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Az egészségi állapotban jelen lévő egyenlőtlenségek csökkentésének egyik hatékony eszköze az egészségügyi szolgáltatásokhoz való hozzáférés feltételeinek és a hozzáférés esélyegyenlőségének biztosítása. Az egészségügyi ellátáshoz való hozzáférés vizsgálatában a közfinanszírozott szürkehályogműtétek 2008. évi adatait vizsgáltuk. A kutatás során arra voltunk kíváncsiak, hogyan oszlanak meg az ellátási kapacitások és az ellátási típusok a szolgáltatást végző intézmények között, illetve milyen domináns útvonalak különíthetők el az igénybevételhez kapcsolódó betegmobilitásban. Regionális és kistérségi esettanulmányunkban külön elemeztük, hogy egyrészt az egészségügyi intézmények elérhetősége milyen mértékben van hatással az igénybevételre, másrészt mekkora különbség tapasztalható az utazási távolságban, időtartamban és költségekben akkor, amikor a beteg nem a lakóhelyéhez legközelebbi intézményben vette igénybe a műtéti szolgáltatást. A lakóhelytől függően nagy egyenlőtlenséget tapasztaltunk az intézmények elérhetőségében. A műtétek során a betegek nagy része nem a lakóhelyéhez legközelebbi intézményt kereste fel, ezzel vállalva az utazási és kiadási többletet. Közülük sokan a területi ellátási kötelezettség alapján, tehát a szabályokat követve utaztak a távolabbi ellátó intézménybe. A lakosság egészségügyi ellátással való elégedettségének növelésében a jövőben azt is vizsgálni kell, hogy milyen további tényezők befolyásolják a betegek orvos- és intézményválasztását. A tanulmány javaslatokat fogalmaz meg a térségi egészségügyi ellátórendszerek kialakításához, valamint kísérletet tesz egy olyan módszertan kidolgozására, amely segítségül szolgálhat a szakpolitikai döntéshozatalhoz.

Purpose: To assess the prevalence, types, sociodemographic factors, and reported dangerous activities of sleep-related behaviors likely representing NREM parasomnia episodes, as well as their association with adverse childhood experiences in Hungary., Methods: Cross-sectional survey of 1000 adults (aged ≥18 years) representing the Hungarian population, using a non-probability quota sampling with a random walk method and a structured face-to-face interview. A multi-criterion weighting procedure was applied to correct bias along the main sociodemographic variables to the data available. Binary logistic regression estimated the odds of NREM parasomnia-related behaviors associated with sociodemographic factors and adverse childhood experiences., Results: The prevalence of NREM parasomnia-related behaviors was 2.7 %, and self-reported sleep-eating was 0.1 % of the population (4.6 % of parasomnia-like activities). For middle-aged adults, the odds of sleep ambulation were significantly lower than for younger adults (OR 0.3; P = 0.03). A participant's family occurrence of reported parasomnia-like activity increased their odds of having it by more than 7 times (OR 7.1; P < 0.001). Nine participants out of those 27 people reporting NREM parasomnia-related behavior episodes, reported childhood adverse experiences, increasing the odds of parasomnia-related behavior by more than six times (OR 6.2; P < 0.001) compared to those not reporting it., Conclusion: This is the first population survey in Hungary on adult sleep-related behaviors likely representing NREM parasomnia episodes and the potential association with childhood traumatic events preceding them. The related dangerous behaviors call for safety measures and prevention. The significant association between adverse childhood events and NREM parasomnia-related behaviors needs further analysis., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Vivian Miranda Correa reports Semmelweis University provided financial support. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Several countries have introduced public health product taxes with the objective of reducing the absolute amount of consumption of unhealthy food and tackling obesity. This study aims to estimate the long-term impact of the Hungarian public health product tax introduced in 2011. To achieve this, a unique consumer purchase dataset was analysed to examine daily fast-moving consumer goods purchases from a representative sample of 2,000 households from 2010 to 2018. The results indicate that the tax has been fully reflected in consumer prices. A decline in consumption was observed initially, consistent with previous experiences in Hungary and other countries. However, over time, the data suggests a recovery and even an increase in line with the growth of disposable income. The proportion of taxed products in total fast-moving consumer goods purchases increased from 5.9 % (95 % CI: 5.7 % to 6.0 %) in 2010 to 7.4 % (95 % CI: 7.3 % to 7.6 %) in 2018. Furthermore, the tax has contributed to increased inequality as low-income households spend a higher proportion of their total expenditure on it. Although taxes on unhealthy foods have proven effective in the short-term, they may not be adequate for reducing overall consumption in the long-term, particularly as disposable income increases. In conclusion, implementing complex interventions is necessary to achieve sustainable positive changes in dietary habits., Competing Interests: Declaration of competing interest Márta Bakacs is affiliated with the National Center for Public Health and Pharmacy that can benefit from up to 10 % of the amount of the public health product tax, which can be used to finance healthcare programs. The other authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: Maternal health service uptake remains an important predictor of maternal outcomes including maternal mortality. This systematic review and meta-analysis aimed to summarize the available evidence on the uptake of maternal health care services in developing countries and to assess the impact of place of residence, education status, and wealth index on the uptake of these services., Methods: We examined the databases MEDLINE, Web of Science, Global Index Medicus, and Scopus until June 14, 2022. Cross-sectional studies done between 2015 and 2022 were considered. Mothers of reproductive age and all states of health were included in the study. Independently, two authors determined the eligibility of studies, extracted data, evaluated the risk of bias, and ranked the evidence's degree of certainty. To combine the data, we performed a random-effects meta-analysis. The PROSPERO registration ID is CRD42022304094., Results: We included 51 studies. Mothers living in urban areas were three times more likely to receive antenatal care (OR 2.95; 95% CI 2.23 to 3.89; 15 studies; 340,390 participants) than rural mothers. Compared with no education, those with primary education were twice as likely to utilize antenatal care (OR 2.36; 95% CI 1.80 to 3.09; 9 studies; 154,398 participants) and those with secondary and higher education were six and fourteen times more likely to utilize antenatal care, respectively. Mothers in the second wealth index were twice as likely as mothers in the lowest wealth index to utilize antenatal care (OR 1.62; 95% CI 1.36 to 1.91; 10 studies; 224,530 participants) and antenatal care utilization increased further among mothers in the higher wealth index. We observed similar relative inequalities in skilled delivery care and postnatal care utilization based on the pace of residence, education, and wealth index., Conclusion: In developing countries, the problem of inequity in utilizing maternal health care services persists and needs considerable attention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gube, Murányi, Vitrai and Lohner.)

