Toxoplasma gondii genotypes and frequency in domestic cats from Romania.

BACKGROUND: Toxoplasma gondii is a zoonotic protozoan parasite with a heteroxenus life cycle that involves felids as the definitive hosts and any warm-blooded animal, including humans, as intermediate hosts. Cats are key players in parasite transmission as they are capable of shedding high numbers of oocysts in their feces that contaminate the environment. METHODS: The study was performed on 31 domestic cats (31.23 ± 27.18 months old) originating from rural and urban areas (5.17:1) in the center and north-west Romania. Feces (n = 31), blood (n = 28), and heart samples (n = 27) were collected. Fecal samples were analyzed by flotation technique, and PCR (529 bp repetitive element). Fecal samples with T. gondii oocysts were bioassayed in mice. Serum samples were analyzed by modified agglutination test and ImmunoComb for the detection of specific anti-T. gondii IgG antibodies. Heart samples were bioassayed in mice, and analyzed by PCR. Toxoplasma gondii positive samples were genotyped by nPCR-RFLP targeting eleven genetic loci (SAG1, SAG2, alt-SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico). RESULTS: Toxoplasma gondii oocysts were found in 2 out of 31 fecal samples collected from a 3-months old stray kitten, and a 4-years old female. In total, 17 out of 27 sera were positive for T. gondii IgG antibodies. The antibody titers in MAT ranged from 1:6 to 1:384. Toxoplasma gondii DNA was detected in 7 out of 27 heart samples, and four of them were positive also by bioassay. Six T. gondii DNA samples from bioassayed mice could be assigned to ToxoDB PCR-RFLP genotype #1 or #3 (Type II) and one T. gondii DNA from heart digest to genotype #2 (Type III). Both of these genotypes are common in Europe. CONCLUSIONS: Our results revealed that the infection with T. gondii is still high in cats from Romania. The oocysts shedded by these cats represent an important source of infection for intermediate hosts, including humans. Further studies on a wider range of cases are necessary for a more exhaustive definition of the T. gondii genotypes circulating in Romania.

Flood hazard potential evaluation using decision tree state-of-the-art models.

Floods occur frequently in Romania and throughout the world and are one of the most devastating natural disasters that impact people's lives. Therefore, in order to reduce the potential damages, an accurate identification of surfaces susceptible to flood phenomena is mandatory. In this regard, the quantitative calculation of flood susceptibility has become a very popular practice in the scientific research. With the development of modern computerized methods such as geographic information system and machine learning models, and as a result of the possibility of combining them, the determination of areas susceptible to floods has become increasingly accurate, and the algorithms used are increasingly varied. Some of the most used and highly accurate machine learning algorithms are the decision tree models. Therefore, in the present study focusing on flood susceptibility zonation mapping in the Trotus River basin, the following algorithms were applied: forest by penalizing attribute-weights of evidence (forest-PA-WOE), best first decision tree-WOE, alternating decision tree-WOE, and logistic regression-WOE. The best performant, characterized by a maximum accuracy of 0.981, proved to be forest-PA-WOE, whereas in terms of flood exposure, an area of over 16.22% of the Trotus basin is exposed to high and very high floods susceptibility. The performances applied models in the present work are higher than the models applied in the previous studies in the same study area. Moreover, it should be noted that the accuracy of the models is similar with the accuracies of the decision tree models achieved in the studies focused on other areas across the world. Therefore, we can state that the models applied in the present research can be successfully used in by the researchers in other case studies. The findings of this research may substantially map the flood risk areas and further aid watershed managers in limiting and remediating flood damage in the data-scarce regions. Moreover, the results of this study can be a very useful for the hazard management and planning authorities.

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe.

BACKGROUND: Cervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings. METHODS: Our research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants' interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context. RESULTS: Conducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions. CONCLUSIONS: Our study's novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

Ukrainian refugees in Romania: perception and social challenges.

Millions of people from Ukraine have been forced to flee their homes to seek safety, protection, and assistance owing to armed conflict. This study aims to draw a parallel between the meaning and importance of the initial impact of Russian military aggression in February 2022 and the recent plight of Ukrainian refugees on Romania's territory. It is based on the results of a dedicated thematic survey of Ukrainian refugees as part of fieldwork carried out by the authors between March and April 2022 and a survey launched by the United Nations Refugee Agency in Romania between October 2022 and August 2023. The study emphasises the importance of raising awareness and building solidarity and support to counterbalance the effects of the crisis with respect to: (i) refugees in their hometowns and losses incurred; (ii) refugees' needs, help provided, and expectations; (iii) the need to integrate refugees into different fields of daily life; and (iv) a return to Ukraine.

