[Stereotypes of medical students about different social groups]

Bevezetés: Az orvostanhallgatók marginalizált csoportokkal kapcsolatos ismeretei, előítéletei befolyásolhatják a betegekkel való kapcsolatukat. Célkitűzés: Az orvostanhallgatók véleményének vizsgálata abból a szempontból, hogy mely társadalmi csoportokat fogadnának el betegként kevésbé. Módszer: A Szegedi Tudományegyetem orvostanhallgatói önkéntes, anonim kérdőívet töltöttek ki 2021-ben (n = 410), mely több kérdéscsoportot tartalmazott (szociodemográfiai jellemzők, családi háttér, pályaválasztási motivációk, orvosi identitás alakulása, jövőbeli szakmai tervek, egyetem alatti munkavégzés, 19 társadalmi csoportra vonatkozóan kedvesség és kompetencia, társadalmi távolság mérése, saját tapasztalatok). Eredmények: A hallgatók a legkevésbé a bántalmazókkal, az oltásellenesekkel és a fogvatartottakkal szeretnének munkájuk során találkozni. Az orvostanhallgató-nők nagyobb arányban utasították el a bántalmazókat, míg férfi társaik inkább a hajléktalanokat, az alkoholistákat, az AIDS-betegeket, illetve a pszichiátriai betegségben szenvedőket, a felsőbb évesek pedig az oltásellenes és az AIDS-betegeket. A hallgatóknak a különböző társadalmi csoportokkal kapcsolatos tapasztalatai is nagyon eltérőek voltak. Személyesen a legtöbben romát, drogfogyasztót, pszichiátriai beteget, alkoholistát ismertek. A klinikai gyakorlatokon a leginkább romákkal, alkoholistákkal és pszichiátriai betegekkel találkoztak. Az oktatás során oltásellenesekről, alkoholistákról, romákról, hajléktalanokról, AIDS-betegekről hallottak a leggyakrabban. Megbeszélés: A hallgatók a különböző társadalmi csoportokba tartozó betegekkel kapcsolatban elfogadók voltak. Az előítéleteik mögött álló személyes, illetve az oktatás során szerzett tapasztalataik azonban nagyon szerteágazóak. Következtetés: Törekedni kell arra, hogy a hallgatók magatartás-tudományi, népegészségtani tanulmányaik alatt és klinikai munkájuk során is találkozzanak a különböző társadalmi csoportokkal, megismerhessék őket, így megtanulhassák a velük való megfelelő kommunikációt. Orv Hetil. 2023; 164(48): 1912–1919.

Healthcare-seeking of medical students: the effect of socio-demographic factors, health behaviour and health status - a cross-sectional study in Hungary

BACKGROUND

Medical students are more likely to have various physical and psychological issues, but less information is available about the healthcare-seeking behaviour for physical and mental health issues. The aim of this study is to determine the factors affecting medical students' healthcare-seeking when visiting a general practitioner (GP) and/or psychologist.

METHODS

688 medical students (326 International and 362 Hungarian,) participated in a cross-sectional study. The information was gathered using a self-administered online questionnaire and covered socio-demographic background, health behaviour, general and mental health status and healthcare-seeking. For analysing adjusted associations, multivariable logistic regression models were used.

RESULTS

Overall, 56.8% of medical students visit the GP; and 17.2%, the psychologist. Hungarian medical students visited the GP with chronic diseases, International medical students were more likely to visit a GP when they encountered sexual activity and had chronic diseases. Moreover, there was a significant correlation between sex, alcohol consumption, and perceived stress in the total sample of psychologist visits. When Hungarian medical students were in their clinical years and had a poor self-rated mental health, they were more likely to visit a psychologist. Whereas female international medical students and those who had poor self-rated mental health were more likely to seek psychological help.

CONCLUSION

Students visit a GP and/or psychologist is associated with a variety of factors, including socio-demographic background, health behaviours, and health issues. Medical schools should encourage help-seeking behaviours and early disclosure of medical students. Their ability to grasp healthcare attitudes and designing treatments will be important for both their academic success and future profession.

Effect of osteoarthritis and its surgical treatment on patients' quality of life: a longitudinal study

BACKGROUND

Osteoarthritis (OA) is one of the primary causes of pain and disability worldwide leading to patients having some of the worst health-related quality of life (QOL). The purpose of our study was to investigate the progression of the generic and disease-specific QOL of osteoarthritic patients going through total hip or knee replacement surgery and the factors that might alter the effect of surgery on QOL.

METHODS

A longitudinal study was performed based on data collected from 120 OA patients who filled in the short version of the WHO's generic measure of quality of life (WHOQOL-BREF) and the disease-specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and after surgery.

RESULTS

Domains related to physical health status showed relatively lower scores in patients before surgery. Patients reported a significant increase of QOL after surgery in the WHOQOL-BREF physical domain, especially if they were from the younger group (< 65 years, p = 0.022) or had a manual job (p = 0.008). Disease-specific QOL outcome results indicate that overall patients gained significantly better QOL in all domains of the WOMAC score. Patients with hip OA seemed to have the most benefit of their operation as they reported better outcome in WOMAC pain (p = 0.019), stiffness (p = 0.010), physical function domains (p = 0.011) and total score (p = 0.007) compared to knee OA patients.

CONCLUSION

There was a statistically significant improvement in all domains concerning physical functions in the study population. Patients also reported significant improvement in the social relationship domain, which indicates that OA itself as well as its management might have a profound effect on patients' life beyond the reduction of their pain.

[Knowledge and attitudes about vaccinations among medical students during the COVID-19 pandemic]

INTRODUCTION

In Hungary, regarding the age-related mandatory vaccinations, the population is almost 100% vaccinated. In the case of recommended vaccinations, however, the situation is less favourable, and during the COVID-19 pandemic, anti-vaccination sentiment has also appeared in some groups to a greater extent than before. Reducing this is the task of all health professionals.

OBJECTIVE

The exploration of knowledge and attitudes about vaccinations, and the analysis of the characteristics of these factors according to gender, year and vaccine willingness/hesitancy among medical students at the University of Szeged.

METHOD

The cross-sectional study was conducted among first and fourth year medical students of the University, using an online questionnaire, which examined, in addition to sociodemographic characteristics, the administration of influenza and COVID-19 vaccinations, the self-assessment of knowledge about vaccinations, the importance of vaccinations, and student opinions about recommended vaccinations.

RESULTS

Based on the definition of the WHO Strategic Advisory Group, 88.6% of the students belonged to the "vaccine willingness" group, who administered the vaccine against COVID-19 as soon as it became available, while the "vaccine hesitancy" group (11.4%) only asked for the vaccine when vaccination was made mandatory or not even then. According to the model adjusted to gender and year, those who showed willingness to vaccinate were more likely to consider the use of vaccinations, counselling, etc. important than those who were hesitant, while there was no correlation with the self-rating of knowledge. On the basis of the odds ratio of the statements related to the recommended vaccinations, it was possible to identify the opinions associated with vaccine willingness or hesitancy.

