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Editorial
Health service coverage and its evaluation
Elena
Lungu
Health service coverage is considered as a
concept expressing the extent of interaction between the service and the
people for whom it is intended. For the measurement of coverage, several
key stages are first identified, each of them involving the realization of
an important condition for providing the service: a coverage measure is
then defined for each stage, namely the ratio between the number of people
for whom the condition is met and the target population. Thus, a set of
these measures represents the interaction between the service and the
target population. In many countries high priority has been given to the
development of basic health services or primary health care.
Health service coverage depends on the
ability of a health service to interact with the people who should benefit
from it, for example: the ability to transform the intention to serve
people into a successful intervention for their health. This
transformation process involves a variety of factors, such as availability
of resources and manpower, distribution of facilities, supply logistics,
people attitudes towards healthcare, etc. It is quite impossible to
evaluate the process in its many details, but it is possible to observe
the number of people for whom the service has satisfied certain criteria
related to the intended health intervention and to compare that number
with the target population.
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Health
Patterns and Determinants
Multi-stage maximum variation sampling in health promotion programs’
evaluation
AncaVitcu, Elena Lungu,
Luminiţa Vitcu, Aurelia Marcu
Abstract. Aim.
The current paper presents an
effective sampling method accessible to health promotion programs’
evaluation fitted to get rich information about issues of central
importance to the purpose of the assessment. Method. The data
collection procedure is rooted in a maximum variation sampling. The sample
design is based on the principle of
maximum diversity, which is an extension of the statistical
principle of regression towards the mean based on which instead of
seeking representativeness through equal probability, it is sought by
including a broad range of extremes.
Results.
The desirable sample size
for our evaluation is 264
respondents. Based on this value we established the key dimensions of
diversity which enable us to set up the entire sampling procedure.
Conclusions. Maximum variation sampling allows that against scarcity
of data to achieve considerable
results which can be more representative than those gained through a
random sample.
Key words: health promotion, evaluation program, sampling design, sample
size, maximum variation principle
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Is poverty yet a problem in Romania?
Adriana Galan,
Aurelia Marcu
Abstract.
Aim. To analyze the level and trends of poverty indicators in relation with
health indicators in Romania during
1996 – 2003, and place of Romania among other EU countries. Method.
Instead of using one-dimensional poverty indicators, we preferred to
analyse composite indexes of wealth, combining the different dimensions of
poverty. Composite indexes used by United Nations Development Programme (UNDP)
to measure poverty, Human Development Index (HDI)
and Human Poverty Index (HPI – 2, for developed countries) were analysed
at European Union level (EU-27) for 2004.
A trend analysis for the same indicators was done for
Romania, covering the period
1996–2003, as well as correlations between HPI-2 and some relevant health
indicators. Few comparisons between Urban/Rural areas for Romania are also
included.
Results.
All EU-27 member states are included in “High human development” country
cluster, having a value of HDI above 0.8 in 2004.
The trend analysis of HDI for Romania
reveals a constant increasing tendency after 1999.
A slight decrease can be also noticed for HPI-2
values in Romania
after 1999. Remarkable differences between rural/urban areas are still
present after 17 years of transition in Romania, being even more prominent
for severe poverty rate. Infant mortality rate revealed a constant
decreasing trend after 1996, following a similar pattern for HPI-2.
An unexpected reverse correlation was obtained for the correlation
analysis of Tuberculosis (TB) incidence (both in general population and in
children under 15 years of age) with HPI-2. Conclusion.
If before 2004
Romania was classified as medium human development countries, after 2004
Romania belongs to the cluster of high human development countries
(with a HDI value of
over 0.800). Nevertheless,
Romania ranks last according
to HDI between EU-27 member states. Yet existing
poverty in Romania is one of the major factors contributing to the
unsatisfactory population health status.
Sustained efforts are requested to develop and implement effective poverty
reduction policies in
Romania.
Key words: poverty, Human Development Index,
Human Poverty Index, health status,
Romania
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A brief analysis of noncommunicable diseases
in Romania, 1996-2004
Luminiţa
Vitcu, Anca-Gabriela Vitcu, Aurelia Marcu, Alexandra Cucu
Abstract. Aim.
