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Mohos A, Szőllősi GJ, Kolozsvári LR, Rinfel J, Varga A, Kucsera MM, Hargittay C, Torzsa P. Rural family medicine as a career option among Hungarian medical students. Eur J Gen Pract 2023; 29:2174258. [PMID: 36794681 PMCID: PMC9937003 DOI: 10.1080/13814788.2023.2174258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The shortage of family physicians is a considerable challenge in Hungary. The number of vacant practices is increasing and the rural and deprived areas are more affected. OBJECTIVES This study aimed to investigate medical students' attitudes towards rural family medicine. METHODS The current study used a cross-sectional design with a self-administered questionnaire. Each of the four Hungarian medical universities was represented by their medical students from December 2019 to April 2020. RESULTS The response rate was 67.3% (n = 465/691). Only 5% of the participants plan to be a family doctor, 5% of the students plan to work in rural areas. On a 5-point Likert scale (1 = 'surely not', 5 = 'surely yes'), half of the participants answered 1 or 2 to choose rural medical work, while 17.5% answered 4 or 5. There was a significant relationship between rural working plans and rural origin (OR = 1.97; p = 0.024), and the plan to work in family practice (OR = 4.90; p < 0.001). CONCLUSION Family medicine is not a popular career option among Hungarian medical students and rural medical work is even less attractive. Medical students with a rural origin and an interest in family medicine are more likely to plan to work in rural areas. More objective information and experience need to be given to medical students about rural family medicine to increase the attractiveness of the speciality.
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Affiliation(s)
- András Mohos
- Albert Szent-Györgyi Medical School, Department of Family Medicine, University of Szeged, Szeged, Hungary,European Rural and Isolated Practitioners Association, Paris, France
| | | | - László Róbert Kolozsvári
- Department of Family Medicine and Occupational Health, University of Debrecen, Debrecen, Hungary
| | | | - Albert Varga
- Albert Szent-Györgyi Medical School, Department of Family Medicine, University of Szeged, Szeged, Hungary
| | - Maria Marko Kucsera
- Albert Szent-Gyögyi Medical School, Department of Public Health, University of Szeged, Szeged, Hungary
| | | | - Peter Torzsa
- Family Medicine, Semmelweiss University, Budapest, Hungary,CONTACT Peter Torzsa Family Medicine, Semmelweiss University, Budapest, Stáhly u. 7-9., Budapest, 1085Hungary
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Vajer P, Jarmohammed J, Velgan M, Ficzere F, Torzsa P, Kalda R, Michels N. A multi-country study on students’ career choices: towards a balance between the need for general practitioners and what students choose. Education for Primary Care 2019; 30:186-187. [DOI: 10.1080/14739879.2019.1600045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Peter Vajer
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Joey Jarmohammed
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
| | - Marta Velgan
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ferenc Ficzere
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Nele Michels
- Faculty of Medicine and Health Sciences, Department of General Practice, University of Antwerp, Antwerp, Belgium
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Huas C, Petek D, Diaz E, Muñoz-Perez MA, Torzsa P, Collins C. Strategies to improve research capacity across European general practice: The views of members of EGPRN and Wonca Europe. Eur J Gen Pract 2019; 25:25-31. [PMID: 30607993 PMCID: PMC6394293 DOI: 10.1080/13814788.2018.1546282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The effectiveness of any national healthcare system is highly correlated with the strength of primary care within that system. A strong research basis is essential for a firm and vibrant primary care system. General practitioners (GPs) are at the centre of most primary care systems. Objectives: To inform on actions required to increase research capacity in general practice, particularly in low capacity countries, we collected information from the members of the European General Practice Research Network (EGPRN) and the European World Organization of Family Doctors (Wonca). Methods: A qualitative design including eight semi-structured interviews and two discursive workshops were undertaken with members of EGPRN and Wonca Europe. Appreciative inquiry methods were utilized. Krueger’s (1994) framework analysis approach was used to analyse the data. Results: Research performance in general practice requires improvements in the following areas: visibility of research; knowledge acquisition; mentoring and exchange; networking and research networks; collaboration with industry, authorities and other stakeholders. Research capacity building (RCB) strategies need to be both flexible and financially supported. Leadership and collaboration are crucial. Conclusion: Members of the GP research community see the clear need for both national and international primary care research networks to facilitate appropriate RCB interventions. These interventions should be multifaceted, responding to needs at different levels and tailored to the context where they are to be implemented.
