C O N T E N T S
Gaining health: the European strategy for the prevention and control of noncommunicable diseases, debated at the 56th session of the World Health Organization (WHO) Regional Committee for Europe during 11th -14th September 2006, promotes a comprehensive and integrated approach to tackling noncommunicable diseases (NCDs). Its objectives are to combine integrated action on risk factors and determinants across sectors with efforts to strengthen health systems toward improved prevention and control. Ü FULL TEXT.PDF
Health Patterns and Determinants
Brigitte Scutaru, Doina Popa, V Cazuc, Irina Popescu, Iulia Roman, Valeria Hurduc, Iliana Palamaru
Abstract. Romanian health and safety regulations require employers to monitor the exposure by a suitable procedure in any case where it is necessary for ensuring the maintenance of adequate control of exposure of employees to hazardous substances. Objectives. The aim of this study was to estimate the occupational exposure risk of electroplating plant’s workers. Materials and methods. Indoor air quality was evaluated by workplace measurements of chemicals in two cadmium-nickel-chrome electroplating and zinc coating units. For the determination of internal exposure 69 workers (mean age: 42.7±6.3 years, mean exposure length: 20±7.4), including 28 women, and a matched control group (72 subjects) were examined in a cross-sectional study. Whole blood samples were analyzed for cadmium and post-shift urine samples for beta 2-microglobulin. The dermal exposure levels of heavy metals were measured by wipe sampling in combination with adequate analytical techniques. 23 electroplaters belonging to workplaces with major risk were analyzed for chromosomal aberrations and micronuclei in peripheral lymphocytes. The results were statistically analyzed through usual methods (Student’s t-test, c2-test, Pearson′s correlation coefficient). Results and discussion. Airborne concentrations exceeded threshold limit values (TLV-TWA) for cadmium, chromium, nickel, cyanide, sodium hydroxide, sulphuric acid and trichloroethylene. Mean concentrations of cadmium in whole blood, of dermal chrome, cadmium and nickel and of urinary beta 2-microglobulin were significantly higher among electroplaters than in controls. A positive correlation was found between urinary beta 2-microglobulin and blood cadmium levels. The prevalence of chromosomal aberrations and micronuclei in peripheral lymphocytes was significantly higher in exposed as compared with controls. Conclusions. The study revealed the presence of a high occupational risk in metal plating shops. The concentrations of a great number of chemicals, some of them inducing cancer, exceeded the allowed exposure limits. The results confirm that beta 2-microglobulin is a sufficiently sensitive indicator for use in monitoring heavy metal occupational exposure, especially for cadmium. As a complement to traditional exposure assessment, monitoring deposition of aerosols on employees’ skin can be a simple and quick screening method for identifying deposited metals.
Eugenia Dănulescu, Mirela Ghiţescu, Daniela Constantinescu, Carmen Cozmei, Doina Havârneanu, Felicia Grădinariu, Irina Alexandrescu, V Cazuc, Doina Ivanovici, R Dănulescu, Raluca Dănulescu
Abstract. Aim. To assess respiratory system response in long time low-level occupational exposure to anesthetics (AE) and to identify appropriate prophylactic measures. Materials and Methods. Cross-section study on 128 health care workers occupationally exposed to AE (halothane, enflurane, isoflurane) vs matched controls. GC exposure evaluation, clinical examination, immunochemistry, respiratory function tests and oxidative stress markers (SOD, TBARS) were performed. To assess the possible effect of AE on the immune function, peripheral lymphocyte subpopulations, NK cells percentage and NK cytotoxic activity were determined in a subgroup (n=33). Results. AE concentrations in workplaces air were under but close to TLV. Irritative respiratory symptoms prevailed. Discrete distal obstructions were found in 45.3% of workers vs 22.8% in controls (c2=10.1, p<0.01, OR=2.7, CI:1.4-5.2). SOD and TBARS were significantly higher in exposed (p<0.01). Serum immunoglobulins changes suggested alteration of the humoral immune response. The anaesthesiologist subgroup had a slightly reduced percentage of specific cytotoxicity (12.34%) versus exposed (16.06%). Conclusions. It seems that under TLV occupational exposure to anaesthetic gases could interfere with defence mechanisms. Further research could sustain the reconsideration of exposure standards - a suitable prophylactic approach.
