Lege Artis Medicinae

[Maurice Ravel’s Illness ]

KÖVES Péter

DECEMBER 18, 2013

Lege Artis Medicinae - 2013;23(12)

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[Health status and costs of ambulatory patients with multiple sclerosis in Hungary]

PÉNTEK Márta, GULÁCSI László, RÓZSA Csilla, SIMÓ Magdolna, ILJICSOV Anna, KOMOLY Sámuel, BRODSZKY Valentin

[Background and purpose - Data on disease burden of multiple sclerosis from Eastern-Central Europe are very limited. Our aim was to explore the quality of life, resource utilisation and costs of ambulating patients with multiple sclerosis in Hungary. Methods - Cross-sectional questionnaire survey was performed in two outpatient neurology centres in 2009. Clinical history, health care utilisation in the past 12 months were surveyed, the Expanded Disability Status Scale and the EQ-5D questionnaires were applied. Cost calculation was conducted from the societal perspective. Results - Sixty-eight patients (female 70.6%) aged 38.0 (SD 9.1) with disease duration of 7.8 (SD 6.7) years were involved. Fifty-five (80.9%) had relapsing-remitting form and 52 (76.5%) were taking immunomodulatory drug. The average scores were: Expanded Disability Status Scale 1.9 (SD 1.7), EQ-5D 0.67 (SD 0.28). Mean total cost amounted to 10 902 Euros/patient/year (direct medical 67%, direct nonmedical 13%, indirect costs 20%). Drugs, disability pension and informal care were the highest cost items. Costs of mild (Expanded Disability Status Scale 0-3.5) and moderate (Expanded Disability Status Scale 4.0-6.5) disease were 9 218 and 17 634 Euros/patient/year respectively (p<0.01), that is lower than results from Western European countries. Conclusion - Our study provides current inputs for policy making and contributes to understanding variation of costof- illness of multiple sclerosis in Europe.]

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[Illness representation of patiens with migraine and tension headache]

AMANDA Illés, NAGY Beáta Erika

[It’s been proven by many scientific observation that patients describe their diseases both in progression and adaptation in a different manner even though having a similar origin. The reason behind is the various cognitive background. The investigation of this cognitive function may help us understand patients personal reactions better. In 2007 I investigated the effect of three factors (type, understanding and duration of the disease) on illness representation in patients suffering from headache. The patients included were the following three groups: having migraine with aura, migraine without aura and patients with tension headache. I was looking for correlations and differences in disease representations. For this investigation I have used illness representation questionnaires translated and adapted to Hungarian population. The data were obtained in the waiting hall of two headache centres in Debrecen. Although there were no significant correlations in most of the cases, certain tendencies were observed. Understanding of disease representation could be very useful tool in psychological support, psychotherapy for the patients and it could improve their quality of life.]

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["Punishment-therapy” - chances of psycho-rehabilitation for mentally ill offenders under forced medical treatment]

BACSÁK Dániel, KRÁMER Lili

[When examining the life course of mentally disordered offenders it is unavoidable to take into consideration the legal definition of in­sanity that exempts an individual from ordinary punishment in the given context of criminal law. As technical as it is, legal language describes and prescribes institutional responses on how to deal with mentally disordered offenders - not being independent from the everyday societal stereotypes on mental illness. In Hungary, the definition of criminal liability consists of medical and legal elements. Thus, in practice court appointed psychiatric experts are solely relied upon in determining whether or not the accused are criminally liable - the formal decision is in the hands of the court. If no criminal liability is determined by the experts, the court has to acquit the accused. In some special cases this acquittal opens the way to criminal psychiatric detention that is maintained by the Hungarian Prison Service. The aims of criminal psychiatric detention are twofold: rehabilitation and punishment. We suggest that it is nearly impossible to serve both of the aforementioned aims simultaneously. Furthermore, our article argues that the philosophy of care is focused on punishment and biomedical treatment nowadays, rather than rehabilitation and holistic bio-psycho-social treatment. The approach of treatment in operation makes successful recovery of patient-detainees difficult. Moreover, there are systemic issues as well: limited effects of review proceedings, holes in the psychiatric-social institutional care system and the general societal stigmatisation of people with mental illnesses can unreasonably prolong discharging “guilty patients”, thus, they stay detained 4-5 years longer. ]

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[Current questions of multiple sclerosis: the secunder progressive form of the disease]

VÉCSEI László

[Recent data suggest that long-term worsening is common in relapsing-remitting multiple sclerosis patients and is largely independent of relapses or new lesion formation on brain MRI. The current definition of secunder progressive multiple sclerosis is worsening of disability independent of relapses over at least 6-month interval. Early focal inflammatory disease activity and spinal cord lesion are predictors of very-long term disease outcomes in relapse - onset multiple sclerosis. The potential of PET imaging to visualize hidden inflammation in MS brain in vivo is an important contribution for better understanding the progression of the disease. Therefore, PET imaging is a promising tool in detecting the conversion from relapsing remitting multiple sclerosis to secunder progressive form of multiple sclerosis. Furthermore, neuro-axonal damage is the pathological substrate of permanent disability in different neurological disorders including multiple sclerosis. The neurofilament proteins have promise in this context because their levels rise upon neuro-axonal damage not only in the cerebrospinal fluid but also in blood. Patients with increased serum levels of neurofilament at baseline, independent of other clinical and MRI variables, experience significantly more brain and spinal cord volume loss over 2 years and 5 years of follow-up. The kynurenine-pathway abnormalities may be associated with the swich from early-mild stage multiple sclerosis to debilitating progressive forms of the disease. Analysis of these metabolites in serum may have application as multiple sclerosis disease biomarkers. Free radical action has been suggested as a causal factor in the illness. Increased free radical production and consumption of the scavenger molecules were found during the active phase of the disease. Based on the clinical findings (EXPAND Study) and pathomechanism of the disease siponimod is approved by the US Food and Drug Administration for the treatment of relapsing remitting forms of multiple sclerosis, to include secunder progressive multiple sclerosis with active disease, relapsing-remitting multiple sclerosis and clinically isolated syndrome.]

Journal of Nursing Theory and Practice

[Young adults with inflammatory bowel disease of quality of life]

VARGA Győrfi Krisztina, VÁRADYNÉ HORVÁTH Ágnes, TÓTH Marianna, SZUNOMÁR Szilvia, PAKAI Annamária

[Aim of the research: In the recent years the number of individuals with inflammatory bowel disease shows a significant increase. The aim was to highlight those factors that negatively affect the quality of life of young adults with inflammatory bowel disease. Research and sampling methods: The authors made a cross-sectional, quantitative research at PTE KK between July 15, 2014 and December 31, 2014. During the non-random, convenience sampling, patients with Crohn’s disease or Ulcerative Colitis, aged between 18 and 46 years were included in the target audience. The data collection tools were standard questionnaires (Illness Intrusiveness Ratings Scale, IBDQ, Stoma Quality of Life Scale) and also demographic information (N=103). Beside the descriptive statistics we also used two-sample t-test with the help of the Microsoft Excel 2013 program (p<0,05). Results: The Illness Intrusiveness Ratings Scale mean score was 55,34±17,06 and in the context of the basic disease and socio-demographic indicators show no significant difference (p> 0.05). The average score of the IBDQ was 51,92 ±18,54, as regard the residence we found significant difference (p <0.001). Conclusions: The quality of life of young adults with inflammatory bowel disease must be improved and should be pursued to reduce the disease burden. The multidisciplinary treatment of the disease is important.]