[A proposal for introduction of Europeristat-compatible information system aiming a unified quality control of obstetrical and perinatological care in Hungary]. / Javaslat a terhesgondozás és perinatológiai ellátás egységes minoségkontrollját célzó, Europeristat-konform adatszolgáltatási rendszer bevezetésére Magyarországon.

It is a regrettable deficiency in the Hungarian healthcare that the culture and the system of quality control of cure have not been formed (except for a few subspecialties, units or wards). If hospital wards do not have a national, professionally unified and modern information system presenting the most important quantity and quality indicators of their medicinal activity annually, a stable basis for definition of future tasks is absent. The author puts forward a proposal for the establishment of the information systems for different professional fields. On the basis of experience of perinatological information system operating for over 3 decades in Borsod-Abaúj-Zemplén county, he also proposes introduction of a nationally unified, Europeristat-compatible information system following Tauffer-statistics which may serve as a uniform quality control of obstetrics and perinatological care, as well as introduction of its base, the dataform "TePERA" (Form of Obstetrics and Perinatological Care Risk).

Comparative evaluation of local and international reference databases for forearm densitometry: different impacts on diagnostic decisions.

Reference databases play a key role in the management of osteoporosis. The aim of this preliminary study was to compare the diagnostic consequences of using either an international or a local reference database in peripheral densitometry. For this purpose, standard curves for bone mineral density (measured by dual-energy X-ray absorptiometry at the distal and proximal forearm) were generated for healthy Hungarian men and women. In total, 303 healthy volunteers of both sexes (age range: 20-94 yr) were recruited from four osteoporosis centers. Subjects with medical conditions or taking medication affecting the bone metabolism were excluded. Bone densitometry was performed with pDEXA (Norland-Stratec, Fort Atkinson, WI) devices in each center after cross-calibration of the machines. The precision error of the forearm measurement was also determined (<1% in vitro, and 1.2-2.5% in vivo). In females, the peak forearm density was detected in the 30-39-yr group. The density decreased by 8% per 5 yr in early postmenopausal females, and by 10% per 10 yr in late postmenopausal females. In males, the highest bone mineral density was found in the 30-39-yr group for the distal forearm, but 1 decade later for the proximal site. Subsequently, a 5% decrease in density occurred per 10 yr, except in the 8th decade, in which a 20% decrease was demonstrated. One thousand four hundred thirty-four patients with suspected osteoporosis were classified according to the forearm density T-scores using both the new Hungarian reference database and the international database provided by the manufacturer. Comparison of the results measured at the distal forearm with the two different databases led to similar outcomes. However, at the proximal site, one fifth of the female patients were reclassified from the low-density group to the normal group using the domestic normative database. An opposite difference was observed for the males: use of the Hungarian reference data resulted in 40% more men being categorized in the low-density group than when the international normal database was applied. Our results suggest that not only geographic differences, but also the reference database used, can influence the prevalence of the diagnosis of osteoporosis. Further data are currently being collected to increase the statistical power of the study.

[A proposed new interpretation and revised definition of perinatal mortality]. / Javaslat a perinatalis mortalitás fogalomkörének újbóli átgondolására és definíciójának módosítására.

A proposed new interpretation and revised definition of perinatal mortality. Perinatal mortality rate is a commonly used index, which reflects the quality of obstetrical and neonatological care. Relying on critical remarks considered for his study, the author believes that a novel classification should be developed in order to redefine the term perinatal mortality and pregnancy-related losses. The author points out that intrauterine death during pregnancy cannot be associated with fatal incidents about birth, because the former precedes the latter. While regarding the cases of intrauterine death at late pregnancy as being important specific indicators, the author proposes excluding them from the cases covered by the term perinatal mortality. Furthermore, the author argues that all cases of neonatal death, that is, those at birth and those occurring in the first 28 days of life should be regarded as cases of perinatal mortality. It is reasonable to extend perinatal period this way, because due to a more advanced neonatological care, immature preterm babies may be lost 6 or even 27 days after birth. A novel interpretation of perinatal mortality, not including the cases of intrauterine death at late pregnancy, but including all cases of neonatal mortality makes perinatal mortality rate a more exact qualifier of obstetrical and neonatological care.

