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PREVENTIVE

MEDICINE

 

ISSN: 1582-5388

 

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Editorial

 

Health service coverage and its evaluation

Elena Lungu

Health service coverage is considered as a concept expressing the extent of interaction between the service and the people for whom it is intended. For the measurement of coverage, several key stages are first identified, each of them involving the realization of an important condition for providing the service: a coverage measure is then defined for each stage, namely the ratio between the number of people for whom the condition is met and the target population. Thus, a set of these measures represents the interaction between the service and the target population. In many countries high priority has been given to the development of basic health services or primary health care.

Health service coverage depends on the ability of a health service to interact with the people who should benefit from it, for example: the ability to transform the intention to serve people into a successful intervention for their health. This transformation process involves a variety of factors, such as availability of resources and manpower, distribution of facilities, supply logistics, people attitudes towards healthcare, etc. It is quite impossible to evaluate the process in its many details, but it is possible to observe the number of people for whom the service has satisfied certain criteria related to the intended health intervention and to compare that number with the target population.   Ü FULL TEXT.PDF

 

Health Patterns and Determinants

 

Multi-stage maximum variation sampling in health promotion programs’ evaluation

AncaVitcu, Elena Lungu, Luminiţa Vitcu, Aurelia Marcu

Abstract. Aim. The current paper presents an effective sampling method accessible to health promotion programs’ evaluation fitted to get rich information about issues of central importance to the purpose of the assessment. Method. The data collection procedure is rooted in a maximum variation sampling. The sample design is based on the principle of maximum diversity, which is an extension of the statistical principle of regression towards the mean based on which instead of seeking representativeness through equal probability, it is sought by including a broad range of extremes. Results. The desirable sample size for our evaluation is 264 respondents. Based on this value we established the key dimensions of diversity which enable us to set up the entire sampling procedure.  Conclusions. Maximum variation sampling allows that against scarcity of data to achieve considerable results which can be more representative than those gained through a random sample.

Key words: health promotion, evaluation program, sampling design, sample size, maximum variation principle     Ü FULL TEXT.PDF

 

Is poverty yet a problem in Romania?

Adriana Galan, Aurelia Marcu

Abstract. Aim. To analyze the level and trends of poverty indicators in relation with health indicators in Romania during 1996 – 2003, and place of Romania among other EU countries. Method. Instead of using one-dimensional poverty indicators, we preferred to analyse composite indexes of wealth, combining the different dimensions of poverty. Composite indexes used by United Nations Development Programme (UNDP) to measure poverty, Human Development Index (HDI) and Human Poverty Index (HPI – 2, for developed countries) were analysed at European Union level (EU-27) for 2004. A trend analysis for the same indicators was done for Romania, covering the period 1996–2003, as well as correlations between HPI-2 and some relevant health indicators. Few comparisons between Urban/Rural areas for Romania are also included. Results. All EU-27 member states are included in “High human development” country cluster, having a value of HDI above 0.8 in 2004. The trend analysis of HDI for Romania reveals a constant increasing tendency after 1999. A slight decrease can be also noticed for HPI-2 values in Romania after 1999. Remarkable differences between rural/urban areas are still present after 17 years of transition in Romania, being even more prominent for severe poverty rate. Infant mortality rate revealed a constant decreasing trend after 1996, following a similar pattern for HPI-2. An unexpected reverse correlation was obtained for the correlation analysis of Tuberculosis (TB) incidence (both in general population and in children under 15 years of age) with HPI-2. Conclusion. If before 2004 Romania was classified as medium human development countries, after 2004 Romania belongs to the cluster of high human development countries (with a HDI value of over 0.800). Nevertheless, Romania ranks last according to HDI between EU-27 member states. Yet existing poverty in Romania is one of the major factors contributing to the unsatisfactory population health status. Sustained efforts are requested to develop and implement effective poverty reduction policies in Romania.

Key words: poverty, Human Development Index, Human Poverty Index, health status, Romania      Ü FULL TEXT.PDF

 

