Iván Devosa

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.

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.

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.

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.

Predictive model of repeat induced abortion in Hungary

BackgroundContraceptive and sociodemographic risks of repeat induced abortion have not yet been interpreted in Central Eastern Europe.MethodsA consecutive series of women requesting initial (n=647) or repeat (n=553) artificial abortion were surveyed by means of a questionnaire at a Hungarian university teaching hospital in Szeged, in 2005 and 2006. Self-reported demographic characteristics, attitudes and habits regarding contraceptives were assessed as potential correlates of repeat induced abortion in multivariate logistic regression.ResultsReliable contraceptive methods were applied slightly less frequently in case of repeat versus first abortion seekers (21.0% vs. 20.1%, P=0.72, [odds ratio (OR) = 1.06, 95% confidence interval (CI): 0.80–1.40]). Adjusted odds ratios (AORs) for undergoing repeat versus first abortion increased significantly with age (1.10, 95% confidence interval [CI] 1.07–1.14), more children (AOR: 2.66, 95% CI: 1.57–4.50), secondary education compared to the tertiary level (AOR: 1.15, 95% CI: 1.08–1.30). A better knowledge of the fertile period of the menstrual cycle was present among women who had had previous abortion (AOR=2.05, 95% CI 1.37–3.05).ConclusionsAttitude improvement towards modern contraception and promotion of knowledge of correct use of contraceptives among women with reproductive ages may lead to the prevention of recurrent abortion more effectively. EC: emergency contraceptive pill; NS: not significant

Magzati és anyai betegségek kockázata 40 évesnél idősebb édesanyák esetén

A rising trend in advanced maternal age has been observed over the last few decades. Several studies have assessed the association between advanced maternal age and adverse pregnancy outcome, including miscarriage, stillbirth, pre-eclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, delivery of a small- or large-for-gestational-age neonates and elective or emergency Cesarean section. These studies reported contradictory findings. The aim of the present paper is to summarize the evidence-based information regarding advanced maternal age and pregnancy outcomes.

Epilepsziával szövődött terhesség preconceptionalis és perinatalis kihívásai

Absztrakt Reproduktiv koru, epilepsziaban szenvedő nőknel szamos specialis problema jelentkezhet a mindennapi klinikai gyakorlatban. Az epilepszias gorcsrohamoknak a szules kimenetelere valo hatasa, valamint az alkalmazott antiepileptikus terapia teratogen kockazatanak minimalisra csokkentese gondos odafigyelest es egyuttműkodest igenyel a szulesz-nőgyogyasz es neurologus reszeről. A szerzők attekintik a gorcsrohamok magzatra gyakorolt hatasat, valamint az antiepileptikumok hatasmechanizmusat es teratogenitasat. Orv. Hetil., 2016, 157(15), 563–568.Reproductive-aged women with epilepsy may present a number of specific issues to be managed in daily clinical practice. The impact of epileptic seizures and antiepileptic therapy on pregnancy outcome and the risk of teratogenicity should be minimized, which require careful attention and cooperation between obstetric gynecologyst and neurologist. The aim of the present paper is to review the impact of epilepsy attack on fetus and the pathomechanism and teratogenic effect of antiepileptic drugs.

Szegedi egyetemi hallgatók ismeretei a megbízható fogamzásgátlásról és a szexuális úton terjedő betegségekről

Absztrakt Bevezetes: A promiszkuitas es a megbizhato fogamzasgatlas hianya noveli a szexualis uton atvihető betegsegek előfordulasi valoszinűseget, amely a felmeres szerint az egyetemi hallgatok koreben gyakoribb. Celkitűzes: A vizsgalat celja az volt, hogy felmerjek az egyetemistak megbizhato fogamzasgatlasra es nemi uton terjedő betegsegekre vonatkozo ismereteit, valamint a kozepiskolai szexualis egeszsegneveles hatekonysagat, kiemelt tekintettel a kortars segitők altal vegzett oktatasra. Modszer: A fogamzasgatlasi szokasokra es a nemi betegsegekkel kapcsolatos ismeretekre iranyulo onkitolteses, anonim kerdőives felmerest vegeztek 2009 es 2011 kozott a Szegedi Tudomanyegyetem hallgatoinak randomizalt mintajan (n = 472, 298 nő es 174 ferfi, atlageletkoruk 21 ev). Eredmenyek: A kortars segitők altal tartott iskolai reproduktiv egeszsegnevelő orakat a valaszadok 62,1%-a tartotta megbizhato es hiteles informacioforrasnak, 12,3%-uk itelte kevesbe megbizhatonak, es 25,6%-uk nevezte meg az iskolai felvilagosit...

Eye-Tracking Analysis of the Figures of Anti-Smoking Health Promoting Periodical's Illustrations.

Abstract Nowadays new education technologies and e-communication devices give new measuring and assessing tools for researchers. Eye-tracking is one of these new methods in education. In our study we assessed 4 figures from the anti-smoking heath issues of National Institute for Health Development. In the study 22 students were included from a 7th grade class of a Kecskemét primary school. Our results show that students concentrate on the text-part of the figures except if the picture is frightening. However if the text and the picture are not both frightening enough, the message will not be transferred to young students.