Orvosi hetilap最新文献

Introduction: Mobility is a central element of health-related quality of life and functional capacity, the loss of which has long-term consequences affecting multiple organ systems, particularly in elderly individuals requiring long-term care. For healthcare professionals working in elderly care, maintaining, or improving basic mobility capacity is of primary importance. Objective: Our research had dual objectives: to assess the mobility capacity levels of elderly individuals living in long-term care facilities; and to understand the physical, cognitive, and self-care indicators of elderly individuals at different mobility levels, which could make optimal planning of institutional care easier. Method: We conducted a cross-sectional study among residents aged 60 years and over in three nursing homes between June 2023 and June 2024 (n = 209). Mobility was assessed using the validated Hungarian version of the de Morton Mobility Index (DEMMI), physical functions with the 30 Second Sit to Stand Test and Timed Up and Go test, cognitive functions with the Mini Mental State Examination, fear of falling with the FES-I questionnaire, and self-care with the Barthel Index. DEMMI results were categorized into four groups according to Thorsted et al.’s cut-off values. Results: The average age of participants was 81.34 years, with 71.3% being women. Based on DEMMI scores, 53 individuals (25.4%) had very low mobility, 41 (19.6%) had low mobility, 64 (30.6%) had moderately reduced mobility, and 51 (24.4%) had independent mobility. Higher mobility levels were associated with significantly better lower limb muscle strength, dynamic postural control, cognitive function, lower fear of falling, and better self-care. Discussion: DEMMI more sensitively indicates remaining mobility capabilities compared to traditional tests, and successfully avoids floor effects, thus can effectively help institutions allocate human resources appropriately, and plan needs-based care. Conclusion: DEMMI is suitable for differentiated assessment of mobility capacity in elderly individuals living in long-term care, and results can provide guidance to institutions for ensuring quality elderly care, and optimal assignment of human resources. Orv Hetil. 2025; 166(45): 1777–1785.

Introduction: Midfacial fractures can result not only in functional and aesthetic impairments but also in psychological disorders, including post-traumatic stress disorder (PTSD). The most characteristic symptoms are intrusion (unwanted memories, dreams) and avoidance (efforts to evade trauma-related reminders). Objective: The aim of this study was to assess the prevalence of PTSD symptoms among patients with midfacial fractures and to analyze their associations with demographic (sex, age) and clinical (etiology, hospitalization) factors. We hypothesized that symptoms would be more severe in women, younger patients, those with violence-related injuries, and hospitalized cases. Method: In this retrospective, questionnaire-based study, using purposive (quota-like) sampling, 116 patients were evaluated with the validated Hungarian Impact of Event Scale; subgroup proportions are non-representative. Internal consistency of the subscales and the influence of demographic and clinical factors were analyzed. Results: PTSD symptoms were reported by 33.6% of patients. Internal consistency was excellent (intrusion α = 0.915; avoidance α = 0.933). Women scored higher, but differences were not statistically significant. Younger patients showed significantly higher intrusion scores (p = 0.046). Violence-related etiology and hospitalization were both significantly associated with higher intrusion and avoidance scores (p<0.05). Conclusion: A considerable proportion of patients experience long-term psychological burden after midfacial fractures. Psychological screening and early intervention should be integrated into multidisciplinary maxillofacial care, especially in high-risk subgroups. Orv Hetil. 2025; 166(45): 1786–1792.

Dementia represents a growing public health challenge in the elderly population worldwide, with its development being influenced by multifactorial mechanisms. In recent years, increasing evidence has supported the notion that certain viral infections – particularly herpesviruses, the human immunodeficiency virus (HIV), and SARS-CoV-2 – may contribute to neurodegenerative processes either directly or indirectly. It has been demonstrated that chronic inflammation, immune system dysregulation, and blood–brain barrier damage induced by viral agents potentially promote the pathogenesis of dementia, especially Alzheimer’s disease. Simultaneously, remarkable new research has emerged highlighting the potential protective effects of vaccination. According to a study conducted by Stanford University and published in 2025, elderly adults vaccinated against herpes zoster (shingles) exhibited a significantly lower incidence of dementia over a 7-year follow-up period. Researchers identified a 20% relative risk reduction, particularly among women. Other studies have supported similar effects for vaccines against influenza, tetanus, and diphtheria. The aim of our publication was to summarize the causative role of viral infections in dementia and to present the inhibitory effects of vaccines, which likely extend beyond specific antiviral infection prevention. Furthermore, we sought to emphasize the clinical and public health significance of these findings, particularly for the elderly population with compromised immune systems. Orv Hetil. 2025; 166(45): 1763–1768.

