Răzvan M. Cherecheş

Defining informal payments in healthcare: a systematic review.

OBJECTIVESnTo explore the literature for the definitions of informal payments in healthcare and critically analyze the proposed definitions. This will serve in the process of getting to a coherent definition of informal payments, which will further support acknowledging and addressing them globally.nnnMETHODSnA search strategy was developed to identify papers addressing informal payments on PubMed, ScienceDirect, Econlit, EconPapers and Google Scholar.nnnRESULTSn2225 papers were identified after a first search. 61 papers were included in the systematic review. Out of all definitions provided, we selected three definitions as being original. All other definitions either cite these definitions or do not provide new insight into the topic of informal payments. Although informal payments have been nominated by various terms over the years, there is a tendency in recent years towards an agreement to use this singular term. Definitions differ in terms of the relation of informal payments with other informal activities, their legality and the motivation behind them.nnnCONCLUSIONSnThe variety of forms which informal payments may take makes it difficult to define them in a comprehensive manner. However, we identified a definition that could serve as a beginning in this process. More effort is needed to build on it and get to a commonly accepted and shared definition of informal payments.

Epidemiology of assault and self-harm injuries treated in a large Romanian Emergency Department.

Objectives Intentional injury, including interpersonal violence and self-harm, is one of the world’s leading causes of preventable injury. In Europe alone, nearly 1.5 million individuals receive medical treatment each year for a violence-related injury. We examined violent injuries treated in the largest Emergency Department (ED) in Tîrgu Mures County, Romania, with a catchment area of approximately 580 000 residents to describe the epidemiology of assault and self-harm injuries. Methods Data were collected as part of the European Injury Database project, from a sample of patients who presented with a violence-related injury and received care from the ED of the Mures County Emergency Hospital, Romania. The data were collected for 9 months by two trained emergency physicians. Information about individual demographics; mechanism, nature, place, and activity of injury; injury types, and body regions affected; and discharge state were compared for assault and self-harm injuries. Results Of the 380 patients treated for violence-related injuries, 88.7% were for assault and 11.3% were for self-harm. For both types of injuries, the majority of patients were between the ages of 15 and 44. Assaults frequently occurred in the home, on streets and highways, or in public places; and men (80.4%) were far more likely than women (19.6%) to be treated for this type of injury; a slightly higher proportion of men (55.8%) than women (44.2%) were treated for self-harm, most of which occurred in homes. Discussion Of all injuries treated in the Tîrgu Mures ED, one out of five was violence related. One out of 10 patients that suffered an injury as a consequence of a violent event and treated in the ED required admission to a hospital for further medical care, leading to a significant health care burden. These data suggest that prevention strategies should focus on young adults, and particularly men. Interventions that focus on detection and treatment of psychological illness, reduction of alcohol use and associated aggression, and family and intimate partner violence are suggested as priorities.

Validation of a Romanian scale to detect antenatal depression

The aim of this study was to develop and validate a linguistically and culturally appropriate version of the Edinburgh Postnatal Depression Scale (EPDS) for use with women attending antenatal care in Romania. We translated and tested a Romanian version of the EPDS (EPDS-R) in four hospitals in three Romanian cities: Cluj-Napoca, Satu Mare, and Sighetu-Marmatiei. The study population included third-trimester women attending antenatal clinics (n=418); 364 subjects were included in the analytic sample. We used the Center for Epidemiologic Studies Depression Scale (CES-D) as a “gold standard”. We assessed reliability, validity, and conducted sensitivity analysis to establish an EPDS-R cutpoint. We found that reliability was robust (α=0.89) and there was a significant linear relationship between EPDS-R and CES-D scores (r=0.77; p<0.001). We established an EPDS-R cutpoint of >12 to balance sensitivity and specificity. Principal component analysis revealed a two-factor solution. We detected antenatal depressive symptoms prevalence rates of 32% (CES-D) and 38% (EPDS-R). This is the first study to report exclusively on antenatal depression and the use of the EPDS in Central and Eastern Europe. The EPDS-R is easy to administer, reliable, and valid for screening depression among antenatal women in Romania.

A Structured Public Health Approach to Increasing Rates and Duration of Breastfeeding in Romania

BACKGROUNDnStudies indicate that since 1990, rates of breastfeeding initiation and duration in Eastern Europe, including Romania, have decreased. Most breastfeeding promotion efforts in Romania have focused on in-hospital care, with an emphasis on training clinicians. Prior studies report that about 88% of Romanian mothers initiate breastfeeding in the hospital; however, these same studies report limited breastfeeding duration. We posit that an important problem is lack of support and education in the weeks and months following the birth. The nature of this problem suggests the need for an integrated and structured public health solution.nnnMETHODSnBased on our independent research, the results of an international maternal and child health (MCH) conference, and consultation with Romanian and American experts, we propose use of the public health problem-solving paradigm to support breastfeeding in Romania.nnnRESULTSnThis article presents a conceptual model showing the integration of input, output, and process components and a logic model explicating possible interventions (or needs) and barriers to breastfeeding. We propose a public health solution that begins with a new MCH within the public health training structure at a major Romanian university and a summer course bringing together Romanian and American students to study MCH, including breastfeeding.nnnCONCLUSIONSnWe believe that these two courses will promote enthusiasm and generate ideas to develop community-based interventions as well as policy recommendations to increase breastfeeding duration in Romania. We suggest that this public health problem-solving approach provides an integrated way of maintaining and increasing breastfeeding; furthermore, this approach could be broadly used in Eastern Europe.

