La lutte pour la vie. Une analyse multiscalaire de la dynamique de la mortalité infantile dans l’Europe contemporaine

The infant mortality analyse may be approached also of the geographical perspective. This perspective is centered arround the concept of spatial differentiation. The study followed the disparities developed during the processus of the demographical modernization, especially of the infant mortality. The outset of the study is a complexe database, organized in three levels: continental, national and departmental. The period surveyed began in 1950, for the top two levels and in 1966, for the third level. The statistical analysis effectuated by the Statlab point to the existence of an strong correlation between the economic and social evolution and the stint of infant mortality incidence. Next to this correlation there are a series of contradictions, engendered by the local peculiarities. The most often, these characteristics derived from the quality of the medical services and sanitary infrastructure. The political and the cultural contexte may be added. These contradictions there are much manifested at the local level. One other conclusion converged towards the existence of any tendence of a quickely decrease o the infant mortality, unresponsive at the economic growth and the amelioration of the social estate

Assessment of community mental health centers in Moldova

Catedra Psihiatrie, Narcologie şi Psihologie Medicală, USMF „Nicolae Testemiţanu” UMF „Gr.T.Popa”, Iaşi, RomâniaThe purpose of this trial was to study the system of mental health services in Moldova. MHC Somato is an independent institution for adults and has all the necessary components of MH community-based service. CCTMSD Danko is an independent institution for children with day and home care services. CMHC Buiucani provides predominant psychiatric psychological and social consultations; NMHC provides services to patients from the CPH and Botanica’s sector (Chisinau). CMHC Rezina and CMHC Ungheni function as a psychosocial rehabilitation day services. Scopul lucrării a constat în studierea sistemului serviciilor de Sănătate Mintală în Republica Moldova. CSM Somato este o instituţie independentă pentru adulţi şi are toate componentele necesare a unui serviciu comunitar de SM. CCTDM este o instituţie independentă pentru copii cu asistenţă de zi şi la domiciliu. CCSM Buiucani activează preponderent prin consultații psihiatrice, consiliere psihologică și socială. CNSM prestează servicii pacienţilor din cadrul SCP și sectorul Botanica (mun. Chișinău). CCSM Ungheni şi CCSM Rezina funcţionează ca un serviciu de reabilitare psihosocială de zi

The context, methodology and results of evaluation of community mental health centers in Moldova

Catedra Psihiatrie, Narcologie şi Psihologie Medicală, USMF „Nicolae Testemiţanu” UMF „Gr.T.Popa”, Iaşi, RomâniaThe aim of this study is to assess the activity, assess the level of adjustment to national standards of Community Mental Health Centers. Performing the analysis, we concluded that all centers are different in terms of organizing activities and functionality. Community Mental Health Centers have various documents governing their operation and different component of the staff; staff is competent, has undergone various training from various projects; the quality of services, staff and beneficiaries’ satisfaction is not monitored at all centers; the community mental health centers are funded from different sources and its calculation is done through different methodologies from case to case. Scopul lucrării constă în evaluarea activităţii, aprecierea nivelului de adaptare la standardele naţionale a Centrelor Comunitare de Sănătate Mintală. În urma analizei s-a constatat că toate centrele sunt diferite din punct de vedere al organizării activității și funcționalității. Centrele de Sănătate Mintală au diferite documente ce reglementează funcţionarea lor şi componenţă diferită de personal; personalul este competent, a beneficiat de multiple instruiri din cadrul diverselor proiecte; calitatea serviciilor, satisfacţia personalului şi a beneficiarilor nu este monitorizată la nivel în toate centrele, iar finanţarea lor este din diferite surse şi calcularea lor diferă de la caz la ca

