Genetic Background of Acute Heart Rate Response to Exercise.

The acute heart rate response (AHRR) to physical activity, which refers to the change in heart rate during and after exercise, has been associated with cardiovascular and all-cause mortality. Previous studies have shown that AHRR is significantly determined by genetics in addition to environmental and lifestyle factors. The aim of this study was to investigate the genetic background of AHRR by analysing ten single nucleotide polymorphisms (SNPs) associated with leisure-time physical activity (LTPA) in 620 samples from the Hungarian population. The AHRR can be characterised as the difference between post-exercise and resting heart rate, i.e., the delta heart rate (ΔHR) defined by the YMCA 3 min step test, with a lower value indicating better cardiovascular fitness. The association of SNPs with ΔHR was analysed both separately and in combination using an optimised polygenic score (oPGS). The results showed that five SNPs (rs10252228, rs459465, rs6022999, rs8097348, and rs12405556) had at least nominally significant (p < 0.05) individual associations with ΔHR. After optimizing the PGS, a cumulative effect was observed for eight SNPs (rs6022999, rs12405556, rs459465, rs10252228, rs8097348, rs10887741, rs12612420, and rs7023003) that had a strong and statistically significant association with ΔHR (B = -2.51, 95% CI: -3.46--1.76; p = 2.99 × 10-9). Of the four main domains of physical activity, the oPGS showed a significant positive association only with LTPA (B = 84.60; 95%CI: 25.23-143.98; p = 0.005). In conclusion, our results suggest that the SNPs we investigated influence individual leisure-time physical activity, mediated by their effects on the acute heart rate response.

Daily Optional Physical Education Does Not Counteract Increasing Inactivity by Age among Adolescents.

BACKGROUND: This paper describes the outcomes of an integrated health promotion programme implemented in a Hungarian high school offering health education in the curriculum, daily optional physical education, teacher training in applying a person-centered approach in teaching, and parental involvement in school activities. METHODS: The evaluation used mixed methods of which results of the before-6-months-after quantitative survey among pupils is described. The health status and behaviour of students were assessed by applying the Hungarian version of the HBSC questionnaire. RESULTS: Significant improvement was found in the self-rated health of girls (6.6% increase in being of excellent health, p = 0.04), and the consumption of sweets and sugary soft drinks decreased significantly for both genders (boys: -10.2%, p = 0.01; girls: -6.06%, p = 0.04). However, the proportion of physically inactive girls significantly increased (girls: 11.2%, p = 0.01), and substance use did not change significantly. DISCUSSION AND CONCLUSIONS: The intervention had significant positive impacts on subjective health and dietary habits and could counteract the secular trend of increasing tobacco, alcohol, and drug consumption by age among adolescents, but this unfortunately does not include physical inactivity. Offsetting the most widespread health risk behavior, physical inactivity, may require mandatory daily physical education in schools.

Efficiency of Printed Patient Information Leaflets Written for Total Knee and Hip Arthroplasty Patients to Reduce Their Fear of Surgery.

Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients' fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00-40.00 vs. median 20.00 IQR 16.00-24.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 20.00 IQR 16.00-22.00). A control group with TKA (median 37.50 IQR 30.00-40.00 vs. median 64.50 IQR 54.00-82.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 73.00 IQR 56.00-81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00-10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.

The Pendulum Swings Both Ways: Evidence for U-Shaped Association between Sleep Duration and Mental Health Outcomes.

Short sleep duration is a known risk to health, but less certain is the impact of longer sleep duration on various measures of health. We investigated the relationship between sleep duration and mental health outcomes in a cross-sectional survey conducted on a homogenous sample of healthy governmental employees (N = 1212). Data on sleep duration, subjective health, psychological stress, sense of coherence, life satisfaction and work ability along with sociodemographic data were collected. Sleep duration was significantly longer, and mental health outcomes and work ability were significantly better among those in at least good subjective health. Fitting mental health outcomes on sleep duration suggested a quadratic or fractional polynomial function, therefore these were tested and the best-fitting models were selected. Longer than 8 h of sleep duration was associated with a decreasing sense of coherence and decreasing work ability. However, psychological stress and life satisfaction were positively impacted by more than 8 h of sleep. Sleep duration likely has an optimum range for health, similar to other variables reflecting homeostatic functions. However, this is difficult to prove due to the left-skewed distribution of sleep duration.

