Main Features of Prevalence and Severity of Major Depressive Episode in Romania

The objectives of the current article are to present some nationally representative estimates of lifetime, 12-months prevalence of MDE the age of onset, years in episode, the effects of MDE on role impairment. The lifetime prevalence of MDE was 3.3% for “all ages”, with higher values for females than for males (4.1% versus 2.5%) and the prevalence estimates of CIDI/DSM-IV 12-months Major Depressive Episode (MDE) was 1.8% (2.2% for females and 1.4% for males).  Approximately half of those with lifetime prevalence MDE presented 12-months MDE too (53.8%).  Within the age groups “18-34”, “all ages” and “50-64”, the females have the mean onset of MDE earlier than males (a slight difference for the first two situations, a difference of about 8 years for the latter). Within the age groups “35-49” of “65 years and over”, the males have the onset of MDE earlier than the females with 3-4 years. Regarding the mean number of years in episode, for all subjects was found a value of 5.7 years. Symptom severity assessed with the Quick Inventory of Depressive Symptomatology Self Report (QIDS-SR), revealed that almost two thirds of cases with MDE were “severe” or “very severe” from clinical point of view.  Number of weeks depressed in the 365 days before the interview, expressed as mean was 30.8 for those with “severe” symptoms/domain. In the past 30 days, the highest WHODAS score was for out of role domain (36.2), then for mobility (14.6).  Regarding the number of days out of role in the last year due to depression, this was 82.1 for the age group “50-64” and 63.5 for those of “65 years old and over”.  Major Depression Episode is a seriously impairment condition. The severe consequences of the depression on functioning in labour and social areas call attention to the need for early diagnostic, proper treatment and intervention. Key words: major depressive episode, lifetime prevalence, 12-mo prevalence, Sheehan score, disability assessment schedul

Influenţa laserului de joasă frecvenţă asupra funcţionalităţii fizice şi a durerii, în cazul entorselor la copii

This study presents aspects resulted from a project „FOTOLAS” (Photophysicalmethods of posttraumatic therapy on children, adults, aged persons and sportsmen).The goal of this study – to prove that the laser therapy could be more efficient than theclassical therapy with non-steroid antiinflammatory drugs in the evolution of minorinvalidant trauma , such as children sprain.Type of study – clinical experimental quasi randomizedMeasurable results – physical pain, degree of physical functionality (mobility), thepatient’ satisfaction related to received treatment.Finally conclusion – both treatments offer a decrease of body pains in a significantstatistical manner between the two moments of analised time (arriving to doctor andending of the treatment). There are no statistical significant differences between the twogroups of patients that followed laser therapy and non-steroid antiinflammatory therapy.Keywords: low level laser therapy, children sprain, non-steroidal antiinflamatory drugsContent available only in Romanian. This study presents aspects resulted from a project „FOTOLAS” (Photophysicalmethods of posttraumatic therapy on children, adults, aged persons and sportsmen).The goal of this study – to prove that the laser therapy could be more efficient than theclassical therapy with non-steroid antiinflammatory drugs in the evolution of minorinvalidant trauma , such as children sprain.Type of study – clinical experimental quasi randomizedMeasurable results – physical pain, degree of physical functionality (mobility), thepatient’ satisfaction related to received treatment.Finally conclusion – both treatments offer a decrease of body pains in a significantstatistical manner between the two moments of analised time (arriving to doctor andending of the treatment). There are no statistical significant differences between the twogroups of patients that followed laser therapy and non-steroid antiinflammatory therapy.Keywords: low level laser therapy, children sprain, non-steroidal antiinflamatory drug

