Lege Artis Medicinae

[Botero in Budapest]

FEBRUARY 20, 2011

Lege Artis Medicinae - 2011;21(02)

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Lege Artis Medicinae

[Environment and Disease, or the Necessary Paradigm Shift of Medicine]

HARANGOZÓ Judit

Lege Artis Medicinae

[Disabled person’s satisfaction with health and social care - an internationally developed instrument ]

KULLMANN Lajos, PAULIK Edit

[Introduction - Quality of health and social care is being assessed by largely different methods. Obtaining comparable and valuable data is difficult. Thus, internationally developed instruments have special value. Sample and methods - A set of instruments has been developed simultaneously using World Health Organization’s instrument development method. One of these is the instrument “Quality of Care and Support for People with Disabilities”. Response scales contain five options for physically and three for intellectually disabled persons. Psychometric analysis of the Hungarian instrument version was based on interviews with 151 physically and 166 intellectually disabled persons. Results - Answering rate was high, above 95% with the exception of one item. Internal consistency of the two instrument versions by Cronbach’s alpha is 0.845 and 0.745 respectively. Lowest satisfaction was found in the domain “information” in both groups that correlates significantly with health conditions at p<0.01 and p<0.05 level respectively. Conclusions - The field trial confirms validity and reliability of the instrument. Its wider use may help the evaluation of satisfaction concerning different components of quality of care, consequently better tailoring of services to needs.]

Lege Artis Medicinae

[Influenza vaccination of pregnant women and the experiences related to the pandemic influenza A-virus H1N1 infection in Hungary 2009]

CZEIZEL Endre

[During the influenza A-H1N1 pandemic, only about 16% of pregnant women were vaccinated against the virus, despite their higher expected mortality risk. According to the official data, five pregnant women died. In addition, the high fever that occurs in influenza increases the risk of some congenital abnormalities. The vaccine used in Hungary is not associated with severe complications in pregnant women and their fetuses, therefore, it can be administered during any stage of pregnancy. The author discusses the causes that deterred pregnant women from being vaccinated. The main problem seems to be that some physicians were under-informed and were reluctant to take responsibility.]

Lege Artis Medicinae

[Current trends and future perspectives in cardiological therapy Riga, 21-22th January 2011.]

LIPTÁK Judit

Lege Artis Medicinae

[Anti-atherosclerotic effect of pioglitazone - The first evidence of the role of triglyceride/HDL ratio]

CSÁSZÁR Albert

[The presence of multiple risk factors can multiply exponentially the risk of cardiovascular events, thus cardiovascular diseases are more severe in diabetes mellitus. One of the challenges we face today is the application of drugs that, besides improving glucose homeostasis, also have antiatherosclerotic effect. Such candidates are glitazones, which have pleiotropic efficiency beyond their main effect: they improve distribution of adipose tissue, blood pressure and endothelial function and also have anti-inflammatory and anti-coagulation capacity. Regarding the effects on lipid metabolism, there are differences between various glitazones: improvements are mainly achieved by pioglitazone, which markedly reduces triglyceride levels, and also elevates HDL levels and decreases the ratio of small, dense LDL-particles. Studies on clinical outcomes also show the superiority of pioglitazone. Imaging of blood vessels (carotis-IMT, intracoronary ultrasound technique) also suggest a greater efficiency of pioglitazone. According to the latest analysis of the PERISCOPE study, the stability of the coronary plaque was associated only with the triglyceride/ HDL ratio in case of pioglitazone. The newest data also revealed that pioglitazone uniquely increases the cholesterol-efflux attributed to HDL-related macrophages. On the basis of the latest results, pioglitazone not only improves glucose homeostasis, but also has a remarkable anti-atherosclerotic effect, which is primarily due to its favourable lipid metabolism profile.]

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Hungarian Radiology

[Breast Imaging Day - Budapest, 4th April, 2008]

SIMON Éva

Lege Artis Medicinae

[How can the specialists be contacted? Ways of communication in the specialist-patient consultation]

MOLNÁR Regina, PAULIK Edit, SÁGI Zoltán, KÖVES Béla

[Consulting the specia­list means face-to-face meetings traditionally. Nowadays patients do not need to go to the outpatient clinic to see the doctor since many new communication options have already been available. The aim of our study was to explore how typically doctors and patients use other options (as phone call or e-mail) beside face-to-face appointments in the outpatient clinic. We conducted a focus group interview with specialists and health workers and an in-depth interview with the chief nurse of an outpatient clinic in Budapest. The specialist-patient consultation is mostly face-to-face in the specialist’s office in the presence of the nurse, whose role is complex and pivotal. Fur­ther­more, the landline phone is an essential device, as the patients can reach the specialist or nurse in their office hours. The application of e-mail or mobile phone is incidental. The website of the outpatient clinic provides practical information to patients. Traditional postal letters, leaflets, and publications are also typical for providing information. The doctors’ opinion was rather heterogeneous about the pa­tients’ Internet usage and about the on­line contact with patients. Beside increasing the capacities the deliberate and organized introduction and application of technical de­vices, may reduce the overburdening of health professionals.]

