József Vitrai
6603855839
Publications - 12
A global framework for integrating public health into wellbeing: why a public wellbeing system is needed
Publication Name: Frontiers in Public Health
Publication Date: 2025-01-01
Volume: 13
Issue: Unknown
Page Range: Unknown
Description:
There is a growing focus on public health initiatives that prioritize wellbeing. The main question of our study is whether this, in its current form, can really represent a new response to the challenges of previous strategies, or whether there is a greater chance that it will essentially reproduce the problems associated with the paradoxical situation of public health. Based on a review, analysis and evaluation of the literature on wellbeing in public health, we outlined the foundations of a new meta-theory of wellbeing and a possibility for its social application. In our view, wellbeing is seen as a social representation of a combination of positive and negative freedom of choice concerning the quality of everyday life, used in a positioning process involving both individual and collective aspects. Health is a particular aspect of the social representation and positioning of wellbeing, which encompasses aspects of the physical, psychological, social and spiritual functioning of individuals. The wellbeing meta-theory also opens up the possibility for more effective solutions to the social challenges related to wellbeing and salutogenetic health. It underscores the importance of the need for a dedicated social subsystem where the goals and organizational culture of the organizations involved are focused on wellbeing and health promotion. In our study, we consider this to be the Public Wellbeing System (PWS). Our conclusion is that the development and operation of a new set of institutions—the Public Wellbeing System (PWS)—based on the co-production of services that meet the needs and demands of society, and dedicated to the promotion of wellbeing, may provide an opportunity to overcome the public health paradox.
Open Access: Yes
Lost working time due to ill health in Hungary in 2021
Publication Name: Orvosi Hetilap
Publication Date: 2024-12-22
Volume: 165
Issue: 51
Page Range: 2026-2032
Description:
Introduction: Deteriorating of workers' health means reduced performance for the employers, lower incomes for workers and increased health care costs for the country. Objective: Examination of the loss of working time due to ill health in 2021, its gender differences and changes compared to 2019, and the differences of the Hungarian data compared to other countries. Methods: Working time loss in the 30-64 years age group was analyzed by the number of working days lost in 2021 due to disability and 'premature' deaths in the 30-64 years age group, and by the number of future working days lost by the deceased until retirement age. Data on disability and mortality were taken from the Global Burden of Disease Study database, and population and mortality data from the National Statistical Office and Eurostat. Hungarian data were compared with the corresponding figures for the Visegrad countries and Austria. Results: In the year 2021, 30-64-year-old workers lost one in seven working days, meaning they could not work at all for 37 working days. In addition, more than 117,000 years that could be worked until retirement were lost. For women, the loss of working time was due to disability, for men more to mortality. Compared to 2019, the number of working days lost per capita increased by 7% and the future loss of working days due to mortality by 40%. Hungary was similar to other countries in the number of days lost per capita due to limitation, but the number of deaths was much higher than in the others. Discussion: The female excess of disability and the male excess of mortality are assumed to be due to different attitudes towards disease: men perceive their health better and therefore use health care less often. The higher mortality in Hungary compared to other countries reflects the lower effectiveness of prevention and medical care. The high rate of deaths that can be prevented or avoided with medical intervention is largely due to deficiencies in the health system, and not to a low willingness to seek medical care. Conclusions: The results show that reducing time lost to work requires a different approach by gender. To mitigate losses, improvements in the effectiveness of public health and medical interventions are needed. Measures to promote healthy lifestyles and create an enabling environment are also essential to increase the country's competitiveness.