The correlation between coronary stent`s length and in-stent restenosis

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicina Internă, USMF “NicolaeTestemițanu”, IMSP Institutul de Cardiologie, IMSP SCM “SfântaTreime”In this study was analyzed the coronary stent`s length impact in in-stent restenosis occurrence after a 6 month term from the coronary angioplasty procedure with bare metal stent implantation in a group of 150 patients with different forms of ischaemic heart disease that underwent invasive treatment during the 2011 year. According to the stent`s length the group was divided into two subgroups: subgroup I – that of ,,long” stents (>20mm) – 64 patients and group II – that of ,,short” stents (≤20mm) – 86 patients. In-stent restenosis confirmed angiographically after a 6 month term from angioplasty had 10,5% of patients with short stents and 20,3 % with long stents. În această lucrare a fost analizat impactul lungimii stentului coronarian în apariția restenozei intrastent după un termen de 6 luni de la procedura de angioplastie coronariană cu implantare de stent metalic simplu la un lot de 150 de pacienți cu diferite tipuri de cardiopatie ischemică care au suferit tratament invaziv pe perioada anului 2011. Conform lungimii stentului coronarian lotul a fost divizat în 2 grupuri: grupul I – al stenturilor ,,lungi” (>20mm) – 64 pacienți și grupul II – al stenturilor ,,scurte” (≤20mm) – 86 pacienți. Restenoză confimată angiografic după 6 luni de la angioplastie prezentau 10,5% pacienți cu stenturi scurte și 20,3% cu stenturi lungi

STUDIU PRIVIND CALITATEA PROCESELOR ÎN SPITALE, DIN PERSPECTIVA DECIDENȚILOR ȘI A PROFESIONIȘTILOR DIN SĂNĂTATE

In Romania, the level of knowledge in terms of hospital quality processes is quite low. The project "Regional Centers of Excellence for Performance Improvement Processes in Health Care System in Romania" has proposed, as a first step to configure the present quality of hospital processes, seen from the perspective of decision makers and professionals of health.The project is focused on the implementation of innovative concepts for optimization of hospital processes by developing skills in quality management, performance and efficiency of health services of the medical and managerial staff from hospitals in three regions in Romania, as well as implementation of improvement projects. By this project in addition to the research stage, important steps have been made  to introduce an innovative methodology -  Lean Six Sigma tool in hospitals from Romania, through a training program for the managers and specialists from hospitals in order to identify the processes that they are carrying out, the problems they are facing and to find and apply solutions with the help of small or large-scale projects.We hope that this steps will open a new perspective, will bring a new mind setting for the staff and the new approaches based on activity optimization to be an important part of the hospital practice and activity in Romania.   Key words: processes, hospital actyivity, quality, RomaniaÎn România, nivelul de cunoaştere în ceea ce priveşte calitatea proceselor care stau la baza activităţii spitaliceşti este destul de scăzut. Proiectul “Centre Regionale de Excelență în Domeniul Îmbunătățirii Performanței Proceselor din Sistemul de Îngrijiri de Sănătate din România” şi-a propus ca, într-o primă etapă, să configureze o imagine reală şi actuală asupra calităţii proceselor spitaliceşti, văzută din perspectiva decidenților și a profesioniștilor din sănătate.Proiectul se focalizează pe implementarea unor concepte inovatoare de optimizare a proceselor, prin  dezvoltarea de competenţe profesionale în domeniul managementului calităţii, performanţei şi eficienţei serviciilor de sănătate și dezvoltarea unor proiecte de îmbunătățire a proceselor din spitale.Ca urmare a concluziilor cercetării din acest studiu, au fost intreprinși pași importanți în introducerea unei metodologii inovatoare de îmbunătățire a proceselor -  Lean Six Sigma,  în cadrul serviciilor spitalicești din România, printr-un program de formare a managerilor și specialiștilor din spitale. Scopul a fost de a identifica  procesele pe care aceștia le desfășoară, problemele cu care se confruntă și de a identifica  și aplica soluții prin intermediul unor proiecte de mai mică sau mai mare anvergură.Sperăm ca acești pasi  să deschidă o nouă perspectivă, să aducă un mod nou de gândire, iar noile abordări bazate pe optimizare şi eficientizarea activităţii să facă parte integrantă din practica şi activitatea spitalicească din România. Cuvinte cheie: procese, activitatea spitalicească, calitate, Români

MODEL INOVATOR DE CONSILIERE SI ÎNDRUMARE A BOLNAVILOR DE CANCER SI PERSOANELOR LA RISC, ÎN VEDEREA ÎMBUNATATIREA CALITATII SERVICIILOR ONCOLOGICE

