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Lege Artis Medicinae

OCTOBER 21, 2020

[Attitudes towards obesity in the health care system]


[Bias, prejudice and discrimination are part of the everyday life of people with obesity, even in the health care system. Obesity-related prejudices can lead to disrespectful, humiliating treatment of pa­tients with excess weight and impair the quality of care for patients. There is a bidirectional relationship between stigmatization of obesity and obesity: discrimination against obesity is frequent, while stigmatization experiences lead to additional weight gain and result in avoidance of health care, and health deterioration and increas­ed risk of mortality. The aim of the study is to raise awareness among professionals about obesity-related prejudices and dis­crimination, and to present strategies to reduce stigmatization of obesity in the health care system. All this will serve better care and may have public health significance in the long run.]

Lege Artis Medicinae

OCTOBER 20, 2019

[Population-level QALY gain estimates with the use of cariprazine for patients with negative symptoms of schizophrenia in Hungary]

BENDES Rita, NÉMETH Bertalan, PITTER János György, KÓCZIÁN Kristóf, GÖTZE Árpád, KALÓ Zoltán

[INTRODUCTION - The loss in quality of life caused by mental illnesses has been growing in developed countries. This study aims to quantify the possible gains in quality of life by advantages of cariprazine therapy while treating patients with negative symptoms of schizophrenia in Hungary. Comparator therapy was defined as the currently available second-generation oral antipsychotic drugs. METHODS - In order to estimate the reachable gain in quality of life with cariprazine, an 8-state deterministic Markov cohort model was developed. Data was gathered from relevant scientific literature and public databases. The main assumptions regarding patient pathways have been validated by clinical experts, based on their real-life experience. The number of patients with negative symptoms of schizophrenia was estimated by the same methods as well. Sensitivity analyses were conducted on the input parameters. RESULTS - When compared with currently available second-generation oral antipsychotics, cariprazine generated an estimated increase of 0.05 quality-adjusted life years per patient in 2 years run. The deterministic sensitivity analysis confirmed the robustness of the results. Based on data of the National Health Insurance Fund and the scientific literature, a total gain of 450 quality-adjusted life years is expected at national level over a time horizon of 2 years. Even higher gains of QALY can be expected for longer time horizons. CONCLUSION - Based on conservative estimates significant health gain can be ge­ne­rated, if all patients with negative symp­toms of schizophrenia would receive the adequate cariprazine therapy in Hungary in­stead of the currently used se­cond-ge­ne­ration oral antipsychotic drugs. ]

Lege Artis Medicinae

SEPTEMBER 10, 2019

[The health economic ISSUES of geriatric care in Hungary]

NÉMETH Bertalan

[INTRODUCTION - In Hungary, the ageing of the population is a major challenge for the healthcare system (and for the social care). Due to the complexity of treatment of the elderly, geriatric care needs to have a special integrative approach, in order to function effectively. METHODS - We analysed the data that was made publicly available by the Hungarian Payer, together with domestic and international publications, to provide suggestions regarding geriatric care. RESULTS - Based on public data, the utilization of geriatric healthcare services is low, and major differences could be observed within different areas of the country. Within outpatient care, geriatric care shows a decreasing trend. DISCUSSION - It is complicated to navigate through the services provided by the Hungarian healthcare system, while international examples show that additional health gain can be realized with geriatric care. The role of geriatric care needs to be increased within the Hungarian healthcare system, together with addressing the shortage of experts, and clarification of the relations and coordination amongst macro-level systems, and different healthcare professions.]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

[Focus on quality of life: Reconstruction in Vascular Surgery ]


[The aims of the study: The aim of our research was to gain deeper insight into the quality of life of patients after reconstructive vascular surgery of the lower limb. Material and method: The Vascuqol questionnaire survey was performed at the PTE KK Vascular Surgery Clinic on the day before the surgery and 3-6 weeks after surgery (N=54). Statistical analysis was carried out with Microsoft Office Excel 2013. Results: In summary it can be stated that following surgical intervention the quality of life of patients significantly improved, this finding ephasises the importance of invasise therapy. As the extent of pain decreased after surgery, patients’ ability to walk started to improve, as well as their overall physical state and ability to carry out certain household activities. There was also an improvement in their social life, more time was spent with family and friends. Conclusions: Although the VascuQoL-25 questionaire is senstivie device to measure quality of life, it is difficult to apply in clinical practice beacause of its length.]

