Éva Susánszky

Physician Burnout in Hungary A Potential Role for Work—Family Conflict

In a study among Hungarian physicians (N = 420), we tested the hypothesis that compared to men female physicians experience higher work—family conflict (WFC) and consequent burnout. As predicted, female physicians scored significantly higher on the emotional exhaustion subscale of the Maslach Burnout Inventory and significantly more female physicians experienced high levels of emotional exhaustion compared to male physicians. WFC emerged as a significant predictor of burnout (emotional exhaustion and depersonalization). These findings suggest a potential path from WFC to burnout in a scarcely researched population of physicians in a unique cultural setting and provide further data for cross-cultural burnout research.

Timing of suicide attempts by self-poisoning during pregnancy and pregnancy outcomes

Objective: The purpose of this study was to examine the timing and consequences of suicide attempts by self‐poisoning during pregnancy. Methods: A population‐based prospective study was organised in the toxicological in‐patient hospital in Budapest which is responsible for health services for adult inhabitants poisoned by ingesting chemicals in Budapest and the surrounding area involving 3 million people between 1985 and 1993. All women aged between 16 and 50 years (22 969) who were admitted to the study hospital due to suicide attempts by drug ingestion were examined by a sensitive serum pregnancy test. Results: Of 559 self‐poisoned pregnant women, two died. The peak period of suicide attempts was found to be in the first postconceptual month and its majority resulted in a very early fetal loss. The second highest figure was recorded in the second postconceptual month. Thus, 61% of suicide attempts occurred before the third postconceptual month. Later pregnancies had a significantly lower proportion of attempting suicide parallel with advanced fetal development. Conclusions: Most suicide attempts by self‐poisoning occurred after the early recognition of unwanted pregnancies and most resulted in a very early fetal loss. Pregnancies with advanced gestation months had a significantly lower proportion of attempting suicide.

Association of young and advanced age of pregnant women with the risk of isolated congenital abnormalities in Hungary - A population-based case-matched control study

Abstract Objective: To analyze the possible association of maternal age with the risk of all congenital abnormalities (CAs) in a population-based large case-matched control data set. Methods: The Hungarian Case-Control Surveillance of Congenital Abnormalities included 21 494 cases with isolated CA and their 34 311 matched controls. First the distribution of maternal age groups in 24 CA-groups and their matched controls was compared. In the second step, young (19 years or less) and advanced (35 years or more) age groups were compared. Finally, the subgroups of neural-tube defects, congenital heart defects and abdominal walls CA were evaluated separately. Results: A higher risk of gastroschisis, congenital heart defects, particularly left-sided obstructive defects, undescended testis and clubfoot was found in the youngest age group (19 years or less) of cases. The higher proportion of pregnant women with advanced age (i.e. 35 years or more) showed only a borderline excess in cases with clubfoot. The so-called U-shaped risk of maternal age distribution was found in cases with clubfoot and in the total group of isolated CAs. Conclusions: The maternal age is a contributing factor to the origin of some isolated CAs mainly in young pregnant women.

Lower birth weight of offspring born after self-poisoning of parent

Birth weight was evaluated in 777 and 217 livebirths, respectively, of index females and female partners of index males born before and after severe self-poisoning with drugs. Birth weight was also evaluated in matched controls. Babies born to index females months or years after an attempted self-poisoning were found to have a lower birth weight than before this suicide attempt. The difference in the birth weight of subsequent pregnancies of index and control females was also highly significant. A similar trend was observed in livebirths of female partners of index males. However, the differences were not significant between previous and subsequent pregnancies and between index cases and matched controls.

