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Journal of Nursing Theory and Practice

AUGUST 30, 2013

[Factors influencing job satisfaction by health care workers]

NÉMETH Anikó

[The healthcare workers spend most of their lifetime at the workplace. Job satisfaction is influenced by many factors some of which are connected to the working environment, physical safety at workplace, salary, social relations at workplace and the position in the workplace hierarchy. The diversity of the job, the level of control at workplace, the amount of skills required for the position, the quantity and quality of social relations all contribute to the level of job satisfaction. When the job does not satisfy the most important needs of the workers, job dissatisfaction develops. Dissatisfaction may have many different consequences. It impacts the work performance, extends the length of sick leaves and increases the intent to leave the career. When the health care worker experiences general bad mood, spleen and low self esteem at the workplace, it has a negative influence not only on job satisfaction, but even emotional exhaustion, prolonged anxiety and depression might develop in consequence.]

Clinical Neuroscience

JULY 30, 2013

[Survey of adults with epilepsy in Hungary: health related quality of life and costs]

PÉNTEK Márta, BERECZKI Dániel, GULÁCSI László, MIKUDINA Boglárka, ARÁNYI Zsuzsanna, JUHOS Vera, BAJI Petra, BRODSZKY Valentin

[Background and purpose - Disease burden of epilepsy in Hungary is underexplored. The aim of our study was to assess the quality of life and costs of adults with epilepsy. Methods - Cross-sectional questionnaire survey was performed in two hospital based outpatient neurology centres involving consecutive patients with epilepsy. Demography, clinical characteristics, health status (EQ-5D) and health care utilisation in the past 12 months were surveyed. Cost calculation was performed from the societal perspective. Results - Altogether 100 patients (women 58%) were involved, their mean age was 37.6 (SD=12.5) years. Disease duration was 15.0 (SD=12.1) years on average and 22 (22%) patients were disability pensioners. The EQ- 5D score was mean 0.83 (SD=0.24) which is significantly lower than the age-matched population norm (p=0.017). Pain/discomfort and anxiety/depression are the most problematic health dimensions. The annual cost per patient was mean 2421 (SD=3249) Euros (679 397 SD=911 783 HUF; conversion: 1 Euro=280.6 HUF), distribution between direct medical, direct non-medical and indirect costs was 33%, 18% or 49%. Patients with seizure in the past 12 months have higher cost on avergare than the asymptomatic subsample (3119 vs. 988 Euros/patient/year; 935 481 vs. 277 209 HUF/patient/year). Conclusion - Adults with epilepsy have significantly worse health status by the EQ-5D than the gender and age matched Hungarian general population. Disease related costs are significant especially in cases with seizure, productivity loss related costs are dominant. Our study provides basic data for clinical and sustainable health care financing decisions.]

Lege Artis Medicinae

APRIL 20, 2013

[Detection of endemic MRSA colonisation in a retirement home]

STÁNITZ Éva, TOMPITY Tünde, UNGVÁRI Erika, PÁSZTI Judit

[Methycillin-resistant Staphylococcus aureus (MRSA) colonisation was proved in a retirement home. A resident of the social institution (a 83-year-old man) was hospitalised and was cared for in a ward where a patient positive for MRSA was treated. Screening tests of the above mentioned resident, one of his room-mates at the retirement home as well as three of the four nurses being on duty at the weekend when the man returned to the social institution from the hospital proved the presence of MRSA colonisation. The screening test, which had been extended to the whole staff due to epidemiological reasons and also because of their anxiety, revealed MRSA positivity in the throat and nasal mucus of a fourth nurse. We presumed that the patient released from the hospital had infected his roommate as well as the four nurses. In order to investigate the epidemiological correlations we requested the cultured strains to be typified. With the use of phage typification, three different types of MRSA strains were identified in the six persons positive for MRSA, and a further MRSA strain could not be typified with the basic phage sequence. We review some interventions with regard to the avoidance and prevention of methycillin- resistant Staphylococcus aureus infection, which we had the opportunity to order as well as implement at the retirement home. We raise some of the problems we encountered.]

Lege Artis Medicinae

JANUARY 20, 2013

[Fear of medical care: epidemiology and prevention among 5-6 years old children]