DISCUSSION

Overall, student knowledge and attitudes showed a positive picture. On the other hand, it should be emphasized that the misconceptions identified among students showing vaccine hesitancy are the same as the anti-vaccination sentiments found among the general population.

CONCLUSION

During university training, more emphasis should be placed on monitoring the willingness of students to be vaccinated, and on developing knowledge and communication. Orv Hetil. 2023; 164(21): 803-810.

Female Sexual Dysfunction in Association with Sexual History, Sexual Abuse and Satisfaction: A Cross-Sectional Study in Hungary

Female sexual dysfunction (FSD) has a negative impact on women's quality of life, self-esteem, and physical health. The aim of the present study was to explore the prevalence and the factors associated with FSD using an online questionnaire. A cross-sectional survey was conducted among young adults (18-35 years old) in Hungary using the DSM-5 criteria. The participants (n = 5942) were divided into three major groups: FSD (20.3%), an intermediate group (43.9%), and a control group (35.6%). Most of the women showing FSD were affected with female orgasmic disorder (9.2%) and genito-pelvic pain/penetration disorder (4.6%), while female sexual interest/arousal disorder was found in altogether 100 women (1.7%); 4.8% of women were affected by more than one definite disorder. The occurrence of female sexual dysfunction was related to the women's previous sexual history (first sexual experience, sexual education, early encounter with pornographic content, and sexual abuse), their self-satisfaction (with their own body, genitalia, and sexual attraction), and their sexual orientation. Sexual dysfunction showed a strong association with abuse, sexually transmitted diseases, and self-esteem. The present study identified the relationship between sexual dysfunctions and other health conditions, which can be the basis for some form of screening and early assistance programs for FSD.

International medical students' acculturation and self-rated health status in Hungary: a cross-sectional study

Background

Over the past few decades, the number of international students has increased dramatically. These students have to adjust to unfamiliar social, cultural, and educational environments. The concept of acculturation has been applied in multiple studies on various health outcomes. This study investigated the relationship between acculturation and self-rated health (SRH) among international medical students.

Methods

A cross-sectional study was conducted among international medical students at the University of Szeged, Hungary between April and October 2021. A total of 326 participants filled out questionnaires about sociodemographic characteristics, acculturation, and SRH. The modified Stephenson multigroup acculturation scale (SMAS) was used to assess the acculturation status; the scale defined acculturation as the degree of dominant society immersion (DSI, 12 items) and ethnic society immersion (ESI, 16 items). To measure SRH, participants were asked to rate their current general health and mental health. The data were analyzed by using descriptive statistics and the multiple logistic regression model.

Results

32.5% of the students reported having poor general and 49.7% poor mental health. We have found that acculturation was associated with SRH in multivariable logistic regression models controlling for sociodemographic characteristic. Bidimensional acculturation, such as ESI and DSI significantly influenced SRH as the likelihood of poor general health decreased (OR = 0.50; 95% CI = 0.31–0.81, P = 0.005), when the ESI was higher, whereas the likelihood of poor mental health decreased (OR = 0.52; 95% CI = 0.35–0.79, P = 0.002) if students had a greater DSI.

Conclusion

Both types of immersion can affect the students’ SRH. If the student could integrate better into their own ethnic group, their general health was better, and if they could strongly integrate into the Hungarian society, their mental health was more favorable. Acculturation measures should be promoted by academics and public health professionals in order to better understand their role in the behaviors, health outcomes, and health care use of medical international students. These findings will help professionals shape culturally sensitive prevention and counselling strategies for international student populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14334-y.

Adverse Maternal and Perinatal Outcome of Women Aged 40 Years or Over: A Retrospective Study

BACKGROUND

Advanced maternal age is traditionally described to be 35 years of age or over. In recent years, new trends have suggested that it may be 40 years of age or over; this occurs in Hungary.

AIM

The aim of this study was to determine the association between advanced maternal age and various adverse maternal and neonatal outcomes.

METHODS

A retrospective analysis was performed among women who delivered between 2015 and 2017. All women aged 40 years or over (cases) were involved into the analysis (n = 374). The controls (n = 378) were randomly selected from women aged 25 to 29 years who delivered during the same period considering the number of previous gestations and previous deliveries. The data collected from the medical records comprised the mothers’ demographic and obstetric characteristics and neonatal data. To assess the contribution of maternal age to various maternal and neonatal outcomes, multiple logistic regression analyses were used.

RESULTS

The logistic regression analyses showed higher odds of gestational diabetes (AOR, adjusted odds ratio: 2.81), preeclampsia (AOR: 13.05), threatened preterm delivery (AOR: 3.62), and cesarean section (AOR: 3.31) in mothers of higher age. The odds of low birth weight (AOR: 2.56) and intensive care (AOR: 2.03) were significantly higher in older vs. younger mothers, while no significant associations were between maternal age and fetal macrosomia and congenital malformations.

CONCLUSIONS

Considering our results, it is important to educate women about the consequences of delayed childbearing and the need of continuous observation within prenatal care.

The relationship between genital hygiene behaviors and genital infections among women: A systematic review

Introduction: Genital hygiene is an important part of women’s health and is essential for protecting reproductive health. Women adopt many genital hygiene behaviors, which will have direct and indirect effects on genitals and possible sexually transmitted infections. This systematic literature review aimed to know the types of genital hygiene behaviors practiced by women and assess the relationship between genital hygiene behavior and genital infection. Methods: A systematic search of the electronic databases, PubMed, Ovid, Web of Science, Scopus, ScienceDirect, JSTOR, and SAGE, for literature published between January 2001 and 2021. The keywords used were “genital hygiene behavior” AND “genital infections” AND “women OR female.” The inclusion criteria focused on genital hygiene behavior and the incidence of genital infection. The included full papers with observational research methods followed the PRISMA guidelines. After reading the full content of the included studies, key themes and concepts were extracted and synthesized. Results: In total 383 articles were screened. Five articles met the inclusion criteria and were analyzed. The analysis revealed four categories related to genital hygiene behavior among women: underwear hygiene, bathing habits, menstrual hygiene, and coital hygiene. Genital infections included bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. The review showed that incorrect and inadequate genital hygiene behavior increases the risk of vaginal infection. Conclusion: A higher incidence of genital infections occurred in women with improper genital hygiene practices. It is necessary for health professionals to educate women about good genital hygiene practices in order to reduce the rate of genital infections.

Suicide Attempts among School-Attending Adolescents in Mongolia: Associated Factors and Gender Differences

Attempting suicide is an important risk factor that can lead to suicide death. The aim of the current study was to examine the prevalence of suicide attempts and to identify the gender-specific predictors of suicide among adolescents in Mongolia. We analyzed data from the 2019 Mongolian Global School-Based Health Survey (GSHS) conducted nationwide among 13–18-year-old students. Univariable and multivariable analyses were performed to assess the correlates of suicide attempts. Overall, 32.1% of the adolescents reported to have had suicide attempts. Multivariable analysis showed a significant association in the total sample of suicide attempts with lack of close friends, anxiety, injury and violence, smoking and alcohol drinking, and sexual intercourse. Male suicide attempters were less likely to have close friends and more likely to have injuries, been physically attacked, been bullied, smoke, drink alcohol, and have had sexual intercourse. Within the female subgroup, anxiety, injury and violence, smoking and alcohol drinking significantly increased the odds of reporting suicide attempts. Increase of the student’s age by one year decreased the odds ratio of suicide attempts. Nearly one in three students had had a suicide attempt. Several factors, including mental distress, violence, and risky behaviors were found to be associated with suicide attempts. These can aid in designing intervention strategies for preventing suicidal behaviors among adolescents.

