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JOURNAL OF PREVENTIVE MEDICINE
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1582-5388
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Editorial Elena Lungu Health is influenced by many factors. The
performance of health sector is an important determinant of the health status
of population and individuals. Many factors outside the direct aim of the
health sector have also an important impact on health, as poverty, lack of
safe water and sanitation, poor education. (1) In order to improve the performance of health
system, to adjust to changing conditions, countries worldwide have started
health care reforms. (1). Since 1980 several European Countries started to
reassess their health care systems, mainly investigating whether or not
health care reforms are consistent with “The Health for All” principles, one of the greatest challenges
facing health system reform being how to develop an overall “health system
perspective” (1, 2). Ü FULL
TEXT.PDF Health Patterns and Determinants Antiretroviral therapy in Romania: Haart? Apetrei C, Diane Descamps, Ivona Pandrea, Groza P,
Prisecariu L, Irina Teodorescu, Andra Teodor, Collin G, Luminiţa-Smaranda Iancu, Luca V, Françoise Brun-Vézinet Abstract. This study aimed to investigate resistance
mutation in patients under discontinued antiretroviral (ARV) therapy. Material and methods. Selection of
reverse-transcriptase (RT) and protease mutations was investigated in 48
pediatric patients treated for at least 52 weeks by tritherapy including
non-nucleoside inhibitors but whose treatment was discontinued for at least
three times (< 1 week) during the follow-up, mainly due to lack of
financial resources. Viral load (VL) was measured by Monitor Roche (detection
limit: 200 copies/mL). Results.
All the patients were infected by HIV-1 subtype F1. VL was undetectable in 5
patients. RT and protease were amplified in 44 and 42 patients respectively.
Wild-type protease was observed in 29 patients, while wild RT was observed in
3 cases. 4 patients with detectable VL had non-nucleoside inhibitors of
reverse-transcriptase (NNRTI) mutations (K103N=30; Y181C=6; Y188L=2;
V106M=1). Four of them presented substitutions associated with high-level
resistance to NRTI (M184V=2; T215Y=2), whereas 13 patients presented
substitutions associated with resistance to PI (M46I; V82A). All the patients
presenting substitutions associated with the resistance to PI also presented
mutations associated with resistance toward NNRTI. Conclusions. Our results
show a very high frequency of selection of NNRTI mutations in patients
receiving a discontinued treatment containing this class of drugs. NNRTIs
should be avoided in those situations where for economical reasons there are
risks of discontinuations of treatment. Key-words:
HIV-1, reverse-transcriptase, protease, ARV resistance mutations Ü FULL
TEXT.PDF Groza P, Diane Descamps, Ivona Pandrea, Collin G,
Prisecariu L, Irina Teodorescu, Andra Teodor, Luminiţa Smaranda Iancu, Luca V, Françoise Brun-Vézinet,
Apetrei C Abstract. This study was aimed to investigate the efficiency
of the ARV management based on plasma genotypic antiretroviral resistance
testing in patients with failing ARV therapy. Material and methods. There were included 48 of patients in which
ARV therapy was modulated according to the results of genotypic resistance
which registered therapeutic failure in 43 of cases (89.6%) in 2000. In 2001
out of 42 plasma samples, viral load was undetectable in 23 (55%). The
protease was amplified in 19/42 of cases, ten of which being wild type. Results. New resistance mutations
comparing to 2000 were observed in proteases from 7 patients.
Reverse-transcriptase (RT) was amplified in 19/42 patients and new resistance
mutations were observed in 4. These mutations conferred resistance toward
nucleozid inhibitors of RT (NNRTIs). Reverse-mutations occurred very rarely
following therapeutic switch. Conclusion.
Our study shows that monitoring the ARV therapy based on genotypic testing is
highly effective in controlling the HIV infection evolution. The low rates of
reverse mutations following the therapeutic switch stress the importance of
the responsible treatment monitoring. Key words: HIV-1, reverse-transcriptase,
protease, resistance mutations, viral resistance, GART Ü FULL
TEXT.PDF Urinary nicotine metabolites levels
in teenagers Gabriela Mancaş,
Marieta Vasilov, Oana Barna, Iliana Palamaru, Gabriela
Albu, Roxana Alexandrescu Abstract.
