Florentina Ligia Furtunescu

Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children below five years of age in Romania.

INTRODUCTION Rotavirus (RV) is a leading cause of acute gastroenteritis (AGE), affecting 95% of children below five years of age. METHODS In this prospective, multi-center study, children below five years of age who were hospitalized or those who visited the emergency room (ER) due to AGE or who developed AGE at least 48 hours after hospitalization (nosocomial infection) and had a RV-positive stool sample were included (n=1,222). RV-positive samples were genotyped by reverse-transcriptase polymerase chain reaction. RESULTS RV test results were available for 1,212 children (hospitalizations [n=677], ER visits [n=398] and nosocomial AGE cases [n=137]). Proportions of rotavirus gastroenteritis (RVGE) hospitalizations and ER visits were 51.70% (350/677; 95%CI: 47.86-55.52) and 36.18% (144/398; 95%CI: 31.45-41.12), respectively. Overall, 45.95% (494/1075) of all community-acquired AGE cases were due to RV. High numbers of RVGE cases were recorded between January and March. Most common genotypes were G9P[8] (34.27%) followed by G4P[8] (25.83%) and G1P[8] (23.02%). Of all community-acquired RVGE cases, the highest number of cases was observed in children aged 12-23 months. Median duration of hospitalization among RV-positive subjects was six days (range: 2-31 days). Incidence of nosocomial RVGE was 0.52 (95%CI: 0.45-0.60) cases per 1,000 child-days hospitalization. Median duration for additional hospitalization due to nosocomial RVGE was five days (range: 1-10). The highest burden of nosocomial RVGE was observed in children aged 12-23 months (42.34%, 58/137). Our findings confirm a high burden of acute RVGE disease in Romania and provide useful data to support the implementation of RV vaccination in Romania. TRIAL REGISTRATION NCT01253967.

Recent trends of cancer mortality in Romanian adults: Mortality is still increasing, although young adults do better than the middle-aged and elderly population

We analysed the mortality trends (1986–2009) for all cancers combined and selected cancers in adult Romanians by three age groups (15–49, 50–69 and older than 70 years of age) in comparison with 11 other European countries. We extracted mortality data from the WHO database and grouped the countries into four regions: central and eastern Europe (Romania, Bulgaria, the Czech Republic, Hungary), Baltic countries (Estonia, Latvia and Lithuania), western and northern Europe (Austria, the Netherlands and Finland), and southern Europe (Croatia and Slovenia). Mortality rates were age-standardized against the standard European population. Significant changes in mortality trends were identified by Joinpoint regression and annual percentage changes (APCs) were calculated for periods with uniform trends. Cancer mortality in Romania was among the lowest in Europe in 1986, but was higher than most countries by 2009. Despite the declining mortality (APC) in younger Romanians for all cancers combined (men−1.5% from 1997, women−1.2% 1997–2004 and −3.8% 2004–2009), male lung cancer (−2.8% from 1997), female breast (−3.5% from 1999) and cervical (−5.4% from 2004) cancers, mortality has increased in middle-aged and elderly patients for most cancers analysed. The exception was declining stomach cancer mortality in most Romanians, except elderly men. For most cancers analysed, mortality declined in the Baltic countries in young and middle-aged patients, and in western and northern countries for all ages. Lung cancer mortality in women increased in all countries except Latvia. We urge immediate steps to reverse the alarming increase in cancer mortality among middle-aged and elderly Romanians.

The iris signal: blue periphery, tan collaret and freckles pattern – strong indicators for epidermal skin cancer in South‐Eastern Europe

Eye and skin share the embryological origin. Both are established risk factors in epidermal skin cancer. There are few reports using iris colour classification scales, most of them analyse colour in general or are too complex to use in daily practice.

