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A szerzők az orvostudomány különböző területeiről érkeztek, tapasztalt szakemberek. Vannak köztük gyakorló orvosok az alapellátásból és a kórházi/klinikai ellátásból, diagnosztikai szakemberek, egészségügyi szervezéssel, egészség-gazdaságtannal vagy betegjogokkal foglalkozó kutatók, betegszervezetek képviselői. Közös bennük, hogy valamennyien elkötelezettek a személyre szabott orvoslás és a személyre szabott egészségügyi ellátórendszer bevezetése mellett. Jelen – vitaindítónak is szánt – közleményükben azt a két téveszmét szeretnék eloszlatni, hogy a személyre szabott orvoslás ma még csak a jövő tervezőinek kísérleti terepe, azaz még nem a való világ része, illetve hogy a személyre szabott egészségügyi ellátórendszer hazai bevezetését csak (vagy főképpen) anyagi okok akadályozzák. Orv Hetil. 2023; 164(6): 202–209.

This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article.PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores.The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms.To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.

This study aimed to evaluate the performance of machine learning and regression methods in the prediction of 3-level version of EQ-5D (EQ-5D-3L) index scores from a large diverse data set.A total of 30 studies from 3 countries were combined. Predictions were performed via eXtreme Gradient Boosting classification (XGBC), eXtreme Gradient Boosting regression (XGBR) and ordinary least squares (OLS) regression using 10-fold cross-validation and 80%/20% partition for training and testing. We evaluated 6 prediction scenarios using 3 samples (general population, patients, total) and 2 predictor sets: demographic and disease-related variables with/without patient-reported outcomes. Model performance was evaluated by mean absolute error and percent of predictions within clinically irrelevant error range and within correct health severity group (EQ-5D-3L index0.45, 0.45-0.926,0.926).The data set involved 26 318 individuals (clinical settings n = 6214, general population n = 20 104) and 26 predictor variables plus diagnoses. Using all predictors and the total sample, mean absolute error values were 0.153, 0.126, and 0.131, percent of predictions within clinically irrelevant error range were 47.6%, 39.5%, and 37.4%, and within the correct health severity group were 56.3%, 64.9%, and 63.3% by XGBC, XGBR, and OLS, respectively. The performance of models depended on the applied evaluation criteria, the target population, the included predictors, and the EQ-5D-3L index score range.Regression models (XGBR and OLS) outperformed XGBC, yet prediction errors were outside the clinically irrelevant error range for most respondents. Our results highlight the importance of systematic patient-reported outcome (EQ-5D) data collection. Dialogs between artificial intelligence and outcomes research experts are encouraged to enhance the value of accumulating data in health systems.

Background Acceptable health and sufficientarianism are emerging concepts in health resource allocation. We defined acceptability as the proportion of the general population who consider a health state acceptable for a given age. Previous studies surveyed the acceptability of health problems separately per EQ-5D-3L domain, while the acceptability of health states with co-occurring problems was barely explored. Objective To quantify the acceptability of 243 EQ-5D-3L health states for six ages from 30 to 80 years: 1458 health state–age combinations (HAcs), denoted as the acceptability set of EQ-5D-3L. Methods In 2019, an online representative survey was conducted in the Hungarian general population. We developed a novel adaptive survey algorithm and a matching statistical measurement model. The acceptability of problems was evaluated separately per EQ-5D-3L domain, followed by joint evaluation of up to 15 HAcs. The selection of HAcs depended on respondents’ previous responses. We used an empirical Bayes measurement model to estimate the full acceptability set. Results 1375 respondents (female: 50.7%) were included with mean (SD) age of 46.7 (14.6) years. We demonstrated that single problems that were acceptable separately for a given age were less acceptable when co-occurring jointly (p Conclusion The acceptability set of EQ-5D-3L quantifies societal preferences concerning age and disease severity. Its measurement profiles and potential role in health resource allocation needs further exploration.

Objectives The ICEpop CAPability measure for Adults (ICECAP-A) was developed to assess the capability well-being of adults for use in economic evaluations. Currently, ICECAP-A tariffs are available only for the UK population. The objectives of this study were to develop a Hungarian tariff set for the ICECAP-A instrument and to explore intercountry differences between the Hungarian and the UK value sets. Methods A survey was conducted by computer-assisted personal interviews on a sample representative of the Hungarian adult population (N = 1000) to elicit their preferences regarding ICECAP-A attributes with the use of a best-worst scaling choice task. A latent class multinomial logit model with continuous variance scale was used to estimate the weights for each of the 4 capability levels of all 5 ICECAP-A attributes, namely, attachment, stability, achievement, enjoyment, and autonomy. Results The model identified 2 preference classes with approximately equal share. The first class had a stronger relative preference for autonomy and achievement, whereas the second class had a strong preference for attachment. Multivariate analysis of the classes revealed that women, pensioners, people who are married or living in a partnership, and people with poorer health status are characteristics associated with the latter class membership (preference for attachment). Population tariffs were estimated from the model. Overall, attachment was found to be the most important attribute, followed by stability, enjoyment, achievement, and autonomy. Conclusions Hungarian tariffs are largely consistent with those found for the United Kingdom; nevertheless, autonomy seems to be less important in Hungary compared with the United Kingdom.

