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                 ISSN: 1582-5388

 

 

 

 

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The challenge of change

Elena Lungu

Health is influenced by many factors. The performance of health sector is an important determinant of the health status of population and individuals. Many factors outside the direct aim of the health sector have also an important impact on health, as poverty, lack of safe water and sanitation, poor education. (1)

In order to improve the performance of health system, to adjust to changing conditions, countries worldwide have started health care reforms. (1). Since 1980 several European Countries started to reassess their health care systems, mainly investigating whether or not health care reforms are consistent with “The Health for All” principles, one of the greatest challenges facing health system reform being how to develop an overall “health system perspective” (1, 2).  Ü FULL TEXT.PDF

 

Health Patterns and Determinants

 

Antiretroviral therapy in Romania: Haart?

Apetrei C, Diane Descamps, Ivona Pandrea, Groza P, Prisecariu L, Irina Teodorescu, Andra Teodor, Collin G, Luminiţa-Smaranda Iancu, Luca V, Françoise Brun-Vézinet

Abstract. This study aimed to investigate resistance mutation in patients under discontinued antiretroviral (ARV) therapy. Material and methods. Selection of reverse-transcriptase (RT) and protease mutations was investigated in 48 pediatric patients treated for at least 52 weeks by tritherapy including non-nucleoside inhibitors but whose treatment was discontinued for at least three times (< 1 week) during the follow-up, mainly due to lack of financial resources. Viral load (VL) was measured by Monitor Roche (detection limit: 200 copies/mL). Results. All the patients were infected by HIV-1 subtype F1. VL was undetectable in 5 patients. RT and protease were amplified in 44 and 42 patients respectively. Wild-type protease was observed in 29 patients, while wild RT was observed in 3 cases. 4 patients with detectable VL had non-nucleoside inhibitors of reverse-transcriptase (NNRTI) mutations (K103N=30; Y181C=6; Y188L=2; V106M=1). Four of them presented substitutions associated with high-level resistance to NRTI (M184V=2; T215Y=2), whereas 13 patients presented substitutions associated with resistance to PI (M46I; V82A). All the patients presenting substitutions associated with the resistance to PI also presented mutations associated with resistance toward NNRTI. Conclusions.  Our results show a very high frequency of selection of NNRTI mutations in patients receiving a discontinued treatment containing this class of drugs. NNRTIs should be avoided in those situations where for economical reasons there are risks of discontinuations of treatment.

Key-words: HIV-1, reverse-transcriptase, protease, ARV resistance mutations    Ü FULL TEXT.PDF

 

Antiretroviral therapy management based on the results of genotyping resistance tests in patients failing antiretroviral therapy

Groza P, Diane Descamps, Ivona Pandrea, Collin G, Prisecariu L, Irina Teodorescu, Andra Teodor, Luminiţa Smaranda Iancu, Luca V, Françoise Brun-Vézinet, Apetrei C

 Abstract. This study was aimed to investigate the efficiency of the ARV management based on plasma genotypic antiretroviral resistance testing in patients with failing ARV therapy. Material and methods. There were included 48 of patients in which ARV therapy was modulated according to the results of genotypic resistance which registered therapeutic failure in 43 of cases (89.6%) in 2000. In 2001 out of 42 plasma samples, viral load was undetectable in 23 (55%). The protease was amplified in 19/42 of cases, ten of which being wild type. Results. New resistance mutations comparing to 2000 were observed in proteases from 7 patients. Reverse-transcriptase (RT) was amplified in 19/42 patients and new resistance mutations were observed in 4. These mutations conferred resistance toward nucleozid inhibitors of RT (NNRTIs). Reverse-mutations occurred very rarely following therapeutic switch. Conclusion. Our study shows that monitoring the ARV therapy based on genotypic testing is highly effective in controlling the HIV infection evolution. The low rates of reverse mutations following the therapeutic switch stress the importance of the responsible treatment monitoring.

