Novel motivational interviewing-based intervention improves engagement in physical activity and readiness to change among adolescents with chronic pain

INTRODUCTION

Engaging adolescents with chronic pain in physical activities is challenging. Motivational interviewing (MI) combined with activity promotion may encourage teens to make behavioural changes. This research aimed to assess the feasibility and acceptability of our MI-based physical activity promotion programme, the M3 training.

METHODS

In our exploratory study with 35 adolescent-parent dyads, we evaluated the feasibility by enrolment, drop-out and retention rates. Acceptability of the M3 training was examined by adherence rates and participation experiences through open-ended questions. We also assessed changes in pain self-efficacy and readiness to change after the M3 training intervention.

RESULTS

The M3 training was feasible with an adequate enrolment (77.8%) and retention (85.7%) rate. Both teens and parents found the M3 training acceptable and considered exercise and physical activity the most helpful elements of the programme (36% and 37%, respectively). While self-efficacy remained unchanged, we identified a significant increase in the readiness to change for adolescents and parents.

CONCLUSION

M3 training improved physical activity engagement while prioritising adolescents' autonomy. Furthermore, it appears to be a clinically relevant approach and could result in a positive shift in readiness to change within a shorter timeframe.

PATIENT OR PUBLIC CONTRIBUTION

The preliminary version of the M3 training was reviewed and commented upon by the public (adolescents and adults). Adolescents who participated in this study were designing their own movement programme, considering their lived experiences. Participants' feedback was used to create the online version of the M3 training (which will be published elsewhere).

High prevalence of burnout among midwives in Hungary: High job demands and low resources as potential persistent stressors, a focus on prevention

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.

The validity and reliability of the hungarian version of the brief work-family conflict questionnaire – an effective method to measure work-to-family and family-to-work conflict

The current study aimed to investigate the validity and reliability of the Hungarian version of the brief Work-Family Conflict Questionnaire (Conflicto Trabajo – Familia, CCTF) using both homogeneous (social care workers, N = 206) and heterogeneous (N = 586) occupational samples. In order to examine construct validity, we explored both two-factor and bifactor models. Our findings provided greater support for the two-factor model (homogeneous sample: χ² = 14.032, p = .379, df = 13; CFI = 0.999; NNFI = 0.998; RMSEA = 0.020 [0.000–0.051]; heterogeneous sample: χ² = 40.213, p < .001 df = 13; CFI = 0.993; NNFI = 0.985; RMSEA = 0.060 [0.023–0.079]). Our results demonstrated good reliability (ω = 0.797–0.911) and predictive validity, which we tested by exploring the relation of the construct with burnout and psychosomatic symptoms. Our results suggest that the Hungarian version of the CCTF is a reliable and valid instrument for measuring both work-to-family and family-to-work conflict.

Diagnostic and treatment recommendations from international guidelines for chronic low back pain

Összefoglaló. Nemzetközi kutatások szerint a deréktáji fájdalom 2019-ben 568 millió embert érintett világszerte. Magyarországon a lakosság 20%-a él krónikus derékfájdalommal, ami nemcsak egészségügyi, de szociális és ökonómiai krízist is jelent. A probléma aktualitását jól mutatja az is, hogy a Nemzetközi Fájdalomkutatási Társaság a 2021. évet a derékfájdalomról szóló globális évnek kiáltotta ki. A derékfájdalmak megfelelő kezelése és a krónikussá válás megelőzése tehát kiemelten fontos. Ebben nyújthatnak segítséget az evidenciákon alapuló irányelvek. Magyarországon azonban jelenleg nincs hatályos, egységes irányelv, mely a derékfájdalmakkal, azon belül is a krónikus derékfájdalom kezelésével foglalkozna. A jelen közleményben a krónikus derékfájdalom evidenciákon alapuló diagnosztikai és kezelési lehetőségeinek áttekintését tűztük ki célul. Az irodalomkutatást követően, a jelenleg is hatályos, AGREE II. rendszer szerinti magas minőségű besorolást elérő, krónikus deréktáji fájdalomra vonatkozó, angol nyelvű nemzetközi irányelvek ajánlásainak összehasonlítását végeztük el. Tanulmányunkban hét irányelvet dolgoztunk fel (négy európai, kettő amerikai, egy kanadai), melyek mindegyikében a következő közös ajánlások kerültek megfogalmazásra: a súlyos patológiák kizárása az alarm tünetek alapján, a pszichoszociális tényezők figyelembevétele, a szükségtelen képalkotó vizsgálat visszaszorítása, az elsősorban aktív, nem gyógyszeres terápiák preferálása és a nemszteroid gyulladáscsökkentők körültekintő felírása. Az európai irányelvekben új elemként szerepelt a krónikussá válás korai rizikóbecslése. Orv Hetil. 2021; 162(49): 1951-1961. Summary. In 2019, low back pain caused the highest burden globally, among musculoskeletal disorders, affecting 568 million people. According to Hungarian sociodemographic data, 20% of the Hungarian adults live with chronic low back pain that is a global health priority. Therefore, the International Association for the Study of Pain announced 2021 as the global year about back pain. Evidence-based guidelines about the appropriate treatment of acute low back pain and prevention of chronic low back pain are therefore of paramount importance. However, there are currently no valid, uniform treatment guidelines in Hungary about acute and chronic lower back pain. In this paper, we aimed at summarizing up-to-date, evidence-based diagnostic and treatment recommendations for chronic low back pain. Using a literature review, we identified seven international treatment guidelines (four from Europe, two from the United States and one from Canada) in English for the management of chronic low back pain that were previously assessed by the AGREE II quality assessment tool. We found consistent recommendations in the guidelines such as exclusion of alarm symptoms, assessment of psycho-social factors, reduction of unnecessary imaging, initialization of primarily active, non-pharmacological therapies, and careful and cautious prescription of non-steroidal anti-inflammatory medications. A new recommendation in the European guidelines is the early risk assessment of low back pain becoming chronic. Orv Hetil. 2021; 162(49): 1951-1961.