Infection prevention and control (IPC) is a set of evidence-based practices of hospital epidemiology aiming to prevent and control healthcare-associated infections. The aim of the present study was two-fold. First, we estimated the costs of IPC in the Medical Centre of the Hungarian Defence Forces (MCHDF) in Hungary using a bottom-up microcosting approach. Second, we analysed how the involvement of the MCHDF in Covid-19 care changed the occurrence of multidrug-resistant infections in the hospital. Our results showed that depending on the type of ward, the daily costs of standard care ranged between 3,809–8,589 HUF, while the costs of isolation were between 9,203–11,200 HUF. Daily costs were highest in the intensive care unit (ICU). Total costs per patient ranged between 20,875–78,904 HUF for standard care and 79,996–282,892 HUF for isolation with highest values in the Neonatal Intensive Care Unit (NICU). The incremental isolation cost per patient compared to standard care ranged between 20,363–158,216 HUF. When the MCHDF became a Covid-19 care centre, the incidence of introduced Clostridium difficile and multidrug resistant cases increased by nearly 200 per cent and 40 per cent, respectively. Our results can be used as basic input data for the economic evaluation of IPC strategies and highlights an important IPC aspect to be considered for the redistribution of hospital capacities during the Covid-19 pandemic.

Összefoglaló. Bevezetés: A gyulladásos folyamatok és a tumorok kialakulása, illetve progressziója közötti összetett kapcsolat ismert. Az interleukin-6 (IL6) egy pleiotrop gyulladásos citokin, melynek tumorstimuláló és -gátló tulajdonsága is van. Célkitűzés: Kutatásunk célja az IL6-expresszió vizsgálata volt colorectalis adenocarcinoma miatt reszekción átesett betegek szövettani metszetein. Módszer: Az Uzsoki Utcai Kórházban 2004 és 2011 között reszekált 64, colorectalis tumoros beteg demográfiai, sebészeti és patológiai adatait gyűjtöttük össze. A betegek szövettani metszeteit IL6-antitesttel festettük. A digitalizált metszeteket kvantitatív színelemzéssel kiértékeltük, majd az eredményeket a betegek klinikai paramétereinek függvényében elemeztük. Eredmények: Előrehaladott stádiumú betegekben a tumorsejtek IL6-expressziója szignifikánsan magasabbnak bizonyult lineáris regresszióval. A tumorsejtek IL6-expressziója azonban nem korrelált a nemmel, az életkorral vagy a tumor differenciáltságával. Megbeszélés: Különbségek mutatkoztak a tumorsejtek és a stromasejtek IL6-kifejeződése között. Következtetés: Az IL6 hasznos marker és potenciális terápiás cél lehet az előrehaladottabb stádiumú colorectalis tumoros betegeknél. Orv Hetil. 2021; 162(37): 1502–1507. Summary. Introduction: It is well known that there is a complex correlation between inflammation and tumor development and tumor progression. Interleukin-6 (IL6) is a pleiotropic inflammatory cytokine with both tumor stimulating and inhibiting effect. Objective: The goal of our study was to evaluate the IL6 expression of histological slides from patients after resection of colorectal adenocarcinoma. Method: Demographical, surgical, and pathological findings of 64 patients with colorectal cancer operated between 2004 and 2011 in Uzsoki Teaching Hospital were evaluated. Histopathological slides were stained with IL6 antibody. The digitalized slides were assessed with quantitative color analysis, and the results were evaluated according to patients’ clinical parameters. Results: Linear regression showed significantly higher IL6 expression in the tumor cells in patients with advanced stages. However, the IL6 expression of the tumor cells did not correlate with sex, age, or tumor grade. Discussion: There were differences between the IL6 expression in tumor cells and stromal cells. Conclusion: IL6 may be a useful marker and potential therapeutic target in patients with advanced colorectal cancer. Orv Hetil. 2021; 162(37): 1502–1507.

