Tamás Bödecs

Gender differences in antidepressant use-related seasonality change in suicide mortality in Hungary, 1998-2006

Abstract Objectives. Studies show that the seasonality of suicide (spring/early summer peak, winter low) is mainly the consequence of the seasonal incidence of depression-related suicides. The aim of the present study was to analyse the relationship between increasing antidepressant utilization and national suicide rate of Hungary between 1998 and 2006, with particular regard to seasonal patterns and gender differences. Methods. Time trend analysis (ARIMA) had been applied to investigate the correlation between the trend of antidepressant prescription and both of suicide rates and seasonality index. Results. During the 9 years of the study period there was a significant (P<0.001) correlation between the steadily increasing antidepressant prescription (113%) and continuous decline in total national suicide rate (23%) as well as both in females and males (21 and 23%, respectively), but this relationship was 8-fold stronger in males. Increasing antidepressant utilization was associated with significantly decreased seasonality of suicides only among males. Conclusions. The results suggest that decreasing seasonality of suicides could be a good marker of lowering rate of depression-related suicides in the population particularly among males.

Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period

Abstract Objective: To assess neonatal outcomes and associated findings in pregnant women identified after delivery as having had underlying subclinical chorioamnionitis by either histology or bacterial culture. Methods: In 16 years, 8974 clinical, histological, and bacterial culture data were obtained retrospectively. Results: Placental histology was analyzed in 4237 pregnancies (2785 term and 1452 preterm) and 4737 amniotic cavity cultures were obtained during 5446 cesarean deliveries (3268 term and 1469 preterm). Histological results and bacterial cultures were both available in 1270 of the preterm deliveries. Histology revealed inflammation, suggestive of infection, in 13.6% of placentas. Subclinical acute chorioamnionic inflammation was confirmed in 142 out of 2785 term pregnancies (5.1%) and in 436 out of 1452 preterm pregnancies (30.0%, P<0.001). Bacteriological culture of the intrauterine cavity was obtained from the lower uterine segment of the uterus during cesarean section. A positive culture was found in 19.9% of all cases (941/4737), this proportion was significantly higher in preterm deliveries (343/1273, 26.9%) than in term (17.3%, P<0.001). The lower the birth-weight or gestational age, the higher the frequency of silent infections in the uterine cavity. Conclusions: Our study findings support the association between intra-amniotic infections and preterm delivery.

Histological chorioamnionitis is associated with cerebral palsy in preterm neonates.

OBJECTIVE To determine the interaction between histological chorioamnionitis and unexplained neonatal cerebral palsy among low birth weight infants. STUDY DESIGN We studied 141 preterm infants below 1500 g delivered between 2000 and 2010. Clinical data, neonatal neuroimaging, laboratory results, the histopathological features of the placenta and gastric smear within the first hour of delivery, were evaluated. RESULTS Cerebral palsy was detected in 11 out of 141 preterm newborns (7.8%). The incidence of silent histological chorioamnionitis was 33.6% (43 of 128 cases). Chorioamniontis was significantly associated with the risk of unexplained cerebral palsy (p=0.024). There were also significant correlations between maternal genital infections and chorioamnionitis (p=0.005), and between maternal infections and a positive smear of neonatal gastric aspirates (p=0.000). The rate of cesarean section was 67.4% (95 out of 141 deliveries), and elective cesarean section was performed in 68 cases. CONCLUSION Intrauterine exposure to maternal infection was associated with a marked increase in the risk of cerebral palsy in preterm infants.