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Affiliation(s)
- Caroline Huas
- a UVSQ, CESP, INSERM , Université Paris-Saclay, Univ. Paris-Sud , Villejuif , France.,b Fondation santé des étudiants de France , Paris , France
| | - Davorina Petek
- c Department of Family Medicine, Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.,d Executive Board , European General Practice Research Network , Maastricht, The Netherlands
| | - Esperanza Diaz
- e Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway.,f Norwegian Centre for Migration and Minority Health , Oslo , Norway
| | - Miquel A Muñoz-Perez
- g Departement de Salut, Generalitat de Catalunya , Institut Català de la Salut. IDIAP-Jordi Gol , Barcelona , Spain
| | - Peter Torzsa
- h Department of Family Medicine , Semmelweis University Faculty of Medicine , Budapest , Hungary
| | - Claire Collins
- d Executive Board , European General Practice Research Network , Maastricht, The Netherlands.,i The Irish College of General Practitioners , Dublin , Ireland
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Adam S, Mohos A, Kalabay L, Torzsa P. Potential correlates of burnout among general practitioners and residents in Hungary: the significant role of gender, age, dependant care and experience. BMC Fam Pract 2018; 19:193. [PMID: 30541461 PMCID: PMC6290496 DOI: 10.1186/s12875-018-0886-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Burnout is increasingly prevalent among general practitioners (GPs) in Hungary, which may lead to functional impairment and, subsequently, to poor quality of patient care. However, little is known about potential predictors of burnout among GPs. The aim of this study was to explore psychosocial correlates of burnout among GPs and residents in Hungary. METHODS We collected socio-demographic and work-related data with self-administered questionnaires in a cross-sectional study among GPs (N = 196) and residents (N = 154). We assessed burnout with the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and calculated the mean level of burnout and the proportion of physicians suffering from low, intermediate and high degree of burnout. To identify potential socio-demographic and work-related correlates of burnout among physicians, we determined Spearman's and Mann-Whitney U correlation coefficients and conducted stepwise linear regression analyses. We deployed Mann-Whitney U test to explore gender disparity in the level of burnout between female and male physicians and between general practitioners and residents. RESULTS The prevalence of moderate to high level emotional exhaustion, depersonalisation, and impaired personal accomplishment was 34.7, 33.5 and 67.8% as well as 41.0, 43.1, and 71.1% among GPs and residents, respectively. Residents reported significantly lower level of personal accomplishment vs GPs. We identified a significantly higher level of depersonalization among male physicians compared to female physicians. Age correlated negatively with emotional exhaustion and depersonalization and positively with personal accomplishment among GPs. Dependant care was positively associated with burnout among female GPs. Female residents were more likely to report depersonalization. High workload was positively correlated with depersonalization among female GPs. Younger age emerged as the strongest predictor of emotional exhaustion. Male gender and fewer years of experience predicted depersonalization best, and male gender showed a significant predictive relationship with low personal accomplishment. CONCLUSION We identified specific socio-demographic and work-related correlates of burnout, which may guide the development of specific and effective organizational decisions to attenuate occupational stress and subsequent burnout as well as functional impairment among GPs, and thus, may improve the quality of patient care.
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Affiliation(s)
- Szilvia Adam
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Andras Mohos
- Department of Family Medicine, Faculty of Medicine ,University of Szeged, Szeged, Hungary
| | - Laszlo Kalabay
- Department of Family Medicine, Medical Faculty, Semmelweis University, Budapest, Hungary
| | - Peter Torzsa
- Department of Family Medicine, Medical Faculty, Semmelweis University, Budapest, Hungary.
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Streit S, Gussekloo J, Burman RA, Collins C, Kitanovska BG, Gintere S, Gómez Bravo R, Hoffmann K, Iftode C, Johansen KL, Kerse N, Koskela TH, Peštić SK, Kurpas D, Mallen CD, Maisonneuve H, Merlo C, Mueller Y, Muth C, Ornelas RH, Šter MP, Petrazzuoli F, Rosemann T, Sattler M, Švadlenková Z, Tatsioni A, Thulesius H, Tkachenko V, Torzsa P, Tsopra R, Tuz C, Verschoor M, Viegas RPA, Vinker S, de Waal MWM, Zeller A, Rodondi N, Poortvliet RKE. Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old. Scand J Prim Health Care 2018; 36:89-98. [PMID: 29366388 PMCID: PMC5901445 DOI: 10.1080/02813432.2018.1426142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. DESIGN This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. SETTING GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. SUBJECTS This study included 2543 GPs from 29 countries. MAIN OUTCOME MEASURES GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. RESULTS Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98). CONCLUSIONS GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age). • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years. • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60. • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.
