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.

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.

Association between sociodemographic, obstetric, and lifestyle factors among Hungarian pregnant women-A cross-sectional study.

AIM: To learn the association between sociodemographic and obstetric factors and lifestyle characteristics of pregnant women, and to identify factors that can influence pregnant women's health consciousness. METHODS: A cross-sectional, questionnaire-based study was performed among women who gave birth in Szeged in 2014-2015. Data collection was based on a self-administered questionnaire and health documentations. Overall maternal health promoting behavior (MHPB) index was defined by summarizing the scores obtained from diet, physical activity, smoking status, and alcohol consumption. RESULTS: The final analysis included 1548 mothers; 41.3% (n = 602) of the sample had healthy diet, 9.0% (n = 134) were physically active and attended special pregnancy exercise classes, 84.4% (n = 1279) did not drink alcohol, and 93.5% (n = 1447) were nonsmokers. Regarding the MHPB index, 0.8% (n = 11) of the women reached the maximum score (20), while the average was 14.8 (SD = 2.58). Advanced maternal age (p < 0.001), having a spouse or partner (p < 0.001), higher educational level (p < 0.001), planned pregnancy (p < 0.001), and early visit at pregnancy care (p = 0.046) were significantly associated with higher MHPB index. CONCLUSION: The lifestyle of pregnant women can have a great impact on the developing fetus, either in a positive or negative way. In order to evaluate maternal lifestyle, overall health behavior should be considered. Lifestyle of the included women was not satisfactory, an improvement in health consciousness is needed at every social level; however, the differences between the various social classes may suggest the importance of further promotion and improvement of pregnancy planning and pregnancy care among younger and lower educated women.

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.

[Possibilities of doctor-patient communication - understanding patients' expectations]. / Az orvos­beteg kommunikáció új lehetoségei ­ a betegek elvárásai alapján.

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.

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.

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.

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.

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.

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.

A Study of Vitamin D Status and Its Influencing Factors among Pregnant Women in Szeged, Hungary: A Secondary Outcome of a Case-Control Study.

Adequate vitamin D (VD) intake during pregnancy is needed for fetal development and maternal health maintenance. However, while there is no doubt regarding its importance, there is not a unified recommendation regarding adequate intake. The main aim of our study was to measure the VD serum level of studied women, together with its potential influencing factors: demographic (i.e., age, level of education, relationship status and type of residence), conception and pregnancy related factors. Results are based on secondary data analyses of a retrospective case-control study of 100 preterm and 200 term pregnancies, where case and control groups were analyzed together. Data collection was based on a self-administered questionnaire, health documentation, and maternal serum VD laboratory tests. VD intake was evaluated by diet and dietary supplement consumption. According to our results, 68.1% of women took some kind of prenatal vitamin, and only 25.9% of them knew about its VD content. Only 12.1% of included women reached the optimal, 75 nmol/L serum VD level. Higher maternal serum levels were associated with early pregnancy care visits (p = 0.001), assisted reproductive therapy (p = 0.028) and advice from gynecologists (p = 0.049). A correlation was found between VD intake and serum levels (p < 0.001). Despite the compulsory pregnancy counselling in Hungary, health consciousness, VD intake and serum levels remain below the recommendations. The role of healthcare professionals is crucial during pregnancy regarding micronutrients intake and the appropriate supplementation dose.

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.

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.

[Knowledge and attitudes about vaccinations among medical students during the COVID-19 pandemic]. / A védooltásokkal kapcsolatos ismeretek és attitudök orvostanhallgatók körében a COVID­19-pandémia alatt.

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.

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.

Association of smoking, physical activity, and dietary habits with socioeconomic variables: a cross-sectional study in adults on both sides of the Hungarian-Romanian border.

BACKGROUND: The association between socioeconomic status and health-related behaviours has been clarified in several epidemiological studies. The aim of this study was to reveal the socioeconomic differences in health-related behaviours and in nutritional status of Hungarian and Romanian citizens living on both sides of the border. METHODS: A cross-sectional study based on interviewer-administered questionnaires was conducted on both sides of the Hungarian-Romanian border. The survey was completed by 1, 099 Hungarians (Hu) and 852 Romanians (Ro) aged 18 years and over; the overall participation rate was 92.9%. Demographic and socioeconomic factors, health-related behaviours (smoking, dietary habits and physical activity), body weight and height were recorded. All analyses were performed separately for Hungarians and Romanians. Simple descriptive statistics and logistic regression models were used to measure the associations between socioeconomic status and behaviour, as well as obesity. RESULTS: The prevalence of smoking was similar in Hungarians and Romanians (33.2% and 36.4%). The frequency of "unhealthy diet" was 70.6% in Hungarians and 75.2% in Romanians. Physical inactivity was more prevalent in Romanians (73.2%) than in Hungarians (32.0%), while the prevalence of obesity was higher in Hungarians (22.0%) than in Romanians (16.5%). Based on the univariate logistic regression models the risk of smoking was higher among those with medium educational level (ORHu = 1.66) and poor financial conditions (ORHu = 3.13) in Hungarians. The risk of unhealthy diet was higher among the low educated (ORHu = 1.77; ORRo = 7.91) and among those with poor financial conditions (ORHu = 2.05; ORRo = 4.25). None of the socioeconomic factors was associated with leisure time physical inactivity. In the multivariate models obesity was associated with medium level of education in Hungarians, and with unhealthy diet in Romanians (ORRo = 2.10). Physically inactive Hungarians were more (ORHu = 1.74), whereas inactive Romanians were less (ORRo = 0.64) likely to be obese than physically active people from the same country. CONCLUSIONS: The present study shows that socioeconomic status is associated with health-related behaviours in a small area of Hungary and Romania. The results highlight the need for developing interventional strategies, focusing more on people in lower socioeconomic status, in order to reduce the existing inequalities in health and health-related behaviours.