Economic burden of long-term care of rheumatoid arthritis patients in Hungary.

BACKGROUND AND AIM: Long-term care (LTC) in Hungary is provided in four major ways: day care, nursing, chronic care, and rehabilitation. The aim of this study was to explore the financing of LTC in Hungary, with a disease-specific focus on rheumatoid arthritis (RA) patients. DATA AND METHODS: Data were derived from the National Health Insurance Fund Administration (NHIFA). For 2012, we analyzed the following indicators: number of patients and cases, crude and weighted hospital days, and health insurance expenditure. RESULTS: The annual health insurance expenditure of LTC was 112.6 million EUR in Hungary in 2012 and covered 209,000 patients (225,000 cases). The NHIFA spent 0.69 million EUR for the LTC of 976 patients with RA. The annual health insurance cost per patient was significantly (by 32%) higher for patients with RA (710 EUR) than the average cost of all patients (538 EUR). The average length of stay was also higher for patients with RA (19.7 days) than for the general LTC population (17.4 days). CONCLUSIONS: The cost of LTC of patients with RA is higher than the average cost of the general LTC patient population. Early treatment of RA patients could contribute to decreasing LTC expenditure. More generally, health technology assessment can inform future LTC funding debates in Central and Eastern European countries by putting more emphasis on LTC utilization and costs.

Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis.

BACKGROUND: The incidence of fractures is substantially increased in patients with chronic kidney disease (CKD) compared to the general population. The factors associated with increased bone fracture in this population are not well understood. Vitamin D deficiency has been associated with decreased bone mass and higher incidence of fractures in the general population. In this study, we aimed to assess the association between fracture and vitamin D status and other factors potentially associated with fracture in patients on maintenance hemodialysis. METHODS: One hundred and forty-four patients were assessed and interviewed about previous low-trauma fractures. Evidence of fracture was obtained from medical records and also through patient interviews. Routine laboratory results were collected from medical records. Serum intact PTH (iPTH) and 25(OH) vitamin D(3) were measured. All patients underwent bone densitometry of the lumbar spine, femoral neck and distal radius. Bone quality was also assessed with quantitative bone ultrasound (QUS). Descriptive statistics, logistic regression models were used to analyze factors associated with fractures. RESULTS: One hundred and thirty patients were included in the final analysis. Patients with fractures (n = 21) had lower 25(OH) vitamin D(3) levels (15.8 nmol/l (interquartile range, IQR: 27) vs. 30.0 nmol/l (IQR: 28.5), P = 0.029), were more likely females, had longer duration of end-stage kidney disease, and lower bone mineral density (BMD) at the distal radius. QUS parameters were not associated with fractures. Multivariate analyses revealed that serum 25(OH) vitamin D(3) concentration, BMD at the radius, iPTH less than 100 pg/ml and history of fractures were independent predictors of new bone fracture after the initiation of dialysis therapy. CONCLUSION: Increased bone fragility in dialysis patients is associated with vitamin D deficiency and relative hypoparathyroidism in addition to reduced BMD at the radius. Further studies are needed to determine whether patients with vitamin D deficiency benefit from vitamin D supplementation to reduce fracture risk.

Bone mineral density and parathyroid function in patients on maintenance hemodialysis.

BACKGROUND: The relationship between parathyroid function, an important determinant of bone turnover, and bone mineral density (BMD) in patients with chronic kidney disease is not fully understood. We wanted to analyze the association between BMD and parathyroid function in hemodialysis patients in details. METHODS: In a cross-sectional design, data from 270 patients (age 55 ± 15 years, 60% men, all Caucasian) on maintenance hemodialysis were analyzed. All patients underwent dual energy X-ray absorptiometry of the lumbar spine (LS), femoral neck (FN) and distal radius (DR). In addition to routine laboratory tests, blood samples were collected for iPTH, serum markers of bone metabolism (alkaline phosphatase, type I collagen crosslinked-C-telopeptide) and 25OH vitamin D. RESULTS: Based on Z-scores, bone mineral density was moderately reduced only at the femoral neck in the total cohort. The average Z-score of the "low PTH" group (iPTH < 100 pg/ml) was not different from the Z-score of patients with iPTH in the "target range" (100-300 pg/ml) at any measurement site. While iPTH was negatively correlated with BMD at all measurement sites in patients with iPTH > 100 pg/ml (rho = -0.255, -0.278 and -0.251 for LS, FN and DR, respectively, P < 0.001 for all), BMD was independent of iPTH in patients with iPTH < 100 pg/ml. Furthermore, iPTH was not associated with serum markers of bone metabolism, but these markers were negatively correlated with BMD in the "low PTH" group. CONCLUSIONS: Low PTH levels are not associated with low BMD in patients with end-stage kidney disease. Furthermore, bone metabolism seems to be independent of iPTH in patients with relative hypoparathyroidism likely reflecting skeletal resistance to PTH.

Experiences with fetal phonocardiographic telemonitoring and future possibilities.

Phonocardiography (PCG) makes possible the examination of some fetal cardiac anomalies which otherwise usually remain undetected during pregnancy. The application of PCG in a telemonitoring system enhances its diagnostic capabilities, allowing long-term measurements even at home. The paper summarizes the intensive fetal monitoring campaign carried out in Hungary during the last three years that yielded useful experience regarding recent and future possibilities of fetal monitoring. Results collected from a large number of measurements suggest that PCG home monitoring may be a suitable screening method for fetal congenital heart diseases, even if surgical intervention in this phase of pregnancy is not easy.

Application of the matching pursuit method in a fetal phonocardiographic telemedicine system.

A novel compact method for fetal home monitoring optimized for long data acquisition time has already been presented. The method involves preprocessing a disturbed acoustic signal received on the maternal abdomen. The present work summarizes phenomena encountered during analysis of the incoming PCG signal, and describes further improvements made to the analysis system already in use including the application of the MP method to determining heartbeat lengths and identifying murmurs between heart sounds.

New benzoyl urea derivatives as novel NR2B selective NMDA receptor antagonists.

A novel series of benzoyl urea derivatives was prepared and identified as NR2B selective NMDA receptor antagonists. The influence of the substitution of the piperidine ring on the biological activity of the compounds was studied. Compound 9 was active in the formalin test in mice.

Fetal breathing transmission in phonocardiographic monitoring telemedicine systems.

The phonocardiographic monitoring of fetal heart activity due to its passive nature enables extremely long measuring times providing thus the possibility of fetal breathing recovery. The long monitoring time is required because of the temporary appearing of breathing movement. However, the long measurement time and consequently the large amount of data to be transmitted to the hospital's computer centre may be costly on mobile phone network. To keep monitoring costs low an appropriate data compression should be applied assuring the transmission of all important features of the detected acoustic signal. The present work summarizes the results of the extension of the novel telemedicine system with measurement of breathing periodicity and the achieved compression level of acquisited data. The Golomb-Rice compression is applied for lossless transmission of the segmented beat cycles considering the importance of the given segments in order to obtain the most accurate transfer of beat-to-beat time and all irregular heart sounds.

Long-term Phonocardiographic Fetal Home Monitoring for Telemedicine Systems.

A novel compact method for fetal home monitoring optimized for long data acquisition time and low communication costs is presented. The method incorporates the preprocessing of disturbed acoustic signal received on the maternal abdomen. The basic idea of the preprocessing is that the detection of the systolic and diastolic sounds takes place on two separated frequency bands with autocorrelation on predicted time intervals. Measurements on 47 selected pregnant women have shown that the use of this method significantly reduces the amount of data to be transferred to the computer centre in the hospital, where only the very disturbed time periods have to be evaluated. Based on this method a new, phonocardiographic fetal telemedicine system can be built without time limitation of measurements.

Surface and pore diffusion in macroporous and gel-filled gigaporous stationary phases for protein chromatography.

A recently introduced method [Biotechnol. Prog. 13 (1997) 429] for determining intraparticle mass transfer parameters in high speed liquid chromatography is considered in the present study for the case where the eluite adsorbs onto the stationary phase. The validity of the method was verified theoretically using simulated elution profiles and then applied to experimental data obtained using columns packed with either a macroporous or a gel-filled gigaporous stationary phase. For this purpose, experimental measurements were made using alpha-lactalbumin and bovine serum albumin as eluites at several retention factors. Apparent intraparticle diffusivities measured for the gel-filled gigaporous stationary phase were seen to increase with the retention factor, which indicates that for this material surface diffusion is a significant mechanism of mass transfer under retained conditions. Data obtained on the macroporous stationary phase revealed that the intraparticle diffusivity was independent of the retention factor, which suggests that pore diffusion remains the principal mass transfer mechanism even under conditions where proteins are adsorbed on the column packing.