The current paper presents a
brief method focused on the identification of noncommunicable diseases (NCDs)
with unfavourable evolution which need target interventions policies for
diminishing the deterioration of populations’ health. Method. A
valid supervises of health needs involve at least the description of two
major components: disease and death. The method proposed is based on the
calculus of percentage change in the rate of standardised mortality for
age group 0-64 years and in the rate of discharge from hospital for NCDs
which are important causes of premature death. In the same time it
is presented a simple mathematical model from time series analysis. The
methodology is applied in EU and recommended by WHO. Results. In
this paper the analysis is applied for Romania by comparing the main
outcomes with the corresponding EU results. For both cases the chronic
diseases with a sharply evolution were identified and for Romania an
expected development of standardised premature mortality rate after 2004
and the percentage change in health over 2004-2009 estimated with 95%
confidence were also proposed. Conclusions. The growth in the rate
of hospital discharges during 1996-2004 shows in an indirect way the
unfavourable evolution of a special group of diseases. The calculation of
percentage change is complementary to the classical calculus of rate and
brings about value-added pointing at the explosive evolution of some major
diseases. The method is a useful tool for the elaboration of strategies on
prevention of NCDs and a map for an optimal resource management (health
units, staff, budget) according to their trend.
Key words: noncomunicable
diseases, premature mortality, standardised death rate per 100000,
hospital discharges, percentage change, trend analysis
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Meningococcal disease in the North – East
region of Romania
Angela Romaniuc, Anca Nistor,
Michaela Scripcaru, Dana Zagnat
Abstract.
The meningococcal disease represents a priority in epidemiological
surveillance; mortality remains high – 10.39 %000 as well as neurological
complications are severe. Since 2006 it had been benefiting by a
methodology of surveillance at the national level. Objective. The
knowledge of the evolutionary specific features of meningococcal disease
after the introduction of the standardized surveillance for optimization
of control strategies. Material and methods. A descriptive study
using regional database (EPIDATA) containing meningococcal disease cases
reported between 2002 and 2006. The processing and analyzing data was
achieved with EPI INFO and Health Mapper programmes. Results. The
average of incidence rate in the North-East region of Romania, in last 25
years, was equal to 3.4 per 100,000 populations with two epidemical
increases: one between 1985 and 1987 – 16.2%000 (in years 1986) and
another between 1998 and 1999 – 3.1%000. In the last years (2002- 2006)
the average of incidence rate decreased at 1.35%000. The highest incidence
rates were observed in the <5 years age group (12.56%000) followed by the
5-9 years age group and 10-14 years age group. The average of mortality
was 0.17 %000 with a case fatality ratio equal to 11.9 %.The highest case
fatality ratio was observed in the 0-5 years age group (15.28%)
(IC95%:10.08-21.86). The epidemiological indicators of meningococcal
disease surveillance evidenced low precocious detection (30.5 %) with the
reporting in time of the cases at the Authority of Public Health.
Conclusions. The meningococcal disease is a priority because of its
severity. There are necessary efforts for early detection, reporting in
time, optimization of the criterias for confirmation and the introduction
of definition of surveillance for invasive meningococcal disease.
Key words:
meningococcal disease, epidemiology, standards of surveillance
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Seasonal mortality in
Romania (Part
I – general methodology)
Anca Vitcu, Luminiţa
Vitcu, Elena Lungu, Carmen
Ispas
Abstract. Aim.
The aim of the present study
is to examine the form and
relationship between total mortality/morbidity and temperature variations
within the cities of Romania during a 2004-2007 as well as to assess the
magnitude of this association.
Method.
The epidemiological evaluation of the
dynamic relationship between environmental temperature and health is
undertaken using both simple analysis and ARIMA models. In this article we
present methodologies appropriate for the available data in Romania.
Results.
A statistically significant
association is expected to be found between temperature and
mortality/morbidity.
Conclusions.
Research on the association between
temperature and mortality/morbidity has relevance to the formulation of
health policy serving at-risk populations.
Key words: climate change, extreme temperature, excess mortality,
morbidity, ARIMA models
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Dermatoglyphics in juvenile delinquence
Ana Ţarcă
Abstract. Aim.
The author develops complete digital
dermatoglyphic investigations, on the basis of a pathological perspective,
on a group of delinquents from Moldova (North-East part of Romania).
Materials and methods. The study was performed on a group of 105
teen-agers and young delinquents with ages between 16 and 26 years,
imprisoned in the Penitentiary of Iaşi, coming from different districts
(the district of Iaşi, especially) of Moldova. Results. The main
observation to be made is that the large range of blamable actions
committed by the delinquents, from robbery up to crime, is correlated with
the presence – in their fingerprints – of some important malformative
sketches (distortions or anomalies) bearing deep pathological
significance. At the level of the whole sample, the frequency they
record differs sensibly from that of the reference group of Moldova, being
nevertheless situated between the values found out by the author in other
severe brain disorders, such as autism, IEP and epilepsy. Conclusion.
All these observations demonstrate that such anomalies had been formed as
early as the pre-natal period, when the papillary ridges are also finished
up, under the action of some hereditary or teratogeneous factors, while
bursting of an aggressive behaviour from the part of their carriers occurs
in post-natal periods, at different ages, earlier or later (in the case
under study: at juvenile ages), as a function of the severity of the
disorders having occurred at brain level in the prenatal period and,
equally, as a function of multiple external circumstantial (social,
family) factors which they have to face. Most of the digital distortions
here under analysis had been also evidenced on other European groups of
delinquents, with the exception of two, namely: the extremely high ratio
of the raketoid-type loops – on fingers IV and V, especially – and that of
the bilateral and individual monomorphism, anomalies representing the
personal contribution brought by the author to the list of digital
dermatoglyphic indicators, for a precocious tracing of the persons risking
commitment of severe offences, at least at the level of Moldova, the
region from which the investigated subjects come.
Key words: digital dermatoglyphics, distortions or anomalies, pathology,
juvenile delinquency
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Felicia Gradinariu, Al.
Maftei, Doina Popa
Abstract:
This study investigates the possible
protective effect of dietary supplements and their efficacy in rat
experimental 6 months intoxication with 2,4-dichloro-phenoxyacetic acid
herbicide (2,4-D). The protecting tested agents were: metaspar (M),
a drug containing methionine, aspartic acid, B1, B6 and PP vitamins and
eurovita (E),.a mix of multiminerals and multivitamins. All tested
substances were administered in food, twice a week, dissolved in sunflower
oil. Animals 10/group were fed respectively with: standard food (control),
equivalent vehicle (vehicle control), toxic (2,4-D), metaspar
protected group (2,4-D+M) and eurovita protected group (2,4-D+E).
After 6 months they were sacrificed, blood and liver were analyzed with
standard methods and commercial kits for total and reduced glutathione,
erythrocyte superoxide dismutase (SOD) activity and serum thiobarbiuric
acid reactive substances (TBARS) (lipoperoxides). The results showed the
enhancement of antioxidant defense in protected groups, without clear-cut
differences between the two tested compounds.
Key words:
2,4-dichlorophenoxyacetic acid, protection, amino acid, lipid peroxidation,
herbicide
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Natural radionuclides in some Romanian medicinal mineral water
Elena Botezatu, Olga Iacob, Andreea Grigorescu
Abstract.
Aim. There are many natural springs and drilled wells in the
north-eastern of Romania, which produce waters enriched in minerals and
are used as medicinal waters. For this reason, we were interested in
finding out the extent to which these waters can be a natural radiation
source. This survey aimed at assessing the radioactive content of these
waters and their contribution to the population exposure. Materials and
methods. The mineral water springs clustered in northeastern Romania
and their uses for medicinal aims have been inventoried. Between 1999 and
2005, mineral water samples were collected several times over this period
at locations of mineral water in the Slanic Moldova (Bacău district) and
Vatra Dornei (Suceava district) spa resorts. Also, some communal springs,
which are open to public and frequently used as medicinal drinking water
without any sanitary certificate in the same districts, were studied. All
samples (800) were analysed for gross alpha and beta radioactivity and the
natural radioelements of utmost interest (natural uranium and thorium,
radium-226 and potassium-40). Results and discussion. The natural
radioactivity varies over a large range (up two orders of magnitude). The
activity concentrations in water samples were found to be over the
detection limit, with values ranging from 1.5 to 74 mBq/l, from 1.5 to 25
mBq/l and from 17 to 1780 mBq/l for 226Ra, 238U and
40K, respectively. It can be seen a similar situation in both
districts that is the low concentration of 232Th (0.4 - 2.5 mBq/l).
The average concentrations of radium-226 were three times higher in water
from Bacău district, but the uranium-238 activity was twice lower than
that in Suceava district. The geometric means values for radium-226 were
of 22.6 mBq/l and 5.7 mBq/l in Bacău and Suceava district, while, those
for uranium-238 were 6.2 mBq/l and 9.6 mBq/l, respectively, for the same
districts. The estimated effective doses received by individuals
undergoing mineral water drinking cure are of 0.06 – 0.65
mSv
and through inhalation are of 0.05 up to 0.4
mSv.
The individual effective dose rates in external cure treatment are very
small, respectively, (1.3 – 3.5) x 10-4mSv
by immersion and (0.2 – 4.4) x 10-8mSv
by washing. Conclusions. An hypotetical person that undergoes a
cure of mineral water by ingestion, inhalation and immersion is receiving
an average supplementary dose of only 0.3 μSv over background radiation of
2,450 µSv·y-1 due to all natural radiation sources in Moldavia
(northeastern
of Romania). The contribution of mineral water used in therapeutic
purposes to the natural irradiation of population is very slight, almost
insignificant.