The aim of this study was to
investigate the relationship between the tobacco smoke exposure (assessed by
questionnaire) and the urinary total nicotine metabolites in teenagers using
an accessible and rapid method and, also, to validate is method using the
questionnaire in relation with nicotine metabolites levels measurements. Material and methods. A sample of 296 young aged 15-20 years was
randomly selected from three high schools. An adequate questionnaire for
assessing their smoking status was used and urine specimens were sampled for
measurement of total nicotine metabolites and creatinine levels. Adequate
analytical techniques were applied for accurate comparison of the two methods
for tobacco smoke exposure assessment in
teenagers. Results. A
smoker frequency of 40% among the investigated teenagers was
self-reported, ranging from 38% in the subjects aged 15-17 years to 50% in
those aged 19-20 years. Only 22% of them were self-reported unexposed and
nonsmokers and 37.6 % - passive smokers. An increasing trend was found for
the urinary cotinine levels according to the duration of exposure through
smoking only for those teenagers self-reported to smoke daily 5-10
cigarettes. An increasing trend was established for cotinine levels according
with the smoking intensity of the subjects, with statistical significant
differences between different smoker categories. The urinary thiocyanate
levels did not correlate with the smoking intensity. The validation of
self-reported smoker status (assessed by questionnaire) in comparison with the
urinary cotinine levels has indicated a sensitivity of 0.92 and a specificity
of 0.49. Conclusions. The findings of our study have
highlighted a linear positive correlation between the urinary cotinine levels
and the number of cigarettes smoked daily and, partially, with the duration
of smoking exposure of teenagers. The urinary cotinine level, as exposure
bioindicator, was proved to be a useful tool for measurement of organism
impregnation, as smoking consequence. The techniques of validation by the help
of questionnaire have indicated that is a sensitive but less specific method
for exposure assessment in the comparison with the major urinary nicotine
metabolite measurement. Key
words: tobacco smoking, teenagers, urinary
nicotine metabolites, validation Ü FULL
TEXT.PDF Indicators
of dermatoglyphic diagnosis of sekelary infantile encephalopathyes (IEP) Ana Ţarcă Abstract.
The aim of this paper is a dermatoglyphic study in 200 children and
teen-agers aged between 2 and 17 years with various infantile encephalopathy
(IEP) sekeles, such as hemiplegy, paraplegy, tetraplegy from a dermatoglyfic
pathological perspective. Material and
methods. A total of 400 palmary prints have been collected between 1995
and 2003 in the Mental Health Center of Iaşi with the catchments area
the Eastern part of the country. Results
and discussion. Among the complex clinical symptoms evidenced in the
affected people, mention should be made of the presence of epilepsy, autism,
ocular diseases, which have been further used, along with the reference
sample of Moldavia, in the comparative analysis of the obtained results. One
of the first observations to be made is that the ample symptomatic
polymorphism of patient’s disease is suggestively illustrated in their
palmary dermatoglyphic picture by multiple abnormalities or distortions
(between 3 and 6 for each patient), with deep clinical implications. The
frequency of them exceeds by far that of the reference sample, being instead
much closer or even exceeding the values recorded in epilepsy, infantile
autism or serious ocular diseases. Present in both boys and girls and on both
hands of the affected ones, but especially on the left hands, these
distortions, as malformative stigma, suggest that, among the factors
responsible for causing the disease, one should not leave aside the genetic
or teratologic ones, which intervened in the first 3-5 months of intrauterine
life (during the final establishment the papillary ridges); the lesions of
central nervous system (CNS) produced in the last 4 months of pregnancy or in
the first two years of post-natal life as considered as releasing factors of
the clinical symptoms and of their amplification, as well. Conclusions. Among the factors responsible for the
production of sekelary IEP-es, an important role is played by the genetic or
teratological ones, known as intervening in the first 3-4 months of
intrauterine life. Also the CNS lesions that occurring in the last 4 months
of pregnancy and the first 2 years of post-natal life, act exclusively as
elements that release the malady’s symptoms and their amplification. Key
words: dermatoglyphics, sekelary infantile encephalopathyes, abnormalities or
distortions Ü FULL
TEXT.PDF Dermatoglyphics in insulin – dependent diabetes or
diabetes mellitus type 1 (T1DM) Ana Ţarcă, Elena Tuluc Abstract.
