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Lege Artis Medicinae

OCTOBER 21, 2020

[Atherosclerosis: an ancient process in a new interpretation]


[The progress of atherosclerosis starts in childhood and lasts until the body dies. Most cardiovascular diseases and deaths can be traced back to atherosclerotic vascular changes. The process is thousands of years old, but its complex pathophysiology becomes recognized and realised only nowadays. Based on the evidence available today, atherosclerosis is such a chronic inflammatory disease of large- and medium-sized arteries, which is characterized by lipoproteins and immune cells transformed through oxidative and other changes and subendothelial accumulation of extracellular matrix. Innate and adaptive immunity provide a complex regulating system of atherogenesis, which while directing specifically the pro-atherogenic inflammatory and atheroprotective anti-inflammatory processes intensify plaque progression or even stabilize them respectively. With our growing knowledge about the pathology of atherogenesis, we can further improve the identification of cardiovascular risk conditions and apply more personalized therapeutic strategies.]

Hypertension and nephrology

NOVEMBER 04, 2020

[The role of stress management in the care of hypertension and the treatment of cardiovascular disease]

SOMOGYI Éva, KISS Zoltán, STAUDER Adrienne

[The aim of this paper is to give an overview of the relationship between stress and hypertension and cardiovascular diseases, furthermore to introduce an evidence based stress management intervention available in Hungary. The correlation between cardiovascular disease and psychosocial factors (including concomitant mental disorders as well as personality traits or the effect of social environment) has been established in numerous studies aimed at investigating pathogenesis or various clinical endpoints. The 2016 Guidelines of the European Society of Cardiology include the assessment and the management of psychosocial problems with behavioral medicine interventions as a I.A level recommendation. The implementation of these guidelines in everyday clinical practice is crucial to decrease cardiovascular risk. This involves the training of health care professionals, the facilitation of multidisciplinary collaboration and the integration of behavioral intervention into everyday care. The Williams Life Skills (WLS) program is an evidence based behavioral medicine intervention aiming to improve stress management and communication skills which implemented internationally and also available all over Hungary. It involves the learning of simple coping strategies that facilitate the successful management of every day psychosocial stress situations and the self-conscious reduction of bodily and psychological tensions. In cardiovascular disease, this improves quality of life and survival. The WLS program is especially recommended for healthcare workers to decrease the negative health consequences of their high stress load and to prevent burnout. Stress may affect both doctors and patients during their interactions. Bálint groups have a positive impact on the physician-patient collaboration and help to reduce burnout by improving the understanding of the diseases from a more complex approach.]

Hypertension and nephrology

APRIL 24, 2020

[Possibilities and limitations. Dietary difficulties of chronic renal failure in childhood]

REUSZ György, SZABÓ Adrienn

[In chronic kidney disease (CKD), the role of the kidney in assuring homeostasis is gradually deteriorating. Besides fluid, electrolyte and hormonal disturbances, detoxification and control of blood pressure is insufficient without external help. In children, in addition to achieving equilibrium it is also essential to ensure optimal physical and cognitive/psychological development. Adequate calorie intake is a major determinant of growth during infancy. Among the therapeutic options it is essential to ensure a proper diet. In addition to reflecting the special needs of renal failure in its composition, it must be palatable for the child. Children with kidney disease should have a normal energy diet. Protein intake should not be reduced from the baseline recommendation, but lower phosphorus and high bioavailability should be preferred. A low sodium and potassium diet is recommended for a significant proportion of patients and is based on dietary advice. Further, diet planning may be problematic if the child has special dietary requirements and is in need of nasogastric tube feeding. Because diet planning is a complex task, it is difficult to achieve optimal protein supply and mineral restriction along with high energy intake. In such cases, enteral nutrition with special formulas/ drinks developed for pediatric nutrition may provide a solution.]

Clinical Oncology

APRIL 10, 2019

[System approach in oncological care]


[As a successor of the traditional biomedical approach the biopsychosocial model provides an explanation for the origin of diseases which does not only focus on the biologic aspects, but suggests the infl uence of psychological and social factors as well. Paradigm shift resulted enhanced physician-patient cooperation while treatments have been expanded with the consideration of psychological and social factors which enabled the multidisciplinary team to more precisely estimate the patient’s condition and suitability for treatment, therefore, comprehensive direction of intervention can be conducted. Reactions, adaptation and coping with cancer can be described as an interaction of individual level, which involves the psychological features of the person in addition with social level that can be explained by family context.]

Lege Artis Medicinae

DECEMBER 10, 2019

[Why did I survived? Treatment of acute stress reaction after a road accident]

SZABÓ József, SIPOS Mária

[INTRODUCTION - Survivors and witnesses of traffic accidents often experience an acute stress reaction. Immediate or at least fast psychological support, relieving the subjective suffering is very important in the respect of preventing psychological crisis, post-traumatic stress disorder or depression and the associated increasing risk of suicide. CASE REPORT - We present the case of a 27-year-old male patient who was the victim of a traffic accident and was partly responsible for it. He lost his mother in the accident, his sister was injured, and there was a casualty in the other affected car. He applied for a psychiatric appointment one week after the accident. He complained of insomnia, loss of appetite, sadness, weakness, anxiety. The treatment consisted of low-dose anxiolytic therapy, recommended in case of need, and a psychological support via acute stress protocol (G-tep) of EMDR therapy. Both short-term feedback from his family doctor and psychiatry outpatient follow-up after three weeks showed significant symptomatic improvement. CONCLUSIONS - In the last one and a half year, he has not applied for psychiatrical treatment. According his general practitioner there were no new psychological problems during this time. Our work has been successful in terms of immediate relief of suffering and prevention of psychological crisis and PTSD.]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

