International students' perceived quality of university health centre services: an exploratory sequential mixed methods study.

AIM: This study aims to investigate international students' perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. BACKGROUND: International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students' requirements, including healthcare services, is essential. METHODS: A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students' perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students' perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. FINDINGS: The qualitative strand revealed five major themes representing the study participants' thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students' socio-demographic characteristics.

Understanding International Students' Perspective of Health Service Quality: A Cross-Sectional Study in a Hungarian University.

Purpose: Understanding patient's preferences is important to delivering good quality services. Patients' feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students' requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student's point of view to be used to improve the quality of services. Methods: This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis. Results: 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor's highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified. Conclusion: The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.

Exploration of the Hungarian Version of Test Your Memory in General Practice: A Cross-Sectional Correlational Study of a Convenience Sample of Middle-Aged and Older Adults.

BACKGROUND: Dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners (GPs) may be the first to notice the cognitive deficit; therefore, it is crucial for them to have access to a screening test that can be administered quickly and efficiently. We explored the Hungarian version of the Test Your Memory self-administered dementia screening test in general practice for the early detection of dementia and cognitive impairment. METHODS: In the four Hungarian cities with medical universities, 368 patients over the age of 50 attending GPs filled out the questionnaire within the framework of our cross-sectional study. RESULTS: The total scores of the test showed a significant correlation with education and type of occupation and a significant negative correlation with age. The results of this research showed that the clock drawing and recall subtest scores deteriorate at the earliest age. CONCLUSION: The test can be filled out in a GP's office easily and two of its subtests can raise the possibility that patients may need further assessment, especially if they have symptoms, at an earlier age than the other subtests.

Lifestyle Medicine in Focus: A Cross-Sectional Study Comparing Domestic and International Students.

This study investigated lifestyle factors among Hungarian and international students, utilizing lifestyle medicine principles to enhance overall well-being. Conducted at the University of Debrecen through a cross-sectional survey, we examined selected lifestyle factors, more specifically sleep patterns, weight management, nutrition, physical activity, mental well-being, and alcohol use. Hungarian (N = 122) and international (N = 139) students were compared, revealing significant differences. Hungarian students slept less (p = 0.041), desired weight loss (p = 0.040), ate more fruits and vegetables (p = 0.014), exercised longer (p = 0.002), and reported higher purpose and social support (p = 0.009), with higher alcohol use (p < 0.001). These findings highlight distinct experiences and challenges faced by these student groups including variations in sleep, weight management, diet, exercise, and social support. Targeted interventions and tailored support are essential to address their specific needs. To promote the well-being of both Hungarian and international students, educational programs addressing various facets of a healthy lifestyle are crucial. This study offers valuable insights into lifestyle factors and health outcomes among Hungarian and international students and underscores the importance of addressing the unique needs of each group through tailored interventions.

Novel Therapeutic Approaches for the Management of Elevated Lipoprotein(a): From Traditional Agents to Future Treatment Options.

Cardiovascular disease is the leading cause of mortality worldwide. Despite the availability of effective low-density lipoprotein cholesterol (LDL-C) lowering agents, an increased cardiovascular risk is still observed in individuals with therapeutic LDL-C levels. One of these cardiovascular risk factors is elevated plasma lipoprotein(a) (Lp(a)) concentration, which maintains chronic inflammation through the increased presence of oxidized phospholipids on its surface. In addition, due to its 90 percent homology with the fibrinolytic proenzyme plasminogen, Lp(a) exhibits atherothrombotic effects. These may also contribute to the increased cardiovascular risk in individuals with high Lp(a) levels that previous epidemiological studies have shown to exist independently of LDL-C and other lipid parameters. In this review, the authors overview the novel therapeutic options to achieve effective Lp(a) lowering treatment, which may help to define tailored personalized medicine and reduce the residual cardiovascular risk in high-risk patients. Agents that increase LDL receptor expression, including statins, proprotein convertase subtilisin kexin type 9 inhibitors, and LDL production inhibitors, are also discussed. Other treatment options, e.g., cholesterolester transfer protein inhibitors, nicotinic acid derivatives, thyroid hormone mimetics, lipoprotein apheresis, as well as apolipoprotein(a) reducing antisense oligonucleotides and small interfering RNAs, are also evaluated.