[Comparative analysis of the full and shortened versions of the Oldenburg Burnout Inventory]

Background - The two free-to-use versions of the Oldenburg Burnout Inventory (OLBI) have been increasingly utilised to assess the prevalence of burnout among human service workers. The OLBI has been developed to overcome some of the psychometric and conceptual limitations of the Maslach Burnout Inventory, the gold standard of burnout measures. There is a lack of data on the structural validity of the Mini Oldenburg Burnout Inventory and the Oldenburg Burnout Inventory in Hungary. Purpose - To assess the structural validity of the Hungarian versions of the Oldenburg Burnout Inventory and the Mini-Oldenburg Burnout Inventory. Methods - We enrolled 564 participants (196 healthcare workers, 104 nurses and 264 clinicians) in three cross-sectional surveys. In our analysis we assessed the construct validity of the instruments using confirmatory factor analysis and internal consistency using coefficient Cronbach's α. Results - We confirmed the two-dimensional structure (exhaustion and disengagement) of the Mini-Oldenburg Inventory and a shortened version of the Oldenburg Burnout Inventory Internal consistency coefficient confirmed the reliability of the instruments. The burnout appeared more than a 50 percent of the participants in every subsample. The prevalence of exhaustion was above 54.5% in each of the subsamples and the proportion of disengaged clinicians was particularly high (92%). Conclusions - Our findings provide support for the construct validity and reliability of the Hungarian versions of the Mini-Oldenburg Burnout Inventory and a shortened version of the Oldenburg Burnout Inventory in the assessment of burnout among clinicians and nurses in Hungary.

Self-reported specific learning disorders and risk factors among Hungarian adolescents with functional abdominal pain disorders: a cross sectional study

BACKGROUND

Despite its increasing clinical significance and diagnostic challenges, little is known about functional abdominal pain disorders (FAPDs) in Central-Eastern Europe. In this paper, the prevalence and potential sociodemographic correlates of FAPDs among Hungarian adolescents are explored.

METHODS

A cross-sectional, nationwide, questionnaire study in a representative sample of 657 adolescents has been conducted. With a response rate of 80.2%, 522/527 (99.1%) questionnaires were eligible for data analysis (N = 267, 51.1% girls, mean age 14.8, SD 2.4 years). The questionnaire included sociodemographic variables (age, sex, place of residence, marital status of the parents, family income, religion, educational level of parents), questions regarding self-reported specific learning disorders and the Questionnaire for Paediatric Gastrointestinal Symptoms Rome ΙΙΙ Edition.

RESULTS

The prevalence of FAPDs was 11.9% (N = 62). FAPDs were significantly associated with female sex. Living in a county town showed a negative correlation with FAPD. Adolescents with self-reported arithmetic learning disorders had an 8.7-fold likelihood of FAPD (OR, 8.7; 95% CI (3.5-21.9). Adolescent girls reported pain in all subtypes of FAPDs more frequently than adolescent boys except functional abdominal pain syndrome. The most prevalent FAPD was abdominal migraine (N = 32, 6.1%), followed by irritable bowel syndrome (N = 24, 4.6%).

CONCLUSIONS

The prevalence of FAPDs in Hungary is similar to that reported worldwide, however, contrary to international data, abdominal migraine is the most frequently encountered FAPD in Hungary. In addition to well-known correlates of FAPDs, such as female sex and place of residence, arithmetic learning disorders have also been identified as correlating with the prevalence of FAPDs. Our results suggest culture-specific differences in the distribution of FAPDs, and confirm the significance of school performance indicators such as specific learning disorders as a correlate of FAPDs.

