Regional Disparities in Romania. Contribution of the Regional Operational Program to Health Infrastructure

Health infrastructure is one of the weaknesses of socio-economic development in Romania and in other European states. In order to get a better picture of the Romanian health system issues, this paper analyzes a number of statistical indicators considered representative for the national and European health infrastructure for a 20 years period, between 1990 and 2010. Our paper has three main objectives: (a) to identify the main trends for health infrastructure in some of the European Union countries; (b) to describe the evolution of the health system in Romania, the comparative situation at the European level as well as regional level indicators dynamics; (c) to overview the Regional Operational Program in Romania, how much does it help the regional health infrastructure in our country. At the European level, there is a constant decrease in the number of hospital beds. For this indicator, Romania has slightly higher values than the European average. We must mention that the hospital beds indicator offers limited information on health infrastructure which also includes medical equipment and specific devices and practices. The number of hospitals in Romania increased with 18.9% during the last 20 years (1990-2010). During the observed timeline, the number of hospitals in Romania had a constant positive evolution at regional level. The number of doctors in hospitals has an increasing trend at the local as well as at the international level. Romania has a number of doctors twice lower than the European average (3.6 doctors for one thousand inhabitants). The Regional Operational Program (ROP) has a limited influence in achieving the objectives stated in Applicants Guide for Priority Axis 3. Major Intervention Area 3.1. This happens because supporting infrastructure improvements will not create institutional modernization. The financial contribution through ROP will result in the modernization of 11% of the existing hospitals in Romania

Primary Headaches and their Relationship with the Autonomic Nervous System

Headache disorders, described as early as 3000 BC, represent both a treatment challenge and a serious public health concern, with impact on the individual and society. Existing research in primary headache syndromes (not being caused by any underlying problem) focuses mainly on pain mechanisms. However, the painful symptomatology is the main encounter for the decreased quality of life and discomfort, the vegetative manifestations that frequently accompany the cephalalgic syndromes represent an important source of distress. Despite the advancement of the understanding of the molecular basis of headache disorders and neurovascular complex interactions, there is still lack of a cohesive understanding of the neurovegetative modulation in different types of primary cephalalgic syndromes. The aim of this chapter is to present an overview of the neurochemical mechanisms and pathways, which subtend dysautonomic manifestations in headache

Cardiac autonomic modulation in drug-resistant epilepsy patients after vagus nerve stimulation therapy

The positive effect of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy is considered to be mediated by the afferent pathways of the vagus nerve, but the efferent pathways may influence the cardiac autonomic activity.Aim of the study. To assess the effects of VNS on cardiac autonomic modulation in epilepsy patients, over three months of neurostimulation.Clinical rationale for the study. Linear and non-linear heart rate variability (HRV) analysis can provide information on the sympathovagal balance and reveal particularities of the central control of the autonomic cardiovascular function.Materials and Methods. Using Biopac Acquisition System, we analysed HRV parameters in resting condition and during sympathetic and parasympathetic activation tests in five patients with drug-resistant epilepsy, who underwent VNS procedure.Results. During the sympathetic and vagal activation tests, all five patients presented normal responses of cardiac autonomic activity, reflected in RMSSD, HFnu and LF/HF dynamics in both HRV evaluations. No bradycardia, cardiac arrhythmia or orthostatic hypotension was registered during the two evaluations.Conclusions. Our results indicate that VNS appears not to alter the cardiac autonomic function after three months of neurostimulation. HRV analysis is a useful tool for evaluating cardiac autonomic modulation in epilepsy patients during VNS therapy.Clinical Implications. Patients with decreased HRV should be periodically monitored. Cardiac changes in patients with epilepsy are important because of the additional risk of arrhythmias mediated through the autonomic dysfunction

Metodologie preliminară Analiza Cost Beneficiu pentru bazine hidrografice

This study refers to the methodological framework for performing the cost-benefit analysis, at the level of a river basin, for the program of measures needed to achieve the good environmental condition of water bodies within the framework of Water Framework Directive (WFD). The Cost-Benefit Analysis (CBA) aims to identify the disproportionate threshold of costs associated with the program of measures, in order to justify the exceptions to the environmental objectives of water bodies, according to the requirements of the Water Framework Directive 2000/60 / EC. The WFD defines two categories of measures: "basic" and "additional". "Basic measures" are the minimum compliance requirements and consist of those measures required by the implementation of Community water protection legislation, including measures under the legislation specified in Article 10 and Part A of Annex VI (list of basic measures to be included in programs of measures). "Additional measures" are those measures identified and implemented in addition to the basic measures, in order to achieve the objectives, set as a result of art. 4 to the WFD

Atenuarea impactului COVID-19, în România, prin gestionarea corespunzătoare a deșeurilor medicale periculoase

