Preparation of the specialists with high medical education for the professional activity in the field of public health

Department of Epidemiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaThe purpose of the article is to analyze the process of the training of specialists with higher medical education for professional activity in the organizations of public health services and the development of current requirements for human resources in this area. For the period of 1963-2012, 2695 students were enrolled in the first year course, and 1941 doctors graduated from the university having got the diplomas of this profile. Since 1991, after the declaration of independence, a number of changes and reforms of the entire health system, including the training of specialists have been conducted. The purpose of the reforms has been the maintenance of the functionality of the sanitary and epidemiological service in the conditions of a deep socioeconomic crisis, the worsening of epidemiological situation due to the decrease of the of organizational measures to fight and prevent infectious diseases, emergence of the new diseases with high epidemiological potential of distribution and reemergence of some diseases, that used to be under control; the latter has presented a trend of the deterioration of many health indicators of the population. In the framework of the Tempus project Master Programmes in Public Health and Social Services, a new curriculum for postgraduate training through Master/Residency Program for the graduates on the specialty Public Health has been elaborated. The curriculum was implemented in 2012-2013 academic year. A questionnaire on the training quality evaluation has been filled in by residents at the end of the teaching modules. 129 questionnaires on the training at 9 of 12 modules have been filled in. The results of the performed study will be used to improve the curriculum of post graduate training, elaborate the requirements for the specialists in the field of public health of the Republic of Moldov

Efficiency assessment of the information system on surveillance of communicable diseases and public health events

Department of Epidemiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, National Center of Public Health, Chisinau, the Republic of MoldovaBackground: The process of the implementation of information technologies in the system of public health surveillance is going on, providing an essential support in improving the quality and accessibility of the data on the epidemiological situation and morbidity trends as well as in improving the surveillance optimization and control of communicable diseases and health events in the terms of time, human resources and effective financial management. Material and methods: The efficiency evaluation of the electronic system of surveillance over communicable diseases and public health events has been performed by analyzing the system functionalities and assessing the health workers’ satisfaction in the light of simplicity, flexibility, quality and acceptability of the system. Results: The level of the satisfaction of medical personnel (family doctors and epidemiologists) concerning the electronic system functionalities has a direct correlation with the general computer knowledge and working skills. The informatization of the main activities of the public health service corresponds to the information complex integrated into the health care system and e-government strategy and consists of its subsequent integration into the unified information space of the country. Conclusions: At present the integration of information systems in the field of medical care and public health supervision is a problem that requires an integrated and comprehensive approach, focused on the consolidation and optimization of the management of human and financial resources and the achievements of the best indicators in the public health service

Rolul căpuşelor Ixodes ricinus (Ixodidae) în menţinerea riscului de contractare a borreliozei Lyme în ecosistemele Republicii Moldova