A brief analysis of noncommunicable diseases in Romania, 1996-2004

Luminiţa Vitcu, Anca-Gabriela Vitcu, Aurelia Marcu, Alexandra Cucu

Abstract. Aim. The current paper presents a brief method focused on the identification of noncommunicable diseases (NCDs) with unfavourable evolution which need target interventions policies for diminishing the deterioration of populations’ health. Method. A valid supervises of health needs involve at least the description of two major components: disease and death. The method proposed is based on the calculus of percentage change in the rate of standardised mortality for age group 0-64 years and in the rate of discharge from hospital for NCDs which are important causes of premature death. In the same time it is presented a simple mathematical model from time series analysis. The methodology is applied in EU and recommended by WHO. Results. In this paper the analysis is applied for Romania by comparing the main outcomes with the corresponding EU results. For both cases the chronic diseases with a sharply evolution were identified and for Romania an expected development of standardised premature mortality rate after 2004 and the percentage change in health over 2004-2009 estimated with 95% confidence were also proposed. Conclusions. The growth in the rate of hospital discharges during 1996-2004 shows in an indirect way the unfavourable evolution of a special group of diseases. The calculation of percentage change is complementary to the classical calculus of rate and brings about value-added pointing at the explosive evolution of some major diseases. The method is a useful tool for the elaboration of strategies on prevention of NCDs and a map for an optimal resource management (health units, staff, budget) according to their trend.

Key words: noncomunicable diseases, premature mortality, standardised death rate per 100000, hospital discharges, percentage change, trend analysis Ü FULL TEXT.PDF

 

Meningococcal disease in the North – East region of Romania

Angela Romaniuc, Anca Nistor, Michaela Scripcaru, Dana Zagnat

Abstract. The meningococcal disease represents a priority in epidemiological surveillance; mortality remains high – 10.39 %000 as well as neurological complications are severe. Since 2006 it had been benefiting by a methodology of surveillance at the national level. Objective. The knowledge of the evolutionary specific features of meningococcal disease after the introduction of the standardized surveillance for optimization of control strategies. Material and methods. A descriptive study using regional database (EPIDATA) containing meningococcal disease cases reported between 2002 and 2006. The processing and analyzing data was achieved with EPI INFO and Health Mapper programmes. Results. The average of incidence rate in the North-East region of Romania, in last 25 years, was equal to 3.4 per 100,000 populations with two epidemical increases: one between 1985 and 1987 – 16.2%000 (in years 1986) and another between 1998 and 1999 – 3.1%000. In the last years (2002- 2006) the average of incidence rate decreased at 1.35%000. The highest incidence rates were observed in the <5 years age group (12.56%000) followed by the 5-9 years age group and 10-14 years age group. The average of mortality was 0.17 %000 with a case fatality ratio equal to 11.9 %.The highest case fatality ratio was observed in the 0-5 years age group (15.28%) (IC95%:10.08-21.86). The epidemiological indicators of meningococcal disease surveillance evidenced low precocious detection (30.5 %) with the reporting in time of the cases at the Authority of Public Health. Conclusions. The meningococcal disease is a priority because of its severity. There are necessary efforts for early detection, reporting in time, optimization of the criterias for confirmation and the introduction of definition of surveillance for invasive meningococcal disease.

Key words: meningococcal disease, epidemiology, standards of surveillance  Ü FULL TEXT.PDF

 

Seasonal mortality in Romania (Part I – general methodology)

Anca Vitcu, Luminiţa Vitcu, Elena Lungu, Carmen Ispas

Abstract. Aim. The aim of the present study is to examine the form and relationship between total mortality/morbidity and temperature variations within the cities of Romania during a 2004-2007 as well as to assess the magnitude of this association. Method. The epidemiological evaluation of the dynamic relationship between environmental temperature and health is undertaken using both simple analysis and ARIMA models. In this article we present methodologies appropriate for the available data in Romania. Results. A statistically significant association is expected to be found between temperature and mortality/morbidity. Conclusions. Research on the association between temperature and mortality/morbidity has relevance to the formulation of health policy serving at-risk populations.

Key words: climate change, extreme temperature, excess mortality, morbidity, ARIMA models  Ü FULL TEXT.PDF

 

Dermatoglyphics in juvenile delinquence

Ana Ţarcă

Abstract. Aim. The author develops complete digital dermatoglyphic investigations, on the basis of a pathological perspective, on a group of delinquents from Moldova (North-East part of Romania). Materials and methods. The study was performed on a group of 105 teen-agers and young delinquents with ages between 16 and 26 years, imprisoned in the Penitentiary of Iaşi, coming from different districts (the district of Iaşi, especially) of Moldova. Results. The main observation to be made is that the large range of blamable actions committed by the delinquents, from robbery up to crime, is correlated with the presence – in their fingerprints – of some important malformative sketches (distortions or anomalies) bearing deep pathological significance. At the level of the whole sample, the frequency they record differs sensibly from that of the reference group of Moldova, being nevertheless situated between the values found out by the author in other severe brain disorders, such as autism, IEP and epilepsy. Conclusion. All these observations demonstrate that such anomalies had been formed as early as the pre-natal period, when the papillary ridges are also finished up, under the action of some hereditary or teratogeneous factors, while bursting of an aggressive behaviour from the part of their carriers occurs in post-natal periods, at different ages, earlier or later (in the case under study: at juvenile ages), as a function of the severity of the disorders having occurred at brain level in the prenatal period and, equally, as a function of multiple external circumstantial (social, family) factors which they have to face. Most of the digital distortions here under analysis had been also evidenced on other European groups of delinquents, with the exception of two, namely: the extremely high ratio of the raketoid-type loops – on fingers IV and V, especially – and that of the bilateral and individual monomorphism, anomalies representing the personal contribution brought by the author to the list of digital dermatoglyphic indicators, for a precocious tracing of the persons risking commitment of severe offences, at least at the level of Moldova, the region from which the investigated subjects come.

