Ethical Implications of Obstetric Care in Hungary: Results from the Mother-Centred Pregnancy Care Survey

Background: Informed consent plays an important role in clinical decision making. It is a basis of self determination in health care. In ideal situations health care professionals inform their patients about all relevant aspects of care and alternative care options, map the value system of the patients, and adjust the information process accordingly. Objectives: Our objective was to see the frequency of selected interventions (birth induction, caesarean section, episiotomy, forced supinal position during birth, and the consent process associated to these interventions. Methods: 1,257 women (with childbearing capacity) between the age of 18 and 45 with children under the age of 5 were surveyed online. Results: Caesarian section was done without permission in 10.2% of women. Labour was inducted in 22.2% of all deliveries and it was done without permission in 25.4% . Episiotomy was done in 39.9% of women having vaginal delivery in the Sample 2 group and in 72.2% of women having vaginal delivery in the Sample 1 (representative) group. Women undergoing episiotomy were not asked for consent in 62.0% in the Sample 1 group and in 57.1% in the Sample 2 group. Freedom to choose labour position for women having vaginal birth was restricted in 65.7% in the Sample 1 group and in 46% in the Sample 2 group. Discussion and Conclusions:We have found that the right of women to informed consent and best available treatment is frequently and seriously violated in obstetric practice in Hungary in the given period. These findings should serve as an important basis for improving the quality of maternity care

Stressz és megküzdés = Stress and Coping. Hungarian Experiences with Rahe Brief Stress and Coping Inventory

Tanulmányunkban a Rahe-féle Rövidített Stressz és Megküzdés Kérdőív (Rahe és Tolles 2002) hazai adaptációjának eredményeit szemléltetjük. Vizsgálatunk empirikus hátterét 152 személy alkotta (91 nő és 61 férfi), akiknek az átlagéletkora 29,7 év. A Rövidített Stressz és Megküzdés Kérdőív mellett a Derogatis Tünetlista is felvételre került. A Rövidített Stressz és Megküzdés Kérdőív skáláinak megbízhatóságát összességében jónak tekinthetjük. A stresszre adott válaszok testi és lelki tüneteit meghatározó tényezők vizsgálatakor láthattuk, hogy a kérdőív 8 skálája a pszichológiai tünetek varianciájának a 40%-át, a testi tüneteknek pedig a 23%-át magyarázza. A skálák jelentős mértékű bejósló ereje a mérőeszköz kiváló felépítését és alkalmazásának hasznosságát bizonyítja. A stressz kutatásokban újszerű, a stressz és a megküzdés balanszát jelző Globális Stressz és Megküzdési Index kiváló elemzési és interpretációs lehetőséget biztosít. A mutató szoros együttjárást mutatott a validálásra használt SCL-90R általános pszichiátriai problémákat jelző mutatójával. A Rövidített Stressz és Megküzdési Kérdőív újszerű megközelítése a kutatási alkalmazások mellett kiváló lehetőséget nyújt a különböző stresszkezelő programok hatékonyságának vizsgálatára. A mérőeszköz gyors egyéni kiértékelése lehetőséget teremt a stressz és megküzdési kapacitások mértékének és ezek balanszának visszajelzésére, ami az önsegítés és egészségnevelés fontos eszköze. | Our study examines the psychometric characteristics of the Brief Stress and Coping Inventory (BSCI; Rahe és Tolles, 2002) in a 152 (91 females, 61 males) subjects. Beside of BSCI the Derogatis Symptom Checklist (SCL-90R) was assessed in our sample. The internal consistencies of the BSCI were moderate to high. A multiple regression analysis identified, that 8 scales of BSCI contributed significantly and uniquely for psychological symptoms (R 2 = 0.40) and the somatic symptoms (R 2 = 0.23). Global score summary data, which measuring the balance of the stress and coping is very helpful and interpretable. This score was correlated highly with the SCL-90R Global Severity Index, which is the global index of distress. The BSCI can be used well for measuring efficiency of the stress management programs. The multifaceted Brief Stress and Coping Inventory was designed primarily as an educational instrument, it also has research potential

Az életminőség demográfiai, társadalmi és regionális egyenlőtlenségeinek pszicho-szociális meghatározói a magyar népesség körében és a beavatkozás lehetőségei. Életminőség és esélyerősítés = Psycho-social and demographic determinants of social and regional disparities in quality of life of the Hungarian population and the possibilities for interventions. Quality of life and empowerment