Open Access: Yes
Potential cardiovascular benefit of optimized lipid-lowering and antiplatelet therapy in patients with acute coronary syndrome - A simulation analysis
Publication Name: Orvosi Hetilap
Publication Date: 2024-11-03
Volume: 165
Issue: 44
Page Range: 1746-1752
Description:
Introduction: Lipid lowering therapy - despite the accumulated clinical trial evidence behind it and its significant preventive role reflected in the guidelines - does not have its rightful place in the value system of patients or doctors, there is a great gap between practice and principles. Objective: In order to increase the prestige of lipid-lowering therapy, the potential benefit of lowering LDL cholesterol was compared with antiplatelet therapy, which is generally more accepted. Method: We processed the data of 531 patients of the Bekes County Central Hospital Pandy Kalman Branch in Gyula who underwent percutaneous coronary intervention for acute coronary syndrome for one year starting on April 1, 2020. A simulation study was conducted during which, based on the results of large clinical studies, the cardiovascular prevention effect of optimal lipid reduction and platelet aggregation inhibition for one year was estimated. Results: In all 531 patients treated for acute coronary syndrome, if LDL cholesterol levels had remained at the mean level of 3.37 mmol/L found at admission, 59 major cardiovascular events could have occurred within one year after the index event. If LDL-cholesterol levels were to be reduced to 1.4 mmol/L, which is the very high-risk target value in the lipid recommendations of the European Society of Cardiology, the number of events would be 13, and 16 if the theoretical, very low, non-target value of 0.5 mmol/L was reached. Lowering LDL cholesterol levels is therefore expected to avoid 13 and 16 major cardiovascular events, respectively. If aspirin alone was given for antiplatelet aggregation, 14 events could be prevented over a year, 17 events could be prevented using aspirin and clopidogrel combination, and 20 events with aspirin and prasugrel or aspirin and ticagrelor. Discussion: Based on the low rates of achieving LDL cholesterol targets, there is a considerable potential for optimizing lipid-lowering treatment worldwide. In patients with acute coronary syndrome, one of the most vulnerable patient groups in cardiology practice, the study results suggest that lipid reduction and platelet aggregation inhibition could achieve a similar reduction in the number of major cardiovascular events. Conclusion: The simulation study confirms the comparable cardiovascular benefit of the two interventions. Since the attainment rate of LDL cholesterol targets set in the guidelines is very poor - with physicians' therapeutic inertia playing a major role -, we hope our findings will convince colleagues that more attention should be paid to more optimal lipid reduction.
Open Access: Yes
NREM parasomnia-related behaviors and adverse childhood experiences
Publication Name: Sleep Medicine
Publication Date: 2024-09-01
Volume: 121
Issue: Unknown
Page Range: 365-369
Description:
Purpose: To assess the prevalence, types, sociodemographic factors, and reported dangerous activities of sleep-related behaviors likely representing NREM parasomnia episodes, as well as their association with adverse childhood experiences in Hungary. Methods: Cross-sectional survey of 1000 adults (aged ≥18 years) representing the Hungarian population, using a non-probability quota sampling with a random walk method and a structured face-to-face interview. A multi-criterion weighting procedure was applied to correct bias along the main sociodemographic variables to the data available. Binary logistic regression estimated the odds of NREM parasomnia-related behaviors associated with sociodemographic factors and adverse childhood experiences. Results: The prevalence of NREM parasomnia-related behaviors was 2.7 %, and self-reported sleep-eating was 0.1 % of the population (4.6 % of parasomnia-like activities). For middle-aged adults, the odds of sleep ambulation were significantly lower than for younger adults (OR 0.3; P = 0.03). A participant's family occurrence of reported parasomnia-like activity increased their odds of having it by more than 7 times (OR 7.1; P < 0.001). Nine participants out of those 27 people reporting NREM parasomnia-related behavior episodes, reported childhood adverse experiences, increasing the odds of parasomnia-related behavior by more than six times (OR 6.2; P < 0.001) compared to those not reporting it. Conclusion: This is the first population survey in Hungary on adult sleep-related behaviors likely representing NREM parasomnia episodes and the potential association with childhood traumatic events preceding them. The related dangerous behaviors call for safety measures and prevention. The significant association between adverse childhood events and NREM parasomnia-related behaviors needs further analysis.
Open Access: Yes
Long-term impact of unhealthy food tax on consumption and the drivers behind: A longitudinal study in Hungary
Publication Name: Health Policy
Publication Date: 2024-08-01
Volume: 146
Issue: Unknown
Page Range: Unknown
Description:
Several countries have introduced public health product taxes with the objective of reducing the absolute amount of consumption of unhealthy food and tackling obesity. This study aims to estimate the long-term impact of the Hungarian public health product tax introduced in 2011. To achieve this, a unique consumer purchase dataset was analysed to examine daily fast-moving consumer goods purchases from a representative sample of 2,000 households from 2010 to 2018. The results indicate that the tax has been fully reflected in consumer prices. A decline in consumption was observed initially, consistent with previous experiences in Hungary and other countries. However, over time, the data suggests a recovery and even an increase in line with the growth of disposable income. The proportion of taxed products in total fast-moving consumer goods purchases increased from 5.9 % (95 % CI: 5.7 % to 6.0 %) in 2010 to 7.4 % (95 % CI: 7.3 % to 7.6 %) in 2018. Furthermore, the tax has contributed to increased inequality as low-income households spend a higher proportion of their total expenditure on it. Although taxes on unhealthy foods have proven effective in the short-term, they may not be adequate for reducing overall consumption in the long-term, particularly as disposable income increases. In conclusion, implementing complex interventions is necessary to achieve sustainable positive changes in dietary habits.
