Older adults in the digital health era: insights on the digital health related knowledge, habits and attitudes of the 65 year and older population.

BACKGROUND: The COVID-19 pandemic has increased internet use by older age groups to an unprecedented level in Hungary mirroring the general tendency in the total population. Nevertheless, international trends indicate that this group is less likely to use digital health technologies than younger ones. The aging population raises the question of successfully integrating elderly people into the digital health ecosystem. Our research aim is to investigate the digital health usage patterns and attitudes of the population aged 65 and over through a representative sample. METHODS: A national representative questionnaire survey was conducted by telephone (CATI), interviewing 1723 respondents. Within this sample we examined 428 people in the over-65 age group, 246 in the 65-74 age group and 182 in the over-75 age group. Predictors of demand for digital solutions were tested using binary logistic regression model. RESULTS: 50.8% of people aged 65-74 and 37.1. % of people aged 75 + use the internet for health-related purposes, mostly to access websites. 85% of respondents in 65-74 and 74% in 75 + age group have used more than one digital health device and around 70% of both age groups have a need for more than one digital solution. 90.2% (64-75 age group) and 85.7% (75 + age group) of respondents are familiar with e-prescription, 86.4% and 81.4% of them use it. 77.1% of 65-74-year-olds have heard of and nearly half 45.5% have used online appointment. More than half (52.7%) of the respondents in this age group have heard of and used electronic transmission of medical records and data. A similar proportion has heard about and used apps: 54.3% has heard of them, but only 17.3% has used them. The multivariate analyses emphasized that the need for digital solutions increases with the level of education and the more benefits one perceives in using digital solutions. CONCLUSION: Our research has shown that the senior age group has measurable needs in the field of digital health, so helping them on this journey is in the interest of the whole health ecosystem. Their high level of interest is indicated by the fact that more than a fifth of older adults would like to have access to between 7 and 10 of the maximum number of digital devices available. The differences between the two age groups - with younger people being more open to digital solutions and using them more - and the fact that the under 65s are better adapted digitally in all respects, raises the possibility that the specific trends in digital health for older people may virtually disappear in 10 years' time (when the under 65s now enter this age group).

Creating work-life balance among physicians in the age of digitalization: the role of self-consciousness and communication - a qualitative study.

BACKGROUND: Besides the positive effects of using digital health solutions, digitalization can affect the healthcare worker burnout. The ability to coordinate different aspects of life (WLB) also plays a significant role in the development of burnout among medical workers. The aim of our study is to show, through qualitative interviews, the impact of digitalization on work-life balance in Hungarian physicians. METHODS: 62 semi-structured interviews were conducted between October 2021 and June 2022, of which, a total of 31 interviews were used for the analysis, which were all related to the theme of work-life balance. Purposive sampling and inductive thematic approach were used to collect and analyse the data and identify patterns of the themes. RESULTS: Based on this analysis, 5 main themes emerged: (1) the use of digital health tools, (2) Impact of digital tools on everyday work, (3) Work-life balance, (4) Setting and maintaining work-life boundaries, (5) Potential solutions. With the spread of digital communication, most of the respondents feel that their working hours increased even at the expense of their private life. The majority considers constant availability as a serious problem, however, several physicians indicated that as a result of a learning curve, they are able to change and set the necessary boundaries. Respondents were divided on whether or not they were successful in setting and maintaining boundaries. The 2 most important factors of establishing WLB in a digital age are self-consciousness and communication. However, these skills are not self-evident: the responses also show that in many cases there is a need for external support, but also for health professionals to actively reflect from time to time on their role as healers and their relationship with technology. CONCLUSION: Basic principles and tools for establishing successful digital work-life balance in healthcare should be involved in the training curriculum of future physicians and healthcare professionals, while institutions should elaborate specific policies to include digital work-life balance in the institutional setting, as part of the preventive measures against burnout.

The impact of digital healthcare and teledentistry on dentistry in the 21st Century: a survey of Hungarian dentists.