Key words: HIV-1, reverse-transcriptase, protease, resistance mutations, viral resistance, GART    Ü FULL TEXT.PDF

 

Urinary nicotine metabolites levels in teenagers

Gabriela Mancaş, Marieta Vasilov, Oana Barna, Iliana Palamaru, Gabriela Albu, Roxana Alexandrescu

Abstract. The aim of this study was to investigate the relationship between the tobacco smoke exposure (assessed by questionnaire) and the urinary total nicotine metabolites in teenagers using an accessible and rapid method and, also, to validate is method using the questionnaire in relation with nicotine metabolites levels measurements. Material and methods.  A sample of 296 young aged 15-20 years was randomly selected from three high schools. An adequate questionnaire for assessing their smoking status was used and urine specimens were sampled for measurement of total nicotine metabolites and creatinine levels. Adequate analytical techniques were applied for accurate comparison of the two methods for tobacco smoke exposure assessment in teenagers. Results.  A smoker frequency of 40% among the investigated teenagers was self-reported, ranging from 38% in the subjects aged 15-17 years to 50% in those aged 19-20 years. Only 22% of them were self-reported unexposed and nonsmokers and 37.6 % - passive smokers. An increasing trend was found for the urinary cotinine levels according to the duration of exposure through smoking only for those teenagers self-reported to smoke daily 5-10 cigarettes. An increasing trend was established for cotinine levels according with the smoking intensity of the subjects, with statistical significant differences between different smoker categories. The urinary thiocyanate levels did not correlate with the smoking intensity. The validation of self-reported smoker status (assessed by questionnaire) in comparison with the urinary cotinine levels has indicated a sensitivity of 0.92 and a specificity of 0.49. Conclusions.  The findings of our study have highlighted a linear positive correlation between the urinary cotinine levels and the number of cigarettes smoked daily and, partially, with the duration of smoking exposure of teenagers. The urinary cotinine level, as exposure bioindicator, was proved to be a useful tool for measurement of organism impregnation, as smoking consequence. The techniques of validation by the help of questionnaire have indicated that is a sensitive but less specific method for exposure assessment in the comparison with the major urinary nicotine metabolite measurement.

Key words: tobacco smoking, teenagers, urinary nicotine metabolites, validation   Ü FULL TEXT.PDF

 

Indicators of dermatoglyphic diagnosis of sekelary infantile encephalopathyes (IEP)

Ana Ţarcă

Abstract. The aim of this paper is a dermatoglyphic study in 200 children and teen-agers aged between 2 and 17 years with various infantile encephalopathy (IEP) sekeles, such as hemiplegy, paraplegy, tetraplegy from a dermatoglyfic pathological perspective. Material and methods. A total of 400 palmary prints have been collected between 1995 and 2003 in the Mental Health Center of Iaşi with the catchments area the Eastern part of the country. Results and discussion. Among the complex clinical symptoms evidenced in the affected people, mention should be made of the presence of epilepsy, autism, ocular diseases, which have been further used, along with the reference sample of Moldavia, in the comparative analysis of the obtained results. One of the first observations to be made is that the ample symptomatic polymorphism of patient’s disease is suggestively illustrated in their palmary dermatoglyphic picture by multiple abnormalities or distortions (between 3 and 6 for each patient), with deep clinical implications. The frequency of them exceeds by far that of the reference sample, being instead much closer or even exceeding the values recorded in epilepsy, infantile autism or serious ocular diseases. Present in both boys and girls and on both hands of the affected ones, but especially on the left hands, these distortions, as malformative stigma, suggest that, among the factors responsible for causing the disease, one should not leave aside the genetic or teratologic ones, which intervened in the first 3-5 months of intrauterine life (during the final establishment the papillary ridges); the lesions of central nervous system (CNS) produced in the last 4 months of pregnancy or in the first two years of post-natal life as considered as releasing factors of the clinical symptoms and of their amplification, as well. Conclusions.  Among the factors responsible for the production of sekelary IEP-es, an important role is played by the genetic or teratological ones, known as intervening in the first 3-4 months of intrauterine life. Also the CNS lesions that occurring in the last 4 months of pregnancy and the first 2 years of post-natal life, act exclusively as elements that release the malady’s symptoms and their amplification.

