Tobacco Smoking and Smokeless Tobacco Use among Domestic and International Medical Students in Hungary.

BACKGROUND: Medical students as future physicians will have an important role in tobacco control; therefore, their tobacco use behavior is of particular interest. Consumption of combustible tobacco (cigarettes, waterpipes, cigars, and pipes) is prevalent throughout Europe, whereas smokeless tobacco use is common mainly in the Nordic countries. Objectives: Aim of our study is to assess tobacco use among medical students from different countries studying in Hungary with special focus on students from Norway where smokeless tobacco is widely used. A self-administered questionnaire survey was carried out to measure current tobacco use. Results: The survey included 1337 students from Hungary, Norway, Germany, and from other countries (Multinational group). The lowest prevalence of cigarette smoking was found among students from Norway (13.0%) when compared with students from Hungary (21.5%), Germany (34.2%), or with students in the Multinational group (29.5%). Conversely, prevalence of smokeless tobacco use was the highest among students from Norway (40.9%) when compared with students from Hungary (1.4%), Germany (2.6%), or with students in the Multinational group (6.2%). Waterpipes, cigars, and pipes were rarely used, mostly only 1-3 times a month in all groups. More than half of Norwegian students used some form of tobacco (smokeless and/or combustible tobacco). Conclusions: Considering the impending role of medical students in tobacco control, faculties of medicine should sensitize their students on the topic of possible health risks associated with combustible and smokeless tobacco products. Culturally tailored tobacco cessation programs need to be offered to medical students coming from different cultural backgrounds.

Increasing Prevalence of Electronic Cigarette Use among Medical Students. Repeated Cross-Sectional Multicenter Surveys in Germany and Hungary, 2016-2018.

BACKGROUND: Use of electronic cigarettes (e-cigarettes) is gaining popularity among young adults. Medical students' nicotine use behavior is of particular interest because of their impending role in health promotion. Objectives: Aim of our study is to assess changes that occurred between 2016 and 2018 in the prevalence of e-cigarette use among medical students and to explore associations between e-cigarette use, demographic characteristics, and cigarette smoking. Self-administered questionnaire surveys were used to obtain cross-sectional data of medical students in Budapest and Pécs, Hungary, and Dresden, Germany. Results: Sample sizes for 2016 and 2018 were 2297 and 1514, respectively. In the whole sample, past-30-day use of e-cigarettes increased from 4.5% to 8.0% (p < 0.001). The increase in e-cigarette use was significant in both genders (from 3.6% to 5.6% among females, p = 0.028, and from 5.9 to 11.4% among males, p < 0.001). Prevalence of e-cigarette use was higher among Hungarian students than among German students (2.2% versus 5.7% in 2016, and 4.1% versus 10.5% in 2018, p < 0.05 for both years). There was no significant difference in e-cigarette use among different academic years. The ratio of e-cigarette users increased significantly among current cigarette smokers but not among nonsmokers. We could not detect a decrease in cigarette smoking. Conclusions: Prevalence of e-cigarette use increased significantly among medical students without a reduction in cigarette smoking. Medical schools should add the topic of e-cigarettes to their curricula and need to develop cessation programs to help their students quit both cigarettes and e-cigarettes.

Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary.

