Mental health effects of adult children's outmigration on older parents in Central and Eastern Europe.

OBJECTIVE: To examine the association between adult children's migration and depression among older parents in Central and Eastern Europe (CEE) and explore the role of intergenerational support in contributing to their depression. METHODS: Data are from the eighth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), pooling a study sample of 11 CEE countries, with a cross-sectional design. Analysis of covariance (ANCOVA) and hierarchical linear regression were conducted using a study sample of 9133 respondents. RESULTS: Older adults whose children migrated over 500 km were more likely to experience depression compared to those with no migrant child or all children within 500 km. Among intergenerational support, frequent parent-child contact mitigated the effects of migration on depression in older parents with all their children who migrated over 500 km. CONCLUSION: This study suggests that older parents with migrant children over 500 km away should be considered a vulnerable population at risk for mental health in CEE countries. It is crucial for local governments and policymakers to address these challenges through improving integrated mental health and social programs for better mental health outcomes among older adults in CEE countries.

Characterization of Electrospun Polysuccinimide-Dopamine Conjugates and Effect on Cell Viability and Uptake.

Biocompatible nanofibrous systems made by electrospinning have been studied widely for pharmaceutical applications since they have a high specific surface and the capability to make the entrapped drug molecule amorphous, which increases bioavailability. By covalently conjugating drugs onto polymers, the degradation of the drug as well as the fast clearance from the circulation can be avoided. Although covalent polymer-drug conjugates have a lot of advantages, there is a lack of research focusing on their nano-formulation by electrospinning. In this study, polysuccinimide (PSI) based electrospun fibrous meshes conjugated with dopamine (DA) are prepared. Fiber diameter, mechanical properties, dissolution kinetics and membrane permeability are thoroughly investigated, as these are crucial for drug delivery and implantation. Dopamine release kinetics prove the prolonged release that influenced the viability and morphology of periodontal ligament stem cells (PDLSCs) and SH-SY5Y cells. The presence of dopamine receptors on both cell types is also demonstrated and the uptake of the conjugates is measured. According to flow cytometry analysis, the conjugates are internalized by both cell types, which is influenced by the chemical structure and physical properties. In conclusion, electrospinning of PSI-DA conjugates alters release kinetics, meanwhile, conjugated dopamine can play a key role in cellular uptake.

Nurse preferences of caring robots: A conjoint experiment to explore most valued robot features.

AIM: Due to the COVID pandemic and technological innovation, robots gain increasing role in nursing services. While studies investigated negative attitudes of nurses towards robots, we lack an understanding of nurses' preferences about robot characteristics. Our aim was to explore how key robot features compare when weighed together. METHODS: Cross-sectional research design based on a conjoint analysis approach. Robot dimensions tested were: (1) communication; (2) look; (3) safety; (4) self-learning ability; and (5) interactive behaviour. Participants were asked to rank robot profile cards from most to least preferred. RESULTS: In order of importance, robot's ability to learn ranked first followed by behaviour, look, operating safety and communication. Most preferred robot combination was 'robot responds to commands only, looks like a machine, never misses target, runs programme only and behaves friendly'. CONCLUSIONS: Robot self-learning capacity was least favoured by nurses showing potential fear of robots taking over core nurse competencies.

Characterization of a conjugated polysuccinimide-carboplatin compound.

Carboplatin, an advanced anticancer drug with excellent efficacy against ovarian cancer, was developed to alleviate the side effects that often occur with cisplatin and other platinum-based compounds. Our study reports the in vitro characteristics, viability, and activity of cells expressing the inducible nitric oxide synthase (iNOS) gene after carboplatin was conjugated with polysuccinimide (PSI) and administered in combination with other widely used anticancer drugs. PSI, which has promising properties as a drug delivery material, could provide a platform for prolonging carboplatin release, regulating its dosage, and improving its side effects. The iNOS gene has been shown to play an important role in both cancer cell survival and inhibition. Herein, we synthesized a PSI-carboplatin conjugate to create a modified anticancer agent and confirmed its successful conjugation. To ensure its solubility in water, we further modified the structure of the PSI-carboplatin conjugate with 2-aminoethanol groups. To validate its biological characteristics, the ovarian cancer cell line SKOV-3 and normal ovarian Chinese hamster ovary cells were treated with the PSI-carboplatin conjugate alone and in combination with paclitaxel and topotecan, both of which are used in conventional chemotherapy. Notably, PSI-carboplatin conjugation can be used to predict changes in the genes involved in cancer growth and inhibition. In conclusion, combination treatment with the newly synthesized polymer-carboplatin conjugate and paclitaxel displayed anticancer activity against ovarian cancer cells but was not toxic to normal ovarian cancer cells, resulting in the development of an effective candidate anticancer drug without severe side effects.

