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.

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.

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.

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.

Patient-related factors, antibiotic prescribing and antimicrobial resistance of the commensal Staphylococcus aureus and Streptococcus pneumoniae in a healthy population - Hungarian results of the APRES study.

BACKGROUND: Antimicrobial resistance (AMR) is an increasing public health problem worldwide. We studied some patient-related factors that might influence the antimicrobial resistance. and whether the volume of antibiotic prescribing of the primary care physicians correlate with the antibiotic resistance rates of commensal nasal Staphylococcus aureus and Streptococcus pneumoniae. METHODS: The socio-demographic questionnaires, the antibiotic prescription and resistance data of commensal nasal S. aureus and S. pneumoniae were collected in the 20 participating Hungarian practices of the APRES study. Multivariate logistic regression analyses were performed on the patient-related data and the antimicrobial resistance of the S. aureus and S. pneumoniae on individual, patient level. Ecological analyses were performed with Spearman's rank correlations at practice level, the analyses were performed in the whole sample (all practices) and in the cohorts of primary care practices taking care of adults (adult practices) or children (paediatric practices). RESULTS: According to the multivariate model, age of the patients significantly influenced the antimicrobial resistance of the S. aureus (OR = 0.42, p = 0.004) and S. pneumoniae (OR = 0.89, p < 0.001). Living with children significantly increased the AMR of the S. pneumoniae (OR = 1.23, p = 0.019). In the cohorts of adult or paediatric practices, neither the age nor other variables influenced the AMR of the S. aureus and S. pneumoniae. At practice level, the prescribed volume of penicillins significantly correlated with the resistance rates of the S. aureus isolates to penicillin (rho = 0.57, p = 0.008). The volume of prescribed macrolides, lincosamides showed positive significant correlations with the S. pneumoniae resistance rates to clarithromycin and/or clindamycin in all practices (rho = 0.76, p = 0.001) and in the adult practices (rho = 0.63, p = 0.021). CONCLUSIONS: The age is an important influencing factor of antimicrobial resistance. The results also suggest that there may be an association between the antibiotic prescribing of the primary care providers and the antibiotic resistance of the commensal S. aureus and S. pneumoniae. The role of the primary care physicians in the appropriate antibiotic prescribing is very important to avoid the antibiotic resistance.

Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants.

BACKGROUND: The ongoing refugee crisis has revealed the need for enhancing primary health care (PHC) professionals' skills and training. OBJECTIVES: The aim was to strengthen PHC professionals in European countries in the provision of high-quality care for refugees and migrants by offering a concise modular training that was based on the needs of the refugees and PHC professionals as shown by prior research in the EUR-HUMAN project. METHODS: We developed, piloted, and evaluated an online capacity building course of 8 stand-alone modules containing information about acute health issues of refugees, legal issues, provider-patient communication and cultural aspects of health and illness, mental health, sexual and reproductive health, child health, chronic diseases, health promotion, and prevention. The English course template was translated into seven languages and adapted to the local contexts of six countries. Pre- and post-completion knowledge tests were administered to effectively assess the progress and knowledge increase of participants so as to issue CME certificates. An online evaluation survey post completion was used to assess the acceptability and practicability of the course from the participant perspective. These data were analyzed descriptively. RESULTS: A total of 390 participants registered for the online course in 6 countries with 175 completing all modules of the course, 47.7 % of them medical doctors. The mean time for completion was 10.77 hours. In total, 123 participants completed the online evaluation survey; the modules on acute health needs, legal issues (both 44.1%), and provider-patient communication/cultural issues (52.9%) were found particularly important for the daily practice. A majority expressed a will to promote the online course among their peers. CONCLUSION: This course is a promising learning tool for PHC professionals and when relevant supportive conditions are met. The course has the potential to empower PHC professionals in their work with refugees and other migrants.

[Primary care of refugees and migrants. Lesson learnt from the EUR-HUMAN project]. / Menekültek, migránsok az alapellátásban. Mit tanulhattunk az EUR-HUMAN projekt eredményeibol?