Cost-Effective Healthcare in Rehabilitation: Physiotherapy for Total Endoprosthesis Surgeries from Prehabilitation to Function Restoration.

Knee and hip joint replacements for the elderly are increasingly placing a burden on healthcare. Our aim was to verify the efficiency of the prehabilitation program among patients with knee arthroplasty (TKA) and hip arthroplasty (THA), taking into account the length and cost of postoperative rehabilitation and the restoration of function. We introduced a two-week preoperative physiotherapy program for patients awaiting knee and hip replacement surgery. We measured the duration and costs of the hospital stays, the active and passive range of motion of the hip and knee joints, and the quality of life. In the study, 99 patients participated (31 male, 68 female), with a mean age of 69.44 ± 9.69 years. We showed that, as a result of the prehabilitation program, the length of postoperative hospital stay decreased (THA: median 31.5 (IQR 26.5-32.5) vs. median 28 (IQR 21-28.5), TKA: median 36.5 (IQR 28-42) vs. median 29 (IQR 26-32.5)), and the patients' quality of life showed a significant improvement (TKA: median 30.5 (IQR 30-35) vs. median 35 (IQR 33-35), THA: median 25 (IQR 25-30) vs. median 33 (IQR 31.5-35)). The flexion movements were significantly improved through prehabilitation in both groups. Based on our positive results, we recommend the introduction of prehabilitation into TKA- and THA-related care.

Bad for Girls and Boys: Gender Does Not Modify the Negative Effect of Physical Inactivity on Life Satisfaction in Adolescents.

Objectives: Physical activity (PA) has a positive effect on life satisfaction (LS) among adolescents, but the moderating effect of gender and level of PA intensity have been equivocal. Our aim was to examine the pattern of physical activity by grade in high school students, and the role of gender and grade on the association between physical activity and life satisfaction. Methods: Four repeated cross-sectional online questionnaire surveys between 2011 and 2013 were carried out among all students in one Hungarian high school (N = 3,450). Health status and behavior was assessed by the Hungarian online version of the health behavior of school-aged children (HBSC) questionnaire. Regression with robust variance estimator was used to identify determinants of life satisfaction. Results: Good self-reported health as opposed to bad increased life satisfaction by 0.30 standard deviation; having very well or well-off family as opposed to not well-off increased LS by 0.16 standard deviation; and being inactive compared to being vigorously active decreased LS by 0.1 standard deviation. Conclusions: Physical inactivity has a negative effect on life satisfaction in boys and girls regardless of grade but compounded by low perceived family wealth.

Self-Esteem Is Independent Factor and Moderator of School-Related Psychosocial Determinants of Life Satisfaction in Adolescents.

Our aim was to investigate the impact of the school psychosocial environment, including students' general attitude towards the school, perception of support from teachers and classmates as well as individual psychosocial factors including self-esteem and loneliness on life satisfaction (LS). Four repeated cross-sectional online questionnaire surveys were carried out between 2011 and 2014, inviting all students in one Hungarian high school. Health status and behaviour were assessed by the Hungarian version of the HBSC questionnaire. Results from the surveys were pooled for analysis (N = 3310 students). Heteroskedastic regression estimating robust variance was used to identify potential determinants of LS. Family wealth perceived to be well-off, self-esteem, and being perceived as a good student were identified to be the most important significant positive contributing factors of LS. Perceived good relations with classmates and teachers and an overall positive attitude to school had smaller but still significant positive effects on LS. Self-esteem was a significant moderator for the effect of perceived difficulty of schoolwork, relation with classmates, and gender. This paper shows that self-esteem is not only an independent factor but also a modifier of some school-related variables on LS. The complex interplay among school-related and individual potential determinants of LS should be taken into account in future research by controlling for their interactions.

Effects of Classical Breathing Exercises on Posture, Spinal and Chest Mobility among Female University Students Compared to Currently Popular Training Programs.

Worldwide, university students' physical health and posture are declining due to a sedentary lifestyle. The aim of our study was to evaluate the effectiveness of physiotherapeutic breathing exercises on posture and spinal mobility among healthy female university students compared to other training methods. Sixty-one female students of the University of Debrecen were assigned to breathing exercise (BE; n = 15), yoga (Y; n = 16), Pilates (P; n = 15) programmes and interval-training (IT; n = 15). Each training session lasted one hour, performed twice a week for 7 weeks. Students were assessed using standardized clinical tests. All programmes resulted in significant improvement in chest expansion. Results of Schober's test showed substantial improvement using BE (p < 0.05), Y, P (p ≤ 0.01) programmes. Significant changes in occiput-to-wall distance (Y, P p ≤ 0.01) (BE p ≤ 0.001) were observed in three groups except the IT group. Fingertip-to-floor test (Y, P p < 0.05) results showed significant changes in two groups. The most outstanding effects on lateral flexion were achieved using BE (right, left p ≤ 0.001) programme. A comparison with results achieved using yoga and Pilates revealed that the physiotherapeutic breathing exercise programme is an equally effective method to significantly improve spinal mobility and correct postural problems in healthy young women.

Impact Analysis of 20-Week Multimodal Progressive Functional-Proprioceptive Training among Sedentary Workers Affected by Non-Specific Low-Back Pain: An Interventional Cohort Study.

According to the latest data published by the WHO, 1.71 billion people suffer from musculoskeletal disorders and 568 million are affected by back pain, making these the most significant occupational health problems. The aim of this study was to analyze the effects of a newly developed Multimodal Workplace Training Program implemented among young sedentary employees in order to treat and prevent these problems. The 20-week Training Program was conducted at the National Instruments Corporations' Hungarian subsidiary in Debrecen between January and June, 2019. Pre- and post-intervention questionnaires were used to assess subjective parameters. Baseline and follow-up physical examinations were performed using the SpinalMouse, Y-Balance, Sit and Reach, Prone and Side Plank, Timed Abdominal Curl, and Biering-Sorensen tests. The results for 76 subjects were eligible for statistical analysis. Our Training Program was effective in several aspects, including a reduction in musculoskeletal symptoms and improvements in posture (p < 0.001), in dynamic (p < 0.01) and static-isometric (p < 0.001) core strength, in flexibility (p < 0.001), in spinal inclination in the sagittal (p < 0.001) and frontal (p < 0.01) plane, and in balance and coordination (p < 0.05). The Multimodal Progressive Functional-Proprioceptive Training was highly effective, and the application of such a complex training program can be recommended in workplace settings.

Leadership position is protective for health among non-manual workers / A vezetoi beosztás mint egészségprotektív tényezo szellemi munkát végzok körében.

Összefoglaló. Bevezetés: A munkavégzés fontos egészségprotektív tényezo, de munkahelyi pszichoszociális kockázatokkal jár, amelyeknek az egészségi állapottal való összefüggéseire az elmúlt évtizedekben derült fény. Célkituzés: A vizsgálat célja a munkahelyi beosztás és az egészségi állapot közti összefüggés vizsgálata volt olyan, viszonylag homogén mintában, amelynek tagjait közintézmények dolgozói adták. Módszer: Kérdoíves egészségfelmérés történt online adatgyujtéssel, keresztmetszeti elrendezésben, egy megyeszékhely két közintézményében alkalmazottak körében. A kérdoív demográfiai, az egészségi állapotra, az egészségmagatartásra és a munkavégzésre, köztük a munkahelyi beosztásra vonatkozó, validált kérdéseket tartalmazott. Az adatelemzés beosztási kategóriák szerint két (vezeto vs. beosztott), illetve három (vezeto, diplomás beosztott, nem diplomás beosztott) rétegben történt. Eredmények: A vizsgált mutatók közül a szubjektív egészség, az élettel való elégedettség, a koherenciaérzés, a túlzott mértéku pszichés stressz, a munkahelyi hiányzás, a munkahelyi és magánéleti társas támogatottság a vezeto beosztásban dolgozók körében volt a legkedvezobb. A vizsgált indikátorok közül csak a munkaképesség nem különbözött beosztás szerint, és csak az alvásido volt szignifikánsan kedvezotlenebb (rövidebb) a vezetok körében a beosztottakhoz képest. A háromrétegu elemzés szerint a legkedvezotlenebb mutatók a nem diplomás beosztottakra voltak jellemzoek. Eredményeink szerint a vezeto beosztásban dolgozók egészségi állapota és mentális egészsége kedvezobb, mint a beosztottaké. Következtetés: A munkahelyi beosztás az egyéni társadalmi-gazdasági helyzet mellett a munkahelyi pszichoszociális stressz mértékével is összefüggésben van, ezért a munkahelyi stressz vizsgálata során érdemes beosztás szerinti elemzést is végezni. A munkahelyi pszichoszociális stressz nyomon követése minden munkahelyen ajánlott, amelynek egyszeru módja az alkalmazási ido és a hiányzott napok számának létszámarányos és beosztásra stratifikált, idosoros nyomon követése. Orv Hetil. 2021; 162(29): 1172-1179. INTRODUCTION: Employment is an important health protective factor but also entails workplace psychosocial risks with multiple impacts on health. OBJECTIVE: The present study aimed at examining the association between employment position and subjective health in a relatively homogenous sample of public servants with mostly tertiary degrees. METHOD: Online health survey was conducted among employees of two large public institutes in a large city in Hungary. The questionnaire contained items on demographic data, health status, mental health, health behaviour, and work-related questions including employment position (leadership). Data analysis was carried out by employment position in two (manager, subordinate) and three (manager, subordinate with college degree, subordinate with no college degree) strata. RESULTS: Subjective health, satisfaction with life, sense of coherence, pathological stress, sickness absence, social support in the workplace and private life were most favourable among those in leadership position. Work ability did not differ by employment position, but sleep time was significantly less favourable (shorter) among leaders compared to subordinates. Subordinates with no college degree had the worst measures of health. CONCLUSION: Employment position is related to individual socioeconomic status and workplace psychosocial stress, therefore research on workplace stress should include employment level as a potential confounder. Psychosocial stress at workplaces should be monitored for which various recommendations are available. The simplest method is to monitor mid- and long-term turnover and sickness absence stratified for employment position and proportionate to the workforce. Orv Hetil. 2021; 162(29): 1172-1179.

Modelling Health in University Students: Are Young Women More Complicated Than Men?

The biopsychosocial model of health in a limited life course perspective was tested among students in higher education using data from a nationwide cross-sectional survey of students on track to become teachers in Hungary. Health determinants were grouped into categories of biological, psychological, and social determinants and arranged in a temporal manner from childhood to the present. The model was tested by canonical correlation analysis followed by multivariate analysis of covariance. One composite outcome of health and six determinant groups were examined out of a total of 24 variables in both genders. Separate sets of health determinants were identified for men and women. The health of men was determined by fewer variables that were more proximal in time, more centred around physical activity, and less influenced by social relations. As opposed to that of men, women's health was influenced by age; determinants were grouped around the ingestion of various substances and social support. In contrast to men, the health of women seemed to be more obviously multifactorial. The study supports the usefulness of the biopsychosocial model of health in research. The best fit models provided evidence for the importance of gender awareness when designing public health interventions aimed at students.

Functional Analysis of the Spine with the Idiag SpinalMouse System among Sedentary Workers Affected by Non-Specific Low Back Pain.

WHO describes "low back pain" (LBP) as the most common problem in overall occupational-related diseases. The aim of this study was to evaluate characteristics of spinal functionality among sedentary workers and determine usability of the SpinalMouse® skin-surface measurement device in workplace settings in a risk population for LBP. The spinal examination was implemented at National Instruments Corporations' Hungarian subsidiary, Debrecen in October, 2015, involving 95 white-collar employees as volunteers to assess spinal posture and functional movements. Data from the physical examination of 91 subjects (age: 34.22 ± 7.97 years) were analyzed. Results showed significant differences (p < 0.05) in posture and mobility of the spinal regions in sitting compared to standing position. Significant positive correlations were observed between values measured in standing and sitting positions in all observed regions and aspects of the spine (p < 0.05) except posture of lumbar extension (p = 0.07) and mobility of sacrum/hip in E-F (p = 0.818). Significant (p < 0.001) difference (5.70°) was found between the spinal inclination in sitting 6.47 ± 3.55° compared to standing 0.77 ± 2.53 position. Sitting position has a negative effect on the posture and mobility of the spine among white-collar employees. The SpinalMouse can be used effectively to determine spinal posture and mobility in cross-sectional studies and impact analysis of physical exercise interventions.

Prevalence of Insulin Resistance in the Hungarian General and Roma Populations as Defined by Using Data Generated in a Complex Health (Interview and Examination) Survey.