BACKGROUND: Tobacco use is the leading preventable cause of death worldwide. Besides cigarette smoking, waterpipe and e-cigarettes are gaining popularity among young adults. Medical students' smoking behavior is of particular interest because of their impending role in health promotion as future physicians. Aim of our study is to examine the prevalence and predictors of cigarette, waterpipe and e-cigarette use and the association of tobacco use with self-reported health status in an international sample of medical students. METHODS: In a multicenter cross-sectional study data on different aspects of health behavior were collected from medical students of 65 nationalities using a self-administered questionnaire in Germany (Dresden, Munich) and Hungary (Budapest, Pécs). The survey was conducted among 1st, 3rd and 5th year students. To explore associations between smoking behavior and socio-cultural factors Pearson's chi2-tests and multivariate binary logistic regression analyses were performed. RESULTS: The largest subpopulations were formed by German (n = 1289), Hungarian (n = 1055) and Norwegian (n = 147) students. Mean age was 22.5 ± 3.3 years. Females represented 61.6% of the sample. In the whole sample prevalence of cigarette smoking was 18.0% (95% CI 16.6-19.4%), prevalence of waterpipe use was 4.8% (95% CI 4.0-5.7%), that of e-cigarette 0.9% (95% CI 0.5-1.2%). More males (22.0%) than females (15.5%) reported cigarette smoking. The lowest prevalence of cigarette smoking was found among Norwegian students (6.2%). Cigarette smokers were older, waterpipe users were younger than non-users. E-cigarette use was not associated with age of the students. Religious involvement was protective only against cigarette smoking. Financial situation showed no association with any kind of tobacco consumption. Cigarette smokers and e-cigarette users were less likely to report very good or excellent health status. CONCLUSIONS: Cigarette smoking is still the most popular way of consuming tobacco, although alternative tobacco use is also prevalent among medical students. To further health consciousness, medical schools should pay more attention to students' health behavior, especially their smoking habits. Tobacco prevention and cessation programs for medical students should consider not only the health risks of cigarette smoking but the need to discourage other forms of tobacco use, such as waterpipe.

Do socio-cultural factors influence medical students' health status and health-promoting behaviors? A cross-sectional multicenter study in Germany and Hungary.

BACKGROUND: Physical and mental health is important for coping with the high requirements of medical studies that are associated with a higher risk for severe stress, insomnia, smoking, harmful alcohol consumption and easier access to drugs. Health behaviors of medical students influence not just their own health but also the health of their future patients. We examined whether socio-cultural factors can explain differences in students' health status and health-promoting behaviors. METHODS: A multicenter cross-sectional survey in Germany (Dresden, Munich) and Hungary (Budapest, Pécs) enclosed international medical students in their 1st, 3rd and 5th academic years. The students were invited to voluntarily and anonymously complete a questionnaire on different aspects of health behavior during obligatory seminars and lectures in 2014. The response rate of the total sample was 56.2 % (n = 2935); the subgroup analysis enclosed data of German (n = 1289), Hungarian (n = 1057) and Norwegian (n = 148) students. RESULTS: A high number of Norwegian students (84.5 %) assessed their health status as very good/excellent. In comparison, only 60.3 % of the Hungarian and 70.7 % of the German participants reported a very good/excellent health status. The distributions were comparable between the study sites. Although gender, financial situation and nationality were significant health status predictors, they could explain only 8.2 % of the total variance of health status in the multivariable model. A comparably high number of Hungarian students (95.3 % vs. 67.4 % German and 56.7 % Norwegian) reported that they can currently do a lot/very much for their health. In contrast, a significant number of Norwegians (73.0 % vs. 63.7 % Hungarian and 51.5 % German) reported that they currently do a lot/very much for their health (chi(2)-test, p ≤ 0.001). Financial situation, study site and study year were the strongest predictors for health promotion activities (Nagelkerkes R(2) = 0.06). CONCLUSIONS: Based on our study, gender and study year played only a minor role in the health status and health promotion beliefs and activities of medical students. Structural (study site) and somewhat socio-cultural factors (nationality, financial situation) mainly explained the differences regarding health promoting behaviors. Obligatory, free-of-charge courses for health promotion (activity and relaxation) should be included in study curriculums.

Screen time and sleep among medical students in Germany.

Medical students are a vulnerable group for harmful health behaviours due to academic stress. Increased screen time is associated with adverse health behaviour, particularly delayed bedtime, shorter sleep duration and poorer sleep quality. This possible relationship has not yet been examined among medical students in Europe. Medical students at the Technical University of Dresden were invited to participate in an online questionnaire based cross-sectional study. To analyse correlations between screen time and sleep parameters, correlation coefficients, linear regression and mixed-model analysis were calculated. 415 students (average age 24 years, 70% female) were included in the analysis. The students reported an average of 7 h screen time per day and 7.25 h sleep duration per night. Approximately 23% (n = 97) reported sleeping less than 7 h per night and 25% (n = 105) reported fairly to very poor sleep quality. Students who reported more screen time for leisure went to bed significantly later (r = 0.213, p < 0.001). Students who spent more screen time for study/work tended to sleep shorter (r = - 0.108, p < 0.015). There was no significant association between screen time and sleep quality (p = 0.103). The results show a need for educational interventions to promote healthy sleep behaviour and to limit screen time.