Factors Influencing Pain Management of Patients with Osteoarthritis: A Cross-Sectional Study

Background: Osteoarthritis (OA) is a complex disease associated with chronic pain. Many patients treat their joint pain at a symptomatic level with over-the-counter (OTC) pain medications, often without the knowledge of their physicians. The aim of this study was to provide physicians with data about osteoarthritic patients’ habits of pain management and to examine the explanatory factors of various ways of self-treatment. Methods: A cross-sectional study involving 189 patients with hip or knee OA and scheduled for joint replacement surgery was carried out. Participants filled out a self-administered questionnaire consisting of the Western Ontario and McMaster Universities Osteoarthritis Index and questions about their methods of alleviating pain. Results: 2.6% of patients did not use anything to alleviate their pain, while 63% practiced a non-pharmacological method. Diclofenac was the most frequently used drug, followed by ibuprofen. Profession had the greatest impact on medication habits; patients doing manual work were significantly more likely to take OTC non-steroidal anti-inflammatory drugs and use topical analgesics. Conclusions: Patients utilized a wide variety of pain management techniques. They seemed to use well-known painkillers, even if their side effects were less desirable. Such patients require comprehensive pain management, including educational and behavioural interventions, complemented by topical and oral medication.

Changing pattern of smoking behavior among Mongolian adolescents: Results from the GYTS (2003-2019)

Background

Tobacco use has become a global health concern. Most part of smokers initiate smoking during their adolescence. This study aims to analyze the changing pattern of cigarette smoking among adolescents in Mongolia.

Methods

The retrospective data analysis is based on four repeated national cross-sectional Global Youth Tobacco Surveys (GYTS) conducted in 2003, 2007, 2014 and 2019. Data were collected by self-administered questionnaires. The sample represented the students aged 12-16 years. Pearson's chi-squared tests and logistic regression analyses were performed by using IBM SPSS version 24 software.

Results

Altogether, 17,458 students participated in the four surveys. There was an overall decrease in the prevalence of ever smokers (40.4% in 2003, 21.2% in 2019; p &lt; 0.001), current smokers (9.2% in 2003, 4.4% in 2019), and planning of cessation (84.0% in 2003, 62.9% in 2019; p &lt; 0.001). Smoking related knowledge has been changed, e.g., the prevalence of students who thought smoking helps people feel more comfortable decreased from 28.3% to 7.2%. From the point of the media effects the percentage of students who saw anti-tobacco message in the media significantly decreased (from 84.0% to 62.9%, p &lt; 0.001). Additionally, the percentage of participants who were exposed to tobacco smoke at home decreased from 64.1% to 42.6% (p &lt; 0.001) between 2003 and 2019. The multivariate logistic regression analyses by years showed that males, those who were exposed by smoke at home, who thought that smoking makes people more comfortable were more likely to be current smokers; no association was found with anti-tobacco messages.

Conclusions

Despite of the implementation of tobacco control policies, smoking is a major problem in the Mongolian population. The findings of GYTSs provide information to the development of an adolescent specific national tobacco control program, which will help to combat the tobacco epidemic.

Key messages

A positive trend of smoking behavior among adolescents has been demonstrated in Mongolia. The findings help to develop a comprehensive adolescent specific school-based tobacco control program.

Vitamin D status and its influencing factors among pregnant women in Szeged, Hungary

Background

During pregnancy vitamin D plays an important role in maternal and fetal immune regulation as well. The aim of our study was to evaluate vitamin D serum level and its influencing factors among pregnant women and their newborns.

Methods

A cross-sectional study was performed among women delivering at the Department of Obstetrics and Gynecology in 2019. Altogether 301 women were included into the study, who filled the questionnaire one or two days after delivery. Data collection was based on a self-administered questionnaire, health documentation, and maternal serum and infant cord-blood vitamin D laboratory tests. Vitamin D intake was evaluated by dietary and vitamin D containing dietary supplement intake. Statistical analyses (descriptive statistics, chi square, Pearson's correlation, Kruskal-Wallis test) were performed with the IBM SPSS 26.0 program. The study protocol was approved by the Research Ethics Committee of the University of Szeged (number: 4419). Written informed consent was obtained from each participant of the study.

Results

The average maternal age of the included women was 33.28 years. More than half of women did not eat sea fish during the pregnancy, 66.3% drank daily milk, 51.5% ate daily yoghurt, and 30.2% used daily margarine as a spread. During pregnancy 77.6% of included women took some kind of vitamin D containing dietary supplement with which their average daily vitamin-D supplementation was 17.19 microgram (SD = 22.45 microgram). The average serum vitamin D level was 52.81 nmol/L in mothers and 72.96 nmol/L in newborns' cord-blood. Only 12.1% of mothers, and 43.1% of their newborns reached the optimal (75 nmol/L) level.

Conclusions

Our results showed that dietary and supplementary vitamin-D intake are insufficient among pregnant women, and consequently vitamin D serum levels are also lower than the optimal among mothers and their newborns, consequently.

Grant support: University of Szeged, Faculty of Medicine, Hetényi Géza Grant

Key messages

Low vitamin D level is a global public health issue. Vitamin D supplementation during pregnancy is important to maintain the optimal vitamin D serum level.

Exploring the effort-reward structure of university work focusing on perceived overall stress, self-reported health, and musculoskeletal disorders

Background: The effort-reward imbalance (ERI) model by Siegrist encouraged numerous scientific investigations that reported particular ties between psychosocial risks and poor self-reported health (SRH), while psychosocial work-related stress has also been linked to musculoskeletal disorders (MSDs). The aim of this study was to examine the health status and the perceived levels of occupational stress of university employees and to analyse the findings according to the employees’ effort and reward structure of work, perceived overall stress, SRH and the presence of MSDs.

Design and methods: 398 employees – including healthcare professionals, academic personnel and workers with administrative or other jobs – employed at the University of Szeged, Faculty of Medicine were investigated with a self-administered questionnaire including the Effort-Reward Imbalance Questionnaire (ERIQ) and Perceived Stress Scale 4 (PSS-4).

Results: More than half of the investigated subjects (54.8%) reported some forms of MSDs. Low self-reported health (P<0.001) and presence of MSDs (P=0.015) were significantly associated with the level of perceived stress and effort-reward imbalance (ERI), moreover increased level of perceived stress was independently associated with the likelihood of MSDs (AOR=1.13) and low self-reported health (AOR=1.30). ERI well predicted low self-reported health (AOR=2.05) as well. Increased level of perceived stress positively correlated with high workrelated effort (r=0.247, P<0.001) and over-commitment (r=0.387, P<0.001) while with work-related reward (r=−0.181, P=0.011) perceived stress showed a negative connection.