The continuous preoccupation at the international level to improve the quality of oncologic care has led to the development of models of good practice with proven efficacy, such as "oncology nurse navigator".  Given the current situation in Romania, in terms of morbidity and mortality through cancer, it is necessary  the adoption and  introduction of such innovative practice models, of great benefit to patients with cancer, but also for the health system. National School of Public Health, Management and Professional Development and Romanian Nursing Association meet this aim through the project "Innovative Strategy for Bridging Cancer Care in Romania" by elaboration of aninnovativemodel for oncology services in Romania. This modelstartsfrom the knowledge of the current situation regarding the barriers in the system, the needs of patients and medical staff and proposes the integration of the positive experiences in United States regarding the improving of early detection of the disease, improving the quality of patients' care and patients’ satisfaction. The model of "nurse navigator" adapted, adequate for Romania is one of guidance, counselling, information and support for patients with oncological diseases, but at the same time, of education and prevention among the general population and population groups at higher risk for cancer.                          Keywords: cancer, quality of services, innovative models, Romania, "nurse navigator"Preocuparea continua, la nivel international, pentru îmbunatatirea calitatii îngrijirilor oncologice a condus la dezvoltarea unor modele de buna practica cu eficacitate demonstrata, cum ar fi serviciile „oncology nurse navigator”.  Data fiind situatia actuala din Romania în ceea ce priveste morbiditatea si mortalitatea prin cancer, este necesara adoptarea si introducerea unor astfel de modele de practica inovatoare, benefice pentru pacientii oncologici, dar si pentru sistemul de sanatate. Scoala Nationala de Sanatate Publica, Management si Perfectionare în Domeniul Sanitar Bucuresti si Asociatia de Nursing din Romania vin în întampinarea acestui deziderat, prin intermediul proiectului „Innovative Strategy for Bridging Cancer Care in Romania” fiind elaborat un model inovator pentru serviciile oncologice din Romania. Acesta porneste de la cunoasterea situatiei actuale privind barierele din sistem,  nevoile pacientilor si personalului medical si propune integrarea experientelor pozitive din SUA referitor la modelul de consiliere si îndrumare în sistem a pacientului oncologic. Scopul vizeaza obtinerea unor rezultate masurabile la nivel de pacient: îmbunatatirea accesului la servicii, cresterea gradului de informare si educare, îmbunatatirea detectarii precoce a bolii, îmbunatatirea calitatii îngrijirilor si a satisfactiei pacientilor. Modelul de tip “nurse navigator” adaptat si adecvat pentru Romania este  unul de îndrumare, consiliere, informare si suport pentru bolnavii cu afectiuni oncologice, dar în acelasi timp si de educare si prevenire în randul populatiei generale si a grupelor populationale la risc pentru cancer.   Cuvinte cheie: cancer, calitatea serviciilor, modele inovatoare, Romania, „nurse navigator