Developing intercultural competences for more effective patient care and international medical and research collaborations / Interkulturális kompetenciák fejlesztése a hatékonyabb betegellátás és a nemzetközi gyógyító és kutatói együttmuködések érdekében

Introduction: In our globalised world, the role of intercultural competence in healthcare is increasing as societies become multicultural. The development of this competence should start in medical education. Objective: In our qualitative study among Hungarian medical students, we sought to find out to what extent the multicultural student composition of our elective course contributes to the development of their intercultural competence. Method: In our action research, semistructured focus group interviews were conducted with 35 Hungarian medical students between April and November, 2021. The transcripts of the digitally recorded interviews were evaluated using qualitative methods. Results: After a thematic analysis of the interviews, the vast majority of the students' opinions could be classified into one of the following four thematic categories: 1) the benefits of studying together with international students, 2) the development of cultural awareness, 3) the development of an open mindset, and 4) the expected longterm impact of intercultural competence on medical work. Overall, Hungarian students evaluated their learning in the multicultural course positively. Based on the results of the focus group interviews, it can be claimed that by the end of the semester, the Hungarian students' perceived intercultural competence had improved due to the course and its multicultural composition. Conclusion: The course, with its multicultural student population, can contribute to and promote the acquisition of intercultural competence, which in the long run can be effectively used by future doctors both in patient care and in effective communication within healthcare teams as well as in international medical, research and scientific collaborations. Providing a multicultural student environment in the classroom, including interactive teaching methodologies and intercultural project work, have many potentials to make the learning-teaching process more effective and could be applied in the future when developing new courses.

Accepting cultural differences in the integration of foreign medical students / Kulturális különbözoségek elfogadása a külföldi orvostanhallgatók beilleszkedésében.