Objective: To assess the adult Hungarian population's knowledge about and attitude toward epilepsy and compare the present findings with previous ones in 1994 and 2000., Methods: We performed a cross-sectional survey of the Hungarian adult population from 28th February to 8th March 2023. A non-probability quota sampling with a random walk method was used. We applied the computer-assisted personal interviewing (CAPI) method and used a multicriteria weighting procedure to correct for bias along the main sociodemographic variables. To detect changes over time, we used chi-squared tests, and to analyze the effect of sociodemographic characteristics, we applied multivariate logistic regression., Results: One thousand participants (53.1% women, mean age 48.1 ± 16.75 years) representing Hungary's population were interviewed yielding a response rate of 80.3%. 26.3% knew someone with epilepsy (55.9% in 1994 and 51.9% in 2000), and 30.8% saw an epileptic seizure (58% in 1994 and 55.3% in 2000). Compared to the young, fewer adults and elderly people knew someone with epilepsy or had seen a seizure. Like in 1994 and 2000, 16.6% reported objection to their children's interaction with people with epilepsy; however, in the present study, significantly fewer people opposed their children marrying or working together with epileptic people, indicating a change in attitude (p < 0.0001). Rural residents had less objection to their children's interaction with people with epilepsy (p < 0.05). People with secondary education objected significantly more often than those with primary education to their children's interaction (p = 0.037), marriage to people with epilepsy (p = 0.043), or their having equal employment (p = 0.008). Higher education people were as "permissive" as those with primary education., Significance: Certain parameters of familiarity and attitude markers of the Hungarian population toward epilepsy have improved. These tendencies are promising, but work is still needed; our results will hopefully evoke educational programs and campaigns against negative attitudes., Plain Language Summary: The knowledge of the Hungarian population about epilepsy and their attitude toward people with epilepsy has been improved since 1994. People from rural areas have shown more acceptance for people with epilepsy. Those people who completed secondary education were significantly more prone to stigmatization than those with primary education., (© 2024 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Study Objective: Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups., Methods: We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms "sleepwalking", "somnambulism", "sleep eating" "sleep sex", "sleep talking" and "aggression in sleep" in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95 % confidence interval and the probability of statistical significance., Results: 224 videos (102 women; 68 children, 116 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) less odds of ambulation in sleep likely consistent with somnambulism compared to adults and children. Adult females performed complex manual activities during sleepwalking more often, than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001)., Conclusion: Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Midwifery practice in Hungary is characterized by chronic stress, which may in turn lead to burnout and impaired perinatal care. However, little is known about the degree and potential stressors of burnout, which hinder the development of strategies to promote well-being among midwives in Hungary., Aim: To assess the prevalence of burnout and identify persistent individual and occupational stressors among midwives in Hungary over the past decade to inform prevention., Methods: We conducted two cross-sectional studies among midwives in 2014 and 2022. We used the Maslach Burnout Inventory to assess burnout (emotional exhaustion, depersonalization, and personal accomplishment) over time. We also collected data on individual and work characteristics. We performed a multivariate regression analysis to explore associations between burnout and respondents' characteristics., Findings: The degree and prevalence of emotional exhaustion among midwives increased significantly between 2014 (N = 224) and 2022 (N = 152). High workload, not feeling valued at work, poorly perceived health status and work dissatisfaction emerged as a significant positive correlate of emotional exhaustion or depersonalization in both studies. Living alone showed both a positive and inverse association with burnout in 2014 and 2022, respectively. Work satisfaction was a positive correlate of personal accomplishment in both studies., Conclusions: Our results add to and confirm the growing body of evidence about the high prevalence of burnout among midwives in Hungary. We identified potential risk factors and outcomes of burnout, which remained unchanged over time. To prevent or reduce burnout among midwives, future interventions should focus on addressing these potential persistent risk factors. However, the time-varying role of factors influencing burnout makes it advisable to review preventive interventions from time to time., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: The healthcare sector is the most studied area of burnout, as the mental health of healthcare workers has a significant impact on the mental health of the people they care for., Objective: The aim of our study was to investigate whether there have been changes in the dimensions of burnout among midwives, and how the relationships between burnout and the individual factors and working conditions that influence it have evolved, using national data from 2014 and 2022., Method: An anonymous, voluntary, questionnaire-based survey of midwives working exclusively in maternity units was conducted using the Maslach Burnout Inventory questionnaire, which measures burnout, and questions on respondents' demographic characteristics and working conditions. Multivariate ordinal logistic regression was used to explore associations between burnout and respondent characteristics, and associations were characterized by odds ratios., Results: Among the dimensions of burnout, no change in depersonalization was observed in 2022, but both emotional exhaustion and personal ineffectiveness were significantly more common in 2022 than in 2014. Responses from 224 midwives in 2014 and 152 midwives in 2022 were analyzed. Looking at the influencing factors, higher levels of burnout in 2014 were significantly associated with poorer perceived health, lack of a partner, smoking, shorter time in healthcare, having a job in a larger city, feeling overworked and dissatisfied. In 2022, on the other hand, younger age, smoking, shorter time in healthcare, feeling overworked, dissatisfied and unvalued were associated with higher levels of burnout. Looking at the combined effect of these factors, willingness to attend a health promotion lecture and having a second job also showed a significant effect on burnout in 2022., Discussion: The authors discuss the change in burnout among midwives and the possible reasons for the correlations shown., Conclusion: The results of the first study on burnout among midwives in Hungary show that improving the working conditions of midwives is essential for the functioning of family-friendly midwifery. In addition, to prevent burnout, more emphasis should be placed on the prevention of the risk factors identified in the study in education and training. Orv Hetil. 2023; 164(40): 1592-1599.