Összefoglaló. Bevezetés: A lakosság idősödésével növekvő betegségteher egyéni és társadalmi szinten is fokozódó nyomást jelent. Célkitűzés: Felmérni a hazai általános felnőtt lakosságnak a korlátozottsággal, a gondozási igényekkel és a munkavégzéssel kapcsolatos időskori szubjektív várakozásait. Módszer: Online keresztmetszeti felmérést végeztünk. A korlátozottsággal kapcsolatos várakozásokat a hivatalos szakstatisztikákban alkalmazott globális tevékenységkorlátozottsági mutató (Global Activity Limitation Indicator, GALI) segítségével elsőként vizsgáltuk. A jelen és szubjektíve várt munkavégzést, gondozási igényt, gondozói tevékenységet, valamint a jelen egészségi állapotot és szociodemográfiai helyzetet vizsgáló kérdéseket is feltettünk. Statisztikai analízis: A mintában mért adatokat lokális polinom segítségével simítottuk, és a 60/70/80/90 éves korra adott szubjektív várakozásokkal hasonlítottuk össze. A szubjektív várakozásokat meghatározó tényezőket intervallumregresszióval becsültük. Eredmények: 1000 kitöltőtől 914 érvényes választ kaptunk. Az átlagéletkor (± szórás) 51,2 (± 15,2) év, a minta 55,8%-a nő volt. A férfiak között a fizetett munkát végzők (pKövetkeztetés: Az egészséggel, munkával és gondozással kapcsolatos szubjektív várakozások eltérőek a populációban mért valós adatoktól, és különböznek a nemek között. Orv Hetil. 2021; 162(23): 911–923. Summary. Introduction: The growing disease burden due to ageing populations poses a challenge on both individuals and societies. Objective: To explore the general population’s subjective expectations concerning disability, care needs and employment at older ages. Method: We conducted an online cross-sectional survey. We were the first to measure subjective health expectations using the Global Activity Limitation Indicator (GALI) of official health statistics. Respondents’ actual status and subjective expectations concerning employment, care needs and informal caregiver status, self-perceived health and sociodemographic factors were queried. Statistical analysis: We estimated sample characteristics by local polynomial smoothing and compared with subjective expectations at ages of 60/70/80/90 years. Determinants of subjective expectations were analyzed via interval regression. Results: From 1000 subjects, 914 provided valid responses. Mean (± SD) age was 51.2 (± 15.2) years, and 55.8% of respondents were women. Paid employment was more frequent among men (pConclusion: Subjective expectations concerning health, employment and care needs differ from actual values of the general population, with considerable gender differences. Orv Hetil. 2021; 162(23): 911–923.

Összefoglaló. Bevezetés: Régóta ismert, hogy a daganatokhoz társuló emelkedett vérlemezkeszám rosszabb túléléssel társul. Fej-nyak tumoros betegek esetében kevés információ áll rendelkezésünkre ezzel az összefüggéssel kapcsolatban. Célkitűzés: Vizsgálatunk célja a fej-nyak daganatos betegek prognózisa és a thrombocytosis közötti összefüggés tanulmányozása volt. Módszer: Különféle stádiumú és lokalizációjú, 312, fej-nyak tumoros beteg retrospektív adatait elemeztük. A műtét előtti vérlemezkeszámokat vizsgáltuk, a 300 G/l feletti értéket tekintettük emelkedett thrombocytaszámnak. A vérlemezkeszám és a túlélés közötti kapcsolatot Kaplan–Meier-módszerrel és multivariáns Cox-regresszióval elemeztük. Eredmények: Emelkedett thrombocytaszám mellett szignifikánsan rosszabb túlélést észleltünk (5 éves túlélés: p = 0,007, betegségmentes túlélés: p = 0,192). Ez az összefüggés még akkor is fennállt, amikor multivariáns analízissel nemre, korra, stádiumra, differenciáltsági fokra, lokalizációra, valamint fehér- és vörösvérsejtszámra korrigáltuk az elemzést (5 éves túlélés: p = 0,027). A különféle anatómiai lokalizációkban eltérő mértékben észleltünk 300 G/l feletti vérlemezkeszámot (algarat: 43,6%, sub- és supraglottis: 35,8%, szájüreg: 35,7%, hangszalag: 22,5%, szájgarat: 19%, multiplex: 50%), ez azonban nem befolyásolta szignifikánsan a túlélést (p = 0,603). Következtetés: A daganathoz társuló thrombocytosis összefüggésbe hozható a fej-nyak tumoros betegek rosszabb túlélésével. Az egyes lokalizációkban talált különböző vérlemezkeszámok nem befolyásolják eltérő mértékben a túlélést. Orv Hetil. 2021; 162(17): 676–682. Summary. Introduction: The association between cancer-related thrombocytosis and worse survival has been described with a variety of solid neoplasms. However, only limited data are available on the prognostic significance of elevated platelet count in head and neck tumours. Objective: We aimed to investigate the correlation between the survival of patients with head and neck cancer and thrombocytosis. Method: We conducted an analysis of the data from 312 patients with head and neck squamous cell carcinoma of various stages and locations. Preoperative platelet counts were analysed; elevated platelet count was defined as 300 G/l or higher. The influence of platelet count on survival was calculated with the Kaplan–Meier method as well as with multivariate Cox regression. Results: In patients with excessive thrombocytosis, survival was significantly worse (overall survival: p = 0.007, disease-free survival: p = 0.192). This association remained significant even after adjusting the multivariate analysis for age, gender as well as tumour stage, grade, location, red and white blood cell count (overall survival: p = 0.027). The magnitude of thrombocytosis differed among tumours of different anatomical locations (hypopharynx: 43.6%, sub- and supraglottis: 35.8%, oral cavity: 35.7%, vocal cord: 22.5%, oropharynx: 19%, multiple: 50%), but this did not affect survival significantly (p = 0.603). Conclusion: Elevated platelet count may be related to a worse prognosis in head and neck squamous cell carcinoma patients. The impact of thrombocytosis does not vary with the anatomical location of the tumour. Orv Hetil. 2021; 162(17): 676–682.

