Doctor-patient communication training with simulated patient during the coronavirus pandemic / Orvos-beteg kommunikációs gyakorlat szimulált pácienssel a koronavírus-járvány idején. (A COVID-19-pandémia orvosszakmai kérdései)

INTRODUCTION: During the state of emergency caused by the coronavirus pandemic, the Doctor-patient communication training for medical students at the University of Szeged was moved online. The training is based on the method of video analysis, involving simulated patients, making online implementation extremely challenging. AIM: The study aims to present our experiences with the online training and to analyse the students' evaluations. METHOD: We used the free version of Zoom for small groups of five students, a trainer and a simulated patient. All students participated in a situation that we recorded. The viewing of the recordings was followed by group discussion. Then, the students evaluated the course using an online questionnaire. We used descriptive statistics and content analysis. RESULTS: 74.4% of the students (n = 64) completed the questionnaire. 78.1-100% of them gave a good (4) or excellent (5) evaluation for the questions. The highest average score (4.95 ± 0.21) was given to the professionalism of the trainers, the lowest was given to the choice of topic of the theoretical part (4.06 ± 1.02). The majority of the students were satisfied with the course, they would be happy to attend it again; however, in-person learning still seems to be the preferred option. CONCLUSION: The online practice was a success. In many ways, it proved to be an adequate replacement for the traditional form. The students evaluated the training similarly to those of previous years. The lack of personal contact is a limiting factor, thus, online practice should not be seen as an alternative to personal communication trainings; however, as an independent form of training, it can make a significant contribution to effective, modern education. Orv Hetil. 2020; 161(33): 1355-1362.

[Place and role of medical anthropology in medical education. The so-called Szeged model]. / Az orvosi antropológia címu tantárgy helye és szerepe az orvosképzésben. Az úgynevezett szegedi modell.

It is a necessary part of modern medical education that medical students should learn about the binary nature of human beings - biological and cultural - since both have an impact on our behavior. The subject of medical anthropology helps with understanding the mechanisms and lay concepts behind patients' decisions which is particularly important in our globalized world. The major goal of this course is to help medical students with acquiring cultural competence through theoretical bases and empirical examples that may help them later in their work when they meet patients with different cultural backgrounds. In the present study, we introduce the course of Medical Anthropology as it happens at the Faculty of Medicine, University of Szeged: the so-called Szeged model - its aims, syllabus, strengths, opportunities and possible difficulties. During the development of the subject, we greatly focused on its links to other subjects of behavioral and medical sciences and on its practice-oriented nature. Thus, the course partly contains of lectures and seminars which display cultural variability in relation to biological reality through practical examples. As a result, the topics of medical anthropology prepare the students to use the knowledge as well as skills and attitudes in clinical practice. Orv Hetil. 2019; 160(39): 1527-1532.

[The medical psychology in Hungary: way of thinking, frame of references and applications]. / Az orvosi pszichológia fejlodése hazánkban: szemléleti keretek, határterületek és alkalmazások.

The present study aims at overviewing the different stages of the education of medical psychology in Hungary. In the perspective of the achievements of cognitive and affective neuroscience as well as developmental psychology, we intend to define the roots of doctor-patient relationship, certain determining factors of diagnosis forming and therapy efficiency as well as the essential components of empathy. We attest to the fact that the current psychosomatic medicine with its evidence-based achievements is a valid component and constitutive pillar of everyday medical care. The integrated university level instruction of medical psychology and behavioral sciences aims at consolidating this perspective. We also emphasize that the ill body hinders adequate psychological functioning and mental disorders provide risk factors concerning somatic illnesses. Through spreading health psychology perspective, we support the concept that in everyday medical care, health protection and the development of health conscious behavior relies on responsible, informed and committed decision-making patients as well as on similarly educated extended medical care teams. Orv Hetil. 2018; 159(36): 1455-1464.

[Interventions in medical practice to reduce tobacco use among adolescents]. / Intervenciók az orvosi gyakorlatban a serdülokori dohányzás visszaszorítására.

Interventions to facilitate prevention of tobacco use and smoking cessation are the most cost-effective health care measures. They are invaluable among adolescents, since adult smokers start smoking in adolescence. There is evidence that early smoking initiation makes cessation difficult and it is associated with lifelong health risks. Our study aims at reviewing current approaches and interventions that can help health care professionals involved in paediatric care to reduce tobacco use in adolescence. International guidelines include short, practical interventions that are easy to apply by health care professionals in the primary and paediatric care. In tobacco use prevention, the role of health care professionals is of special importance. They have social respect, therefore they can provide credible information on tobacco use and cessation. Studies have found that short, goal-oriented counselling can further reduce the prevalence of smoking among adolescents presenting to their health care professional. Reduction of tobacco use is one of the primary health care goals in the 21st century, which should be started as early as childhood and adolescence. There have been several evidence-based approaches, which are essential for health care professionals involved in adolescent care. Orv Hetil. 2018; 159(15): 593-602.