Key
words: mineral water, springs, medicinal water, internal and external
cure treatment,
natural
radioactivity, gross alpha and beta radioactivity, specific activities of
natural uranium, natural thorium, radium-226, potassium-40, effective
doses
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Evolution of the main growth and development parameters in teenagers from
the Chisinau district (Republic of Moldova), versus the evolution
of teenagers from the districts of Bacau, Neamt, Suceava and Timis
(Romania)
Angela Simalcsik,
Robert-Daniel Simalcsik
Abstract.
The study analyzes the evolution of the main growing and development
parameters (stature and weight), along the 10-16 years interval of age, in
the teenagers of the Chişinău district (Republic of Moldova),
comparatively with the teenagers of the same chronological ages from the
Bacău, Neamţ, Suceava and Timiş (Romania) districts. In the pre-pubertal
stage (10-13 years), both the girls and the boys from the Chisinau city
evidence average values of stature and weight higher than the other groups
while, in the post-pubertal period, the situation
is wholly reversed, the series under study appearing inferior in both it
stature and weight, comparatively with the other 4 series (the cities of
Bacău, Piatra Neamţ, Suceava and Timişoara). In the rural medium, as to
stature, the situation is similar with that of the girls from the urban
group, while, in the case of boys, a clear-cut superiority is evidenced in
the villages of the Chişinău district, over the whole interval under
study, versus their colleagues from the other series. Referring to
bodily weight, over the 10-16 years interval, the teenagers (both boys and
girls) from the rural area of Chişinău evidence higher average values than
their colleagues from the comparative groups, the differences recorded
being significant for all classes of age.
Key words: growth,
development, teenagers, stature, weight
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Compensation issues in case of occupational diseases and accidents
Laura Grădinariu
Abstract:
This study investigates the possible
protective effect of dietary supplements and their efficacy in rat
experimental 6 months intoxication with 2,4-dichloro-phenoxyacetic acid
herbicide (2,4-D). The protecting tested agents were: metaspar (M),
a drug containing methionine, aspartic acid, B1, B6 and PP vitamins and
eurovita (E),.a mix of multiminerals and multivitamins. All tested
substances were administered in food, twice a week, dissolved in sunflower
oil. Animals 10/group were fed respectively with: standard food (control),
equivalent vehicle (vehicle control), toxic (2,4-D), metaspar
protected group (2,4-D+M) and eurovita protected group (2,4-D+E).
After 6 months they were sacrificed, blood and liver were analyzed with
standard methods and commercial kits for total and reduced glutathione,
erythrocyte superoxide dismutase (SOD) activity and serum thiobarbiuric
acid reactive substances (TBARS) (lipoperoxides). The results showed the
enhancement of antioxidant defense in protected groups, without clear-cut
differences between the two tested compounds.
Key words:
2,4-dichlorophenoxyacetic acid, protection, amino acid, lipid peroxidation,
herbicide
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Activities concerning non-ionizing electromagnetic radiation protection at
the Institute of Public Health of Iasi
Cristian
Goiceanu, Răzvan Dănulescu
Abstract.
During last decades, at international and EU level, the issue of health
protection against non-ionizing electromagnetic radiation has shown an
increasing interest. World Health Organization initiated projects on
effects of exposure to electromagnetic fields and to ultraviolet
radiation. The International Commission on Non-Ionizing Radiation
Protection elaborated guidelines on limiting exposure to non-ionizing
radiation. EU adopted Directives and Recommendations to limit human
exposure to this kind of radiation. In Romania, before 1990, the issue of
health protection against non-ionizing radiation focused on ultraviolet,
infrared and lasers radiation. The first standard for occupational
exposure to electromagnetic fields was adopted in 1996 and later, in 2002,
regulations on general public exposure were adopted. At the Institute of
Public Health of Iaşi, the topic of non-ionizing electromagnetic radiation
protection has been addressed since 1992. In 1997, the Romanian Working
group on Non-Ionizing electromagnetic Radiation Protection was founded in
Iasi, based on a core from the Institute of Public Health of Iaşi. During
last 15 years, our team has carried out many activities in this field:
drafting exposure standards, calculation of exposure limits, determination
of electromagnetic field levels, elaboration of procedures and
methodologies for electromagnetic field measurement. A “Practical guide
for electromagnetic field measurement at workplaces” was published in
2006. Moreover, our consultancy services on human exposure to
electromagnetic fields are provided for various levels of society. Our
team is also carrying out scientific research activities in this domain
like epidemiological studies concerning health consequences of
occupational exposure to electromagnetic fields. Moreover, experimental
studies on animals exposed to electromagnetic fields have also been
carried out. Scientists from our team have got involved in national and
international research projects and, also, in EU Networking Projects such
as EMF-NET Project and COST.