Open Access: Yes
Changes in public attitude toward epilepsy in Hungary since 1994. A multicriteria weighting analysis
Publication Name: Epilepsia Open
Publication Date: 2024-06-01
Volume: 9
Issue: 3
Page Range: 1042-1050
Description:
Objective: To assess the adult Hungarian population's knowledge about and attitude toward epilepsy and compare the present findings with previous ones in 1994 and 2000. Methods: We performed a cross-sectional survey of the Hungarian adult population from 28th February to 8th March 2023. A non-probability quota sampling with a random walk method was used. We applied the computer-assisted personal interviewing (CAPI) method and used a multicriteria weighting procedure to correct for bias along the main sociodemographic variables. To detect changes over time, we used chi-squared tests, and to analyze the effect of sociodemographic characteristics, we applied multivariate logistic regression. Results: One thousand participants (53.1% women, mean age 48.1 ± 16.75 years) representing Hungary's population were interviewed yielding a response rate of 80.3%. 26.3% knew someone with epilepsy (55.9% in 1994 and 51.9% in 2000), and 30.8% saw an epileptic seizure (58% in 1994 and 55.3% in 2000). Compared to the young, fewer adults and elderly people knew someone with epilepsy or had seen a seizure. Like in 1994 and 2000, 16.6% reported objection to their children's interaction with people with epilepsy; however, in the present study, significantly fewer people opposed their children marrying or working together with epileptic people, indicating a change in attitude (p < 0.0001). Rural residents had less objection to their children's interaction with people with epilepsy (p < 0.05). People with secondary education objected significantly more often than those with primary education to their children's interaction (p = 0.037), marriage to people with epilepsy (p = 0.043), or their having equal employment (p = 0.008). Higher education people were as “permissive” as those with primary education. Significance: Certain parameters of familiarity and attitude markers of the Hungarian population toward epilepsy have improved. These tendencies are promising, but work is still needed; our results will hopefully evoke educational programs and campaigns against negative attitudes. Plain Language Summary: The knowledge of the Hungarian population about epilepsy and their attitude toward people with epilepsy has been improved since 1994. People from rural areas have shown more acceptance for people with epilepsy. Those people who completed secondary education were significantly more prone to stigmatization than those with primary education.
Open Access: Yes
DOI: 10.1002/epi4.12935
Parasomnias manifest different phenotypes of sleep-related behaviors in age and sex groups. A YouTube-based video research highlighting the age slope of sleepwalking
Publication Name: Journal of Clinical Neuroscience
Publication Date: 2024-04-01
Volume: 122
Issue: Unknown
Page Range: 110-114
Description:
Study objective: Finding typical patterns - phenotypes - of sleep behaviors characterizing parasomnias in different age and sex groups. Methods: We analyzed YouTube videos on sleep-related behaviors likely representing parasomnias. We applied the search terms “sleepwalking”, “somnambulism”, “sleep eating”, “sleep sex”, “sleep talking”, and “aggression in sleep” in six languages. We classified those persons shown on the videos into estimated biological sex and age (child, adult, elderly) groups. We scored the activity types by a self-made scale and applied binary logistic regression to analyze the association between sleep behaviors versus sex and age groups by the STATA package, providing a 95% confidence interval and the probability of statistical significance. Results: 224 videos (102 women, 68 children, 16 adults, and 40 elderly people) were scored. Elderly people had significantly (P < 0.012) lower odds of sleepwalking compared to adults and children. Adult females performed complex manual activities during sleepwalking more often than males (P < 0.012). Elderly males had 40-fold odds compared to adults and children, to perform aggressive movements and 70-fold odds of complex movements in bed, compared to adults. Elderly people presented emotional behaviors less frequently than adults (P < 0.004), and females showed them twice as often as males. Adults sleep-talked full sentences more often than children and elderly people (P < 0.001). Conclusion: Our results support the existence of age- and sex-specific parasomnia phenotypes, denoting possible safety measures. The remarkably low odds of sleepwalking in the elderly highlight the possibility of different pathomechanisms in higher age groups compared to children. Brief Summary and study impact: Parasomnias present highly variable clinical forms and often cause injuries. Identifying typical phenotypes may help risk management and imply theoretical conclusions. Our study supports the existence of age-specific parasomnia phenotypes. We found that adult women have a high risk of performing dangerous activities during sleep, and elderly males often move violently in bed, likely representing dream enactment behaviors. Elderly people of both sexes have low odds of sleep ambulation- likely representing somnambulism; compared to adults and children, constituting a descending “age slope” of somnambulism that might reflect different underlying pathomechanisms in children versus adults and the elderly.