BACKGROUND: The era of digitalization has arrived in the field of dentistry. Teledentistry (TD), the use of digital solutions in dentistry, is already used in practice; however, only some possibilities are considered. During the COVID-19 pandemic, remote patient monitoring and patient communication had to be solved with TD, thus causing a rapid spread of new tools. In addition to digital workflows, patient communication, AI, and online forums are also available. METHODS: An online self-administered survey was developed for the study. The Hungarian Medical Chamber contacted potential respondents in a newsletter or e-mail. The Evasys survey system was used. The weighting procedure was executed for gender, age group, and type of settlement. A digital dental index variable was created and built with a linear regression model as a dependent variable. Explanatory variables are advantages, disadvantages, what would be necessary, experienced needs from the patients, and age. RESULTS: A total of 171 dentists completed the survey. The best-known digital technologies are online conferences (96.5%), E-prescriptions (94.6%), and digital impressions (86.0%). Unawareness is the highest in the field of artificial intelligence in dentistry (50.5%), store-forward solutions (43.5%), and real-time solutions (41.8%). The digital dental index is 14.24 (standard deviation (SD) = 5.5), with a high power of the model. CONCLUSION: Hungarian dentists need to be made aware of all the possibilities of TD. In addition to digital workflows, store-forward and real-time solutions can be beneficial to substitute face-to-face visits. TD can be used effectively to monitor oral cavity changes and develop dental confidence and proper oral care habits. Our survey suggests that it is necessary and inevitable to integrate TD into both graduate and postgraduate education, which may form the basis of primary health care in the next decade.

Telemedicine in community shelters: possibilities to improve chronic care among people experiencing homelessness in Hungary.

BACKGROUND: Digital health has expanded during the COVID-19 pandemic, while the exclusion of vulnerable populations with limited access to these technologies widens the gap to receive proper care. There is very little data available on the feasibility of telemedicine solutions regarding the chronic care of homeless persons. METHODS: In our study, 75 participants experiencing homelessness were recruited from four social institutions in Budapest, Hungary. The telecare pilot service consisted of six online consultations with a physician and was available in shelters biweekly. Self-developed questionnaires were used after every online session on the originating and remote sites as well, while a follow-up study was also completed among patients after four to six months of pilot closure. Parameters as frequencies, averages, and percentage distributions were analyzed and two linear regression models were built on explaining the doctors' and patients' overall rating of visits. RESULTS: During the pilot, 92.2% (n = 415) of originally planned visits were delivered and 55 clients (73.3%) attended the full program. Both the patients' and physicians' overall satisfaction was very high (4.52 and 4.79, respectively, on a 5-point Likert scale) and the patients' overall rating remained similarly high during the follow-up. Comparing the first and sixth visits, physicians reported significant improvements in almost all aspects. The linear regression models proved that confidence in the patients' assessment and diagnosis had the most prominent effect on the physicians' overall rating, while ease of use and lack of communication gaps influenced positively the patients' rating. CONCLUSION: The results suggest that telehealth services represent a promising tool to ensure better care continuity while using shelter infrastructure and on-site assistance might reduce the digital exclusion of people experiencing homelessness.

Digital Technology Access and Health-Related Internet Use Among People Experiencing Homelessness in Hungary: Quantitative Survey.

