Utilization of psychotropic medicines in Romania during 1998-2018.

Background: Mental disorders can have a significant impact on patients' life, including economic, social and individual consequences, and psychotropic medication is essential to treat these conditions. Psychotropic drug utilization studies contribute to a clearer picture of the management of these conditions. Data published from Romania on this topic is limited. The present study aims to characterize the utilization patterns of anxiolytics, antidepressants (ADs), and antipsychotics (APs) in Romania during 1998-2018. Methods: Drug utilization data were provided by Management Center for Documentation, Information and Marketing (CEGEDIM) Romania and quantitative data for each psychotropic medicine were converted to total defined daily doses (DDDs) and to DDD/1000inhabitants/day (DDD/TID). The total use of medicines in DDD/TID was computed in order to obtain the drug utilization 90% (DU90%) segment. Results: An increasing trend in total utilization of psychotropic medicines in Romania started in 2004. Anxiolytics use was predominant until 2013 and the yearly anxiolytic use over the entire study period remained between 10 and 15 DDD/TID. Diazepam lost popularity over time in detriment of the utilization of other anxiolytic benzodiazepines, such as alprazolam and lorazepam. ADs utilization markedly increased during the study period (the average annual growth rate was 13.66% starting 1999). Selective serotonin reuptake inhibitors (SSRIs) became present on the 2008 DU90% and was the dominant class of ADs, with sertraline being the most prescribed, followed by escitalopram and paroxetine. APs utilization showed an increasing trend from 2003 until 2018. Atypical APs became present on the 2008 DU90%, while typical APs were no longer included in the 2018 DU90%. Among atypical APs, olanzapine was the main agent prescribed, and starting 2010 was followed by quetiapine and risperidone. The uptake of APs long-acting formulations became more evident during the last analyzed years (2015-2018). Conclusion: We observed an increasing utilization of APs and a more prominent increase in ADs utilization in Romania during 1998-2018. The anxiolytic prescribing remained nearly stable during this time. Further research can bring more information on the various factors influencing psychotropic utilization in Romania.

Neuroenhancement in French and Romanian University Students, Motivations and Associated Factors.

This cross-sectional study aimed to determine the use of neuroenhancers, the motivations and factors associated with their use in French and Romanian university students. Students from two universities in France (Rouen and Opal Coast University) and one in Romania (Cluj-Napoca) were asked to complete a self-administered anonymous questionnaire, either online or on paper, about the use of three different categories of substance: Prescription drugs (methylphenidate, modafinil, and beta-blockers), drugs of abuse (alcohol, cannabis, cocaine, and amphetamines), and soft enhancers (coffee, vitamins, caffeine tablets, and energy drinks). In total, 1110 students were included: The users were 2.2% for prescription drugs, 4.3% for drugs of abuse, and 55.0% for soft enhancers. Students used neuroenhancement to stay awake for study (69.3%), to improve concentration (55.5%), to decrease stress (40.9%), and to improve memory (39.6%). Neuroenhancement was considered to meet expectations by 74.4% of users. The factors associated with the use of drugs of abuse were frequent binge drinking (Adjusted Odds Ratio-AOR: 6.49 [95% CI: 2.53-16.6]), smoking (AOR: 5.50 [95% CI: 2.98-10.14]), having a student job (AOR: 2.42 [95% CI 1.13-5.17]), and being male (AOR: 2.23 [95% CI:1.21-4.11]). No significant associations with eating disorders were detected for any of the three categories of substances. University students reported neuroenhancement with prescription drugs, drugs of abuse, and mainly soft enhancers. These substances were used mainly to increase the waking hours. Educational programs in universities seem to be required in order to increase student awareness of the problems caused by neuroenhancements, and to decrease the associated risks by changing students' attitudes and beliefs.

Estimated physical fitness and sociability: an interdisciplinary pilot study among French students.