Psychological Distress and Food Insecurity among International Students at a Hungarian University: A Post-Pandemic Survey.

The aim of the present study was two-fold: Firstly, to estimate the prevalence of psychological distress among international students at a Hungarian university two years after the COVID-19 outbreak; and secondly, to identify its demographic and socioeconomic factors, with special regard to the students' food-security status. A cross-sectional study using a self-administered questionnaire was carried out from 27 March to 3 July 2022 among international students at the University of Debrecen. The questionnaire included information on demographic and socioeconomic characteristics, food-security status (six-item United States Department of Agriculture Food Security Survey Module (USDA-FSSM)), and psychological distress (Depression, Anxiety and Stress Scale (DASS-21)). Bivariate analysis was conducted to examine the potential associations between demographic/socioeconomic factors and psychological distress. Additionally, multiple logistic regression was employed to further analyze these associations. Of 398 participants, 42.2%, 48.7%, and 29.4% reported mild to extremely severe depression, anxiety, and stress, respectively. The ages 18-24 (AOR = 2.619; 95% CI: 1.206-5.689) and 25-29 (AOR = 2.663; 95% CI: 1.159-6.119), reporting a low perception of health status (AOR = 1.726; 95% CI: 1.081-2.755), and being food insecure (AOR = 1.984; 95% CI: 1.274-3.090) were significantly associated with depressive symptoms. Being female (AOR = 1.674; 95% CI: 1.090-2.571), reporting a low perception of health status (AOR = 1.736; 95% CI: 1.098-2.744), and being food insecure (AOR = 2.047; 95% CI: 1.327-3.157) were significantly associated with anxiety symptoms. Furthermore, being female (AOR = 1.702; 95% CI: 1.026-2.824)), living with roommates (AOR = 1.977; 95% CI: 1.075-3.635), reporting a low perception of health status (AOR = 2.840; 95% CI: 1.678-4.807), and being food insecure (AOR = 2.295; 95% CI:1.398-3.767) were significantly associated with symptoms of stress. Psychosocial programs combined with strategies to alleviate food insecurity are required to enhance international students' mental health and well-being.

Effects of Health Anxiety, Social Support, and Coping on Dissociation with Mediating Role of Perceived Stress during the COVID-19 Pandemic.

BACKGROUND: Our study aimed to examine whether health anxiety, social support, and ways of coping relate to dissociation directly or only through the mediation of perceived stress, moderated by the time of measurement (lockdown). We investigated the effect of perceived stress on different forms (sub-scales) of dissociation. METHODS: A cross-sectional survey was conducted by an online form at two points in time: the beginning and the later stage of the COVID-19 pandemic. RESULTS: We received a total of 1711 responses. Perceived stress moderately correlated with dissociation in both international and Hungarian samples. Health anxiety showed a strong direct and indirect correlation with dissociation. Regarding social support, the support of family significantly decreased the dissociative experiences in the Hungarian sample mediated by perceived and direct stress. In the international sample, goal-oriented coping strategies strongly decreased all dissociation scales in the first measurement, through the mediation of perceived stress. As for the Hungarian sample, positive thinking was found to decrease dissociation by decreasing perceived stress. CONCLUSION: health anxiety, coping, and social support appeared to influence dissociation directly and through the mediation of perceived stress. Social support, mainly support of the family and problem-focused coping strategies may decrease the level of stress, this way decreasing dissociative behavior.

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.

The Effects and Differences of Social Support, Depression, and Vital Exhaustion during the COVID-19 Pandemic among International and Domestic University Students.