Key words: digital dermatoglyphics, distortions or anomalies, pathology, juvenile delinquency  Ü FULL TEXT.PDF

 

Antioxidant status in protected experimental herbicide intoxication

Felicia Gradinariu, Al. Maftei, Doina Popa

Abstract: This study investigates the possible protective effect of dietary supplements and their efficacy in rat experimental 6 months intoxication with 2,4-dichloro-phenoxyacetic acid herbicide (2,4-D). The protecting tested agents were: metaspar (M), a drug containing methionine, aspartic acid, B1, B6 and PP vitamins and eurovita (E),.a mix of multiminerals and multivitamins. All tested substances were administered in food, twice a week, dissolved in sunflower oil. Animals 10/group were fed respectively with: standard food (control), equivalent vehicle (vehicle control), toxic (2,4-D), metaspar protected group (2,4-D+M) and eurovita protected group (2,4-D+E). After 6 months they were sacrificed, blood and liver were analyzed with standard methods and commercial kits for total and reduced glutathione, erythrocyte superoxide dismutase (SOD) activity and serum thiobarbiuric acid reactive substances (TBARS) (lipoperoxides). The results showed the enhancement of antioxidant defense in protected groups, without clear-cut differences between the two tested compounds.

Key words: 2,4-dichlorophenoxyacetic acid, protection, amino acid, lipid peroxidation, herbicide  Ü FULL TEXT.PDF

 

Natural radionuclides in some Romanian medicinal mineral water

Elena Botezatu, Olga Iacob, Andreea Grigorescu

Abstract. Aim. There are many natural springs and drilled wells in the north-eastern of Romania, which produce waters enriched in minerals and are used as medicinal waters. For this reason, we were interested in finding out the extent to which these waters can be a natural radiation source. This survey aimed at assessing the radioactive content of these waters and their contribution to the population exposure. Materials and methods. The mineral water springs clustered in northeastern Romania and their uses for medicinal aims have been inventoried. Between 1999 and 2005, mineral water samples were collected several times over this period at locations of mineral water in the Slanic Moldova (Bacău district) and Vatra Dornei (Suceava district) spa resorts. Also, some communal springs, which are open to public and frequently used as medicinal drinking water without any sanitary certificate in the same districts, were studied. All samples (800) were analysed for gross alpha and beta radioactivity and the natural radioelements of utmost interest (natural uranium and thorium, radium-226 and potassium-40). Results and discussion. The natural radioactivity varies over a large range (up two orders of magnitude). The activity concentrations in water samples were found to be over the detection limit, with values ranging from 1.5 to 74 mBq/l, from 1.5 to 25 mBq/l and from 17 to 1780 mBq/l for 226Ra, 238U and 40K, respectively. It can be seen a similar situation in both districts that is the low concentration of 232Th (0.4 - 2.5 mBq/l). The average concentrations of radium-226 were three times higher in water from Bacău  district, but the uranium-238 activity was twice lower than that in Suceava district. The geometric means values for radium-226 were of 22.6 mBq/l and 5.7 mBq/l in Bacău and Suceava district, while, those for uranium-238 were 6.2 mBq/l and 9.6 mBq/l, respectively, for the same districts. The estimated effective doses received by individuals undergoing mineral water drinking cure are of 0.06 – 0.65 mSv and through inhalation are of 0.05 up to 0.4 mSv. The individual effective dose rates in external cure treatment are very small, respectively, (1.3 – 3.5) x 10-4mSv by immersion and (0.2 – 4.4) x 10-8mSv by washing. Conclusions. An hypotetical person that undergoes a cure of mineral water by ingestion, inhalation and immersion is receiving an average supplementary dose of only 0.3 μSv over background radiation of 2,450 µSv·y-1 due to all natural radiation sources in Moldavia (northeastern of Romania). The contribution of mineral water used in therapeutic purposes to the natural irradiation of population is very slight, almost insignificant.