The aim of the present paper is the study of the dermatoglyphics
pathology on a lot of 133 subjects diagnosed with Diabetes Mellitus type 1
(58 men and 75 women) out of which 58 are children and teen-agers aged 4 and
18 years diagnosed with Diabetes Mellitus type 1 (T1DM) at the age 2 and 17
years. The other 75 are adults and old people aged are 24 and 79 years,
diagnosed with T1DM since they were between 22 and 76. T1DM can be primary
insulin dependent in 51.12% of the studied cases and the secondary insulin-dependent
in 48.88%. Material and methods.
We gathered a total of 266 digito-palmar prints (166 from the masculine
series and 150 from the feminine ones). Results
and discussion. We are entitled to say that both patients with a juvenile
debut in diabetes and those with a late release of the disease present –in
their digital dermatoglyphic picture- important distortions or anomalies with
serious medical implications, that reach percentages that bring them close to
those patients suffering from serious cardio-vascular diseases (CVD) and
ophtalmic diseases (OD) at the level of the whole sample, but are different
from the witness lot. These distortions, which are present to both the
masculine and the feminine series, in both hands of the affected people
(especially on the left ones), are the graphic expression of the intervention
of the diabetes genetic factor, and partially of the external triggers from
the uterus level in an early stage of prenatal life. Conclusions. The
environment factors from the prenatal life act in the post-natal period,
being responsible for the release and clinical manifestation of the proper
disease. The results we got, even if they are the first of this type in our
country, support the idea of using dermatoglyphics (a less costly and easier
to reproduce in any stage of post-natal life) as marker, together with metabolic, immunologic and genetic markers,
in predicting a potential diabetogen risk at the population level. Key
words: dermatoglyphics, insulin–dependent Diabetes Mellitus (T1DM),
distortions or anomalies Ü FULL
TEXT.PDF Methicillin
- resistant staphylococcus aureus
strains isolated from children in the community Sofia Constantiniu, Angela Romaniuc, Aurora Ambăruş, Roxana Alexandrescu,
Adriana Coşofreţ, Carmen Stanciu Abstract. Aim. The aim of this study was to estimate the proportion of the
MRSA strains in community by analysis of
the pharyngeal swabs from children with acute and chronic pharyngitis
assisted in medical ambulatory units. Material
and methods. A number of 128 S.aureus
strains isolated during the period of 2002-2004 from 1782 children were
tested concerning their susceptibility to oxacillin. All S.aureus strains with oxacillin inhibition zones diameter <13
mm were tested concerning the Minimal Inhibitory Concentrations (MICs) by
agar dilution method, recommended by National Committee for Clinical
Laboratory Standards (NCCLS). The strains with MICs ≥ 4 μg/ml to
oxacillin were considered methicillin -resistant Staphylococcus aureus (MRSA). Results. Among the 128 S.aureus
strains isolated from community, a number of 14 strains had a zone of
inhibition <13 mm diameter and 7 (5.4 %) strains had MICs ≥ 4 μg/ml,
being MRSA. Only one strain (3.1%) from a number of 32 strains isolated in
the year of 2002 was MRSA. From a number of 32 strains isolated in 2003, only
2 (6.2 %) were MRSA and from 62 strains isolated in the year of 2004, 4 (6.4
%) were MRSA. The MICs were ≥ 4 μg/ml for one strain, 8 μg/ml for 4
strains and 16 μg/ml for 2 strains. Conclusions.