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Affiliation(s)
- Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Biljana Gerasimovska Kitanovska
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia
| | - Sandra Gintere
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņs University, Riga, Latvia
| | - Raquel Gómez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Iftode
- Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania
| | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tuomas H. Koskela
- Department of General Practice, University of Tampere, Tampere, Finland
| | - Sanda Kreitmayer Peštić
- Family Medicine Department, Health Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | | | - Hubert Maisonneuve
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland
| | - Yolanda Mueller
- Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland
| | - Christiane Muth
- Institute of General Practice Goethe-University, Frankfurt/Main, Germany
| | | | - Marija Petek Šter
- Department for Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- SNAMID (National Society of Medical Education in General Practice), Caserta, Italy
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg
| | | | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Hans Thulesius
- Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden
- Senior Researcher Region Kronoberg, Växjö, Sweden
| | - Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Rosy Tsopra
- LIMICS, INSERM, Paris, France
- Leeds Centre for Respiratory Medicine, St James’s University Hospital, Leeds, UK
| | - Canan Tuz
- Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey
| | - Marjolein Verschoor
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rita P. A. Viegas
- Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Shlomo Vinker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Margot W. M. de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Andreas Zeller
- Centre for Primary Health Care (uniham-bb), University of Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rosalinde K. E. Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- CONTACT Rosalinde K. E. Poortvliet Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD Leiden, The Netherlands
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Torzsa P, Hargittay C, Kalabay L. [The importance of anxiety and depression in family practice]. Neuropsychopharmacol Hung 2017; 19:137-146. [PMID: 29306905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Representative studies indicate that prevalence of anxiety disorders among adults is between 12.6-17.2%, while in Hungary it is 17.7%. According to both international and national studies the point prevalence of diagnosed major depression requiring treatment is 6-10 % in general practice. As untreated depression is the most important risk factor for suicide, early detection and effective management of depression are critical in prevention. According to international and national studies the recognition of major depression in primary care significantly contributes to the decline of suicide mortality. In our article we review screening of anxiety and depressive disorders and treatment and management of these patients in primary care. We present two short questionnaires used for recognizing depression and acute suicide risk and describe their use in family/ general practice.
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Affiliation(s)
- Peter Torzsa
- Semmelweis Egyetem, Általános Orvostudományi Kar, Családorvosi Tanszék, Budapest, Hungary.
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Streit S, Verschoor M, Rodondi N, Bonfim D, Burman RA, Collins C, Biljana GK, Gintere S, Gómez Bravo R, Hoffmann K, Iftode C, Johansen KL, Kerse N, Koskela TH, Peštić SK, Kurpas D, Mallen CD, Maisoneuve H, Merlo C, Mueller Y, Muth C, Šter MP, Petrazzuoli F, Rosemann T, Sattler M, Švadlenková Z, Tatsioni A, Thulesius H, Tkachenko V, Torzsa P, Tsopra R, Canan T, Viegas RPA, Vinker S, de Waal MWM, Zeller A, Gussekloo J, Poortvliet RKE. Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries. BMC Geriatr 2017; 17:93. [PMID: 28427345 PMCID: PMC5399328 DOI: 10.1186/s12877-017-0486-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/11/2017] [Indexed: 01/13/2023] Open
Abstract
Background In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision. Methods Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP. Results The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs’ decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48–0.59; ORs per country 0.11–1.78). Conclusions Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0486-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Marjolein Verschoor
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daiana Bonfim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Gerasimovska Kitanovska Biljana
- Department of Nephrology and Department of Family Medicine, University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia
| | - Sandra Gintere
- Faculty of Medicine, Department of Family Medicine, Riga Stradiņs University, Riga, Latvia
| | - Raquel Gómez Bravo
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Luxembourg, Luxembourg
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Iftode
- Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania
| | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tuomas H Koskela
- Department of General Practice, University of Tampere, Tampere, Finland