[Potential risk factors and consequences of chronic pain among Hungarian adolescents]

Introduction: Based on international data, the prevalence of chronic pain is 25% among adolescents which is associated with poor quality of life, extensive use of healthcare, and overuse of pain medication. Little is known about the medication use and chronic pain in Hungary. Aim: To assess the prevalence and potential socio-demographic risk factors of chronic pain and medication use among Hungarian adolescents. Method: We conducted a cross-sectional epidemiological study at primary and secondary schools with 354 school-children. Adolescents responded to questionnaires about demographic variables, characteristics of chronic pain, use of health-care system and medication. Results: 110 adolescents (31.1%) suffered from chronic pain in our sample. Pain in extremities was the most prevalent pain type. 4.6% (n = 5) of children suffered from continuous pain. The prevalence was lower among boys (χ² = 9.4; p = 0.002) and younger subjects (Mann-Whitney U = 10906.5; p = 0.004). Sleep disorder was more frequent among adolescents with chronic pain (χ² = 8.9; p = 0.03). Time from onset, intensity, prevalence and duration of pain were associated with the prevalence of visits to physicians. 78% (n = 276) of the sample took medication in the previous 6 months, however, regular medication use was as high as 48.3% (n = 171). We found a significant association between medication use and older age, female sex, and the presence of chronic pain. Medication use against pain among adolescents with chronic pain was significantly higher (n = 83.0, 75.5%). Conclusion: The prevalence of chronic pain, medication use and visits to physicians is considerable among Hungarian adolescents. It is an important healthcare challenge with long-term consequences until adulthood. Orv Hetil. 2020; 161(13): 502-509.

Risk factors for multiple suicide attempts among Roma in Hungary

In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.

Validation of the Hungarian version of Carlson's Work-Family Conflict Scale

Background and purpose

Work-family conflict has been associated with adverse individual (e.g., cardiovascular diseases, anxiety disorders), organizational (e.g., absenteeism, lower productivity), and societal outcomes (e.g., increased use of healthcare services). However, lack of standardized measurement has hindered the comparison of data across various cultures. The purpose of this study was to develop the Hungarian version of Carlson et al.'s multidimensional Work-Family Conflict Scale and establish its reliability and validity.

Methods

In a sample of 557 employees (145 men and 412 women), we conducted confirmatory factor analysis to investigate the factor structure and factorial invariance of the instrument across sex and data collection points and evaluated the tool's validity by assessing relationships between its dimensions and scales measuring general, marital, and job-related stress, depressive symptomatology, vital exhaustion, functional somatic symptoms, and social support.

Results

Our results showed that a six-factor model, similarly to that of the original instrument, fit the data best. Internal consistency of the six dimensions and the whole instrument was adequate. Convergent and divergent validity of the instrument and discriminant validity of the dimensions were also supported by our data.

Conclusion

This study provides empirical support for the validity and reliability of the Hungarian version of the multidimensional Work-Family Conflict Scale. Deployment of this measure may allow for the generation of data that can be compared to those obtained in different cultural settings with the same instrument and hence advance our understanding of cross-cultural aspects of work-family conflict.

A two-week inpatient programme with a booster improved long-term management of severe chronic paediatric pain

In the context of limited healthcare resources and increasing demands for more cost-effective healthcare solutions, this study assessed the short- and long-term clinical outcomes and resource utilization of a two-week inpatient, interdisciplinary, pain treatment (IIPT) including individual and group cognitive behavioural, occupational, physical and recreational therapy, education and family intervention and a booster in the chronic paediatric pain setting. Using a longitudinal design with a two-year follow-up, two-week IIPT resulted in sustainable improvements in mean and maximum pain intensity, physical functioning and internalization and reductions in the mean number of medical visits, school absence and frequency of pain medication at year 2 following IIPT. While pain-related disability scores did not improve, problem-focused coping became more prevalent, and patient and parent-assessed satisfaction as well as pain experience continued to improve throughout the study. Our results demonstrate that a two-week IIPT with a booster confers meaningful short- and long-term improvements in clinical outcomes and resource utilization among paediatric patients with severe chronic pain.

Gender differences in deliberate self-poisoning in Hungary: analyzing the effect of precipitating factors and their relation to depression

BACKGROUND

The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder.

AIMS

The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression.

METHOD

Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire.

RESULTS

Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression.

CONCLUSION

Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.

