J Betlehem

The changing face of European healthcare education: The Hungarian experience

Throughout Europe, higher education is undergoing great changes in order to establish what is being called the European Higher Education Area (EHEA) based on the Bologna process. The goal being the establishment of a uniform, transparent and efficient development of professionals in a higher education system that can react in a flexible way to the changes in the labor market, and to the challenges presented by increasing globalization. The aim of this article is to provide an overview of the Bologna process and to give a summary of the implemented initial stages in the health care higher education of Hungary. As a consequence, the Hungarian higher education in healthcare has undergone considerable reforms to facilitate transition into this new system. The results indicate that the new structure in health sciences is not compatible with other way of European countries of introducing Bologna reforms, although the content of the former BSc curriculum still remained the same. MSc programs are still being discussed.

Training nurses for CPR: support for the problem-based approach.

Aim: to assess whether problem-based learning (PBL) is more effective over conventional teaching methods by comparing final resuscitation exam results of nursing students who received cardiopulmonary resuscitation (CPR) training either by traditional or by a PBL approach. Methods: A retrospective and comparative research design was implemented. Data on final CPR exam grades, collected both from PBL and traditionally trained students, were obtained for a total of 1775 students between 2000 and 2007 in three major schools of health sciences in Hungary. Comparison between PBL and traditional teaching methods as well as across schools was made. Results: t-tests on means yielded significant differences (t = 3.569; p < 0.001) between PBL and conventional training favoring PBL instructed students. Students who received PBL training had better final CPR exam grades than traditionally trained peers. The only significant difference among schools was found for PBL training. There was no difference across schools in final CPR grades when traditional training was concerned. Conclusion: PBL was a superior instruction method for CPR training. Students who attended PBL classes achieved greater theoretical knowledge and demonstrated better resuscitation skills when tested. Whether or not PBL is superior in real-life application of CPR practice is yet to be confirmed.

Development of health economics in Hungary between 1990-2006

cz1,2 · Csa ba Dózsa3 · Zoltán Kaló4 · Lás zló Nagy5 · Bar bara Borc sek3 · Ágnes Brandt müller6 · József Betle hem7 · An dor Sebestyén8 · Lás zló Gulác si6 1 De part ment of Health Pol i cy, Na tion al Health In sur ance Fund Ad min is tra tion (OEP), Bu dapest, Hun gary 2 In sti tute of Di ag nos tics and Man age ment, Fac ul ty of Health Sci ences, Uni ver si ty of Pécs, Pécs, Hun gary 3 Min istry of Health, Bu dapest, Hun gary 4 No var tis, Bu dapest, Hun gary 5 MSD, Bu dapest, Hun gary 6 De part ment of Pub lic Pol i cy and Man age ment, Unit of Health Eco nomics and Health Tech nol o gy As sess ment, Corv i nus Uni ver si ty Bu dapest, Hun gary 7 In sti tute of Nurs ing and Clin i cal Sci ences, Fac ul ty of Health Sci ences, Uni ver si ty of Pécs, Pécs, Hun gary 8 Coun ty Baranya Health In sur ance Fund Ad min is tra tion, Pécs, Hun gary

Emergency medical preparedness during the 2006 World Cup in Frankfurt, Germany

This paper describes emergency medical preparedness during FIFA (Fédération Internationale de Football Association) World Cup matches in Frankfurt, Germany, in 2006. The methods employed were document analysis and personal observation of games over five days in June-July 2006. The medical authorities in Frankfurt drew on a wide range of scientific literature and experiences to elaborate a National Concept. They paid attention to different models of handling mass catastrophes in shaping the final version of the document. The participation of designated authorities, associations, and volunteer organisations was coordinated sufficiently and the games in Frankfurt proceeded without great incident, even though more than 300,000 people in total attended. The adopted emergency medical procedure was appropriate for a mass gathering event. Official and volunteer organisations collaborated precisely in emergency preparedness. While one uniform concept for all mass gatherings events cannot be developed, case reports and experiences are useful tools.

