Zsuzsa Szántó

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.

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.

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.