Összefoglaló. Bevezetés: A 21. századra a multikulturális társadalmi közegben az interkulturális tudás, mint készség, fokozott mértékben válik kulcskompetenciává. E társadalmi kompetencia elsajátításának egyik lehetséges területe a nemzetközi hallgatói mobilitás, mely világszerte, így hazánkban is, egyre nagyobb jelentoségu. Célkituzés: Magyar és külföldi hallgatók körében folytatott vizsgálatunk fókuszában a beilleszkedési folyamatoknak, valamint az interkulturális kompetencia és érzékenység kialakulásának és fejlodésének vizsgálata állt, a Pécsre érkezo mintegy 60 különbözo kultúra, valamint a magyar befogadó közeg vonatkozásában egyaránt. Kutatásunk során többek között arra kerestünk választ, hogy az eredeti és a befogadó kultúra közötti különbségek mely területeken nyilvánulnak meg a leginkább, illetve egy másik kultúrához történo alkalmazkodás során milyen beilleszkedést lassító vagy támogató tényezok tárhatók fel. Módszer: Kutatásunkban kvantitatív és kvalitatív módszereket alkalmaztunk, önkitöltéses kérdoíves felmérés, valamint fókuszcsoportos interjúk formájában. A PTE ÁOK német, angol és magyar nyelvu általánosorvos-képzésében részt vevo hallgatókat a 2010 és 2018 közötti idoszak tavaszi szemesztereiben saját fejlesztésu, anonim, önkéntesen kitöltheto kérdoívvel kerestük meg (a kitöltött kérdoívek száma: n = 13 084 kérdoív). A kérdoíveket három tanévben hét, félig strukturált fókuszcsoportos interjúval egészítettük ki (n = 92 fo). Eredmények: A hazánkba érkezo külföldi orvostanhallgatók számára a befogadó közeghez való alkalmazkodást tekintve a kapcsolódás elsosorban a szocializációs, nyelvi, kommunikációs különbségek miatt bizonyult kihívásnak. Megállapítható azonban, hogy a képzési ido elorehaladtával a különbözoségekbol fakadó nehézségek csökkentek, így a hallgatók egyre inkább képessé váltak az etnorelatív irányba történo elmozdulásra, valamint a multikulturális közeg pozitív aspektusainak értékelésére. Következtetések: A multikulturális környezetben folytatott tanulmányok alatt a kultúraközi kapcsolódási pontok és együttmuködések kialakulása és fejlodése lehetové teszi és támogatja az interkulturális kompetencia elsajátítását, annak minden résztvevoje számára, akár az egyetemi képzésen túlmutatóan, a késobbi orvosi pályát tekintve is. Orv Hetil. 2021; 162(25): 978-987. INTRODUCTION: In the increasingly multicultural social environment of the 21st century, intercultural knowledge as a social skill is gradually becoming a key competence. One of the possible areas of acquiring this competence is international student mobility, which is of increasing importance worldwide, including Hungary. OBJECTIVE: The focus of our study was to examine integration processes and the development and improvement of intercultural competence and sensitivity among Hungarian and international students, both in relation to the approximately 60 different cultures arriving in Pécs and in relation to the Hungarian host environment. In the course of our research, we sought - among other factors - areas, in which the differences between the original and the host culture are the most prominent, and we aimed at identifying those factors that are slowing down or supporting the integration during the adaptation period to another culture. METHOD: In our research, we used both quantitative and qualitative methods, in the form of a self-administered questionnaire and focus group interviews. General medical students of the University of Pécs studying in the German-, English- and Hungarian-language programmes participated in the survey during the spring semesters of the academic years between 2010 and 2018. We used our self-developed questionnaires (number of completed questionnaires: n = 13 084), which were filled in on a voluntary basis and anonymity was ensured. The questionnaires were supplemented with seven semi-structured focus group interviews over three academic years (n = 92 students). RESULTS: Regarding the adaptation to the host environment of foreign medical students studying in Hungary, relationship building arising from socialization, language and communication differences, proved to be a challenge. However, it can be stated that as the training time progressed, the difficulties arising from the differences decreased, so that the students gradually became more able to move towards an ethno-relative direction and evaluated the positive aspects of the multicultural environment. CONCLUSION: During studies in a multicultural university environment, the emergence and development of intercultural connections and collaborations enable and support the acquisition of intercultural competence for all of the students, which will be of great benefit for them, even beyond the university, in their future medical career. Orv Hetil. 2021; 162(25): 978-987.

Prejudices and their healthcare implications. Lessons learnt from a national survey. / [Eloítéletek és hatásaik az egészségügyi ellátásban. Egy felmérés tanulságai].

Introduction: The presence and recognition of prejudice during care were examined among healthcare professionals towards the Roma population, the largest ethnic minority in Hungary. Aim: The aim of this study was to explore the extent to which prejudice in the Hungarian healthcare system might affect the quality of care and, thereby, the health of the Roma patients. Method: Semi-structured interviews were conducted between June 2017 and May 2018 with 13 interviewees. Qualitative methods were applied to analyse the transcripts. Results: Our respondents generally confirmed the presence of prejudices in the healthcare system. Prejudicial attitudes and discriminatory behaviour are less common in wards where the prevalence of disadvantaged patients (HIV-positive, homeless) is high (e.g., infectology). Prejudice is not specifically directed at the Roma ethnic minority, but also extends to populations living under poor socio-economic conditions, or with underlying self-destructive behaviour (alcoholism, drug use). In the opinion of our interviewees, occasional prejudicial behaviour does not lead to sub-standard care, but, on the contrary, to positive discrimination. Prejudice does not directly lead to poorer health, but it cannot be ruled out that it may indirectly contribute to it, in the case if the patient does not seek medical attention due to a former negative experience within healthcare. Conclusion: Our results confirmed the occasional presence of prejudice against the Romas in the healthcare system, however, this may not directly contribute to Romas' poorer health status. Our results also highlighted the importance of prevention, including the education of both parties and the prevention of the burnout of care providers. Orv Hetil. 2020; 161(19): 789-796.