Conclusion: Our results suggest that addressing the burden of effort-reward imbalance and MSDs would likely lessen employees’ perceived level of overall stress and affect their self-reported overall state of health.

Prevalence and Correlates of Poor Oral Hygiene among School-Going Students in Mongolia

Brushing at least twice a day is one of the most effective methods for the prevention of dental caries and oral diseases. The aim of the present study was to determine the prevalence and correlates of poor oral hygiene in Mongolian school-going students. A secondary analysis of nationally representative data from the 2013 Mongolian Global School-based Health Survey (GSHS) was performed. In the survey, a questionnaire was completed by 5393 students aged 12–16 years old. The prevalence of poor oral hygiene and its association with some independent variables were analyzed by frequency distribution, chi-squared test, and logistic regression. The overall prevalence of poor oral hygiene was 33%. In the multivariate analysis, male students, inadequate fruit and vegetable intake, parents’ smoking, being exposed to second-hand smoke, poor parental supervision and connectedness, physical inactivity, and sedentary behavior were significantly associated with poor oral hygiene. Meanwhile, students who ate fast food and drank carbonated soft drink were found to be less likely to be poor tooth-brushers in 2013. Various determinants were identified in connection with poor oral hygiene. Based on these findings, it is recommended that an oral health promotion program should be combined with general health promotion and lifestyle intervention programs for this target population.

Diabetic Retinopathy Screening in Patients with Diabetes Using a Handheld Fundus Camera: The Experience from the South-Eastern Region in Hungary

PURPOSE

Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients.

METHODS

A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded.

RESULTS

787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening (HbA1c > 7% associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance).

CONCLUSION

The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs.

Health consciousness during pregnancy: the association between dietary supplementation and lifestyle

Background

Dietary supplements are recommended for pregnant women who cannot meet the daily dose through food intake, or who are at higher risk of deficiencies because of a substance abuse (e.g. smoking). Today, the preventive effect of folic acid (FoA) in the periconceptional period is evidence based, and there are studies about the positive effects of omega-3 fatty acids (n-3 FAs) during pregnancy. The aim of this study was to determine the association between FoA and n-3 FAs supplementation and health behavior - diet, physical activity, smoking - of pregnant women.

Methods

The cross-sectional study was conducted among women having their babies at the Department of Obstetrics and Gynecology (N = 1548). Data collection was based on self-administered questionnaire and health documentation. Uni- and multivariable logistic regression analyses were performed with IBM SPSS 26.0; the results are expressed in odds ratios (OR) and 95% confidence intervals (CI).

Results

Mean age of women was 31 years, most of them had university degree, nearly 90% of them lived in partnership. The prevalence of smoking during pregnancy was 6.5%, 39.8% did not consume fruits/vegetables daily, 58.5% ate fish less than weekly, 47.9% were physically inactive; 67.6% took FoA, and 30.6% n-3 FAs. FoA and n-3 FAs taking were more likely among those who ate fruits and vegetables every day (OR/CI: 1.30/1.01-1.66; 1.47/1.15-1.89) and among non-smokers (OR/CI: 1.73/1.06-2.83; 4.80/1.69-13.61), while FoA consumption associated with physical activity (OR/CI: 1.37/1.07-1.74) and n-3 FAs with fish consumption (OR/CI: 1.35/1.06-1.72).

Conclusions

Our results showed that a high proportion of pregnant women did not follow a healthy lifestyle, and the unhealthy behavior was significantly associated with the less frequent use of dietary supplementation. The results call the attention for the importance of counseling on healthy lifestyle and appropriate supplement use before and during pregnancy.

Key messages

Use of dietary supplementation is higher among pregnant women following a healthy way of lifestyle. The results reinforce the importance of lifestyle counseling during pregnant care.

Factors influencing obesity among Hungarian school-age children

Background

Childhood obesity has increased almost 80% worldwide in the last 30 years. According to WHO COSI data, Hungary is ranked 15th in the prevalence of overweight/obesity in 6-9 years children, with national values (27.4%) higher than the average of the participating countries. The aim of the study was to investigate the factors contributing to childhood obesity, along some components of the ecological model, and to identify factors promoting or inhibiting lifestyle changes.

Methods

The survey was conducted in three primary schools of Szeged, involving 9-12 years old children and their parents (N = 459). The questionnaire examined the child's physical activity, dietary habits, mood, postnatal medical history as well as parents' anthropometric, socio-demographic data, attitudes to their child's nutrition, health-related value system, lifestyle knowledge and relevant history of obesity.

Results

The prevalence of overweight/obesity was 22.7% in the sample, with higher proportion of boys than girls (59.6% vs. 40.4%). Overweight/obese children were significantly more dissatisfied with their shape than children with normal BMI (39.8% vs. 8.9%, p &lt; 0.001) and fewer of them participated in out-of-school sports activities (69.1% vs. 79.1 %, p &gt; 0.05;). Obese children were significantly more likely to eat even when they were not hungry (37.2% vs. 26.4%, p &lt; 0.05). Frequency of meals with the family was also the lowest among overweight/obese (60.6%), and three times as many of them ate alone in their room than their nutritionally normal fellows. There was no significant difference in the diet preferences and quality of food of the two groups.

Conclusions

In our study, prevalence of childhood obesity was beyond than global prevalence. Parents' attitudes, and family conventions significantly influenced the success of a child's lifestyle change hence it is high priority to increase the knowledge of the parents.

Funding

The research is supported by the EFOP-3.6.1-16-2016-00008.

Key messages

Childhood obesity is a complex problem, simultaneous, positive modification of the family, community, and social environment is indispensable for effective intervention. Parents’ lifestyle influences the children’s dietary habits, therefore parent’s health education is important in the prevention of childhood obesity.

Abdominal obesity increases metabolic risk factors in non-obese adults: a Hungarian cross-sectional study

Background

The prevalence of abdominal obesity is increasing worldwide. Adults with abdominal obesity have been reported to have increased risk of cardiometabolic disorders.

The aim of this study was to examine whether non-obese subjects (body mass index (BMI) < 25 kg/m²) with abdominal obesity examined in the framework of the Swiss–Hungarian Cooperation Programme had increased metabolic risk compared to participants without abdominal obesity.

Methods

A cross-sectional study was carried out in 5228 non-obese individuals. Data were collected between July 2012 and February 2016. Descriptive statistics, Pearson’s correlation analysis and multiple logistic regression models were applied, odds ratios (OR) with 95% confidence interval (CI) being the outcomes.

