Acceptability of Human Papilloma Virus Self-Sampling for Cervical Cancer Screening in a Cohort of Patients from Romania (Stage 2).

(1) Background: Low patient's adherence to conventional cervical cancer screening methods determined the need to take into consideration alternative approaches, and vaginal HPV self-sampling is one of them. We aimed to evaluate, using an online survey, the Romanian women's acceptability of vaginal HPV self-sampling. (2) Methods: A 13-questions online survey was distributed on three Facebook groups, and the results were summarized. (3) Results: Despite of good educational background, 10.8% (n = 60) of the respondents did not know what a Pap smear is, and 33% (n = 183) were not informed about the free national cervical cancer screening program. Multivariate analysis revealed an increased likelihood of vaginal self-sampling acceptance among respondents who did not know about Pap test (OR: 7.80; 95%CI: 1.062−57.431; p = 0.021), national cervical cancer screening program (OR: 1.96; 95%CI: 1.010−3.806; p = 0.02), HPV infection (OR: 7.35; 95%CI: 3.099−17.449; p< 0.001) or HPV test (OR: 1.67; 95%CI: 0.950−2.948; p = 0.03). Moreover, women who did not previously undergo a cervical cancer screening program were more likely to accept the new screening method (OR: 1.62; 95%CI: 0.878−3.015; p = 0.04). (4) Conclusions: Our results showed high acceptability rates of vaginal HPV self-sampling among participants.

Large ovarian tumors in adolescents, a systematic review of reported cases, diagnostic findings and surgical management.

The purpose of this study was to analyze the published cases regarding large ovarian masses in adolescents, in order to find useful clinical implications for the diagnosis and management of the condition. The methodology employed a systematic review of reported cases of large/giant ovarian tumor in adolescence. The main objective was to assess the imagery findings, histology of the tumor, and the type of surgery performed. Our study included 58 patients with the tumor diameters ranged between 11 and 42 cm, with a median value of 22.75 cm and a mean diameter of 24.66 ± 8.50 cm. The lesions were benign in 47 cases (81%), borderline in 2 cases (3.4%), and malign in 9 cases (15.6%). We found no statistically significant difference (p > 0.05) between the size of the tumors and the ovarian markers levels. At the same time, a statistically significant difference was identified (p=<0,001) between elevated levels of the serum markers and the malignant tumor type (OR = 12.45; CI95 = 2.55-94.77). The main types of surgery performed were cystectomy (35 cases), oophorectomy (4 cases), salpingo-oophorectomy (18 cases). Open laparotomy was performed in 46 cases on tumors with a median diameter of 25 ± 8.8 cm, while laparoscopy was done in 12 cases on tumors with a median diameter of 23.7 ± 7.6 cm. For optimal surgical management, it is advisable to assess first the imagery findings and tumor markers. Then, the laparoscopic approach should be considered as a feasible option, especially in cases where there are no predictive factors for a malign disease.

Cantrell syndrome in the first trimester of pregnancy: imagistic findings and literature review.

Pentalogy of Cantrell (POC) is a rare condition characterized by complete or partial expression of 5 types of congenital birth defects originating in (1) the lower sternum, (2) the anterior diaphragm, (3) the diaphragmatic pericardium, (4) the midline/ventral supraumbilical abdominal wall region, and (5) the heart. POC can be diagnosed antenatally by means of ultrasonography (US), the task being difficult if defects are minor. Advances in the field of US and the introduction of the first morphology trimester as state-of-the-art pregnancy monitoring, facilitate the early diagnosis of this condition. We performed a systematic review on 67 reported cases of POC diagnosed in the first trimester of pregnancy (published from January 1980 to July 2019). The aim of our systematic review was twofold: to assess the main US findings in the first trimester of pregnancy and to increase awareness of early diagnostic possibilities. Our study showed that POC can be diagnosed in the first trimesterof pregnancy based on key US findings such as the association between omphalocele and ectopia cordis. When these two anomalies are present, increased nuchal translucency can also be considered a marker of POC in the first trimester.

ASSESSMENT OF ADVERSE DRUG REACTIONS AS CARDIOVASCULAR RISK FACTORS.