BACKGROUND: The aim of this pilot study is to explore the main social factors influencing estimated physical fitness. METHODS: During the academic year of 2014/2015, 909 students from two French universities of the Hauts-de-France region completed a study including standardized anonymous self-reported questionnaires. Data were related to age, sex, social class, physical activity, social life and sociability. Physical fitness estimation was assessed through a validated VO2max questionnaire. RESULTS: A total of 749 17- to 24-year-old students were included. The mean age was 19.58. The sample was composed mainly of girls (59.68%). The mean estimated VO2max was 39.30±2.29 for males and 32.79±2.56 for girls. Some significant dependence and risk factors were found between estimated PF and some sociocultural aspects. CONCLUSIONS: Our study shows the importance of the socialization environment. The role, the age and the employment status of the parents are significant as they are a reference for the practice of sports and physical activities. The level of independence and sociability is strongly correlated to estimated physical fitness. These findings stress the need to develop a more holistic study, based on comprehensive and interdisciplinary approaches.

Ultrasonographic evaluation of the median nerve at the level of the carpal tunnel outlet and mid forearm in patients with type II Mucopolysaccharidosis.

AIMS: The ultrasonographic (US) evaluation of the median nerve at the level of the carpal tunnel outlet (CTO) and mid forearm in pediatric patients with mucopolysaccharidosis type II (MPS II) and comparison with healthy subjects. MATERIAL AND METHOD: Fifteen children with MPS II and 44 healthy children were included in the study and they were divided into three age groups. The cross-sectional area, the appearance of the nerve, and the ratio of the cross-sectional areas were evaluated by US. RESULTS: At the level of the CTO the mean area of the nerve was increased in all MPS II groups compared with the correspondent healthy age groups and the differences were statistically significant (p<0.01). At the level of the mid forearm the differences were statistically significant only for the first age group. Other US findings at the level of the CTO in the MPS II groups were represented by hypoechogenicity (86.67 % on the right and 93.33% on the left), thickened fascicles (80% bilaterally), irregular contour (53.33% bilaterally) and the presence of the Doppler signal including the nerve (26.67 % on the right and 33.33 % on the left). The CTO/mid forearm cross-sectional area ratio was higher in all MPS II age groups and the differences were statistically significant (p<0.001). CONCLUSION: In patients with MPS II there are significant US changes in the size and aspect of the median nerve.

G.I.S. Surveillance of Chronic Non-occupational Exposure to Heavy Metals as Oncogenic Risk.

INTRODUCTION: The potential oncogenic effect of some heavy metals in people occupationally and non-occupationally exposed to such heavy metals is already well demonstrated. This study seeks to clarify the potential role of these heavy metals in the living environment, in this case in non-occupational multifactorial aetiology of malignancies in the inhabitants of areas with increased prevalent environmental levels of heavy metals. METHODS: Using a multidisciplinary approach throughout a complex epidemiological study, we investigated the potential oncogenic role of non-occupational environmental exposure to some heavy metals [chrome (Cr), nickel (Ni), copper (Cu), zinc (Zn), cadmium (Cd), lead (Pb) and arsenic (As)-in soil, drinking water, and food, as significant components of the environment] in populations living in areas with different environmental levels (high vs. low) of the above-mentioned heavy metals. The exposures were evaluated by identifying the exposed populations, the critical elements of the ecosystems, and as according to the means of identifying the types of exposure. The results were interpreted both epidemiologically (causal inference, statistical significance, mathematical modelling) and by using a GIS approach, which enabled indirect surveillance of oncogenic risks in each population. RESULTS: The exposure to the investigated heavy metals provides significant risk factors of cancer in exposed populations, in both urban and rural areas [ χ2 test (p < 0.05)]. The GIS approach enables indirect surveillance of oncogenic risk in populations. CONCLUSIONS: The role of non-occupational environmental exposure to some heavy metals in daily life is among the more significant oncogenic risk factors in exposed populations. The statistically significant associations between environmental exposure to such heavy metals and frequency of neoplasia in exposed populations become obvious when demonstrated on maps using the GIS system. Environmental surveillance of heavy metals pollution using GIS should be identified as an important element of surveillance, early detection, and control of neoplastic risks in populations, at the level of a single locality, but even on a wider geographical scale.

HCV Infection Frequency and Trends Among Voluntary Blood Donors in Cluj County (Romania) Between 2006 and 2011.