Összefoglaló. Bevezetés: Nagyszámú kutatás igazolta, hogy a dohányzás növeli a legjelentősebb krónikus betegségek kockázatát. Habár 2009 óta csökkenő tendenciát mutat Magyarországon a hagyományos dohányzók aránya, az e-cigarettát kipróbálóké az utóbbi években folyamatosan növekszik. Célkitűzés: A 2018-ban a felnőtt lakosság körében végzett Népegészségügyi Felmérés dohányzásra és e-cigaretta-használatra vonatkozó eredményeinek bemutatása az előző vizsgálatok tükrében. Módszer: A kérdőíves felmérésben 1586 fő került személyesen lekérdezésre. Az iteratív súlyozás a többlépcsős mintavételi designhatást és a 2016-os mikrocenzus adatait vette figyelembe. Eredmények: 2018-ban a dohányzók aránya a magyar felnőtt lakosság körében 28,7% (95% MT: 26,3-31,1%), az e-cigarettát használók aránya pedig 1,7% (95% MT: 1,1-2,5%) volt. Az iskolai végzettség a 65 év alattiak esetében a dohányzást befolyásoló tényező volt (EH: 3,32; 95% MT: 2,53-4,34), de a 65 éves és annál idősebb korcsoportban már nem (EH: 1,11; 95% MT: 0,59-2,09). Az e-cigarettát kipróbálók és használók között a leginkább említett (54,3% 95% MT: 44,0-64,5%) motivációs tényezőcsoport a dohányzásról való leszokással, az ártalomcsökkentéssel és a visszaesés megelőzésével volt kapcsolatos. A 65 éves és idősebb korcsoportban a dohányzók aránya 2015-höz képest emelkedett. 2018-ban az alapfokú iskolai végzettségűek körében volt a legmagasabb a dohányzók aránya, míg 2014-ben az érettségivel nem rendelkező középfokú végzettségűek körében. Következtetés: Bár összességében csökkent, az alacsony iskolai végzettségűek és az idősek körében emelkedett a dohányzók aránya Magyarországon. Az e-cigarettát kipróbálók és használók száma növekvő tendenciát mutat hazánkban. Eredményeink az alacsony iskolai végzettségűekre kiemelten fókuszáló, megelőző és leszokást támogató népegészségügyi alprogramokat is tartalmazó komplex beavatkozást sürgetnek. Orv Hetil. 2022; 163(1): 31-38., Introduction: The body of evidence suggests that smoking increases the risk of the most prevalent chronic diseases. Although the proportion of traditional smokers in Hungary has been on a declining trend since 2009, the proportion of those who tried e-cigarette has been steadily increasing in recent years., Objective: To present - in the light of previous studies - the results of the Public Health Survey among adults in 2018 on smoking and e-cigarette use., Method: 1586 persons were personally interviewed in a survey. The iterative weighting algorithm considered both the design effect of multistaged sampling and the 2016 Hungarian microcensus., Results: In 2018, the proportion of smokers in the Hungarian adult population was 28.7% (95% CI 26.3-31.1%), and the proportion of e-cigarette users was 1.7% (95% CI 1.1-2.5%). Educational level was a predictor of smoking among respondents younger than 65 years old (OR 3.32; 95% CI 2.53-4.34), but not for those aged 65 years or older (OR 1.11; 95% CI 0.59-2.09). Among e-cigarette ever or current users, the most commonly mentioned (54.3% 95% CI 44.0-64.5%) motivational factor-group to try or use e-cigarettes included motivations to quit smoking, to reduce harm, and to avoid relapsing. In the population aged 65 years old or older, the proportion of smokers increased compared to 2015. The proportion of smokers was the highest among those with primary education in 2018, while in 2014, it was the highest among those with secondary education without a graduation certificate., Conclusion: In Hungary, although overall smoking rates are declining, the smoking rate in the low educational group and among the elderly increased. The number of people trying or using e-cigarettes is showing an increasing trend in our country. Our results call for a complex public health intervention program including prevention and smoking cessation supporting subprograms with high focus on those with primary education. Orv Hetil. 2022; 163(1): 31-38.