ÎNGRIJIREA PERSOANELOR CU TULBURĂRI COGNITIVE (TC) ÎN PERIOADA PANDEMIEI

At  SARS-CoV2 infection has produced many changes in our lives, both through the rules of physical distance and isolation imposed, and through a series of restrictions in social and cultural life. Patients with dementia or other cognitive impairment have also been affected by this pandemic, international studies documenting a decrease in the rate of face-to-face consultations by up to 65% during this period. Currently, there is a lack of information on identifying new cases of cognitive impairment during the COVID-19 pandemic as well as the management of patients previously diagnosed in family doctors' offices in Romania. In this context, the present study aimed to describe the activity of identifying new cases of cognitive impairment at the level of family doctors' offices, their referral to specialized services and the management of these patients in evidence between March and December 2020. An electronic questionnaire developed by the authors was distributed via mailing lists over five days. The questionnaire was answered by 62 family doctors, who report a small number of new cases being identified between March and December 2020, of which only half have been referred for evaluation to the specialist. Regarding patients already diagnosed with cognitive disorders, about half of the respondents managed to consult over 70% of them. The majority of the family doctors continued to provide face to face services at the office and about half of them opted for a mix of teleconsultations and face to face consultations. The results of this study indicate the increase of undiagnosed CI cases and difficulties related to the management of existing cases during the pandemic, difficulties generated primarily by the limitations of teleconsultations, poor communication with specialists and the absence of medical letters. Given the fact that family doctors have constituted the first line of healthcare service provision during the pandemic, it is all the more important to update their knowledge in the field of cognitive disorders.   Keywords: SARS-CoV2, COVID-19, cognitive impairment, RomaniaAt Infecția cu SARS-CoV2 a produs multe schimbări în viața noastră, atât prin regulile de distanțare fizică și izolare impuse, cât și printr-o serie de restricții din viața socială și culturală. Pacienții cu demență sau alte deficiențe cognitive au fost, de asemenea, afectați de această pandemie, studiile internaționale documentând o scădere a ratei consultațiilor față în față cu până la 65% în această perioadă. În prezent, există o lipsă de informații cu privire la identificarea noilor cazuri de tulburare cognitivă în timpul pandemiei COVID-19, precum și la gestionarea pacienților diagnosticați anterior în cabinetele medicilor de familie din România. În acest context, prezentul studiu și-a propus să descrie activitatea de identificare a noilor cazuri de tulburare cognitivă la nivelul cabinetelor medicilor de familie, trimiterea acestora la servicii specializate și gestionarea pacienților aflați în evidență în perioada martie - decembrie 2020. Un chestionar electronic dezvoltat de autori a fost distribuit prin liste de discuții pe parcursul a cinci zile. La chestionar au oferit răspunsuri 62 de medici de familie, care au raportat că un număr mic de cazuri noi au fost identificate în perioada martie - decembrie 2020, dintre care doar jumătate au fost trimise spre evaluare specialistului. În ceea ce privește pacienții deja diagnosticați cu tulburări cognitive, aproximativ jumătate dintre respondenți au reușit să consulte peste 70% dintre ei. Majoritatea medicilor de familie au continuat să ofere servicii față în față la cabinet și aproximativ jumătate dintre aceștia au optat pentru un mix de teleconsultații și consultații față în față. Rezultatele acestui studiu indică creșterea cazurilor de tulburări cognitive nediagnosticate și dificultăți legate de gestionarea cazurilor existente în timpul pandemiei, dificultăți generate în primul rând de limitările teleconsultațiilor, comunicarea slabă cu specialiștii și absența scrisorilor medicale. Dat fiind faptul că medicii de familie au constituit prima linie de furnizare a serviciilor medicale în timpul pandemiei, este cu atât mai important să-și actualizeze cunoștințele în domeniul tulburărilor cognitive.   Cuvinte cheie: SARS-CoV2, COVID-19, pandemie, tulburări cognitive, Români

