Earning opportunities and informal payment as influencing factors in medical students' speciality choice.

BACKGROUND: The Hungarian primary care system faces a severe shortage of family physicians. Medical students' perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students' knowledge about their future earning opportunities and their attitudes towards informal payment. METHODS: A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. RESULTS: Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = 'no influence', 10 = 'very big influence') 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. CONCLUSIONS: Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs - this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.

Perceived cardiovascular risk and attitude towards lifestyle change.

Background: Cardiovascular diseases are prominent cause of death. Lifestyle change is effective in decreasing mortality. Perception of patients' cardiovascular risk by physicians is a drive for following preventive recommendations. Whether the hazard perceived by patients influences their attitude towards lifestyle is uncertain. Objective: We hypothesized that high perceived risk would be associated with a stronger determination for lifestyle change, while incorrectly optimistic patients would be less motivated. Methods: Two hundred patients visiting their family physicians were asked to fill out a questionnaire about demographic, clinical and lifestyle characteristics, about their attitude towards lifestyle change and their estimation of their cardiovascular risk. Actual risk was estimated by family physicians based on the national guideline. Results: Questionnaires were completed by 80.5% (161/200) of patients approached. Patients underestimated their risk (P < 0.001), mainly because high-/very high-risk patients classified themselves into lower risk categories. The majority of patients were planning a lifestyle change, losing weight being the most popular goal. It was the priority even for some normal weight subjects and for smokers, too. Perceived risk played a marginal role as a determinant of lifestyle change. Underestimation of perceived risk had no effect on patients' motivation. Self-rated obesity was the predictor of three out of five means of change (weight loss, diet, physical activity). Conclusion: Perceived cardiovascular risk and incorrect optimism about this hazard have minimal, if any, influence on attitude towards lifestyle change. Patients' motivation seems not to be primarily health related.

[The importance of anxiety and depression in family practice]. / A szorongás és a depresszió jelentosége a családorvosi gyakorlatban.

Representative studies indicate that prevalence of anxiety disorders among adults is between 12.6-17.2%, while in Hungary it is 17.7%. According to both international and national studies the point prevalence of diagnosed major depression requiring treatment is 6-10 % in general practice. As untreated depression is the most important risk factor for suicide, early detection and effective management of depression are critical in prevention. According to international and national studies the recognition of major depression in primary care significantly contributes to the decline of suicide mortality. In our article we review screening of anxiety and depressive disorders and treatment and management of these patients in primary care. We present two short questionnaires used for recognizing depression and acute suicide risk and describe their use in family/ general practice.

[A családorvosok alvási apnoéval kapcsolatos ismeretei és attitudjei. Megvalósul-e az OSAS szurése a jármuvezetok egészségi alkalmasságának vizsgálata során?] / A családorvosok alvási apnoéval kapcsolatos ismeretei és attitudjei. Megvalósul-e az OSAS szurése a jármuvezetok egészségi alkalmasságának vizsgálata során?

BACKGROUND AND PURPOSE: Obstructive sleep apnea syndrome (OSAS) without treatment can cause serious cardiovascular, cardiorespiratory, neurological and other complications. Family physicians have an important role in recognizing the disease. The aim of the study is to assess the knowledge and attitude of family physicians related to sleep apnea. Whether OSAS screening is realized during the general medical checkup for drivers. METHODS: In the cross-sectional study we used a validated OSAKA questionnaire in mandatory continuous medical education courses, supplemented with four additional questions. RESULTS: 116 family physicians and 103 family medicine residents filled out the questionnaire. Hungarian family physicians, especially male doctors lack the adequate knowledge of sleep apnea. The average score of female physicians was significantly higher than that of males (13.4±1.8 vs. 11.7±2.6, p=0.005). The more specializations the doctor has, the higher the score. Zero or one special examination holders reached 12.5±2.3 points, two special examination holders 12.7±2.2 points. three or four special examination holders reached 14.0±2.1 (p=0.05). Residents' average score was 12.1±2.4 points, which is higher than that of family doctors (p=0.012). Female residents also had higher average points than male residents (12.6±2.0 vs. 11.3±2.7; p=0.008). The size, location and type of the practice or the doctor's age did not show any statistically significant correlation with the number of points achieved. According to our regression analysis, corrected to variables in the model, we found correlation between gender and medical knowledge, but there was no correlation between age, number of specialities, body mass index and the theoretical knowledge of the doctors. In terms of attitude female GPs had higher average scores than male GPs (3.5±0.6 vs. 2.9±0.6, p<0.001). Despite the modification of the 13/1992 regulation only 39% of the practices carried out regularly the required OSAS screening as part of the medical examination for a driving licence. CONCLUSION: Despite the high prevalence and clinical importance of OSAS, GPs often do not recognize sleep apnea and they have difficulty in treating their patients for this problem.