| | - Sanda Kreitmayer Peštić
- Family Medicine Department, Health Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wrocław, Poland
| | - Christian D Mallen
- Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Hubert Maisoneuve
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph Merlo
- Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland
| | - Yolanda Mueller
- Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland
| | - Christiane Muth
- Institute of General Practice, Goethe-University, Frankfurt / Main, Germany
| | - Marija Petek Šter
- Department for Family Medicine, Medical faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- SNAMID (National Society of Medical Education in General Practice), Prata Sannita, Italy.,Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Sattler
- SSLMG, Societé Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg
| | | | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Hans Thulesius
- Family Medicine, Department of Clinical Sciences, Lund University, Malmö and senior researcher Region Kronoberg, Växjö, Sweden
| | - Victoria Tkachenko
- Department of Family Medicine, Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Rosy Tsopra
- LIMICS, INSERM, U1142, F-75006 Paris, Université Paris 13, Sorbonne Paris Cité, UMR_S 1142, F93000 Bobigny, Sorbonne Universités, UPMC Université Paris 06, UMR_S 1142, F75006 Paris, Paris, France.,Leeds Centre for Respiratory Medicine, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Tuz Canan
- Family Medicine Specialist, Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey
| | - Rita P A Viegas
- Family Doctor, Invited Assistant of the Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Shlomo Vinker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands
| | - Andreas Zeller
- Centre for Primary Health Care (uniham-bb), Basel, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, The Netherlands.
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Vajo Z, Balaton G, Vajo P, Kalabay L, Erdman A, Torzsa P. Dose sparing and the lack of a dose-response relationship with an influenza vaccine in adult and elderly patients - a randomized, double-blind clinical trial. Br J Clin Pharmacol 2017; 83:1912-1920. [PMID: 28378403 DOI: 10.1111/bcp.13289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 11/26/2022] Open
Abstract
AIMS The currently licensed seasonal trivalent influenza vaccines contain 15 μg haemagglutinin per strain for adult, and up to 60 μg for elderly patients. However, due to recent shortages, dose sparing to increase production capacity would be highly desirable. In the present study, we attempted to find a dose-response relationship for immunogenicity and, thus, the optimal dose for seasonal influenza vaccines in adult and elderly patients. METHODS A total of 256 subjects, including adult (aged 18-60 years) and elderly (aged over 60 years) individuals, were enrolled. Subjects were randomly assigned in a 1:1:1:1 ratio to receive a whole-virion, aluminium-adjuvanted trivalent influenza vaccine containing 3.5, 6, 9 or 15 μg haemagglutinin of seasonal A/H1N1, A/H3N2 and B influenza antigens manufactured by Omninvest Ltd., Hungary. Serum antibody titres against the vaccine virus strains were measured by haemagglutination inhibition. RESULT All vaccines were well tolerated. All four vaccines fulfilled all three immunogenicity licensing criteria, as determined by the European Committee for Proprietary Medicinal Products (CPMP)/Biotechnology Working Party (BWP)/214/96 guideline for all three virus strains and both age groups. The 3.5 μg vaccine showed 28% less seroconversion compared to the 15 μg dose in terms of influenza AH3N2 in the adult group (95% confidence interval -51, -3; P < 0.05). All other doses showed no significant difference in immunogenicity compared with the licensed vaccine containing 15 μg haemagglutinin. CONCLUSIONS Our data suggested that significant dose sparing is possible with the use of whole-virion vaccines and aluminium adjuvants, without compromising safety. This could have significant economic and public health impacts.
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Affiliation(s)
- Zoltan Vajo
- Department of Family Practice, Semmelweis University, Budapest, Hungary
| | - Gergely Balaton
- Department of Family Practice, Semmelweis University, Budapest, Hungary
| | - Peter Vajo
- Medical and Health Sciences Centre, University of Debrecen, Debrecen, Hungary
| | - Laszlo Kalabay
- Department of Family Practice, Semmelweis University, Budapest, Hungary
| | | | - Peter Torzsa
- Department of Family Practice, Semmelweis University, Budapest, Hungary
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Eory A, Rozsa S, Gonda X, Dome P, Torzsa P, Simavorian T, Fountoulakis KN, Pompili M, Serafini G, Akiskal KK, Akiskal HS, Rihmer Z, Kalabay L. The association of affective temperaments with smoking initiation and maintenance in adult primary care patients. J Affect Disord 2015; 172:397-402. [PMID: 25451443 DOI: 10.1016/j.jad.2014.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/16/2014] [Accepted: 10/18/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences. METHODS 459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance. RESULTS Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females. LIMITATIONS The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships. CONCLUSIONS Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups.