Lucia Bârlean, Luminiţa Smaranda Iancu, I Dănilă, Tinca Navrotescu, Iuliana Cotea, Luminiţa Minea
Abstract. Aim. The aim of the study was to determine the degree of contamination of the water in the dental unit and the risk of pathogens transmission on this route, in Iaşi dental practices in 2006. The water supply in dental units through oral rinses, air/water syringes, ultrasonic scalers, and high or low-speed hand pieces may be heavily contaminated with microorganisms that present potential risks of contamination for both medical team and patients. The microorganisms detected in Dental Unit Water System (DUWS) are mainly bacteria, but some protozoa and fungi may also be found. Materials and methods. A total of 93 water samples were collected of which 67 from the DUWS, in four distribution points. Contamination was determined using bacteriological indicators: Total Number of mesophilic Germs (TNG/ml) growing at 370C, coliform bacteria (CFU/100 ml), Escherichia coli (CFU/100 ml) and enterococci (CFU/100 ml). Results. The values for TNG/ml exceeded European Union drinking water guidelines in 52.5% of DUWS water samples. Coliform bacteria were present in 30.3% of the samples collected from DUWS. E. coli was detected in one air-water syringe sample. Conclusions. The pathogenicity and metabolism of the biofilm in the DUWS, insufficiently evaluated till now, require further studies in this field in view of elaborating effective strategies for water supply quality control aiming the decrease of the risk for microorganisms transmission on this route.
Victoria Papadopol, Gabriela Mancaş, Cristina Cîmpeanu, Elena Popa, Nicoleta Florescu, Gabriela Albu
Absract. Aim. The aim of the study was to determine the relationship between smoking and food ingestion in a pregnant women group. The literature in the field has shown that smoking during pregnancy is harmful, affecting pregnancy evolution, delivery and newborn health. Also, smoking can indirectly influence fetus evolution affecting the alimentary mother behavior. Material and methods. The cohort study implied a group of 263 pregnant women, 18-39 years old, from Iaşi city. They were investigated early in pregnancy, late in pregnancy and about 2 months postpartum. They were asked about the frequencies of food consumption and 24 h recall of food intake and smoking data. Total energy intake and the main nutrients intake were estimated. Urinary cotinine, thiocyanates and creatinine were determined. Relationship smoking-nutrition was investigated using ”chi squared” and Anova tests. Results. Before pregnancy 43.4% of women smoked; during pregnancy and postpartum about 10% of women smoked. Smoking associated with defavourized socio-economical status (low education, singles, unemployed). The number of smoked cigarettes very well correlated with the urinary level of cotinine and thiocyanates reported by creatinine. Smoking women had a higher ingested energy and consumed more lipids than nonsmoking women. In early pregnancy, smoking women consumed fewer dairy products and in late pregnancy they consumed less fish then the other ones. After delivery, the smoking women consumed less eggs and fish. During the whole study period, they consumed more coffee comparing the nonsmoking women. Conclusions. About a quarter of smoking women continued to smoke during pregnancy and after delivery; they had a less healthy nutrition comparing the nonsmoking women. So, smoking pregnant women is a group of particular importance in terms of public health interventions on nutrition.