Selective association of endogenous ouabain with subclinical organ damage in treated hypertensive patients

According to previous studies endogenous ouabain (EO) closely correlates with high blood pressure, congestive heart failure and kidney disease in humans. Our aims were to analyse associations between plasma, urinary EO level and various markers of cardiovascular damage in treated hypertensive patients. Forty-one adult patients with hypertension and/or diabetes mellitus (DM) and/or chronic kidney disease (CKD) were studied. We assessed plasma and urinary EO, pro-brain natriuretic peptide and catecholamines, profile of ambulatory blood pressure monitor and cardiovascular status by echocardiography and echo-tracking. The highest level of plasma EO (19.7±9.5 pmol l–1) was measured in hypertensive patients with DM and CKD. The nighttime mean arterial blood pressure independently correlated with the level of plasma EO (P=0.004), while independent predictor of the β-stiffness of carotid artery was the urinary EO (P=0.011). Elevated level of EO was associated with nighttime blood pressure and subclinical organ damage in treated hypertensive patients, suggesting possible role of EO in the pathogenesis of impaired diurnal blood pressure rhythm and arterial stiffness.

Major contributing factors of self perceived health in Hungarian ambulance personnel

UNLABELLED Health status of ambulance personnel has an important impact on the quality of patient care. Surveys in some smaller regions of Hungary have been conducted on health behavior of ambulance personnel; however they do not mirror the complexity of multidimensional health status in this respect. The aim of the present study is to examine the self-perceived health status of ambulance personnel (AP) and its most salient work related and individual factors. METHODS A quantitative cross-sectional survey was carried out among AP of the Hungarian National Ambulance and Emergency Service in 2008. The survey covered all the regions and sample taking ensured the study to be of representative value. Anonymously 364 individuals gave their answers that could be evaluated. After data procession and coding, records were statistically analyzed by SPSS 15.0. Spearman correlation, chi-square test and multivariable logistic regression analyses were applied to measure the significance of variables. The survey was conducted with a self-fill-in questionnaire measuring the following dimensions of self-perceived health: self-rated health, self-rated physical fitness and limitation in daily activities by health problems. RESULTS The results revealed that self-perceived general health status of ambulance personnel does not differ significantly among the emergency units in many terms. However, there are significant differences regarding the complexity of the duties what they have to deal. In their self rated health 1.9 times (95% CI:1.2-2.8), in their self rated physical fitness 2.0 times (95% CI:1.3-3) and in the limitation of daily activities by health problems 1.9 times (95% CI:1.2-3.1) those ambulance personnel feel more favorable who do any kind of sports activity. Generally they experience serious stress; they have not enough leisure time and hardly do sport. Due to their bad lifestyle all fifth ambulance personnel suffer from serious obesity. CONCLUSION Physical activity may enhance self perceived health even though if the person delivers physical symptoms. Regular training to increase the physical fitness should be implemented for ambulance personnel that could well contribute to copying with psychological trauma.

PREHOSPITAL EMERGENCY CARE IN HUNGARY: WHAT CAN WE LEARN FROM THE PAST?

BACKGROUND In Hungary, prehospital emergency medical services are provided by the National Ambulance Service. The 60(th) anniversary of the National Ambulance Service provides a good opportunity to give an overview of the current trends in prehospital emergency medical care in Hungary. OBJECTIVES In this report, a description of the organizational structure and the latest developments in the National Ambulance Service are described with the intention to highlight future directions in emergency medical services, as well as the influence of international trends in emergency patient care. RESULTS In Hungary, the ambulance cars are staffed by two or three crew members trained in rescue, stabilization of the patients status, transport, and advanced care of traumatic and medical emergencies. There are three major levels of care provided by ambulance personnel: a basic level ambulance crew (Emergency Medical Technician Unit), a second level (Ambulance Officer Unit), and the highest level (Emergency Physician Unit). The personnel on the latter two units are trained in all aspects of Basic Life Support and Advanced Life Support procedures for prehospital emergency care. Following the latest international developments in medical rescue devices and guidelines, all staff are retrained yearly. Recently, private services for transportation for non-acute illnesses have been introduced, allowing the National Ambulance Service to concentrate on emergencies only. CONCLUSIONS Although the Hungarian Ambulance Service has a very long and meaningful past and a respected professional development, new challenges facing prehospital emergency care are inevitable and continuous development is necessary.