BACKGROUND: In recent years, there has been an increase in the use of digital technology for personal health and well-being. Previous research has revealed that these technologies might provide vulnerable populations, including those who are homeless, better access to health services and thus a greater chance of more personalized care. OBJECTIVE: However, little is known about the relationship between technology and health among people experiencing homelessness in Central and Eastern Europe. This study is part of a series of studies by the Digital Health Research Group at Semmelweis University (Budapest, Hungary) in cooperation with the Hungarian Charity Service of the Order of Malta; it aims to assess the existing technological resources available for the homeless population and their health-related internet use characteristics to set the ground for potential health policy interventions, enabling better access to health services by strengthening the digital components of the existing health care system. METHODS: Between April 19, 2021, and August 11, 2021, a total of 662 people from 28 institutions providing social services for people experiencing homelessness in Budapest, Hungary, were surveyed about their access to digital tools and internet use patterns. For selected questions, the responses of a representative sample of the Hungarian population were used for comparison as the reference group. Chi-square tests and logistic regression analyses were performed to identify variables affecting internet use for health-related reasons. RESULTS: The results demonstrated a considerable level of internet use in the homeless population; 52.9% (350/662) of the respondents used the internet frequently compared with 81.3% (1220/1500) of the respondents in the reference group. Among the homeless group, 69.6% (461/662) of the respondents reported mobile phone ownership, and 39.9% (264/662) of the respondents added that it had a smartphone function. Moreover, 11.2% (70/662) of the respondents had already used a health mobile app, and 34.6% (229/662) of the respondents had used the internet for medical purposes. On the basis of these characteristics, we were able to identify a broadly defined, digitally engaged group among people experiencing homelessness (129/662, 19.5%). This subpopulation was inclined to benefit from digitalization related to their personal health. Multivariate analysis demonstrated that internet use for health reasons was more significant for younger respondents, women, those with higher levels of education, and those with no chronic conditions. CONCLUSIONS: Although compared with the general population, health-related internet use statistics are lower, our results show that the idea of involving homeless populations in the digital health ecosystem is viable, especially if barriers to access are systematically reduced. The results show that digital health services have great promise as another tool in the hands of community shelters for keeping homeless populations well ingrained in the social infrastructure as well as for disease prevention purposes.

Factor structure of The Opening Minds Stigma Scale for Health Care Providers and psychometric properties of its Hungarian version.

BACKGROUND: The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure the stigmatising attitudes of healthcare providers towards patients with mental health problems. The psychometric properties of the scale; however, have never been investigated in Hungary. We aimed to thoroughly explore the factor structure of the OMS-HC and examine the key psychometric properties of the Hungarian version. METHODS: The OMS-HC is a self-report questionnaire that measures the overall stigmatising attitude by a total score, and three subscales can be calculated: Attitude, Disclosure and Help-seeking, and Social Distance. Our study population included specialists and trainees in adult and child psychiatry (n = 211). Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. We calculated the test-retest reliability on a subgroup of our sample (n = 31) with a follow-up period of 1 month. The concurrent validity of the scale was measured with the Mental Illness: Clinician's Attitudes-4 scale (MICA-4). RESULTS: Three factors were extracted based on a parallel-analysis. A bifactor solution (a general factor and three specific factors) showed an excellent model-fit (root mean square error of approximation = 0.025, comparative fit index = 0.961, and Tucker-Lewis index = 0.944). The model-based reliability was low; however, the general factor showed acceptable reliability (coefficient omega hierarchical = 0.56). The scale demonstrated a good concurrent validity with the MICA-4 [intraclass correlation coefficient (ICC) = 0.77]. The test-retest reliability was excellent for the general factor (ICC = 0.95) and good for the specific factors (ICC = 0.90, 0.88, and 0.84, respectively). CONCLUSIONS: The three dimensions of the OMS-HC was confirmed, and the scale was found to be an adequate measure of the stigmatising attitude in Hungary. The bifactor model is more favourable as compared to the three correlated factor model; however, despite the excellent internal structure, its model-based reliability was low.

The Rise of the Empowered Physician in the Digital Health Era: Viewpoint.

Being a 21st-century health care provider is extremely demanding. The growing number of chronic diseases, lack of medical workforce, increasing amounts of administrative tasks, the cost of medical treatment, and rising life expectancy result in an immense challenge for medical professionals. This transformation has been triggered by the growing presence of digital health. Digital health does not only refer to technological transformation; it also fundamentally reshapes the physician-patient relationship and treatment circumstances. We argue that patient empowerment, the spread of digital health, the biopsychosocial-digital approach, and the disappearance of the ivory tower of medicine lead to a new role for physicians. Digital health allows the job of being a medical professional to become more rewarding and creative. The characteristics of a physician-as-idol could shift from self-confident to curious, from rule follower to creative, and from lone hero to team worker. Empowered physicians (e-physicians) can be described as "electronic," where they use digital technologies in their practice with ease; "enabled," where they are enabled by regulations and guidelines; and "empowered," where they are empowered by technologies that support their job and their empowered patients (e-patients). They can be described as "experts" in the use of technologies in their practice or in knowing the best, most reliable, and trustworthy digital health sources and technologies. They can also be described as "engaged," when understanding the feelings and points of view of their patients, giving relevant feedback, and involving them throughout the whole healing process. The skills and approaches that characterize this era of e-physicians, such as face-to-face communication skills, digital literacy, interdisciplinarity, knowing where to find information, translating large amounts of data into insights for patients, among others, should always have been at the core of practicing medicine. However, the economical, technological, and administrative burden of the profession has not made it possible for most physicians to enjoy the benefits of their training, individual capabilities, and creativity. By understanding how digital health technologies can support or augment their capabilities, physicians would have the chance to practice the art of medicine like never before.