PÓCS Dávid, SIKLÓSI Réka, NYÁRI Tibor, BARABÁS Katalin

[INTRODUCTION - At least 5-10% of the adult population is afraid of medical care. These fears may begin in preschool years. Therefore, the aim of our study was to assess the rates of medical fears among 5-6 year old children, and to prove that medical fears can be reduced by a health promotion program for children called “Teddy Bear Hospital” POPULATION AND METHODS - 248 children participated in the study (average age: 5.5 years, 45% girl, 55% boy). The “Teddy group” (129 children) took part in the Teddy Bear hospital program (Teddy group). The control group (119 children) did not take part in this program (control group). Questionnaires, including a Visual Analog Scale, a picture test, and drawing analyses were completed on two separate occasions three weeks apart difference. RESULTS - Fear of needles was the most frequent fear (59%) among the participating children, followed by the fear of medical environment (33%), the fear because of the lack of information (27%), the fear of doctors (20%), and the fear of pain (15%). On the basis of the picture test the fear of doctors significantly decreased in the Teddy group (from 18% to 7%) compared with the control group (from 10% to 11%, p<0.05). Drawing analyses also showed that children in the Teddy group had significantly lower levels of medical anxiety (29% and from 19.3 point to 17.6 point) than the control group (19% p<0.05 and from 18.8 point to 18,33 point p<0.05). On the drawings of the Teddy group we found significantly more new medical information (38%) compared with the control group (21%, p<0.05). CONCLUSIONS - Medical fears are frequently present among 5-6 year old children, therefore, their prevention is greatly needed. A potential way of the prevention is the “Teddy Bear Hospital” program, which efficiently reduces children's medical fears and anxiety.]

Clinical Neuroscience

JULY 30, 2012

[Neurophobia]

SZIRMAI Imre

[Neurophobia is the fear of neurological diseases. Its main symptom is that medical students and young doctors are not able to utilize their basic neurological knowledge at the bedside. According to statistics, every second student suffers from neurophobia. This attitude could explain why in the last two decades less and less young doctors wanted to become neurologist. Medical students complain that they receive no instructions, and are afraid of loosing their interest and of facing the failure of their competency. The hardship of neurology was explained by the insufficient knowledge of anatomy and the infrequent encounter with patients. Even general practitioners have anxiety about neurological patients. The loss of interest in neurosciences seems to associate with insensitivity of human-centered culture and corruption of empathic thinking. The burnout syndrome of medical doctors and students can be explained by stress, loss of respect, permanent competition, independency that interferes with responsibility, stiff hierarchy of medical society, fear of diagnostic failures and of economical difficulties. The scores of depression in female students were higher than in male. The idea of the “good neurologist” has been changed. The business oriented care, the shortage of time, and the financial restrictions corroded the conventional practice and ceased the vocational idealism. At present, personal teaching is going to transform into impersonal multimedia learning. Because of the drastic change of values, the age of inner-oriented professionals has terminated also in the medicine. Medical doctors follow even less the traditional troll of professional behavior, but according the social demands, they choose their specialization for subsistence. The highly esteemed social status of neurologists and psychiatrists is going to sink in Europe. To reduce neurophobia it would be desirable 1. to introduce neurology training in the early years of medical school; 2. to teach neurology in all semesters, 3. to assure the effective teaching of neuro-anatomy and physiology, 4. to organize more one-to-one teacher-student communication. In the United States, residents participate in teaching during their residency training. To master neurology dedicated teachers are necessary whom neurology residents ought to meet personally with optimal frequency. However, these requirements seem to fail because of the chiefly technical characters of the actual reforms.]

Clinical Neuroscience

JULY 30, 2012

[Are oppressive dreams indicators in bereavement?]

PUREBL György, PILLING János, KONKOLY THEGE Barna, BÓDIZS Róbert, KOPP Mária

[Objectives - It is widely believed that oppressive dreams are frequent in bereavement - despite the lack of scientific investigations of the subject. The aims of our study were the analysis of dream quality as well as the correlates of oppressive dreams in bereavement. Method - Participants with (N=473) and without bereavement were compared upon the database of a national representative study (Hungarostudy Epidemiological Panel Survey 2006, N=4329). Dream contents were assessed with the Dream Quality Questionnaire (DQQ). Depressive symptoms (BDI-S) and the presence anxiety were also investigated. Results - Oppressive dreams occurred significantly higher frequency in the first year of bereavement (men: F=17.525, p<0.001, women: F=8.291, p=0.004). Oppressive dreams were significantly associated with anxiety (F=37.089, p<0.001) and with depressive symptoms (F=50.562, p<0.001). Discussion - Oppressive dreams are significantly more frequent in the first year of bereavement, and may act as indicators of bereavement-linked mental health consequences like depression and anxiety. These are often masked by the symptoms of grief and therefore remain untreated. Our preliminary results could be a starting point for the development of further research aiming to clarify the relationship amongst dream contents, anxiety, and depression in bereavement.]