[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 association between diabetes complications and symptoms of depression and anxiety]. / A cukorbetegség szövodményeinek összefüggése a depressziós és szorongásos tünetekkel.

INTRODUCTION: The bidirectional relationship between diabetes and depression results in severe disease burden. Co-occurring depression is associated with a higher rate of diabetes complications. These complications impair quality of life, however, their impact on depressive symptoms is controversial. OBJECTIVE: In our cross-sectional study, we aimed to investigate whether the presence of diabetes complications is associated with depressive and anxiety symptoms among patients with type 2 diabetes in general practice. METHOD: We obtained patient history, anthropometric, socioeconomic, laboratory parameters. For symptom assessment, the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. We collected data between September 2018 and February 2020. RESULTS: We included 338 consecutive patients with type 2 diabetes. The mean age of the sample was 63.98 ± 11.51 (years ± SD), 61.2% of participants were female. We found significant univariate association between diabetes complications and older age, less physical activity, higher body mass index, insulin therapy, higher HbA1c, higher creatinine and carbamide concentrations, worse depressive and anxiety symptoms. In multivariate analysis, diabetes complications and certain socio-demographic factors (female gender, lower education, rural-dwelling) were the determinants of higher BDI and HAM-A scores. CONCLUSION: Among primary care patients with type 2 diabetes, the prevalence of depressive and anxiety symptoms was higher and more severe in patients with diabetes complications. The recommended screening for affective disorders among patients with diabetes is especially justified if complications are present. Orv Hetil. 2023; 164(3): 79-87.

Rural family medicine as a career option among Hungarian medical students.

BACKGROUND: The shortage of family physicians is a considerable challenge in Hungary. The number of vacant practices is increasing and the rural and deprived areas are more affected. OBJECTIVES: This study aimed to investigate medical students' attitudes towards rural family medicine. METHODS: The current study used a cross-sectional design with a self-administered questionnaire. Each of the four Hungarian medical universities was represented by their medical students from December 2019 to April 2020. RESULTS: The response rate was 67.3% (n = 465/691). Only 5% of the participants plan to be a family doctor, 5% of the students plan to work in rural areas. On a 5-point Likert scale (1 = 'surely not', 5 = 'surely yes'), half of the participants answered 1 or 2 to choose rural medical work, while 17.5% answered 4 or 5. There was a significant relationship between rural working plans and rural origin (OR = 1.97; p = 0.024), and the plan to work in family practice (OR = 4.90; p < 0.001). CONCLUSION: Family medicine is not a popular career option among Hungarian medical students and rural medical work is even less attractive. Medical students with a rural origin and an interest in family medicine are more likely to plan to work in rural areas. More objective information and experience need to be given to medical students about rural family medicine to increase the attractiveness of the speciality.

Evaluating real-patient learning in medical education - Hungarian validation of the Manchester Clinical Placement Index.

Introduction: The Manchester Clinical Placement Index (MCPI) is an instrument to measure medical undergraduates' real-patient learning in communities of practice both in hospital and in GP placements. Its suitability to evaluate the quality of placement learning environments has been validated in an English-language context; however, there is a lack of evidence for its applicability in other languages. Our aim was to thoroughly explore the factor structure and the key psychometric properties of the Hungarian language version. Methods: MCPI is an 8-item, mixed-method instrument which evaluates the quality of clinical placements as represented by the leadership, reception, supportiveness, facilities and organization of the placement (learning environment) as well as instruction, observation and feedback (training) on 7-point Likert scales with options for free-text comments on the strengths and weaknesses of the given placement on any of the items. We collected data online from medical students in their preclinical (1st, 2nd) as well as clinical years (4th, 5th) in a cross-sectional design in the academic years 2019-2020 and 2021-2022, by the end of their clinical placements. Our sample comprises data from 748 medical students. Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. Results: Although a bifactor model gave the best model fit (RMSEA = 0.024, CFI = 0.999, and TLI = 0.998), a high explained common variance (ECV = 0.82) and reliability coefficients (ωH = 0.87) for the general factor suggested that the Hungarian version of the MCPI could be considered unidimensional. Individual application of either of the subscales was not supported statistically due to their low reliabilities. Discussion: The Hungarian language version of MCPI proved to be a valid unidimensional instrument to measure the quality of undergraduate medical placements. The previously reported subscales were not robust enough, in the Hungarian context, to distinguish, statistically, the quality of learning environments from the training provided within those environments. This does not, however, preclude formative use of the subscales for quality improvement purposes.

