Hybrid health regimes: Access to primary care physicians and COVID-19 vaccine uptake across municipalities in Romania.

This study analyses COVID-19 vaccine uptake at the municipal level in Romania using the global health regimes and vaccine hesitancy perspectives. Our spatial regression (SARAR-het Durbin) shows that the number of primary care physicians is a significant predictor of vaccine uptake, and municipalities with higher access to the labour market have higher vaccination rates. We provide a historical perspective to demonstrate that the current health regime in Romania is a hybrid of internationalist and global health regimes, with socialist investments affecting labour participation, education, poverty, and vaccination rates. Our findings highlight the impact of regional disparities and partial privatization of the health system.

Spatial clustering behaviour of Covid-19 conditioned by the development level: Case study for the administrative units in Romania.

Spatial analyses related to Covid-19 have been so far conducted at county, regional or national level, without a thorough assessment at the continuous local level of administrative-territorial units like cities, towns, or communes. To address this gap, we employ daily data on the infection rate provided for Romanian administrative units from March to May 2021. Using the global and local Moran I spatial autocorrelation coefficients, we identify significant clustering processes in the Covid-19 infection rate. Additional analysis based on spatially smoothed rate maps and spatial regressions prove that this clustering pattern is influenced by the development level of localities, proxied by unemployment rate and Local Human Development Index. Results show the features of the 3rd wave in Romania, characterized by a quadratic trend.

Does voluntary health insurance improve health and longevity? Evidence from European OECD countries.

The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population's health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study's findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.

The accuracy of endorectal ultrasonography and high-resolution magnetic resonance imaging for restaging rectal cancer after neoadjuvant chemoradiotherapy.

AIM: Endorectal ultrasonography (ERUS) and high-resolution Magnetic Resonance Imaging (HR-MRI) are two frequently used techniques for the preoperative staging of rectal cancer to offer proper neoadjuvant or surgical treatment. Because tumor restaging after neoadjuvant therapy using ERUS and HR-MRI remains challenging the aim of this study is to determine which of the two imaging methods used in restaging rectal cancer has the highest accuracy. MATERIAL AND METHODS: We included patients with rectal cancer who underwent ERUS and HR-MRI scans before and after neoadjuvant chemo-radiotherapy (n-CRT). The n-CRT was followed by imagistic restaging at 6 weeks after the last therapy session and by surgical resection. The pathology stage from the surgical sample was compared with the HR-MRI and ERUS restaging. RESULTS: Fifty-four patients underwent n-CRT and 47 were restaged by both ERUS and HR-MRI. ERUS was accurate in tumor restaging after n-CRT in 29 cases (61.7%) and HR-MRI in 32 cases (68%). Regarding lymphatic node status, ERUS was accurate for 34 patients (72.3%) and had an overall rate of over-staging of 12.8% and 14.9% of under-staging. HR-MRI was accurate for 30 patients (63.8%) in restaging the lymph nodes after n-CRT and had an overall rate of over-staging of 25.5% and 10.7% of under-staging. CONCLUSION: Restaging rectal cancer after n-CRT remains difficult because of radiotherapy tissue alteration, which results in low diagnostic accuracy for both methods. KEY WORDS: Endorectal Ultrasonography (ERUS), High-Resolution Magnetic Resonance Imaging (HR-MRI), Neoadjuvant Chemo-Radiotherapy, Rectal Cancer Restaging.

The accuracy of endorectal ultrasonography in rectal cancer staging.

BACKGROUND AND AIMS: The incidence of rectal cancer in the European Union is about 35% of the total colorectal cancer incidence. Staging rectal cancer is important for planning treatment. It is essential for the management of rectal cancer to have adequate preoperative imaging, because accurate staging can influence the therapeutic strategy, type of resection, and candidacy for neoadjuvant therapy. The aim of this work is to evaluate the accuracy of endorectal ultrasound (ERUS) in rectal cancer staging. METHODS: A retrospective study was performed to assess the accuracy of ERUS by analyzing patients discharged from Regional Institute of Gastroenterology and Hepatology (IRGH) Cluj-Napoca, Romania, diagnosed with rectal cancer between 01 January 2011 and 31 December 2013. Patients who were preoperatively staged by other imaging methods and those who had ERUS performed in another service were excluded from the analysis. As inclusion criteria remained ERUS performed for patients with rectal cancer in IRGH Cluj-Napoca where they were also operated. We analyzed preoperative T stage obtained by ERUS and it was compared with the histopathology findings. RESULTS: The number of patients discharged with a diagnosis of rectal cancer were 200 (operated - 157) in 2011, 193 (operated - 151) in 2012, and 198 (operated - 142) in 2013. We analyzed a total of 51 cases diagnosed with rectal cancer who performed ERUS in IRGH Cluj-Napoca. The results according to the T stage obtained by ERUS and histopathology test were: Under-stage T2= 25.0%, T3=7.9% of cases;Over-stage T2=25.0%, T3=31.6% and T4=60.0% of cases.Less than 20% of patients underwent preoperative radio-chemotherapy. CONCLUSIONS: ERUS is a method of staging rectal cancer which is human dependent. ERUS is less accurate for T staging of stenotic tumours, but the accuracy may still be within acceptable limits. Surgeons use ERUS to adopt a treatment protocol, knowing the risk of under-staging and over-staging of this method. The accuracy of ERUS is higher in diagnosing rectal cancer in stages T1, T2 and even in stage T3 with malignant tumor which is not occlusive. ERUS is less accurate for T staging of locally advanced and stenotic tumours.

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant.

BACKGROUND AND AIMS: To assess the role of diffusion weighted imaging sequence (DWI), routinely used in hepatic magnetic resonance imaging (MRI) for the differentiation of focal liver lesions (FLLs) as benign or malignant. METHOD: 99 FLLs assessed by liver MRI in 80 patients were included in the present study. All lesions were retrospectively analyzed by two experienced radiologists, independent from each other, who were not aware of the previous results obtained by using different imaging techniques. All included FLLs had a final histological diagnosis or a final diagnosis based on consensus reading by two experienced radiologists and follow-up at 6 months. The FLLs signal was qualitatively appreciated on the b-800 sequences and on the apparent diffusion coefficient (ADC) map. The ADC value of each FLL was measured and the ADC ratio between the ADC value of the assessed FLL and that of the surrounding liver parenchyma were calculated. RESULTS: The mean ADC value for benign FLLs as assessed by the two independent readers was 1.78 x 10¯³ and 1.72 x 10¯³, respectively. The mean ADC value for malignant FLLs was 0.92 x 10¯³ for the first reader and 0.95 x 10¯³ for the second reader. The mean ADC ratio for benign FLLs was 1.91 and 1.85 for the two readers and for malignant FLLs was 0.91 and 0.94, respectively. Using an ADC value lower than 1.024 x 10¯³ offers a specificity of 100% and a sensitivity of 62.5% for the diagnosis of malignant FLLs. The ADC value is an indicator which is less prone to interobserver variability (correlation of 0.919→1). The ADC ratio has, as the analysis of the ROC curve shows, the best predictive value for differentiation between benign and malignant FLLs. Analysis of the signal intensity on the DWI b-800 image alone is of no significance in differentiating benign from malignant FLLs (p>0.05). CONCLUSIONS: The ADC value and the ADC ratio assessed on liver DWI are useful diagnostic tools in the differential diagnosis of benign vs. malignant FLLs. Quantitative methods such as calculating the ADC value or ADC ratio have better diagnostic value than the qualitative techniques.