[The effect of intrauterine development and nutritional status on intrauterine and neonatal mortality]. / A magzat méhen belüli fejlettségének és tápláltságának hatása az intrauterin és újszülött-halálozásra.

The authors study to what extent bodily development and nutritional status influence the viability of foetuses and neonates, that is, their perinatal mortality. They developed a new method, the MDN system (MDN: Maturity, Development, Nutritional status) to determine the weight and length standard positions of neonates in relation to reference standards on the basis of their gestational ages, birth weights and lengths. The system contains a chessboard-like matrix (or MDN Table) comprising 64 cells arranged in eight horizontal lines of the most common zones of weight percentile standards and eight vertical columns of the length percentile standards. Depending upon its weight and length, each neonate can be positioned in one of the cells of the MDN Table. The table allows differentiating the major neonate groups with significantly different developmental and nutritional statuses. The authors used a computerised program to process in one MDN table the data of 680,947 neonates born in the 7 five years from 1997 to 2003 in Hungary. When the ratio of body length and weight was considered, 90.6% of this neonate population was found normally (proportionally) nourished. 4.9% of the population was relatively over-nourished, while 4.5% was relatively undernourished. Then, the authors computed the intrauterine and neonatal mortality rate of the newborns in each cell of the MDN Table. Intrauterine (neonatal) mortality rate in the neonate group with an absolute average development was 3,6 per thousand (4,4 per thousand), that in the proportionally retarded group under weight and length percentiles 10 was 21 per thousand (14 per thousand). This rate was 41 per thousand (24 per thousand) under weight and length percentiles 3. The mortality rate was 51 per thousand (49 per thousand) in the extremely overnourished group and 124 per thousand (78 per thousand) in the extremely undernourished group. The authors believe that the MDN system including the MDN table is a suitable method to differentiate the most endangered groups of neonates on the basis of their development and nutritional status.

[Thoughts about the efforts for the elimination of labour pain and the application of epidural analgesia in obstetrics]. / Gondolatok a szülési fájdalom kikïisöböalésére ircányuló törekvésekro1, az epiduralis analgesia szülészeti alkalmázásró1.

The author takes its stand in a dispute over epidural analgesia [EDA] widely used in practical obstetrics, a disagreement, which has divided obstetricians in the past few decades. The author believes that the psychosomatic preparation of mothers is more important and agrees that it is absolutely necessary to relief hard-to-stand labour pains lived by some as suffering, however he disagrees with the application of EDA as full analgesia in labour. He argues that one should not interfere in biological processes, developed by nature in the course of a very long evolution of human life, using particularly far-reaching and invasive methods. He points out that labour pains are important elements of a defence mechanism warning the body of imminent dangers and that the experience of pain at labour is most likely to initiate psychological reflexes that certainly contribute to the development of a healthy motherly pride and motherly identity and of a closer, long-term emotional attachment between mother and baby. Besides, EDA does not at all fit in the practice of natural labour recently reviving worldwide. At the same time, the author acknowledges that a controlled use of EDA can be justified in cases when the mother insists on having it, or, when it is recommended by her doctor, providing, however that the mother is correctly informed in either case. The author mentions the medical and legal difficulties involved in the application of EDA and underlines the necessity of correct information including its risks and negative effects also raised in his paper.

The effect of intrauterine development and nutritional status on perinatal mortality.

OBJECTIVE: To study the influence of bodily development and nutritional status on perinatal mortality. METHODS: The authors developed a new method, the MDN system (MDN: Maturity, Development, Nutritional Status), to determine the development and nutritional status of newborns based on their weight and length standard positions. Using data of 680,947 neonates born in the 7 years from 1997 to 2003 in Hungary, they computed the perinatal mortality (PM) rate of each developmental groups of neonates. RESULTS: PM in the group of neonates of absolute average development was 7 per thousand, 30 per thousand in the proportionally retarded group and it was 90 per thousand in the extremely overnourished group. The PM rate was the highest (191 per thousand) in the extremely undernourished group. CONCLUSIONS: Both bodily development and nourishment have a major impact on PM. The MDN system is a suitable method to differentiate the most endangered groups of neonates based on their development and nutritional status.