BACKGROUND: Our study aimed to assess the differences between domestic and international students in terms of social support, vital exhaustion, and depression during the period of COVID-19 and to examine the relationships and potential effects of these factors on each other. METHODS: The online cross-sectional survey was conducted via Google Forms® at three time intervals during the pandemic. RESULTS: Here, 1320, 246, and 139 students completed our questionnaires in the different time intervals. The international students reported significantly lower values in terms of perceived social support. Concerning depression, the international female students reported higher values than the domestic female students. Significant correlations were found in both samples between vital exhaustion and depression, as well as between perceived social support and depression. CONCLUSION: In this study, the international students reported lower levels of perceived social support and higher levels of depression, particularly among females. The correlations between depression, social support, and vital exhaustion might highlight protective and risk factors. These findings emphasize the importance of addressing social support and mental health among university students, especially among international students who have a difficult time finding social support during times of stress, such as during the COVID-19 pandemic.

Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan.

BACKGROUND: The relationship between smoking and coronavirus disease-2019 (COVID-19) is still topical with mixed epidemiological evidence. However, the pandemic may affect people's beliefs toward smoking as well as their smoking behavior and quit intentions. Considering high smoking rates in Jordan, our current study aimed to assess the following domains in a community-based sample from Jordan: (i) the beliefs that surround smoking/vaping and COVID-19 and (ii) the pandemic impact on smoking behavior and quit intention. METHODS: A cross-sectional study was conducted in Jordan from March 9 to March 16, 2021, utilizing a web-based structured questionnaire. The questionnaire comprised 13 items on sociodemographic, health, and smoking profiles, 14 items to assess beliefs surrounding COVID-19 and the use of combustible cigarettes (CCs), waterpipe (WP), and electronic cigarettes (ECs), and 12 items to assess the pandemic impact on smoking behavior and quit intention. RESULTS: Of 2424 survey respondents who participated in our study, there were 1163 never-smokers, 1044 current smokers, and 217 ex-smokers. The mean age of participants was 35.2 years (SD: 11.06). Most participants have reported anti-smoking beliefs with around 72.9% believed that WP smoking is related to the risk of contracting COVID-19. Also, 71.7% believed that smoking CC may worsen the COVID-19 clinical course, while 74.1% of respondents believed that smoking has no protective effect against COVID-19. During the pandemic, about 28.1% and 19.3% of current smokers reported increased or reduced smoking, respectively. Besides, 459 current smokers have expressed their plans/intention to quit smoking during the pandemic, of whom 27.5% (n = 126) confirmed that the driving force for their decision is a COVID-19-related reason, such as self-protection (n = 123) and protection of family members (n = 121) which were the most cited reasons. Also, around 63 participants have successfully ceased smoking during the pandemic. However, only 22 of them reported that the main driving motivation of their successful quit attempt was the COVID-19 pandemic. CONCLUSION: Most participants' beliefs and attitudes were against smoking during the pandemic. Nevertheless, the double-edged effect of the pandemic on smoking habits should be carefully considered, and reliable anti-smoking measures should be strengthened and sustained in the country.

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.

Predicting the epidemic curve of the coronavirus (SARS-CoV-2) disease (COVID-19) using artificial intelligence: An application on the first and second waves.

OBJECTIVES: The COVID-19 pandemic is considered a major threat to global public health. The aim of our study was to use the official epidemiological data to forecast the epidemic curves (daily new cases) of the COVID-19 using Artificial Intelligence (AI)-based Recurrent Neural Networks (RNNs), then to compare and validate the predicted models with the observed data. METHODS: We used publicly available datasets from the World Health Organization and Johns Hopkins University to create a training dataset, then we employed RNNs with gated recurring units (Long Short-Term Memory - LSTM units) to create two prediction models. Our proposed approach considers an ensemble-based system, which is realized by interconnecting several neural networks. To achieve the appropriate diversity, we froze some network layers that control the way how the model parameters are updated. In addition, we could provide country-specific predictions by transfer learning, and with extra feature injections from governmental constraints, better predictions in the longer term are achieved. We have calculated the Root Mean Squared Logarithmic Error (RMSLE), Root Mean Square Error (RMSE), and Mean Absolute Percentage Error (MAPE) to thoroughly compare our model predictions with the observed data. RESULTS: We reported the predicted curves for France, Germany, Hungary, Italy, Spain, the United Kingdom, and the United States of America. The result of our study underscores that the COVID-19 pandemic is a propagated source epidemic, therefore repeated peaks on the epidemic curve are to be anticipated. Besides, the errors between the predicted and validated data and trends seem to be low. CONCLUSION: Our proposed model has shown satisfactory accuracy in predicting the new cases of COVID-19 in certain contexts. The influence of this pandemic is significant worldwide and has already impacted most life domains. Decision-makers must be aware, that even if strict public health measures are executed and sustained, future peaks of infections are possible. The AI-based models are useful tools for forecasting epidemics as these models can be recalculated according to the newly observed data to get a more precise forecasting.

Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study.

BACKGROUND: Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system. METHODS: The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data. FINDINGS: Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.

Expectations, values, preferences and experiences of Hungarian primary care population when accessing services: Evaluation of the patient's questionnaires of the international QUALICOPC study.

BACKGROUND: Preferences and wishes of patients is an important indicator of primary health care provision, although there are differences between national primary care systems. AIM: The aim of this paper is to describe and evaluate the preferences and values of Hungarian primary care (PC) patients before accessing and to analyse their experiences after attending PC services. METHODS: In the Hungarian arm of the European QUALICOPC Study, in 2013-2014, information was collected with questionnaires; the Patient Values contained 19 and the Patient Experiences had 41 multiple-choice questions. FINDINGS: The questionnaires were filled by 2149 (840 men, 1309 women) using PC services, aged 49.1 (SD ± 16.7) years, 73% of them having chronic morbidities. Women preferred to be accompanied and rated their own health better. Patients in the lowest educational category and women visited their GPs more often, and they are consulted more frequently by other doctors as well. Men, older and secondary educated people reported more frequently chronic morbidities. Longer opening hours were preferred by patients with higher education. The most preferred expectations were availability and polite communication of doctors, not pressures on consultation time, clear instructions provided during consultations, shared decisions about treatments and options for consultations, the knowledge of the doctors concerning the living conditions, social and cultural backgrounds of patients, updated medical records, short waiting times, options for home visits, wide scope of professional competences and trust in the doctor. CONCLUSION: Wishes, preferences of patients and fulfilment were similar than described in other participating countries of the study. Although there are room to improve PC services, most of the questioned population were satisfied with the provision.

Health anxiety, perceived stress, and coping styles in the shadow of the COVID-19.

BACKGROUND: In the case of people who carry an increased number of anxiety traits and maladaptive coping strategies, psychosocial stressors may further increase the level of perceived stress they experience. In our research study, we aimed to examine the levels of perceived stress and health anxiety as well as coping styles among university students amid the COVID-19 pandemic. METHODS: A cross-sectional study was conducted using an online-based survey at the University of Debrecen during the official lockdown in Hungary when dormitories were closed, and teaching was conducted remotely. Our questionnaire solicited data using three assessment tools, namely, the Perceived Stress Scale (PSS), the Ways of Coping Questionnaire (WCQ), and the Short Health Anxiety Inventory (SHAI). RESULTS: A total of 1320 students have participated in our study and 31 non-eligible responses were excluded. Among the remaining 1289 participants, 948 (73.5%) and 341 (26.5%) were Hungarian and international students, respectively. Female students predominated the overall sample with 920 participants (71.4%). In general, there was a statistically significant positive relationship between perceived stress and health anxiety. Health anxiety and perceived stress levels were significantly higher among international students compared to domestic ones. Regarding coping, wishful thinking was associated with higher levels of stress and anxiety among international students, while being a goal-oriented person acted the opposite way. Among the domestic students, cognitive restructuring as a coping strategy was associated with lower levels of stress and anxiety. Concerning health anxiety, female students (domestic and international) had significantly higher levels of health anxiety compared to males. Moreover, female students had significantly higher levels of perceived stress compared to males in the international group, however, there was no significant difference in perceived stress between males and females in the domestic group. CONCLUSION: The elevated perceived stress levels during major life events can be further deepened by disengagement from home (being away/abroad from country or family) and by using inadequate coping strategies. By following and adhering to the international recommendations, adopting proper coping methods, and equipping oneself with the required coping and stress management skills, the associated high levels of perceived stress and anxiety could be mitigated.