Severity of depressive but not anxiety symptoms impacts glucose metabolism among patients with type 2 diabetes in primary care.

Background: Data from primary care regarding the prevalence of symptoms of depression and anxiety, and their effect on glycemic control among people with diabetes is lacking in Hungary. The recently introduced Patient Health Record (PHR) requires family doctors to screen for depressive symptoms. Objectives: We aimed to investigate the prevalence of depressive and anxiety symptoms among patients with type 2 diabetes in the general practice, and the relationship between these affective disorders and glycated hemoglobin (HbA1c) level. Methods: We included 338 consecutive patients with type 2 diabetes from six primary care practices in this cross-sectional study. A self-administered questionnaire (patient history, anthropometric, socioeconomic, laboratory parameters), the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. Results: The mean age of the sample was 64.0 ± 11.5 (years ± SD), 61% of participants were female. The prevalence of depressive symptoms was 21%, mainly moderate/severe symptoms (13%). Anxiety symptoms were more common (35%). We found significant univariate association between the depressive symptoms and HbA1c (p = 0.001), suicide attempt (p < 0.001), anxiety (p < 0.001), micro- and macrovascular complication (p = 0.028 and p < 0.001), education (p = 0.001) and place of residence (p = 0.002). In multivariate analysis, however, only BDI score had significant (p = 0.03191) association with glycemic control. Conclusion: Among primary care patients with type 2 diabetes, the prevalence of depressive symptoms was less frequent than anxiety symptoms. More severe depressive symptoms were associated with worse glycemic control.

[Examination of the health status and health behaviors of Hungarian family physicians]. / Magyar családorvosok egészségi állapotának, életmódjának vizsgálata.

Összefoglaló. Bevezetés: A családorvosok testi, lelki egészségi állapota hatással van a munkavégzésükre, a betegellátás minoségére, ezáltal a társadalom egészségmutatóira is. Az életmód pedig az egyik legjelentosebb, egészségi állapotot befolyásoló tényezo. Célkituzés: A vizsgálat célja a magyar háziorvosok egészségi állapotának és az azt befolyásoló életmódtényezoknek a felmérése. Módszer: Keresztmetszeti vizsgálat. Kvantitatív, papíralapú felmérés családorvosok körében (n = 569, életkor 54 ± 10 év, nok 42%). Eredmények: A háziorvosok 61%-a túlsúlyos vagy elhízott, 88%-ának a vércukorszintje ≤5,5 mmol/l. A résztvevok 50%-a legalább heti rendszerességgel végez testmozgást, 20%-uk egyáltalán nem. A háziorvosok 13%-a dohányzik jelenleg, 5%-a tekintheto nagyivónak. Enyhe fokú depressziós tünetegyüttes 19%-uknál, közepes fokú 6%-uknál, súlyos fokú 5%-uknál fordult elo. A súlyos fokú kiégés mindkét nemben, mindhárom dimenzióban 18­39% volt. Következtetés: A magyar háziorvosok általános egészségi állapota nem mondható jobbnak sem a hazai nem orvos populációénál, sem a külföldi orvoskollégákénál. A magyar háziorvosok dohányzási mutatói kedvezobbek a lakossági adatoknál, míg az alkoholfogyasztás terén kedvezotlenebb eredményeket kaptunk. Nemzetközi összehasonlításban, a káros szenvedélyek terén a hazai kollégák eredményei jónak tekinthetok. A depresszió és a kiégés gyakori elofordulása jelentos probléma a háziorvosok körében. Mentális egészségük monitorozása és gondozása a hatékony egészségügyi ellátórendszer kulcskérdése. Orv Hetil. 2021; 162(12): 449­457. Summary. Introduction: General practitioners' somatic and mental health status have an impact on their work and the quality of care they provide and thus influence the health indicators of the society. Lifestyle is one of the most important influencing factors of health. Objective: The study aims to assess the health status of Hungarian general practitioners and the lifestyle factors influencing it. Method: Cross-sectional study. Quantitative, paper-based questionnaire among general practitioners (n = 569, age 54 ± 10 years, female 42%). Results: 61% of family physicians are overweight or obese, 88% of them have blood glucose level ≤5.5 mmol/l. 50% of the participants do exercise at least once a week, 20% do not take any exercise at all. 13% currently smoke, 7% are considered heavy drinkers. Mild, moderate and severe depression symptoms occurred in 19%, 6% and 5% of them, respectively. A severe level of burnout syndrome was reported in 18­39% in both sexes, in all three dimensions. Conclusion: The health status of Hungarian general practitioners is not better than that of the non-medical Hungarian population or than that of foreign colleagues. The smoking indicators of Hungarian doctors are more favorable than the Hungarian population data, while we obtained worse results in the field of alcohol consumption. In international comparison, the results of Hungarian colleagues in the field of smoking and alcohol consumption are good. The frequent occurrence of depression and burnout is a significant problem among family physicians. Monitoring and caring for their mental health is a key factor in the effective health care system. Orv Hetil. 2021; 162(12): 449­457.