Background and Purpose: We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients., Methods: This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine., Results: Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05-1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27-3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16-0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding., Conclusion: Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Web-based samples of e-cigarette users commonly report significant vaping-related health improvements (HIs) and mild adverse events (AEs). This cross-sectional study with in-person interviewing data collection examined self-reported AEs and perceived HIs among Hungarian adult current daily exclusive e-cigarette ( n = 65) and dual users ( n = 127), and former daily e-cigarette users ( n = 91) in 2018. Logistic regression was used to evaluate associations between reporting any AEs/HIs, vaping status, and covariates. More former users (52.7%) reported AEs than current users (39.6%; p = 0.038). Exclusive and dual daily users reported similar rates of AEs (44.6% and 37.0%, respectively; p = 0.308). More current users (46.9%) experienced HIs than former users (35.2%; p = 0.064). Exclusive daily users were more likely to report HIs than dual users (63.1% versus 38.6%; p = 0.001). Former user status and smoking cessation/reduction reasons increased the odds of reporting AEs, whereas nicotine-containing e-liquid use and older age decreased the odds of reporting AEs. Exclusive vaper status, using advanced generation devices, and smoking cessation/reduction reasons increased the odds of experiencing HIs. This study, which used a traditional data collection methodology, found a higher rate of AEs and a lower rate of HIs compared to web-based surveys. Our results highlight that experiencing AEs and HIs is affected by users' characteristics, in addition to the device and e-liquid type.