Building capacity for equitable healthcare workforce policy, learning from migrant healthcare workers: A qualitative study with Romanian physicians working in Germany during COVID-19.

BACKGROUND: Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers' experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy. METHODS: Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed. RESULTS AND DISCUSSION: Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.

The Influence of HLA Polymorphisms on the Severity of COVID-19 in the Romanian Population.

In this study, we aimed to investigate whether specific HLA alleles found in patients from Romania and the Republic of Moldova were associated with the severity of COVID-19 infection and its associated mortality. We analyzed the HLA alleles at the -A, -B, -C, -DRB1, and -DQB1 loci in a cohort of 130 individuals with severe and extremely severe forms of COVID-19, including 44 individuals who died. We compared these findings to a control group consisting of individuals who had either not been diagnosed with COVID-19 or had experienced mild forms of the disease. Using multivariate logistic regression models, we discovered that the B*27 and B*50 alleles were associated with an increased susceptibility to developing a severe form of COVID-19. The A*33 and C*15 alleles showed potential for offering protection against the disease. Furthermore, we identified two protective alleles (A*03 and DQB1*02) against the development of extremely severe forms of COVID-19. By utilizing score statistics, we established a statistically significant association between haplotypes and disease severity (p = 0.021). In summary, this study provides evidence that HLA genotype plays a role in influencing the clinical outcome of COVID-19 infection.

The distribution of natural radionuclides 40K, 228Ac, and 226Ra on Romanian Territory: a radiometric study.

To estimate the radiation hazard due to the natural terrestrial radioactivity, 598 samples of soil covering the entire Romanian territory were collected and analyzed for the distribution of natural radionuclides 40K, 228Ac, and 226Ra. The ultra-low background Slanic-Prahova underground laboratory was used to determine the gamma-ray-specific activity of these radioactive isotopes with an uncertainty between 5 and 20%. All these data permitted to establishing a set of 2D maps illustrating the distribution of specific activity of each radionuclide as well as of the resulting air dose rate, all of them illustrating an heterogeneous distribution, increased values being displaced on the western and south-western territory. Mediated over 598 points, these determinations led to a value of annual effective dose of 0.7 ± 0.15 mSv/y and an external hazard index of 0.46 ± 0.1, both attesting to a radioecologically safe environment for human activity.

Cross-Cultural Adaptation and Validation of the Romanian Musculoskeletal Tumor Society Scoring System for Patients with Extremity Bone Sarcomas.

Background and Objectives: Primary malignant bone tumors are rare lesions, and their complex treatment can lead to functional impairment. It is important to have a postoperative assessment tool for patients' functional outcomes to be evaluated and to consequently adapt future treatments in the pursuit of a continuous improvement of their quality of life. The Musculoskeletal Tumor Society Score (MSTS) is a validated specific system score that is used frequently in the follow-up of these patients. We found no information about a valid translated Romanian version of this score neither for the upper limb nor for the lower limb. We proposed in this study to translate the original version of the MSTS Score into Romanian and to perform validation analysis of the Romanian-language MSTS Score. Materials and Methods: We selected 48 patients who underwent limb-salvage surgery after resection of bone sarcomas. Patients were interrogated twice according to the translated Romanian version of the MSTS Score during their follow-up. The translation was performed according to the recommended guidelines. A total number of 96 questionnaires were valid for statistical analysis. Results: Internal consistency and reliability were good for both sets of questionnaires' analytic measurements, with Cronbach's alpha values of 0.848 (test) and 0.802 (retest). The test-retest evaluation proved to be statistically strong for reproducibility and validity with Spearman's rho = 0.9 (p < 0.01, 95% CI). Conclusions: This study permitted the translation of this score and the validation of psychometric data. Our results showed that the Romanian version of the MSTS is a reliable means of assessment of the functional outcome of patients who received limb-salvage surgery for the upper and lower extremities.

Cremation in Interwar Romania: The Case of the Potter's Field.

This article aims to analyse the activities of Potter's Field practice in Romania as part of the Patriarch Miron Orthodox Association. From its very beginning it was orientated against the apparition of cremation in Romania, realized in the first cremation at the Cenușa Crematorium in Bucharest (1928). The target was to 'save' poor people from cremation, considering that the cremation aimed to remove from the local authorities the pressure of supporting the costs of burials for unidentified bodies and bodies that were unclaimed by families ('the social cremations'). Therefore, the Potter's Field practice developed in Romania in an original way in comparison to other countries. This situation indicated a way of translating cremation into reality in Romania and expressed some of its particularities in this country (the implication of the authorities, cremation as a personal choice or the forms of criticism by the religious environments).

Hysterical lesbians and respectable gays. Lesbian anonymity in mainstream LGBT+ and grassroots activisms.

This article is informed by sixteen in-depth interviews with LGBT + activists in Romania, my archive and notes during my involvement in feminist and queer activist circles, as well as archival materials of an LGBT + NGO. It proposes the concept of lesbian anonymity as a means of investigating the way in which marginal positions within mainstream movements are anonymized and their contributions to the movement dispersed within the generic queer/gay activism. By looking at specific case studies from Romaniás transition period (1989 to mid 2000s), I analyze how matters of representation were tackled within the LGBT + mainstream movements in relation to grassroots activist circles. The article explores what happens when queer gatekeepers fail to engage with internal criticisms concerning the selective erasure of certain categories of voices such as queer women, trans people, racialized people, sex workers. I argue that lesbian anonymity offers another angle of analyzing the clashes between and within different LGBT + groups in post-socialist spaces. How does lesbian anonymity shape the queer movements and why is it important to keep representational issues in mind while working on non-normative sexualities, gender, and women´s reproductive rights? This contribution offers a necessary critique of the representational gaps within queer movements.

Population norms for the EQ-5D-3L and EQ-5D-5L in Romania.

BACKGROUND: The majority of patient reported outcome measures (PROMs) don't have population norms in Romania. This is the case with the EQ-5D as well. Therefore, we aimed to estimate population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ-VAS. METHODS: A cross-sectional survey was conducted in all regions of Romania from November 2018 to November 2019. A three-stage probability sampling procedure stratified by region and settlement size was used to select a representative sample. Interviews were computer-assisted and conducted in respondents' homes by trained interviewers. Health status was assessed with the EQ-5D-5L, the EQ-5D-3L and the EQ VAS. Descriptive statistics were used to estimate population norms by age groups and sex for the EQ-5D-5L, the EQ-5D-3L, their indexes and the EQ VAS. Population norms were weighted using survey weights. Indexes for the EQ-5D questionnaires were estimated using the recently developed Romanian value sets. RESULTS: Data from 1,649 interviews was analysed in the present study. Survey weights were used so that sex and place of residence ratios for the weighted sample matched the Romanian general population distribution. Participants' mean age was 47.4 years (SE = 1.157) and 50.3% of them reported being in good health. The dimension for which people reported the highest number of problems for both questionnaires was the pain/discomfort dimension. Men aged 35 plus reported fewer problems with pain/discomfort than women for both the EQ-5D-5L and EQ-5D-3L. Health decreased with age as shown by the decrease from age group 18-24 to age group 75 plus in the indexes of both questionnaires: from 0.977 (SE = 0.005) to 0.765 (SE = 0.017) for EQ-5D-5L and from 0.981 (SE = 0.005) to 0.784 (SE = 0.019) for EQ-5D-3L. There was 29.9 points drop in the EQ VAS score between the youngest and oldest group. CONCLUSIONS: Population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ VAS are now available. These can now be used as reference values by healthcare professionals, researchers and decision-makers leading to a further development of health-related quality of life research in Romania.

Mental health related stigma in Romania: systematic review and narrative synthesis.

BACKGROUND: Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and middle-income countries, with former Soviet bloc countries identified as a particular contributor to this evidence gap. Romania struggles with mental health stigma at many levels. The aim of this review was to bring together all relevant data regarding stigma and discrimination related to mental illness as well as actions to address these problems in Romania in order to prioritise further stigma research and identify priority targets for stigma reduction. METHODS: A systematic literature search was conducted in three online databases and grey literature. After the analysis of full manuscripts, four were excluded based on lack of relevance or incomplete data reporting. Quality assessment was performed for included studies using the Mixed Methods Appraisal Tool (MMAT) and the narrative was synthesized based on the research questions. RESULTS: The review included fifteen studies, the majority having a cross-sectional design. Stigma related to mental illness in Romania, has an impact on help-seeking attitudes and behaviours, workplace environment and social relationships of people with mental health problems. Negative stereotypes are maintained and validated by mass media reports. Significant stigma in healthcare and mental care settings has also been observed. Self-stigma was less frequently reported than public stigma. Despite a few stigma reduction actions, no rigorous evaluation of content, delivery and effectiveness has been conducted and no empirical evidence has been published. CONCLUSIONS: Based on this review, three lines of action are recommended in Romania. Increase research concerning stigma in healthcare and mental care settings and use behavioural outcomes. Develop and deliver evidence-based tailored interventions to reduce stigma in identified priority subgroups of the population and ensure rigorous evaluation and scientific dissemination. Elaborate guidelines for working with community stigma and advocate for structural changes.

Barriers to access adequate maternal care in Romania, Bulgaria, and Moldova: A cross-country comparison.

BACKGROUND: Eastern European health system indicators (e.g., number of health workers and care coverage) suggest well-resourced maternity care systems, but maternal health outcomes compare poorly with those in Western Europe. Often, poor maternal health outcomes are linked to inequities in accessing adequate maternal care. This study investigates access-related barriers (availability, appropriateness, affordability, approachability, and acceptability) to maternity care in Romania, Bulgaria, and Moldova. METHODS: This cross-country study (n = 7345) is based on an online survey where women who received maternity care and gave birth in 2015-2018 in Bulgaria (n = 4951), Romania (n = 2018), and Moldova (n = 376) provided information on their experiences with the care received. We used regression analysis to identify factors associated with accessing maternity care across the three countries. RESULTS: Results show high rates of cesarean births (CB) and a low number of antenatal and postnatal care visits. Informal payments and use of personal connections are common practices. Formal and informal out-of-pocket payments create a financial burden for women with health complications. Women who had health complications, those who gave birth by cesarean, and women who gave birth in a public facility and had fewer antenatal check-ups, were more likely to describe facing access-related barriers. CONCLUSIONS: This study identifies several barriers to high-quality maternity care in Romania, Bulgaria and Moldova. More attention should be paid to the appropriateness of care provided to women with complicated pregnancies, to those who have CBs, to women who give birth in public facilities, and to those who receive fewer antenatal care visits.

Ongoing measles outbreaks in Romania, March 2023 to August 2023.

Measles cases have recently been increasing in Romania, with 460 confirmed cases by August 2023. From March 2023, measles cases increased, and outbreaks were recorded in Cluj, Bistrita Nasaud, Sibiu and Mures counties. New D8 virus variants were identified, different from the variants detected in Romania before the COVID-19 pandemic. We here provide epidemiological and molecular data on the current increase in measles cases in the context of the measles elimination process in the World Health Organization European Region.

Characterization of the Tongue Worm, Linguatula serrata (Pentastomida), Identified from Hares (Lepus europaeus) in Romania.

Linguatula serrata (Frölich, 1789) is a widespread parasite known as the tongue worm belonging to the family Linguatulidae. The adult form of the parasite is usually located in the upper respiratory tract of domestic and wild carnivores while the larval forms are located in the visceral organs of intermediate hosts (various herbivorous mammals). Twenty-four European brown hares (Lepus europaeus) were examined in this study, of which two were positive with L. serrata nymphs. The collected nymphs were examined morphologically using electron-microscopic analysis and molecularly by amplification of 18S rRNA and COX1 genes. Lung tissue samples were also collected and histopathological examination was performed. Histopathological examination revealed the following lesions: generalized inflammatory oedema, granulomas with necrosis, calcification and fibrosis in the bronchial tree. The results of molecular sequencing for L. serrata specimens collected from the European brown hares are deposited in GenBank. This study presents the first report on Linguatula serrata nymphs collected from L. europaeus in Romania, using molecular and morphological characterization simultaneously.

Machine learning-based prediction and assessment of recent dynamics of forest net primary productivity in Romania.

While the analysis of spatio-temporal changes in the net primary productivity (NPP) of forests can provide critical information on carbon cycle and climate change, these ecological trends have remained unclear in many countries worldwide, including Romania. By using complex (satellite, forest and climate) data, many sophisticated (machine learning) algorithms and some widely applied (the Mann-Kendall test and Sen's slope estimator) statistical procedures, this study investigates, for the first time, recent forest NPP trends (1987-2018) that occurred in Romania, in relation to climate change that affected the country over the past decades. Following the modelling, mapping and assessment of NPP dynamics, results showed almost exclusively positive trends for this ecological parameter, which accounts for ∼99% of all forest NPP changes that occurred throughout the country, after 1987. Interestingly, almost three quarters (∼73%) of all NPP increasing trends are statistically significant, which indicates that Romania's forests have recently experienced a large-scale improvement in carbon fluxes and stocks. Investigations of eco-climatic relationships suggest that climate change has partially contributed to these surprising NPP dynamics observed in recent decades. All these findings can provide valuable information for forest management and for many stakeholders and policymakers who operate in the forestry and climate fields in Romania.

137Cs distribution on the territory of Romania 30 years after Chernobyl accident.

To estimate the contribution of Chernobyl 137Cs contamination, in 1993 and especially 2016, its total inventory was determined by gamma-ray high-resolution spectroscopy in 62 and respectively 747 soil samples covering the entire Romanian territory. This permitted to estimate the 137Cs inventory as varying between 0.4 and 187 as well as between 0.2 and 94.2 kBq/m2 for years 1993 and 2016, respectively. By representing the spatial distribution of 137Cs inventory in Voronoi polygons, it was possible to evidence a decrease of the total 137Cs inventory over entire Romanian territory with a factor of about 3 from about 3.6 TBq to less than 1.2 TBq, exceeding in this way the natural decay which suggests that a certain amount of 137Cs was washed out by precipitation and, at a lower extent, was incorporated into plants. At the same time, by evaluating the maximum contribution of 137Cs to the population exposure, in 1993 as well as in 2016, the supplementary annual effective dose did not exceed, in the majority of sampling points the value of 0.2 mSv/year.

Characteristics of submerged and partially submerged caves (habitat type 8330) in Romania.

Underwater sea caves form a relatively under-examined habitat type within the marine regions of Europe, although they provide unique physical conditions such as reduced light and wave energy, in addition to reduced temperature amplitude. This study aimed at revealing the characteristics of submerged cavities on the southern Romanian continental shelf where six protected areas exist. We used high-resolution bathymetry data and side-scan sonar imaging to identify limestone outcrops where cavities would be most probable to form and then performed visual observation during SCUBA diving activities. We found that submerged cavities appear in all marine-protected areas and their neighboring unprotected areas from the shore to ~20-m depth mostly in the form of caverns, niches, and overhangs that meet the physical requirements of the habitat type 8330 as defined by the European Commission. We propose that habitat type 8330 should be listed in the Natura 2000 Standard Data Forms of the protected areas where it is missing, and we also propose that some protected areas should be expanded to include important areas with the occurrence of this habitat type. Finally, we note here for the first time the occurrence of Movile-type karst and an associated sulfidic water spring on the southern shore of Lake Techirghiol, similar to the region near Mangalia where it was first described in the literature. Although our finding prompts for a more detailed study, it indicates the existence of an underground ecosystem similar to that from the well-studied Movile Cave, but isolated by a distance of over 20 km.

Caregivers' perspectives on future planning for their adult children with intellectual disabilities in Romania.

BACKGROUND: Much of the research and program innovation regarding future planning for adults with intellectual disabilities has occurred in countries with well-developed disability service systems. This study explored how family caregivers planned for their adult children's future caregiving needs in Romania, a country with a limited array of disability services. METHOD: In this exploratory qualitative study, we conducted 30 face-to-face interviews with caregivers of adults with intellectual disabilities in Romania. We used thematic analysis to analyse the transcribed and translated interview data. RESULTS: The majority of participants, while believing that future planning was necessary, had not engaged in planning and had no supports for planning. As there were few disability services, the majority of the participants reported that they could not engage in planning, and many avoided thinking about the future. CONCLUSION: Romania and other countries with fewer disability services likely need alternative models of future planning than those that have been developed and tested previously.

Validity and Reliability of Rule Orientation Scale among Romanian Physicians-A Pilot Study.

Background and Objectives: Legal compliance is influenced by several factors, including individuals' attitudes about when breaking the law may be acceptable or justifiable. The rule orientation scale provides a measurement capable of predicting an individual's offensive behavior, regardless of the legal punishment. The current research is the first that aims to evaluate the construct validity of the translated Romanian version of the rule orientation scale. Materials and Methods: A cross-sectional study was conducted online among Romanian physicians in Dolj County. A 12-item questionnaire previously validated in the United States was used for this study. Results: A total of 69 physicians responded to the survey with a mean age of 38.53 ± 8.28 and an average experience of 10.49 ± 8.27 years. Physicians were prone to adhere to the law and found only a few instances when legal breaches were acceptable. Nonetheless, they deemed it permissible to violate the law when they did not know its content. These attitudes were not affected by respondents' ages, genders, numbers of years in practice, industries, or specialties. The internal consistency of the questionnaire was high (Cronbach's α = 0.925). Conclusions: The rule orientation scale validated in the Romanian language can be used to determine conditions under which individuals find it acceptable to break the law.