In 2015, local wars, starvation and misery in some Middle Eastern, Asian and African countries forced millions of people to leave their homelands. Many of these people migrated toward Europe, reaching Hungary as well. The refugee crisis created significant challenges for all national healthcare systems across Europe. Limited attention has been given to the extent to which health service provision for refugees and migrants has become a task for primary health care (PHC), which has been unprepared as a profession and pressured by the enormous workload. Hungarian primary care was involved only to an extent in the refugees' health care, as most of the migrants entering Hungary wanted to move forward to other countries. The need for evidence-based patient-centred interventions to assess refugee healthcare needs, and for training programmes for rapid capacity-building for integrated PHC was addressed by the EUropean Refugees - HUman Movement and Advisory Network (EUR-HUMAN) project, which 7 European countries developed together. The overall aim of the EUR-HUMAN project is to enhance the knowledge and expertise of European member states who accept refugees and migrants in addressing their health needs, safeguarding them from risks, while at the same time to minimize cross-border health risks. This initiative focuses on addressing the early arrival period, transition and longer-term settlement of refugees in European host countries. A primary objective of this project is to identify, design and assess interventions to improve PHC delivery for refugees and migrants with a focus on vulnerable groups. The structure, the main focus and outputs of the project are described and summarized in this paper, providing relevant information and access to educational materials for Hungarian (primary care) physicians. The EUR-HUMAN project was operated in 2016 under the auspices of the European Commission and funded by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). Orv Hetil. 2018; 159(35): 1414-1422.

Validation of the Hungarian version of the Test Your Memory.

Concerns regarding the projected prevalence of Alzheimer's disease (AD) over the next several decades have stimulated a need for the detection of AD in its earliest stages. A self-administered cognitive test (Test Your Memory, TYM) is designed as a short, cognitive screening tool for the detection of AD. Our aim was to validate the Hungarian version of the Test Your Memory (TYM-HUN) test for the detection of AD. The TYM-HUN was applied in case of individuals aged 60 years or more, 50 patients with AD and 50 healthy controls were recruited into the study. We compared the diagnostic utility of the Hungarian version of the TYM in AD with that of the Mini-Mental State Examination (MMSE). The sensitivity and specificity of the TYM-HUN in the detection of Alzheimer's disease were determined. The patients with AD scored an average of 15.5/30 on the MMSE and 20.3/50 on the TYM-HUN. The average score achieved by the members of the healthy control group was 27.3/30 on the MMSE and 42.7/50 on the TYM. The total TYM-HUN scores significantly correlated with the MMSE scores (Spearman's rho, r=0.8830; p<0.001). Multivariate logistic regression model demonstrated that a one-point increase in the TYM score reduced the probability of having AD by 36%. The optimal cut-off score on the TYM-HUN was 35/36 along with 94% sensitivity and 94% specificity for the detection of AD. The TYM has a much wider scoring range than the MMSE and is also a suitable screening tool for memory problems, furthermore, it fulfils the requirements of being a short cognitive test for the non-specialists. The TYM-HUN is useful for the detection of Alzheimer's disease and can be applied as a screening test in Hungarian memory clinics as well as in primary care settings.

[Evaluation of the quality of performance of general practitioners. What is the problem with primary care quality indicators in Hungary?]. / A háziorvosok teljesítményének minoségi értékelése. Mi a probléma a háziorvosi indikátorokkal?

The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary.

Do family physicians need more payment for working better? Financial incentives in primary care.

INTRODUCTION: Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. OBJECTIVE: Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. METHODS: Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. RESULTS: Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. CONCLUSIONS: The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well.

Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians.

BACKGROUND: Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. METHODS: The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. RESULTS: The knowledge about multimorbidity, a main consequence of obesity was balanced.Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue.There were wider differences regarding attitudes and practice, influenced by the the doctors' age, gender, known BMI, previous qualification, less by working location.GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients' waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors.Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for patients significantly more frequently (65% vs 52%). Most of the younger doctors agreed that obesity management was a primary care issue.Doctors in the normal BMI range were unanimous that they should be a model for their patients (94% vs 81%). CONCLUSION: More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary.

[Quality improvement in primary care. Financial incentives related to quality indicators in Europe]. / A minoség javításának lehetséges eszközei az alapellátásban. Minoségi indikátorokhoz kapcsolt anyagi ösztönzok Európában.

Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus.