Changes in public attitude toward epilepsy in Hungary since 1994. A multicriteria weighting analysis.

OBJECTIVE: To assess the adult Hungarian population's knowledge about and attitude toward epilepsy and compare the present findings with previous ones in 1994 and 2000. METHODS: We performed a cross-sectional survey of the Hungarian adult population from 28th February to 8th March 2023. A non-probability quota sampling with a random walk method was used. We applied the computer-assisted personal interviewing (CAPI) method and used a multicriteria weighting procedure to correct for bias along the main sociodemographic variables. To detect changes over time, we used chi-squared tests, and to analyze the effect of sociodemographic characteristics, we applied multivariate logistic regression. RESULTS: One thousand participants (53.1% women, mean age 48.1 ± 16.75 years) representing Hungary's population were interviewed yielding a response rate of 80.3%. 26.3% knew someone with epilepsy (55.9% in 1994 and 51.9% in 2000), and 30.8% saw an epileptic seizure (58% in 1994 and 55.3% in 2000). Compared to the young, fewer adults and elderly people knew someone with epilepsy or had seen a seizure. Like in 1994 and 2000, 16.6% reported objection to their children's interaction with people with epilepsy; however, in the present study, significantly fewer people opposed their children marrying or working together with epileptic people, indicating a change in attitude (p < 0.0001). Rural residents had less objection to their children's interaction with people with epilepsy (p < 0.05). People with secondary education objected significantly more often than those with primary education to their children's interaction (p = 0.037), marriage to people with epilepsy (p = 0.043), or their having equal employment (p = 0.008). Higher education people were as "permissive" as those with primary education. SIGNIFICANCE: Certain parameters of familiarity and attitude markers of the Hungarian population toward epilepsy have improved. These tendencies are promising, but work is still needed; our results will hopefully evoke educational programs and campaigns against negative attitudes. PLAIN LANGUAGE SUMMARY: The knowledge of the Hungarian population about epilepsy and their attitude toward people with epilepsy has been improved since 1994. People from rural areas have shown more acceptance for people with epilepsy. Those people who completed secondary education were significantly more prone to stigmatization than those with primary education.

Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking.

STUDY OBJECTIVE: Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups. METHODS: We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms "sleepwalking", "somnambulism", "sleep eating" "sleep sex", "sleep talking" and "aggression in sleep" in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95 % confidence interval and the probability of statistical significance. RESULTS: 224 videos (102 women; 68 children, 116 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) less odds of ambulation in sleep likely consistent with somnambulism compared to adults and children. Adult females performed complex manual activities during sleepwalking more often, than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001). CONCLUSION: Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children.

High prevalence of burnout among midwives in Hungary: High job demands and low resources as potential persistent stressors, a focus on prevention.

Background: Midwifery practice in Hungary is characterized by chronic stress, which may in turn lead to burnout and impaired perinatal care. However, little is known about the degree and potential stressors of burnout, which hinder the development of strategies to promote well-being among midwives in Hungary. Aim: To assess the prevalence of burnout and identify persistent individual and occupational stressors among midwives in Hungary over the past decade to inform prevention. Methods: We conducted two cross-sectional studies among midwives in 2014 and 2022. We used the Maslach Burnout Inventory to assess burnout (emotional exhaustion, depersonalization, and personal accomplishment) over time. We also collected data on individual and work characteristics. We performed a multivariate regression analysis to explore associations between burnout and respondents' characteristics. Findings: The degree and prevalence of emotional exhaustion among midwives increased significantly between 2014 (N = 224) and 2022 (N = 152). High workload, not feeling valued at work, poorly perceived health status and work dissatisfaction emerged as a significant positive correlate of emotional exhaustion or depersonalization in both studies. Living alone showed both a positive and inverse association with burnout in 2014 and 2022, respectively. Work satisfaction was a positive correlate of personal accomplishment in both studies. Conclusions: Our results add to and confirm the growing body of evidence about the high prevalence of burnout among midwives in Hungary. We identified potential risk factors and outcomes of burnout, which remained unchanged over time. To prevent or reduce burnout among midwives, future interventions should focus on addressing these potential persistent risk factors. However, the time-varying role of factors influencing burnout makes it advisable to review preventive interventions from time to time.

[Burnout syndrome among Hungarian midwives in 2014 and 2022]. / Kiégésszindróma a magyar szülésznok körében 2014-ben és 2022-ben.

INTRODUCTION: The healthcare sector is the most studied area of burnout, as the mental health of healthcare workers has a significant impact on the mental health of the people they care for. OBJECTIVE: The aim of our study was to investigate whether there have been changes in the dimensions of burnout among midwives, and how the relationships between burnout and the individual factors and working conditions that influence it have evolved, using national data from 2014 and 2022. METHOD: An anonymous, voluntary, questionnaire-based survey of midwives working exclusively in maternity units was conducted using the Maslach Burnout Inventory questionnaire, which measures burnout, and questions on respondents' demographic characteristics and working conditions. Multivariate ordinal logistic regression was used to explore associations between burnout and respondent characteristics, and associations were characterized by odds ratios. RESULTS: Among the dimensions of burnout, no change in depersonalization was observed in 2022, but both emotional exhaustion and personal ineffectiveness were significantly more common in 2022 than in 2014. Responses from 224 midwives in 2014 and 152 midwives in 2022 were analyzed. Looking at the influencing factors, higher levels of burnout in 2014 were significantly associated with poorer perceived health, lack of a partner, smoking, shorter time in healthcare, having a job in a larger city, feeling overworked and dissatisfied. In 2022, on the other hand, younger age, smoking, shorter time in healthcare, feeling overworked, dissatisfied and unvalued were associated with higher levels of burnout. Looking at the combined effect of these factors, willingness to attend a health promotion lecture and having a second job also showed a significant effect on burnout in 2022. DISCUSSION: The authors discuss the change in burnout among midwives and the possible reasons for the correlations shown. CONCLUSION: The results of the first study on burnout among midwives in Hungary show that improving the working conditions of midwives is essential for the functioning of family-friendly midwifery. In addition, to prevent burnout, more emphasis should be placed on the prevention of the risk factors identified in the study in education and training. Orv Hetil. 2023; 164(40): 1592-1599.

Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking.

STUDY OBJECTIVE: Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups. METHODS: We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms "sleepwalking", "somnambulism", "sleep eating", "sleep sex", "sleep talking", and "aggression in sleep" in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95% confidence interval and the probability of statistical significance. RESULTS: 224 videos (102 women, 68 children, 16 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) lower odds of sleepwalking compared to adults and children. Adult females performed complex manual activities during sleepwalking more often than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001). CONCLUSION: Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children. BRIEF SUMMARY AND STUDY IMPACT: Parasomnias present highly variable clinical forms and often cause injuries. Identifying typical phenotypes may help risk management and imply theoretical conclusions. Our study supports the existence of age-specific parasomnia phenotypes. We found that adult women have a high risk of performing dangerous activities during sleep, and elderly males often move violently in bed, likely representing dream enactment behaviors. Elderly people of both sexes have low odds of sleep ambulation- likely representing somnambulism; compared to adults and children, constituting a descending "age slope" of somnambulism that might reflect different underlying pathomechanisms in children versus adults and the elderly.

The epidemiology of smoking and e-cigarette use in the Hungarian adult population in 2018 / A dohányzás és az e-cigaretta-használat epidemiológiája a felnott magyar népesség körében 2018-ban.