Choice of contraception at 6-8 weeks postpartum in south-eastern Hungary.

OBJECTIVES: The aims of the study were to describe the sociodemographic determinants, breastfeeding- and sexual life-related predictive factors of contraceptive use at 6-8 weeks postpartum. METHODS: A prospective, web-based questionnaire survey was carried out by distributing an access code to women immediately after delivery at the Department of Obstetrics and Gynaecology, the University of Szeged, Szeged, Hungary, between 1 September 2013 and 1 May 2015. RESULTS: In total, 1875 women were invited to participate in the study, 632 of whom refused or were excluded and 644 were not sexually active. The remaining sexually active women (n = 599) completed the questionnaire. At 6-8 weeks postpartum, 22.5% were using an effective contraceptive method and 40.2% were relying on lactational amenorrhoea (LAM). We found a significant direct association between the educational level of a woman's partner and her use of an effective contraceptive method (p < .001) (adjusted odds ratio [AOR]: 1.9) or LAM (AOR: 1.49). Use of an effective contraceptive method before pregnancy increased the likelihood of using the same method after delivery (AOR: 3.16) and decreased the likelihood of LAM use at weeks 6-8 (AOR: 0.31). The AOR for effective contraceptive use was 2.23 times higher in women who had sexual intercourse once or more a week compared with those who had sexual intercourse less frequently. CONCLUSIONS: Concerted efforts to promote the use of long-acting reversible contraception (LARC) are required, particularly among women who would like future childbearing. Further research is needed on the factors contributing to the low uptake of LARC in this population.

[Knowledge of university students in Szeged, Hungary about reliable contraceptive methods and sexually transmitted diseases]. / Szegedi egyetemi hallgatók ismeretei a megbízható fogamzásgátlásról és a szexuális úton terjedo betegségekrol.

INTRODUCTION: Promiscuity and lack of use of reliable contraceptive methods increase the probability of sexually transmitted diseases and the risk of unwanted pregnancies, which are quite common among university students. AIM: The aim of the study was to assess the knowledge of university students about reliable contraceptive methods and sexually transmitted diseases, and to assess the effectiveness of the sexual health education in secondary schools, with specific focus on the education held by peers. METHOD: An anonymous, self-administered questionnaire survey was carried out in a randomized sample of students at the University of Szeged (n = 472, 298 women and 174 men, average age 21 years) between 2009 and 2011. RESULTS: 62.1% of the respondents declared that reproductive health education lessons in high schools held by peers were reliable and authentic source of information, 12.3% considered as a less reliable source, and 25.6% defined the school health education as irrelevant source. Among those, who considered the health education held by peers as a reliable source, there were significantly more females (69.3% vs. 46.6%, p = 0.001), significantly fewer lived in cities (83.6% vs. 94.8%, p = 0.025), and significantly more responders knew that Candida infection can be transmitted through sexual intercourse (79.5% versus 63.9%, p = 0.02) as compared to those who did not consider health education held by peers as a reliable source. The majority of respondents obtained knowledge about sexual issues from the mass media. CONCLUSIONS: Young people who considered health educating programs reliable were significantly better informed about Candida disease.

[Current concepts in tobacco cessation and prevention]. / A dohányzás megelozése és a leszokás támogatásának lehetoségei.

In the recent years, for oral care in general, both improving oral hygiene and tobacco use cessation have been identified as necessary measures to gain and maintain long-term periodontal health. This growing evidence has given the dental team a whole new task to tackle when achieving and maintaining oral health with their patients. In order to support dental patients to quit tobacco use, it is helpful for the clinician to have a clear understanding of the genesis of 'tobacco use disease' in general. At present, the evidence-based method for tobacco use cessation consists of professional counselling on behavioural change using the so called "5A Method" (Ask, Advise, Assess, Assist and Arrange") in combination with pharmacotherapy. A suitable model for behavioural support in tobacco use cessation would help patients to move from one stage to the next. People who want to quit the smoking habit do not always participate in carefully controlled nicotine withdrawal programs, e.g. in linear fashion and from start to finish. Nevertheless, simple instructions - like those offered in the "Assist" (to help) and "Arrange" (to organize follow-up visits) - can be valuable tools for dental professionals supporting their patients to quit smoking. On the basis of significant evidence on the recovery of the oral mucosa and the periodontal tissue following tobacco use cessation, a new task has been emerged in dentistry: the role of oral health professionals providing counselling for patients who ought to quit tobacco use.