Willingness to migrate-a potential effect of burnout? A survey of Hungarian physicians.

BACKGROUND: Burnout worldwide and migration of caregivers are among the most important challenges of the twenty-first century health care. METHODS: Quantitative, online survey of Hungarian physicians (n = 4 784) was performed in 2013. A link to an anonymous, self-administered questionnaire was sent to all potential participants, namely to the registered members of the Hungarian Medical Chamber with a valid e-mail address. Linear regression analysis was used to determine the risk factors of burnout. The association between physicians' burnout and their willingness to migrate was determined by binary logistic regression analysis. RESULTS: Moderate/mild level of personal accomplishment was detected in 65% of respondents, whereas moderate/severe level of emotional exhaustion and depersonalization was detected in 49% and 46%, respectively. Single male physicians younger than 35 composed the cohort with the highest risk for developing burnout. Higher daily working hours and multiple workplaces contribute to the risk of developing burnout. According to logistic regression analysis, the intention to work abroad was affected by the emotional exhaustion dimension of burnout (OR = 1.432) and depersonalization had a tendency to have an impact on the willingness to migrate. CONCLUSIONS: We assume that there is a circular causality between burnout and the willingness to migrate. Burnout increases the willingness to work abroad, whereas contemplating migration might evoke a certain degree of depersonalization in caregivers who are in a dilemma.

[Willingness to work abroad among Hungarian medical students]. / Magyarországi orvostanhallgatók külföldi munkavállalási szándékai.

INTRODUCTION: Migration, drop-out and ageing of physicians are the most important challenges of the 21st century healthcare system. The young doctors' willingness to work abroad will become a decisive issue of the human resources of healthcare in the following decades. AIM: To explore the willingness of migration among medical university students. METHOD: Quantitative and qualitative online survey of students from 4 Hungarian medical universities (n = 530). In the present study we investigated only the 5th- and 6th- year students' answers (n = 165). RESULTS: 40% of students plan to work abroad, mostly for a 2-5 year timeframe. The motivation of working abroad are the following: work conditions of medical system, inadequate pay and general living conditions in Hungary. The content analysis of open answers showed that the willingness to return depends mainly on family reasons and the objective working conditions (infrastructure, pay, abolition of the gratuity system). An equally important factor is the evolution of work culture. CONCLUSIONS: As opposed to previous studies, our results indicate a more prevalent willingness to work abroad while an unambiguous return is only possible with a drastic change in the healthcare system. Orv Hetil. 2018; 159(1): 31-37.

[What do family medicine trainees think about gratitude payment?] / Mit gondolnak a családorvos-rezidensek a hálapénzrol?

INTRODUCTION: The issue of gratuity is one of the most important health policy issues in Hungary. AIM: The authors' aim is to investigate the attitude of Hungarian family medicine trainees towards gratitude payment. METHOD: Quantitative, paper-based survey among trainees from four Departments of Family Medicine in Hungary (n = 152). RESULTS: More than 50 percent of the residents do not approve of accepting gratitude money. Men (p<0.026), and graduating residents accept it significantly more often (p<0.036) while doctors with children tend to accept it more frequently (p<0.051). They think that the reason for this phenomenon is the lack of proper care (65%), vulnerability and the sense of real gratitude patients feel (52%). According to the participants, the least influencing factor was the low salary of physicians (14.4%). They believe that accepting gratuity is a corruption, and it's humiliating for doctors (80-80%). CONCLUSION: Family medicine residents approve of gratitude money even less as compared to the results of previous studies, but related to other gratitude payment issues we have found similar opinions. Orv Hetil. 2017; 158(26): 1028-1035.

