Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.

BACKGROUND: Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. METHODS: Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses. RESULTS: Experts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire. CONCLUSIONS: We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.

[Psychometric characteristics of the Shortened Hungarian Cloninger Temperament and Character Inventory (TCI55) based by nationwide samples].

INTRODUCTION: The shortened Hungarian 55-item version (TCI55) of the Cloninger Temperament and Character Inventory (TCI) is presented in the article. The goal of the examination was testing the psychometric parameters of the shortened questionnaire. The Cloninger TCI based by psychobiological model is the most recent personality inventory. Cloninger divides the personality to temperament dimensions into those that are determined by genetic attributes, and into the character dimensions that evolve by environment. The inventory includes four temperament factors (Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence) and tree character factors (Self- Directedness, Cooperativeness, and Self-Transcendence). The temperament dimensions characterized by automatic answers to emotional stimuli are related on the main neurotransmitters (dopamine, serotonin and norandrenalin). The character dimensions are based on the concepts of myself, others, and world, and represent the purposes, goals, and attitudes of the person. METHODS: The validation of the shortened 55-item version inventory was tested by surveys: one on a normative sample consisting 2861 persons (Rozsa, 2002), and two other samples that had been representative by sex, age, education, and habitation, and consisted 5020 and 2000 persons (HEP 2006 and HS 2013, respectively). RESULTS: The reliability and validity of the shortened inventory had been sufficient, the selected items represent sufficiently the original questionnaire. CONCLUSION: Based on results, TCI55 is an opportunity to measure the socialbiological model of personality, when the testing of original 240-items version questionnare is not possible.

[How do physicians sleep and dream?]. / Hogyan alszanak es álmodnak az orvosok?

INTRODUCTION: Satisfying sleep is especially important for physicians. Our study analyses physicians' sleep and dream from the point of view of continuous night-and-day duty. SAMPLE AND METHOD: Questionnaires were completed by 125 physicians among whom the proportion of night shift taking and only day-time working persons was equal. The questionnaire contained the Athens Insomnia Scale and the Dream Quality Questionnaire as well as questions about demographical characteristics and work circumstances. RESULTS: Almost each doctor mentioned sleep problems, principally daytime sleepiness (78%) and sleep deprivation (70%). Long sleep latency is reported more often by women doctors; the frequency of night awakenings increases, while daytime sleepiness decreases by age. The feeling of performance-loss is more prevalent among night shift takers. Dream characteristics differ significantly neither along demographical characteristics nor by work shifts. CONCLUSION: Although sleep problems are more frequent among physicians when comparing to the Hungarian general population, the frequency of clinical level insomnia is not higher. On the other hand, physicians can recall their dreams more often (25% vs 7%) and the emotional load of their dreams influence their daytime mood more commonly.

Psychosocial determinants of premature cardiovascular mortality differences within Hungary.

OBJECTIVES: The life expectancy gap between Central-Eastern European (CEE) countries, including Hungary, and Western Europe (WE) is mainly attributable to excess cardiovascular (CV) mortality in midlife. This study explores the contribution of socioeconomic, work related, psychosocial, and behavioural variables to explaining variations of middle aged male and female CV mortality across 150 sub-regions in Hungary. DESIGN: Cross sectional, ecological analyses. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12 643 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were income, education, control in work, job insecurity, weekend working hours, social support, depression, hostility, anomie, smoking, body mass index, and alcohol misuse. MAIN OUTCOME MEASURES: Gender specific standardised premature (45-64 years) total CV, ischaemic heart disease, and cerebrovascular mortality rates in 150 sub-regions of Hungary. RESULTS: Low education and income were the most important determinants of mid-aged CV mortality differences across sub-regions. High weekend workload, low social support at work, and low control at work account for a large part of variation in male premature CV mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most noticeably to variations in premature CV mortality rates among women. Low social support from friends, depression, anomie, hostility, alcohol misuse and cigarette smoking can also explain a considerable part of variations of premature CV mortality differences. CONCLUSION: Variations in middle aged CV mortality rates in a rapidly changing society in CEE are largely accounted for by distinct unfavourable working and other psychosocial stress conditions.

Relationships between unfavourable health status and smoking cessation attempts in Hungary.

OBJECTIVES: The study examines associations between intentions to quit smoking and health status in three age groups of Hungarian smokers, along with social-demographic background variables. METHODS: In 2002, a cross-sectional representative health survey of the sample of 12668 adults was conducted in Hungary. The associations between health status and intentions to quit smoking were analysed with logistic regression among current smokers (N = 3408). The influence of health-related and social predictor variables was tested separately in different age groups (18-34, 35-49, 50-64, >65). RESULTS: Experiences of chest pain principally motivate young adults to quit smoking. Middle-aged smokers consider quitting because of suffering from cardio-vascular disease. Among the oldest, only respiratory disease influenced quitting attempts. Among social background variables only the fact of living with a spouse had an influence, gender and socio-economic status did not. CONCLUSIONS: Connections between health status and quitting intentions are weakening as age is increasing. The population seems to become gradually conscious of the connections between circulatory problems and smoking. Quitting attempts are restrained by the general attitude that ill health is a normal part of the ageing process.