The Stigma of the Medical Personnel in Psychiatry

This research was structured as a descriptive study based on a questionnaire with seven questions, addressed to the medical personnel involved in the medical assistance of the patient with mental disorders (psychiatrists, family doctors, physicians from other specialties, psychologists). This study refers to the relationship medical team – psychiatric patient from the point of view of the health professionals. The main appreciation criteria refer to the lack of knowledge or minimizing the importance of patients’ rights, aspect that can influence the voluntary addressability of psychiatric patients to treatment and therapeutic success.The lot of this study had a number of 217 subjects from which are part psychiatrists, family doctors, physicians from other specialties and psychologists, who work in therapy centers and hospitals from the following counties: Iaşi, Botoşani, Suceava, Vaslui.</p

TRICOBEZOAR GASTRIC GIGANT LA O ADOLESCENTĂ CU TRICOTILOMANIE

Introducere. Bezoarul este un conglomerat alcătuit din material parţial digerabil sau nedigerabil impactat la nivelul stomacului. Tricobezoarul (aglomerările de păr) apare cel mai frecvent la pacienţii cu tulburări psihice (tricotilomanie) şi reprezintă o patologie rară care poate determina dificultăţi diagnostice si terapeutice. Material şi metodă. Prezentăm un caz de tricobezoar gastric la o pacientă in varsta de 12 ani, fără antecedente personale patologice, internată pentru epigastralgii şi vărsături alimentare. Examenul clinic relevă la palparea abdomenului o formaţiune epigastrică de aprox. 5/3cm, dură, imobilă, aderentă de planul profund la care examenele de laborator relevă doar o uşoară anemie hipocromă microcitară. Endoscopia digestivă superioară vizualizează tricobezoar gigant de aprox 17 cm, vizibil din zona subcardială până în regiunea antrală, fixat cu un fir de păr de o zonă cu aspect inflamator pseudopolipoid, situata prepiloric. Pacienta a fost dirijată către serviciul de chirurgie pediatrică, întrucât dimensiunea tricobezoarului nu a permis extragerea pe cale endoscopică. S-a tentat initial extragere prin abord laparoscopic, care nu a reuşit si a impus laparotomie minimă subcostală stângă, gastrotomie cu evacuarea tricobezoarului gastric. Postoperator evoluţie favorabilă. Discuţii. Cu toate că prevalenţa la om este scăzută, mortalitatea poate atinge în anumite cazuri 30%, datorită sângerărilor, obstrucţiei, peritonitei sau eventualei perforaţii gastrointestinale ce pot apărea. Diverse metode endoscopice au fost raportate pentru extragerea bezoarului, precum litotripsie cu unde şoc, îndepărtare prin aspirare folosind endoscop cu canal larg de lucru, extracţie cu ansă de polipectomie şi forceps de biopsie. Concluzie. Raritatea acestei patologii în populaţia pediatrică impune un diagnostic diferenţial atent. Dificultăţile terapeutice se datorează dimensiunilor tricobezoarului, iar prognosticul depinde de patologia psihiatrică subiacentă

DIRECT RELATIONSHIP MANAGEMENT BETWEEN DENTISTS, THE PROMOTION SYSTEM AND THE DISTRIBUTION CHANNELS OF DENTISTRY PRODUCTS

This project wreathes three years work in medical field and it comes to mark out and understand the main forces of marketing field followed by examples which underline the impact on the market of a distribution company and, also, understanding the company relationship between its internal and external environment, the direct relationship with the market and with its’ the competitors. The aim of this cross-sectional study was to underline the relationship between the distibution companies and the private dental offices, also the direct relationship between the dentist and the promoting sistem, the distribution way of dentistry products. For a most acurate research, it’s necessary to apply different methods of research in the market. The main methods are observation and investigation. The measurement of the products circulation in the final sale point– all across the distribution line–is the primary function of marketing research. In the study, measurements can be determinated by: the number of sold units, by the value in standard currency of total sales from one period to another. In relationship with the economic and social environment and also with the dentistry market, the marketing of modern companies can’t limit only to the production process and distribution of the units; it involves a permanent and complex communication with the extern environment which imply a good information of the leaders, specific actions of lobby for sales and input; all those actions represents the promotion policy of the distibution companies of dentistry product