UNLABELLED: A wide range of pharmaceutical substances can induce side-effects expressed as cardiovascular changes or events, adding to other risk factors or worsening preexisting cardiovascular diseases. AIM: Continuous study focused on iatrogenic conditions representing cardiovascular risk factors. METHODS: We developed a descriptive study of patients admitted to the Iasi Vth Internal Medicine and Geriatrics-Gerontology Clinic between 1998-2013, focusing on iatrogenic conditions representing cardiovascular risk factors. RESULTS: We have diagnosed 81 cases of drug-induced hypertension, and 43 patients with hypertensive crises; 72 cases of iatrogenic hyperglycemia; 36 cases of drug-induced hyperuricemia; 50 cases of drug-induced dyslipidemias; and 17 cases of iatrogenic obesity. These iatrogenic diseases were more common in women and the elderly. Twenty-eight patients have developed simultaneous adverse drug reactions induced by the same drug and manifest as different cardiovascular risk factors. CONCLUSIONS: Cardiovascular risk factors can be induced to a significant extent by chronic drug administration. Some medications (e.g., NSAIDs, corticoids, beta-blockers, diuretics, contraceptives) can act on the same patient by multiple pathogenic links. The adverse drug reactions can be cardiovascular risk factors that persist in time, or can be removed (by discontinuing the administration of the implicated drug). The highest importance of their acknowledgment relies on the possibility of their prevention through carefully balancing the benefits and the risk of each new medication.

Patterns of Road Traffic Accident in North-East Romania.

Romania is ranked first among mortality road traffic accidents in Europe. The aim of our study was to evaluate some statistical patterns of population group who unfortunately was admitted at an emergency hospital of Iasi, a large city in the North East of the country. Material and Methods: The study was performed on 1623 patients admitted in the Emergency Room ("Sf. Spiridon" Emergency Hospital of Iasi, Romania) suffering from road traffic accidents, during 2009 and 2013. Results: The prevalence of 19-45 age group cases represented more than 50% of all patients, with a high significance (p<0.05), and men were involved more frequently (69.69%) than women (30.31%); most of the patients were injured while driving an automobile; 6 PM was the "rush" hour (6.4%), Monday was the "black" week day (16.02% of total cases), September the "harvest" time (12.7%), and Summer the "hottest" season (48.49%). Conclusions: The "B plan" is imperative to be implemented in Romania, including better roads, better vehicles, better legislation, and better teens' education, in order to avoid road traffic accidents.

Using ArcGIS software in the pre-hospital emergency medical system.

AIM: To measure the accessibility to healtcare services in order to reveal their quality and to improve the overall coverage, continuity and other features. MATERIAL AND METHODS: We used the software ESRI Arc GIS 9.3, the Network Analyst function and data provided by Ambulance Service of Iasi (A.S.I.) with emergencies statistics for the first four months of 2012, processed by Microsoft Office Excel 2010. As examples, we chose "St. Maria" Children's Emergency Hospital and "St. Spiridon" Emergency Hospital. RESULTS: ArcGIS Network Analyst finds the best route to get from one location to another or a route that includes multiple locations. Each route is characterized by three stops. The starting point is always the office of Ambulance Service of Iasi (A.S.I.), a second stop at the case address and the third to the hospital unit chosen according to the patient's diagnosis and age. Spatial distribution of emergency cases for the first four months of 2012 in these two examples is one unequable, with higher concentrations in districts located in two areas of the city. CONCLUSIONS: The presented examples highlight the poor coverage of healthcare services for the population of Iasi, Romania, especially the South-West area and its vulnerability in situations of emergency. Implementing such a broad project would lead to more complex analyses that would improve the situation of pre-hospital emergency medical services, with final goal to deserve the population, improve the quality of healthcare and develop the interdisciplinary relationships.

Some observations on the optimization of pre-hospital emergency medical services from the city of Iasi, Romania.

UNLABELLED: In the lasi City, with a population of 825,100 inhabitants, the number of requests for ambulance service has increased steadily for the past 17 years. One of the determining factors could be the development of the primary health care prevention. MATERIAL AND METHODS: We take into study some factors which consider influencing the reorganization of emergency medical systems in the lasi City territory. RESULTS: According to the spatial analyzes, distribution of health units in lasi City is concentrated type, developing in the downtown area, where there is also a high accessibility to health care services. There are some areas with a high population density, have low accessibility to hospital units, due to the presence of spatial network railroad as a spatial barrier, limiting interaction with other areas of the city. CONCLUSIONS: The analysis of optimization concept of Medical Services in a city like lasi is about the challenge to understand the impact of the population health towards the development and organizing the territory, and, interrelated, how we can improve the population health by the best possible organization.

[Medical-social aspects of medical staff migration]. / Aspecte medico-sociale ale migratiei personalului medical.