IntroductionDigital transformation has been promoted by the World Health Organization (WHO), Food and Drug Administration (FDA) and the European Commission (EC) to help improve health outcomes. To ensure sustainability, digital health interventions (DHI) require funding by payers. Evidence-informed decision and policy making requires an assessment of the impact on relevant outcomes vs current healthcare practice. Various national and international organizations are involved in creating or guiding the development of standards for the evidence required for digital technologies.MethodsWe undertook an intensive individual investigation of the websites of leading payer and health technology assessment (HTA) bodies in France, UK, Germany, Belgium, Austria, Finland, Canada, Australia, and the USA to identify new frameworks and any updated information. As the objective focused on evaluation frameworks which were used across DHIs by a particular payer to support pricing and reimbursement decisions, we excluded individual case studies where DHIs had been assessed, regulatory frameworks for approval of DHIs and frameworks which assessed feasibility or applicability of a DHI since these were not directly influencing the decision for funding.ResultsWe found six frameworks which directly address digital health interventions for the purposes of pricing and reimbursement: NICE Evidence Standards, FinCCHTA, MSAC, Germany BfArM, Belgium RIZIV and France HAS. The context for the framework and the requirements were compared on parameters including those normally found in HTA and for criteria related to digital technologies. The parameters included varied considerably across the frameworks as did the level of evidence expected to be available for the assessment. In some cases, these related to the level of risk or impact of the intended DHI.ConclusionsWhile DHIs are increasingly used in health, HTA is struggling to adapt to assess these technologies. Due to the multidisciplinary nature of digital health (combination of health care and technology), and the speed and rate of change of innovations in this area, an approach based upon the risk assessment posed by the technology seems reasonable. In this way the level of effort can be tailored to those interventions which seek to influence care or predict outcomes rather than those which are tailored to increased awareness of the patient about their condition.

(1) Background: System-level data on waiting time in the outpatient setting in Hungary is scarce. The objective of the study was to explore self-reported waiting time for an appointment and at a doctor’s office. (2) Methods: An online, cross-sectional, self-administered survey was carried out in 2019 in Hungary among a representative sample (n = 1000) of the general adult population. Chi-squared test and logistic regression analysis were carried out to explore if socioeconomic characteristics, health status, or residence were associated with waiting times and the perception of waiting time as a problem. (3) Results: Proportions of 90%, 41%, and 64% of respondents were seen within a week by family doctor, public specialist, and private specialist, respectively. One-third of respondents waited more than a month to get an appointment with a public specialist. Respondents in better health status reported shorter waiting times, those respondents were less likely to perceive a problem with: (1) waiting time to get an appointment (OR = 0.400) and (2) waiting time at a doctor’s office (OR = 0.519). (4) Conclusions: Longest waiting times were reported for public specialist visits, but waiting times were favorable for family doctors and private specialists. Further investigation is needed to better understand potential inequities affecting people in worse health status.

Several risk factors were studied in endoscopic type I. tympanoplasty, however, an easy-to-use risk stratification model is still missing. Retrospective chart review, focusing on individual risk factors and middle ear risk index (MERI). Patients who underwent endoscopic type I. tympanoplasty were included. Closed tympanic cavity was succesfully created in 88.1% of the 42 cases, the overall 21,5 dB air–bone gap (ABG) was reduced by 9,8 dB. The average MERI score of the patients was 2.1 ± 1.5. 78.6% of the patients were categorised into the mild, while 21.4% into the moderate risk group. The perforation was considered small in 81.0% of the cases, while large in 19.0%. The size of the perforation and the preoperative ABG, but not the MERI status were the only single predictors of success. Using a risk stratification model that is based on the size of the perforation, the preoperative ABG and MERI status, patients could be referred into two distinct groups of risk: the majority expecting excellent outcomes with maximum one risk factor present, and patients with deteriorated rate of success when having two or three risk factors. Endoscopic type I. tympanoplasty with underlay perichondrium graft can be performed with good chance of success. However, if more than one risk factors are present, the chance of residual perforation becomes great. In addition to the established risk factors, our results point out that despite its strong correlation with perforation size, ABG may have a predictive role.