GIANT GASTRIC TRICHOBEZOAR IN A TEENAGE GIRL WITH TRICHOTILLOMANIA

Introduction. A bezoar is a conglomerate comprising partially digested or undigested matters, impacted in the stomach. Trichobezoars (agglomerations of hair) occur most frequently in patients with mental disorders (trichotillomania) and represent a rare pathology that can entail diagnostic and therapeutic difficulties. Material and method. We are reporting a gastric trichobezoar case in 12 years old female patient with no pathological personal history, admitted for epigastric pain and food vomiting. Clinical examination revealed an epigastric formation of approx. 5/3cm, rigid, immobile and adhering to the deep structure, while laboratory tests revealed a mild microcytic hypochromic anemia. Upper gastrointestinal endoscopy provided visualization of a giant trichobezoar of approximately 17 cm, visible from the subcardial region down to the antral region, hooked by one hair onto an area with a pseudopolypoid inflammatory aspect located in the prepyloric region. The patient was referred to the pediatric surgery department, as the size of the trichobezoar did not allow for its endoscopic extraction. The initial attempt for laparoscopic extraction was unsuccessful and required a minimal left subcostal laparotomy, followed by gastrotomy with evacuation of the gastric trichobezoar. The postsurgical evolution was favorable. Discussions. Despite its low prevalence in humans, mortality can sometimes reach 30% in certain cases due to the bleeding, obstruction, peritonitis or ultimately the gastrointestinal perforations that could occur. Various endoscopic methods were reported for bezoar extractions, such as shock wave lithotripsy, removal via aspiration using a large gauge endoscope, extraction with polypectomy snare and biopsy forceps. Conclusion. The rareness of this pathology in the pediatric population requires a very careful differential diagnosis. The therapeutic difficulties result from the size of the trichobezoar, while the prognosis depends on the underlying psychiatric pathology

Comorbidity and Health Condition – the Necessity for Integrated Care

Comorbidity has become a global health problem, a phenomenon which equally affects developing and developed countries. Comorbidity is associated with an increase of morbidity, mortality, has a strong impact on economy and is multidimensional in the frame of mental health and beyond. Management of comorbidity requires an integrated approach; community related and also focused on person, who takes into account medical, psychiatric and contextual factors

ABORDAREA PSIHOSOMATICĂ A BOLILOR DIGESTIVE LA COPIL

Bolile psihosomatice sunt acele afecţiuni medicale a căror apariţie şi/sau evoluţie este determinată, în mod semnifi cativ, de factori psihologici. Principalele tulburări digestive în care factorul psihosomatic este prevalent sunt: afecţiunile gastroduodenale, esofagitele corozive, constipaţia, encompresis, diareea emoţională, sindromul colonului iritabil, rectocolita ulceroasă şi boala Crohn. Conduita terapeutică se bazează pe strânsa colaborare dintre psiholog şi pediatrul gastroenterolog. Psihoterapia de susţinere este necesară pentru completarea medicaţiei. Copilul trebuie să primească suport emoţional şi ajutat să îşi înţeleagă sentimentele faţă de situaţia de boală traversată. Medicul trebuie să realizeze o relaţie de încredere, să dezvolte o atitudine empatică, onestă şi deschisă în relaţiile cu copiii

UPDATES IN EPIDEMIOLOGY AND PREVENTION OF HELICOBACTER PYLORI INFECTION

Worldwide more than 1 billion people are estimated to be infected with Helicobacter pylori. Numerous factors from age to genetic predisposition and educational level were incriminated in the high prevalence of the bacteria. The direct and indirect transmission paths were studied but a defined transmission path is not established. The most plausible transmission path is human-to-human: vertical or horizontal and the possible routes are gastro-oral, oral-oral, or fecal-oral. Due to the increased resistance to various antibiotics, which leads to treatment failure, more attention is given to prevention and new alternative therapies. From Cladosiphon fucoidan a safe, non-antibiotic agent to plant extract with antibacterial activity mixed with baby milk many alternative therapies were proposed in order to prevent H. pylori infection and reduce the risk of associated gastric cancer. The ultimate strategy regarding the infection must be the complete eradication of the bacterium and vaccination against H. pylori remains the most challenging issue