Translation and validation of the Hungarian Version of the infection control standardized questionnaire: a cross-sectional study.

BACKGROUND: To our knowledge, there is currently no psychometrically validated Hungarian scale to evaluate nurses' knowledge about infection prevention and control (IPC) practices. Thus, we aim in this study to assess the validity and reliability of the infection control standardized questionnaire Hungarian version (ICSQ-H). METHODS: A cross-sectional, multisite study was conducted among 591 nurses in Hungary. The original ICSQ included 25 questions. First, the questionnaire was translated into Hungarian. Then, content validity was assessed by a committee of four specialists. This was done by calculating the item content validity index and scale content validity index. Afterward, structural validity was evaluated in a two-step process using principal component analysis and confirmatory factor analysis. The goodness of fit for the model was measured through fit indices. Convergent validity was assessed by calculating the average variance extracted. Additionally, discriminant validity was evaluated by computing the Spearman correlation coefficient between the factors. Finally, the interitem correlations, the corrected item-total correlations, and the internal consistency were calculated. RESULTS: The content validity of the questionnaire was established with 23 items. The final four-factor ICSQ-H including 10 items showed a good fit model. Convergent validity was met except for the alcohol-based hand rub (ABHR) factor, while discriminant validity was met for all factors. The interitem correlations and the corrected item-total correlations were met for all factors, but the internal consistency of ABHR was unsatisfactory due to the low number of items. CONCLUSIONS: The results did not support the original three-factor structure of the ICSQ. However, the four-factor ICSQ-H demonstrated an adequate degree of good fit and was found to be reliable. Based on our findings, we believe that the ICSQ-H could pave the way for more research regarding nurses' IPC knowledge to be conducted in Hungary. Nevertheless, its validation among other healthcare workers is important to tailor effective interventions to enhance knowledge and awareness.

Discriminating Low to High Adherent Type 2 Patients with Diabetes by Glycosylated Hemoglobin A1c, Eating Self-Efficacy and Other Psychosocial Determinants: Difference Between Patient and Physician Adherence Models.

Objective: Develop individual discriminant models using clinical and psychosocial variables for physicians and patients with diabetes based on their perceptions of patient adherence. Methods: This was a cross-sectional research design utilizing a discriminant analysis approach. Type 2 patients on treatment for diabetes for at least 2 years prior to research were selected. Clinical data were obtained from patient records, and psychosocial variables were collected by survey instruments filled out by patients. A final sample of 200 patients was recruited. Results: We found a positive correlation between patient and physician assessment of patient adherence behaviors. Greater adherence efforts were associated with lower HbA1c. Better quality of the patient-physician relationship was linked to better patient adherence. Increased HbA1c, longer therapy duration and higher BMI described low patient adherence for physicians. Lower HbA1c, female gender and fewer difficulties in marital adjustment characterized high adherence for patients. Dietary self-efficacy as well as emotional and social isolation discriminated mid-level adherers in both models. Conclusion: This research confirmed that patients and physicians perceived and judged patients' adherence behaviors differently. Physicians and patients associated different clinical and psychological factors with low and high adherence. Further research is recommended to clarify how the quality of the physician-patient as well as the patient-spouse relationship affect dietary efficacy and patient adherence. A randomized, controlled clinical trial approach is recommended to establish the effectiveness of interventions aiming to improve dietary self-efficacy on adherence outcomes.

Analysis of Three-Dimensional Cell Migration in Dopamine-Modified Poly(aspartic acid)-Based Hydrogels.