A biotechnológia, mely élő vagy élettelen anyagokat változtat meg tudás, termékek vagy szolgáltatások létrehozásáért, a nemzetközi versenyképességet meghatározó alaptechnológiák egyike. A Magyar Biotechnológiai Szövetség által koordinált BNTP (Biotechnológiai Nemzeti Technológiai Platform) 2009-ben határozta meg a biotechnológiai ipar 2030-ra elérendő stratégiai céljait. A szerzők tanulmányukban a biotechnológiai ipar helyzetét, valamint a 2030-ig terjedő fejlesztési célkitűzések alakulását kívánják felmérni, továbbá a szektor működésének, teljesítményének, társadalmi-gazdasági hasznának mérését lehetővé tevő adatok azonosítására vállalkoznak. Áttekintik a hazai biotechnológiai iparról publikált jelentéseket, megvizsgálják a biotechnológiai szektor definíciós lehetőségeit. A szektor üzleti és tudományos indikátorait teljes körben felölelő adatbázis nem áll rendelkezésre, így a 2008 és 2018 közötti időszakra vonatkozó fő teljesítménymutatókat többféle adatforrás (a KSH [Központi Statisztikai Hivatal] által vezetett OSAP [Országos Statisztikai Adatfelvételi Program], a TEÁOR [Tevékenységek Egységes Ágazati Osztályozási Rendszere], illetve cégekre vonatkozó adatokat tartalmazó [Cégfürkész] adatbázis) és módszer alkalmazásával elemzik. Feltételezésük szerint a biotechnológiai célú kutatások tudományos eredményei és a biotechnológiai ipar helyzete között összefüggés mutatható ki, ezért a hazai kutatók biotechnológiai témájú tudományos teljesítményét is vizsgálják.

Purpose The CarerQol instrument has been designed and validated as an instrument able to measure both the positive and the negative impacts of caregiving on the quality of life of informal caregivers (CarerQol-7D), as well as their general happiness (CarerQol-VAS). The aim of this study was to assess the construct validity of the CarerQol in the Hungarian context. Methods The CarerQol was translated into Hungarian. Subsequently, in a cross-sectional online survey, representative for the general Hungarian population (N = 1000), informal caregivers were identified (N = 149, female 51.2%, mean age 53.2). Clinical, convergent and discriminant validity of the CarerQol were evaluated in relation to the caregivers’ and care recipients’ EQ-5D-5L health status, and caregiving situation characteristics. Results Average CarerQol-7D and CarerQol-VAS scores were 76.0 (SD 16.2) and 6.8 (SD 2.3), respectively. CarerQol-7D and CarerQol-VAS scores were significantly correlated with caregiving time (r = − 0.257; − 0.212), caregivers’ EQ-5D-5L scores (r = 0.453; 0.326) and the CarerQol-7D also with care recipients’ EQ-5D-5L scores (r = 0.247). CarerQol-7D scores differed significantly with relevant caregiving characteristics (e.g. nature and severity of care recipients’ health status, sharing household) and both the CarerQol-7D and CarerQol-VAS with the overall care experience. Conclusion Our findings confirmed the validity of the Hungarian language version of the CarerQol and support the cross-cultural validity of the instrument. CarerQol-7D scores performed better in distinguishing caregiving situation characteristics than the general happiness measure CarerQol-VAS. Care recipients’ health status was only weakly associated with informal caregivers’ care-related quality of life and happiness. Caregivers’ own health and caregiving circumstances were more strongly associated with these scores.