Results

607 (11.6%) out of the 5228 non-obese individuals had abdominal obesity. The correlation analysis indicated that the correlation coefficients between BMI and waist circumference (WC) were 0.610 in males and 0.526 in females. In this subgroup, the prevalence of high systolic blood pressure, high fasting blood glucose, and high total cholesterol and triglyceride levels were significantly higher. The logistic regression model based on these data showed significantly higher risk for developing high systolic blood pressure (OR = 1.53; 95% CI = 1.20–1.94), low HDL cholesterol (OR = 2.06; 95% CI = 1.09–3.89), and high trygliceride level (OR = 1.65; 95% CI = 1.27–2.16).

Conclusions

There was a very high, significant, positive correlation between WC and BMI. Abdominal obesity was found to be strongly related to certain metabolic risk factors among non-obese subjects. Hence, measuring waist circumference could be recommended as a simple and efficient tool for screening abdominal obesity and related metabolic risk even in non-obese individuals.

[Medical aspects of sexual education according to national and international guidelines]

INTRODUCTION

The prevention of early sexual life and its unwanted consequences is a worldwide problem. National and international surveys have shown that adolescents have their first sexual intercourse at a younger age.

AIM

The study aimed to determine the way of sexual education of young people provided by physicians - general practitioners, paediatricians, obstetricians, gynaecologists etc. - in accordance with the results of a questionnaire-based study, the experiences gained during the interactive education and the suggestions of international guidelines dealing with sexual education.

METHOD

Self-administered questionnaire-based study was performed among 13-18-year-old girls attending primary or secondary school (N = 868) between 2009 and 2016. The sexual activity of adolescent girls, their knowledge related to contraception and sexually transmitted infectious diseases, gynaecological (e.g., cancer screening) experiences were measured before sexual education performed by a gynaecologist.

RESULTS

Every 4th girl had the first sexual act at the age of 14 or before, but at the same time their sexual knowledge was incomplete and there was a significant proportion of those who already have had sex but have never had a gynaecological examination.

CONCLUSION

The results highlighted the educational deficiencies of reproductive life, which is a complex task to solve, to address the changing approach of national healthcare and education systems, to adopt and follow scientific evidence-based guidelines. All health-care workers who are in contact with adolescents during their work must be involved in the sexual education. It is essential to continue incorporating sex education into education from early childhood to young adult age. Orv Hetil. 2019; 160(13): 494-501.

[Possibilities of doctor-patient communication - understanding patients' expectations]

INTRODUCTION

Nowadays doctor-patient consultation is not limited to personal appointments, there are new technical possibilities to keep contact.

AIM

The aim of our study was to examine the way in which the doctor and patient interact with each other between two personal consultations and how the patients would like to reach their physicians when needed.

METHOD

Questionnaire survey was done among waiting patients in an outpatient clinic in Budapest. The questionnaire was based on the following groups of questions: habits of visiting a doctor, the methods of communication with a specialist, use of technical tools and socio-demographic data.

STATISTICAL ANALYSIS

Simple descriptive analysis, chi-square test and binary logistic regression were used.

RESULTS

The participants (260 persons) were in 36.2% male and in 63.8% female. One out of four patients did not contact the doctor between two personal consultations. The rest of the patients contacted the nurse by phone or their doctors on their mobile even as per different socio-demographic groups but without a significant difference in between those. Two thirds of the patients would like to have more face to face appointments with their doctor, half of them would like to keep contact by e-mail, and one out of three would call the doctor on mobile phone as far as possible. More men need personal consultations dominantly and in smaller proportion divorced, widowed and patients with vocational education. Half of the patients would like to e-mail their doctor, especially the younger and higher educated people.

CONCLUSION

Patients' consultation preferences differ by socio-demographic groups. Reestablishing conditions by taking all of our results into account, the efficiency of outpatient-clinics could be increased. Orv Hetil. 2018; 159(50): 2136-2143.

Bidirectional associations of e-cigarette, conventional cigarette and waterpipe experimentation among adolescents: A cross-lagged model

PURPOSE

With an increasingly diverse tobacco product market, it is imperative to understand the trajectories of product experimentation in order to design effective prevention programs. This study aims to explore the bidirectional associations of conventional cigarette, e-cigarette and waterpipe experimentation in a large adolescent sample.

METHODS

Longitudinal assessment of conventional cigarette, e-cigarette and waterpipe use initiation was conducted in a school-based cohort of 1369 9th graders (mean age=14.88 SD=0.48 at baseline) during fall 2014 and reassessed 6-months later using online self-reported questionnaires. Autoregressive cross-lagged analysis within structural equation modeling framework was performed to simultaneously estimate the initiation of these products over a six-month period, controlling for age, gender, and participation in an intervention program to reduce conventional cigarette initiation.

RESULTS

Tobacco product lifetime use was prevalent at baseline in the sample: conventional cigarettes (48.4%), e-cigarettes (35.8%), and waterpipe (20.8%). At six-month follow-up, trying conventional cigarettes predicted trying e-cigarette (adjusted odds ratio (AOR)=3.78, CI95%: 2.66-5.37) and trying waterpipe (AOR=2.82, CI95%: 2.00-3.97). Trying e-cigarette predicted trying conventional cigarette (AOR=3.57, CI95%: 1.96-6.49) and trying waterpipe (AOR=1.51, CI95%: 1.07-2.14). Although trying waterpipe predicted trying e-cigarette at follow-up (AOR=2.10, CI95%: 1.30-3.40), its use did not predict trying conventional cigarette (AOR=0.55, CI95%: 0.24-1.30).

CONCLUSIONS

The high rates of poly-tobacco use and the bidirectionality of tobacco product experimentation demands comprehensive tobacco control and prevention programs that address the increasingly diverse tobacco product market targeting adolescents.

Association of cardiovascular risk factors and Parkinson's disease - case-control study in South East Hungary

Background and purpose

Parkinson's disease (PD) has the second highest incidence among neurodegenerative diseases in the world population. The study aimed to investigate the presence of some cardiovascular risk factors - dyslipidemia, diabetes, and hypertension - in PD patients and to compare their risk with non-PD population in South East Hungary.

Methods

A case-control study was conducted at the Department of Neurology, University of Szeged, Hungary. The study included 1299 subjects out of which 620 patients were identified as cases of diagnosed PD and 679 as controls. Logistic regression analyses were conducted to reveal the association of vascular risk factors with PD.

Results

In the univariate analysis, diabetes mellitus was positively associated with PD, while dyslipidemia showed negative association to it in the total population, and no significant associations were found between hypertension and PD. The multivariate logistic regression models showed that the odds of diabetes mellitus was higher (OR=2.86), while the odds of dyslipidemia was lower (OR=0.58) among PD patients than in the control group. Hypertension showed a different pattern by gender: the odds of registered hypertension was significantly lower in female PD patients (OR=0.68), whereas the result was not significant in males.

Conclusion

This is the first study that provides a comprehensive view of the cardiovascular risk factors in PD patients in Hungary and shows considerable relationship between diabetes mellitus and PD.

The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial

INTRODUCTION

Although web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, "A Smoking Prevention Interactive Experience," an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States.

METHODS

Sixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students.

RESULTS

Never-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44-0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44-1.46).

CONCLUSIONS

ASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe.

IMPLICATIONS

(1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.

Neurotoxic effects of subchronic intratracheal Mn nanoparticle exposure alone and in combination with other welding fume metals in rats

Manganese (Mn) is a toxic heavy metal exposing workers in various occupational settings and causing, among others, nervous system damage. Metal fumes of welding, a typical source of Mn exposure, contain a complex mixture of metal oxides partly in nanoparticle form. As toxic effects of complex substances cannot be sufficiently understood by examining its components separately, general toxicity and functional neurotoxicity of a main pathogenic welding fume metal, Mn, was examined alone and combined with iron (Fe) and chromium (Cr), also frequently found in fumes. Oxide nanoparticles of Mn, Mn + Fe, Mn + Cr and the triple combination were applied, in aqueous suspension, to the trachea of young adult Wistar rats for 4 weeks. The decrease of body weight gain during treatment, caused by Mn, was counteracted by Fe, but not Cr. At the end of treatment, spontaneous and evoked cortical electrical activity was recorded. Mn caused a shift to higher frequencies, and lengthened evoked potential latency, which were also strongly diminished by co-application of Fe only. The interaction of the metals seen in body weight gain and cortical activity were not related to the measured blood and brain metal levels. Fe might have initiated protective, e.g. antioxidant, mechanisms with a more general effect.

Menarche as a predictor of risk-taking behavior in a sample of Hungarian adolescent girls

Background The age at the time of the first sexual intercourse is declining, and the prevalence of smoking is increasing in adolescent girls in developed countries. Objective To assess the relationship between menarche and tobacco smoking and sexual activity in adolescent girls. Subjects Girls between 14 and 18 years, attending primary or secondary school. Methods Socio-demographic characteristics (age, living place, educational level of parents, self-estimated financial background), onset and parameters of periods, and risk behaviors (smoking, sexual activity) were measured by self-administered questionnaires. A multivariate logistic regression analysis was used to assess the relationship between tobacco use and sexual activity and socio-demographic characteristics, menarche and presence of other risk behaviors. Results Adolescent girls who had an earlier onset of their periods were about twice as likely to smoke as girls with later onset of their first period [odds ratio (OR): 2.28, confidence interval (CI): 1.14-4.55]. Being sexually active meant more than 7-fold odds of being a regular tobacco user (OR: 7.24, CI: 4.39-11.94). Regarding sexual activity, increasing age (OR: 4.42, CI: 3.45-5.67) and regular smoking (OR: 7.07, CI: 4.24-11.80) increased, while poor financial status decreased (OR: 0.35, CI: 0.13-0.97) the odds of being sexually active. Conclusion In light of these findings, the reconsideration of health and sexual education in Hungary is needed. Implementation of these programs at an earlier age should be desirable to avoid unfavorable consequences, such as early pregnancy.

Size-Dependent Toxicity Differences of Intratracheally Instilled Manganese Oxide Nanoparticles: Conclusions of a Subacute Animal Experiment

Incomplete information on toxicological differences of micro- and nanometer-sized particles raised concerns about the effects of the latter on health and environment. Besides chemical composition, size and surface-to-volume ratio of nanoparticles (NPs) can affect toxicity. To investigate size-dependent toxicity differences, we used particles made of dioxide of the neurotoxic heavy metal manganese (Mn), typically found in inhaled metal fumes, in three size ranges (size A, 9.14 ± 1.98 nm; size B, 42.36 ± 8.06 nm; size C, 118.31 ± 25.37 nm). For modeling the most frequent route of exposure to Mn, NPs were given to rats for 6 weeks by intratracheal instillation. Of each NP size, 3 or 6 mg/kg body weight was given while control animals were vehicle treated. Neurotoxicity was assessed by measuring spontaneous locomotor activity in an open field and by recording spontaneous and evoked electrical activity from the somatosensory cortical area. Mn content of brain, lung, and blood, measured by ICP-MS, were correlated to the observed functional alterations to see the relationship between Mn load and toxic effects. Body weight gain and organ weights were measured as general toxicological indices. The toxicity of size A and size B NPs proved to be stronger compared to size C NPs, seen most clearly in decreased body weight gain and altered spontaneous cortical activity, which were also well correlated to the internal Mn dose. Our results showed strong effect of size on NP toxicity, thus, beyond inappropriateness of toxicity data of micrometer-sized particles in evaluation of NP exposure, differentiation within the nano range may be necessary.

Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study in Hungary

Introduction. Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients' satisfaction when using such tools (fundus camera examination) and the effect of demographic and socioeconomic factors on participation in screening. Methods. Pilot study involving fundus camera screening and self-administered questionnaire on participants' experience during fundus examination (comfort, reliability, and future interest in participation), as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrád County, a southeastern region of Hungary. Results. Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (Spectra™ software). Large majority of the patients were satisfied with the screening and found it reliable and acceptable to undertake examination under pupil dilation; 67.3% were willing to undergo nonmydriatic fundus camera examination again. There was a statistically significant relationship between economic activity, education and marital status, and future interest in participation. Discussion. Participants found digital retinal screening to be reliable and satisfactory. Telemedicine can be a strong tool, supporting eye care professionals and allowing for faster and more comfortable DR screening.

Rutin, a flavonoid phytochemical, ameliorates certain behavioral and electrophysiological alterations and general toxicity of oral arsenic in rats

Arsenic affects large populations and attacks, among others, the nervous system. Waterborne or occupational exposure causes electrophysiological alterations and motor disturbances in humans, and analogous effects were found in animals. Certain phytochemicals may be protective against As-caused damages. In the present study it was investigated whether the flavonoid rutin, applied via the drinking water (2 g/L), ameliorates the effects of arsenic given by gavage (10 mg/kg b.w., in form of NaAsO2) on open field motility, evoked cortical and peripheral electrophysiological activity, and body weight gain in adult male Wistar rats. Body weight gain was significantly reduced from the 4th week of the 6 weeks arsenic treatment and this effect was largely abolished by rutin in the combination treatment group. Rats treated by arsenic alone showed decreased open field motility; latency of the cortical evoked potentials increased and peripheral nerve conduction velocity decreased. These functional alterations were also counteracted by co-administration of rutin, and both the antioxidant and the chelating activity of rutin might have contributed to the ameliorative effect. These results are apparently novel and support the potential role of natural agents in preserving human health in a contaminated environment.

Role of gynecologists in reproductive education of adolescent girls in Hungary

AIM

The aim of this study was to assess whether the socioeconomic characteristics of adolescent girls, their knowledge about cervical cancer screening, and their sexual activity are associated with whether or not they have already visited a gynecologist.

MATERIAL AND METHODS

A self-administered questionnaire-based study was performed among secondary school girls (n = 589) who participated in professional education provided by a pediatric and adolescent gynecologist. The questionnaire comprised sociodemographic characteristics, sexual activity, knowledge on contraceptive methods, cervical screening and sources of their knowledge. Simple descriptive statistics, χ(2) and one-way-anova tests, multivariate logistic regression analysis and Pearson correlation were applied. All statistical analyses were carried out using spss 17.0 for Windows.