Workload, mental health and burnout indicators among female physicians.

BACKGROUND: Female doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians. METHODS: Two time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis. RESULTS: No significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment. CONCLUSIONS: In comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.

Maternal bonding styles in smokers and non-smokers: a comparative study.

BACKGROUND: Parental bonding has been implicated in smoking behavior, and the quality of maternal bonding (MB) has been associated with poor mental health and substance use. However, little is known about the association of MB and the smoking of the offspring. METHODS: In our study, 129 smokers and 610 non-smoker medical students completed the parental bonding instrument, which measures MB along two dimensions: care and overprotection. Four categories can be created by high and low scores on care and overprotection: optimal parenting (OP; high care/low overprotection); affectionless control (ALC; low care/high overprotection); affectionate constraint (AC; high care/high overprotection), and neglectful parenting (NP; low care/low overprotection). Nicotine dependence was assessed by the Fagerstrom Nicotine Dependence Test, exhaled CO level, and daily cigarette consumption (CPD). RESULTS: Higher CPD was significantly associated with lower overprotection (p = 0.016) and higher care (p = 0.023) scores. The odds for being a smoker were significantly higher in the neglectful maternal bonding style compared to the other rearing styles (p = 0.022). Besides, smokers showed significantly higher care and lower overprotection scores with the Mann-Whitney U-test than non-smokers, although these associations did not remain significant in multiple regression models. CONCLUSION: Our results indicate that focusing on early life relationship between patient and mother can be important in psychotherapeutic interventions for smoking. Registration trials retrospectively registered.

Career motivation and burnout among medical students in Hungary - could altruism be a protection factor?

BACKGROUND: Burnout is a major issue among medical students. Its general characteristics are loss of interest in study and lack of motivation. A study of the phenomenon must extend beyond the university environment and personality factors to consider whether career choice has a role in the occurrence of burnout. METHODS: Quantitative, national survey (n = 733) among medical students, using a 12-item career motivation list compiled from published research results and a pilot study. We measured burnout by the validated Hungarian version of MBI-SS. RESULTS: The most significant career choice factor was altruistic motivation, followed by extrinsic motivations: gaining a degree, finding a job, accessing career opportunities. Lack of altruism was found to be a major risk factor, in addition to the traditional risk factors, for cynicism and reduced academic efficacy. Our study confirmed the influence of gender differences on both career choice motivations and burnout. CONCLUSION: The structure of career motivation is a major issue in the transformation of the medical profession. Since altruism is a prominent motivation for many women studying medicine, their entry into the profession in increasing numbers may reinforce its traditional character and act against the present trend of deprofessionalization.

[Retired physicians in Hungary - nationwide, representative study]. / Nyugdíjas orvosok helyzete Magyarországon ­ országos, reprezentatív felmérés eredményei alapján.

INTRODUCTION: The aging population and the aging physician society is an important challenge of the New Millenium. Despite this, very few publications are dealing with the older generations' physical and mental well-being, quality of life and working conditions. AIM: The aim of this study was to describe the retired physicians populations' (n = 2112) demographic data, work status, income and health status. METHOD: Data of this representative, cross-sectional epidemiological study was obtained from online and paper-based questionnaires completed by 2112 retired physicians. RESULTS: The retired physicians' average age is 72 years, nearly two-thirds of the respondents retired after 35-45 years of service. Currently, nearly 60% are working, almost a quarter of them more than 40 hours per week. 35% of the respondents' income is below HUF 150,000. On this issue, significant differences emerge between female doctors and their male colleagues. CONCLUSIONS: The employment data of the results is consistent with the international trend, but the gender perspectives has unique significance in the international literature. Orv. Hetil., 2016, 157(43), 1729-1736.

[The role of physical activity in health promotion of healthcare workers]. / A testmozgás szerepe az egészségügyi dolgozók egészségfejlesztésében.