Hypertension and nephrology

DECEMBER 10, 2018

[Prognostic role of arterial stiffness in IgA nephropathy]

SÁGI Balázs, KÉSŐI István, VAS Tibor, CSIKY Botond, KOVÁCS Tibor, NAGY Judit

[Background: Arterial stiffness has a prognostic role in chronic cardiovascular diseases. Pulse wave velocity (PWV) determined by the carotid-femoral pulse detection is accepted as a gold standard method. Further diagnostic procedures are in use to assess the arterial stiffness including the finger photoplethysmography. The prognostic role of this method is limited in chronic renal diseases. The goal of our investigation was to determine the prognostic significance of the stiffness index (SIDVP) measured by the photoplethysmographic method in IgA nephropathy. Patients and methods: One hundred and three histologically proved IgA nephropathy patients with chronic kidney disease stage 1-4 were investigated (67 male, 36 female, 45 ± 11 years) and followed for an average 65 (6-107) months. The stiffness index was determined by the volume alteration of the digital artery during the cardiac cycle (Pulse Trace system, Micro Medical, Gilingham, Kent, UK). The primary combined end point was total mortality, major cardiovascular events (stroke, myocardial infarction or cardiovascular procedure, for example revascularisation) plus achieving end stage renal disease. The secondary end points were cardiovascular and renal end points alone. Results: The patients with increased stiffness index (> 10 m/s) had significantly more combined primary end point events (10/60 vs. 19/43, P = 0.015). In case of the secondary end points the renal end points were significantly more frequent in patients with higher stiffness index. Stiffness index has also proved to be an independent predictor on survival from other cardiovascular risk factors (age, hypertension, diabetes, obesity, lipid disturbances and decrease of renal function) using the Cox regression model in IgA nephropathy. Every 1 m/s increase in stiffness index resulted a 17% gain in the occurrence of the combined primary end point. Conclusions: Stiffness index determined by finger photoplethysmography is an eligible parameter to assess the prognosis in IgA nephropathy. Increased stiffness index in IgA nephropathy seems to be a good prognostic tool for identification of higher risk patients.]

Lege Artis Medicinae

SEPTEMBER 20, 2018

[Feeding and eating in infancy and early childhood part III. - Development of self-feeding skills in the large-sample of the “For Healthy Offspring” project ]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[Feeding and eating in infancy and early childhood part III. - Development of self-feeding skills in the large-sample of the “For Healthy Offspring” project INTRODUCTION - After introducing adequate complementary food to the diet of breastfed/formula-fed babies, the frequency and amount of semisolid/solid food is increasing, the breastmilk/formula intake is decreasing and finally the weaning process is completed. During this process the developing feeding skills of the infant enables them to self-feed. The self-feeding infant and toddler should participate in family meals. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Issues concerning the development of self-feeding skills were analyzed. RESULTS - With advancing age the proportion of infants/toddlers, reported to be able to (partially) self-feed, has increased. The age, at which the majority of toddlers (83.1%) were reported to self-feed, was at 13-15 months. By the age over 2 years 57.2% of the toddlers were fully self-feeding, 39.3% were self-feeding with some assistance, and 3.5% were still completely fed by their mother/caregiver. While self-feeding became more prevalent, the proportion of toddlers with feeding problems and insufficient weight gain has increased. With more prevalent complementary feeding more parents assessed their feeding style rather scheduled than on demand. In the whole sample the proportion of infants/toddlers, who ate with the family, was 43.8%. CONCLUSIONS - In our sample, as previously described in the scientific literature, the developmental readiness to self-feed has developed in the majority of infants by the age of 13-15 months. During progres­sion of weaning an increasing proportion of parents thought, that feeding was rather scheduled than on demand. This finding points at the importance of educating parents about the importance of responsive feeding during and after weaning. For self-feeding toddlers, responsive feeding means, that the mother/caregiver offers a choice of healthy and adequate amount of food, at a proper place, at proper times, responds to the hunger and satiety cues of the child and the toddler decides, whether to eat, what and how much to eat.]

Lege Artis Medicinae

SEPTEMBER 20, 2018

[The liaison between internal medicine and psychiatry can be life-saving in the treatment of severe anorexia nervosa]

SZÉNYEI Gábor, BENE László, TÚRY Ferenc

[INTRODUCTION - In the severe forms of anorexia nervosa hospitalization may be required, and the somatic treatment is provided in a department of internal medicine. In such cases, collaboration between internist and psychiatrist is essential. Psycho­logical support is necessary even in the period of nutritional rehabilitation. This can be applied in the framework of consultation-liaison psychiatry. After the initial weight gain providing psychotherapy in an outpatient setting is fundamental. In the case of anorexic patients who maintain a close relationship with the family, family therapy is the most effective treatment. CASE REPORT - A 26-year old female patient with anorexia was hospitalized in a department of internal medicine after an extreme emaciation, her body mass index was 11.6. During this period there was a psychiatric consultation involving the fa-ther of the patient as well. Her body weight increased, and outpatient family therapy was initiated. Fifteen family sessions were conducted in nine months, with special focus on the separation-individuation process. At the end of the therapy a full remission could be observed, with a normal body weight, and her periods returned. After a four-month follow-up her state was stable, and she got married. CONCLUSION - Interdisciplinary collaboration can be cardinal when somatic and psychological disorders are interwoven. The role of family therapy is crucial in those cases where emotional separation from the family of origin is difficult, even if the patient does not live with the parents any longer. ]