The use of the Hungarian Test Your Memory (TYM-HUN), MMSE, and ADAS-Cog tests for patients with mild cognitive impairment (MCI) in a Hungarian population: a cross-sectional study.

BACKGROUND: Mild cognitive impairment (MCI) often presages the development of Alzheimer's disease (AD). Accurate and early identification of cognitive impairment will substantially reduce the burden on the family and alleviate the costs for the whole society. There is a need for testing methods that are easy to perform even in a general practitioner's office, inexpensive and non-invasive, which could help the early recognition of mental decline. We have selected the Test Your Memory (TYM), which has proven to be reliable for detecting AD and MCI in several countries. Our study was designed to test the usability of the Hungarian version of the TYM (TYM-HUN) comparing with the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in MCI recognition in the Hungarian population. METHODS: TYM test was translated and validated into Hungarian (TYM-HUN) in a previous study. The TYM-HUN test was used in conjunction with and compared with the MMSE and the ADAS-Cog. For our study, 50 subjects were selected: 25 MCI patients and 25 healthy controls (HC). Spearman's rank correlation was used to analyse the correlation between the scores of MMSE and ADAS-Cog with TYM-HUN and the receiver operating characteristic (ROC) curve was established. RESULTS: MCI can be distinguished from normal aging using TYM-HUN. We established a 'cut-off' point of TYM-HUN (44/45points) where optimal sensitivity (80%) and specificity (96%) values were obtained to screen MCI. The total TYM-HUN scores significantly correlated with the MMSE scores (ρ = 0.626; p < 0.001) and ADAS-Cog scores (ρ = - 0.723; p < 0.001). CONCLUSIONS: Our results showed that the TYM-HUN is a reliable, fast, self-administered questionnaire with the right low threshold regarding MCI and can be used for the early diagnosis of cognitive impairment.

Acute stroke awareness of family physicians: translation of policy to practice.

BACKGROUND: Translating clinical guidelines into routine clinical practice is mandatory to achieve population level improvement of health. Emergence of specific therapy for acute stroke yielded the 'time is brain' concept introducing the need for emergency treatment, pointing to the need for increasing stroke awareness of the general population. General practitioners (GPs) manage chronic diseases and could hence catalyse stroke awareness. In our study, the knowledge of general practitioners toward accurate identification of acute stroke candidacy was investigated. METHODS: GPs and residents in training for family medicine participated in a survey on a voluntary basis using supervised self-administration between the 1st of February 2018 and 31st July 2018. Two clinical cases of acute stroke that differed only regarding the patient's eligibility for intravenous thrombolysis were presented. Participants answered two open-ended questions. Text analysis was performed using NVIVO software. RESULTS: Of the 127 respondents, 69 (54.3%) were female. The median age was 49 (34-62) years. The median time spent working after graduation was 14.5 (2-22.5) years. Board-certified GPs made up 77.2% of the sample. Qualitative analysis revealed stroke as the most frequent diagnosis for both cases. Territorial localization and possible aetiology were also established. Respondents properly identified eligibility for thrombolysis. Quantitative assessment showed that having the practice closer to the stroke centre increases the likelihood of adequate diagnosis for acute stroke. CONCLUSIONS: Our results show that GPs properly diagnose acute stroke and identify intravenous thrombolysis candidates. Moreover, we found that a vigorous acute stroke triage system facilitates the translation of theory into practice.

Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement.

BACKGROUND: Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. METHODS: Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. RESULTS: There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. CONCLUSIONS: Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.