National Centre for Public Health, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaIntroducere. Borrelioza Lyme (BL) reprezintă o zooantroponoză cu tendinţă clinică de cronicizare, cauzată de Borrelia burgdorferi şi transmisă de căpuşele din genul Ixodes (familia Ixodidae Murray, 1887). Ixodidele se alimentează cu sânge în unele faze biologice de dezvoltare (larve, nimfe şi imago). Larvele şi nimfele se alimentează cu sânge, în special, pe mamifere mici (Rodentia, Insectivora), păsări şi reptile, cele adulte (imago) – pe mamifere sălbatice (căprioare), domestice (bovine, ovine, caprine) şi de campanie (pisici, câini). Omul neprotejat, nimerind în arealul ixodidelor poate fi „muşcat”, inclusiv şi de căpuşe infectate. Primele date despre existenţa focarelor de BL în Republica Moldova au fost publicate în anii 1990-1992. Însă la acel moment BL nu era inclusă în lista maladiilor raportabile în sistemul de supraveghere al bolilor infecţioase în Republica Moldova. Înregistrarea oficială a cazurilor de BL în Republica Moldova a început în anul 2000. Raportarea standardizată în sistemul naţional de supraveghere în baza definiţiei de caz «suspect», «probabil» şi «confirmat», inclusiv a criteriilor de laborator se realizează din 2007 şi continuă până în prezent. Material şi metode Ca material de studiu au servit căpuşele ixodide, colectate în perioada anilor 2009-2011, în conformitate cu metodele standard, din teritorii selectate pentru monitorizare. De pe vegetaţie s-au colectat 1 056 de exemplare căpuşe ixodide şi 1 169 de ex. de pe ovine, bovine şi caprine, fiind analizate diversitatea şi densitatea speciilor în cauză. Pentru determinarea nivelului de infectare cu borrelii au fost investigate 437 de ex. căpuşe ixodide, cercetând hemolimfa şi conţinutul intestinului prin microscopia frotiurilor cu fond negru, în conformitate cu indicaţiile metodice. Rezultatele obţinute au fost supuse unui calcul statistic, acceptat prin intermediul programului de calculator EXCEL. Rezultate obţinute Au fost identificate speciile de păşune Ixodes ricinus, Dermacentor marginatus, D.reticulatus, Haemaphysalis inermis şi H.punctata. Datorită caracteristicilor vitale de acomodare în mediul înconjurător, specia I.ricinus a fost identificată în toate cele trei zone geografice ale ţării. Indicele densităţii medii a speciei I.ricinus în perioada anilor de studiu a fost ~ de 21 de ex. la ruta standard 200 m. Pentru determinarea prezenţei borreliilor în căpuşe s-au investigat speciile I.ricinus şi D.marginatus. Prezenţa borreliilor s-a depistat la 17,9% căpuşe investigate în anul 2009, la 36,4% în anul 2010 şi 28,5% în 2011. Prezenţa borreliilor a fost determinată doar la specia I.ricinus. În condiţiile, când populaţia frecventează zonele de odihnă şi agrement, biotopuri de pădure şi agrocenoze, care sunt intens populate de căpuşele speciei I.ricinus, cu o pondere înaltă de infectare cu borrelii, nu respectă regulile comportamentale şi de protecţie contra „muşcăturilor” de căpuşe, contractarea borreliozei Lyme devine iminentă. În ultimii ani numărul îmbolnăvirilor prin borrelioza Lyme este în creştere (anii 2009 – 33 cazuri, 2010 – 117, 2011 – 171). În anul 2011 boala s-a înregistrat în 15 teritorii administrative, preponderent în mun. Chişinău (70,1%), în rândul populaţiei mature (84,2%), în lunile mai-octombrie (89,4%). Depistarea borreliozei Lyme are loc în rândul pacienţilor ce se adresează cu „muşcătură” de căpuşă, acuză prezenţa eritemului migrator la locul „muşcăturii”, unele afecţiuni ale sistemelor nervos, cardio-vascular, musculo-scheletal. Raportarea cazurilor de BL se efectuează de către medicul de familie şi alţi specialişti ce au depistat boala, în baza definiţiilor de caz «suspect», «probabil» sau «confirmat». Confirmarea de laborator al diagnosticului clinic include determinarea anticorpilor specifici IgM sau IgG către B.burgdorferi în serul sangvin sau LCR în reacţia imunoenzimatică (ELISA) sau reacţia imunofluorescentă indirectă (RIFi), urmate de confirmarea prin Western blot. Detectarea ADN-ului genospeciilor patogene de B.burgdorferi se efectuează prin reacţia de polimerizare în lanţ (PCR). Cazurile de boală sunt furnizate în sistemul electronic de supraveghere a bolilor transmisibile şi se efectuează anchetarea epidemiologică pentru identificarea circumstanţelor de molipsire şi implementarea măsurilor de răspuns. Concluzii Căpuşele din specia I. Ricinus, contaminate cu borrelii patogene menţin riscul de molipsire prin borrelioză Lyme. Gradul de expunere la risc a populaţiei poate fi diferit şi este determinat atât de aflarea în arealul căpuşelor, densitatea acestora, circulaţia borreliilor patogene la căpuşe, cât şi respectarea regulilor comportamentale şi de protecţie individuală. Suspectarea precoce a cazului de BL, diagnosticarea corectă şi administrarea unui tratament eficace va diminua frecvenţa complicaţiilor posibile, iar raportarea calitativă în sistemul de supraveghere va permite implementarea măsurilor de sănătate publică pentru a diminua răspândirea cazurilor de BL

Peculiarities of directions and causal agents’ distribution of tick-borne encephalitis in the Republic of Moldova