Based on Michie's COM-B model, we developed a survey methodology and segmentation procedure to identify groups of Hungarian school children and adults with distinctive characteristics, named healthstyles. We aimed to find interventions fitting to each healthstyle to generate behavioural change. For the segmentation of data, the latent class analysis method was applied. The analysis resulted in 8 healthstyles for the school children and 13 for the adults. Each healthstyle possess distinctive 'traits' and, therefore, special behavioural change methods and prevention strategies can be fitted for them. For demonstrating the advantages of using healthstyles, we discuss possible approaches for selecting behavioural change interventions, one for school children and one for adults.

Összefoglaló. Bevezetés: Magyarországon a csecsemőhalandóság 2014 óta folyamatosan javult, azonban 2019-ben az előző évi adathoz képest 11%-kal magasabb érték mutatkozott. Célkitűzés: A vizsgálat célja a 2019. évi kedvezőtlenebb csecsemőhalálozási mutató lehetséges összetevőinek feltárása. Módszer: A 2018. és 2019. évi csecsemőhalálozási adatokat hasonlítottuk össze a csecsemő kora, a halál oka és a gyógyintézeti, illetve nem gyógyintézeti elhalálozás szerint. A vizsgálathoz a Központi Statisztikai Hivatal adatait használtuk. A trendvizsgálatnál 2010-től elemeztük az adatokat. A nem gyógyintézeti haláleseteket 10 évre összevonva járásonként térképesen ábrázoltuk. Eredmények: 2018-ban 304, 2019-ben 335 csecsemő halt meg Magyarországon, a csecsemőhalálozási arányszám 3,4 ezrelékről 3,8 ezrelékre emelkedett. A 2019. évi érték az előző évtizedek trendjére illesztett görbe alapján megfelelt a várható értéknek. 2019-ben a 0-27 napos csecsemőhalálozás alig változott a 2018. évihez képest, a 28-364 napos korban bekövetkezett halálesetek száma viszont növekedett. A vizsgált évben 59%-kal emelkedett a nem gyógyintézeti csecsemőhalálozás. A 2019. évi csecsemőhalálozás növekedéséért 74%-ban a nem gyógyintézeti esetek voltak felelősek. A nem gyógyintézeti halálozás döntő többsége késői csecsemőkorban következett be. A járásonkénti, 10 évre összevont, nem intézményben elhunyt csecsemők számában és 1000 élve születésre vonatkozó arányában ötszörös területi különbségek mutatkoztak. A halálokok közül a perinatalis szakban keletkező bizonyos állapotok miatt meghalt csecsemők száma emelkedett a leginkább, a nem gyógyintézeti halálozás esetében pedig a hirtelen csecsemőhalál szindrómában meghaltaké. Következtetés: 2019-ben kiugróan magas volt a nem gyógyintézeti, késői csecsemőhalálozás száma és részaránya, ezen esetek feltűnő regionális halmozódást mutattak. A csecsemőhalandóság csökkentésének hatásos eszköze lehetne a jövőben minden egyes csecsemőhalál részletes szakmai értékelése. Orv Hetil. 2021; 162(1): 830-838., Introduction: In Hungary, infant mortality has been steadily declining since 2014, but in 2019 it increased by 11% compared to 2018., Objective: The aim of our study is to explore the possible components of the above increase., Method: Ten-year trends of infant mortality were analized and compared by age, cause, place of deaths (hospital or non-hospital environment) and location, using Central Statistical Office data., Results: There were 304 infant deaths in Hungary in 2018 and 335 in 2019. Infant mortality rate rose from 3.4‰ to 3.8‰, however, it was in line with the expected value based on the curve fitted to the trend of previous decades. In 2019, 0-27-day infant mortality basically did not change compared to 2018, while the number of deaths at 28-364 days of age increased. Non-hospital infant mortality increased by 59% in 2019 and these cases accounted for 74% of the total increase in infant mortality; the vast majority of these deaths occurred in late infancy. There were fivefold regional differences in the number of non-hospital infant deaths. Among the causes of death, the conditions related to the perinatal period and sudden infant death syndrome increased the most., Conclusion: In Hungary, the number and proportion of non-hospital infant mortality was remarkably high in 2019 compared to previous years. These cases showed a striking regional accumulation. An effective tool for reducing infant mortality could be an appropriate professional assessment of each infant death in the future. Orv Hetil. 2021; 162(21): 830-838.

