TPA, whereas the specific inhibitor of the PKC alpha isoform, the indocarbazole Go6976, reduced it by 40%. These PKC inhibitors had similar inhibitory effects on TPA increased apoptosis and inhibition of cell growth, suggesting that the observed actions of TPA are mediated by PKC, and a close connection between TGc activity, increased apoptosis and cell growth inhibition. We conclude that TPA may offer new approaches in the management of colon cancer cell growth.

ARTICLE ARTICLE The public health focused operation of primary health care (PHC) is impeded by its reactive approach and old fashioned treatment-oriented organization in many countries, including Hungary. Our general practitioners’ (GPs’) cluster model, to solve the presently existing organizational problems, builds a new structure described by Adany et al. 1 The lack of adequate education in public health of the current PHC staff2 represents another crucial obstacle of the improvement of PHC performance, which is also handled by the Programme.3 An additional obstacle is that guidelines for PHC preventive services are generally lacking. Although certain countries have developed such kind of guidelines, their proposals are adopted by other countries to a limited extent. The Decree No. 51/1997 of the Minister of Welfare (on the compulsory health insurance-based health services, aimed to prevent and timely detect the diseases and the certification of screenings) defines the preventive tasks of GPs and health visitors. Although, the listed tasks are almost entirely in harmony with the international recommendations, due to the lack of organizational base, financing incentives, relevant training, detailed protocols and auditing, the interventions/screenings prescribed by the decree are hardly implemented. The performance indicators obtained in the preliminary studies in connection with the Swiss Contribution Programme are unacceptably low: 1. Assessment of family history, 36.2% 2. Assessment of dietary habit, 24.7% 3. Screening for alcohol misuse, 16.3% 4. Assessment of smoking …

ARTICLE ARTICLE ‘Why a renewal of primary health care (PHC), and why now, more than ever?’ is the question by which the World Health Report 2008 is introduced.1 A primary care system in which health professionals are just simply entry points into the health system can respond neither to the challenges of a changing world nor to the growing expectations of people for better performance. The question of how to renew PHC is answered in the Report by ‘putting people first’, that is, by visioning a people-centred PHC service ‘delivered by teams that focus on health needs, create enduring personal relationships, take responsibility for the health of all in the community along the life cycle, as well as for tackling determinants of ill-health, and in which people are partners in managing their own health and that of their community’. The vision has remained a vision until now,2 and it will remain a vision forever if its implementation is considered just a health care system reform. A definitive link between PHC and public health services has to be formed to transform the vision into reality, in line with the Health 2020,3 the new World Health Organization European health policy framework and strategy, which indicates as one of its four priority areas ‘the strengthening of people-centred health systems along with public health capacity’. Lacking preventive services is one of the many previously identified anomalies of the Hungarian primary care system that needs to be corrected.4 Primary care presently is provided by one general practitioner (GP) and one nurse per practice, assisted by an …