[Facilitating the diagnosis of depression and burnout by identifying demographic and work-related risk and protective factors among nurses]

INTRODUCTION

Depression and burnout are frequent comorbidities among nurses. Despite similar symptoms, their management differ. Therefore, their timely diagnosis is essential.

AIM

To identify demographic and work-related risk and protective factors of burnout and depression, and facilitate their diagnosis.

METHOD

A cross-sectional study among 1,713 nurses was carried out. Depression and burnout were assessed by the shortened Beck Depression Questionnaire and Maclach Burnout Inventory, respectively. Risk and protective factors were explored using t-tests and analysis of variance.

RESULTS

The prevalence of depression and moderate-to-high burnout was 35.1% and 34-74%, respectively. Having a partner/child and longer employment in the outpatient setting protected from burnout. Lack of a partner and male sex emerged as risk factors of depression and depersonalisation, respectively.

CONCLUSIONS

High prevalence of depression and burnout among nurses poses a significant public health issue. Familiarity with the disease-specific risk and protective factors identified in this research may facilitate timely diagnosis and effective disease management.

[The relationship of work-related psychosocial risk factors with depressive symptoms among Hungarian workers: preliminary results of the Hungarian Work Stress Survey]

INTRODUCTION

Research has shown that psychosocial stress acts as a risk factor for mental disorders.

AIM

The present study aims at processing the preliminary results of the Hungarian Survey of Work Stress, concerning the relationship between depressive symptoms and work stress.

METHODS

Cross-sectional survey among Hungarian workers was carried out (n = 1058, 27.5% man, 72.5% woman, age 37.2 years, SD = 11 years). Psychosocial factors were measured using the COPSOQ II questionnaire, while BDI-9 was used for the assessment of depressive symptoms. Statistical analysis was carried out applying Spearman's correlation and logistic regression.

RESULTS

A quarter of the workers reported moderate or severe symptoms of depression (BDI≥19). The study confirmed the association between depressive symptoms and work-family conflict (OR = 2.21, CI: 1.82-2.68), possibilities for development (OR = 0.76, CI: 0.59-0.97) meaning of work (OR = 0.69, CI: 0.59-0.89) and commitment (OR = 0.60, CI: 0.47-0.78).

CONCLUSION

The results point toward the need of such organizational measures that allow for the reduction of psychosocial stress.

Negative and positive predictive relationships between coping strategies and the three burnout dimensions among Hungarian medical students

Introduction: Effective management and prevention of widespread burnout among medical students in Hungary require thorough understanding of its relations to coping strategies, which lacks sufficient data. Aim: To explore the prevalence of burnout and its relations to coping strategies among medical students. Method: Cross-sectional study with 292 participants. Burnout was assessed by the Maslach Burnout Inventory-Student Survey. Coping strategies were evaluated by the Folkman–Lazarus Ways of Coping Questionnaire and questions about health-maintenance behaviours. Associations between burnout and coping strategies were explored with linear regression analyses. Results: The prevalence of high-level burnout was 25–56%. Both problem-focused coping and support-seeking were protective factors of exhaustion and cynicism, however, they predicted reduced personal accomplishment. Emotion-focused coping predicted exhaustion and cynicism and correlated negatively with reduced personal accomplishment. Health-maintenance behaviours were protective factors for exhaustion and predicted reduced personal accomplishment. Conclusions: Deployment of coping strategies that target the most prevalent burnout dimension may improve effective management of burnout.

Somatic and mental morbidity of young female physicians. Does emotional exhaustion constitute the missing link?

Introduction: The high prevalence of morbidity among female physicians in Hungary is well documented, however, little is known about the prevalence of that in certain age groups. Aims: To assess the prevalence of somatic and psychiatric morbidity in two age cohorts (Cohort 1: age 24–43 and Cohort 2: age 44–76) of female physicians and to explore the relationship between morbidity and potential risk factors including work-related stressors. Methods: Representative, cross-sectional, quantitative survey among representative samples of female physicians (N = 408). Results: Physicians in Cohort 1 reported more frequent night shift rotation, less leisure time, and fewer days off compared to physicians in Cohort 2. Physicians in Cohort 1 were less satisfied with their work, workplace, reported less support from their colleagues, and received lower salary compared to physicians in Cohort 2. Physicians in Cohort 1 scored significantly higher on the emotional exhaustion and the personal accomplishment scales MBI as compared to Cohort 2 physicians. In Cohort 1 emotional exhaustion and personal accomplishment were associated with high depression scores and frequent suicidal ideation. Conclusions: The role of emotional exhaustion is decisive of young physicians’ well-being. Future research should focus on understanding the psycho-social, individual, organizational, and societal correlates of the high prevalence of morbidity among young female physicians in Hungary. Orv. Hetil., 2013, 154, 20–27.