PREVALENCE OF DEPRESSION AND ANXIETY IN EARLY PREGNANCY ON A POPULATION BASED HUNGARIAN SAMPLE

UNLABELLED In Hungary, no survey has been conducted so far concerning of the incidence of depression and anxiety during pregnancy. AIM Besides determining missing data, the aim was to scrutinize their socio-demographic relations. METHODS A population-based monitoring system was established in 10 districts of health visitors in Szombathely. The system covered every woman who was registered as pregnant between 1st February 2008 and 1st February 2009. 307 expectant women in the early stage of their pregnancy were surveyed using the Short Form of Beck Depression Inventory, which enabled the measurement of depression whereas the Spielberger Trait-Anxiety Inventory was used for the measurement of anxiety. RESULTS 17.9% (95%CI: 13.0-21.5%) of pregnant women showed signs of depression, 1.0 % of whom had severe depression. 14.6% of them showed signs of anxiety (95%CI: 10.7-18.6%), moreover, 4.2 % of them had explicit angst. Depression and anxiety proved to be significantly more prevalent among unskilled workers, those with low incomes and unemployed women. Depression turned out to be significantly more prevalent among women under the age of 18, and those living in common-law relationships. CONCLUSIONS In the examined sample, prevalence of depression and anxiety during early pregnancy basically coincides with the situation in developed countries.

Association between health beliefs and health behavior in early pregnancy

Folate-supplementation significantly reduces the risk of neural tube defects. The aim of this research was to reveal associations between health beliefs and folate -supplementation as well as other elements of health behavior among Hungarian women early in their pregnancy. Three-hundred and seven women in early pregnancy completed the second part of Health and Illness Scale. Factor structure of health beliefs was established and associations of factors with pregnancy planning, folate-intake, vitamin-intake, smoking-habits and alcohol-consumption were tested. A six factor health model was formulated; the factor named ‘mental capacities and abilities’ was associated with greater chance on folate-intake, vitamin-intake and prepared pregnancy, as well as a reduced chance of smoking. The factors ‘destiny’, ‘measures aiming at prevention’, and ‘relatives and acquaintances’ related to lower chance on folate-intake. The health belief factor representing Internal Health Locus of Control was associated with more than one component of healthy behavior, while factors of external dimensions (Powerful Others Health Locus of Control and Chance Health Locus of Control) were predictive on unhealthy behavioral tendencies. New approaches aiming to shift one’s health beliefs and health locus of control from external causes to internal dimensions are needed in order to reach greater openness towards health-improving interventions.

The metabolic syndrome and the risks of unfavourable outcome of pregnancy

UNLABELLED The metabolic syndrome is defined by abdominal obesity, elevation of blood pressure, fasting glucose and triglycerides and low levels of high-density lipoprotein cholesterol. The metabolic syndrome may play an important role in the pathogenesis of unsuccessful pregnancy, by including a pro-inflammatory and prothrombotic state. Some authors have suggested that in case of metabolic syndrome the LMW heparin therapy given from the time of conception has a favourable effect. The aim of our study was to elucidate the association of the metabolic syndrome with the risk of unsuccessful pregnancy. DESIGN AND METHODS During the study period 2005-2008 (4 years) we followed 5869 pregnancies. Retrospectively, 172 (2.9%) patients met the criteria of metabolic syndrome at the time of the first trimester. RESULTS The rate of premature birth was 15.1% [26/172 in the metabolic syndrome group vs. 11.7%; OR: 1.52 (95% CI: 0.996-2.33) p=0.051], in control group. Within the affected group 32 pregnancies were complicated with intrauterine grow retardation (18.6%); versus 3.6%, in the unaffected group; OR: 6.38 (95% CI: 4.24-9.61 p<0.001). In 47 cases we observed preeclampsia during pregnancy [27.3%; vs. 4.7%; OR: 7.93 (95% CI: 5.54-11.33) p<0.001] in the control group. Among the patients affected by the metabolic syndrome 67 patients (38.2%) had more then one pregnancy complications during pregnancy, and only 47 cases (27.3%) were lacking adverse events during pregnancy and delivery [OR: 3.11 (2.27-4.26) p<0.001]. CONCLUSIONS Our study demonstrated higher rate of complicated pregnancies in association with metabolic syndrome compared to the control group. In addition, we started a prospective study in 2007, using LMWH therapy to prevent thromboplastic and atherosclerotic effects of the metabolic syndrome. The study is planned to be reported in 2010 to assess the effect of LMWH therapy on the outcome of pregnancies.

Association of lean and fat body mass, bone biomarkers and gonadal steroids with bone mass during pre- and midpuberty.