Absztrakt: Bevezetés: A betegségek jelentősen befolyásolhatják az egyének munkaképességét, beleértve a munkából való hiányzást (absenteeism) és a csökkent hatékonyságú munkavégzést (presenteeism). Célkitűzés: A hazai felnőtt lakosság egészséggel összefüggő munkaképességének felmérése és lakossági normaértékek kialakítása a munkaképességre és tevékenységcsökkenésre vonatkozó (WPAI-) kérdőívvel. Módszer: Keresztmetszeti kérdőíves vizsgálatot végeztünk 2019-ben reprezentatív felnőtt lakossági minta (n = 2023) bevonásával. Felmértük a résztvevők szociodemográfiai jellemzőit. A válaszadók munkaképességét a WPAI-kérdőívvel, egészségi állapotát az EQ-5D-3L-kérdőívvel és az Európai Minimum Egészség Modul (MEHM) kérdéseivel vizsgáltuk. Statisztikai analízis: Leíró statisztikai elemzéseket végeztünk, Mann–Whitney-, illetve Kruskal–Wallis-teszttel vizsgáltuk az alcsoportok közötti különbségeket. Spearman-féle rangkorrelációval elemeztük a WPAI kapcsolatát az életkorral és az EQ-5D-3L-indexszel. Eredmények: A fizetett munkaviszonyban levők (n = 1194, 59%) közül 70 fő (6%) hiányzott a munkából a felmérést megelőző héten, ez átlagosan heti 1,9 (SD = 8,5) óra munkaidő-veszteséget jelent. Presenteeism 166 főnél (14%) fordult elő. A WPAI-absenteeism átlagosan 3,6%, a presenteeism 4,4%, a napi tevékenységek hatékonyságának csökkenése a teljes mintában 9,5% volt. Az absenteeism nem korrelált az életkorral, és nem különbözött jelentősen a vizsgált szociodemográfiai jellemzők szerint. A presenteeism a dolgozó nyugdíjasok, rokkantnyugdíjasok és a részmunkaidősök körében volt a legmagasabb. A presenteeism közepes (r = –0,379), az absenteeism gyenge (r = –0,113) kapcsolatot mutatott az EQ-5D-3L-indexszel. Közepes, illetve erős korrelációt találtunk a napi tevékenységek hatékonysága és az életkor (r = 0,412), valamint az EQ-5D-3L-index (r = –0,592) között. A MEHM szerinti állapotok rosszabbodásával szignifikánsan rosszabb WPAI-eredményeket mértünk. Következtetés: Kutatásunk elsőként nyújt hazai lakossági referenciaértékeket az egészséggel összefüggő munkaképességről a WPAI-kérdőívvel. A presenteeism területén jelentkező munkaképesség-csökkenés fokozott figyelmet érdemel a munkáltatók, a munkaügyi, egészségügyi és szociális szektor részéről. Orv Hetil. 2020; 161(36): 1522–1533.

Purpose We aimed to develop and assess the psychometric characteristics of the Hungarian language version of two well-being capability measures, the ICEpop CAPability measure for Adults/Older people (ICECAP-A/-O), and to establish population norms. Methods A cross-sectional survey was performed involving a representative sample of the Hungarian population. Socio-demographic characteristics, the use and provision of informal care were recorded. The Minimum European Health Module (MEHM), EQ-5D-5L, WHO-5 well-being index, happiness and life satisfaction visual analogue scale (VAS), Satisfaction with Life Scale (SWLS) measures were applied alongside the ICECAP-A (age-group 18–64) and ICECAP-O (age-group 65+). Results Altogether 1568 and 453 individuals completed the ICECAP-A/-O questionnaires, respectively. Cronbach’s alpha was 0.86 for both measures (internal consistency). Subgroup analyses showed positive associations between ICECAP-A/-O scores and marital status, employment, income, health status (MEHM) and informal care use (construct validity). Pearson correlations were strong (r > 0.5; p Conclusion This is the first study to provide ICECAP-A/-O population norms. Also, it is the first to explore associations with WHO-5 well-being index which, alongside the MEHM measures, enable estimates from routinely collected international health statistics. The Hungarian ICECAP-A/-O proved to be valid and reliable measurement tools. Socio-demographic characteristics had minor or no impact on ICECAP-A/-O. Other influencing factors deserve further investigation in future research.