Vizsgálataink célja az volt, hogy magatartástudományi alapú esélyerősítési modellt dolgozzunk ki. Ok-okozati összefüggések bemutatására nyílt lehetőségünk a 2002-es 12.600 főre kiterjedő országos reprezentatív felmérés, valamint a 2006-os 4849 főt magába foglaló követéses vizsgálat adatai alapján. A kutatási témában elért eredményeinkről "Esélyerősítés és életminőség a mai magyar társadalomban" címmel monográfia készült. A pályázat keretében a tudományos iskola munkatársaitól 156 publikáció készült. Vizsgáltuk az esélyteremtés egyéni, közösségi és populációs szintjeinek jellemzőit, valamint az esélyteremtés színtereit: az egyes életszakaszokkal, a társas kapcsolatok minőségével, a közösségi viszonyokkal, a munkával, a kultúrával, vallással, a televiziónézéssel, internet használattal, valamint a negatív életeseményekkel való megbirkózással kapcsolatos esélyteremtési lehetőségeket, a cigány/roma népesség esélyerősítésének kérdéseit. Vizsgálataink kiemelt területe volt az önkárosító és egészségvédő magatartásformák, attitűdök, valamint a krónikus betegek, fogyatékkal élők esélyerősítésének elemzése. Elemeztük az idő előtti halálozás pszichoszociális prediktív tényezőit, ennek nemi különbségeit. Számos esélyerősítést javító intervenciós programot vezettünk be. Pszichofiziológiai vizsgálataink során olyan eljárásokat fejlesztettünk ki, amelyek lehetővé teszik az alváslaboratóriumi felvételek primer prevencióban is kamatoztatható aspektusainak feltárását. | The main aim of our studies was to elaborate a behavioural sciences based model of empowerment. On the basis of our national representative study in 2002 including 12.600 persons and the 2006 follow-up study including 4849 persons we could analyse cause-effect relationships. We have completed a monograph entitled "Empowerment and Quality of Life in the Hungarian population". Furthermore, altogether 156 scientific publications were published within the frame of the grant. We analysed the individual, community and population based levels of empowerment. The arenas of empowerment covered in these studies: life course perspectives, the quality of social relationships, community affiliations, work related protective and risk factors, culture, religion, information and communication technology (internet and television), and possibilities of coping with negative life events. We analysed the possibilities of empowering the gipsy population. Recommendations were made to decrease self-destructive behaviours and to thel realisation of empowering the chronically ill and the disabled. We examined the psychosocial predictive factors of premature mortality as well as the gender differences in this respect. In our psychophysiological studies we developed specific methods which could be important in primary prevention by extracting adequate information from sleep laboratory recordings

Ethical questions in human germ-line gene therapy

Although the first steps in somatic gene therapy have already taken place, research on human germ-line gene therapy still remains taboo. However, the first protocol aiming to cure defective genes of mitochondria in germ cells has been published recently. Germ-line gene therapy is an entirely new method. Its effects and impact on future generations differ considerably from those of somatic gene therapy.A systematic and critical analysis of the arguments for and against germline gene interventions, such as "playing God" and moving on the slippery slope to enhancement will be elaborated. Special attention will be focused on the irreversible changes of the genome of future generations as well as on ethical considerations raised by different therapeutic and experimental possibilities, such as In Vitro Ovum Nuclear Transplantation (IVONT) or the creation of transgenic organisms

Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?

BACKGROUND: In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region. No previous study has examined the associations among informal payments, intervention rates, and quality of maternity care. METHODS: We distributed an online cross-sectional survey in 2014 to a nationally representative sample of Hungarian internet-using women (N = 600) who had given birth in the last 5 years. The survey included items related to socio-demographics, type of provider, obstetric interventions, and experiences of care. Women reported if they paid informally, and how much. We built a two-part model, where a bivariate probit model was used to estimate conditional probabilities of women paying informally, and a GLM model to explore the amount of payments. We calculated marginal effects of the covariates (provider choice, interventions, respectful care). RESULTS: Many more women (79%) with a chosen doctor paid informally (191 euros on average) compared to 17% of women without a chosen doctor (86 euros). Based on regression analysis, the chosen doctor's presence at birth was the principal determinant of payment. Intervention and procedure rates were significantly higher for women with a chosen doctor versus without (cesareans 45% vs. 33%; inductions 32% vs. 19%; episiotomy 75% vs. 62%; epidural 13% vs. 5%), but had no direct effect on payments. Half of the sample (42% with a chosen doctor, 62% without) reported some form of disrespectful care, but this did not reduce payments. CONCLUSION: Despite reporting disrespect and higher rates of interventions, women rewarded the presence of a chosen doctor with informal payments. They may be unaware of evidence-based standards, and trust that their chosen doctor provided high quality maternity care

Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument

BackgroundInstruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women.MethodsFollowing literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses.ResultsExperts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire.ConclusionsWe developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond