A prospective study of Romanian agriculture workers for zoonotic influenza infections.

BACKGROUND: In this prospective study we sought to examine seroepidemiological evidence for acute zoonotic influenza virus infection among Romanian agricultural workers. METHODS: Sera were drawn upon enrollment (2009) and again at 12 and 24 months from 312 adult agriculture workers and 51 age-group matched controls. Participants were contacted monthly for 24 months and queried regarding episodes of acute influenza-like illnesses (ILI). Cohort members meeting ILI criteria permitted respiratory swab collections as well as acute and convalescent serum collection. Serologic assays were performed against 9 avian, 3 swine, and 3 human influenza viruses. RESULTS: During the two-year follow-up, a total of 23 ILI events were reported. Two subjects' specimens were identified as influenza A by rRT-PCR. During the follow-up period, three individuals experienced elevated microneutralization antibody titers ≥1∶80 against three (one each) avian influenza viruses: A/Teal/Hong Kong/w312/97(H6N1), A/Hong Kong/1073/1999(H9N2), or A/Duck/Alberta/60/1976(H12N5). However, none of these participants met the criteria for poultry exposure. A number of subjects demonstrated four-fold increases over time in hemagglutination inhibition (HI) assay titers for at least one of the three swine influenza viruses (SIVs); however, it seems likely that two of these three responses were due to cross-reacting antibody against human influenza. Only elevated antibody titers against A/Swine/Flanders/1/1998(H3N2) lacked evidence for such confounding. In examining risk factors for elevated antibody against this SIV with multiple logistic regression, swine exposure (adjusted OR = 1.8, 95% CI 1.1-2.8) and tobacco use (adjusted OR = 1.8; 95% CI 1.1-2.9) were important predictors. CONCLUSIONS: While Romania has recently experienced multiple incursions of highly pathogenic avian influenza among domestic poultry, this cohort of Romanian agriculture workers had sparse evidence of avian influenza virus infections. In contrast, there was evidence, especially among the swine exposed participants, of infections with human and one swine H3N2 influenza virus.

Assessing health literacy in rural settings: a pilot study in rural areas of Cluj County, Romania.

Health literacy improves knowledge and builds skills to help individuals make appropriate decisions regarding their health. Over the past 20 years, several studies have described associations between health literacy and health outcomes. With respect to Romania, evidence is scarce on the level of health literacy, as well as on its determinants. Thus, the objectives of this study were to briefly screen functional health literacy levels in a sample of rural inhabitants, to assess the relationship between health literacy and reported health status, as well as to explore health literacy determinants within this population. Data were collected between September-November 2010, in four villages in Cluj County, Romania, using a cross-sectional survey. The mean age of respondents in the sample was 56 years, with roughly half of respondents being retired. The brief screening of health literacy suggested inadequate to marginal levels within the sample. Significant associations were observed between health literacy score and education, and self-perceived health status, whereas the relationship between health literacy and gender, and the presence of a chronic disease was not statistically significant. Limited health literacy has been shown to be common in people who rated their health as poor, those who attended only middle school, and individuals lacking basic information about their body. In order to minimize the adverse effects of low health literacy on health and health outcomes, efforts should be invested in identifying and addressing the health needs of adults with low and marginal health literacy, especially in underserved areas such as rural and remote settings, where access to health-related information is limited.

Serological evidence for avian H9N2 influenza virus infections among Romanian agriculture workers.

In recent years, wild birds have introduced multiple highly pathogenic avian influenza (HPAI) H5N1 virus infections in Romanian poultry. In 2005 HPAI infections were widespread among domestic poultry and anecdotal reports suggested domestic pigs may also have been exposed. We sought to examine evidence for zoonotic influenza infections among Romanian agriculture workers. Between 2009 and 2010, 363 adult participants were enrolled in a cross-sectional, seroepidemiological study. Confined animal feeding operation (CAFO) swine workers in Tulcea and small, traditional backyard farmers in Cluj-Napoca were enrolled, as well as a non-animal exposed control group from Cluj-Napoca. Enrollment sera were examined for serological evidence of previous infection with 9 avian and 3 human influenza virus strains. Serologic assays showed no evidence of previous infection with 7 low pathogenic avian influenza viruses or with HPAI H5N1. However, 33 participants (9.1%) had elevated microneutralization antibody titers against avian-like A/Hong Kong/1073/1999(H9N2), 5 with titers ≥ 1:80 whom all reported exposure to poultry. Moderate poultry exposure was significantly associated with elevated titers after controlling for the subjects' age (adjusted OR = 3.6; 95% CI, 1.1-12.1). There was no evidence that previous infection with human H3N2 or H2N2 viruses were confounding the H9N2 seroreactivity. These data suggest that H9N2 virus may have circulated in Romanian poultry and occasionally infected man.

Epidemiology of assault and self-harm injuries treated in a large Romanian Emergency Department.

OBJECTIVES: Intentional injury, including interpersonal violence and self-harm, is one of the world's leading causes of preventable injury. In Europe alone, nearly 1.5 million individuals receive medical treatment each year for a violence-related injury. We examined violent injuries treated in the largest Emergency Department (ED) in Tîrgu Mures County, Romania, with a catchment area of approximately 580 000 residents to describe the epidemiology of assault and self-harm injuries. METHODS: Data were collected as part of the European Injury Database project, from a sample of patients who presented with a violence-related injury and received care from the ED of the Mures County Emergency Hospital, Romania. The data were collected for 9 months by two trained emergency physicians. Information about individual demographics; mechanism, nature, place, and activity of injury; injury types, and body regions affected; and discharge state were compared for assault and self-harm injuries. RESULTS: Of the 380 patients treated for violence-related injuries, 88.7% were for assault and 11.3% were for self-harm. For both types of injuries, the majority of patients were between the ages of 15 and 44. Assaults frequently occurred in the home, on streets and highways, or in public places; and men (80.4%) were far more likely than women (19.6%) to be treated for this type of injury; a slightly higher proportion of men (55.8%) than women (44.2%) were treated for self-harm, most of which occurred in homes. DISCUSSION: Of all injuries treated in the Tîrgu Mures ED, one out of five was violence related. One out of 10 patients that suffered an injury as a consequence of a violent event and treated in the ED required admission to a hospital for further medical care, leading to a significant health care burden. These data suggest that prevention strategies should focus on young adults, and particularly men. Interventions that focus on detection and treatment of psychological illness, reduction of alcohol use and associated aggression, and family and intimate partner violence are suggested as priorities.

Promoting health in rural Transylvania, Romania. a descriptive analysis of health promotion activities.

Even though efforts are made to reduce health disparities, promote health for all social groups and improve health outcomes, inconsistencies still exist. Existing evidence shows that lack of funding, lack of properly trained workforce, as well as heavy workload on health care workers, are the most employed explanations for the limited number of health promotion interventions in the area. This paper presents the results of a descriptive study that pursues to render a comprehensive image of health promotion efforts undertaken in rural Transylvania, Romania. This descriptive analysis is conducted on data extracted from a larger dataset, obtained through a study which pursues a cross-sectional design, with a quantitative strategy of inquiry on access to health information in rural Transylvania. The instrument used for data collection is a questionnaire administered by telephone to a sample of medical doctors working in rural medical offices in the studied area (n = 226). Results show overall low rates of health promotion activities in the area, as well as low levels of collaboration with other local actors. In the context of behavioral risk factors, this study clearly shows the need of targeted health promotion activities in rural Transylvania in order to improve health outcomes and mitigate health disparities.

Reliability and validity of the Romanian version of a scale to measure infant feeding attitudes and knowledge.

AIM: To describe the development and testing of the Romanian version of the Iowa Infant Feeding Attitude Scale (IIFAS-R). The original instrument has well-established psychometrics for use in English-speaking countries. METHODS: Questionnaires including demographics and items about prior pregnancy and opinions about breastfeeding in public were administered to women in Cluj-Napoca, Romania, attending antenatal clinic (n = 336) and to a separate cohort of mothers within 24 h of delivery (n = 276). Postpartum follow-up was conducted with a sample of maternity cohort subjects who initiated breastfeeding in the hospital (n = 52). RESULTS: Internal consistency was adequate in both cohorts (antenatal alpha= 0.50; maternity alpha= 0.63), with improved reliability for antenatal multigravid (alpha= 0.60) and university-educated women (alpha= 0.57). Score distributions were comparable and item means were approximately central across cohorts. Among pregnant women, higher scores (more positive towards breastfeeding) were associated with longer planned maternity leave (chi2= 17.8; p = 0.02). Higher maternity cohort scores were associated with age (r = 0.31, p = 0.003), urban residence (chi2= 10.2, p = 0.04), breastfeeding a prior infant for at least 6 weeks (chi2= 6.4, p = 0.04), and with intending to breastfeed for at least 6 weeks (chi2= 4.7, p = 0.03). Postpartum women still breastfeeding at follow-up also scored higher (chi2= 9.3, p = 0.009). CONCLUSION: This is the first study to report on use of the IIFAS in Eastern Europe. The IIFAS-R is easy to administer, reliable and valid in Romania. The IIFAS-R can support data collection to promote and assess breastfeeding initiatives consistent with World Health Organization recommendations.