Összefoglaló. Bevezetés: Nagyszámú kutatás igazolta, hogy a dohányzás növeli a legjelentosebb krónikus betegségek kockázatát. Habár 2009 óta csökkeno tendenciát mutat Magyarországon a hagyományos dohányzók aránya, az e-cigarettát kipróbálóké az utóbbi években folyamatosan növekszik. Célkituzés: A 2018-ban a felnott lakosság körében végzett Népegészségügyi Felmérés dohányzásra és e-cigaretta-használatra vonatkozó eredményeinek bemutatása az elozo vizsgálatok tükrében. Módszer: A kérdoíves felmérésben 1586 fo került személyesen lekérdezésre. Az iteratív súlyozás a többlépcsos mintavételi designhatást és a 2016-os mikrocenzus adatait vette figyelembe. Eredmények: 2018-ban a dohányzók aránya a magyar felnott lakosság körében 28,7% (95% MT: 26,3-31,1%), az e-cigarettát használók aránya pedig 1,7% (95% MT: 1,1-2,5%) volt. Az iskolai végzettség a 65 év alattiak esetében a dohányzást befolyásoló tényezo volt (EH: 3,32; 95% MT: 2,53-4,34), de a 65 éves és annál idosebb korcsoportban már nem (EH: 1,11; 95% MT: 0,59-2,09). Az e-cigarettát kipróbálók és használók között a leginkább említett (54,3% 95% MT: 44,0-64,5%) motivációs tényezocsoport a dohányzásról való leszokással, az ártalomcsökkentéssel és a visszaesés megelozésével volt kapcsolatos. A 65 éves és idosebb korcsoportban a dohányzók aránya 2015-höz képest emelkedett. 2018-ban az alapfokú iskolai végzettséguek körében volt a legmagasabb a dohányzók aránya, míg 2014-ben az érettségivel nem rendelkezo középfokú végzettséguek körében. Következtetés: Bár összességében csökkent, az alacsony iskolai végzettséguek és az idosek körében emelkedett a dohányzók aránya Magyarországon. Az e-cigarettát kipróbálók és használók száma növekvo tendenciát mutat hazánkban. Eredményeink az alacsony iskolai végzettséguekre kiemelten fókuszáló, megelozo és leszokást támogató népegészségügyi alprogramokat is tartalmazó komplex beavatkozást sürgetnek. Orv Hetil. 2022; 163(1): 31-38. INTRODUCTION: The body of evidence suggests that smoking increases the risk of the most prevalent chronic diseases. Although the proportion of traditional smokers in Hungary has been on a declining trend since 2009, the proportion of those who tried e-cigarette has been steadily increasing in recent years. OBJECTIVE: To present - in the light of previous studies - the results of the Public Health Survey among adults in 2018 on smoking and e-cigarette use. METHOD: 1586 persons were personally interviewed in a survey. The iterative weighting algorithm considered both the design effect of multistaged sampling and the 2016 Hungarian microcensus. RESULTS: In 2018, the proportion of smokers in the Hungarian adult population was 28.7% (95% CI 26.3-31.1%), and the proportion of e-cigarette users was 1.7% (95% CI 1.1-2.5%). Educational level was a predictor of smoking among respondents younger than 65 years old (OR 3.32; 95% CI 2.53-4.34), but not for those aged 65 years or older (OR 1.11; 95% CI 0.59-2.09). Among e-cigarette ever or current users, the most commonly mentioned (54.3% 95% CI 44.0-64.5%) motivational factor-group to try or use e-cigarettes included motivations to quit smoking, to reduce harm, and to avoid relapsing. In the population aged 65 years old or older, the proportion of smokers increased compared to 2015. The proportion of smokers was the highest among those with primary education in 2018, while in 2014, it was the highest among those with secondary education without a graduation certificate. CONCLUSION: In Hungary, although overall smoking rates are declining, the smoking rate in the low educational group and among the elderly increased. The number of people trying or using e-cigarettes is showing an increasing trend in our country. Our results call for a complex public health intervention program including prevention and smoking cessation supporting subprograms with high focus on those with primary education. Orv Hetil. 2022; 163(1): 31-38.

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study.

BACKGROUND AND PURPOSE: We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. METHODS: This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. RESULTS: Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05-1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27-3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16-0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. CONCLUSION: Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Vaping-Related Adverse Events and Perceived Health Improvements: A Cross-Sectional Survey among Daily E-Cigarette Users.

Web-based samples of e-cigarette users commonly report significant vaping-related health improvements (HIs) and mild adverse events (AEs). This cross-sectional study with in-person interviewing data collection examined self-reported AEs and perceived HIs among Hungarian adult current daily exclusive e-cigarette (n = 65) and dual users (n = 127), and former daily e-cigarette users (n = 91) in 2018. Logistic regression was used to evaluate associations between reporting any AEs/HIs, vaping status, and covariates. More former users (52.7%) reported AEs than current users (39.6%; p = 0.038). Exclusive and dual daily users reported similar rates of AEs (44.6% and 37.0%, respectively; p = 0.308). More current users (46.9%) experienced HIs than former users (35.2%; p = 0.064). Exclusive daily users were more likely to report HIs than dual users (63.1% versus 38.6%; p = 0.001). Former user status and smoking cessation/reduction reasons increased the odds of reporting AEs, whereas nicotine-containing e-liquid use and older age decreased the odds of reporting AEs. Exclusive vaper status, using advanced generation devices, and smoking cessation/reduction reasons increased the odds of experiencing HIs. This study, which used a traditional data collection methodology, found a higher rate of AEs and a lower rate of HIs compared to web-based surveys. Our results highlight that experiencing AEs and HIs is affected by users' characteristics, in addition to the device and e-liquid type.

Investigation of possible causes of increase in Hungarian infant mortality in 2019 / A hazai csecsemohalandóságban 2019-ben tapasztalt emelkedés lehetséges okainak vizsgálata.