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

Summary.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 12 668 adults was conducted in Hungary. The associations between health status and intentions to quit smoking were analysed with logistic regression among current smokers (N = 3 408). 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.Zusammenfassung.Zusammenhänge zwischen ungünstigem Gesundheitsstatus und Versuchen, mit dem Rauchen aufzuhören, in UngarnFragestellung: Die Studie untersucht die Zusammenhänge zwischen der Absicht, mit dem Rauchen aufzuhören, und dem Gesundheitsstatus in Altersgruppen (18–34, 35–49, 50–64, >65) von ungarischen Rauchern, zusammen mit soziodemographischen Drittvariablen. Methoden: In 2002 wurde eine repräsentative Querschnittstudie bei 12 668 Erwachsenen in Ungarn durchgeführt. Die Zusammenhänge zwischen Gesundheitsstatus und den Versuchen, mit dem Rauchen aufzuhören, wurden mittels logistischer Regression bei aktuellen Rauchern (N = 3 408) analysiert. Der Einfluss von gesundheitsrelevanten und sozialen Prädiktorvariablen wurde separat für die Altersgruppen getestet. Ergebnisse: Erfahrungen mit Brustschmerzen motiviert junge Erwachsene hauptsächlich, mit dem Rauchen aufzuhören. Erwachsene im mittleren Alter erwägen einen Rauchstopp bei kardio-vaskulären Erkrankungen. Bei den ältesten Erwachsenen sind es nur Atembeschwerden, die Rauchstopp-Versuche beeinflussen. Bei den sozialen Drittvariablen hat nur die Tatsache, mit einem Ehepartner zu leben, einen Einfluss, Gender und sozioökonomischer Status hingegen nicht. Schlussfolgerungen: Zusammenhänge zwischen Gesundheitsstatus und den Versuchen, mit dem Rauchen aufzuhören, werden mit zunehmenden Alter schwächer. Die Bevölkerung scheint sich der Verbindungen zwischen Kreislaufproblemen und Rauchen allmählich bewusst zu werden. Rauchstopp-Versuche werden durch die allgemeine Haltung eingeschränkt, dass Krankheit ein normaler Teil vom Altersprozess ist.Résumé.Association entre l’état de santé et l’intention d’arrêter de fumer : le cas de la HongrieObjectifs : Identifier les liens existant entre le désir d’arrêter de fumer et l’état de santé dans quatre groupes d’âge de fumeurs en Hongrie, selon plusieurs variables sociodémographiques. Méthodes : Une étude transversale a été menée en 2002 auprès d’un échantillon de 12 668 adultes hongrois. Les associations possibles entre l’état de santé et l’intention d’arrêter de fumer ont été analysées au moyen de la régression logistique parmi les actuels fumeurs (N = 3 408). L’influence des variables prédictrices liées à la santé et au statut social a été testée séparément selon le groupe d’âge (18–34, 35–49, 50–64, >65 ans). Résultats : Le fait de souffrir de douleurs thoraciques pousse principalement les jeunes adultes à cesser de fumer. Les fumeurs d’âge moyen envisagent de cesser de fumer lorsqu’ils souffrent de maladie cardiovasculaire. Pour les plus âgés, seule une maladie respiratoire a un effet sur les tentatives de cesser de fumer. Parmi les variables sociodémographiques, seul le fait de vivre maritalement exerce une influence, mais ni le sexe ni le statut socioéconomique. Conclusions : L’association entre l’état de santé et l’intention d’arrêter de fumer diminue avec l’âge. La population ne semble prendre que graduellement conscience des liens existant entre les problèmes cardiovasculaires et le tabagisme. Les tentatives d’arrêter de fumer sont limitées par la croyance générale selon laquelle un état de santé précaire fait partie du processus de vieillissement normal.

Possible association of first and high birth order of pregnant women with the risk of isolated congenital abnormalities in Hungary – a population-based case-matched control study

OBJECTIVE In epidemiological studies at the estimation of risk factors in the origin of specified congenital abnormalities in general birth order (parity) is considered as confounder. The aim of this study was to analyze the possible association of first and high (four or more) birth order with the risk of congenital abnormalities in a population-based case-matched control data set. STUDY DESIGN The large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities included 21,494 cases with different isolated congenital abnormality and their 34,311 matched controls. First the distribution of birth order was compared of 24 congenital abnormality groups and their matched controls. In the second step the possible association of first and high birth order with the risk of congenital abnormalities was estimated. Finally some subgroups of neural-tube defects, congenital heart defects and abdominal walls defects were evaluated separately. RESULTS A higher risk of spina bifida aperta/cystica, esophageal atresia/stenosis and clubfoot was observed in the offspring of primiparous mothers. Of 24 congenital abnormality groups, 14 had mothers with larger proportion of high birth order. Ear defects, congenital heart defects, cleft lip± palate and obstructive defects of urinary tract had a linear trend from a lower proportion of first born cases to the larger proportion of high birth order. Birth order showed U-shaped distribution of neural-tube defects and clubfoot, i.e. both first and high birth order had a larger proportion in cases than in their matched controls. CONCLUSIONS Birth order is a contributing factor in the origin of some isolated congenital abnormalities. The higher risk of certain congenital abnormalities in pregnant women with first or high birth order is worth considering in the clinical practice, e.g. ultrasound scanning.

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

BackgroundInstruments 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.MethodsFollowing 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.ResultsExperts 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.ConclusionsWe 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.