INTRODUCTION: The health status of doctors, nurses and any other professionals working in the healthcare sector influences the quality of their work. Therefore, health promotion of healthcare workers is not only an occupational health program but it can be considered as an action towards improving the quality of care. AIM: The current study was designed to assess the efficacy of a health promotion intervention among healthcare workers after health status assessment. METHOD: Before and after the intervention a self-assessment questionnaire-based health survey and physical status examination were performed. Members of the intervention group were offered to use fitness facilities, professional psychological help, dietary counselling, and dental consultation. RESULTS: The intervention program lasted for 12 months with the participation of 79 health care professionals (based on their decision being in the intervention or in the control group). Significant decrease was found in the abdominal perimeter in participants of the intervention group and they ran a longer distance on the 12 minute-long-run test at the end of the study. CONCLUSIONS: The positive effect of regular physical exercise as part of active lifestyle has been demonstrated not only in the increase of physical capacity, but in the change of body shape, as well. Orv. Hetil., 2016, 157(39), 1563-1570.

[Opinions of Hungarian family physicians and residents on vocation and informal payment]. / Hivatással és hálapénzzel kapcsolatos vélekedések a magyarországi családorvosok és családorvos rezidensek körében.

INTRODUCTION: The changing of the family medicine can be observed in the New Millennium. Migration, the aging of the healers and informal payment are crucial to the human resource crisis of the health sector. AIM: The aim of this study was to investigate the family physicians' and residents' opinions about the vocation and informal payment. METHOD: Exploratory, quantitative study was carried out among family physicians (n = 363) and family physician residents (n = 180). The central questions of the study were the vocation, the income and the informal payment. RESULTS: The most decisive factors of the carrier choice were altruism, service and responsibility. Residents were significantly rejective (19.7% vs. 38.3%, p<0.001) about informal payment. They would accept smaller amounts of informal payment (14.3% vs. 8.9%, p<0.034), and would spend it on praxis development (1.4% vs.9.4% p<0.023). CONCLUSIONS: The attitudes of family physicians and residents are the same in case of the vocation, but on the issue of informal payment, the two generations have different opinions. Orv. Hetil., 2016, 157(36), 1438-1444.

The effects of dissection-room experiences and related coping strategies among Hungarian medical students.

BACKGROUND: Students get their first experiences of dissecting human cadavers in the practical classes of anatomy and pathology courses, core components of medical education. These experiences form an important part of the process of becoming a doctor, but bring with them a special set of problems. METHODS: Quantitative, national survey (n = 733) among medical students, measured reactions to dissection experiences and used a new measuring instrument to determine the possible factors of coping. RESULTS: Fifty per cent of students stated that the dissection experience does not affect them. Negative effects were significantly more frequently reported by women and students in clinical training (years 3,4,5,6). The predominant factor in the various coping strategies for dissection practicals is cognitive coping (rationalisation, intellectualisation). Physical and emotional coping strategies followed, with similar mean scores. Marked gender differences also showed up in the application of coping strategies: there was a clear dominance of emotional-based coping among women. Among female students, there was a characteristic decrease in the physical repulsion factor in reactions to dissection in the later stages of study. CONCLUSIONS: The experience of dissection had an emotional impact on about half of the students. In general, students considered these experiences to be an important part of becoming a doctor. Our study found that students chiefly employed cognitive coping strategies to deal with their experiences. Dissection-room sessions are important for learning emotional as well as technical skills. Successful coping is achieved not by repressing emotions but by accepting and understanding the negative emotions caused by the experience and developing effective strategies to deal with them. Medical training could make better use of the learning potential of these experiences.

[Burnout among Hungarian physicians. Who are the most at risk?]. / Kiégés a magyarországi orvosok körében. Kik a legveszélyeztetettebbek?