Several types of promising cell-based therapies for tissue regeneration have been developing worldwide. However, for successful therapeutical application of cells in this field, appropriate scaffolds are also required. Recently, the research for suitable scaffolds has been focusing on polymer hydrogels due to their similarity to the extracellular matrix. The main limitation regarding amino acid-based hydrogels is their difficult and expensive preparation, which can be avoided by using poly(aspartamide) (PASP)-based hydrogels. PASP-based materials can be chemically modified with various bioactive molecules for the final application purpose. In this study, dopamine containing PASP-based scaffolds is investigated, since dopamine influences several cell biological processes, such as adhesion, migration, proliferation, and differentiation, according to the literature. Periodontal ligament cells (PDLCs) of neuroectodermal origin and SH-SY5Y neuroblastoma cell line were used for the in vitro experiments. The chemical structure of the polymers and hydrogels was proved by 1H-NMR and FTIR spectroscopy. Scanning electron microscopical (SEM) images confirmed the suitable pore size range of the hydrogels for cell migration. Cell viability assay was carried out according to a standardized protocol using the WST-1 reagent. To visualize three-dimensional cell distribution in the hydrogel matrix, two-photon microscopy was used. According to our results, dopamine containing PASP gels can facilitate vertical cell penetration from the top of the hydrogel in the depth of around 4 cell layers (~150 µm). To quantify these observations, a detailed image analysis process was developed and firstly introduced in this paper.

Predicting cervical screening and HPV vaccination attendance of Roma women in Hungary: community nurse contribution is key.

BACKGROUND: HPV screening/vaccination has been observed lower for ethic minorities. Understanding factors that predict and can improve attendance is therefore key. Hence, the aim was to identify causes, especially concerning the quality of the patient-provider relationship, that predict past HPV screening and vaccination turnout of Roma women in Hungary. METHODS: Cross-sectional research design with self-developed, culturally sensitive questionnaire. A final, female Roma sample of 368 participants was randomly selected from census register. Community nurses contacted participants and distributed surveys. Surveys were mailed-in by participants. Bivariate logistic regression was used to predict former participation in HPV screening/vaccination. RESULTS: Of the total sample, 17.4% of women attended at least one cervical screening and HPV vaccination in the past. Bad screening experience was positively associated with racially unfair behaviors of physicians. The odds of past attendance were 4.5 times greater if 'no negative earlier experience' occurred, 3.3 times likelier if community nurse performed screening/immunization and 1.6 times more probable if respondent felt 'no shame'. Evaluating the screening/vaccination process painful, being only financially motivated and attendance involving a lot of travel decreased the odds of 'no show' by 50%, 40% and 41%, respectively. CONCLUSIONS: When considering the ratio of past cervical screening attendance, we conclude that our female Roma sample did not behave differently from the general population. We saw no evidence that racial mistreatment made any contribution to explaining cervical screening participation. Past positive screening experience and the quality of patient-provider relationship increased the odds of participation the most. Cancer of friends, pain, financial motivation and travel distance decreased odds of participation to a lesser extent. In order to improve future screening and immunization, community nurses should play more central and advanced role in the organization and implementation of such services specifically targeting Roma populations.

The relationship between paediatric nurses' quality of life and intent to leave: The moderating role of hospital type.

BACKGROUND: Different types of hospitals exist in Jordan, and each type has its own leadership style. This might affect the nursing workforce in terms of quality of life and intent to leave. AIM: This study aimed at (1) assessing the relationship between paediatric nurses' quality of life and intent to leave, (2) examining the moderating effect of the hospital type on this relationship, (3) comparing the quality of life of paediatric nurses working at ministry of health and the University-Affiliated hospitals and (4) exploring the determinants of nurses' intent to leave. DESIGN: A cross-sectional, comparative and correlational design was used in this study. METHODS: A multi-site sample was selected from two types of hospitals in Jordan; the ministry of health and the University-Affiliated hospitals. A sample of 225 paediatric nurses responded to the brief quality of life questionnaire by the World Health Organization in addition to a group of sociodemographic and work-related questions. RESULTS AND CONCLUSION: Nurses' quality of life and intent to leave were negatively correlated. This correlation was moderated by the type of hospital. Nurses' quality of life was significantly different in the two types of hospitals. Both salary and nursing care model predicted paediatric nurses' intent to leave. The managerial style and work environment of the ministry of health hospitals should be benchmarked against the University-Affiliated hospitals.