Key words: dermatoglyphics, sekelary infantile encephalopathyes, abnormalities or distortions   Ü FULL TEXT.PDF

 

Dermatoglyphics in insulin – dependent diabetes or diabetes mellitus type 1 (T1DM)

Ana Ţarcă, Elena Tuluc

Abstract. The aim of the present paper is the study of the dermatoglyphics pathology on a lot of 133 subjects diagnosed with Diabetes Mellitus type 1 (58 men and 75 women) out of which 58 are children and teen-agers aged 4 and 18 years diagnosed with Diabetes Mellitus type 1 (T1DM) at the age 2 and 17 years. The other 75 are adults and old people aged are 24 and 79 years, diagnosed with T1DM since they were between 22 and 76. T1DM can be primary insulin dependent in 51.12% of the studied cases and the secondary insulin-dependent in 48.88%. Material and methods. We gathered a total of 266 digito-palmar prints (166 from the masculine series and 150 from the feminine ones). Results and discussion. We are entitled to say that both patients with a juvenile debut in diabetes and those with a late release of the disease present –in their digital dermatoglyphic picture- important distortions or anomalies with serious medical implications, that reach percentages that bring them close to those patients suffering from serious cardio-vascular diseases (CVD) and ophtalmic diseases (OD) at the level of the whole sample, but are different from the witness lot. These distortions, which are present to both the masculine and the feminine series, in both hands of the affected people (especially on the left ones), are the graphic expression of the intervention of the diabetes genetic factor, and partially of the external triggers from the uterus level in an early stage of prenatal life. Conclusions.  The environment factors from the prenatal life act in the post-natal period, being responsible for the release and clinical manifestation of the proper disease. The results we got, even if they are the first of this type in our country, support the idea of using dermatoglyphics (a less costly and easier to reproduce in any stage of post-natal life) as marker, together with metabolic, immunologic and genetic markers, in predicting a potential diabetogen risk at the population level.

Key words: dermatoglyphics, insulin–dependent Diabetes Mellitus (T1DM), distortions or anomalies  Ü FULL TEXT.PDF

 

Methicillin - resistant staphylococcus aureus strains isolated from children in the community

Sofia Constantiniu, Angela Romaniuc, Aurora Ambăruş, Roxana Alexandrescu, Adriana Coşofreţ, Carmen Stanciu

Abstract. Aim. The aim of this study was to estimate the proportion of the MRSA strains in community by analysis of the pharyngeal swabs from children with acute and chronic pharyngitis assisted in medical ambulatory units. Material and methods. A number of 128 S.aureus strains isolated during the period of 2002-2004 from 1782 children were tested concerning their susceptibility to oxacillin. All S.aureus strains with oxacillin inhibition zones diameter <13 mm were tested concerning the Minimal Inhibitory Concentrations (MICs) by agar dilution method, recommended by National Committee for Clinical Laboratory Standards (NCCLS). The strains with MICs ≥ 4 μg/ml to oxacillin were considered methicillin -resistant Staphylococcus aureus (MRSA). Results. Among the 128 S.aureus strains isolated from community, a number of 14 strains had a zone of inhibition <13 mm diameter and 7 (5.4 %) strains had MICs ≥ 4 μg/ml, being MRSA. Only one strain (3.1%) from a number of 32 strains isolated in the year of 2002 was MRSA. From a number of 32 strains isolated in 2003, only 2 (6.2 %) were MRSA and from 62 strains isolated in the year of 2004, 4 (6.4 %) were MRSA. The MICs were ≥ 4 μg/ml for one strain, 8 μg/ml for 4 strains and 16 μg/ml for 2 strains. Conclusions. A number of 7 strains of 128 S. aureus strains were MRSA (5.4%). The community isolates which are generally susceptible to multiple antibiotics are in contrast to the typical, multiple-drug-resistant hospital MRSA ones. Although the percentage of the community - MRSA strains in our area is low, our data pointed out their presence in the community and underlined the importance of MRSA strains from community as possible sources for hospital infections.