Lege Artis Medicinae

[CONTROVERSIAL ISSUES IN THE TREATMENT OF OPERABLE CERVICAL CANCER]

PETE Imre

[Wertheim hysterectomy as a baseline surgical treatment for patients with FIGO stage 1a2-2a cervical cancer was introduced in 1989 at the National Institute of Oncology, Budapest, Hungary. From then until 2002 when the results were first evaluated 308 such operations were performed. The average 5- and 10-year survival rates were 80% and 75%, respectively. Although these results are comparable to literature data, several issues concerning this group of patients remain to be solved. The participation rate in the Pap test screening programme covered by the national health insurance is only 30%. There is no national database on the current treatment of these patients that could help identify the necessary steps to be taken in order to improve the results. The number of radical hysterectomies performed a year in Hungary, or their outcome, is not known. The treatment scheme varies among the institutes and so does surgical experience. There is no consent regarding treatment policy, preoperative irradiation or chemotherapy, surgical technique, or postoperative management. The improvement of the participation rate in the screening programme, the use of prognostic factors to determine the most appropriate treatment, the role of minimally invasive and fertility-preserving surgery, the preservation of ovaries and the use of neoadjuvant chemotherapy are some of the further issues that need to be discussed. The first step should be data acquisition from all institutes in the country in order to develop and apply uniform treatment guidelines.]

Journal of Nursing Theory and Practice

[Episiotomy practice in Hungary ]

SZÉNÁSI Rita, LIPIENNÉ KRÉMER Ibolya, MÉSZÁROS Judit

[Aim of the study: The aim of the research was to assess the ways in which pregnant women prepared for giving birth, and the alternative opportunities for labour and delivery, and to examine the attitudes of professionals and mothers to episiotomy. Sample and method: Participating in the first part of the study, a questionnaire-based survey with 35 questions, were women who underwent spontaneous vaginal labour in hospital after week 36 (643 persons). The data was processed in a descriptive statistical model with percentage distribution indicators. In the second part of the study, 314 spontaneous vaginal births that took place in a Budapest hospital between 1 January and 31 March 2011 were examined on the basis of the birth log, with the focus on episiotomy. Results: The results show that today the proportion of women who give birth with an episiotomy is still very high, and the incidence of intervention and tests in the course of labour is also high. The survey also revealed that episiotomies were carried out in fewer cases where the obstetrician was accompanied by a midwife. Conclusions: In comparison to past years there is a greater focus now on alternative obstetrician training and midwifery methods, and on perineal protection, but the use of these methods in everyday practice is still not sufficiently prevalent. It is essential to bring about a change in the professional attitudes of specialists to natural birth, which could promote a more humane standard of obstetric care.]

Clinical Neuroscience

[Assessment of health related quality of life among epileptic patients in the context of coping strategies and subjective disease perception]

KOVÁTS Daniella, CSÁSZÁR-NAGY Noémi, JUHOS Vera, SALLAY Viola, BÉKÉS Judit, FABÓ Dániel, KELEMEN Anna, KURIMAY Tamás

[Purpose – Psychosocial condition and life quality of epileptic patients are greatly determined by the existence of the disease-related comorbid disorders, like depression, anxiety, and the subjective disease perception, as well as the neuropsychological consequences of the seizures. (Whitehead et al. 2015; Goldstein et al. 2005). It has been examined in patients living with epilepsy how subjective disease perception and coping strategies influence life quality, comorbid depression and the condition of anxiety. Methods – Study patients were asked to fill in a self-completion questionnaire, which examined their psychosocial condition (HADS, Beck Depression Scale), life quality (Qolie-31), coping strategies (FKV-LIS), and subjective disease perception (IPQ-R), as well as sociodemographic and disease variables. The subjects of the study: the data of epileptic patients between the age of 18 to 70 was recorded. Patients were selected from the adult outpatients of a national centre, a regional hospital and two private health care centres located in Budapest. Results – Based on the multiple regression analysis. Beck’s depression (b coefficient=-0.351, t=-4.703, p<0.001**). Depressive coping strategy (FKV Dep) (b coefficient = -0.235, t=-3.123, p=0.002**). Subjective health perception (b coefficient =0.232. t=3.643, p<0.001**). Sex (women; b coefficient =-0.162, t=-3.008, p=0.003**). IPQ consequences (b coefficient =-0.161, t=-2.572, p=0.012*). Active coping strategy (FKV Act; b coefficient =0.146, t=2.572, p=0.012*). Type of seizure (b coefficient =-0.138, t=-2.527, p=0.013*), and Sleep quality (b coefficient =-0.125, t=-1.995, p=0.049) explain some 75.6% of the variance of life quality’s total score (model3: F=33.333, p<0.001**. adjusted R2=0.733). Conclusions – Among the factors of the subjective disease perception (IPQ-R), the physical, mental and social consequences play the most important role. Similarly, the impact of negative emotional representation, as well as the erratic nature of the seizures are decisive. Emotional representation, cyclicity and disease coherence have an important role in coping with disease-related negative emotions. ]