Poly(amino acid) based fibrous membranes with tuneable in vivo biodegradation.

In this work two types of biodegradable polysuccinimide-based, electrospun fibrous membranes are presented. One contains disulfide bonds exhibiting a shorter (3 days) in vivo biodegradation time, while the other one has alkyl crosslinks and a longer biodegradation time (more than 7 days). According to the mechanical measurements, the tensile strength of the membranes is comparable to those of soft the connective tissues and visceral tissues. Furthermore, the suture retention test suggests, that the membranes would withstand surgical handling and in vivo fixation. The in vivo biocompatibility study demonstrates how membranes undergo in vivo hydrolysis and by the 3rd day they become poly(aspartic acid) fibrous membranes, which can be then enzymatically degraded. After one week, the disulfide crosslinked membranes almost completely degrade, while the alkyl-chain crosslinked ones mildly lose their integrity as the surrounding tissue invades them. Histopathology revealed mild acute inflammation, which diminished to a minimal level after seven days.

Sports activities of 60 above Hungarian elderly-explaining and predicting impact of exercise on health.

BACKGROUND: The proportion of elderly is on the rise both in Europe and in Hungary. The challenge is to increase the number of years spent in good health as well as to improve quality of life of those 60 years and above. This study focuses on the impact of physical activity on this age group. METHODS: A nationally representative sample of 2000 respondents were surveyed in an age range of 15-74. Our data concerns those being 60-74 years of age. The focus of our investigation was level and impact of physical activity in the group above. First, we used Chi-squared tests and correspondence analysis to identify the deviation in the answers of different groups in our sample. After we built a hierarchical linear regression model to get a deeper understanding of the impact of physical activity for elderly. RESULTS: Those reporting no physical/sports activity at all have to do with the negative culture of exercising. Only 9.3% reported being engaged with any sports; 72% reported no regular exercising throughout their lives. The relationship between sport activity and self-reported health was significant (p = 0.009, Cramer's V = 0.2). Elderly were characterized by walking, hiking and less intense sports. CONCLUSIONS: Those who actively exercised in this research reported better health outcomes than those who stopped or had never been engaged in any sports. We conclude that of all variables tested, physical activity was most effective to improve personal health of the elderly in this sample. Compared to European data on physical activity of elderly populations, Hungary seems to fall behind and needs to consider concentrated efforts to improve the future health of its senior populace.

Influence of cognitive function and nurse support on malnutrition risk in nursing home residents.

AIM: To predict malnutrition risk of older residents by cognitive function, nurse support and self-care capacity as primary measures of interest. DESIGN: Cross-sectional, correlation design with linear regression analysis. METHODS: Older residents over 60 years of age were randomly selected from nursing homes. Mini Mental State Exam and the Mini Nutritional Assessment were used were as main measures. RESULTS: Lower malnutrition risk was associated with better cognitive functioning. Improved independence of self-feeding was also linked to reduced nutritional risk. Nurse support was positively related to BMI and cognitive impairment. General self-care capacity and 'appetite the week before' were key predictors of malnutrition risk; 1-point increase in both variables caused nutritional risk to decrease by 1.73 and 1.38 points, respectively. That is, a 1-point increase in self-care capacity and appetite would decrease malnutrition risk by 5.76% and 4.6%. The regression model explained significant amount (65.6%) of variance in malnutrition risk.

Burnout and patient safety: A discriminant analysis of paediatric nurses by low to high managerial support.

AIM: To explore how levels of managerial support discriminate paediatric nurses' burnout, quality of life, intent to leave and adverse patient events. DESIGN: A quantitative correlational study. METHODS: A total of 225 paediatric nurses were selected from nine major hospitals across Jordan. The main measures used were the Copenhagen Burnout Inventory and the brief version of World Health Organization-Quality of Life Instrument. The study methods were compliant with the STROBE checklist. RESULTS: Nurse manager support was negatively associated with adverse patient events, work-related burnout, client-related burnout, and intent to leave; and positively with physical and psychological quality of life. Frequency of nosocomial infections characterized low manager support, whereas medication errors described high support. Greater nurse manager support decreased the likelihood of adverse patient outcomes.

