Recognition of COVID-19 with occupational origin: a comparison between European countries.

OBJECTIVES: This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. METHODS: A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. RESULTS: The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. CONCLUSIONS: COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.

ROAD SAFETY KNOWLEDGE AND ATTITUDES AMONG DRIVERS.

Introduction: Road traffic injuries are a significant issue for society in the twenty-first century, but public health experts frequently ignore them despite the fact that massive and coor-dinated efforts are required for their effective and long-term prevention. Human factors and poor driving performance are the most significant contributors to car accidents globally, as shown by a series of studies exploring the causes of traffic road accidents. Since road safety is a key concern in developing countries, our research focuses on the car driver behavioral risk factors in the Republic of Moldova. Material and methods: A cross-sectional quantitative descriptive using a questionnaire was applied online via a Google form document among car drivers, between January-March 2022. Microsoft Excel was used for the statistical analyses. Results: The questionnaire was completed by 257 respondents above 18 years, of which 61.9% were female and 38.1% were male, mostly with a category B license (73.5%) and majority from urban area (87.5%). More than half (55.6%) mention that drove a car daily and 30% of them have a drive experience of more than ten years. Respondents express great concern (71.2%) about the issue of traffic accidents, and 76.3% think that unsafe roads are a key contributing factor. At least once being involved as a driver in road accidents where medical care was needed was mentioned by 2.7% of respondents. Conclusions: Educational programs and awareness campaigns about road safety among drivers and other vulnerable road users should be systematically organized.

Traumatic head injuries in Moldova: a cross-sectional analysis of medical registry data.

AIM: The aims of this study were to evaluate the demographics and crash profiles of road traffic-related traumatic brain injury (TBI) patients treated at two emergency departments in the Republic of Moldova, and to identify areas for prevention.

Emerging Treatments for Disorders of Consciousness in Paediatric Age.

The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0-4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.

A profile of traumatic brain injury within hospital emergency departments - a retrospective study in the Republic of Moldova.

Background: Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence, and outcome of TBI necessary. TBI is a major cause of mortality and morbidity in adolescents, young adults, and the elderly, one of the leading causes being road traffic accidents. Methods: A retrospective study was conducted among patients with TBI within 2 medical institutions from Chisinau municipality: Emergency Medicine Institute (EMI) and Valentin Ignatenco Municipal Children's Hospital (MCH). A questionnaire was applied, completed on the basis of medical records according to the International Classification of Diseases (ICD) 10 codes. The collection period was August, 1 - October 31, 2018. Data were uploaded using the existing electronic data collection tool - Red Cap and analyzed through Microsoft Excel. Data collection was performed by a resident neurosurgery and a scientific researcher. The ethics committee's approval has been obtained. Results: There have been identified 150 patients: 57 cases (38.5%) of TBI among children and 93 cases (61.5%) among adults aged between 18-73 years old. A large majority (62%) of head injuries were among patients from the urban area (most in adults - 60% and males - 74%). The most common mechanisms of head injury were falls (53.3%) and road traffic injuries (24%), followed by assault (14.7%) and struck by/or against (8%). The distributions by place of occurrence highlighted that most injuries occurred at home (33.4%) and transport area (25.3%). Most head injuries were registered among men 121(81.2%) with a predominance of minor Glasgow Coma Scale (GCS) (65.1%), followed by moderate GCS (9.4%), while in women all cases with GCS minor (18.8%). Conclusion: The data obtained could be useful for the hospital administration in managing the necessary resources and for conducting information campaigns among the high-risk groups.

Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries.

BACKGROUND: Low-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries. METHODS: A prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country. RESULTS: Among 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9-11) or severe injury (GCS 0-8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care. CONCLUSIONS: Implementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

A 3-Country Assessment of Traumatic Brain Injury Practices and Capacity.

BACKGROUND: The World Health Organization predicts a striking rise in the burden of traumatic brain injury (TBI) burden in the next decades. A disproportionately large increase is predicted in low- and middle-income countries, which have brain injury rates 3 times higher than high-income countries. The aim of this study was to identify current TBI practices and treatment capacity in 3 low- and middle-income countries: Republic of Armenia, Georgia, and Republic of Moldova. METHODS: After a national inventory of hospitals treating TBI, a situational analysis was conducted in the highest volume adult and pediatric hospital in each country. The situational analysis included key informant interviews with content analysis and a quantitative checklist of treatment resources. RESULTS: All 3 countries follow international, national, and hospital protocols for TBI treatment, and the in-hospital management of patients with TBI is similar to international standards in all 3 countries. Although health care specialists were well trained, however, lack of proper equipment, a scant number of hospitals outside the capital region, lack of specialized personnel in regional areas, and lack of rehabilitation services were mentioned as difficulties in interviews from all 3 countries. CONCLUSIONS: Particular gaps were found in pre-hospital and rehabilitative care, as well as national leadership and data collection. Surveillance and standardized data collection are important measures to fill treatment gaps and reduce the burden of TBI.

KEY INFORMANT INSIGHTS IN MOLDOVA'S PREVENTION AND RESPONSE SYSTEM FOR TRAUMATIC BRAIN INJURIES.

The purpose of the current study was to identify the existing practices and policies on TBI treatment and rehabilitation in the Republic of Moldova. METHODS: Qualitative face-to-face interviews were conducted with health care professionals from two major emergency hospitals in Chisinau Municipality in 2018. An interview guide was modeled according to a standard operation procedure with a set of concrete questions. RESULTS: Participants' underlines important issues in the health care management of TBI for different medical levels: pre-hospital care ambulance system and definitive care work, acute care focused on the existing frameworks for treatment and care of TBI patients in hospitals, rehabilitation care, treatment, prevention gaps, and country-level resources. The main gaps in the prevention and treatment of traumatic injuries were identified to be related to road accidents, alcohol-related injuries, home injuries, and long arriving times of ambulance, lack of medical equipment both at pre-hospital and acute care and low salaries of medical staff. CONCLUSION: Our results suggested the need for health promotion and health education campaigns, police interventions, state support, acquiring financial support and modern equipment.