Clinical Neuroscience

JANUARY 30, 2018

Functional neurotoxicity and tissue metal levels in rats exposed subacutely to titanium dioxide nanoparticles via the airways

HORVÁTH Tamara, VEZÉR Tünde, KOZMA Gábor, PAPP András

Introduction and aims - Nanoparticles of titanium dioxide are suspected neurotoxic agents and have numerous applications possibly resulting in human exposure by several ways including inhalation. In the present work, rats were exposed to spherical TiO2 nanoparticles of two different sizes by the intratracheal route. It was investigated how the neuro-functional alterations, detected by electrophysiological and behavioral methods, were related to the concentration of Ti in the tissue samples and what the influence of the size of the NPs was. Materials and methods - Rats (young adult Wistar males, 10/group) were exposed to TiO2 nanoparticles of ca. 10 and 100 nm diameter (suspension medium: neutral PBS with 1% hydroxyethyl cellulose) by intratracheal instillation in 5 and 18 mg/kg b.w. dose; 5 days per week for 6 weeks. Controls were instilled with saline, and vehicle controls, with the suspension medium. To see general toxicity, body weight was checked daily, and organ weights were measured at the end of experiment. Grip strength test, to assess motor function damage, was done before and after the 6-week treatment. Finally, the rats were anesthetized with urethane, spontaneous cortical activity and sensory evoked potentials were recorded, then the rats were dissected and tissue samples were taken for Ti level measurement. Results - Body weight gain indicated no general toxicity, and no significant change in the relative organ weights, except that of the lungs, was seen. However, change of time-to-fall in the grip strength test, and latency of cortical evoked po­tentials, were altered in the treated groups, indicating functional damage. Correlation of these alterations with the cortical Ti level was dissimilar for the two sizes of nanoparticles. Conclusion - The results provided further support to the functional neurotoxicity of TiO2 nanoparticles. The exact role of particle size, and the mechanisms involved, remain to be elucidated.

Clinical Oncology

SEPTEMBER 15, 2016

[Actual place and role of communication in Hungarian oncology]

MUSZBEK Katalin, GAAL Ilona

[The move to shared decision model from the patriarchal model of doctor-patient relationship is a communication challenge for doctors and patients as well. Communication is extremely important in Oncology, because the suggestive effect of every action of doctors and nurses is outstanding in this fi eld of healthcare. This burden has to urge professionals to self-improvement. One of the most important success of the Doctor-Patient Relationship program of the Hungarian Hospice Foundation since its launch in 2014 is the statement of two clinical centres on the importance of communication skills in everyday praxis, and engaging themselves in self-improvement. The successful cooperation also depends on patients and their care-givers not just on professionals. To gain all the necessary information is a learning process for them; even as to fi nd out the depth of information and decision level they wish. The patient who is satisfied with his or her own communication in healthcare is less distressed than the one who feels like adrifting. That gives the sense of achievement to professionals as well.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2016

[Prenatal care and the role of midwifery in Europe and in Hungary]

SZÖLLŐSI Katalin, KÖVI Rita, SZABÓ László

[Aim of the study: To provide a picture about the prenatal care practice and assess the attitude of obstetrics and midwives about the new prenatal care system in Hungary. To compare the Hungarian prenatal care system with that of other countries in the European Union (Finland, England). Procedure and Sample: We used self-developed questionarre with 50 midwives, 40 pregnants and interview with 5 midwives and 5 obstetricians. To compare the prenatal care systems in the EU we used the experienses of a study trip in Finland and informations from international databases. Results: 8% of the midwives work in prenatal care, 32% of participants are not interested in this field. In their view the new system is not elaborated yet, they need more professional survellance. Obstetricians acknowledge the competence of midwifery, however they suggest to gain more practical knowledge on the field. 75% of participating pregnant women would have chosen the prenatal care of obstetricians. The role of midwives in prenatal care is significant in Europe. The Hungarian system is unique, which is approached to the european practice by introduce the new prenatal care system. Discussion: The new Hungarian prenatal care system has several loops in its structure and effectiveness from the view of midwives and obstetricians.]