Predictors of dietary self-efficacy in high glycosylated hemoglobin A1c type 2 diabetic patients.

OBJECTIVE: To predict dietary self-efficacy behaviors in high glycosylated hemoglobin A1c (HbA1c) patients using type D personality (TDP) and other psychosocial measures. METHODS: A cross-sectional, predictive research design was implemented. Participants were type 2 diabetes mellitus patients diagnosed more than 2 years prior to the study. Data were collected for demographics, dietary self-efficacy and psychological measures. Spearman's rank-order correlation was used to test for relationships, the Mann-Whitney test was used to test for differences and multiple linear regression was used to examine predictors of dietary self-efficacy. RESULTS: Lower dietary self-efficacy was strongly correlated with greater social isolation (r = 0.93) and moderately correlated with more mental health problems (r = 0.20) and higher TDP scores (r = 0.17). Higher HbA1c was inversely related to self-reported physical health (r = -0.19). Social and emotional isolation and time since diagnosis predicted dietary self-efficacy (greater isolation was associated with more dietary management difficulties). CONCLUSIONS: Regression outcomes suggested that a 10% decrease in social isolation improves dietary self-efficacy by 30%, a significant boost to therapeutic adherence. We recommend assessment of social isolation to improve dietary self-efficacy and achieve better patient adherence to therapy.

Free thiol groups on poly(aspartamide) based hydrogels facilitate tooth-derived progenitor cell proliferation and differentiation.

Cell-based tissue reconstruction is an important field of regenerative medicine. Stem and progenitor cells derived from tooth-associated tissues have strong regeneration potential. However, their in vivo application requires the development of novel scaffolds that will provide a suitable three-dimensional (3D) environment allowing not only the survival of the cells but eliciting their proliferation and differentiation. Our aim was to study the viability and differentiation capacity of periodontal ligament cells (PDLCs) cultured on recently developed biocompatible and biodegradable poly(aspartamide) (PASP)-based hydrogels. Viability and behavior of PDLCs were investigated on PASP-based hydrogels possessing different chemical, physical and mechanical properties. Based on our previous results, the effect of thiol group density in the polymer matrix on cell viability, morphology and differentiation ability is in the focus of our article. The chemical composition and 3D structures of the hydrogels were determined by FT Raman spectroscopy and Scanning Electron Microscopy. Morphology of the cells was examined by phase contrast microscopy. To visualize cell growth and migration patterns through the hydrogels, two-photon microscopy were utilized. Cell viability analysis was performed according to a standardized protocol using WST-1 reagent. PDLCs were able to attach and grow on PASP-based hydrogels. An increase in gel stiffness enhanced adhesion and proliferation of the cells. However, the highest population of viable cells was observed on the PASP gels containing free thiol groups. The presence of thiol groups does not only enhance viability but also facilitates the osteogenic direction of the differentiating cells. These cell-gel structures seem to be highly promising for cell-based tissue reconstruction purposes in the field of regenerative medicine.

Hypertension in Thyroid Disorders.

Arterial hypertension represents a major global health concern; more than one fourth of the population is affected by high blood pressure. Albeit the underlying cause of the disease remains unclear in the vast majority of the cases, ~10% are of secondary origin. Endocrine disorders are common illnesses and some of them may lead to elevated blood pressure, among which thyroid diseases are of high prevalence and often overlooked, especially in mild cases. Overt and subclinical hyper- and hypothyroidism can both lead to (mostly mild) hypertension; however, the underlying mechanisms are only partially understood. The results of clinical studies are often controversial. During the past decades, some genetic mutations in the hypothalamus-pituitary-thyroid axis with cardiovascular consequences were revealed. Atherosclerotic changes resulting from lipid abnormalities due to thyroid dysfunction also affect the vasculature and can cause elevated blood pressure. The review gives a synopsis of our knowledge how thyroid hormone metabolism and functional thyroid diseases affect the cardiovascular system, their negative impact and causative role in the development of hypertension.