Do physical activity and screen time mediate the association between European fathers' and their children's weight status? Cross-sectional data from the Feel4Diabetes-study.

BACKGROUND: Most research on parenting and childhood obesity and obesity-related behaviours has focused on mothers while fathers have been underrepresented. Yet, recent literature has suggested that fathers uniquely influence their children's lifestyle behaviours, and hence could also affect their weight status, but this has not yet been scientifically proven. Therefore, the present study aimed to determine whether the association between fathers' weight status and their children's weight status is mediated by fathers' and children's movement behaviours (i.e. physical activity (PA) and screen time (ST)). METHODS: Cross-sectional data of 899 European fathers and their children were analyzed. Fathers/male caregivers (mean age = 43.79 ± 5.92 years, mean BMI = 27.08 ± 3.95) completed a questionnaire assessing their own and their children's (mean age = 8.19 ± 0.99 years, 50.90% boys, mean BMIzscore = 0.44 ± 1.07) movement behaviours. Body Mass Index (BMI, in kg/m2) was calculated based on self-reported (fathers) and objectively measured (children) height and weight. For children, BMI z-scores (SD scores) were calculated to obtain an optimal measure for their weight status. Serial mediation analyses were performed using IBM SPSS 25.0 Statistics for Windows to test whether the association between fathers' BMI and children's BMI is mediated by fathers' PA and children's PA (model 1) and fathers' ST and children's ST (model 2), respectively. RESULTS: The present study showed a (partial) mediation effect of fathers' PA and children's PA (but not father's ST and children's ST) on the association between fathers' BMI and children's BMI (model for PA; coefficient: 0.001, 95% CI: [0.0001, 0.002]; model for ST; coefficient: 0.001, 95% CI: [0.000, 0.002]). Furthermore, fathers' movement behaviours (PA and ST) were positively associated with their children's movement behaviours (PA and ST) (model for PA, coefficient: 0.281, SE: 0.023, p < 0.001; model for ST, coefficient: 0.345, SE: 0.025, p < 0.001). CONCLUSIONS: These findings indicate that the influence of fathers on their children's weight status partially occurs through the association between fathers' PA and children's PA (but not their ST). As such, intervening by focusing on PA of fathers but preferably of both members of the father-child dyad (e.g. engaging fathers and their children in co-PA) might be a novel and potentially effective strategy for interventions aiming to prevent childhood overweight and obesity. Longitudinal studies or intervention studies confirming these findings are however warranted to make meaningful recommendations for health intervention and policy. TRIAL REGISTRATION: The Feel4Diabetes-study is registered with the clinical trials registry http://clinicaltrials.gov , ID: 643708 .

Primary care behind the former "Iron Curtain": changes and development of primary healthcare provision in the Eastern part of the European Union.

BACKGROUND: The Alma-Ata Declaration was a big step in the development of primary care, defining the main tasks and populations' expectation. Celebrating the 40th year's anniversary is a good opportunity to make an analysis. Development of primary care was not parallel in the Eastern and Western part of Europe. AIM: To provide an overview on the societal and economic situation, structural and financial changes of healthcare systems in the former 'Soviet bloc' countries, to present an analysis of the primary healthcare (PHC) provision and to find relationships between economic development and epidemiological changes of the respective countries. METHOD: Epidemiological data, healthcare expenditures and structure, and financing schemes were compared; systematic literature search was performed. RESULTS: Visible improvements in population health, in the national economic condition, structural changes in healthcare and more focus to primary care were experienced everywhere. Higher life expectancies with high inter-country variation were observed in the former 'Soviet bloc' countries, although it could not be clearly linked to the development of healthcare system. PHC provision improved while structural changes were rarely initiated, often only as a project or model initiation. Single-handed practices are yet predominant. The gate-keeping system is usually weak; there were no effective initiatives to improve the education of nurses and to widen their competences. Migrations of workforce to Western countries become a real threat for the Central-East European countries. CONCLUSION: Lack of coordination between practices and interdisciplinary cooperation were recognized as the main barriers for further improvement in the structure.