Interdisciplinary collaboration between primary health care and occupational health services

Department of General Hygiene, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young DoctorsIntroduction: Employees’ poor health is a major problem both nationally and globally. Healthy workers are the backbone of a prosperous economy, thus in preserving and strengthening employees’ health is interested not only the employer but also the state. Objective of the study: Analysis of interdisciplinary collaboration between primary health care and occupational health. Materials and methods: Bibliographical-descriptive, analytical and comparative study of literature in occupational health and primary health care field. Results: Occupational health and primary heath care have close similarities in disease prevention and health promotion, early notification of professional diseases and vocational rehabilitation. According to WHO, the level of occupational and work-related diseases is growing, while globally only 10-15% of employees have access to occupational health services and the other 85-90% benefit only of primary health care services. So physicians are not only the connecting link between the patient / employee and occupational health specialist, but, in countries with rudimentary occupational health services, is the sole provider of occupational health services. It has been demonstrated that the major share of physicians have diagnosing professional illness as weakness due to the omission of the patient’s occupation and lacks of knowledge about new technologies in the work processes. Unfortunately, in Moldova, there is a minimum intersection between occupational health and primary health care services in daily practice and in continuing medical education. Moreover, with population aging and the increase of retirement age we can expect a growing number of health problems among these economically active persons. Both occupational and habitual factors are important in determining health risks of a worker. Thus, physicians must understand the occupational health services and vice versa. This makes vital the productive collaboration between medical specialists in occupational health with physicians, organizing courses for physicians in the fields of labor hygiene and occupational diseases. An integrated approach of occupational health services and primary health care services will have a greater impact on the health of the working age population

Peculiarities of occupational health specialists’ instruction and training

Department General Hygiene, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Occupational Health Scientific Laboratory, National Center of Public Health Chisinau, Moldova The 6th International Medical Congress for Students and Young DoctorsOccupational Specialty Health is a new specialty for both Moldova and the countries in the European region. Moldova is the only country in Europe that has not implemented a workers’ health and safety surveillance system, in accordance with European and international bodies: EU-OSHA (European Agency for Safety and Health at Work), WHO (World Health Organisation), the ILO (International Labour Organisation). This system is part of the Public Health Strategy at European level and aims employee health surveillance, prevention and detection of occupational and work-related diseases

Expertiza fenomenului de dizabilitate a populaţiei în vârstă aptă de muncă şi morbidităţii profesionale

Morbiditatea profesională şi dizabilitatea sunt probleme actuale şi stringente ale societăţii, fiind una din cauzele majore ale reducerii capacităţii de muncă. Persoanele cu dizabilităţi se confruntă cu problema discriminării şi integrării sociale. Actualmente, persoanele cu dizabilitate prezintă o categorie a populaţiei cu o poziţie evident dezavantajată faţă de alte categorii, această situaţie poate fi soluţionată numai prin efortul comun al societăţii şi instituţiilor de stat. În acest articol sunt prezentate unele aspecte ale expertizei morbidităţii profesionale şi a dizabilităţii în cadrul Consiliilor de Determinare a Dizabilităţii şi Capacităţii de Muncă

