Comparative analysis of the quality of life regarding patients who underwent hip replacement in public versus private hospitals in Hungary.

The study aimed to investigate the impact of hip replacement surgery on the quality of life and to compare the outcomes by sociodemographic and surgical data in Hungarian public and private hospitals. Patients were selected at the Department of Orthopaedics (Clinical Centre, University of Pécs) and at the Da Vinci Private Clinic in Pécs. Patients completed the SF-36 and Oxford Hip Score (OHS) questionnaires before the surgery, 6 weeks and 3 months later. We also evaluated socio-demographic data, disease and surgical conditions. The research involved 128 patients, 60 patients in public, 68 patients in private hospital. Despite the different sociodemographic characteristics and surgical outcomes of public and private healthcare patients, both groups had significantly improved the quality of life 3 months after hip replacement surgery measured by OHS and SF-36 physical health scores (p < 0.001). In the mental health score, only the patients of the private health sector showed a significant improvement (p < 0.001). The extent of improvement did not differ between the two healthcare sectors according to the OHS questionnaire (p = 0.985). While the SF-36 physical health score showed a higher improvement for public patients (p = 0.027), the mental health score showed a higher improvement for private patients (p = 0.015).

Investigation of the short-term quality of life and socio-demographic factors of patients undergoing total hip arthroplasty / Csípoízületi protézismutéten átesett betegek szociodemográfiai jellemzoinek és rövid távú életminoségének vizsgálata

Introduction: Among the health needs related to an aging society, the increase in the number of hip replacement surgeries stands out. Objective: The study aimed to examine the socio-demographic data of patients operated in the private and state health care with total hip arthroplasty in different approaches, and to compare their quality of life before and after surgery. Data and methods: Patients were selected by simple convenience sampling technique at the Department of Orthopedics, Clinical Centre of the University of Pecs and at the Da Vinci Private Clinic in Pecs. Patients completed a complex questionnaire before the surgery and 6 weeks later. We evaluated socio-demographic data, disease and surgical conditions. Two international questionnaires were also completed (SF-36, Oxford Hip Score). Results: The research involved 164 persons, 75 persons of the state care, 89 persons of the private care. The proportion of villagers was significantly higher in the state care (p = 0.014), while mainly metropolitans were found in the private care. The proportion of primary (p < 0.001) and secondary education (p = 0.042) was significantly higher for state care patients, while higher education was prevalent among patients treated in the private sector (p < 0.001). In the state care the proportion of pensioners (p = 0.005), in the private care the proportion of intellectual workers and contractors was significantly higher (p < 0.001). Both groups' quality of life showed significant improvement (p < 0.001). Conclusion: Patients in the two groups significantly differed in socio-demographic characteristics, but both showed significant improvements in the quality of life 6 weeks after surgery.

Effect of the knee replacement surgery on activity level based on ActivPAL: a systematic review and meta-analysis study.

BACKGROUND: The knee replacement (KR) surgery aims to restore the activity level and reduce the risk of experiencing disabilities. The outcomes of this surgery are evaluated mainly with subjective tools or low validity objective tools. However, the effect of the surgery on activity level using high validity objective accelerometer is still in question. METHODS: A systematic review and meta-analysis were conducted to evaluate the benefit of KR surgery alone to enhance physical activity recommendations based on high validity accelerometer. Two independent reviewers evaluated five electronic databases (Cochrane-Central-Register-of-Controlled Trials, EMBASE, PubMed, Web of Science, and Scopus) to find relative studies between January 2000 and October 2021. The quality assessments and risk of bias assessments were examined. RESULTS: Three articles were included with 202 participants (86 males, 116 females), with an average age of 64 years and an average 32 kg/m2 body mass index. The results found that the number of steps was significantly improved up to 36.35 and 45.5% after 6-months and 1-year of the surgery, respectively. However, these changes did not meet the recommended activity level guideline and could be related to the patients' health status and their activity level before the surgery. No significant changes were seen in sedentary time, standing time, and upright time after 6-months and 1-year follow-ups. Heterogeneity among studies was low to moderate (0-63%). CONCLUSION: Knee replacement surgery is an effective treatment for improving patients' quality of life with severe knee injuries. However, various factors impact the success of surgical and achieving maximum benefit of the surgery. One factor, sedentary time, can be reduced by implementing pre-and post-surgery exercise or physical activity recommendations. Further studies are needed to understand the benefit of surgery with or without rehabilitation assessed using high validity monitors.

[Analysis of the utilization of one-day surgery in Hungary]. / Az egynapos sebészeti ellátás igénybevételi mutatóinak elemzése Magyarországon.

Introduction: The impact of one-day surgery has been increasing since the past few decades. This type of health service could fulfil many requirements of health policy, health care services, governments as well as patients. Aim: The aim of the research was to assess the publicly financed case numbers and interventions of one-day surgery in Hungary between 2010 and 2015 from different aspects. Method: A retrospective and quantitative research was made, based on data of the National Health Insurance Fund of Hungary. The database contained all publicly financed one-day surgery cases (both theoretical and performed cases), intervention codes (WHO) as well as the related medical field. Then the database also contained all relevant information related to the patients (age, sex, residency according to the county) and the type of the provider health care institutions. Results: Our results showed an increasing tendency according to the case numbers of one-day surgery from 130 995 (2010) to 251 328 (2015). The mean age of patients also increased in the analyzed period; in 2010: 47.4 years, in 2015: 54.5 years. In 2010, 42% of the theoretically defined one-day surgery cases were practically performed as one-day surgery cases which increased significantly to 65% in 2015. Gynecology, ophthalmology, general surgery and urology have had a significant impact in one-day surgery in Hungary. Conclusion: The analyzed data showed a significant increase of accounted cases, and we could identify the remarkable impact of gynecology and ophthalmology in one-day surgery in Hungary. Orv Hetil. 2019; 160(17): 670-678.