The migration of the medical staff represents an increasingly worring reason for romanian health policy-makers. According to the Ministry of Health, in 2009 year, the human resources indicators pointed out 26.5 physicians/ 10,000 inhabitants (whereas the European Union average was 32.8) and 60.4 nurses and midwives (whereas the European Union average was 108.5). Between 2007-2010, over 9000 physicians requested professional certificates in order to practice abroad and the majority have left the country. This phenomenon is related to the Romania's entrance in European Union and it is supposed to continue in the coming years. The direct consequences of the migration of the medical staff consist of significant differences between the country's regions in the health workforce distribution, the most affected by the critical shortage of health service providers being the North-Eastern region, especially in rural area. In order to limit the migration phenomenon, the Ministry of Health elaborated some strategies and workforce policies on medium and long-term, but the results will be difficult to assess.

[Assessment of the association between occupational categories and cardiovascular diseases among inpatients of an occupational disease facility]. / Evaluarea gradului de asociere categorie profesionala--boli cardiovasculare la pacientii internati într-o clinica de boli profesionale.

UNLABELLED: The objective of this paper is to study the association occupation-cardiovascular diseases in a clinic of occupational diseases from Rehabilitation University Hospital, Iasi, Romania. MATERIAL AND METHODS: The survey represents a descriptive analysis of 2003-2007 data regarding the 1771 first admitted and new diagnosed patients. The association between occupation and cardiovascular diseases was assessed using odds ratio (point estimate and 95% confidence interval). RESULTS: A special attention must be paid for smoking reduction among miners (specific prevalence 67.86 per 100 patients) and for overweight in administrative staff (54.32 cases with body mass index >30 kg/m2 per 100 inpatients). The most significant and strong association between occupational status--cardiovascular diseases has been recorded in administrative staff (ischaemic heart--odds ratio = 12.47; hypertensive heart disease--odds ratio =2.49) and in civil engineering (ischaemic heart disease- odds ratio = 3.12; hypertensive heart disease--odds ratio = 1.81). CONCLUSIONS: Activities in cardiovascular disease prevention should focus on those occupational sectors where cardiovascular risks are most prevalent. Early diagnosis of cardiovascular diseases in connection with risk factors may prevent a premature death, affecting workforce, with medical and socio-economical consequences. Cooperation between general practitioner-occupational diseases specialist-cardiologist may improve the efficiency of prevention programs.

[Identification of cardiovascular risk factors in patients with occupational diseases]. / Identificarea factorilor de risc cardiovasculari la pacientii cu boli profesionale.

UNLABELLED: The objective of this paper is to study the hospitalized morbidity for cardiovascular diseases in connection with risk factors in a clinic of occupational diseases from Rehabilitation University Hospital, Iasi, Romania. MATERIAL AND METHODS: The survey represents a descriptive analysis of 2003-2007 data regarding the 1771 first admitted and new diagnosed inpatients. The association between risk factors and cardiovascular diseases was assessed using odds ratio (point estimate and 95% confidence interval). RESULTS: Blood hypertension has been diagnosed in 9.20 cases per 100 inpatients and ischemic heart disease in 1.98 cases per 100 inpatients. The prevalence increased with age for both diseases. One in five cases was smoker and had vascular family records. In blood hypertension the odds ratio revealed an increased risk with the exposure for following factors: male gender, smoker status, vascular family records, obesity assessed through body mass index > 30 kg/m2, age > 45 years in male, age > 55 years in female (p < 0.05). The ischemic heart disease was significant associated only with family records and age > 55 years in female. Most of these cases diagnosed in the occupational diseases clinic represent active workforce (47.96 +/- 8.82 years). CONCLUSION: Early diagnosis of cardiovascular diseases in connection with risk factors may prevent a premature death, affecting workforce, with medical and socio-economical consequences. Cooperation between general practitioner-occupational diseases specialist-cardiologist may improve the efficiency of prevention programs.

[Analysis of premature deaths in the Iasi district]. / Analiza deceselor premature din judetul Iasi.

