Objectives: The life expectancy gap between Central-Eastern European (CEE) countries, including Hungary, and Western Europe (WE) is mainly attributable to excess cardiovascular (CV) mortality in midlife. This study explores the contribution of socioeconomic, work related, psychosocial, and behavioural variables to explaining variations of middle aged male and female CV mortality across 150 sub-regions in Hungary. Design: Cross sectional, ecological analyses. Setting: 150 sub-regions of Hungary. Participants and methods: 12 643 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were income, education, control in work, job insecurity, weekend working hours, social support, depression, hostility, anomie, smoking, body mass index, and alcohol misuse. Main outcome measures: Gender specific standardised premature (45-64 years) total CV, ischaemic heart disease, and cerebrovascular mortality rates in 150 sub-regions of Hungary. Results: Low education and income were the most important determinants of mid-aged CV mortality differences across sub-regions. High weekend workload, low social support at work, and low control at work account for a large part of variation in male premature CV mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most noticeably to variations in premature CV mortality rates among women. Low social support from friends, depression, anomie, hostility, alcohol misuse and cigarette smoking can also explain a considerable part of variations of premature CV mortality differences. Conclusion: Variations in middle aged CV mortality rates in a rapidly changing society in CEE are largely accounted for by distinct unfavourable working and other psychosocial stress conditions. T he gap in life expectancy between Central-Eastern European (CEE) and Western Europe (WE) continues to be an important public health problem.1 2 This gap increased most dramatically over the past three decades and it is largely attributable to excess cardiovascular (CV) mortality in midlife, and particularly among men. Up to the end of the 1970s, mortality rates in Hungary were lower than those found in Great Britain or Austria. Subsequently, mortality rates declined in WE. But in Hungary and in other CEE countries this trend was reversed, especially among middle aged men. In the 1990, the mortality rates among 45-64 year old men in Hungary rose to and remained at levels that were higher than they were in the 1930s.2 In 1999 the standardised death rates attributable to diseases of the circulatory system were three times higher among Hungarian men and women that the European average, but were 2.8 times higher among men than among women.

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.

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Connections between health status and quitting intentions are weakening as age is increasing. The population seems to become gradually conscious of the connections between circulatory problems and smoking. Quitting attempts are restrained by the general attitude that ill health is a normal part of the ageing process.

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