Background Sensors and digital devices have revolutionized the measurement, collection, and storage of behavioral and physiological data, leading to the new term digital biomarkers. Objective This study aimed to investigate the scope of clinical evidence covered by systematic reviews (SRs) of randomized controlled trials involving digital biomarkers. Methods This scoping review was organized using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. With the search limited to English publications, full-text SRs of digital biomarkers included randomized controlled trials that involved a human population and reported changes in participants’ health status. PubMed and the Cochrane Library were searched with time frames limited to 2019 and 2020. The World Health Organization’s classification systems for diseases (International Classification of Diseases, Eleventh Revision), health interventions (International Classification of Health Interventions), and bodily functions (International Classification of Functioning, Disability, and Health [ICF]) were used to classify populations, interventions, and outcomes, respectively. Results A total of 31 SRs met the inclusion criteria. The majority of SRs studied patients with circulatory system diseases (19/31, 61%) and respiratory system diseases (9/31, 29%). Most of the prevalent interventions focused on physical activity behavior (16/31, 52%) and conversion of cardiac rhythm (4/31, 13%). Looking after one’s health (physical activity; 15/31, 48%), walking (12/31, 39%), heart rhythm functions (8/31, 26%), and mortality (7/31, 23%) were the most commonly reported outcomes. In total, 16 physiological and behavioral data groups were identified using the ICF tool, such as looking after one’s health (physical activity; 14/31, 45%), walking (11/31, 36%), heart rhythm (7/31, 23%), and weight maintenance functions (7/31, 23%). Various digital devices were also studied to collect these data in the included reviews, such as smart glasses, smartwatches, smart bracelets, smart shoes, and smart socks for measuring heart functions, gait pattern functions, and temperature. A substantial number (24/31, 77%) of digital biomarkers were used as interventions. Moreover, wearables (22/31, 71%) were the most common types of digital devices. Position sensors (21/31, 68%) and heart rate sensors and pulse rate sensors (12/31, 39%) were the most prevalent types of sensors used to acquire behavioral and physiological data in the SRs. Conclusions In recent years, the clinical evidence concerning digital biomarkers has been systematically reviewed in a wide range of study populations, interventions, digital devices, and sensor technologies, with the dominance of physical activity and cardiac monitors. We used the World Health Organization’s ICF tool for classifying behavioral and physiological data, which seemed to be an applicable tool to categorize the broad scope of digital biomarkers identified in this review. To understand the clinical value of digital biomarkers, the strength and quality of the evidence on their health consequences need to be systematically evaluated.

BACKGROUND Sensors and digital devices have revolutionized the process of measuring, collecting, and storing health data. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral measures contained in digital devices that are portable, wearable, implantable, or digestible. The clinical utility of digital biomarkers is being supported by an increasing body of research. OBJECTIVE The present study intends to investigate the scope of digital biomarker-based systematic reviews. METHODS The current scoping review was organized using PRISMA-ScR. Limiting the search to English full-text systematic reviews of digital biomarkers that included at least one randomized controlled trial involving a human population and reporting changes in participants' health status. PubMed and the Cochrane library were searched. Separately, two reviewers screened and selected records. In addition, the qualified papers' reference lists were examined for additional reviews. The World Health Organization's (WHO) classification systems for diseases (ICD-11), health interventions (ICHI), and bodily functions (ICF) were used to classify populations, interventions, and outcomes. RESULTS 66 reviews met the inclusion criteria, mostly were published by authors from the United States of America (18, 27.28%). The most prevalent disease areas were Circulatory System (n=12, 18.18%) and External Causes (n=12, 18.18%). 27 and 23 interventions were connected to health-related behaviors and the circulatory system, respectively. Looking after one's health (physical activity) (n=22) and demographic changes (mortality) (n=19) were the most commonly reported outcomes. A substantial number of digital devices, mostly in the form of wearables (n=39/66, 59.09 %) were employed as interventions (n=43/66, 65.15 %). Position sensors (n=33/66) and heart /pulse rate sensors (n=32/66) were identified as the most prevalent types of sensors utilized to capture digital biomarkers. CONCLUSIONS Digital biomarker clinical research encompasses a wide range of technologies, populations, interventions, and clinical outcomes, with cardiovascular and physical activity sensors being the most explored. This necessitates a more thorough examination of the strength and quality of evidence regarding the health consequences of digital biomarker-based therapy.

Background: The CarerQol instrument can be used in economic evaluations to measure the care-related quality of life of informal caregivers. Tariff sets are available for Australia, Germany, Sweden, the Netherlands, the UK, and the USA. Objective: Our objective was to develop tariff sets for the CarerQol instrument for Hungary, Poland and Slovenia and to compare these with the existing value sets. Methods: Discrete-choice experiments were carried out in Hungary, Poland and Slovenia. Data were collected through an online survey between November 2018 and January 2019, using representative samples of 1000 respondents per country. Tariffs were calculated from coefficient estimates from panel mixed multinomial logit models with random parameters. Results: All seven CarerQol domains contributed significantly to the utility associated with different caregiving situations. Attributes valued highest were ‘physical health’ (tariffs for no problems were 15.6–21.8), ‘mental health’ (18.1–18.9) and ‘fulfilment’ (16.3–22.9). Value sets were comparable across the countries, although in Poland ‘a lot of fulfilment’ was valued higher (22.9) than in Hungary (16.3) and Slovenia (17.1). Compared with existing value sets, in the three Central European countries, ‘fulfilment’ was more important, whereas ‘financial problems’ were less important. Conclusion: For the first time in the Central and Eastern European region, country-specific tariffs are now available for the Hungarian, Polish and Slovenian versions of the CarerQol instrument. This facilitates inclusion of the impact of informal care in economic evaluations. Our results can be used to develop and evaluate country-specific health policy strategies to support informal caregivers. The differences found in informal care preferences highlight the limited transferability of CarerQol tariffs across European regions.