UNLABELLED: Potential years of life lost (PYLL) represent an indicator of premature or untimely death and take into account the age at which deaths occur by giving greater weight to deaths at younger age and lower weight to death at older age. AIM: This study represents a descriptive analysis of PYLL in district of Iasi compared to country-wide level, during 2006 year. MATERIAL AND METHOD: Premature deaths have been assessed using following indicators: PYLL per 1000 population (male, female, total); male : female PYLL ratio; average PYLL per a premature death; average PYLL per death. Confidence interval CI95 has been used for an accurate comparison district of Iasi - Romania. RESULTS: The recorded number of PYLL was 67.65 per 1000 population at national level and 54.02 per 1000 population in district of Iasi (CI95 = 67.55-67.75). The average number of PYLL per a premature death was 18.21 in Iasi compared to 20.71 for Romania (CI95 = 19.75-21.66), whereas the average number of PYLL per death was 5.6 for both levels. The values of PYLL by gender pointed out 74.59 per 1000 male population and 33.99 per 1000 female population in district of Iasi. CONCLUSION: The analysis of the premature deaths in Iasi revealed a lower loss of potential life years compared to values reported at national level. PYLL were twice more frequent among male than women. The favourable findings in Iasi may be related to a decrease of infant mortality rate, with a significant contribution to PYLL values in this district.

[New social and economical issues in the assessment of Romanian population's health status]. / Aspecte socio-economice actuale in evaluarea stärii de sanatate a populatiei din România.

Health status is determined by a combination of biological, environmental (physical and socio-economic), behavioural/lifestyle and medical care factors. The social and economic factors include many influences over which an individual may have limited control, such as economic status or educational level. The most important measures of these factors are represented by: gross domestic product per capita, employment rate, unemployment rate, literacy rate, poverty line, and human development index. From this point of view, the following positive issues have been recorded in Romania: a low unemployment rate (6.1%) compared to European Union countries; a high literacy rate (97.3%), very close to the maximum of 100% reported by all developed countries; and a human development index of 0.805 (rank 60 in the international hierarchy), specific to a country with a high human development. Negative issues have been reported in case of the following indicators: the reported gross domestic product per capita expressed in PPP US$ was 8480, among the lowest in Europe, specific to a country with a medium income; population living with less than 2 US$ per day of 13% and living with less than 1 US$ per day 2.1%; the employment rate was 57.4%, but in female population only 51.3%, whereas in male population it was 63.9%.

[Perinatal mortality issues in Botosani County]. / Aspecte privind mortalitaea perinatala din judetul Botosani.

UNLABELLED: This paper describes the main features of perinatal mortality in Botosani County, during 2005 year. MATERIAL AND METHODS: A total number of 55 perinatal death files have been analysed and allowed establishing the following profile: 25-29 years old mother, married, secondary school graduate, performing domestic activities and hard-working in own household, with a poor socio-economical status, at first birth and a premature one, without previous health problems. RESULTS: Pregnancy monitoring has not been performed in 27.2% due to lack of addressability to medical services, whereas most frequent obstetrical diseases have been placenta (21.8%) and umbilical cord anomalies (10.9%). These findings may be related to a poor concern of women for own health and for their baby's health. CONCLUSION: Socio-economical status must be especially taken into account by general practitioners in pregnant women counselling in order to detect risk factors and avoid perinatal deaths.

[Soliciting a model of a child emergency care unit in road accidents in the year 2005]. / Model de solicitare al unei unitati primire urgente copii în cazul accidentelor rutiere in anul 2005.

This paper describes the specific model of burden due to child road traffic injuries upon the emergency care unit from a university paediatric hospital during 2005 year. A total number of 193 road trauma cases required emergency care to this hospital. Distribution by seasons pointed out the highest number in summer (31.1%) and comparing the observed repartition by seasons with an expected symmetrical repartition there have been obtained significant differences between seasons (p < 0.02). The regular number of cases was 1-2 daily. The burden of road trauma was unequal, more boys (58.5%) being injured than girls and children living in urban areas recorded similar rates of injuries with those from rural areas. The median age of injured children was nine years, approximately one third of cases being included in 5-9 years age group. The leading non-fatal injuries requiring emergency care as a result of road traffic collisions have been: multiple trauma--166, intracranial injury--128, fractured lower limbs--31, fractured upper limbs--20 cases. Approximately one third of these cases required admission in hospital for complex care, one third have been referred to another hospital (neurosurgery and maxillo-facial clinic) and one third have been discharged after 24 hours of hospitalized monitoring. In conclusion, more road traffic injuries arrived in the emergency care unit of the studied university paediatric hospital during summer without a specific distribution by weekdays, but with a higher probability of being a boy aged 5-9 years, presenting multiple trauma especially intracranial injury and requiring specialised hospital care.

[The dynamics of risk factors in traffic accidents in Iasi county]. / Dinamica factorilor de risc in accidentele rutiere din judetul Iasi.