A number of 7 strains of 128 S. aureus
strains were MRSA (5.4%). The community isolates which are generally
susceptible to multiple antibiotics are in contrast to the typical,
multiple-drug-resistant hospital MRSA ones. Although the percentage of the
community - MRSA strains in our area is low, our data pointed out their
presence in the community and underlined
the importance of MRSA strains from community as possible sources for
hospital infections. Key-words: S.
aureus, strains, methicillin-resistant, children, community Ü FULL
TEXT.PDF The association
of education and income with nutrition of pregnant and parturient women Victoria Papadopol, Elena Popa, Cristina Cîmpeanu,
Nicoleta Florescu, Otilia Damian Abstract. The aim
of this epidemiological prospective cohort study is the analysis of the
association of education and income with behavior related to nutrition of
pregnant and lactating women in Iaşi area. This study is part of a more
complex one which has investigated the nutrition of pregnant woman and
newborn in the context of many
determinant factors of their health. Material and methods. This study was performed in a group of 263
pregnant women in which we have analyzed how education and income influence
the behavior related to nutrition during pregnancy and postpartum. The
nutrition was investigated by a food consumption frequencies questionnaire
and 24 hour dietary recall data. The total energy intake was under the
recommended values, due to, at least partially, the reduced bread intake. Results. The study found out that the
high educational level and a good income were associated to a high intake of
proteins (meat, dairy, eggs), animal lipids and fruits. The low educational level and a low income
were associated to the high intake of
bread, potatoes, vegetal lipids and alcoholic beverages. Regardless the
education and income, we found out some unhealthy eating habits (like low
fish consumption, high coffee and sweets consumption) that make necessary the improvement of education for
health of all pregnant women, and generally of childbearing women, concerning
the proper nutrition during pregnancy. Conclusions. High educational
level and good income were associated with high intake of proteins (meat,
dairy, eggs), animal lipids, fruits and sweets. Low educational level and low
income were associated with high intake of bread, potatoes, vegetal lipids
and alcoholic beverages. Some unhealthy eating habits (like low fish
consumption, high coffee and sweet consumption) were not related to education
and income. Key words: nutrition, pregnancy, education,
income Ü FULL
TEXT.PDF The barium
meal examination versus endoscopy Doina Davidescu Abstract. The objectives of our study
were to evaluate two diagnostic methods (with and without x-ray) and to
investigate the efficacy of barium meal examination. Material and methods. We performed a clinical randomized study at 675 subjects (aged 4
month-18 years) from University Children Hospital Iaşi (the only
pediatric endoscopies department from North-East of Romania) and Students
Hospital Iaşi. The calculated indices of the diagnostic methods were the
sensitivity, specificity, efficiency, predictive values (PV+ and PV-) and
usefulness index (UI). Results.
The radiological examination had a UI above 0.35 only for esophageal
stricture but in this case the esophagogastroscopy is recommended as
diagnostically and as therapeutic procedure for dilatation of esophageal
stricture. The endoscopy had a UI above 0.35 for all diseases excepted
gastroesophageal reflux (GER) and esophageal diverticula’s. Conclusions. The barium meal
examination was requested in inappropriate situations such as: dyspepsia
(routinely), peptic ulcer (follow-up) and gastrointestinal bleeding. The
barium meal examination was repeated in 65.8% of cases. It is imperative to
disseminate the guidelines for doctors indicating clearly the clinical
context when these two diagnostic methods are to be recommended. Key words: clinical randomized study, barium meal, endoscopy,
efficacy Ü FULL
TEXT.PDF Lacunar stroke - antiplatelet and anticoagulant therapy
for secondary prevention Diana Hodorog, Felicia
Ştefanache Abstract.