Key-words: S. aureus, strains, methicillin-resistant, children, community   Ü FULL TEXT.PDF

 

The association of education and income with nutrition of pregnant and parturient women

Victoria Papadopol, Elena Popa, Cristina Cîmpeanu, Nicoleta Florescu, Otilia Damian

Abstract. The aim of this epidemiological prospective cohort study is the analysis of the association of education and income with behavior related to nutrition of pregnant and lactating women in Iaşi area. This study is part of a more complex one which has investigated the nutrition of pregnant woman and newborn in the context of many determinant factors of their health. Material and methods. This study was performed in a group of 263 pregnant women in which we have analyzed how education and income influence the behavior related to nutrition during pregnancy and postpartum. The nutrition was investigated by a food consumption frequencies questionnaire and 24 hour dietary recall data. The total energy intake was under the recommended values, due to, at least partially, the reduced bread intake. Results. The study found out that the high educational level and a good income were associated to a high intake of proteins (meat, dairy, eggs), animal lipids and fruits.  The low educational level and a low income were associated to the high intake of bread, potatoes, vegetal lipids and alcoholic beverages. Regardless the education and income, we found out some unhealthy eating habits (like low fish consumption, high coffee and sweets consumption) that make necessary the improvement of education for health of all pregnant women, and generally of childbearing women, concerning the proper nutrition during pregnancy. Conclusions.  High educational level and good income were associated with high intake of proteins (meat, dairy, eggs), animal lipids, fruits and sweets. Low educational level and low income were associated with high intake of bread, potatoes, vegetal lipids and alcoholic beverages. Some unhealthy eating habits (like low fish consumption, high coffee and sweet consumption) were not related to education and income.

Key words: nutrition, pregnancy, education, income   Ü FULL TEXT.PDF

 

The barium meal examination versus endoscopy

Doina Davidescu

Abstract. The objectives of our study were to evaluate two diagnostic methods (with and without x-ray) and to investigate the efficacy of barium meal examination. Material and methods. We performed a clinical randomized study at 675 subjects (aged 4 month-18 years) from University Children Hospital Iaşi (the only pediatric endoscopies department from North-East of Romania) and Students Hospital Iaşi. The calculated indices of the diagnostic methods were the sensitivity, specificity, efficiency, predictive values (PV+ and PV-) and usefulness index (UI). Results. The radiological examination had a UI above 0.35 only for esophageal stricture but in this case the esophagogastroscopy is recommended as diagnostically and as therapeutic procedure for dilatation of esophageal stricture. The endoscopy had a UI above 0.35 for all diseases excepted gastroesophageal reflux (GER) and esophageal diverticula’s. Conclusions. The barium meal examination was requested in inappropriate situations such as: dyspepsia (routinely), peptic ulcer (follow-up) and gastrointestinal bleeding. The barium meal examination was repeated in 65.8% of cases. It is imperative to disseminate the guidelines for doctors indicating clearly the clinical context when these two diagnostic methods are to be recommended.

Key words: clinical randomized study, barium meal, endoscopy, efficacy   Ü FULL TEXT.PDF

 

Lacunar stroke  - antiplatelet and anticoagulant therapy for secondary prevention