Injuries caused by traffic accidents represent a major world public health problem, rather neglected up to now, but which can be efficiently dealt with on long term, thanks to joint efforts. The authors present the results of a descriptive study concerning the involvement of various factors in traffic accidents in the county of Iasi, in 2003. This paper highlights the fact that injuries caused by traffic accidents represent an important morbidity and mortality factor. The incidence was of 29.34 serious road traffic injuries for 100,000 inhabitants, as compared to the 30.61 recorded at the national level, whereas the mortality rate--6.9 deaths for 100,000 inhabitants, illustrates a positive situation, as compared to the 10.28 recorded at the national level (p < 0.01). The most frequent causes involved in traffic events were: pedestrians' carelessness, driving carelessness, inadequate speed, exceeding the legal speed limits, failing to give way, illegal passing. Due to the fact that traffic accidents are avoidable, descriptive epidemiology data may represent the starting point in taking preventive measures.

[Present consequences of road traffic accidents worldwide]. / Consecintele actuale ale accidentelor rutiere pe plan mondial.

The paper presents mortality, morbidity and socio-economical consequences of road traffic injuries in the world. WHO data show that during 2002 year there have been recorded 1.2 millions deaths and nearly 20 million injured or disabled people, as a result of road traffic crushes, most of them being reported by low and middle-income countries. According to WHO data for 2002, road traffic injuries accounted for 2.1% of all global deaths and ranked as the 11th leading cause of death. The economic impact of these injuries on individuals, families, communities and nations is enormous, costing countries between 1% and 2% of their gross national product.

[Mortality in a district hospital--an indicator for efficiency]. / Mortalitatea intr-un spital judetean--indicator de evaluare a eficientei.

The paper presents mortality in surgical units of a second referral hospital from Galati. During 2003 year there have been recorded 190 deaths, most of them being reported by neurosurgery department (132). Hospital mortality varied from 2.8 deaths per 100 inpatients in neurosurgery to 0 deaths in urology and obstetrics-gynecology department. The surgical procedure with the highest number of deaths has been craniotomy (133). The death risk during operation was very low for most of surgical procedures, medium in the first 24 hours and high after 48 hours.

Analysis of drug expenditure in medical departments from tertiary hospitals.

The aim of the study was to assess drug expenditure per hospital day in 37 departments of medical specialties from 12 tertiary hospitals of Iasi city in 2001 year. The upper limit for drug expenditure per hospital day was considered the average total cost per hospital day recommended by the Ministry of Health for each specialty. Departments with drug expenditure that exceeded the recommended total cost per hospital day have been separately analyzed from the point of view of performance indicators (average hospital stay, utilization and bed turnover rate). In conditions of an appropriate AHS (meaning less than the recommended value by Ministry of Health for each specialty) and utilization rate (with values within interval 300-365), drug expenditure depend exclusively on the modes of prescribing pharmaceuticals.

Assessment of some performance indicators of medical departments in tertiary hospitals.

The present study assesses the performance of 37 medical departments from 12 tertiary hospitals in Iasi town during year 2001 through the following indicators: average hospital stay, utilization rate and hospital bed turnover rate. The first indicator has been analyzed by comparing the values recorded in various medical departments with those recommended by the Ministry of Health for tertiary hospitals. The highest value was recorded in the nephrology department, with a ratio 2001 value/optimal value of 2.76. Long average hospital stay has been recorded in 14 of the 37 assessed departments (37.8%). During year 2001, the following utilization rates have been found: normal rates of 300-365 inpatient days per hospital bed in 14 departments, high rates (over 365 days) in 11 departments, and low rates (less than 300) in 12 departments. Bed turnover rate varied with department's specialty profile and length of hospital stay from 11 inpatients per hospital bed in the acute mental disorders department to 146 in C intensive care unit.

[Motivation for work based on needs--considerations from the health manager's viewpoint]. / Motivatia muncii determinata de nevoi. Consideratii din perspectiva managerului in sanatate.

Motivation represents the degree in which a persistent effort is focused to achieve a certain goal. Managers, including health managers, are especially interested about motivation, due to the direct relation with productivity. The paper presents two categories of motivations, extrinsic and intrinsic, from the point of view of individual's needs. This theory is known as Maslow's pyramid and shows that basic needs are on the first place in order of importance, followed by needs of safety, association and fulfillment. Satisfied needs cease to represent an effective motivation. Health managers must combine extrinsic and intrinsic motivations, in order to improve productivity.