The expertise of disability and occupational morbidity in working-age people

General Hygiene Department, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The occupational morbidity and disability are acute problems of society, being a major reason of work capacity reduction. According to WHO, more than 1 billion people in the world suffer from disability. More than 184 thousand people with disabilities are registered in Republic of Moldova. People with disabilities are 2-3 times less employed than others. They face with discrimination and social integration problems. This situation can be fixed through mutual exertion of society and state institutions. Aim of the study. Study of occupational morbidity and disability expertise on working-age people. Materials and methods. The bibliographic, mathematical, statistical, sociological and analytical methods have been applied. A cross-sectional, qualitative descriptive study has been done and there was organized an anonymous questionnaire of doctors from Councils of Disability and Work Capacity Determination on expertise methodology of work capacity loss in economically active population. The investigation data was processed with IBM SPSS Statistic 20 and Word- Excel programs. Parametric and non-parametric validity tests (p, t, DS, x2) were applied. Results. In the qualitative descriptive study, 30 expert doctors were interviewed, which is the total number of doctors from 9 councils in Chisinau. 14.43 ± 0.99 people (DS = 5.45) are examined per day. 24 (80.0%) interviewed doctors responded that they had never attended courses on occupational health. During the last year, 9 (30.0%) doctors suspected cases of occupational diseases in examined persons. The average number of suspected occupational diseases in the past year is 7.0 ± 1.51 cases (DS - 4.27). Expert doctors appreciated the cooperation with Republican Center for Occupational Diseases as follows: 23.3% (7) - good; 6.3% (2) - satisfactory; 3,3% (1) - unsatisfactory; 66.7% (20) - nonexistent. Counseling of examined people on professional rehabilitation is informally accomplished by expert doctors. Only 22 (73.3%) doctors responded that they counseled people on professional rehabilitation. Conclusions. In Republic of Moldova, there are high reserves in the notification, diagnosis and investigation of occupational diseases cases at all levels. There is a need to start a ministry program to improve disability determination services and occupational diseases surveillance, to involve all structures, starting with primary and specialized health care, Councils of Disability and Work Capacity Determination and Republican Center for Occupational Diseases. It is also necessary to revise legislation in the field, to create manuals on work capacity expertise and occupational diseases diagnosis for physicians, expert doctors etc

Аспекты профессиональной патологии у профессиональных спортсменов

In this work, using meta-analysis and scientifi c synthesis unit, there were analyzed occupational diseases among performance sportsmen that following the success of sports careers and the consequences of this. At present, in the country, sanitary-hygienic legislation in this area is rudimentary and the educational level of the specialists is low.В этой работе, c помощью методов мета-анализа и научного примера, были проанализированы заболевания, проявившиеся у профессиональных спортсменов после успешного завершения спортивной карьеры, а также их последствия. В настоящее время, в Республике Молдова, санитарно-гигиеническое законодательство в этой области находится в рудиментарном состоянии, уровень подготовки специалистов по выявлению профессиональных заболеваний у спортсменов является очень низким

Antibiotics and antibiotic resistant genes in water - environmental and human health risks

Introduction. Antimicrobial resistance is a worldwide problem that is both pressing and challenging due to the rate at which it is spreading, and the lack of understanding of the mechanisms that link humans, animals and environmental sources contributing to its proliferation. Antibiotic pollution is becoming an increasingly serious threat across different countries. Potential risks associated with release of human antibiotics into the environment have become an increasingly important issue of the environmental health. This concern has been driven by the widespread detection of antibiotics in all aquatic compartments. Antibiotics are ubiquitous in the environment and significant concentrations have been detected in water sources. The prevalence of antibiotics and antibiotic resistant genes in water has drawn attention in recent years, due to their potential public health risks. Material and methods. The purpose of the study was to carry out an analysis of the literature related to antibiotics and antibiotic resistant genes in groundwater, based on 61 bibliographic scientific research across the country and abroad using Academic Google and PubMed databases for articles published between 2016- 2021. Results. Antibiotics play a significant role in the induction and dissemination of antibiotic resistance genes in water that has recently become the primary environmental concern. Over the recent decades, antibiotics and antibiotic resistance genes have been regarded as emerging pollutants. The abuse of antibiotics can increase their residual amount in the water environment, which causes the enhancement of antibiotic resistance, being recognized as a new type of pollutant. Various types of normal bacterial genes that become activated under severe antibiotic stress, produces resistant enzymes even under normal conditions. Therefore, the resistance genes are being transferred horizontally from one bacterial cell to another, thus, increasing resistance to antibiotics. The distribution of antibiotics in water sources varies significantly in time and space, corresponding to the amount of antibiotics used locally. The main source of this contamination in the aquatic environment is the wastewater from antibiotic manufacturers, large scale animal farming, and hospitals. Environmental antibiotics pose a range of risks and have significant effects on human health. Conclusion. Antibiotics have greatly polluted the environment globally. The anti-infectives in environmental waters is of interest because of their potential role in the dissemination of anti-infective resistance in bacteria. Finally, scientific guidance on drug use is still required to discourage and prevent antibiotic abuse. A careful literature review was conducted in order to understand the sources, fate and occurrence of antimicrobials in the aquatic environment. In this context, a broad and specialized background was obtained, enabling a complete overview of the state-of-the-art in these subjects. Acknowledgment.This paper has been written within the framework of the project: 20.80009.8007.09 "Studying the mechanisms of antimicrobial resistance in gram-negative bacilli in order to strengthen the national surveillance system"