Studiul privind sănătatea mentală - România

The article shows the findings of Mental Health Survey – Romania 2007, regarding the lifetime prevalence, the age group variation, the onset age of mental disorders, the projected risk by 75 years, and the comparison of the projected risk with the observed lifetime prevalence the proportion of those making initial treatment contacts in the year of onset and by 75 years.     The lifetime prevalence for any mental disorders, among those of 18 years old and older is 13.4% with the onset in the adolescence or early adulthood. Among the mental disorders the highest prevalence can be found for anxiety disorders. For some of the anxiety disorders (specific phobia, social phobia, posttraumatic stress disorders, panic disorders, and alcohol abuse with or without dependence) can be noticed an increase of prevalence in adulthood compared to younger ages, following a decrease at 65 years or older ages. The major depressive episode registers continuous increase reaching the highest prevalence at elderly people. The projected lifetime risk shows higher values compared to the observed lifetime prevalence. The proportion of those making initial treatment contact  in the year of onset is 32-63% for those with bipolar disorder, dysthymia,   drug abuse, 10,2-24,6% for mood disorders and agoraphobia and under 10% for major depressive episode, panic disorder specific phobia alcohol abuse and substance use disorders.Keywords: mental health, mental disorders, lifetime prevalence, services useArticolul prezintă rezultate din Studiul Sănătatea Mentală România 2007, referitoare la prevalenţa pe durata vieţii, variaţia pe grupe de vârstă, vârsta de debut a tulburărilor mentale, riscul proiectat până la vârsta de 75 de ani, comparaţii ale acestui risc cu prevalenţa pe durata vieţii, proporţia celor care se adresează unui profesionist în vederea iniţierii tratamentului în anul de debut sau până la 50 de ani. De-a lungul vieţii, 13,4% dintre adulţii de 18 ani şi peste vorbitori de limba română îndeplinesc criteriile sistemului de diagnostic DSM-IV pentru cel puţin o tulburare mentală, având debutul de obicei în adolescenţă sau la începutul maturităţii. Dintre tulburările mentale, cea mai ridicată prevalenţă se întâlneşte la tulburările de anxietate. Pentru tulburările de anxietate, fobia specifică, fobia socială şi tulburarea posttraumatică de stress, tulburarea de panică, abuzul de alcool, cu sau fără dependenţă, se observă o creştere a prevalenţei la maturitate faţă de tinereţe, urmând un declin la vârsta de 65 de ani şi peste. Tulburarea depresivă majoră înregistrează în schimb creşteri progresive, având cea mai mare prevalenţă la vârstnici.  Riscul proiectat la vârsta de 75 de ani arată valori mai mari decât prevalenţa observată. Proporţia celor care se adresează unui profesionist în anul de debut al afecţiunii este cuprinsă între 32-63% pentru tulburarea bipolară, distimie, abuzul de droguri, între 10,2-24,6% pentru tulburările de dispoziţie şi agorafobie şi se situează sub 10% pentru episodul depresiv major, tulburarea de panică, abuzul de alcool cu dependenţă, anxietatea generalizată, tulburarea posttraumatică de stress, tulburările de anxietate, fobia specifică, abuzul de alcool şi tulburările legate de consumul de alcool şi droguri.   Cuvinte cheie: sănătate mentală, tulburări mentale, prevalenţa în timpul vieţii, utilizarea serviciilo

IMPROVING LANGUAGE DISORDERS IN THE CASE OF CHILDREN THROUGH THE USE OF MULTIPLATFORM TECHNOLOGY WITH ROMANIAN APPLICATIONS

The role of communication skills of a child is essential because it is closely related to normal child development (cognitive, emotional, motivational) considered major instruments for participation and involvement in all daily social activities, family , group of friends and school environment. From this perspective, we consider necessary to carry out a program of recovery therapy through computer technology access and use of video games as positive indicators for correcting and improving language through highly motivational role instruments

TIMLOGORO - AN INTERACTIVE PLATFORM DESIGN FOR SPEECH THERAPY

This article presents some tehnical and pedagogical features of an interactive platforme used for language therapy. Timlogoro project demonstrates that technology is an effective tool in learning and, in particular, a viable solution for improving speech disorders present in different stages of age. A digital platform for different categories of users with speech impairments (children and adults) has a good support in pedagogical principles. In speech therapy, the computer was originally used to assess deficiencies. Nowadays it has become a useful tool in language rehabilitation. A few Romanian speech therapists create digital applications that will be used in therapy for recovery.This work was supported by a grant of the Romanian National Authority for Scientific UEFISCDI

An Evidence and Consensus-Based Definition of Second Victim: A Strategic Topic in Healthcare Quality, Patient Safety, Person-Centeredness and Human Resource Management

The concept of second victims (SV) was introduced 20 years ago to draw attention to healthcare professionals involved in patient safety incidents. The objective of this paper is to advance the theoretical conceptualization and to develop a common definition. A literature search was performed in Medline, EMBASE and CINAHL (October 2010 to November 2020). The description of SV was extracted regarding three concepts: (1) involved persons, (2) content of action and (3) impact. Based on these concepts, a definition was proposed and discussed within the ERNST-COST consortium in 2021 and 2022. An international group of experts finalized the definition. In total, 83 publications were reviewed. Based on expert consensus, a second victim was defined as: "Any health care worker, directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury and who becomes victimized in the sense that they are also negatively impacted". The proposed definition can be used to help to reduce the impact of incidents on both healthcare professionals and organizations, thereby indirectly improve healthcare quality, patient safety, person-centeredness and human resource management