Open Access: Yes
Peer education program to improve fluid consumption in primary schools—lessons learned from an innovative pilot study
Publication Name: Heliyon
Publication Date: 2024-03-15
Volume: 10
Issue: 5
Page Range: Unknown
Description:
Background: Although it is widely recognized that more attention needs to be paid to children's fluid intake, there is little information on how to improve it. Peer education has been suggested as an effective approach to changing health behaviors among school children. As a new approach, our study piloted a peer education program to improve children's fluid intake in primary schools. Methods: University students were prepared for their role as peer educators in an elective university course, including the concept of peer education and different pedagogical methods. The peer educators evaluated the training process by completing a questionnaire. The intervention took place during a School Health Day led by the peer educators. An anonymous survey with a questionnaire on knowledge of fluid intake was administered two weeks before, at the end of, and 15 weeks after the intervention. Changes in hydration knowledge were tested using repeated measures ANOVA. Results: The pilot program showed increased knowledge about fluid consumption (p < 0.001) in lower and upper primary school children (N = 326) at the end of the School Health Day compared to pre-intervention measures. A positive change was observed after 15 weeks only in upper primary students. Feedback from peer educators was useful for fine-tuning the program. Conclusions: This innovative program induced positive changes in knowledge about fluid intake in primary school children. The persistence of the changes differed between lower and upper primary school children. Based on the results, the intervention should be replicated to adapt the program to the needs of lower primary school children. Because the training of peer educators and the peer education program appeared to be successful, this program is worthy of international replication. This approach may also be suggested for other behavior change issues.
Open Access: Yes
High prevalence of burnout among midwives in Hungary: High job demands and low resources as potential persistent stressors, a focus on prevention
Publication Name: Heliyon
Publication Date: 2024-01-30
Volume: 10
Issue: 2
Page Range: Unknown
Description:
Background: Midwifery practice in Hungary is characterized by chronic stress, which may in turn lead to burnout and impaired perinatal care. However, little is known about the degree and potential stressors of burnout, which hinder the development of strategies to promote well-being among midwives in Hungary. Aim: To assess the prevalence of burnout and identify persistent individual and occupational stressors among midwives in Hungary over the past decade to inform prevention. Methods: We conducted two cross-sectional studies among midwives in 2014 and 2022. We used the Maslach Burnout Inventory to assess burnout (emotional exhaustion, depersonalization, and personal accomplishment) over time. We also collected data on individual and work characteristics. We performed a multivariate regression analysis to explore associations between burnout and respondents' characteristics. Findings: The degree and prevalence of emotional exhaustion among midwives increased significantly between 2014 (N = 224) and 2022 (N = 152). High workload, not feeling valued at work, poorly perceived health status and work dissatisfaction emerged as a significant positive correlate of emotional exhaustion or depersonalization in both studies. Living alone showed both a positive and inverse association with burnout in 2014 and 2022, respectively. Work satisfaction was a positive correlate of personal accomplishment in both studies. Conclusions: Our results add to and confirm the growing body of evidence about the high prevalence of burnout among midwives in Hungary. We identified potential risk factors and outcomes of burnout, which remained unchanged over time. To prevent or reduce burnout among midwives, future interventions should focus on addressing these potential persistent risk factors. However, the time-varying role of factors influencing burnout makes it advisable to review preventive interventions from time to time.
Open Access: Yes
The social cost of ill health among the working-Age population in 2019 in Hungary
Publication Name: Orvosi Hetilap
Publication Date: 2024-01-21
Volume: 165
Issue: 3
Page Range: 110-120
Description:
Introduction: We have quantified the healthy life years lost and the costs incurred in 2019 due to the poor health of the Hungarian population aged 30-64 from a societal perspective, but also from the perspective of several other social actors, calculating the indirect costs according to the human capital approach. Objective: The aim of our estimate is to shed light on the radically high losses that Hungary incurs year after year as a result of its inhabitants living significantly shorter and sicker lives than people in similar situations in other countries. Method: In the first part of the analysis, we aggregated the time lost due to illness and disability for the age group 30-64 in 2019. The aggregated Hungarian values for the studied age group were compared with the corresponding values for the Visegrad countries, Austria and the European Union. The second part of the analysis aggregates the social costs of time spent in ill health. A distinction is made between direct costs, which involve the movement of money, and indirect costs, which are embodied in lost income or production. Results: In Hungary, the nearly 4.8 million people aged 30-64 spent a total of 654,000 years on sick leave in 2019, which equated to an average of about 50 days per person. This means 14% of the total number of working days could have been working days in good health. The direct costs, i.e., the expenditure of the Health Insurance Fund and the expenditure financed by patients and voluntary insurance, amounted to HUF 1,446 billion. Indirect costs, i.e., expenditure due to the loss of working years as a result of premature death and illness, represented a further burden of HUF 2,279 billion. Conclusion: In 2019, the direct and indirect expenditure of people aged 30-64 amounted to HUF 3425 billion, or 7.21% of the GDP. It is well known that in developed countries, including Hungary, the greatest health losses are caused by non-communicable chronic diseases, which can be prevented by a healthy lifestyle. Therefore, the promotion of healthy lifestyles and the creation of a conducive physical and social environment are essential for improving the country s competitiveness.