Antibiotic resistance of Pseudomonas aeruginosa strains isolated from patients

Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova, National Agency of Public Health, Chisinau, Republic of MoldovaIntroduction. Antimicrobial resistance represents a global burden and crisis but also a significant threat to public health nowadays. Healthcare-associated infections with multidrug resistant (MDR) bacteria lead to increased morbidity rates, with a continuous increasing incidence at global levels. The selective pressure created by the widespread use of antibiotics might be the main explanation of this burden. It is known that P. aeruginosa is one of the most frequent bacteria involved in the etiology of ventilator-associated pneumonia, with a relative high prevalence in patients admitted to intensive care units and a high mortality rate. Studies showed that the presence of MDR strains could be an important predictor of hospital death. The aim of this study was to evaluate antimicrobial resistance patterns of P. aeruginosa strains isolated from various clinical specimens of hospitalized patients Material and methods. We conducted a retrospective study during January–December 2020. Isolation of P. aeruginosa strains was performed on selective media for Gram-negative. Identification of strains was done both by conventional methods and by automated methods using Vitek®2 Compact. Antibiotic susceptibility testing was done using the Vitek®2Compact, but also by Kirby-Bauer method. Interpretation susceptibility was performed according to the EUCAST (European Committee on Antimicrobial Susceptibility Testing). Results. They were analyzed 118 isolates from patients hospitalized in surgical wards, 51.2% male, respectively 48.8% women. These strains were isolated from different pathological products: lower tract respirator (39.9%), pus (35.6%), urine (15.4%), central venous catheter insertion (2.7), blood (2.1%) and other secretions (4.3%). P. aeruginosa strains showed the following levels of antibiotic resistance, respectively, 70.7% to ticarcillin, 58.7% to piperacillin, while resistance to the penicillins combined with beta-lactamase inhibitors, piperacillin with tazobactam was 43.5%. Resistance to antipseudomonal cephalosporins was 37.9% to ceftazidime and 50.8% to cefepime, while the level of resistance to carbapenems was 55.9 % to imipenem and 27.1% to meropenem. Resistance to aminoglycosides was 51.9% to gentamicin, 58.4% to tobramycin and 34.4% to amikacin. 62.8% of strains showed resistance to fluoroquinolones (ciprofloxacin). Conclusion. Multidrug resistance is common and increasing. Occurrence of these MDR strain in clinical care settings makes them difficult and expensive to treat because these drug resistant strain are exhibit resistance to essentially all reliable antipseudomonal antibiotics. The available clinical solution for antibiotic resistance Pseudomonas aeruginosa infections requires a precise diagnostic and combination antibiotic therapy based on diagnostics. Judicious administration of antibiotics in combination with nosocomial infection control measures need to be introduced in hospitals to prevent the circulation of these multidrugresistant strains

Охрана здоровья на рабочем месте – часть европейских директив в области служб медицины труда

Laboratorul științific Sănătatea Ocupațională, Centrul Național de Sănătate Publică, IP USMF Nicolae Testemițanu, Conferința ştiinţifico-practică naţională cu participare internaţională ”Promovarea sănătăţii – o prioritate a sănătăţii publice” 22-24 iunie 2016 Orhei, Republica MoldovaThis work shows the analysis of the implementation modality of European legislation and good practices on health promotion at workplace in Republic of Moldova; the approval of Programs and Strategies at national level; justification of the importance of daily process implementing of “List of Health Indicators” – European Core Health Indicators, including “Health Promotion Indicators” from this legislative document.В данной работе был проанализирован опыт реализации европейского законодательства по охране здоровья на рабочем месте применительно для Молдовы и ратификации соответствующих программ и стратегий на национальном уровне; указано о важности внедрения в повседневную практику «Перечня показателей здоровья – ECHI», в том числе «Показателей охраны здоровья» из данного документа