The relationship between anxiety and diabetes / A szorongás és a diabetes közti kapcsolat.

Összefoglaló. A cukorbetegség és a depresszió kapcsolatáról számos tanulmány született. A szorongás és a diabetes közti összefüggést már kevesebben vizsgálták, pedig jelentos szerepük van a szorongásos kórképeknek is, hiszen nagyon gyakori a két betegség együttes elofordulása. A diabetes már önmagában is nagy betegségterhet jelent a betegek számára, a társuló pszichiátriai kórképek pedig tovább rontják a kezelés minoségét, ezért fontos a korai felismerésük és kezelésük. Jelen összefoglaló közleményünk célja a szorongásos kórképek és elsosorban a 2-es típusú cukorbetegség közti összefüggés feltárása. Több elmélet született a köztük lévo kapcsolat magyarázatára. Egyesek szerint szerepet játszhat benne a közös etiológiai háttér, mások szerint a cukorbetegség diagnózisa és a gondozásával kapcsolatos feladatok vezetnek szorongáshoz. Megint mások pedig ellentétes irányból vizsgálva a köztük lévo kapcsolatot, arra a megállapításra jutottak, hogy a szorongás különbözo fiziológiai mechanizmusokon keresztül vezethet cukorbetegséghez. A szorongás és a diabetes közti kapcsolat irányától függetlenül javasolt a depresszió mellett a szorongásnak a szurése és minél korábbi kezelése a cukorbetegek körében, így csökkennének a komorbiditásból származó szövodmények, a kezelési nehézségek, javulna a betegek életminosége és a terápiával való együttmuködésük. Orv Hetil. 2021; 162(31): 1226-1232. Summary. The relationship between diabetes and depression has been evaluated in numerous studies. The association between diabetes and anxiety was less investigated, although the importance of anxiety disorders is underlined by its frequent co-occurrence with diabetes. Diabetes alone carries a significant disease burden for patients. Comorbidity with psychiatric disorders deteriorates the quality of care, therefore early treatment and diagnosis of these conditions are essential. The aim of the present review is to outline the relationship between anxiety and mainly type 2 diabetes. There are several theories to explain the relationship between them. Some researchers suggest that common etiological background may play a role in their co-occurrence, some believe that the diagnosis of diabetes and the burden of self-management lead to anxiety, while others - investigating the relationship from the opposite direction - suggest that anxiety leads to diabetes through physiological mechanisms. Independently of the direction of the relationship, screening for anxiety and timely treatment among diabetic patients may decrease the risk of complications, the difficulty in treatment arising from the co-occurrence of these two conditions and may improve patients' quality of life and adherence to therapy. Orv Hetil. 2021; 162(31): 1226-1232.

[Co-occurrence of diabetes and depression, their potential bidirectional association and the significance of their screening]. / A diabetes és a depresszió együttes elofordulása, lehetséges kétirányú kapcsolata és szurésük jelentosége.

Diabetes and depression are considered global epidemics. Both have multifactorial aetiologies, including external, environmental factors and internal factors in connection with physiological processes as well as genetic variants triggering disease onset. Although the co-occurrence of diabetes and depression is well described, the mechanisms underlying these diseases and their interactions are still not entirely revealed. The authors aimed to present known and potential explanations of the co-occurrence of these diseases and to highlight the importance of their timely diagnosis and effective treatment, as their co-occurrence may increase morbidity and mortality. Screening for depression among diabetes patients and for diabetes among patients with depression may decrease the incidence of complications and consequences of this comorbidity and may foster more effective treatment. General practitioners play a key role in the care of both diseases by providing timely diagnosis and adequate treatment potentially leading to a better quality of life, slower disease progression and decreased risk of complications. Orv Hetil. 2019; 160(21): 807-814.