RESULTS

A total of 50.3% of adolescent girls had already had a sexual contact. Half of the sexually active participants had already visited a gynecologist, and most of them did so due to some kind of complaint. The overall knowledge about cervical screening was quite low; higher knowledge was found among those having visited a gynecologist.

CONCLUSIONS

Adolescent girls' knowledge on cervical screening was improved by previous visits to a gynecologist. The participation of an expert--a gynecologist--in a comprehensive sexual education program of teenage girls is of high importance in Hungary.

Prevalence of multiple sclerosis in Csongrád County, Hungary

OBJECTIVE

Recent epidemiological studies were mainly based on the Poser or other diagnostic criteria. There have been no previous data from Hungary, which were assessed with the more up-to-date McDonald criteria and which give comparable standardized data from the region.

MATERIALS AND METHODS

Data were collected from the MS Register of the Department of Neurology at the University of Szeged. All possible and definitive patients with MS living in the county on the prevalence day were included in the study. Direct standardization was based on the European standard population.

RESULTS

On 1 January 2013, 379 registered patients with MS were alive in the county, that is, a crude MS prevalence of 89.8/100,000, 46.6/100,000 in males and 128.6/100,000 in females; standardized prevalence: 83.7/100,000 (42.3/100,000 for males, 122.6/100,000 for females). The distribution of the clinical forms: 11% clinically isolated syndrome, 69% relapsing-remitting form, 14% secondary progressive form, 6% primary progressive form. Patients with no or only mild symptoms comprised 91.9% of the relapsing-remitting population.

CONCLUSIONS

This is the first standardized epidemiological study based on the McDonald criteria in Central Europe. Hungary is a medium-risk country as concerns the prevalence of MS. The crude prevalence appears to have increased relative to previous reports from the county.

Behavioral and general effects of subacute oral arsenic exposure in rats with and without fluoride

Consequences of oral arsenic and fluoride exposure on motor behavior and general toxicity were modeled in young adult male rats which received sodium (meta)arsenite (10 mg/kg b.w.), sodium fluoride (5 mg/kg b.w.), and their combination by gavage, once daily, 5 days a week for 6 weeks. After 6 weeks, 6 animals per group were dissected, while the other 6 were kept for 6 more weeks untreated. Body weight, together with food and water consumption, was measured daily. Arsenic, alone or along with fluoride, caused significant decrease in rearing, and increase in immobility and local activity in the open field in the 3rd and 6th week. By the 12th week, these changes mostly diminished. Weight gain, and food and water consumption were significantly reduced by arsenic but normalized post treatment. Fluoride had no own effect and mostly no influence on effects of arsenic. Massive deposition of arsenic in the rats' blood, cerebral cortex, and liver by the 6th week, and partial elimination by the 12th week, was seen. The results underline the risk of neuro-functional damage by arsenic and call for further investigations.

Green tea and vitamin C ameliorate some neuro-functional and biochemical signs of arsenic toxicity in rats

BACKGROUND/OBJECTIVES

Nervous system damage is one of the consequences of oral exposure to waterborne inorganic arsenic. In this work, the role of oxidative status in the neurotoxicity of arsenic and the possible role of two foodborne antioxidants in ameliorating arsenic-related oxidative stress were investigated.

METHODS

Male Wistar rats were given 10 mg/kg b.w. of trivalent inorganic arsenic (in the form of NaAsO2), 5 day/week for 6 weeks by gavage, combined with vitamin C solution (1 g/l) or green tea infusion (2.5 g in 500 ml boiled water) as antioxidants given in the drinking fluid.

RESULTS

Body weight gain was reduced by arsenic from the second week and the antioxidants had no effect on that. Cortical evoked potentials had increased latency, tail nerve conduction velocity was reduced, and this latter effect was counteracted by the antioxidants. The effect of green tea was stronger than that of vitamin C, and green tea also diminished lipid peroxidation induced by As. There was fair correlation between brain As levels, electrophysiological changes, and lipid peroxidation, suggesting a causal relationship.

DISCUSSION

Natural antioxidants might be useful in the protection of the central nervous system against the toxicity of oral As.

The role of home smoking bans in limiting exposure to secondhand tobacco smoke in Hungary

Our objective was to assess how exposure to secondhand tobacco smoke occurs in Hungarian homes, particularly among non-smokers, and to examine the effectiveness of home smoking bans in eliminating exposure to secondhand smoke at home. In 2009, 2286 non-smokers and smokers aged 16-70 years, who were selected randomly from a nationally representative sample of 48 Hungarian settlements, completed paper-and-pencil self-administered questionnaires addressing tobacco-related attitudes, opinions and behaviors. Chi-square tests, one-way analysis of variance and multivariate logistic regression models were used to assess the effect of demographics, socio-economic characteristics and home smoking policies on the risk of exposure to secondhand tobacco smoke at home. Significantly higher risk of exposure was found among younger, lower educated and poorer people and among those having no or partial home smoking restrictions. There was a significant interaction between education level and home smoking policies: the effect of a smoking ban on exposure to secondhand tobacco smoke was stronger for the lower educated group than the higher educated group. The results suggest that Hungarians are making good progress in implementing home smoking bans, and that in the majority of population these bans are working. More can be done to promote the uptake of home smoking bans among poorer and less educated subpopulations.

Support for population level tobacco control policies in Hungary

BACKGROUND

Smoking is the leading, preventable risk factor for premature death and disability in Hungary. The objective of this paper was to assess the social acceptability of and the predictors of holding favourable attitudes toward tobacco control policies among the Hungarian population.

METHODS

A self-administered questionnaire-based study was carried out among individuals aged 16-70 years. Logistic regression analysis was used to assess whether support for the ten tobacco control policies varies as a function of age, sex, educational level, and smoking status.

RESULTS

The majority of the respondents supported the studied tobacco control measures. Over 90 percent of the sample supported: fines for retailers selling tobacco products to minors (92.3%), stricter enforcement of restrictions on selling tobacco products to minors (90.5%), and a ban on smoking in health care institutions (91.4%). The lowest levels of support were for bans on sponsorship by the tobacco industry (52.8%) and price increases on tobacco products (54.9%). For each measure, support was significantly lower among smokers than non-smokers. Age and education were significantly related to support for some but not all measures.

CONCLUSIONS

Strong majorities of Hungarians support the enactment and enforcement of a wide range of tobacco control measures, a fact that was acknowledged by Parliament's passage of the 2011 Anti-Smoking Law. Advocacy efforts to encourage the acceptance of tobacco control policies should focus not only on smokers, but also on younger and less educated non-smokers.

Correlations between prescription of anti-hypertensive medication and mortality due to stroke

Background

One of the most important risk factors for stroke is hypertension. A number of studies have attempted to identify the most effective anti-hypertensive therapeutic group for stroke prevention. Using an epidemiologic approach we aimed to find correlations based on Hungarian data on stroke-mortality and on prescription routine of anti-hypertensive therapeutics in three different counties, showing significant difference in stroke mortality.