Aim. To asses the
therapeutic strategy for secondary prevention in lacunar stroke, according to
the underlying mechanism of the cerebral infarct and to determine the
recurrence rate of ischemic stroke in patients with lacunar infarct. Lacunar stroke is a small cerebral infarct
in the territory of a single perforator artery. The mechanisms that underlie
lacunar infarct are various: small vessel disease, atherothrombotic, cardiac
and artery-to-artery embolism. Material and methods. The study was
performed in 1083 patients with lacunar stroke admitted in Ist
Clinic of Neurology, “Saint Trinity” Hospital, Iaşi, during 1.01.1999 -
30.12.2004. The most probable underlying mechanism for the lacunar stroke has
been established for each case. A certain therapeutic strategy has been
applied for secondary prevention. Results and discussion. 163 patients
with hypertension have a lacunar stroke due to small vessel disease and the
other 489 hypertensive patients had an atherothrombotic lacunar stroke. 219
patients had a probable cardioembolic lacunar stroke. In 94 patients the
lacunar stroke was probable due to an artery - to - artery embolism. Aspirin
250 mg was given immediately in 1029 patients and continued for 14 days before
changing the patient to a maintenance dose of 75 mg daily for secondary
prevention. Clopidogrel 75 mg/day was the option
in 54 patients. Anticoagulant therapy was used for selected cases of
cardioembolic lacunar stroke. 59 patients (5.5%) had a recurrent stroke. Conclusions.
The drugs used for acute treatment and for secondary prevention in lacunar
stroke must be similar to that used for any other types of ischemic stroke. A
high proportion of patients have a recurrent lacunar stroke. Key words: lacunar
stroke, anticoagulants, antiplatelet agents, secondary prevention Ü FULL
TEXT.PDF Daniela Constantinescu,
Carmen Cozmei, Laurette Graziella Cozma, Maria Ţepeluş, Andreea Chiriac, Carasievici
E Abstract. Aim. To asses the therapeutic strategy for secondary prevention
in lacunar stroke, according to the underlying mechanism of the cerebral
infarct and to determine the recurrence rate of ischemic stroke in patients
with lacunar infarct. Lacunar stroke
is a small cerebral infarct in the territory of a single perforator artery.
The mechanisms that underlie lacunar infarct are various: small vessel
disease, atherothrombotic, cardiac and artery-to-artery embolism. Material
and methods. The study was performed in 1083 patients with lacunar stroke
admitted in Ist Clinic of Neurology, “Saint Trinity” Hospital,
Iaşi, during 1.01.1999 - 30.12.2004. The most probable underlying
mechanism for the lacunar stroke has been established for each case. A
certain therapeutic strategy has been applied for secondary prevention. Results
and discussion. 163 patients with hypertension have a lacunar stroke due
to small vessel disease and the other 489 hypertensive patients had an
atherothrombotic lacunar stroke. 219 patients had a probable cardioembolic
lacunar stroke. In 94 patients the lacunar stroke was probable due to an
artery - to - artery embolism. Aspirin 250 mg was given immediately in 1029
patients and continued for 14 days before changing the patient to a maintenance
dose of 75 mg daily for secondary prevention. Clopidogrel 75 mg/day was the option in 54 patients. Anticoagulant therapy was
used for selected cases of cardioembolic lacunar stroke. 59 patients (5.5%)
had a recurrent stroke. Conclusions. The drugs used for acute
treatment and for secondary prevention in lacunar stroke must be similar to
that used for any other types of ischemic stroke. A high proportion of
patients have a recurrent lacunar stroke. Key words: lacunar
stroke, anticoagulants, antiplatelet agents, secondary prevention Ü FULL
TEXT.PDF Dental Health The effect of xylitol toothpaste on
the oral cavity environment Surdacka A, Stopa J Abstract: The aim of this work is the
clinical and laboratory evaluation of the influence of Polish toothpaste with
xylitol on the condition of mouth cavity. The evidences of the last few years
show that penitols, especially xylitol, are effective in the prevention of
dental decay. Material and
methods. The
tests were carried out on 34 students who were divided into 2 groups: A and B
with 17 students in each group. The initial clinical examination was carried
out after 2 and 4 months of brushing teeth with fluoride toothpaste with
xylitol (group A) and fluoride toothpaste without xylitol (group B). Clinical
examination related to the evaluation of the hygienic condition of the mouth,
plaque index (PLI) and hygiene index (HI), gingival index (GI), and gingival
bleeding index (GBI) and Decayed Missing Filled Teeth (DMF-t) and Decayed
Missing Filled Surfaces (DMF-s) was performed. Results and discussion. A number of 10 people from
each group underwent a test on saliva secretion focusing on the number of S. mutans
(SM) and L. acidophilus (LB). PH was marked, as well as the amount
of saliva and the level of fluoride in saliva. No significant differences in
the tested parameters were observed between the two groups. The results of
the tests after 2 and 4 months of using both toothpastes pointed out the
improvement of the hygienic condition of the mouth and gums. Conclusions. Tooth paste with xylitol had
influence on the decrease of the number of S. mutans in saliva, the
amount of secreted saliva and the increase of pH value. The use of toothpaste
with xylitol as well as without xylitol caused the increase of mean values of
fluoride in saliva. Xylitol added to the toothpastes has a positive influence
on the quality of the oral environment and, as a result, it would be
purposeful to introduce it into prophylactic programmes.