BACKGROUND AND AIMS: In Europe a wide variation in HCV prevalence between countries was described, ranging from 0.1 to 6.0%, higher in Eastern Europe than in Western Europe, which may threaten the biological safety of donated blood. The HCV frequency among blood donors in Romania has has made the object of only very few published studies. The aim of this study was to analyze the frequency of anti-HCV antibodies in blood donors from Cluj County (Romania) and its trend, in the period 2006-2011. PATIENTS AND METHODS: Between 2006-2011 all donors, new and repeat donors were screened for hepatitis C virus infections using enzyme-linked immunosorbent assay (ELISA). Reactive results were confirmed using radioimmunoblotting assay (RIBA). The frequency and trends were analyzed using the T-test and X(2)-test. RESULTS: There were 95,181 donors tested in the blood transfusion centre (BTC) laboratories between 2006-2011. The overall prevalence was 0.254 % (95% CI 0.222-0.286). The prevalence rates of anti-HCV antibodies increased with age between both genders, being higher among women, starting to decrease after the age of 51. CONCLUSIONS: The results of this study demonstrate a high HCV prevalence in donations from 2006 to 2011, as compared to other countries in Europe, especially among first time blood donors, an infection that might be a potential threat to blood safety.

The seroprevalence of hepatitis C virus infection among blood donors from the North West region of Romania.

The infection with hepatitis C virus (HCV) known also as a blood-borne infection can be life-threatening by delayed consequences of persistent infection. This study aimed to estimate the hepatitis C infection prevalence, its epidemiological mode of manifestation and its recent evolution among blood donors from North West region of Romania. We made a chronological study using the HCV seropositive confirmed results to serological blood donors screening, provided by two Blood Transfusion Centres, chosen for their quality of provided data: Cluj and Satu Mare. The statistics were descriptive and the time series modelling used the polynomial regression. In both counties, about three fourth of donors were male and in Satu Mare, female donors (29.2%; p < 0.001) have been significantly more represented than in Cluj (24.6%). Hepatitis C virus seroprevalence was significantly (p < 0.01) higher in Satu Mare (279.8/10(5) donors, CI: 241.7-317.9/10(5) donors) than in Cluj (212.6/10(5) donors, CI: 187.4-237.8/10(5) donors). The mode of manifestation was endemic in different patterns, one with wave and a stable one with a particular high value of 1.091.1/10(5) female donors (CI: 674-1508.2/10(5) donors) seroprevalence, in 2008, in Satu Mare. The variation of the prevalence value was higher for women and particularly (coefficient of variation: 91.9%) for those from Satu Mare. The hepatitis C virus seroprevalence among blood donors reflected a stable, endemic manifestation with particular variation and high transmission in female populational subgroups.

[Clinical characteristics and lipid profile of patients with life-threatening cardiovascular diseases assisted in different hospitals of Cluj-Napoca]. / Caracteristici clinice si ale profilului lipidic la pacientii cu patologie cardio-vasculara grava asistati în unitati spitalicesti din Cluj-Napoca.

UNLABELLED: The knowledge about lipid profile particularities in patients with atheromatous cardiovascular diseases may have therapeutic and prophylactic implications. MATERIAL AND METHOD: Study included patients with acute myocardial infarction (IMA) and stroke (AVC), cared in Cluj-Napoca's hospitals. RESULTS: The patients with IMA were from urban area in 76% of cases, 72% were males and 58% had arterial hypertension to. Cholesterolemia over 240 mg% level had 11.9% of patients (17.2% female, 9.8% male with IMA), HDL-cholesterolemia less then 35 mg% had 33.4% of male patients and less then 45 mg%, 64.1% of female IMA patients. Patients with AVC were only male who provided in 59% of cases from urban area, had age average of 63 years old, and 82% of them had arterial hypertension to. The average levels for cholesterol were higher in AVC patients (218.6 mg% from urban area, 211.3 mg% from rural area), for triglycerides were higher in patients with IMA and AVC from urban area. High average level of HDL-cholesterolemia had patient with antecedent alcohol consuming (49.5 mg%), women with IMA (45.09 mg %) and in contrast the smokers had the lowers levels (38.37 mg%).

Rabies surveillance in the rural population of Cluj County, Romania.

INTRODUCTION: The rabies virus causes an acute encephalomyelitis that progresses to coma and death within 10 days of the onset of the disease. Taking into account the fatality of the disease and the absence of a specific treatment, preventive methods are of the outmost importance. The purpose of this study was to assess the exposure of the rural population from Cluj County, Romania, to rabies risk factors. METHODS: Data regarding the exposure of the rural population from Cluj County to rabies risk factors were collected from the Vaccination Center registry at the Infectious Diseases Teaching Hospital in Cluj-Napoca. The information was treated confidentially. The data obtained were collected using an Access 2000 database and was analyzed using Epi Info. Information regarding the general population was available from the 2002 General Population and Housing Census. RESULTS: Cluj County reported 1008 cases of human exposure to potentially rabid animals between April 1998 and December 2004. The relative contributions of the major groups of aggressor animals were as follows: 882 dogs (81.55%), 51 cats (5.06%), 30 foxes (2.98%), 28 horses (2.78%), 19 rats (1.89%), and 58 other animals (5.74%). Post-exposure prophylaxis with antirabies serum immune globulin was prescribed in 9% of the cases (n = 90). Vaccine was recommended in 72% of the cases (n = 726). Two hundred and eighty-three patients out of 726 (38.98%) underwent complete vaccine prophylaxis. Diagnoses in animals suspected of having rabies were made by direct immunofluorescent antibody staining of rabies viral antigen in brain material. The number of animals that tested positive for rabies during the period April 1998 to December 2004 was 49. More than 77% (n = 38) were wild animals. The relative contributions of the major groups of animals were as follows: 33 foxes (67.35%), 7 dogs (14.29%), 2 wolves (4.08%) and 7 other animals (14.29%). CONCLUSIONS: The fatal risk of rabies in human beings, and the persistence of the virus in this geographic area, makes legitimate the recommendation of prophylactic procedures for persons exposed to potentially rabid animals.

[Serologic assessment of measles herd immunity in the north-western region of Romania]. / Studiu serologic de evaluare a imunitatii populationale fata de rujeola în, zona de nord-vest a României.

The most objective analysis of measles herd immunity could be made by sero-epidemiological study. In the population of North-West area of Romania we have evaluated the measles immune protection through a seroprevalence study, using an age stratified sample of population in witch the subjects from Cluj and Bistrita-Nasaud counties were voluntarily involved. The measles antibody concentration was determined by immunoassay method using Hycor test. The database was performed in Microsoft Access and the statistics in Epi Info 2000. Levels higher then 40 arbitrary units (the cut-off of protection) of the measles antibody were met in 80% (IC95% : 75.09-84.01) of all subjects, 82.4% of the females and 84.9% of the urban area peoples. 98.3% of all subjects had detectable antibody levels. The protection increased by age: the adults had protective levels in at least 90% of cases. Global vaccine efficacy was 64.7% (IC95 % : 56.5 - 72.9), moderately decreasing with increasing age (the correlation coefficient--58.1%). In the assessed sample, the measles protection was the highest in adults, women and subjects from urban areas. The vaccine efficacy was relatively small, but the majority of subjects had detectable titers of measles antibody.

[Cost-benefit analysis of immunizations programs in north-west Romania]. / Analiza cost-beneficiu a unor programe de vaccinare populationala în zona de nord-vest a României.

Cost/benefit analysis could be an important approach in improving the decisional process in public health. We used the direct benefit/cost analysis and clinical cases of measles, acute hepatitis B, pertussis, and tetanus notified in North-West Romania to evaluate the results of immunization programs against such diseases. The numbers of potentially occurring cases of diphtheria were evaluated based on incidence data published in literature. The Excel under Windows 2000 software has been used to process the data. The benefit/cost rates of mass immunization programs were of 5.5 for measles, 9.5 for acute hepatitis B, 5.8 for pertussis, 71.1 for tetanus and 192.5 for diphtheria. The rate was low for measles because of the occurring outbreaks, for pertussis because of prevailing mild clinical cases, and for hepatitis B because only clinical cases were counted. The immunization programs against tetanus and diphtheria had the most relevant economic advantages.