Clinical Neuroscience

MAY 30, 2012

[Effect of two month positive airway pressure therapy on the structure of sleep, cognitive function and anxiety]

CSÁBI Eszter, VÁRSZEGI Mária, SEFCSIK Tamás, NÉMETH Dezsõ

[Obstructive sleep apnea is a common disorder, characterized by repeated episodes of upper airway obstruction during sleep, resulting intermittent hypoxia and disruption of the normal sleep pattern, which caused cognitive dysfunction in these patients. Nasal continuous positive airway pressure is the treatment of choice for this disorder. The aim of the study is to evaluate the effect of short-term positive airway pressure on sleep pattern (polisomnographic measures), cognitive function and anxiety. Twenty four newly diagnosed and previously untreated patients with obstructive sleep apnea were evaluated a battery of neuropsychological tests before and after 2 and a half months of the treatment. We focused on working memory, short and long-term episodic memory, executive functions, anxiety and subjective sleepiness. Our results showed that the two and half month of treatment improved the respiration during sleep, sleep pattern and the subjective sleepiness. We found improvement in short- and long-term verbal memory, and complex working memory. Despite of treatment we did not find improvement in visuospatial learning. These results reveal that 2 and a half months of positive airway pressure treatment restored not only the normal respiration during sleep and normal sleep pattern, but also the cognitive functions. Our study suggests that cognitive dysfunction is at least partial reversible in obstructive sleep apnea patients after positive airway pressure treatment.]

Lege Artis Medicinae

DECEMBER 21, 2011

[Oxytocin as a neurotransmitter: beyond the peripheral scope]

VARGA Katalin

[Besides its effect on the uterus and breasts, oxytocin also regulates affiliative behaviour. The so-called central oxytocin effect influences pair bonding, maternal care and attachment through the regulatory functions of oxytocin that acts as a neurotransmitter within the brain. The central oxytocin effect increases trust and social support, decreases fear and anxiety, and promotes wound healing. These effects form the basis of the stress-triggered, oxytocin-based ‘calm and connection’ reaction. Some methods that are widely used in modern obstretric practice - such as the use of synthetic oxytocin for inducing or speeding up labour or epidural anaesthesia - hinder the psycho-emotive effects that are based on natural oxytocin. Epigenetic studies performed in animals indicate that the oxytocin effect experienced at birth can be transgenerational.]

Lege Artis Medicinae

NOVEMBER 20, 2011

[“Boys as victims”, or the potential public health consequences of childhood physical abuse]

GYŐRFFY Zsuzsa, IMOLA Sándor, CSOBOTH Csilla, KOPP Mária

[BACKGROUND - Whereas the scientific literature regarding physical abuse primarily focuses on female victims, few studies have been performed on the childhood abuse of men. The aim of our study was to examine the potential effects of childhood physical abuse of men on adult mental health status. METHODS - Data of 4675 male participants of the Hungarostudy nation-wide representative survey were analyzed. RESULTS - Altogether almost 13% of our study group reported physical abuse by a parent or other significant person. Compared with men who did not report abuse, depression, suicidal thoughts and attempts were significantly more common among abused men. Smoking, alcohol- and drugabuse, anxiety disorders and sleeping disorders also had a higher occurence. Moreover, we established that abused men had a significantly greater risk of marital distress and were more likely to have fewer children. Interpretation of the results in a multivariate model indicated that physical abuse is a determinate and independent risk factor of depression, suicidal thoughts and attempts, smoking habits and alcohol abuse. CONCLUSIONS - Our results underline that childhood physical abuse can have a significant effect on numerous mental disorders and maladaptive behaviours in adulthood. However, the deeper understanding of the relationship between physical abuse and mental disorders necessitates further studies.]

Lege Artis Medicinae

JUNE 20, 2010

[Future perspectives and health conditions of recently graduated physicians]

PAPP Szidónia, TÚRY Ferenc

[INTRODUCTION - The purpose of our study was to survey the opinion of students graduating in 2008 at the Semmelweis University Faculty of Medicine about university education, future perspectives and physical as well as their mental health conditions. We have considered factors that might cause or might protect against burnout syndrome. METHODS - The electronic questionnaire has been sent to all graduating students and included the Beck Depression Inventory, the Hungarian version of Spielberger’s State-Trait Anxiety Inventory (STAI), which assesses anxiety, the Hungarian adaptation of the Maslach Burnout Inventory for Human Profession modified for students and the CAGE test, which evaluates alcohol consumption. The questionnaire included general questions concerning medical school education, health condition, support from the community, future perspective and livelihood. RESULTS - 31.4% of the graduating class (94 people) answered the questionnaire. These former students felt that the theoretical education at the university was of high quality; however, 61% considered the practical education insufficient. At the beginning of their careers, merely 5% of the young physicians felt well-prepared professionally. 30% of the responders reported a high degree of burnout; 59% would like to work abroad, and 26% were considering leaving the field of healthcare. A quarter of the students had psychosomatic symptoms. CONCLUSIONS - After graduating from medical school, young physicians have to face the difficulties of finding a job, an unstable livelihood and a high risk of burnout syndrome. The high percentage of young medical school graduates leaving the profession as well as the high migration rate might contribute to the growing problems of the healthcare system.]