INTRODUCTION: Burnout is one of the most challenging questions of the healthcare systems in the 21st century. AIM: The aim of this study was to analyze the Hungarian physicians' burnout and its associations with workload factors (work hours, shift work, multiple workplaces). METHOD: Data of this representative, cross-sectional, online epidemiological study was obtained from online questionnaires completed by 4784 physicians. RESULTS: Medium or high level personal accomplishment was present in 75.9% and emotional exhaustion in 58% among physicians, while medium or high level of depersonalization subscale was 53%. All of the 3 dimensions showed association with young ages (<35 years), work in in-patient care, shift hours and multiple workplaces. The physician partner increased the risk of depersonalization, however, children were protective factors. The work-home interface was associated with higher burnout scores. CONCLUSIONS: Physicians' burnout is an important indicator of the functioning and effectiveness of the healthcare system. The results suggest the importance of prevention and intervention.

MENTAL HEALTH OF PHYSICIANS--NATIONWIDE REPRESENTATIVE STUDY FROM HUNGARY.

BACKGROUND AND AIM: Somatic and mental health and stress factors of physicians became an issue of growing interest in both national and international investigations. Our aim is to give an overview of the mental state of Hungarian physicians. METHODS: Cross-sectional, quantitative survey on a representative sample of Hungarian physicians (n = 4784). The control group was formed by the population group of a national survey conducted by "Hungarostudy 2013" (n = 2000). RESULTS: Suicidal thoughts (18.8% vs. 9.6%, p < 0.001), the scores of Somatic Symptom Scale (PHQ-10, 20.4% vs. 13.6%, p < 0.001) were significantly higher among physicians. The suicidal attempts (1.9% vs. 3.5%, p = 0.053) and BDI depression scores (7.9% vs. 29.5%, p < 0.001) were significantly higher in the control group. High Perceived Stress Scale (PPS) scores occurred in 43.3% of the physicians sample, and 43.4% of them had high scores in the Athenian Insomnia Scale (AIS). The young (< 35) female physicians showed significantly higher rates of suicidal thoughts, higher scores of PHQ and PPS. In the young female cohort, the AIS scores were significantly higher than of the other physicians. CONCLUSIONS: Mental health of physicians (sleep disorders, suicidal thoughts and psychosomatic symptoms) showed poorer results than the population data. BDI scores and the rate of suicidal attempts showed favourable trends. The next step in the research of physicians' mental health is to investigate the most serious risk factors, and to refine the preventive tools.

Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary.

BACKGROUND: There is a worldwide rising tendency of women deciding to become physicians; hence, one of the most remarkable fields of investigation is the wellbeing of female doctors. The aim of this study was to describe female physicians' reproductive health in Hungary and to explore the potential correlation between their reproductive disorders and burnout symptoms. Up to our present knowledge, there have not been any studies investigating the correlation between reproductive disorders and burnout of female physicians; therefore, our study represents a unique approach. METHODS: Data in this representative cross-sectional epidemiological study were obtained from online questionnaires completed by 3039 female physicians. Participants in a representative nationwide survey (Hungarostudy, 2013) served as controls (n = 1069). Differences between physicians and the control group were disclosed by chi-square test. Correlations between certain factors of reproductive health and the three dimensions of burnout were detected by Pearson correlations and X2 test. Binary logistic regression analysis was used to determine the association between burnout and reproductive health. RESULTS: Female physicians were more often characterised by time-to-pregnancy interval longer than one year (18.4% vs. 9.8%), were bearing more high-risk pregnancies (26.3% vs.16.3%), and were more likely to be undergoing infertility therapy (8.5% vs. 3.4%) and experiencing miscarriage (20.8% vs. 14.6%) during their reproductive years, compared with the general female population. With the exception of miscarriages, the difference remained significant in all comparisons with the professional control group. Both high-risk pregnancies and miscarriages of doctors were associated with depersonalisation (p = 0.028 and p = 0.012 respectively) and personal accomplishment (p = 0.016 and p = 0.008 respectively) dimensions of burnout. Results of the multivariate analysis showed that, beside traditional risk factors, depersonalisation acted as an important explanatory factor in case of high-risk pregnancies (OR = 1.086). CONCLUSIONS: There is a circulatory causality between burnout and the development of reproductive disorders. Burnout is an important risk factor for high-risk pregnancies and miscarriages, and it has a negative effect on the outcome of pregnancies. At the same time, women suffering from reproductive disorders are more likely to develop burnout syndrome. Improvement of working conditions and prevention of burnout in female doctors are equally important tasks.