[Utilization indicators of balneotherapy in Hungary]. / A gyógyfürdoellátások igénybevételi mutatói Magyarországon.

INTRODUCTION: The role of spa therapy is well defined and its importance has significantly increased in the healthcare but the utilization indicators of the implemented treatments are less known. AIM: The objective of our study was to analyze the utilization and the social insurance indicators of the healthcare publicly financed by health insurance in spa institutions. DATA AND METHODS: The data used for the analysis were derived from the funding database of the National Health Insurance Fund of Hungary. The period examined covered the years between 2009 and 2016. The spa treatment counts, social insurance expenses, the territorial inequalities in utilization, sex and age distribution of the treatments were examined. RESULTS: The treatment counts were the highest (7 349 587) in 2009 and they gradually decreased with 6 558  204 treatments by 2012. 'Spa pool of medicinal water' treatment was the most common care in each year which incidence showed a downward trend during the past years: 2 544  617 treatments were performed in 2009 but 2016 showed only 1 898  338 treatments. We found the highest health insurance expenditures in 2016: 4.261 billion HUF or 13.8 EUR. In the previous years, there was a lower health insurance expenditure: in 2010 3.928 billion HUF (14.3 million EUR), in 2011 3.921 billion HUF (14.0 million EUR) and in 2012 3.875 billion HUF (13.4 million EUR). The utilization made the highest incidence of treatments in Csongrád county with 13 174/10 000 inhabitants and 8160 thousand HUF/10 000 inhabitants of social security subsidy in 2016. The lowest utilization counts for treatments were found in Nógrád county with 3233/10 000 inhabitants and 2192 thousand HUF/10 000 inhabitants of social security subsidy. The highest utilization indicators were found in the age group between 60 and 69 in the distribution of population and genders. CONCLUSION: In the utilization of spa therapy funded by health insurance fund, no significant change has occurred during the past years but territorial discrepancies can be seen in sex, age, and county breakdown. Orv Hetil. 2019; 160(Suppl 1): 22-28.

[Health policy indicators of neuromusculosceletal rehabilitation in Hungary]. / A neuromusculoskeletalis rehabilitáció szakmapolitikai indikátorai Magyarországon.

INTRODUCTION: With the increasing number of the incidence of neuromusculoskeletal and brain circulation disorders, there is a higher demand for neuromusculoskeletal rehabilitation care. AIMS: The aim of our study is to analyse the performance indicators of neuromusculoskeletal rehabilitation care in Hungary financed by the statutory public health insurance system. METHODS: Data were derived from the financial database of the National Health Insurance Fund of Hungary. We analysed the period between 2014 and 2017. We investigated the distribution of neuromusculoskeletal rehabilitation hospital beds, the patient turnover and patients' pathways. We analysed the regional inequalities in the access to (hospital beds) and utilization (number of patients) of rehabilitation care. RESULTS: In 2017, there were 6798 publicly financed neuromusculoskeletal rehabilitation hospital beds in Hungary (6.94 beds/10 000 population). We observed the lowest number of hospital bed in Komárom-Esztergom (1.5 beds/10 000 population), Somogy (2.0) and Pest (2.7) counties. We found the highest number of hospital beds in Zala (12.6), Gyor-Moson-Sopron (12.2) and Baranya (11.5) counties. The more than 2-fold difference in the utilization (Komárom-Esztergom: 52.3 patients/10 000 population; Gyor-Moson-Sopron: 136 patients/10 000 population) confirms regional inequalities. Between 2014 and 2017, the annual number of patients showed an increasing tendency, while the average length of stay varied between 21.8 and 22.4 days/patient. The correlation coefficient between hospitals beds and the number of patients was very high (0.798). CONCLUSION: We found significant regional inequalities in the access to and utilization of neuromusculoskeletal rehabilitation. Orv Hetil. 2019; 160(Suppl 1): 13-21.

Direct effects of physical training on markers of bone metabolism and serum sclerostin concentrations in older adults with low bone mass.

BACKGROUND: Both gravitational loading and the forces generated by muscle contraction have direct effects on serum markers of bone metabolism. The object of this study was to examine the direct effects of a single session of resistance exercise or walking on biochemical markers of bone metabolism in participants with low bone mass. METHODS: A total of 150 otherwise healthy female subjects (mean age = 59.1 ± 7.1 years) diagnosed with osteoporosis or osteopenia were randomly allocated to either a resistance exercise group (RG; n = 50), walking group (WG; n = 50), or control group (CG; n = 50). Changes in bone-specific alkaline phosphatase (BALP), carboxy-terminal cross-linked telopeptide of type I collagen (CTX), and serum sclerostin concentrations were measured before and immediately after a single exercise intervention. RESULTS: There was no significant change in BALP values in any of the groups. Sclerostin levels increased in the RG and WG, and there was significant difference between the WG and CG after the exercise intervention (P < 0.01). In contrast, the changes in CTX concentrations from baseline were significant in the RG (P < 0.01) but not in the WG (P = 0.11), and there was a significant difference between resistance exercise and walking (P < 0.01). CONCLUSIONS: In participants with low bone mass, resistance exercise influenced the serum concentrations of CTX, a marker of bone resorption, but walking did not. TRIAL REGISTRATION: Current Controlled Trials ISRCTN16329455 ; retrospectively registered on 05/05/2016.