Background: Within the frame of National Epidemiological Surveillance System, family physicians have an obligation to report infections and suspicions cases. The aim of this study was to evaluate the knowledge, attitudes, daily practice and the reporting activities of Hungarian family physicians regarding to infectious diseases., Methods: A self-administered survey was developed, validated and used. The survey was completed by family physicians who had taken part in continuous medical educational programmes of all Hungarian medical faculties. The questionnaire, consisting demographic questions and 10 statements about their reporting habits were completed by 347 doctors, 8% of the total number of family physicians. The data were processed in a cross-sectional design with general linear model., Results: According to the majority of responders, the current reporting system works efficiently. Rural physicians were mainly agreed, that reporting is not a simply obligation, it is a professional task as well. They were less hindered in daily work by reporting activities, waited less for laboratory confirmation before reporting, reported suspicious cases more frequently. Practitioner's based in urban settlements preferred to await laboratory tests before reporting and were hindered less by failures of the electronic reporting system. Older physicians trusted more in the recent system and they wished to increase the number of reports. Female physicians have higher consciousness in epidemiology. They were mostly in agreement that even severe infectious diseases can be diagnosed at primary care level and their daily practices were less burdened by reporting duties., Conclusions: Both the epidemiological knowledge of general practitioners' and the electronic surveillance systems should be improved. There is a need to develope the electronic infrastructure of primary care. More and regular control is also expected by the health care authorities, beside the synthesis of professional and governmental expectations and regulations.

Background: The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010., Methods: Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years., Results: A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women., Conclusion: The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

Introduction: Reporting liability of family physicians/general practitioners is the keystone for proper surveillance of infectious diseases., Aim: The aim of the study was to find out why some of the family physicians neglect to report infectious diseases to the health authorities and determine their motivation and attitude towards the infectious disease reporting system., Method: Self-fill-in questionnaire was used to obtain data. Of the 228 family physicians who were called to participate in the study 116 family physicians sent back evaluable questionnaires. Descriptive statistic method was used to analyze the data and determine the reporting frequencies and ratios., Results: Family physicians reported nearly 50% of all reported cases of infectious diseases. The main reason of underreporting was the lack of knowledge about the rules of the reporting system. According to most family physicians, an online based reporting system would be much more efficient instead of a paper based one., Conclusions: The authors conclude that education of family physicians would be mandatory in order to improve reporting of infectious diseases.

Health impact assessment is an internationally recognized tool for informed decision-making. The authors participated in building statistical models for assessing the health effects of decisions made inside and outside the health sector. They used logistic regression to investigate the role of individual factors like gender, age, education and economic activity determining the all-cause mortality and diseases of circulatory system and neoplasm as well. The results of statistical modelling proved that gender, education and economic activity modify the effect of age on mortality in multiple interactions. Since several factors have impact simultaneously on mortality, modifying the others' effects, analyzing these associations only by use of multivariate statistical methods is an adequate approach. Models presented in this article can be starting points for investigations exploring the effects of multiple health-determinants and researches in which also social-economic determinants are included in health impact assessment.

Authors review studies on associations between mortality and geographic distribution of social-economic health determinants published in the last 15 years. Hungarian publications after the 1990ies identified several indicators with effect on mortality related to the place of residence such as size of the settlement, population density, joblessness, average income, education, and racial or ethnic mixture. As a rule, these papers analyzed time and geographically aggregated data with simple descriptive statistical approach. Major international studies, however, aside the area indicators commonly included individual data and applied multilevel statistical analysis. Earlier, the incoherent results of some complex statistical analyses were explained by lack of overall health concept, which could utilize effects both at individual and population levels. The most recent multilevel statistical methodology, using information related to spatial correlation and fitted to health models, can help researchers to better understand the causes and effects of health inequities.