Obstetric and psychosocial risk factors for depressive symptoms during pregnancy.

We aimed to determine the psychosocial and obstetric correlates of depressive symptomatology during pregnancy in South-Eastern Hungary. A total of 1719 women were screened for depression in four counties in 2006 and 2007, based on a Leverton Questionnaire (LQ) score of ≥12 at 14-24 weeks of gestation. The LQ scores indicated a probable depressive illness (PDI) in 17.2% of the study group. The best predictors in a multiple regression analysis were history of major depression (adjusted odds ratio [AOR]=3.23), and major life events (AOR=2.43). A perceived lack of social support from partner (AOR=1.79) and lack of support by family (AOR=1.23) were also significant determinants. Lack of planning of pregnancy (AOR=1.12) and a history of unfavourable obstetric outcome (AOR=1.42) also seem to predispose to PDI. Overall, psychosocial factors appeared important in the prediction of PDI, whereas economic features did not.

Attitudes of Hungarian dental professionals to tobacco use and cessation.

Smoking is the most preventable cause of death worldwide. The regularity of visits of patients to dental offices offers a valuable contact for health professionals and the healthcare system to initiate anti-smoking activity. However, these contacts remain unutilized and there is little interaction between doctor and patient with regard to prevention of smoking and its consequences. The aim of this study was to evaluate the current situation and attitudes towards smoking and giving up smoking among dental professionals. A survey was carried out in the sample consisting in total of 342 participants, 212 students of dentistry and 130 dentists. Students were asked to complete a questionaire during the enrolment period; dentists were asked to complete the questionnaire while attending an annual compulsory in-service training course at the University of Szeged. The data were analysed statistically using SPSS 10.0 software, significance was tested using the Mann-Whitney U test and results were compared with data from a similar study conducted by the same research group in 2004 in which general knowledge and attitude towards smoking and giving up smoking was measured and evaluated. Results demonstrated that there is a lower number of smokers among dental professionals (dentists: 22.3%; students: 20.3%) than in the Hungarian general population and high interest in encouraging and assisting patients in giving up smoking (dentists: 45%; students: 54%). Comparing the results of this study to earlier data collated in 2004, we find a decreasing ratio of smokers among students (34% in 2004 and 20.3% in 2011). An increasing need for information about smoking cessation, tobacco related health hazards and the lack of detailed knowledge about methods and patient education were identified.

Determinants of emergency contraceptive use after unprotected intercourse: who seeks emergency contraception and who seeks abortion?

OBJECTIVE: To compare differences in contraceptive characteristics and the knowledge of emergency contraception (EC) between women who used EC after unprotected intercourse and those who sought abortion. DESIGN: A questionnaire survey. SETTING: A Hungarian university hospital. SAMPLE: Two large clinical groups were enrolled: women who were prescribed EC after unprotected intercourse (n= 952) (EC group) and women who presented for termination of pregnancy who had not taken EC after a contraceptive failure despite being suitable candidates to take EC (n= 577) (control group). METHODS: Questionnaire evaluation. MAIN OUTCOME MEASURES: Knowledge concerning, previous use of, and other factors related to EC use. RESULTS: The EC group experienced a condom failure significantly more often (odds ratio (OR) = 3.07), while the control group reported more failures with the contraceptive pill (OR = 0.69) and with periodic abstinence (OR = 0.09). Use of EC depended on age, education level, place of residence, accurate knowledge of EC (OR = 3.87) and previous EC use (OR = 1.16). Awareness of EC was influenced by information obtained from healthcare providers (OR = 3.63) or by school education (OR = 1.28). CONCLUSIONS: Women who use less reliable contraceptive methods should be targeted for health education that stresses the importance of reliable contraception and provides more detailed knowledge on EC and when it should be used.

[Psychological factors of successful kidney transplantations. The effects of anxiety and intrapsychic integration of the organ on recovery]. / A vesetranszplantáció sikerességének pszichológiai tényezoi. A szorongásszint és a szerv intrapszichés integrációjának hatása a gyógyulási folyamatra.

UNLABELLED: Transplant patients' attitudes and representations related to their illness, their body, and the healing process have a significant impact on their recovery. AIMS: The study involved 51 patients from the Department of Surgery, University of Szeged, Hungary. The primary aim was to examine the possible connections between emotional and mood factors, illness and body representations, and the successful onset of renal functions after surgery. METHODS: Patients were tested with a combination of 4 instruments: Spielberger's anxiety scale and Beck depression scale, self and organ drawings, and a questionnaire designed by the authors. RESULTS: Our data suggest that high distress correlates with kidney disfunction after transplantation. Patients with higher anxiety drew the kidney larger in their projective drawing test. It was a remarkable result that post-transplant blood test on Day 10 showed significantly lower creatinine and urea levels in those patients who had drawn the kidney smaller in their projective drawing test. This might indicate that the organ's normal intrapsychic integration and the related kidney functions are disturbed. CONCLUSIONS: The results of this study provide useful information about the psychological background, which has received relatively little attention so far. It can also give important clues for further research on clinical health psychology in supporting the healing process.

Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology?

BACKGROUND: Psychosocial and psychological interventions are generally effective in reducing depressive symptomatology in the postpartum period. Our aim was to evaluate the effectiveness of a brief preventive group intervention for postpartum depression (PPD) in a naturalistic setting, and study the effect of this on social and psychological risk factors. METHODS: We conducted a randomized controlled trial (n = 1,719) in south-eastern Hungary in 62 antepartum centers. Pregnant women (n = 710) underwent a 4-session preventive group intervention whereas a control group (n = 1,009) attended 4 sessions providing the same information given in usual care. RESULTS: Our intervention appeared to significantly reduce the risk of PPD, as defined by Leverton Questionnaire total scores (OR = 0.69). It resulted in an absolute risk reduction of about 18% in those with antepartum depression and 0.5% in those with no depression at recruitment. A multiple logistic regression analysis revealed a much reduced risk in those with a perceived lack of partner support (OR = 0.4) in the treatment group. Unplanned pregnancy, an irreversible risk factor affecting every fifth woman, also seemed to have a reduced effect on PPD after our group intervention (OR = 0.81). CONCLUSIONS: A brief preventive antepartum group intervention focusing on psychoeducation, stress management, improving coping mechanisms, and the development of social support can be effective in reducing postpartum depressive symptomatology.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary.

PURPOSE: To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006. METHODS: In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery. RESULTS: The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006. CONCLUSIONS: A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

Validation of the Leverton Questionnaire as a screening tool for postnatal depression in Hungary.

OBJECTIVE: To assess the validity of the 24-item Leverton Questionnaire (LQ) in screening for postnatal depression (PND). METHOD: A two-phase, cross-sectional study was designed. Between January and October 2006, a sample of 1552 women attending a routine postnatal check-up at 6 weeks postpartum completed the LQ in southeast Hungary. On the basis of the LQ total score, the participants were stratified and randomly selected within each stratum for clinical evaluation (Structured Clinical Interview for DSM-IV). Receiver operating characteristic (ROC) analyses were used to examine the sensitivity and specificity of the LQ to detect PND. RESULTS: The best cut-off on the Hungarian version of the LQ for PND was 11/12, with a sensitivity of 88.0%, and a specificity of 94.4%, and a positive predictive value of 53.1%. Internal consistency was satisfactory (Cronbach alpha coefficients > or = 0.753). The sensitivity of the modified Beck Depression Inventory (BDI) in detecting PND was 86.2% and the specificity 90.4%. Although the BDI performed slightly better than the LQ in distinguishing between minor and major depression, both psychometric scales showed satisfactory screening performance. CONCLUSIONS: Our data confirm the validity of the Hungarian version of the LQ reliably to identify PND. We propose a cut-off of 11/12 for screening purposes for PND, the range of 11-14 for detecting minor depression and regarding a total score of 15 points or above as indicative of major depression.

Anxiety, depression and smoking in schoolchildren--implications for smoking prevention.

The prevalence of smoking among 14 to 18-year-old adolescents (one out of three) is as high as in the general population in Hungary. Depression and anxiety disorders are also major public health problems. Our objective was to investigate the correlations between smoking status and anxiety and depressive symptoms, as well as to identify potential implications for the prevention of nicotine dependence. We used a self-developed questionnaire to survey smoking behaviour, and standard self-evaluation tests (the Hungarian version of the Spielberger's State-Trait Anxiety Inventory for Children and the Children's Depression Inventory) to capture anxiety and depressive symptoms in 215 students from randomly selected technical and high schools. Smoking students showed significantly more anxiety and depressive symptoms compared to their non-smoking peers. Importantly, occasional smokers appeared to be more anxious than non-smokers, whereas daily smokers scored higher on the depression inventory than either non-smokers or occasional smokers. The majority of students with high scores suggestive of anxiety or depressive disorders were smokers. Interestingly, Levels of anxiety and depression were associated with smoking status in boys but not in girls. The strong association found between anxiety and depressive symptoms and youth smoking, particularly in boys, suggests that reducing these symptoms (especially high, school-related anxiety) may be preventive against the onset of addictive smoking. This, together with the high level of anxiety and depression found in girls, makes it essential for all professionals dealing with adolescents and education to recognise these symptoms and their significance, and to be aware of the ways of reducing them by changes in the educational system, or medically, if necessary.