‘The year of first aid’: effectiveness of a 3-day first aid programme for 7-14-year-old primary school children

Aim of the study Bystanders can play an important role in the event of sudden injury or illness. Our aim was to evaluate the effects of a 3-day first aid course for all primary school age groups (7–14 years old). Methods 582 school children were involved in the study. Training consisted of three sessions with transfer of theoretical knowledge and practical skills about first aid. The following most urgent situations were addressed in our study: adult basic life support (BLS), using an automated external defibrillator (AED), handling an unconscious patient, managing bleeding and calling the ambulance. Data collection was made with a questionnaire developed for the study and observation. Students were tested before, immediately after and 4 months after training. Results were considered significant in case of p<0.05. Results Prior to training there was a low level of knowledge and skills on BLS, management of the unconscious patient, use of an AED and management of bleeding. Knowledge and skills improved significantly in all of these categories (p<0.01) and remained significantly higher than the pre-test level at 4 months after training (p<0.01). Younger children overall performed less well than older children, but significantly improved over the pre-test level both immediately and 4 months after training (p<0.01). Prior first aid training was associated with knowledge of the correct ambulance number (p=0.015) and management of bleeding (p=0.041). Prior to training, age was associated with pre-test knowledge and skills of all topics (p<0.01); after training, it was only associated with AED use (p<0.001). There was a significant correlation between the depth of chest compression and children’s age, weight, height and body mass index (p<0.001). Ventilation depended on the same factors (p<0.001). Conclusion Children aged 7–14 years are able to perform basic life-saving skills. Knowledge retention after 4 months is good for skills, but thinking in algorithms is difficult for these children.

Cross-sectional survey on self-reported health of ambulance personnel

BackgroundThe high job stress among ambulance personnel is a widely known phenomenon. Purpose: to asses the self reported health status of ambulance workers.MethodsAn anonym self-fill-in questionnaire applying SF-36 was used among workers from the northern and western regions of Hungarian National Ambulance Service.ResultsBased on the dimensions of the SF-36 questionnaire the respondents considered their “Physical Functioning” the best, while “Vitality” was regarded the worst. The more time an employee have been worked at the HNAS the worse his health was in the first four dimensions like, “Physical Functioning”, “Role-Physical”, “Bodily Pain”, “General Health”: p < 0.001. Those working in secondary part-time jobs considered their health in all dimensions worse. The respondents who did some kind of sports hold their health in all dimensions better (p < 0.001). The workers with higher BMI regarded their health status worse, in four dimensions: “Physical Functioning”: p = 0.001; “Role-Physical”: p = 0.013; “General Health”: p < 0.001; “Role-Emotional”: p = 0.05.ConclusionsThe workers health status proved to be insufficient according to the subjective perception and measurable parameters. According to the subjective perception of health and measurable parameters of health status of workers proved to be insufficient. Poor physical health can lead indirectly to psychological problems, which may lower the quality of the work and can lead to high turn-over.

IS 'MEANINGFULNESS' A GENERAL MEDIATING FACToR? The Salutogenic Revolution of Question-Setting in Health Science and occupational Psychology

According to our earlier researches – stating that on the one hand in the career competency of the examined subjects, out of the Core Job Dimensions present in the Hackman-oldham Job Char acteristic Model, only Meaningfulness (task significance) contributed significantly to inducing favourable Personal and Work outcomes, and on the other hand, among the components of the Sense of Coherence, portrayed as a health and well-being factor in Antonovsky’s Salutogenic Model, it was Meaningfulness that had a preeminent role – we asked the question: to what extent can this positive effect of Meaningfulness be further generalized? That is, regarding women in Hungary who choose a healthcare career, whether Meaningfulness felt within their job motivates them with a significant enough force to be a counter-effective factor to job abandonment (especially frequent in Hungary), to persevere despite the difficult circumstances. From a methodical point of view, we completed a quasi-case study in the circle of 158 female students taking health care courses and 79 women working in healthcare for at least five years. As control groups we used the age- and sex-standardized random samples of non-healthcare students as well as workers. Here, Meaningfulness within the Sense of Coherence proved to be the significant factor for staying in the healthcare profession. Practical conclusion of the research: during the training in healthcare courses, an emphasis has to be laid upon developing the Sense of Meaningfulness in the person, by means of establishing life-career models, personal career design, and creating the chances of a healthier lifestyle.