Key words: toothpaste, xylitol, fluoride,
saliva, S. mutans, L.acidophilus Ü FULL
TEXT.PDF Oral health – teachers behavior change – a major factor
of progress Dănilă I,
Evghenikos Adina, Petersen PE, Sălăvăstru C, Stan A Abstract. The aim of this longitudinal study is to put in evidence the changes
in attitudes and behaviors in oral health. Our recommendation is that a
healthy behavior is the main way in order to implement the objectives of the
WHO, as 75% from youth ought to have enough knowledge about etiology and
prevention in oral health in general. Material
and methods. Two lots were performed in 1993 and 2003: 322 mothers and 97
schoolteachers and 278 mothers and 197 schoolteachers, respectively. The main
tool was a questionnaire focused on the etiological factors of the dental
care and parodontopaties and treatment methods. The items were related to
qualitative data as parental support related to attitudes and information in
oral health area. We mention that in 1992 in Romanian children aged 12 years
the mean value of DMFT and DMFS was 4 and, 6, respectively (5). Results. The study shows a rising in
the subject knowledge and information in oral health area from 20-30% up to
40%. The observed information knowledge improvement from the year of 2003 is
statistical significant for factors which contribute in dental decay, gum
bleeding, healthy nutrition, daily dental brushing, TV information sources. Conclusion. Our study showed the
positive evolution of the teachers’ beliefs about the necessity of
schoolchildren education in oral health area. In the same time the quality
and quantity information in the studied subjects significantly arise in time. Key words: education, behavior, attitudes, oral health Ü FULL
TEXT.PDF Socioeconomic status and oral
health Teodora Timiş, Dănilă I Abstract. Inequalities in socioeconomic status
underlie many health disparities in the world, including oral health.
Occupational status, income and education are intrinsically related and often
serve as measure for each-other. In general, the population groups that
suffer the worst oral health status are also those that have the highest
poverty rates and the lowest education. Higher income enable people to afford
better housing and permit increased access to medical care. In the same time,
a high level of education increase the opportunity to engage in oral
health-promoting behaviors. On the other hand, differences in income and
employment of parents generate inequalities in oral health status of
children. All studies conducted in this field confirm the link between
socioeconomic status and oral health, which justifies the struggle to
identify the factors involved in generating and maintaining inequalities in
both general and oral health. Key
words: socioeconomic status, income, education level, oral health,
inequalities Ü FULL
TEXT.PDF Public Health Policy Why do we
need health impact assessment? Guliş G Abstract. Health impact assessment
is increasingly used in countries of European Union with aim to predict
future consequences of recent political investment and strategic decisions
and to tackle health determinants. The presented paper briefly describes the
methodology of health impact assessment and brings examples of use of health
impact assessment to improve decision-making during transition process. Public health systems and public health
workers shall take leadership role in introduction of health impact
assessment as a tool for truly inter-sectoral participation and partnership
based policy-making.
Keywords: determinants of health, health impact assessment,
public health, transition Ü FULL
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