[Who helps the caregivers? - Psychosocial characteristics of nurses in dementia care ]


[The aim of the study: Studies underline the increasing burden of dementia people. Hungarian social care system is also facing dementia care challenge. In case of developing of social sector, it is beneficial to research the psychosocial status of nurses working in dementia care. Material and method: N=130 professional caregivers in dementia care filled out self- administered questionnaires. Standardized health-psychological scales were evaluated: SWLS, Rahe’s Life Meaning, Beck’s Inventory of Measuring Depression, Maastricht Vital Exhaustion, Freudenberger’s Burn Out Inventory. Results: Caregivers have fatigue, dissatisfaction and tendency of quitting profession. Scales show high burn-out, exhaustion and depression and show correlations. Depression correlates with vital exhaustion (r=0.549), depression moves with burn out r=0,528. SWLS correlates opposite with Vital Exhaustion: r = - 366. Coherence and SWLS shows statistically significance correlation: r=0,455. Conclusion: Indicators apply nurses are in risk conditions. More focus on workplace satisfaction, psychosocial care and stress management training is essential. .]

Clinical Neuroscience

MAY 30, 2019

Somatosensory amplification absorption contribute to electrosensitivity


Background - Two trait-like characteristics, somatosensory amplification and absorption, have been associated with symptom reports and idiopathic environmental intolerances in past research. Purpose - As the two constructs are not connected with each other, their independent contribution to symptom reports and electromagnetic hypersensitivity, as well as their interaction can be expected. Methods - On-line questionnaire. Patients - 506 college students completed an on-line questionnaire assessing absorption, somatosensory amplification, negative affect, somatic symptoms, and electromagnetic hypersensitivity. Results - Somatosensory amplification (β = 0.170, p < 0.001) and absorption (β = 0.128, p < 0.001) independently contributed to somatic symptoms after controlling for gender and negative affect (R2 = 0.347, p < 0.001). Similarly, somatosensory amplification (OR = 1.082, p < 0.05) and absorption (OR = 1.079, p < 0.01) independently contributed to electromagnetic hypersensitivity after controlling for somatic symptoms, gender, and negative affect (Nagelkerke R2 = 0.134, p < 0.001). However, no interaction effects were found. Discussion - Somatosensory amplification and absorption independently contribute to symptom reports and electromagnetic hypersensitivity. Conclusion - The findings suggest that psychological mechanisms underlying symptom reports and electromagnetic hypersensitivity might be heterogeneous.

Clinical Neuroscience

MARCH 30, 2019

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors ]

DÉNES Zoltán, TARJÁNYI Szilvia, NAGY Helga

[Objectives - Authors examined the rehabilitation possi­bi­lities, necessities, and results of patients after operation with brain tumor, and report their experiences. Method - Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients - Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. Results - At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. Conclusions - Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors’ experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery. ]

Lege Artis Medicinae

JANUARY 20, 2019

[Animal-assisted therapies for the treatment of elderly dementia ]


[The therapeutic value of the relationship between humans and animals should be considered in the cases of patients suffering from dementia with the onset in old age. This paper provides an overview of the animal assisted interventions in dementia. Reviews emphasize the positive effects of pet-keeping on mental and physical quality of life. However, it can also have adverse effects unless the pet is selected with caution. Regular animal assisted therapies within institutional framework provide a valuable potential programme for the patients in care. Articles published so far depict the physiological, social and psychological output variables of animal assisted therapies. The enhancement of social behavior is considered to be a specific factor of animal assisted therapies. Among the physiological symptoms the enhanced physical activity, the decrease of stress response and sympathic activation have been highlighted. Among the psychological functions reduction of state anxiety, mood lift and the reduction of negative emotions such as isolation and abandonment should be underlined. Acknowledging the available results, it seems that cognitive efficacy is less impacted directly by animal assisted therapies. However, promising results have been acquired in the alleviation of the behavioural and psychological symptoms related to dementia ]

Lege Artis Medicinae

JANUARY 20, 2019

[Psychological resources of positive aging ]

OLÁH Attila

[This study has four parts. In the first part of the study the career of successful aging construct has been presented through the literature of gerontology from Cicero until nowadays while highlighting the problems that were until now hindering the validation of that scientific construct. Suggestions for kin concepts instead of successful aging (e.g. active, optimal, vital, effective aging) have been reviewed in detail. The second part of the paper presents the results of longitudinal and cross sectional empirical studies about influencing factors of successful aging. The third part refers to the research outcomes of ageing people by the positive psychology and suggests the definition of positive aging as a state of good biological, psychological, social and spiritual functions which coincides with above average levels of psychological immunity and coping capacity and abilities of inventing successful strategies in the day-to-day practices. The fourth part of the paper describes an empirical study with 7,506 participants and demonstrates how the (emotional, psychological, social, spiritual) components of well being contribute to the maintaining of old-age physical and mental health further the psychological immunity, savoring capacity, positive orientation and flourishing. While comparing the flourishing levels of specific age groups there was a clear decline of individuals above 65 years with weakening psychological immunity. The study defines positive aging as the ability to maintain flourishing under fire of ageing associated challenges.]