Background/Aims: The association of bone mass with body composition, bone turnover markers and gonadal steroids was examined in Hungarian children during pre- and midpuberty. Methods: Two hundred and thirty-seven 7- to 16-year-old subjects (56% girls) were investigated. Bone mineral density (BMD), fat mass and total and appendicular lean mass were estimated with dual-energy X-ray absorptiometry (Lunar Prodigy). The fat mass index and appendicular lean mass index (LMI) were calculated. Serum bone markers, parathyroid hormone, estradiol and testosterone were analyzed. Associations between variables were evaluated by multiple regression analysis. Results: During prepuberty, bone biomarkers, gonadal steroids and appendicular LMI were associated with bone mass in both genders (p < 0.05). During midpuberty, girls’ bone turnover markers were negatively associated with bone mass (p < 0.001). In prepuberty, appendicular LMI and β-crosslaps were predictors of bone mass in both genders. During midpuberty, appendicular LMI and gonadal steroids positively contributed to bone mass in both genders, while osteocalcin exerted a negative influence on total and L1–L4 spine BMD in girls and on L1–L4 BMD in boys (all p < 0.001). Conclusions: Predictors for bone development varied according to Tanner stage and gender. The most significant determinants of bone mass were appendicular LMI and estradiol.

Metabolic syndrome in normal and complicated pregnancies.

BACKGROUND The aim of our study was to elucidate the association of the metabolic syndrome with the risk of unsuccessful pregnancy. METHODS This was a retrospective observational study conducted at Markusovszky Teaching Hospital, Szombathely, Hungary, a tertiary health care center. During the study period of 2007-2011 (5 years), 7373 pregnancies were followed. Pregnant women who were suffering from metabolic syndrome in the first trimester of gestation during the study period were compared to all other pregnant women without the syndrome. Retrospectively, 219 (2.9%) patients met the criteria of metabolic syndrome during the first trimester. Our goal was to evaluate the prevalence of the metabolic syndrome in normal pregnancies and in those complicated by either premature birth, or intrauterine growth retardation (IUGR), pregnancy-induced hypertension, and preeclampsia. RESULTS The rate of preterm birth was 15.2% [32/219 in the metabolic syndrome group vs. 11.1% (p=0.051) in the control group]. Within the affected group, 40 pregnancies were complicated with IUGR (18.4%) versus 3.3%, in the unaffected group (p<0.001). In 58 cases, we observed preeclampsia during pregnancy [26.7% vs. 5.2% (p<0.001)] in the control group. Among the patients affected by the metabolic syndrome, 83 patients (38.2%) had more then one pregnancy complication during pregnancy, and only 59 cases (27.2%) had no adverse events during pregnancy and delivery (p<0.001). CONCLUSIONS Our study demonstrated a higher rate of complicated pregnancies in association with metabolic syndrome compared to the control group.

Screening pregnant women for group B streptococcus infection between 30 and 32 weeks of pregnancy in a population at high risk for premature birth

To assess the benefits of a chemoprophylaxis program based on screening women for group B streptococcus (GBS) infection between 30 and 32 weeks of pregnancy in a population with a high rate of premature births.

[Effect of demographic factors on folate-supplementation and health-behavior of pregnant women].

UNLABELLED The aim was to scrutinize associations between folate-supplementation and other elements of health-behavior and demographic factors in pregnant women. METHODS A population-based monitoring system was established in 10 districts of health visitors in Szombathely, Hungary. The system covered every woman registered as pregnant between 1st February 2008 and 1st February 2009. RESULTS Young age and lower educational level is associated with less preparation for pregnancy. Those who were prepared for pregnancy, folate-intake was more than twofold, vitamin-intake was threefold higher, while prevalence of smoking was the 50% less, compared to non-prepared women . Older age, higher educational and socio-economic level was positively, while number of siblings was negatively associated with folate-supplementation. Pregnant women with low level of education (OR = 4.72; 95% CI = 2.34-9.51), and living in common-law relationships had higher chance to smoke (OR = 2.74; 95% CI = 1.54-4.89). CONCLUSIONS Pregnant women who do not receive folate-supplementation are younger, have lower educational and socio-economical status and show other unhealthy behavioral tendencies.