Open Access: Yes
Burnout syndrome among Hungarian midwives in 2014 and 2022
Publication Name: Orvosi Hetilap
Publication Date: 2023-10-08
Volume: 164
Issue: 40
Page Range: 1592-1599
Description:
Introduction: The healthcare sector is the most studied area of burnout, as the mental health of healthcare workers has a significant impact on the mental health of the people they care for. Objective: The aim of our study was to investigate whether there have been changes in the dimensions of burnout among midwives, and how the relationships between burnout and the individual factors and working conditions that influence it have evolved, using national data from 2014 and 2022. Method: An anonymous, voluntary, questionnaire-based survey of midwives working exclusively in maternity units was conducted using the Maslach Burnout Inventory questionnaire, which measures burnout, and questions on respondents demographic characteristics and working conditions. Multivariate ordinal logistic regression was used to explore associations between burnout and respondent characteristics, and associations were characterized by odds ratios. Results: Among the dimensions of burnout, no change in depersonalization was observed in 2022, but both emotional exhaustion and personal ineffectiveness were significantly more common in 2022 than in 2014. Responses from 224 midwives in 2014 and 152 midwives in 2022 were analyzed. Looking at the influencing factors, higher levels of burnout in 2014 were significantly associated with poorer perceived health, lack of a partner, smoking, shorter time in healthcare, having a job in a larger city, feeling overworked and dissatisfied. In 2022, on the other hand, younger age, smoking, shorter time in healthcare, feeling overworked, dissatisfied and unvalued were associated with higher levels of burnout. Looking at the combined effect of these factors, willingness to attend a health promotion lecture and having a second job also showed a significant effect on burnout in 2022. Discussion: The authors discuss the change in burnout among midwives and the possible reasons for the correlations shown. Conclusion: The results of the first study on burnout among midwives in Hungary show that improving the working conditions of midwives is essential for the functioning of family-friendly midwifery. In addition, to prevent burnout, more emphasis should be placed on the prevention of the risk factors identified in the study in education and training.
Open Access: Yes
Brain localization and morphological changes in NREM parasomnias. A systematic review study
Publication Name: Sleep Breathing Schlaf Atmung
Publication Date: 2025-10-15
Volume: 29
Issue: 6
Page Range: 319
Description:
BACKGROUND: Individuals with NREM parasomnias exhibit abnormal slow-wave activity and fragmented sleep. Sleep-state dissociation is the prevailing concept of NREM parasomnia-episodes; typically emerging from N3/N2 stages of NREM sleep's first cycle at the turning-point of deep sleep and arousal. While these relations provide a frame to understand these conditions, their mechanism and brain-topography remain unclear. METHODS: We performed a systematic search of the literature (1/01/2015-20/06/2024) on brain-topographies and morphological changes based on neurophysiological and imaging studies in patients with NREM parasomnias. RESULTS: It was shown that immediately preceding clinical episodes, the EEG spectral power of delta and theta frequency-bands increased in parallel with its reduction in the cingulate, motor, and premotor/supplementary motor cortices. Far from clinical episodes, in NREM and REM sleep as well as in wakefulness, a cortico-cortical sleep-state dissociation occurred, too. In addition, the partial arousals of episodes evolved from 'deeper' sleep with lower-amplitude slow waves, compared to episode-free arousals of the same people with NREM parasomnias. A single MR-morphology study revealed decreased grey-matter volume in the left dorsal posterior cingulate and mid-cingulate cortices in patients with mixed NREM parasomnias. CONCLUSION: Based on recent research, the state-dissociation evidenced in clinical episodes might characterize each vigilance state of people with NREM parasomnias, even outside the episodes, making sleep-wake dissociation a trait-like core feature of NREM parasomnias. The anterior cingulo-frontal regions seem to have central roles. PROSPERO registration ID: CRD42024552562.
Open Access: Yes