Data mainly from one-off surveys clearly show that the health of Roma, the largest ethnic minority of Europe, is much worse than that of the general population. However, results from comprehensive exploratory studies are missing. The aim of our study was to create a complex database for comparative and association studies to better understand the background of the very unfavourable health of Roma, especially the high burden of cardiometabolic diseases. A three-pillar (questionnaire-based, physical and laboratory examinations) health survey was carried out on randomly selected samples of the Hungarian general (HG, n = 417) and Roma (HR, n = 415) populations, and a database consisting of more than half a million datapoints was created. Using selected data, the prevalence rates of metabolic syndrome (MetS) and of its components were determined, and to estimate the risk of insulin resistance (IR), surrogate measures (the homeostasis model assessment of insulin resistance index, quantitative insulin sensitivity check index, McAuley and TyG indices and the TG/HDL-C ratio) were calculated. Receiver operating characteristic curve analysis and Youden's method were used to define the optimal cut-off values of each IR index. The prevalence of MetS was very high in both study populations (HG: 39.8%, HR: 44.0%) with no statistically significant difference between the two groups in females or males. The prevalence of MetS showed a very marked increase in the HR 35-49 years age group. Among surrogate measures, the TyG index showed the greatest power for predicting IR/MetS at a cut-off value of 4.69 (77% sensitivity, 84% specificity) and indicated a 42.3% (HG) and 40.5% (HR) prevalence of IR. The prevalence of MetS and IR is almost equally very unfavourable in both groups; thus, the factors underlying the high premature mortality burden of Roma should be further clarified by investigating the full spectrum of risk factors available in the database, with a special focus on the access of Roma people to preventive and curative health services.

Social cognitive intervention reduces stress in Hungarian university students.

Summary: A social cognitive intervention was developed and delivered as a credit course to improve mental distress of university students, based on findings in a previous health survey showing notable mental distress among future teachers in Hungary in 2007. The intervention included increasing information on psychoactive substances used for stress reduction; skills development in stress reduction methods; improving skills in communication and problem-solving. All students who participated in the previous health survey were targeted. Mental status of the participants was assessed by a questionnaire before (n: 128, 22% male, mean age 23.21 years) and after (n: 148, 30% male, mean age 23.54 years) the intervention. Specifically, self-efficacy as outcome was approximated by a trait measure (sense of coherence); psychological distress was measured by the 12-item General Health Questionnaire (Goldberg et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191­197) after the intervention compared with that before. After the intervention, psychological distress was reduced among the participants (p: 0.013). Non-significant improvement occurred in the mean score for sense of coherence (from a mean 60.8 points before to 61.4 points after, p: 0.688). The intervention produced a modest but significant decrease in psychological distress in students at a cost of 54 US$ per 1 point improvement in mental distress. The intervention, a first example of the translation of the social cognitive theory into practice among students in higher education can be integrated into the curriculum as a standardized optional course.

Social support contributes to resilience among physiotherapy students: a cross sectional survey and focus group study.

OBJECTIVE: The present study, taking a resource-oriented approach to mental health, aimed at investigating mental resilience and its determinants among undergraduate physiotherapy students using quantitative and qualitative tools. DESIGN: A questionnaire-based cross-sectional survey supplemented by 2 focus groups. SETTING: One university in Hungary. PARTICIPANTS: 130 physiotherapy students at years 1, 2, and 3. MAIN OUTCOME MEASURES: Sense of coherence, a measure of dynamic self-esteem, as well as social support from family and peers were used to assess mental well-being. A screening instrument for psychological morbidity and perceived stress were used as deficiency-oriented approaches. Student opinions were gathered on positive and negative determinants of mental health. RESULTS: Resilience was lower [mean difference 4.8 (95% CI -3.4; 13.1)], and the occurrence of psychological morbidity (32.5% vs. 0%) was higher among female compared to male students. However, the proportion of students fully supported by their peers was higher among females (63% vs. 37.5%). Female students, unlike their male counterparts, experienced higher stress compared to their peers in the general population. Social support declined as students progressed in their studies though this proved to be the most important protective factor for their mental well-being. CONCLUSIONS: Results were fed back to the course organizers recommending the implementation of an evidence-based method to improve social support as delineated by the Guide to Community Preventive Services of the US the outcomes of which are to be seen in the future.