Background We aimed to determine the acceptability of non-perfect health states with age using the EQ VAS and analyse the influencing factors. Methods We conducted a cross-sectional survey on a convenience sample from the general population (N = 200). Respondents were asked to indicate on the EQ VAS the health states that are still acceptable for ages between 30 and 80 years in 10-year intervals (VAS acceptable health curve, AHCvas). We recorded respondents’ current health, health-related lifestyle, demographic background and explored the reference person they imagined when evaluating acceptable health states. We evaluated the AHCvas by estimating linear multilevel models including a random intercept (estimated at age 30) and a random slope for age. Results AHCvas scores were available for 194 respondents (mean age = 42.8 years, range 19–93, 58% female). For ages of 30, 40, 50, 60, 70 and 80 years, mean AHCvas scores were 93, 87, 80, 73, 65 and 57, respectively. The decline of AHCvas was linear with age. Respondents’ age, health status, lifestyle and health-related experiences, as well as their reference point taken (e.g. imagining themselves, others or both during the valuation task) influenced significantly the acceptability of health problems. Conclusions When measured with the EQ VAS, health problems were increasingly acceptable with age. Capturing well the individual variability in the assessment of acceptable health states at different ages, the EQ VAS is a useful addition to EQ-5D-3L descriptive system-based measures of acceptable health. Electronic supplementary material The online version of this article (10.1007/s10198-019-01060-3) contains supplementary material, which is available to authorized users.

Background EQ-5D-3L population data are available only from Hungary, Poland and Slovenia in Central and Eastern Europe (CEE). We aimed to compare the accessible studies and estimate a regional EQ-5D-3L population norm for CEE. Methods A combined dataset using patient-level data of 8850 respondents was created. Based on the European Census of 2011, regional population norm estimates were calibrated by gender, age and education for the joint citizenry of 11 CEE countries. Results EQ-5D-3L health states were available for 6926 and EQ VAS scores for 6569 respondents. Demographic characteristics of the samples reflected the recruitment methods (Hungary: online; Slovenia: postal survey, Poland: personal interviews). Occurrence of problems differed significantly by educational level in all the five dimensions (p

Backround: Guidelines for economic analyses of health care technologies require local input data for reimbursement decisions in the countries of Central and Eastern Europe (CEE). The aim of this study was to systematically review and analyse the available empirical studies using the EQ-5D instrument as a measure of the health-related quality of life (HRQoL) in patients with neurological diseases. Methods: A systematic literature search was performed up to 1st April 2018 to identify relevant studies in eight selected CEE countries. Original articles reporting on studies of neurological diseases using the EQ-5D instrument were analysed. Results: Thirty-six articles, describing the results of 38 samples of patients and a total of 13,005 patients were included in the review. Most studies were from Hungary (44.4%) and none from Romania or Slovakia. EQ-5D utility scores were reported in 33 (91.7%) articles. In multiple sclerosis (MS) being the most represented disease, the average utility scores ranged from 0.49 in Austria to 0.80 in Poland with a weighted average of 0.69. EQ VAS scores for MS ranged from 39 in Czech Republic to 72.0 in Poland, with weighted average of 59.1. MS patients, together with epilepsy and essential tremor patients, estimated their HRQoL among the highest. Conclusions: EQ-5D research activity in neurology has been increasing through the years in studied CEE countries. There are clinical areas with the significant social burden, such as a migraine or meningitis, that are completely lacking data, other areas, such as stroke or epilepsy, with very scarce data.

Background Patient activation comprises the skills, knowledge and motivation necessary for patients’ effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. Methods A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test–retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. Results The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test–retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p p p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. Conclusion PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.

Background During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data. Objective The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies. Methods A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps’ compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies. Results Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app. Conclusions Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized.

Background Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured using digital devices such as portables, wearables, implantables, or digestibles. For their widespread adoption in publicly financed health care systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. Objective The paper presents the protocol for a systematic review that aims to assess the quality and strength of the evidence reported in systematic reviews regarding the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers. Methods A comprehensive search for reviews from 2019 to 2020 will be conducted in PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of these reviews. To assess the quality of evidence, we will evaluate the systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. To detect the possible presence of reporting bias, we will determine whether a protocol was published prior to the start of the studies. A qualitative summary of the results by digital biomarker technology and outcomes will be provided. Results This protocol was submitted before data collection. Search, screening, and data extraction will commence in December 2021 in accordance with the published protocol. Conclusions Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions, providing practical guidance for health care providers. Our results will help identify clinical areas in which the use of digital biomarkers has led to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated. International Registered Report Identifier (IRRID) PRR1-10.2196/28204