Összefoglaló. Bevezetés: Magyarországon a csecsemohalandóság 2014 óta folyamatosan javult, azonban 2019-ben az elozo évi adathoz képest 11%-kal magasabb érték mutatkozott. Célkituzés: A vizsgálat célja a 2019. évi kedvezotlenebb csecsemohalálozási mutató lehetséges összetevoinek feltárása. Módszer: A 2018. és 2019. évi csecsemohalálozási adatokat hasonlítottuk össze a csecsemo kora, a halál oka és a gyógyintézeti, illetve nem gyógyintézeti elhalálozás szerint. A vizsgálathoz a Központi Statisztikai Hivatal adatait használtuk. A trendvizsgálatnál 2010-tol elemeztük az adatokat. A nem gyógyintézeti haláleseteket 10 évre összevonva járásonként térképesen ábrázoltuk. Eredmények: 2018-ban 304, 2019-ben 335 csecsemo halt meg Magyarországon, a csecsemohalálozási arányszám 3,4 ezrelékrol 3,8 ezrelékre emelkedett. A 2019. évi érték az elozo évtizedek trendjére illesztett görbe alapján megfelelt a várható értéknek. 2019-ben a 0-27 napos csecsemohalálozás alig változott a 2018. évihez képest, a 28-364 napos korban bekövetkezett halálesetek száma viszont növekedett. A vizsgált évben 59%-kal emelkedett a nem gyógyintézeti csecsemohalálozás. A 2019. évi csecsemohalálozás növekedéséért 74%-ban a nem gyógyintézeti esetek voltak felelosek. A nem gyógyintézeti halálozás dönto többsége késoi csecsemokorban következett be. A járásonkénti, 10 évre összevont, nem intézményben elhunyt csecsemok számában és 1000 élve születésre vonatkozó arányában ötszörös területi különbségek mutatkoztak. A halálokok közül a perinatalis szakban keletkezo bizonyos állapotok miatt meghalt csecsemok száma emelkedett a leginkább, a nem gyógyintézeti halálozás esetében pedig a hirtelen csecsemohalál szindrómában meghaltaké. Következtetés: 2019-ben kiugróan magas volt a nem gyógyintézeti, késoi csecsemohalálozás száma és részaránya, ezen esetek feltuno regionális halmozódást mutattak. A csecsemohalandóság csökkentésének hatásos eszköze lehetne a jövoben minden egyes csecsemohalál részletes szakmai értékelése. Orv Hetil. 2021; 162(1): 830-838. INTRODUCTION: In Hungary, infant mortality has been steadily declining since 2014, but in 2019 it increased by 11% compared to 2018. OBJECTIVE: The aim of our study is to explore the possible components of the above increase. METHOD: Ten-year trends of infant mortality were analized and compared by age, cause, place of deaths (hospital or non-hospital environment) and location, using Central Statistical Office data. RESULTS: There were 304 infant deaths in Hungary in 2018 and 335 in 2019. Infant mortality rate rose from 3.4‰ to 3.8‰, however, it was in line with the expected value based on the curve fitted to the trend of previous decades. In 2019, 0-27-day infant mortality basically did not change compared to 2018, while the number of deaths at 28-364 days of age increased. Non-hospital infant mortality increased by 59% in 2019 and these cases accounted for 74% of the total increase in infant mortality; the vast majority of these deaths occurred in late infancy. There were fivefold regional differences in the number of non-hospital infant deaths. Among the causes of death, the conditions related to the perinatal period and sudden infant death syndrome increased the most. CONCLUSION: In Hungary, the number and proportion of non-hospital infant mortality was remarkably high in 2019 compared to previous years. These cases showed a striking regional accumulation. An effective tool for reducing infant mortality could be an appropriate professional assessment of each infant death in the future. Orv Hetil. 2021; 162(21): 830-838.

Defining healthstyles to plan behavior change interventions in representative samples of children and adults.

Based on Michie's COM-B model, we developed a survey methodology and segmentation procedure to identify groups of Hungarian school children and adults with distinctive characteristics, named healthstyles. We aimed to find interventions fitting to each healthstyle to generate behavioural change. For the segmentation of data, the latent class analysis method was applied. The analysis resulted in 8 healthstyles for the school children and 13 for the adults. Each healthstyle possess distinctive 'traits' and, therefore, special behavioural change methods and prevention strategies can be fitted for them. For demonstrating the advantages of using healthstyles, we discuss possible approaches for selecting behavioural change interventions, one for school children and one for adults.

An appraisal: how notifiable infectious diseases are reported by Hungarian family physicians.

BACKGROUND: Within the frame of National Epidemiological Surveillance System, family physicians have an obligation to report infections and suspicions cases. The aim of this study was to evaluate the knowledge, attitudes, daily practice and the reporting activities of Hungarian family physicians regarding to infectious diseases. METHODS: A self-administered survey was developed, validated and used. The survey was completed by family physicians who had taken part in continuous medical educational programmes of all Hungarian medical faculties. The questionnaire, consisting demographic questions and 10 statements about their reporting habits were completed by 347 doctors, 8% of the total number of family physicians. The data were processed in a cross-sectional design with general linear model. RESULTS: According to the majority of responders, the current reporting system works efficiently. Rural physicians were mainly agreed, that reporting is not a simply obligation, it is a professional task as well. They were less hindered in daily work by reporting activities, waited less for laboratory confirmation before reporting, reported suspicious cases more frequently. Practitioner's based in urban settlements preferred to await laboratory tests before reporting and were hindered less by failures of the electronic reporting system. Older physicians trusted more in the recent system and they wished to increase the number of reports. Female physicians have higher consciousness in epidemiology. They were mostly in agreement that even severe infectious diseases can be diagnosed at primary care level and their daily practices were less burdened by reporting duties. CONCLUSIONS: Both the epidemiological knowledge of general practitioners' and the electronic surveillance systems should be improved. There is a need to develope the electronic infrastructure of primary care. More and regular control is also expected by the health care authorities, beside the synthesis of professional and governmental expectations and regulations.

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010.

BACKGROUND: The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010. METHODS: Nationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years. RESULTS: A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. CONCLUSION: The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

[Study of infectious disease reporting by family physicians]. / A családorvosok fertozobeteg-bejelentéseinek vizsgálata.

INTRODUCTION: Reporting liability of family physicians/general practitioners is the keystone for proper surveillance of infectious diseases. AIM: The aim of the study was to find out why some of the family physicians neglect to report infectious diseases to the health authorities and determine their motivation and attitude towards the infectious disease reporting system. METHOD: Self-fill-in questionnaire was used to obtain data. Of the 228 family physicians who were called to participate in the study 116 family physicians sent back evaluable questionnaires. Descriptive statistic method was used to analyze the data and determine the reporting frequencies and ratios. RESULTS: Family physicians reported nearly 50% of all reported cases of infectious diseases. The main reason of underreporting was the lack of knowledge about the rules of the reporting system. According to most family physicians, an online based reporting system would be much more efficient instead of a paper based one. CONCLUSIONS: The authors conclude that education of family physicians would be mandatory in order to improve reporting of infectious diseases.

[Analysis of associations between mortality and biological and social-economic individual determinants]. / A halandóságot befolyásoló egyéni biológiai és társadalmi-gazdasági tényezok hatásrendszerének vizsgálata.

Health impact assessment is an internationally recognized tool for informed decision-making. The authors participated in building statistical models for assessing the health effects of decisions made inside and outside the health sector. They used logistic regression to investigate the role of individual factors like gender, age, education and economic activity determining the all-cause mortality and diseases of circulatory system and neoplasm as well. The results of statistical modelling proved that gender, education and economic activity modify the effect of age on mortality in multiple interactions. Since several factors have impact simultaneously on mortality, modifying the others' effects, analyzing these associations only by use of multivariate statistical methods is an adequate approach. Models presented in this article can be starting points for investigations exploring the effects of multiple health-determinants and researches in which also social-economic determinants are included in health impact assessment.

[How do social-economic differences in residential characteristics affect mortality? A literature review]. / Hogyan befolyásolják a térségi társadalmi-gazdasági különbségek a halandóságot? Irodalmi áttekintés.

Authors review studies on associations between mortality and geographic distribution of social-economic health determinants published in the last 15 years. Hungarian publications after the 1990ies identified several indicators with effect on mortality related to the place of residence such as size of the settlement, population density, joblessness, average income, education, and racial or ethnic mixture. As a rule, these papers analyzed time and geographically aggregated data with simple descriptive statistical approach. Major international studies, however, aside the area indicators commonly included individual data and applied multilevel statistical analysis. Earlier, the incoherent results of some complex statistical analyses were explained by lack of overall health concept, which could utilize effects both at individual and population levels. The most recent multilevel statistical methodology, using information related to spatial correlation and fitted to health models, can help researchers to better understand the causes and effects of health inequities.

[Dietary survey in Hungary, 2003-2004. Micronutrients: vitamins]. / Táplálkozási vizsgálat Magyarországon, 2003-2004. Mikrotápanyagok: vitaminok.

The 3rd Hungarian National Nutritional Survey was carried out as a part of the National Population Health Study and the data collection was done in November/December of 2003. The survey comprised a sample of adults above 19 year of age, the dietary questionnaires of 1179 people could be evaluated. The results of energy and macro-nutrient intake were published in 2005, and the results of the mineral intake in 2007, in the Hungarian Medical Journal. This paper focuses on the intake of vitamins. For the evaluation of the results authors used the data of the two previous national surveys, data of some dietary studies of other countries, and the home and international intake recommendations. In respect of the data found in the present survey, it is a favourable trend that the intake of vitamins retinol equivalent, B1 , B6 and B12 , and niacin, as well as biotin was sufficient both in case of men and women, together with adequate vitamin E intake for men. However the intake of vitamin B2 , C, D, together with pantothenic acid and folic acid of both men and women did not meet the criteria of the Hungarian recommendations, besides the vitamin E intake of women was insufficient as well. In Hungary the intake of vitamin D, biotin, folic acid and pantothenic acid was measured at first at this National Dietary Survey. The authors vigorously stress the importance of the varied and healthy nutrition in the adequate vitamin supply of the population.

[Hungarian national dietary survey, 2003-2004. Micronutrients: mineral salts]. / Táplálkozási vizsgálat Magyarországon, 2003-2004. Mikro-tápanyagok: ásványi sók.

In the course of the 3rd national nutritional survey data were collected in 2003, and the paper on the energy and nutrition intake of a sample group consisting of 1179 people all aged above 19, was published in the Hungarian Medical Journal (Vol. 146, No. 34, 2005). The present paper focuses on one group of micronutrients, namely the minerals' intake. The authors evaluated the results mainly in comparison with the data of the two previous Hungarian national surveys, and the international and national recommendations. The average magnesium intake was considered adequate in both sexes, while iron, zinc and copper intakes also met the recommended level in men. On the other hand, the insufficient calcium and the excessive phosphorus intakes, as well as the disproportionate calcium-phosphorus ratio in both sexes are unfavourable facts. The adverse results include insufficient iron, zinc and copper intake in women and the excessive sodium intake in both sexes, as well. The authors emphasize the importance of spreading the principles of healthy nutrition as well as co-operating with the food industry in order to prevent the occurrence of mineral nutrients deficiency.

Assessment of the health information system in Hungary / by Marta Bakacs, Csilla Kaposvari, Benigna Kiss, Jozsef Vitrai and Janos Vizi

This assessment of the National Health Information System (NHIS) in Hungary was conducted as part of a project of the WHO Regional Office for Europe. Its goal is to enable a better use of information in decision-making, while taking into account the other factors influencing decisions. The methodology was developed in Romania in June 2003, and then tested in the Czech Republic, Denmark, Hungary and Poland in 2004. This report is the result of the Hungarian experience. Semi-structured interviews of high-level key-informants, both decision-makers and professionals working in the field of health information, were performed by a Hungarian team, with the support of WHO. The project methodology is based on building capacities in the country. It aims at identifying gaps and unmet needs in all components of the Health Information System (HIS), both at national and district levels. It will serve as a basis for reviewing and strengthening the HIS; as a result, the HIS could be a better instrument for good governance, responsive to the needs of modern Public Health as expressed by different target audiences and users

[Dietary survey in Hungary, 2003-2004]. / Táplálkozási vizsgálat Magyarországon, 2003-2004.

The third Hungarian national dietary survey was conducted in 2003-2004. This publication describes the first part of the energy and nutrient intake findings in a sample consisting of a population of 1179 persons over 19 years of age (energy and macro nutrients). Energy and nutrient intake values were calculated based on 3 x 24- hour dietary records filled out by the subjects themselves. The authors evaluated the results in light of the two previous dietary surveys in Hungary and the Hungarian and international reference intake data. The total fat intake found in this survey lower than the previous data marks a favourable development, just as the higher unsaturated fatty acid and lower saturated fatty acid energy percent, and furthermore the lower cholesterol intake level. The favourable developments include further a polyunsaturated/saturated fatty acid ratio considerably higher than that obtained earlier (the values conforming to the international reference data), a higher carbohydrate energy percentage, as well as lower added sugar energy percentage, this latter being in the recommended range. The overweight ratio in men was 58.9%, while the female value was 49.5%, not much different from the previous survey data.