[Diagnosis of diabetic cardiac autonomic neuropathy]. / A diabeteses cardialis autonóm neuropathia diagnosztikája.

Cardiac autonomic neuropathy (CAN) is a common complication in type 1 and 2 diabetes and is defined as the impairment of autonomic control of the cardiovascular system. CAN is strongly associated with increased mortality, and in some studies with morbidity of vascular complications, such as stroke, coronary artery disease and myocardial infarction. At the early stages, CAN can be subclinical and it becomes clinically evident as the disease progresses. Subclinically, the disease is defined by cardiovascular reflex testing, which may have prognostic implications. Clinically, the impairment in autonomic function is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, syncope, intraoperative cardiovascular instability, silent myocardial infarction and ischemia, and increased mortality. Although very common and serious, CAN is a frequently overlooked complication of diabetes. Because the progression of cardiovascular denervation is partly reversible or can be slowed down in the early stages of the disease, recent guidelines strongly recommend screening for CAN in patients with diabetes. In this review we summarize the diagnostic tools suggested in the screening for diabetic CAN. Orv Hetil. 2019; 160(35): 1366-1375.

Recent Advances in Investigation, Prevention, and Management of Healthcare-Associated Infections (HAIs): Resistant Multidrug Strain Colonization and Its Risk Factors in an Intensive Care Unit of a University Hospital.

Active screening for resistant multidrug strain carriers remains an important component of infection control policy in any healthcare setting indifferent of financial and logistical costs. The objective of our study was to determine the spectrum of bacterial colonization individually among intensive care unit patients. A retrospective observational study was performed in the Intensive Care Unit of Emergency Clinical County Hospital of Oradea during 2017. Medical records of the patients were used for evaluation of source of ICU admission, previous antibiotic therapy, comorbidities, and length of hospital stay. Nasal and groin swabs for MRSA detection and rectal swabs for ESBL, VRE, and CRE detection were collected upon ICU admission of all patients in the first 24 hours and after 7 days. Swab samples were processed for isolation and identification of these resistant multidrug strains. Bacterial colonization on admission was detected in a quarter of patients included in the study. Carbapenemase-producing bacteria were the most common colonizers (21.16%). On admission, 12.06% of patients have been colonized by ESBL-producing members of the family Enterobacterales. Risk factors for colonization on admission to the ICU were chronic liver diseases and chronic renal failure for ESBL infection and chronic liver disease for CRE in male patients. Evaluation of Carmeli's score for male patients showed association only with CRE colonization. Chronic renal failure was found as risk factor for ESBL colonization in female patients. The prevalence of MRSA was 5.23% and less than 1% for VRE. There was no association between any risk factors studied and the presence of S. aureus or VRE upon admission. The 7-day ICU stay also proved to be an increased risk for ESBL and CRE infection.

Discriminating low-, medium- and high-burnout nurses: Role of organisational and patient-related factors.

AIM: To discriminate low/medium/high burnout in nurses by work and patient-related indicators and explore what factors characterize these categories best. METHODS: Cross-sectional, online survey with a representative sample of nurses. Measures assessed burnout, intragroup conflict, job insecurity, overt aggression and impact of patient aggression on nurses. RESULTS: Top nurse managers experienced more burnout than middle managers or staff, middle managers also reported greater burnout than staff. Those who had never suffered aggression experienced greater burnout but less intragroup conflict and job insecurity. Staff differed on job insecurity from top and midlevel managers. The first discriminant function differentiated high burnout from medium and low; this function was characterized by exhaustion, aggression and intragroup conflict. The second function differentiated medium burnout from others; job insecurity, years worked, over aggression and overtime dominated this function. CONCLUSIONS: Burnout affects managers and staff differently; top managers may be more susceptible to burnout than reported before. Low, medium and high burnout groups require tailored interventions because of their different characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: In the future, burnout assessment should focus on both organisational and care related factors. Determining levels of burnout will guide managers to improve the right aspects of practice and work environment.