Daniela Constantinescu, Carmen Cozmei, Raluca Marina Moraru , Carmen Croitoru, Mirela Ecateriné Ghiţescu, Ecaterina Anisie, Didona Anca Ungureanu, Doina Popa, E Carasevici
Abstract. Aim. Health-care workers occupationally exposed to Mycobacterium tuberculosis were investigated in order to detect immunological parameters useful in monitoring the progression to the disease. Material and methods. We investigated 20 tuberculosis exposed employees, 17 patients with active pulmonary tuberculosis at diagnosis and after 6 months of treatment and 12 healthy controls with no exposure or history of active tuberculosis. We detected flowcytometrically the percentages of circulating lymphocyte subpopulations and Th1/Th2-type cytokines levels. Plasma immunoglobulins were quantified by immune diffusion and chemiluminiscence. Results and discussion. B lymphocytes were significantly lower in exposed and patients. Total IgE and interferon gamma (IFNγ) levels were significantly higher in patients compared to exposed or controls. Tumour necrosis alpha (TNFα) was significantly lower in exposed and patients compared to controls. Conclusions. A continuous clinical status monitoring, correlated with periodical quantification of the above mentioned immunological parameters in tuberculosis exposed workers will help us decide if these are reliable markers for seizing transition to disease.
Irina Alexandrescu, Doina Havârneanu, Doina Popa
Abstract. Aim. The cytological diagnose of exfoliative epithelia has been increasingly used during the last years in biomonitoring human populations exposed to genotoxic agents. Material and methods. While peripheral blood lymphocytes are the tissues most frequently studied to assess cytogenetic damage in humans, in some cases, epithelial tissues may be better models than lymphocytes. Results and discussion. Epithelia are frequently the actual targets of carcinogens, as indicated by the sites of cancers related to exposure. Moreover, exfoliated epithelial cells from the mouth, nose, and bladder can be easily collected for large scale biomonitoring. In the last few years, increasing number of studies, also use other types of epithelia including bronchial, esophageal, intestinal, cervical, and breast duct. Micronuclei (MN) are formed as a result of chromosome damage and can be readily identified in exfoliated epithelial cells. Several methodological issues have to be considered to assure high quality results: timing of cell collection, sufficient number of cells scored, differentiation of normal and degenerated cells on the slides to eliminate false-positives. Factors of interindividual variability, including age and gender differences, are important aspects in the design of biomarker studies using MN assay. Conclusions. Broad spectrum of environmental factors is associated with increased level of MN in epithelial cells. The goal for the future is to validate predictive value of MN in the risk of cancer and other adverse health outcomes.
Dorneanu Olivia, Miftode Egidia, Vremeră Teodora, E Năstase, Filip Olga, V Luca
Abstract. Introduction. Methicillin-resistant Staphylococcus aureus (MRSA) is associated with high morbidity and mortality rates. Materials and methods. We have tested a total of 89 S. aureus strains isolated from blood cultures (25), cerebro-spinal fluid (CSF) (6), pus (48), sputum (3) and urine (10) specimens collected from patients registered in the Infectious Diseases Hospital “Sf. Parascheva” Iaşi, Romania, between 1.01.2006-31.12.2006. The strains have been identified using ID 32STAPH strips and their susceptibility testing was performed using ATB STAPH strips (bioMerieux, France). Minimum inhibitory concentrations (MIC) to oxacillin and vancomycin were assessed using E-tests (AB Biodisk, Sweden). Results. MIC for oxacillin ranged from 0.064 to >256 µg/ml. The prevalence of MRSA in this hospital was 47.1%. Heteroresistance was present in 16.8% strains. MIC for vancomycin was in the susceptible range for all isolates, ranging between 1 to 3 μg/ml. The overall susceptibility of MRSA was: vancomycin 100%, quinupristin-dalfopristin 100%, clindamycin 97%, sulfamethoxazole-trimethoprim 94%, fusidic acid 94%, levofloxacin 50%, erythromycin 19%, gentamicin 9%, tetracycline 9%. Conclusions. Quinupristin-dalfopristin and vancomycin remain the first choice therapy for MRSA infections. To preserve their value, their use should be limited to those cases where they are clearly needed. Sulfamethoxazole-trimethoprim, clindamycin and fusidic acid are good alternatives.