Assessing health literacy in rural settings: a pilot study in rural areas of Cluj County, Romania

Health literacy improves knowledge and builds skills to help individuals make appropriate decisions regarding their health. Over the past 20 years, several studies have described associations between health literacy and health outcomes. With respect to Romania, evidence is scarce on the level of health literacy, as well as on its determinants. Thus, the objectives of this study were to briefly screen functional health literacy levels in a sample of rural inhabitants, to assess the relationship between health literacy and reported health status, as well as to explore health literacy determinants within this population. Data were collected between September–November 2010, in four villages in Cluj County, Romania, using a cross-sectional survey. The mean age of respondents in the sample was 56 years, with roughly half of respondents being retired. The brief screening of health literacy suggested inadequate to marginal levels within the sample. Significant associations were observed between health literacy score and education, and self-perceived health status, whereas the relationship between health literacy and gender, and the presence of a chronic disease was not statistically significant. Limited health literacy has been shown to be common in people who rated their health as poor, those who attended only middle school, and individuals lacking basic information about their body. In order to minimize the adverse effects of low health literacy on health and health outcomes, efforts should be invested in identifying and addressing the health needs of adults with low and marginal health literacy, especially in underserved areas such as rural and remote settings, where access to health-related information is limited.

936 Parent’s experience with child safety restraint in Romania

Background Child safety restrains are known as the most effective measures in protecting children from severe injuries and death while travelling in a car. Little is known about the Romanian rates of child safety restrains as the legal requirements are new and there is little enforcement. Methods An observational study on child safety restraint use was conducted in Cluj-Napoca, Romania, between 2013 and 2014. Child restraint and parent surveys were conducted at 38 schools and kindergartens and 3 commercial areas, to explore the use of safety restraints. Drivers were asked about their knowledge and attitudes towards restraint legislation and safety behaviour. A total of 892 children were observed and 533 (69.4%) drivers approached responded to our survey. Results Of the total number of observed children, 67.4% were travelling in some type of restraint. One third of the children were registered as being properly fitted (38.3%). More than two thirds of the drivers approached (n = 348, 68.4%) had knowledge about the existence of child safety restraint legislation. Among parents who did not use a child safety restraint, low use was attributed to lack of awareness and knowledge (49.4%) followed by being aware but choosing not to (27.9%), financial reasons (12.7%) and the seat being in the other car (10.1%). They were also asked to give examples of what would motivate them to use child restraints for their children and 26.6% indicated that a better law would increase the use, while 11.4% acknowledged that free availability will determine them to use restraints. Conclusions Parent drivers could benefit from proper knowledge on the importance of and how to correctly use child safety restraints, as few children were properly restraint in our sample population. The majority of parents had some information on child safety restraint use and were aware that they are important, yet a large proportion of parents were not using restraints, therefore raising awareness actions are much needed.

Paediatric trauma registries are valuable: preliminary results from a Romanian IDB pilot

Traumatic injuries greatly affect childrens physical and psychological well-being, affecting their school performance, and often leave children with life-long disabilities. A surveillance system has been pilot tested in the Emergency Department of the Cluj-Napoca Hospital as part of the EU Injury Data Base (IDB). Data collection were conducted according to the common IDB standard established in the Member States. The scope of the project was to identify the frequency and characteristics of childhood injuries with the goal of providing information to support prevention efforts and provide comparable data among Member States. Relying on a database in progress (N=1000), preliminary descriptive results indicate that over one third of injured children treated in the Children Hospital of Cluj-Napoca occur between 0 and 4 years of age. Children in this age group suffer twice as many injuries as in any other age group. As a result, every 6 months in Cluj County, one out of every 100 children younger than 4 years old receives emergency healthcare treatment for an injury. Furthermore, over two thirds of children sustained injuries to the head region, 40% of which affected the brain and/or the skull. These injuries have a strong potential for life-long disability, and increase the risk for future injuries. This pilot data provided a baseline for evidence-based prevention strategies with substantial return on investment; while further investigation is needed the pilot demonstrated that there is capability to collect EU quality level data in Romania.

Backyard farm injuries assessment in rural area of Cluj County, Romania

Although 46% of the Romanian population lives in rural areas, little is known about injuries and violence rural residents experience. Research worldwide consistently shows that farm related activities are a major cause of rural injuries. While such injuries can result in considerable suffering and financial losses, little data are available on the prevalence and potential causes of injuries, especially among small farming operations. In Romania, the majority of farming operations are backyard farms, which are a method of survival agriculture, and also provide a place for work and recreation. This project assessed the burden of farm injuries, populations at risk and injury risk factors among backyard family farms in Cluj-Napoca, Romania. 150 backyard farms were targeted, with data collected on injury occurrence, defined as an injury that restricted rural inhabitants from normal activities for at least 4 h, or resulted in loss of consciousness, loss of awareness, or loss of memory for any length of time, or required professional care including backyard farm workers, non-working rural residents and visitors. At the time of abstract submission, data is being collected. Data will include the prevalence and risk factors for injury. The project is unique because it is the first to address backyard farm injuries in Romania. This data will provide the first public health information about backyard farm injuries, which will provide a baseline for future research projects on rural injuries as well as frame backyard farm injury prevention strategies and policies.