A Novel Iris Colour Classification Scale

Background :Eye colour can be a predictive factor for skin cancer. Several iris colour classification scales have been described, but are not widely accepted. Further investigation of the relationship between the iris and skin cancer requires a valid and reliable inst rument for iris colour classification. Objective:Development and validation ofan easy and clinically reliable scale for iris colour classification. Design:This is a descriptive case series study. Participants:We analysed 211 irises digital photograph s of patients with primary skin

Drug Policy in Romania

OBJECTIVES The objectives of this article were to describe the characteristics of the drug policy in Romania in the last 10 years and to present the consequences in terms of patient accessibility to drugs. METHODS The Romanian health care system with pricing and reimbursement legislation was studied while considering the evolution of pricing and reimbursement processes, the key stakeholders, and the reasons behind changes. A critical appraisal was done covering published materials on the effects of pricing and reimbursement decisions. RESULTS Romania uses an external reference pricing model considering the lowest price from 12 European Union countries. The result is the visible list price, which is used by the payer as the basis for the reimbursement prices. The reimbursed price depends on the type of drug and the therapeutic area. The claw-back taxation reduces the reimbursement prices by another 12% to 75%, depending on the type of reimbursement for each drug: unconditional (more than 4000 drugs) or conditional (19 drugs) reimbursement. As a consequence, the Romanian prices are one of the cheapest in the European Union, some drugs are leaving the country subject to intracommunity trade and more than 2000 drugs have disappeared from the market in the last 5 years. CONCLUSIONS The drug policy in Romania is centered on price reduction using different techniques and no value-based criteria are used. The pricing is not included in the health technology assessment system, managed entry agreements are not used, and the main effect visible at the patient level is the lack of drugs for some therapeutic areas.

Assessing The Leadership Style In Health Organizations From Romania

Abstract Based on the situational leadership theory (Hersey&Blanchard), our study aimed to analyze the leadership style in managers of different health facilities from Romania. We included 41 persons with key positions (general manager, medical director, chief of section/department, nursing director, chief – nurse). All these persons filled the LEADself questionnaire (Leader Effectiveness and Adaptability Description Instrument, Center for Leadership Studies, Hersey and Blanchard). The tool measures three dimensions: the dominant (and secondary) leadership style, the style range (flexibility) and the style adaptability (the leader effectiveness). We found a dominance of “Selling/Coaching” style, followed by the “Telling/directing” style. The managers were found to have a high relationship supportive behavior. Only three cases of low relationship dominance were found. Also almost all the managers were found as mostly group centered (only 5 cases were more leader centered). The flexibility of the managers was high, only one persons having the style range<2; the effectiveness score varied from 12 o 25, most of the responders having a low or moderate level of adaptability.

Malnutrition and associated factors in patients with infectious diseases.

Background Worldwide, malnutrition affects 20-50% of patients admitted to hospitals. Malnutrition has a high impact in clinical outcomes and cost of healthcare. In Romania, there is a general lack of hospital malnutrition data, and also of malnutrition prevalence in infectious diseases hospitals. Objective: to assess malnutrition risk and associated factors in hospitalized patients with infectious diseases.

Transversal analysis of junk food diet for a group of medical students and its association with metabolic syndrome

Abstract Objective: to evaluate the nutritional behavior of medical students regarding junk food intake in relation with the metabolic syndrome (MS). Material and Method: 235 medical students completed a food frequency questionnaire; MS risk factors were recorded. Junk food was grouped in 5 categories, according to the predominant nutrient in its composition. Statistical data were processed by SPSS program. Results: 97% of subjects did not fully comply with the WHO recommendations of healthy nutrition. No statistically significant correlations were found between the nutritional intake of nutrients or junk food categories and waist circumference or HDLc, except the glycemic index in women (r=-0.230, p=0.003). A correlation between the intakes of different categories of junk food was found. Conclusions: Most subjects consume in excess nutrients considered risk factors and very few have an optimum intake of nutritional protection factors against MS. The “western diet” pattern prevalent in this population is an argument for educational interventions.