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Affiliation(s)
- Ajandek Eory
- Department of Family Medicine, Semmelweis University, 4 Kutvolgyi Street, Budapest H-1125, Hungary.
| | - Sandor Rozsa
- Center for Well-Being, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States; Department of Personality and Health Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary; Department of Pharmacodymanics, Semmelweis University, Budapest, Hungary; Laboratory for Suicide Research and Prevention, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Peter Dome
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary; Laboratory for Suicide Research and Prevention, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University, 4 Kutvolgyi Street, Budapest H-1125, Hungary
| | | | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant׳Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Gianluca Serafini
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant׳Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Knarig K Akiskal
- International Mood Center, University of California, San Diego, CA, USA
| | - Hagop S Akiskal
- International Mood Center, University of California, San Diego, CA, USA
| | - Zoltan Rihmer
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary; Laboratory for Suicide Research and Prevention, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Laszlo Kalabay
- Department of Family Medicine, Semmelweis University, 4 Kutvolgyi Street, Budapest H-1125, Hungary
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10
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Eory A, Rozsa S, Torzsa P, Kalabay L, Gonda X, Rihmer Z. Affective temperaments contribute to cardiac complications in hypertension independently of depression. Psychother Psychosom 2014; 83:187-9. [PMID: 24752132 DOI: 10.1159/000357364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Ajandek Eory
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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11
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Kender Z, Fleming T, Kopf S, Torzsa P, Grolmusz V, Herzig S, Schleicher E, Rácz K, Reismann P, Nawroth P. Effect of Metformin on Methylglyoxal Metabolism in Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2014; 122:316-9. [DOI: 10.1055/s-0034-1371818] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Z. Kender
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - T. Fleming
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - S. Kopf
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - P. Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - V. Grolmusz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - S. Herzig
- Joint Research Division, Molecular Metabolic Control, German Cancer Research Center DKFZ, Network Aging Research, ZMBH, Heidelberg, Germany
| | - E. Schleicher
- Division of Clinical Chemistry/Central Laboratory, Department of Internal Medicine, University of Tubingen, Tubingen, Germany
| | - K. Rácz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P. Reismann
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P. Nawroth
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
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Eory A, Gonda X, Lang Z, Torzsa P, Kalman J, Kalabay L, Rihmer Z. Personality and cardiovascular risk: Association between hypertension and affective temperaments—a cross-sectional observational study in primary care settings. Eur J Gen Pract 2014; 20:247-52. [DOI: 10.3109/13814788.2013.868431] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Eory A, Gonda X, Torzsa P, Kalman J, Kalabay L, Rihmer Z. EPA-1314 - Affective temperaments in the background of acute cardiac complications in primary hypertension. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Nemcsik J, László A, Babos L, Kis-Igari Z, Pálfy A, Torzsa P, Eőry A, Kalabay L, Cseprekál O, Tislér A, Gonda X, Rihmer Z. P1.9 EVALUATION OF AFFECTIVE TEMPERAMENTS AND ARTERIAL STIFFNESS IN TREATED HYPERTENSIVE PATIENTS. Artery Res 2014. [DOI: 10.1016/j.artres.2014.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Eory A, Rihmer Z, Gonda X, Kalabay L, Torzsa P. P-225 - Affective temperament profile in patients with hypertension. First results with temps-a in primary care in hungary. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74392-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Torzsa P, Rihmer Z, Gonda X, Szokontor N, Sebestyen B, Faludi G, Kalabay L. Family history of suicide: a clinical marker for major depression in primary care practice? J Affect Disord 2009; 117:202-4. [PMID: 19211149 DOI: 10.1016/j.jad.2009.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/09/2009] [Accepted: 01/09/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to investigate the family history of suicide among primary care patients with or without current major depressive episode (MDE). METHODS This study was performed in 2 GP practices in Budapest on 255 consecutively investigated primary care attendees. The diagnosis of current MDE (symptomatic MDE or MDE in partial remission) was made by the Hungarian version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Family history of suicide was rated as positive where the patients reported at least one first or second degree relative with completed suicide. RESULTS Out of the 255 consecutively investigated patients 45 (17.6%) have had current MDE and 24 (9.4%) have had positive family history of suicide. The family history of suicide was significantly more common among patients with current MDE than among those without it (26.6% vs 5.7%, p=0.0001). Fifty percent of patients with, and 14.3% of patients without family history of suicide have had current MDE (p=0.0001). LIMITATION Small sample size, and lacking data on fully remitted major depressives as well as on comorbid psychiatric and medical disorders. CONCLUSION History of completed suicide among first or second degree relatives could be a good and simple clinical marker for current and lifetime MDE in primary care patients.
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Affiliation(s)
- Peter Torzsa
- Department of Family Medicine, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary
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17
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Szentkiralyi A, Molnar MZ, Czira ME, Deak G, Lindner AV, Szeifert L, Torzsa P, Vamos EP, Zoller R, Mucsi I, Novak M. Association between restless legs syndrome and depression in patients with chronic kidney disease. J Psychosom Res 2009; 67:173-80. [PMID: 19616146 DOI: 10.1016/j.jpsychores.2009.05.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 04/09/2009] [Accepted: 05/14/2009] [Indexed: 12/17/2022]
Abstract
Restless legs syndrome (RLS) is reportedly associated with depression. This association may be mediated by both sleep-dependent and sleep-independent mechanisms. Here we analyze the association between RLS and depressive symptoms in patients with chronic kidney disease (CKD). We also assessed whether the relationship is independent of insomnia. In a cross-sectional study, socio-demographic parameters, laboratory data, and medical history were collected from 788 kidney transplant patients and 161 dialyzed patients. Insomnia, depression, and the presence of RLS symptoms were assessed with standard questionnaires. Patients with probable RLS had a higher prevalence of depressive symptoms than those without RLS (56% vs. 22% with vs. without RLS, respectively; P<.001). Patients presenting RLS symptoms had higher Athens Insomnia Scale (AIS) scores than patients without RLS [median AIS score (interquartile range): 7 (6) vs. 3 (4) with vs. without RLS, respectively; P<.001]. The AIS score correlated with the CES-D score (Spearman's rho=0.54, P<.001). In multivariate analysis, the presence of RLS symptoms was independently associated with depressive symptoms (OR=3.96, 95% CI 2.21-7.1, P<.001). This relationship remained significant even after including insomnia in the model (OR=2.9, CI 1.55-5.43, P<.001). The presence of RLS symptoms is associated with depression in patients with CKD. This relationship remained significant even after accounting for insomnia. Sleep-independent mechanisms may also contribute to the association between RLS and depression in patients with CKD.
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Affiliation(s)
- Andras Szentkiralyi
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Torzsa P, Gonda X, Szokontor N, Sebestyen B, Faludi G, Kalabay L, Rihmer Z. Detection and Prevalence of Depressive Disorders in Primary Care Settings in Hungary. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background:Although depressive disorders are common conditions in primary health care service, and many depressed patients consult their general practitioners, GPs have some difficulties in the detection and correct diagnosis of depression. Unrecognized and untreated depression causes great health and economic burden and also contributes to significant suffering, therefore the correct recognition of affective disorder in GP settings is an important healthcare target. The aim of our study was to assess the prevalence of depressive disorders in general practices in Hungary and also to assess the sensitivity and specificity of different depression screening instruments.Method:In the present study the current prevalence of DSM-IV depressive disorders were surveyed among 984 primary care attendees in 6 GP practices in Hungary, using the Beck Depression Inventory and the PRIME-MD screening instrument.Results:The current prevalence rate of any PRIME-MD DSM-IV depressive disorders, including symptomatic major depressive episode, were 18.5% and 7.3% respectively. Beck Depression Inventory identified any current depressive disorders with 95% sensitivity and 56% specificity and the same figures for current symptomatic major depressive episode were 83% and 23%, respectively.Discussion:Our results are similar to those reported previously from Hungary and from other countries. The findings also indicate that the Beck Depression Inventory and PRIME-MD can help in detecting depressive disorders in primary care.
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