The 3rd Hungarian National Nutritional Survey was carried out as a part of the National Population Health Study and the data collection was done in November/December of 2003. The survey comprised a sample of adults above 19 year of age, the dietary questionnaires of 1179 people could be evaluated. The results of energy and macro-nutrient intake were published in 2005, and the results of the mineral intake in 2007, in the Hungarian Medical Journal. This paper focuses on the intake of vitamins. For the evaluation of the results authors used the data of the two previous national surveys, data of some dietary studies of other countries, and the home and international intake recommendations. In respect of the data found in the present survey, it is a favourable trend that the intake of vitamins retinol equivalent, B1 , B6 and B12 , and niacin, as well as biotin was sufficient both in case of men and women, together with adequate vitamin E intake for men. However the intake of vitamin B2 , C, D, together with pantothenic acid and folic acid of both men and women did not meet the criteria of the Hungarian recommendations, besides the vitamin E intake of women was insufficient as well. In Hungary the intake of vitamin D, biotin, folic acid and pantothenic acid was measured at first at this National Dietary Survey. The authors vigorously stress the importance of the varied and healthy nutrition in the adequate vitamin supply of the population.

In the course of the 3rd national nutritional survey data were collected in 2003, and the paper on the energy and nutrition intake of a sample group consisting of 1179 people all aged above 19, was published in the Hungarian Medical Journal (Vol. 146, No. 34, 2005). The present paper focuses on one group of micronutrients, namely the minerals' intake. The authors evaluated the results mainly in comparison with the data of the two previous Hungarian national surveys, and the international and national recommendations. The average magnesium intake was considered adequate in both sexes, while iron, zinc and copper intakes also met the recommended level in men. On the other hand, the insufficient calcium and the excessive phosphorus intakes, as well as the disproportionate calcium-phosphorus ratio in both sexes are unfavourable facts. The adverse results include insufficient iron, zinc and copper intake in women and the excessive sodium intake in both sexes, as well. The authors emphasize the importance of spreading the principles of healthy nutrition as well as co-operating with the food industry in order to prevent the occurrence of mineral nutrients deficiency.

Constrictive pericarditis is a rare condition characterized by clinical signs of right heart failure subsequent to loss of pericardial compliance. The etiology of constrictive pericarditis has changed during the last decades in developed countries. While, in the past, tuberculosis and idiopathic pericardial constriction were the prevalent causes of the disease, cardiac surgery has become one of the main reasons for its development in recent years. However, cases defined as idiopathic constrictive pericarditis are still observed. In addition to the classical chronic and subacute forms, new presentations, such as effusive-constrictive, localized, transient, occult, and constrictive pericarditis with normal pericardial thickness, have been described. Although conservative treatment may alleviate the patient's symptoms, pericardiectomy remains the only definitive treatment for the disease. It is worth noting that the sooner the diagnosis of pericardial constriction is established, the better the outcome is. The pathophysiological features, clinical findings, diagnostic tools, and therapeutic approach to constrictive pericarditis are detailed in this review.

A 61-year-old patient developed severe constrictive pericarditis with exertional dyspnea, 3 weeks after coronary bypass surgery. The diagnosis was confirmed by echocardigraphy and computed tomography examination. Despite the short duration of the disease, the pericardium showed a thickness of about 1 cm. Because initial treatment with steroids, diuretics and antiinflammatory drugs was of no avail, the patient underwent pericardiectomy, with a satisfactory outcome. The relatively rapid progress of constriction and the marked thickness of the pericardium that developed after a short period of time are emphasized.

The third Hungarian national dietary survey was conducted in 2003-2004. This publication describes the first part of the energy and nutrient intake findings in a sample consisting of a population of 1179 persons over 19 years of age (energy and macro nutrients). Energy and nutrient intake values were calculated based on 3 x 24- hour dietary records filled out by the subjects themselves. The authors evaluated the results in light of the two previous dietary surveys in Hungary and the Hungarian and international reference intake data. The total fat intake found in this survey lower than the previous data marks a favourable development, just as the higher unsaturated fatty acid and lower saturated fatty acid energy percent, and furthermore the lower cholesterol intake level. The favourable developments include further a polyunsaturated/saturated fatty acid ratio considerably higher than that obtained earlier (the values conforming to the international reference data), a higher carbohydrate energy percentage, as well as lower added sugar energy percentage, this latter being in the recommended range. The overweight ratio in men was 58.9%, while the female value was 49.5%, not much different from the previous survey data.