Methods

We have used the official yearly reports on stroke-mortality for the period 2003-2008. Based on the significant differences in the change in mortality due to stroke three counties were selected: Baranya, Bekes and Hajdu-Bihar. The usage of antihypertensive therapeutic groups was analyzed. The correlation of stroke mortality difference and different antihypertensive treatment habits was analyzed by using normality test, time series analyses, correlation coefficient, paired samples test, one sample test and chi-square test.

Results

For the year 2003 stroke-mortality standardized with the county population number was highest in county Bekes, followed by county Baranya and county Hajdu-Bihar. For each year stroke mortality has shown significant (p < 0.0001) difference between the three counties and the ranking/order of the counties has been preserved over time. During the period of our study, an increase in the number of days of treatment was observed for most of the anti-hypertensive drugs listed. We have observed that the increased use of high-ceiling diuretics resulted in a mortality advantage, and the reduction in use of calcium channel blockers with direct cardiac effect had negative consequences.

Conclusions

The authors acknowledge that by limiting the study to three counties the findings cannot be generalized to the whole Hungarian population. Two trends can still be identified:

i) increased number of days of treatment (and therefore the probable use) of high-ceiling diuretics is associated with reduction in mortality due to stroke and its immediate complications; ii) reduction in the use of non-dihidropiridin CCBs does not seem justified, as their use appears to be advantageous in stroke prevention. Authors put emphasis on the importance of the adherence of the patients to the preventive therapies. Health care professionals could provide an important added value to the life long preventive therapies by improving the compliance of their patients, giving personalized care and advice.

Consequences of subacute intratracheal exposure of rats to cadmium oxide nanoparticles: Electrophysiological and toxicological effects

Cadmium (Cd) is a metal used in various industrial applications, thereby causing exposure to Cd-containing fumes. The submicron-sized particles in the fumes represent an extra risk due to their high mobility within the organism and high surface area. Toxicity of Cd on the liver, kidney and bones is well known, but there are less data on its neurotoxicity. Here, male Wistar rats were treated for 3 and 6 weeks by intratracheal instillation of cadmium oxide nanosuspension. The body weight gain in treated rats was significantly decreased, and in the rats treated with high dose (0.4 mg/kg Cd daily), there was a significant increase in the weight of lungs and thymus. In this group, the spectrum of spontaneous cortical electrical activity was shifted to higher frequencies, the latency of sensory-evoked potentials was lengthened, and the frequency following ability of the somatosensory evoked potential was impaired--even without detectable Cd deposition in the brain. The data support the role of the nano-sized Cd in the causation of nervous system damage and show the possibility of modeling human neurotoxic damage in rats.

A pilot study with simultaneous recording of changes in motility and cortical electrical activity of rats during four weeks of oral manganese exposure

Manganese as an environmental neurotoxicant can cause oral exposure. Six rats were equipped with a connector "crown", allowing repeated recording of electrocorticogram (ECoG) with simultaneous recording of motor activity in an open field box. Weekly one 30-min recording session was held, and after two control sessions, four of the six rats had 2.5 mg/ml manganese chloride in their drinking water. The treated rats showed higher motility during the exposure period than the untreated ones; and substantially decreased total ECoG power without marked change the spectrum. The changes of both motility and ECoG were correlated to the individual brain Mn levels, and the activity decrease during a session was correlated to the total ECoG power. These effects can be likened to early adult manganism and to symptoms of children exposed to Mn via drinking water. Repeated simultaneous recording of open field motility and spontaneous cortical activity seems suitable to detect early electrophysiological and behavioral effects of an oral neurotoxic exposure.

[The objective assessment of the quality of oral health care and development of quality indicators]

Public health care administration and decision-makers need appropriate tools and information to assess and monitor oral health needs and improve the performance of the oral health system. The aim of the article is to introduce the available methods of measurement of the quality of service, to give a brief summary considering the role of quality indicators in domestic and international sources and the European indicator project (EGOHID) and to introduce ICDAS (International Caries Detection and Assessment System), the method used for clinical examinations. The clinical indicators - that are produced from data gained from the questionnaires and screenings--provide an opportunity to improve and develop quality. Quality indicators are objective measure of the process or outcome of patient care. The 40 indicators were created by the experts of EGOHID program which are described in four categories. Part A is indicators for monitoring the oral health of children and adolescents, Part B is in general population, Part C is indicators for monitoring the oral health systems, Part D concerns indicators for monitoring the oral health quality of life. The purpose of developing public health care and--within it--dental care is the effective use of resources and besides it, reaching the popular level of health gain for which it is a necessary tool when forming and continuously developing the quality approach of providers.

Nervous system effects in rats on subacute exposure by lead-containing nanoparticles via the airways

CONTEXT AND OBJECTIVE

Lead (Pb) is a heavy metal harmful for human health and environment. From leaded gasoline (still used in certain countries), and in Pb processing and reprocessing industries, airborne particles are emitted which can be inhaled. In such exposure, the size of particles entering the airways is crucial. The nervous system is a primary target for Pb, and consequences like occupational neuropathy and delayed mental development of children are well-known. The aim of this work was to investigate the neurotoxicity of Pb nanoparticles (NPs) applied into the airways of rats.

METHODS

Nano-sized lead oxide particles (mean diameter ca. 20 nm) were suspended in distilled water and instilled into the trachea of adult male Wistar rats (in doses equivalent to 2 and 4 mg/kg Pb), 5 times a week for 3 and 6 weeks. At the end, open field motility was tested, then central and peripheral nervous activity was recorded in urethane anesthesia.

RESULTS AND CONCLUSION

The treated rats' body weight gain was significantly lower than that of the controls from the 3rd week onwards, and the weight of their lungs was significantly increased. Horizontal motility increased while vertical motility decreased. Spontaneous cortical activity was shifted to higher frequencies. The somatosensory cortical evoked potential showed increased latency and decreased frequency-following ability, and similar alterations were seen in the tail nerve. Significant Pb deposition was measured in blood, brain, lung and liver samples of the treated rats. The experiments performed seem to constitute an adequate model of the human effects of inhaled Pb NPs.

Smoking behaviour and attitudes of Hungarian Roma and non-Roma population towards tobacco control policies

OBJECTIVES

To assess the smoking status and support for tobacco control policies among the Roma minority compared with the non-Roma population in Hungary.

METHODS

A cross-sectional survey was delivered among Roma minority and local non-Roma population; 83 Roma and 126 non-Roma people were interviewed. Chi-square tests and logistic regression were applied to compare Roma and non-Roma populations.

RESULTS

The prevalence of smoking was significantly higher and the support for tobacco control measures was significantly lower in the Roma population. This effect of ethnicity on attitudes toward tobacco control was explained somewhat, but not completely, by the Roma group's higher rate of smoking and lower level of education.

CONCLUSIONS

Tobacco control policies are a proven strategy for denormalizing smoking and discouraging initiation. This strategy has important potential for Roma communities because of their high rates of tobacco use. However, this study shows that the Roma are resistant the efforts to limit smoking. Changing these attitudes will require targeted public health interventions that take into account not only the lower educational levels of the Roma, but also their cultural beliefs regarding tobacco.