Key words: mineral water, springs, medicinal  water, internal and external cure treatment, natural radioactivity, gross alpha and beta radioactivity, specific activities of natural uranium, natural thorium, radium-226, potassium-40, effective doses  Ü FULL TEXT.PDF

   

Evolution of the main growth and development parameters in teenagers from the Chisinau district (Republic of Moldova), versus the evolution of teenagers from the districts of Bacau, Neamt, Suceava and Timis (Romania)

Angela Simalcsik, Robert-Daniel Simalcsik

Abstract. The study analyzes the evolution of the main growing and development parameters (stature and weight), along the 10-16 years interval of age, in the teenagers of the Chişinău district (Republic of Moldova), comparatively with the teenagers of the same chronological ages from the Bacău, Neamţ, Suceava and Timiş (Romania) districts. In the pre-pubertal stage (10-13 years), both the girls and the boys from the Chisinau city evidence average values of stature and weight higher than the other groups while, in the post-pubertal period, the situation is wholly reversed, the series under study appearing inferior in both it stature and weight, comparatively with the other 4 series (the cities of Bacău, Piatra Neamţ, Suceava and Timişoara). In the rural medium, as to stature, the situation is similar with that of the girls from the urban group, while, in the case of boys, a clear-cut superiority is evidenced in the villages of the Chişinău district, over the whole interval under study, versus their colleagues from the other series. Referring to bodily weight, over the 10-16 years interval, the teenagers (both boys and girls) from the rural area of Chişinău evidence higher average values than their colleagues from the comparative groups, the differences recorded being significant for all classes of age.

Key words: growth, development, teenagers, stature, weight  Ü FULL TEXT.PDF

 

Compensation issues in case of occupational diseases and accidents

Laura Grădinariu

Abstract: This study investigates the possible protective effect of dietary supplements and their efficacy in rat experimental 6 months intoxication with 2,4-dichloro-phenoxyacetic acid herbicide (2,4-D). The protecting tested agents were: metaspar (M), a drug containing methionine, aspartic acid, B1, B6 and PP vitamins and eurovita (E),.a mix of multiminerals and multivitamins. All tested substances were administered in food, twice a week, dissolved in sunflower oil. Animals 10/group were fed respectively with: standard food (control), equivalent vehicle (vehicle control), toxic (2,4-D), metaspar protected group (2,4-D+M) and eurovita protected group (2,4-D+E). After 6 months they were sacrificed, blood and liver were analyzed with standard methods and commercial kits for total and reduced glutathione, erythrocyte superoxide dismutase (SOD) activity and serum thiobarbiuric acid reactive substances (TBARS) (lipoperoxides). The results showed the enhancement of antioxidant defense in protected groups, without clear-cut differences between the two tested compounds.

Key words: 2,4-dichlorophenoxyacetic acid, protection, amino acid, lipid peroxidation, herbicide Ü FULL TEXT.PDF

 

Activities concerning non-ionizing electromagnetic radiation protection at the Institute of Public Health of Iasi

Cristian Goiceanu, Răzvan Dănulescu

Abstract. During last decades, at international and EU level, the issue of health protection against non-ionizing electromagnetic radiation has shown an increasing interest. World Health Organization initiated projects on effects of exposure to electromagnetic fields and to ultraviolet radiation. The International Commission on Non-Ionizing Radiation Protection elaborated guidelines on limiting exposure to non-ionizing radiation. EU adopted Directives and Recommendations to limit human exposure to this kind of radiation. In Romania, before 1990, the issue of health protection against non-ionizing radiation focused on ultraviolet, infrared and lasers radiation. The first standard for occupational exposure to electromagnetic fields was adopted in 1996 and later, in 2002, regulations on general public exposure were adopted. At the Institute of Public Health of Iaşi, the topic of non-ionizing electromagnetic radiation protection has been addressed since 1992. In 1997, the Romanian Working group on Non-Ionizing electromagnetic Radiation Protection was founded in Iasi, based on a core from the Institute of Public Health of Iaşi. During last 15 years, our team has carried out many activities in this field: drafting exposure standards, calculation of exposure limits, determination of electromagnetic field levels, elaboration of procedures and methodologies for electromagnetic field measurement. A “Practical guide for electromagnetic field measurement at workplaces” was published in 2006. Moreover, our consultancy services on human exposure to electromagnetic fields are provided for various levels of society. Our team is also carrying out scientific research activities in this domain like epidemiological studies concerning health consequences of occupational exposure to electromagnetic fields. Moreover, experimental studies on animals exposed to electromagnetic fields have also been carried out. Scientists from our team have got involved in national and international research projects and, also, in EU Networking Projects such as EMF-NET Project and COST.