Background: Only a minor part of headaches are associated with an organic abnormality in the nervous system. In case of migraine and tension headache, the main provoking factor is psychological stress. Furthermore, these syndromes often occur together with depression and anxiety disorders, and when these comorbid conditions are present headache attacks tend to be more frequent, longer and stronger, causing an increase in the consumption of antimigraine agents, and at the same time increase the consumption of antidepressant and anxiolytic agents. Further to drugs, modified versions of Schultz-type autogenic training is also frequently used for anxiolysis. The aim of our research was to study the effect of the cognitive and symbol therapy enhanced autogenic training on headache and related drug consumption in three different types of primary headaches., Method: Twenty five female patients with migraine, tension-type headache or mixed headache participated in an eight-month follow-up study. Headache frequency, analgesic, antimigraine and anxiolytic consumption were measured by means of a headache diary. During the first four months (observation phase) patients became familiar with using the diary, and in the second four months they participated in autogenic training. The data of the second, third and fourth months were considered as baseline data., Results and Conclusion: Our method decreased headache frequency and drug consumption in all three headache groups. This means that the cognitive and symbol therapy enhanced autogenic training is an effective alternative for medications in the treatment of primary headaches.

The aim of the present study was to investigate changes in the plasma calcitonin gene-related peptide (CGRP) concentration and platelet serotonin (5-hydroxytriptamine, 5-HT) content during the immediate headache and the delayed genuine migraine attack provoked by nitroglycerin. Fifteen female migraineurs (without aura) and eight controls participated in the study. Sublingual nitroglycerin (0.5 mg) was administered. Blood was collected from the antecubital vein four times: 60 min before and after the nitroglycerin application, and 60 and 120 min after the beginning of the migraine attack (mean 344 and 404 min; 12 subjects). In those subjects who had no migraine attack (11 subjects) a similar time schedule was used. Plasma CGRP concentration increased significantly (P<0.01) during the migraine attack and returned to baseline after the cessation of the migraine. In addition, both change and peak, showed significant positive correlations with migraine headache intensity (P<0.001). However, plasma CGRP concentrations failed to change during immediate headache and in the subjects with no migraine attack. Basal CGRP concentration was significantly higher and platelet 5-HT content tended to be lower in subjects who experienced a migraine attack. Platelet serotonin content decreased significantly (P<0.01) after nitroglycerin in subjects with no migraine attack but no consistent change was observed in patients with migraine attack. In conclusion, the fact that plasma CGRP concentration correlates with the timing and severity of a migraine headache suggests a direct relationship between CGRP and migraine. In contrast, serotonin release from platelets does not provoke migraine, it may even counteract the headache and the concomitant CGRP release in this model.

Objective: To examine the effects of Schultz-type autogenic training on headache-related drug consumption and headache frequency in patients with migraine, tension-type, or mixed (migraine plus tension-type) headache over an 8-month period., Background: Behavioral treatments often are used alone or adjunctively for different types of headache. There are, however, only a few studies that have compared the efficacy and durability of the same treatment in different types of primary headache, and the effects of treatment on headache-related drug consumption rarely have been assessed even in these studies., Methods: Twenty-five women with primary headache (11 with mixed headache, 8 with migraine, and 6 with tension-type headache) were evaluated via an open-label, self-controlled, 8-month, follow-up study design. After an initial 4 months of observation, patients began learning Schultz-type autogenic training as modified for patients with headache. They practiced autogenic training on a regular basis for 4 months. Based on data from headache diaries and daily medication records, headache frequencies and the amounts of analgesics, "migraine-specific" drugs (ergots and triptans), and anxiolytics taken by the patients were compared in the three subgroups over the 8-month period. Results.-From the first month of implementation of autogenic training, headache frequencies were significantly reduced in patients with tension-type and mixed headache. Significant reduction in frequency was achieved in patients with migraine only from the third month of autogenic training. Decreases in headache frequencies were accompanied by decreases in consumption of migraine drugs and analgesics resulting in significant correlations among these parameters. Reduction in consumption of anxiolytic drugs was more rapid and robust in patients with tension-type headache compared to patients with migraine, and this outcome failed to show any correlation with change in headache frequency., Conclusion: Schultz-type autogenic training is an effective therapeutic approach that may lead to a reduction in both headache frequency and the use of headache medication.