The research paper analyzes the ways of disposing of hazardous medical waste, which also includes infectious medical waste, and proposes some solutions to solve the identified problems. Regarding the evolution of medical waste quantities, in the context of the pandemic caused by COVID-19, it is obvious that large additional quantities of hazardous medical waste are generated. In Romania, the total amount of hazardous medical waste, generated by medical units with beds registered a jump: from a quantity of 8,900 tons of hazardous medical waste in 2012, it reaches 13,031 tons in 2018. It should also be noted that, the total medical waste, in the period of seven years (2012-2018) decreased from 33,732 tons to 15,424 tons (decrease of 54% or 18,308 tons). In 2018, there were several treatment / final disposal stations in Romania for the processing of medical waste: 11 incinerators operating in a centralized system; 14 thermal decontamination treatment plants at low temperatures operating in a centralized system; 23 treatment equipment operating within the sanitary units; 5 transfer stations used for certain categories of medical waste. The existing installations have a cumulative capacity of approx. 15,000 t / year: 11 thousand tons disposal by incineration and 4,000 t by cryogenic treatment. However, there is no information on the quality of existing installations, the degree of wear, the degree of load capacity, the performance achieved, etc. Thus, currently, in 14 counties there is no treatment facility for thermal decontamination at low temperatures of hazardous medical waste; there are also a number of 20 counties that do not have any centralized capacity for incineration of hazardous medical waste. In order to process the high volume of medical waste generated in the process of prevention and treatment of patients infected with the COVID-19 virus, this paper proposes a series of measures, investments and mechanisms

First episode of consciousness loss: setting new standards in acute care management

There is a high prevalence of patients addressed to the emergency department presenting a first episode of consciousness loss. The high prevalence of patients admitted to the emergency departments (ED) with a first episode of consciousness loss (ECL) is well established. Although there are studies assessing acute management in these patients, there is still need for more data on clinical and paraclinical characteristics which may prompt early etiological diagnosis, especially in countries where integrated medical procedures are lacking and access to specialized medical care is still limited. Sudden death syndrome, early cerebral morphological changes emerging in chronic epilepsy is the main motivation for an early diagnosis of epilepsy. The aim of our study was to evaluate demographic, clinical and paraclinical data in adult patients referred to our emergency hospital presenting a first episode of consciousness loss, in order to avoid misdiagnosis (with personal and social high impact) and unnecessary anti-epileptic treatment versus underestimation of epilepsy diagnosis. Conclusion: There is a clear need to improve multidisciplinary circuits in patients with a first episode of consciousness loss at a local level, in order to promote accurate and prompt diagnosis. We consider necessary to build a unitary online platform in order to establish an early and complete diagnosis

Temporal patterns of macrophage- and neutrophil-related markers are associated with clinical outcome in heart failure patients

Aims: Evidence on the association of macrophage- and neutrophil-related blood biomarkers with clinical outcome in heart failure patients is limited, and, with the exception of C-reactive protein, no data exist on their temporal evolution. We aimed to investigate whether temporal patterns of these biomarkers are related to clinical outcome in patients with stable chronic heart failure (CHF). Methods and Results: In 263 patients with CHF, we performed serial plasma measurements of scavenger receptor cysteine-rich type 1 protein M130 (CD163), tartrate-resistant acid phosphatase type 5 (TRAP), granulins (GRN), spondin-1 (SPON1), peptidoglycan recognition protein 1 (PGLYRP1), and tissue factor pathway inhibitor (TFPI). The Cardiovascular Panel III (Olink Proteomics AB, Uppsala, Sweden) was used. During 2.2 years of follow-up, we collected 1984 samples before the occurrence of the composite primary endpoint (PE) or censoring. For efficiency, we selected 567 samples for the measurements (all baseline samples, the last two samples preceding the PE, and the last sample before censoring in event-free patients). The relationship between repeatedly measured biomarker levels and the PE was evaluated by joint models. Mean (±standard deviation) age was 67 ± 13 years; 189 (72%) were men; left ventricular ejection fraction (%) was 32 ± 11. During follow-up, 70 (27%) patients experienced the PE. Serially measured biomarkers predicted the PE in a multivariable model adjusted for baseline clinical characteristics [hazard ratio (95% confidence interval) per 1-standard deviation change in biomarker]: CD163 [2.07(1.47–2.98), P < 0.001], TRAP [0.62 (0.43–0.90), P = 0.009], GRN [2.46 (1.64–3.84), P < 0.001], SPON1 [3.94 (2.50–6.50), P < 0.001], and PGLYRP1 [1.62 (1.14–2.31), P = 0.006]. Conclusions: Changes in plasma levels of CD163, TRAP, GRN, SPON1, and PGLYRP1 precede adverse cardiovascular events in patients with CHF