Diana Hodorog, Felicia Ştefanache

Abstract.  Aim. To asses the therapeutic strategy for secondary prevention in lacunar stroke, according to the underlying mechanism of the cerebral infarct and to determine the recurrence rate of ischemic stroke in patients with lacunar infarct.  Lacunar stroke is a small cerebral infarct in the territory of a single perforator artery. The mechanisms that underlie lacunar infarct are various: small vessel disease, atherothrombotic, cardiac and artery-to-artery embolism. Material and methods. The study was performed in 1083 patients with lacunar stroke admitted in Ist Clinic of Neurology, “Saint Trinity” Hospital, Iaşi, during 1.01.1999 - 30.12.2004. The most probable underlying mechanism for the lacunar stroke has been established for each case. A certain therapeutic strategy has been applied for secondary prevention. Results and discussion. 163 patients with hypertension have a lacunar stroke due to small vessel disease and the other 489 hypertensive patients had an atherothrombotic lacunar stroke. 219 patients had a probable cardioembolic lacunar stroke. In 94 patients the lacunar stroke was probable due to an artery - to - artery embolism. Aspirin 250 mg was given immediately in 1029 patients and continued for 14 days before changing the patient to a maintenance dose of 75 mg daily for secondary prevention. Clopidogrel 75 mg/day was the option in 54 patients. Anticoagulant therapy was used for selected cases of cardioembolic lacunar stroke. 59 patients (5.5%) had a recurrent stroke. Conclusions. The drugs used for acute treatment and for secondary prevention in lacunar stroke must be similar to that used for any other types of ischemic stroke. A high proportion of patients have a recurrent lacunar stroke.

Key words: lacunar stroke, anticoagulants, antiplatelet agents, secondary prevention    Ü FULL TEXT.PDF

 

Characterization of trophoblast cells and decidual lymphocytes isolated from fetal-maternal interface

Daniela Constantinescu, Carmen Cozmei, Laurette Graziella Cozma, Maria Ţepeluş, Andreea Chiriac, Carasievici E

Abstract.  Aim. To asses the therapeutic strategy for secondary prevention in lacunar stroke, according to the underlying mechanism of the cerebral infarct and to determine the recurrence rate of ischemic stroke in patients with lacunar infarct.  Lacunar stroke is a small cerebral infarct in the territory of a single perforator artery. The mechanisms that underlie lacunar infarct are various: small vessel disease, atherothrombotic, cardiac and artery-to-artery embolism. Material and methods. The study was performed in 1083 patients with lacunar stroke admitted in Ist Clinic of Neurology, “Saint Trinity” Hospital, Iaşi, during 1.01.1999 - 30.12.2004. The most probable underlying mechanism for the lacunar stroke has been established for each case. A certain therapeutic strategy has been applied for secondary prevention. Results and discussion. 163 patients with hypertension have a lacunar stroke due to small vessel disease and the other 489 hypertensive patients had an atherothrombotic lacunar stroke. 219 patients had a probable cardioembolic lacunar stroke. In 94 patients the lacunar stroke was probable due to an artery - to - artery embolism. Aspirin 250 mg was given immediately in 1029 patients and continued for 14 days before changing the patient to a maintenance dose of 75 mg daily for secondary prevention. Clopidogrel 75 mg/day was the option in 54 patients. Anticoagulant therapy was used for selected cases of cardioembolic lacunar stroke. 59 patients (5.5%) had a recurrent stroke. Conclusions. The drugs used for acute treatment and for secondary prevention in lacunar stroke must be similar to that used for any other types of ischemic stroke. A high proportion of patients have a recurrent lacunar stroke.

Key words: lacunar stroke, anticoagulants, antiplatelet agents, secondary prevention  Ü FULL TEXT.PDF

 

Dental  Health

 