Elena Toader, Lidia Rusu, Liliana Croitoru, Oana Arhip, Camelia Mihăilă
Abstract. The aim of the present study was to determine the incidence and clinical course of ulcerative colitis (UC) in North-Eastern (NE) Romania during 2000-2006. Ulcerative colitis represents a distinct entity of inflammatory bowel disease (IBD) with unknown etiology which affects young people. UC is ubicvitar disease with an incidence rate that varies greatly worldwide. Material and method. There were identified 301 UC cases with use of the diagnosis criteria for UC during the period of time from the year of 2000 till 2006. The incidence was estimated according to districts registered data recorded within – Health District Authorities. Clinical data concerning UC were registered according to medical (hospital) recordings. Results. UC incidence in NE Romania during 2000-2006 was 1.75/105 inhabitants recording a progressive increasing in the studied period. The distribution of the disease in all four districts was: Botoşani 1.65/105 inhabitants; Iaşi 1.95/105 inhabitants; Suceava 1.83/105 inhabitants and Vaslui 1.57/105 inhabitants. The incidence values were higher in urban areas than rural ones (2.23/105 inhabitants vs 1.21/105 inhabitants). The mean age was 45.5 y with the distribution in age group and sex 46.47±14.54 y for male and 44.48±15.37 y for women, at the time of the diagnosis. Complications of the UC as proctitis were found in 35.3% of cases, lift side colitis in 35.3% and pancolitis in 22.6% at the time of diagnosis. Severity of the first attacks evaluated according to Truelove and Witts criteria was mild in 41.7% cases, moderate in 38,2%cases, and severe in 20.1% cases. Conclusion. The low incidence of UC in NE Romania (1.75/105 inhabitants) confirms the low frequency of the disease in this part of Europe. The progressive increasing of incidence UC during the period study and heterogenity distribution in county as unknown, but the evidence support a possible role for behavioural factors (for example nutrition, life style). Socio-demographic characteristics, clinical features, disease extent and clinical course of UC are the same in low-as well as high-incidence area.
C Goiceanu, R Dănulescu
Abstract. The progress of communication technology led to large-scale use of wireless devices both in occupational environment and in private life. Consequently, human exposure to high-frequency electromagnetic fields is increasing and it is necessary to assess it. An important step in exposure assessment consists in measuring electromagnetic field levels at workplaces, in public areas or in residential buildings. To help understanding the requirements concerning the process of measuring field levels, we present some knowledge in this domain. Principles regarding field characterization and measurement are discussed. Basic knowledge on sensors, probes and instruments adequate for field measurement in the high-frequency range are also presented. In the last part of this paper, we focused on main types of instruments, main categories of measuring methods and some general procedure for accurate measurement of high-frequency electromagnetic fields.
Marinela Păsăreanu, Dana Cristiana Rotaru, Roxana Enache
Abstract. Aim. This study was carried out in order to investigate the prevalence, the degree of severity and related feeding habits of baby bottle caries in children who have required dental care at Department of Pediatric Dentistry. Materials and methods. This research was performed in 216 children: 91 boys and 125 girls aged between 3-8 years old. The examined subjects were pre-school and school populations from Suceava county. Results and discussion. The incidence of ECC in Suceava county, in 2006 was 0.047%. About 10.7% of the examined children presented severe temporary tooth decay, due to the prolonged use of nursery bottles. A percentage of 60.8% of these children presented complicated caries with or without tooth crown destruction. The most prevalent habit was sweetened milk (33.3%), honey, sweetened tea and juices (16.7%). Conclusions. This study attempts to give indications regarding the degree of severity of ECC in affected children. Baby bottle caries can cause severe lesions. A most one half of children presented pulpal and periapical involvement of affected teeth with or without tooth crown destruction.
Abstracts „THE FOURTH ROMANIAN-GERMAN SYMPOSIUM ON OCCUPATIONAL MEDICINE”