The phenomenon of antibiotic resistance and people's knowledge

Introduction. Antibiotic resistance occurs when bacteria evolve to resist the effects of antibiotics that were previously effective in treating bacterial infections. This can happen when antibiotics are overused or misused, as well as in other situations where bacteria are exposed to antibiotics over a long period of time. Antibiotic resistance is a major global health concern, as it can lead to infections that are difficult or impossible to treat, causing prolonged illness, disability, and death. Aim. Studying the level of knowledge of the population with reference to the phenomenon of antibiotic resistance. Material and methods. For this study, open access international information resources were analyzed using PubMed, Hinari, Google Scholar databases. The search was conducted using key words in English and Romanian: "antibiotic resistance", "KAP population", "antimicrobials". Reference period – the last ten years. Rezults. Antimicrobial resistance (AMR) is a growing global health threat that has been recognized as one of the most urgent challenges facing public health today. Antibiotics are a type of antimicrobial drug used to treat bacterial infections. So, people in the world know antibiotics are one of the most commonly prescribed classes of drugs worldwide. They are used to treat a wide range of bacterial infections, including pneumonia, tuberculosis, and urinary tract infections. It is known that overuse and misuse of antibiotics is a major problem around the world. This can lead to the development of antibiotic-resistant bacteria, which can make it more difficult to treat infections and increase the risk of serious complications. In some interviews, people answered that antibiotic resistance is a growing global health threat that has been recognized as one of the most urgent challenges facing public health today. It can lead to a prolonged illness, disability, and death, and it has the potential to render many of our current antibiotic treatments ineffective. The same people know that antibiotics are also widely used in agriculture, particularly in animal agriculture. This can contribute to the development of antibiotic-resistant bacteria and increase the risk of transmission to humans. Although, the development of new antibiotics has been slow in recent years due to a range of factors, including the high cost and lengthy development process. However, there is a need for new antibiotics to combat the rising problem of antibioticresistant bacteria. It is worth noting that people's knowledge and attitudes towards antibiotic resistance in low- and middle-income countries can vary depending on a number of factors, including levels of education, awareness, and access to healthcare. However, in general, there is growing recognition of the problem of antibiotic resistance in low- and middle-income countries, and efforts are being made to raise awareness and address the issue. Conclusions. In general, raising awareness and educating the public about antibiotic resistance is important in order to help prevent the spread of resistant bacteria and ensure that antibiotics remain effective for future generations

Evaluation of costs related to antimicrobial resistance of priority Gram-negative bacilli

Introduction. Antimicrobial Resistance (AMR) is one of the most serious threats to global public health, causing over 700 thousand deaths annually. In addition to the social burden, AMR generates high medical costs, and estimating these at the hospital level has been the subject of research in many international studies. Material and methods. A comprehensive study was conducted, encompassing 172 cases of invasive infections recorded in patients hospitalized at the “Timofei Mosneaga” Republican Clinical Hospital, from which strains of antimicrobial-resistant E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa were isolated in the years 2019-2021. Based on data regarding the duration of hospitalization, treatment costs, and expenses for investigations, indicators such as average cost, the median, minimum and maximum values of treatment, including the cost of antibiotics and laboratory analyses, were calculated. Results. The economic impact indicators of AMR at the hospital level include: the duration of hospitalization, the total costs of a treated case, the costs of antibiotics, and the costs of laboratory analyses. In the structure of microorganisms isolated from the patients included in the study, K. pneumoniae predominates, accounting for 44.2%, and the total treatment cost for this organism was the highest at 202731.5 dollars. The maximum duration of hospitalization was recorded in patients from whom A. baumannii was isolated (27.7 days). Conclusions. The resistance of strains isolated from patients has directly contributed to the extension of the hospitalization period. The resistance of A. baumannii and K. pneumoniae species has predominantly led to the increase in the economic burden of AMR