Transfer of Mental Health Services for Medical Students to Cyberspace during the COVID-19 Pandemic: Service Use and Students' Preferences for Psychological Self-Help Techniques.

The high risk of mental health problems among medical students has been compounded by the COVID-19 pandemic, which greatly reduced social contact. The mental health support service of the medical school of one Hungarian university was transferred to the online learning management system and was expanded by self-help materials in three domains: Improving study skills, stress management techniques, and reducing stress related to the COVID-19 pandemic. We wanted to understand the preferences of medical students for psychological self-help techniques by investigating the pattern of access to online self-help materials and the characteristics of the users. Access to the online materials between April 2020 and April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. Of all the students who logged in during the examination period (n = 458), 36.6-40.4% viewed materials to improve study skills and 23-29% viewed stress management materials, of which short-duration audio format techniques were preferred. The access rate of content targeting coping with the mental health effects of COVID-19 was 9.5-24%. Support to improve study skills is significantly more preferred than interventions targeting distress-reduction. The pattern of access can be used for the development of interventions that are of most interest to medical students.

Barriers to Seeking Mental Help and Interventions to Remove Them in Medical School during the COVID-19 Pandemic: Perspectives of Students.

Medical students are at increased risk for psychological morbidity but the majority of those with mental health problems do not seek professional care. We aimed to uncover the viewpoints of medical students regarding barriers and facilitators to using university mental health services and their attitudes and preferences towards online counselling. Four semi-structured focus groups were conducted (n = 26, mean age = 21.8, ±1.88, 73% males). After reaching data saturation, interviews were audio-recorded, transcribed and content-analysed by two independent coders. Intrapersonal barriers emerged to be perceived low risk, excessive self-reliance, lack of belief in the effectiveness of service, lack of openness. Interpersonal factors were the following: assumed long waiting list, insufficient provision of service information, fear of exposure, and not being familiar with the counsellor and the process. Extrapersonal barriers such as insurance problems, the number of available sessions, adverse sociocultural attitudes, fear of stigmatisation were identified. Students suggested that the university should provide psychoeducation and routine screening, apply social marketing and stigma reduction campaigns, improve information flow, and offer not only personal but also online video counselling to target removing these barriers. The results provide a reference for the redesign of mental health services to facilitate their access by students. Implications and limitations are discussed.

Readability and Comprehension of Printed Patient Education Materials.

Background: Health literacy, a recently determined construct plays an important role in how individuals are able to manage their health. A useful approach for the assessment of health literacy is to measure the comprehension of available patient education materials (PEMs). Objective: We aimed at assessing the usefulness of PEMS available in Hungarian by testing comprehension of selected PEMs in different groups of users. Methods: Comprehension of patient education materials in the domain of healthcare was tested by selecting PEMs and creating questions based on their text in 3 dimensions of health literacy: understand, process/appraise, apply/use. Twenty questions were created that could be answered without pre-existing knowledge by reading the appropriate text taken from PEMs. Comprehension was examined in four groups: laypersons, non-professional healthcare workers, 1st year healthcare students, and 5th year medical students. Readability indices were calculated for the same texts to which questions were created. Results: Laypersons answered <50% of the PEMs-based questions correctly. Non-professional healthcare workers performed better with 57% of right answers but significantly worse than healthcare students or medical students. Those with at least high school qualification (maturity exam) showed significantly higher comprehension compared to those with lower educational attainment. Persons in good or very good health also had significantly better comprehension than those in less favorable health. All readability indices showed that comprehension of the tested PEMs required at least 10 years of schooling or more. Therefore, these PEMS are difficult to understand for persons with less than high school level of education. Conclusion: Rephrasing of the investigated patient educational materials would be recommended so that they better fit the educational attainment of the Hungarian population. Evaluation of the readability and comprehensibility of other PEMs also seems warranted.

COVID-19 vaccination coverage in deprived populations living in segregated colonies: A nationwide cross-sectional study in Hungary.

The segregated colonies (SCs) in Hungary are populated mainly but not exclusively by Roma. Their health care use is restricted in many respects. It has not been studied yet, whether fair COVID-19 vaccination coverage achieved in Hungary is accompanied with fair effectiveness in SCs. Using census data, the vaccination coverage in SCs and the complementary areas (CAs) in the same settlements of the country was determined. To describe the settlement level differences, the vaccination coverage (until June 30, 2021) in SCs were compared to those in CAs by age, sex, and eligibility for exemption certificate standardized measures. Aggregating settlement level data, the level of geographic discrimination in Hungary was also determined. According to nationwide aggregates, crude vaccination coverage was significantly lower in SCs (40.05%, 95% CI 39.87%-40.23%) than in CAs (65.42%, 95% CI 65.37%-65.46%). The relative standardized vaccination coverage was 0.643 (95% CI 0.639-0.647) in SCs. A total of 437 of the 938 investigated settlements showed significant local vaccination disparities. Hungarian citizens living in SCs, mainly of Roma ethnicity, are a distinct high-risk group. Special intervention adapted to SCs is needed to mitigate inequality in vaccination coverage and further consequences of the pandemic.

Changes in Workers’ Physical Activity and Sedentary Behavior during the COVID-19 Pandemic

Background: COVID-19 has changed the world and strongly affected the health of the people and the quality of their life. These changes might impact employees’ physical activity (PA) and sedentary behavior (SB). This study aimed to summarize the literature focusing on the COVID-19-caused changes in physical activity and sedentary behavior among the adult working population. Methods: Literature searches were conducted in June 2021 using multiple electronic databases. The following keywords and synonyms were used during the searching process: physical activity, sedentary behavior, COVID-19, employee. After the data cleaning process (duplicates, inclusion criteria), the title and the abstract of all manuscripts from the searches were screened independently by two reviewers. Results: Thirty-nine manuscripts were selected as a result of the searching process. Of these, 5 were SB related, 15 were PA related and 19 addressed both PA and SB. There were longitudinal (10), cross-sectional (28) and a case study (1) in the selected manuscripts. The majority of studies were conducted in the USA (6) and Europe (18), and four studies examined the PA and/or SB in multiple countries. The majority (34 studies) of the studies used subjective, self-reported, but mostly before-validated questionnaires. Objective measures were less common and used only 12.8% of the examined studies. Moreover, 76.4% of the studies described an overall decrease in the amount of PA during the COVID-19 pandemic. In three cases, researchers observed an increase in PA among the workers. Five studies reported no significant changes in the amount of PA during the pandemic. As far as SB is concerned, 18 out of 24 of the studies reported an overall increase in the amount of SB between the two periods. Four manuscripts reported no significant change in the amount of SB, and there was only one manuscript in the examined studies that reported an overall decrease in the SB time before and during the COVID-19 pandemic. Discussion: There is no doubt that the COVID-19 pandemic, including lockdown and work from home (WFH) policies, impaired the PA and SB level of the populations. This period has delivered an important message for the adult working population as well. They should be as active as possible and avoid high levels of SB and uninterrupted sitting time. Therefore, organizations, policies and public health bodies should motivate workers, especially office workers, to be more active and interventions must be developed to mitigate the negative effects of the COVID-19 on PA and SB.