The effect of xylitol toothpaste on the oral cavity environment

Surdacka A, Stopa J

Abstract: The aim of this work is the clinical and laboratory evaluation of the influence of Polish toothpaste with xylitol on the condition of mouth cavity. The evidences of the last few years show that penitols, especially xylitol, are effective in the prevention of dental decay. Material and methods. The tests were carried out on 34 students who were divided into 2 groups: A and B with 17 students in each group. The initial clinical examination was carried out after 2 and 4 months of brushing teeth with fluoride toothpaste with xylitol (group A) and fluoride toothpaste without xylitol (group B). Clinical examination related to the evaluation of the hygienic condition of the mouth, plaque index (PLI) and hygiene index (HI), gingival index (GI), and gingival bleeding index (GBI) and Decayed Missing Filled Teeth (DMF-t) and Decayed Missing Filled Surfaces (DMF-s) was performed. Results and discussion. A number of 10 people from each group underwent a test on saliva secretion focusing on the number of S. mutans (SM) and L. acidophilus (LB). PH was marked, as well as the amount of saliva and the level of fluoride in saliva. No significant differences in the tested parameters were observed between the two groups. The results of the tests after 2 and 4 months of using both toothpastes pointed out the improvement of the hygienic condition of the mouth and gums. Conclusions. Tooth paste with xylitol had influence on the decrease of the number of S. mutans in saliva, the amount of secreted saliva and the increase of pH value. The use of toothpaste with xylitol as well as without xylitol caused the increase of mean values of fluoride in saliva. Xylitol added to the toothpastes has a positive influence on the quality of the oral environment and, as a result, it would be purposeful to introduce it into prophylactic programmes.

Key words: toothpaste, xylitol, fluoride, saliva, S. mutans, L.acidophilus  Ü FULL TEXT.PDF

 

Oral health – teachers behavior change – a major factor of progress

Dănilă I, Evghenikos Adina, Petersen PE, Sălăvăstru C, Stan A

Abstract. The aim of this longitudinal study is to put in evidence the changes in attitudes and behaviors in oral health. Our recommendation is that a healthy behavior is the main way in order to implement the objectives of the WHO, as 75% from youth ought to have enough knowledge about etiology and prevention in oral health in general. Material and methods. Two lots were performed in 1993 and 2003: 322 mothers and 97 schoolteachers and 278 mothers and 197 schoolteachers, respectively. The main tool was a questionnaire focused on the etiological factors of the dental care and parodontopaties and treatment methods. The items were related to qualitative data as parental support related to attitudes and information in oral health area. We mention that in 1992 in Romanian children aged 12 years the mean value of DMFT and DMFS was 4 and, 6, respectively (5). Results. The study shows a rising in the subject knowledge and information in oral health area from 20-30% up to 40%. The observed information knowledge improvement from the year of 2003 is statistical significant for factors which contribute in dental decay, gum bleeding, healthy nutrition, daily dental brushing, TV information sources. Conclusion. Our study showed the positive evolution of the teachers’ beliefs about the necessity of schoolchildren education in oral health area. In the same time the quality and quantity information in the studied subjects significantly arise in time.

Key words: education, behavior, attitudes, oral health  Ü FULL TEXT.PDF

 

Socioeconomic status and oral health

Teodora Timiş, Dănilă I

Abstract. Inequalities in socioeconomic status underlie many health disparities in the world, including oral health. Occupational status, income and education are intrinsically related and often serve as measure for each-other. In general, the population groups that suffer the worst oral health status are also those that have the highest poverty rates and the lowest education. Higher income enable people to afford better housing and permit increased access to medical care. In the same time, a high level of education increase the opportunity to engage in oral health-promoting behaviors. On the other hand, differences in income and employment of parents generate inequalities in oral health status of children. All studies conducted in this field confirm the link between socioeconomic status and oral health, which justifies the struggle to identify the factors involved in generating and maintaining inequalities in both general and oral health.

Key words: socioeconomic status, income, education level, oral health, inequalities  Ü FULL TEXT.PDF

 

Public Health Policy

 

Why do we need health impact assessment?

Guliş G

Abstract. Health impact assessment is increasingly used in countries of European Union with aim to predict future consequences of recent political investment and strategic decisions and to tackle health determinants. The presented paper briefly describes the methodology of health impact assessment and brings examples of use of health impact assessment to improve decision-making during transition process.  Public health systems and public health workers shall take leadership role in introduction of health impact assessment as a tool for truly inter-sectoral participation and partnership based policy-making.

Keywords: determinants of health, health impact assessment, public health, transition  Ü FULL TEXT.PDF

 

Book Review

 

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