Key words: non-ionizing electromagnetic radiation, human exposure, health protection Ü FULL TEXT.PDF

 

Evaluation of attitudes regarding contraceptive methods

Muntianu Alexandru Emilia

Abstract. Aim. The aim of the study was to identify the degrees of contraceptive methods evaluation, as well as their implications. Method. There was used a questionnaire that was applied to women who appealed to family planning and gynaecologic offices from Iaşi. Results. It were investigated 100 women within family planning office, especially from age groups 25 – 29 and 30 – 34 years (respectively 26%) and 100 women, within gynaecologic office, by age 25 – 29 (33%) and 35 – 39 years (26%). The debut of using contraceptives methods was predominant on age groups 20 – 24 years (26% vs 52%) and under 20 years (24% vs 12%). In the first group women with secondary studies were more numerous (68% vs 40%), and in the second one, those with superior studies (22% vs 59%). The most known modern contraceptive methods in both types of offices were: condoms (67% vs 57%); pills (63% vs 56%); cervical cap  (55% vs 46%) etc. and as those traditional, coitus interruptus (28% vs 22%); calendar method (45% vs 36%) etc. Up to the interview, most of women did not use any contraceptive method (39% vs 54%). Among family planning services to who women appealed before, family planning offices were 35% vs 21% and gynaecologic ones 34% vs 60%. Women declared as information sources: physician (44% vs 61%), mass-media (36% vs 46%), and supplying sources: pharmacy (39% vs 60%), family doctor office/health unit (20% vs 11%) and declared as unknown 33%. Conclusions.  At the two types of offices appealed especially young women (25 – 39 years old). Age of debut of using contraceptive methods using, it proved to be more and more younger (average age for the first group being 16,51 years and for the second, 18,2 years.). More younger women use contraceptive methods (average age of debut being for the first group 16.51 years and for the second, 18.2 years).

Key words: family planning office, gynaecologic office, contraceptive methods Ü FULL TEXT.PDF

 

Tendencies of nitrates acute intoxication in newborn of Bacău county during 2000 - 2005

Mihaela Popescu

Abstracts. Aim. The methemoglobinemy annual monitoring within the National Community Health Program represented the support of the descriptive epidemiologic study of the medical cases in Bacău county, in 2000-2005 period, compared to former periods of time and to other territories in North-Eastern of Romania. Material and methods. On a decreased incidence background in the Romanian Eastern part of the territory, Bacău county maintains an incidence level of 2.0-5.3‰, with a slightly increased (and sometimes constant) tendency in the region. The total of 161 cases registered in Bacău county, in 2000 – 2005 period, represented 19.1% of the cases in North-Eastern region. Results. With descriptive aspects regularly met in cases of methemoglobinemy regarding gender, age, child’s nutrition, over half of them were produced due to exposure to nitrates quantity in water over 101 mg/dm determined by inadequate hygienic conditions of the fountains. Conclusions. The territorial distribution of the cases outlines the areas by risk of the county, indicating, at the same time, the measures of the primary prophylaxis that must be taken.

Key words: child methemoglobinemy, water quality in the rural environment, descriptive epidemiologic study Ü FULL TEXT.PDF

 

 

Dental  Health

 

Considerations regarding early childhood caries

Marinela Păsăreanu 

Early childhood caries (ECC) is a recent term that describes rampant dental caries in infants.

Terms describing this affliction have evolved during the last 20 years, and include names like nursing caries, nursing bottle caries and baby bottle caries (1).

Redefined as ECC, this affliction involves the presence of one or more decayed tooth surfaces (cavitary or non-cavitary lesions) and, or missing teeth due to caries or restorations of any deciduous teeth in children between 3-4 years of age or before 72 months.

The presence of any sign of cavity in children younger than 3 years old indicates severe ECC, S-ECC is also defined as “atypical”, “progressive” acute rampant. In children between 3 and 5 years old the presence of one or more cavities, missing teeth due to cavities, the presence of fillings in the maxillary anterior teeth > 1=4 (for 3 years old), >1=5 (for 4 years old), >1=6 (for 5 years old) are signs of S-ECC (2). Ü FULL TEXT.PDF

 

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Abstracts "THE FIFTH ROMANIAN-GERMAN SYMPOSIUM ON OCCUPATIONAL MEDICINE"