The aim of the study is to determine the circulation of tick-borne encephalitis (TBE) causal agents in the Ixodidae ticks population and the evaluation of the TBE threat to public health. The species of ticks Ixodes ricinus, Dermacentor reticulatus, D. marginatus and Haemaphysalis punctata can be often met in the ecosystems of the Republic of Moldova. The species I. ricinus is the most numerous and widespread one, the fact that shows its high epidemiological significance. At the same time the species D. reticulatus, D. marginatus and H. punctata are the potential directions of TBE maintaining the TBE viruses in the environment. The laboratory results got by the enzyme-linked immunosorbent assay (ELISA) have indicated the TBE virus antigen in of 25.2% of the ticks, collected in the period of 2009-2012. Using the polymerase chain reaction method it has been established that on average the RNA of TBE virus has been 8.1% of all tested tick samples. The specific antibodies to tick-borne encephalitis virus have been identified in 9 (4%) tested human specimens. The rationalization of the system of epidemiological surveillance and control of tick-born encephalitis consists in developing and implementing a definition of the case for report on the basis of clinical and laboratory criteria, as well as the communication with epidemiological station, and studying to obtain standardized and comparable data

Alert-QSAR. Implications for Electrophilic Theory of Chemical Carcinogenesis

Given the modeling and predictive abilities of quantitative structure activity relationships (QSARs) for genotoxic carcinogens or mutagens that directly affect DNA, the present research investigates structural alert (SA) intermediate-predicted correlations ASA of electrophilic molecular structures with observed carcinogenic potencies in rats (observed activity, A = Log[1/TD50], i.e., ASA=f(X1SA,X2SA,…)). The present method includes calculation of the recently developed residual correlation of the structural alert models, i.e., ARASA=f(A−ASA,X1SA,X2SA,…). We propose a specific electrophilic ligand-receptor mechanism that combines electronegativity with chemical hardness-associated frontier principles, equality of ligand-reagent electronegativities and ligand maximum chemical hardness for highly diverse toxic molecules against specific receptors in rats. The observed carcinogenic activity is influenced by the induced SA-mutagenic intermediate effect, alongside Hansch indices such as hydrophobicity (LogP), polarizability (POL) and total energy (Etot), which account for molecular membrane diffusion, ionic deformation, and stericity, respectively. A possible QSAR mechanistic interpretation of mutagenicity as the first step in genotoxic carcinogenesis development is discussed using the structural alert chemoinformation and in full accordance with the Organization for Economic Co-operation and Development QSAR guidance principles

Hormonal signaling in cnidarians : do we understand the pathways well enough to know whether they are being disrupted?

Author Posting. © The Author, 2006. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Ecotoxicology 16 (2007): 5-13, doi:10.1007/s10646-006-0121-1.Cnidarians occupy a key evolutionary position as basal metazoans and are ecologically important as predators, prey and structure-builders. Bioregulatory molecules (e.g., amines, peptides and steroids) have been identified in cnidarians, but cnidarian signaling pathways remain poorly characterized. Cnidarians, especially hydras, are regularly used in toxicity testing, but few studies have used cnidarians in explicit testing for signal disruption. Sublethal endpoints developed in cnidarians include budding, regeneration, gametogenesis, mucus production and larval metamorphosis. Cnidarian genomic databases, microarrays and other molecular tools are increasingly facilitating mechanistic investigation of signaling pathways and signal disruption. Elucidation of cnidarian signaling processes in a comparative context can provide insight into the evolution and diversification of metazoan bioregulation. Characterizing signaling and signal disruption in cnidarians may also provide unique opportunities for evaluating risk to valuable marine resources, such as coral reefs

Köln-Timişoara Molecular Activity Combined Models toward Interspecies Toxicity Assessment

Aiming to provide a unified picture of computed activity – quantitative structure activity relationships, the so called Köln (ESIP-ElementSpecificInfluenceParameter) model for activity and Timisoara (Spectral-SAR) formulation of QSAR were pooled in order to assess the toxicity modeling and inter-toxicity correlation maps for aquatic organisms against paradigmatic organic compounds. The Köln ESIP model for estimation of a compound toxicity is based on the experimental measurement expressing the direct action of chemicals on the organism Hydractinia echinata so that the structural influence parameters are reflected by the metamorphosis degree itself. As such, the calculation of the structural parameters is absolutely necessary for correct evaluation and interpretation of the evolution of M(easured) and the C(computed) values. On the other hand, the Timişoara Spectral-SAR analysis offers correlation models and paths for H.e. species as well as for four other different organisms with which the toxicity may be inter-changed by means of the same mechanism of action induced by certain common chemicals