Key
words: non-ionizing electromagnetic radiation, human exposure, health
protection
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Evaluation of attitudes regarding contraceptive methods
Muntianu
Alexandru Emilia
Abstract. Aim.
The aim of the study was to identify the degrees of contraceptive methods
evaluation, as well as their implications. Method. There was used a
questionnaire that was applied to women who appealed to family planning
and gynaecologic offices from Iaşi. Results. It were investigated
100 women within family planning office, especially from age groups 25 –
29 and 30 – 34 years (respectively 26%) and 100 women, within gynaecologic
office, by age 25 – 29 (33%) and 35 – 39 years (26%). The debut of using
contraceptives methods was predominant on age groups 20 – 24 years (26%
vs 52%) and under 20 years (24% vs 12%). In the first group
women with secondary studies were more numerous (68% vs 40%), and
in the second one, those with superior studies (22% vs 59%). The
most known modern contraceptive methods in both types of offices were:
condoms (67% vs 57%); pills (63% vs 56%); cervical cap
(55% vs 46%) etc. and as those traditional, coitus interruptus
(28% vs 22%); calendar method (45% vs 36%) etc. Up to the
interview, most of women did not use any contraceptive method (39% vs
54%). Among family planning services to who women appealed before, family
planning offices were 35% vs 21% and gynaecologic ones 34% vs
60%. Women declared as information sources: physician (44% vs 61%),
mass-media (36% vs 46%), and supplying sources: pharmacy (39% vs
60%), family doctor office/health unit (20% vs 11%) and declared as
unknown 33%. Conclusions. At
the two types of offices appealed especially young women (25 – 39 years
old). Age of debut of using contraceptive methods using, it proved to be
more and more younger (average age for the first group being 16,51 years
and for the second, 18,2 years.). More younger women use contraceptive
methods (average age of debut being for the first group 16.51 years and
for the second, 18.2 years).
Key words: family planning office, gynaecologic office, contraceptive
methods
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Tendencies
of nitrates acute intoxication in newborn of Bacău county
during 2000 - 2005
Mihaela Popescu
Abstracts.
Aim. The methemoglobinemy annual monitoring within the National
Community Health Program represented the support of the descriptive
epidemiologic study of the medical cases in Bacău county, in 2000-2005
period, compared to former periods of time and to other territories in
North-Eastern of Romania. Material and methods. On a decreased
incidence background in the Romanian Eastern part of the territory, Bacău
county maintains an incidence level of 2.0-5.3‰, with a slightly increased
(and sometimes constant) tendency in the region. The total of 161 cases
registered in Bacău county, in 2000 – 2005
period, represented 19.1% of the cases in North-Eastern region. Results.
With descriptive aspects regularly met in cases of methemoglobinemy
regarding gender, age, child’s nutrition, over half of them were produced
due to exposure to nitrates quantity in water over 101 mg/dm determined by
inadequate hygienic conditions of the fountains. Conclusions. The
territorial distribution of the cases outlines the areas by risk of the
county, indicating, at the same time, the measures of the primary
prophylaxis that must be taken.
Key words:
child methemoglobinemy, water quality in the rural environment,
descriptive epidemiologic study
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Dental
Health
Considerations regarding early childhood caries
Marinela
Păsăreanu
Early childhood caries (ECC) is a recent
term that describes rampant dental caries in infants.
Terms describing this affliction have
evolved during the last 20 years, and include names like nursing caries,
nursing bottle caries and baby bottle caries (1).
Redefined as ECC, this affliction involves
the presence of one or more decayed tooth surfaces (cavitary or non-cavitary
lesions) and, or missing teeth due to caries or restorations of any
deciduous teeth in children between 3-4 years of age or before 72 months.
The presence of any sign of cavity in
children younger than 3 years old indicates severe ECC, S-ECC is also
defined as “atypical”, “progressive” acute rampant. In children between 3
and 5 years old the presence of one or more cavities, missing teeth due to
cavities, the presence of fillings in the maxillary anterior teeth > 1=4
(for 3 years old), >1=5 (for 4 years old), >1=6 (for 5 years old) are
signs of S-ECC (2).
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Abstracts "THE
FIFTH ROMANIAN-GERMAN SYMPOSIUM ON OCCUPATIONAL MEDICINE"
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