Introduction: Hospice-palliative care plays a prominent role in preparing terminally ill patients for a dignified end of life and improving their quality of life. In Hungary, the organizational and financing structure of hospice services has been continuously evolving in recent decades in response to the needs of society and the healthcare system. The annual reports aim to analyze the development and challenges of hospice-palliative care, paying special attention to the quality of patient care. Aim: One of the objectives was to review the situation of home-based hospice and palliative care in 2024, highlighting changes in organizational structures, types of patient care, and financing models. Furthermore, we aimed to identify the growing demand for services and the challenges facing the sector. Method: During the research, we used official statistical data published annually by the Hungarian Hospice-Palliative Association and the National Health Insurance Fund, which provide detailed information on the number of hospice institutions, the composition of home care activities, and the related financing mechanisms. Using the Content Diversity Index (CDI), we quantified the professional complexity of the service structure and explored differences at the county level. We compared the results of the care complexity index with the international Interdisciplinary Care Score (ICS) indicators and with European results. Results: The changes and challenges observed in 2024 clearly reflect the increasing demand for services. According to the analysis, although the number of hospice institutions has increased, the proportion of home-based care unfortunately shows a declining trend. The professional structure varies significantly from county to county, and psychosocial services are typically underrepresented. Conclusion: Hospice and palliative care are continuously developing; however, in light of changing needs and growing professional burdens, further development is required, particularly in the area of financing. Ensuring adequate resources is of paramount importance for the long-term sustainability of hospice services and for improving quality. Orv Hetil. 2025; 166(44): 1746–1753.

Introduction: Mental health professionals in direct patient care are frequently exposed to prolonged stress, increasing the risk of anxiety, depression, and burnout. Mindfulness practice supports self-care by promoting adaptive cognitive emotion regulation strategies, enhancing psychological well-being, and reducing impulsivity. Objective: To examine the effects of MBCT on mindfulness skills, emotion regulation strategies, impulsivity, and psychological well-being among mental health professionals. Method: 91 professionals (mean age: 44.5 years) participated in 9 group mindfulness-based cognitive therapy sessions. Measurements before and after the program included: Five-Factor Mindfulness Questionnaire (FFMQ), Cognitive Emotion Regulation Questionnaire (CERQ), Shortened Barratt Impulsivity Scale (BIS-R-8), and WHO Well-Being Index (WBI-5). Data were analyzed using SPSS 25. Results: Mindfulness levels increased significantly, particularly in nonjudgment, mindful action, and observation. Adaptive emotion regulation strategies improved, especially positive reinterpretation and acceptance. Impulsivity did not decrease directly but showed significant negative correlations with mindful action and description subscales at post-test. The FFMQ observation subscale correlated positively with adaptive cognitive emotion regulation strategies, notably perspective taking and positive reappraisal. Discussion and conclusion: Mindfulness-based cognitive therapy training significantly enhanced mindfulness skills and adaptive emotion regulation strategy use. Improvements in nonjudgment, mindfulness, observation, positive reframing, and acceptance contributed to reduced negative emotional states and more effective coping with professional challenges. Increased acceptance fostered a more open, nonjudgmental attitude toward self and others, further supporting stress reduction. Orv Hetil. 2025; 166(44): 1736–1745.

Over the past decade, three-dimensional design and printing have been used in the field of joint arthroplasty. Planning softwares based on CT or MRI scans provide a more accurate representation of the joints than previously used two-dimensional imaging techniques, allowing more precise surgical planning. Compared to radiography-based software, the difference is significant in the fields of hip, knee, and shoulder arthroplasties as well. With the integration of artificial intelligence, the precision of planning softwares has improved significantly, and their development is still ongoing. Accurate planning substantially reduces surgical time, thereby mitigating numerous intraoperative risks. Using three-dimensional printing, surgical models can be created, allowing the surgeon to examine an exact replica of the joint requiring arthroplasty before the operation. Trial surgeries can also be performed on these models. Sterilizable plastic materials can be used to print custom-designed surgical templates or instruments for patients, aiding a precise execution of the well-planned surgery. With specialized printers, sterilizable titanium implants can also be manufactured, offering personalized, long-term solutions even in cases of severe bone deficiency. Although the duration and cost of three-dimensional printing are currently significant, its use enables the treatment of patients who would otherwise be deemed inoperable. The expected implant survival being relatively high, the patient can potentially avoid future revision surgeries. Based on all these factors, in some cases, this technology may represent the optimal therapeutic choice for both the patient and the healthcare system. Orv Hetil. 2025; 166(44): 1730–1735.

The aim of this article is to present the new definition and classification of low-value healthcare services, developed by the European Commission’s Health Systems Performance Assessment Expert Group. The new definition and detailed description identify three main categories: overuse, misuse, and underuse of healthcare services, and one supplementary category: unwarranted and unjustified variations. The main categories are divided into nine subgroups/types, briefly outlined herein. The paper also reviews potential methods for measuring and monitoring low-value care, as well as strategies for reducing its incidence. Compared to earlier definitions, this new framework is more comprehensive, encompassing a broader range of low-value care situations. It provides healthcare leaders with expanded opportunities to detect and address low-value practices, thereby supporting improvements in healthcare delivery at both national and regional levels. Importantly, the published report offers practical guidance on recognizing and quantifying low-value care, alongside actionable intervention strategies for its reduction, making it a valuable resource for healthcare decision-makers. Orv Hetil. 2025; 166(44): 1722–1729.