Validation of a Quality of Life Assessment Questionnaire for Patients with Infantile Hemangioma and Their Families - the IH-QOL-RO.

Introduction:Despite the fact that infantile haemangioma is one of the most common benign tumour of the child, the impact of this pathology on the quality of life of patients and their families has not aroused much interest in health services research. Several tools have been proposed to date to assess this, but there is no Romanian standardised instrument yet. Taking as a model the questionnaire developed and validated in English by Chamlin et al (2015), we translated, culturally adapted and piloted this instrument into Romanian. The questionnaire was administered during two years, between August 2019 and August 2021, to the parents of children with a diagnosis of infantile hemangioma who attended "M. S. Curie" Children's Emergency Hospital, Bucharest, Romania. Inclusion criteria were the diagnosis of infantile hemangioma and children under the age of 24 months. Other comorbidities which may have caused other health impairments were considered as exclusion criteria. Response rate was 100% for all items in the questionnaire. A total of 112 family respondents were included for analysis. Classic psychometric tests were used. Results:Based on the 29 standardized original items, the four scales have Cronbach-alpha values ranging from 0.489 (CSI), 0.609 (PSF), 0.689 (PEF) to 0.719 (CPS). The proposed final Romanian version includes 26 standardised items. The Cronbach-alpha values improve marginally: 0.63 (PSF), 0.67 (CSI), 0.72 (PEF) and 0.733 (0.78) (CPS). Conclusion:We propose the 21-item scale of the IH-QOL-RO as the Romanian version of the IH-QOL®. The instrument has been culturally adapted and is ready to use in paediatric clinics. We recommend the use of IH-QOL-RO in a longitudinal study design as a measure of health-related quality of life and to complete the classical set of psychometric tests with the 48-hour test-retest reliability.

Infantile Haemangioma in the Romanian Paediatric Population-Characteristics and Therapeutic Approaches.

Infantile haemangioma (IH) is the most common benign tumour in childhood, with an incidence of 4% to 12%. Aim: to describe the characteristics of infantile haemangioma in a sample of Romanian children <2 years old at diagnosis, types of treatment applied, recorded complications and the response to the therapeutic approach. A two-year prospective case series study (August 2019 to August 2021) was carried out. Sample: 117 patients <24 months of age diagnosed with IH at the Emergency Hospital for Children "Marie Sklodowska Curie", in Bucharest, Romania. Five therapeutic approaches were used: oral treatment with propranolol, local treatment with timolol, surgical treatment, topical treatment with steroids and no treatment ("wait and see"). Recorded factors mentioned in the literature were also present in this study population: female patients-68.4%; phototype I-58%. In 53% of cases, IHs had a head and neck location and 10% developed local complications (traumatic bleeding). The majority of patients (86%) required one type of therapy: oral propranolol (51%). A low relapse rate was recorded (4%). We consider that any child with a vascular anomaly should be referred to a highly specialised medical service for therapeutic approach.

Infantile Haemangioma - Elaboration and Piloting a Specific Quality of Life Questionnaire.

Backround:Infantile haemangiomas are the most common benign tumours of the child with clinical manifestations in the first two years of life, which is an additional cause of parents' concerns. Objective:This study describes the first stage in elaborating a specific instrument to evaluate the quality of life of both patients with infantile haemangioma under two years of age and their parents, adapted to the reality of the Romanian context. Methods:Items were generated from a literature review - from both the current generic pediatricians' instruments and specific tools in dermatology for assessing quality of life and the existing consensus among experts - as well as from a qualitative analysis of parents' concerns. The instrument was piloted on a group of patients' relatives. Results:We have developed a 28-item specific infantile haemangioma quality of life questionnaire with four sub-scales to assess physical health, the social function of the child, parents' emotional health and the social function of parents. Demographic data and clinical features (meanings of symptoms and outcomes) that have an impact on the quality of life were obtained. Conclusion:It is important to be able to measure and compare the quality of life of both patients with infantile haemangioma and their parents for adapting the treatment to the specific needs of patients and their family. The effectiveness of new therapeutic options which are especially useful for infants with haemangiomas can be checked by using the questionnaire as a measure of patient-reported outcome. The questionnaire developed by us was well accepted by the patients' parents.

Challenges in Utilization of Osteoporosis Healthcare Services during COVID-19 Pandemic in Romania - a Nationwide Population Study.

Objectives: This study compares the utilization of osteoporosis and osteoporosis complication healthcare services before and during the COVID-19 pandemic in Romania. Methods:The descriptive nationwide population study has used secondary data collected from the national health information system. We have calculated and compared the procedures performed for osteoporosis diagnosis and screening, standardized incidence and hospitalization rate for osteoporosis and osteoporosis fractures before and during the COVID-19 pandemic. Results:A 37.84% reduction in the number of DXA scans performed in 2020 have been observed, decreasing from 30,698 in 2019 to 12,064 in 2020. The standardized incidence for osteoporosis was 212.97 cases/100.000 person-years in 2018, 234 cases/100,000 person-years in 2019, and 185.97 cases/100,000 person-years in 2020. The hospitalization rates for osteoporosis have decreased by 68% compared with 2019 and the continuous hospitalization rate for osteoporotic fracture by 48% compared with 2019. Conclusions:The COVID-19 pandemic affected the utilization of healthcare services for osteoporosis management, posing a threat due to a magnified effect on osteoporotic fracture burden. More efforts are further needed to progress and re-engage with osteoporotic fracture prevention in our country and to develop and shape an optimal implementation of prevention and management strategies for all level of health care in Romania.

Validation of the Romanian Communication Skills Ability Scale - CSAS-RO - A Tool for Medical Schools.

In medicine ability to communicate requires training and continuous development. Aim: To validate the Communication Skills Ability Scale in Romanian. Study design: cross-sectional observational interrupted large case series. Sample and setting: all year 5 medical undergraduate students enrolled at UMF Carol Davila, Bucharest (UMFCD). A two field tests study: 1) 2nd semester of the 2017/2018 academic year (n = 361); 2) 2018/2019 academic year (n = 703). Methodology: The Romanian translation of CSAS® was used. Results: The CSAS-RO confirms the 2-Factor scale; internal consistency: Cronbach-α coefficient was 0.894 for the PAS (0.870 CSAS®) and 0.754 for the NAS (0.805 CSAS®) All item-total and item-rest correlations satisfied the criterion of more than 0.30, ranging from 0.32 to 0.71 with the exception of items 17 (field test 1) and item 11 (field test 2). Conclusion: CSAS-RO is valid to use with medical students. The reuse of the scale with a longitudinal study design will allow to assess any new educational needs for communication ability in medical students plus add the remaining property to test (the test-retest reliability).

Strengthening Romania’s health system to address antimicrobial resistance: EVIPNet evidence brief for policy, number 6

This report is the first evidence brief for policy produced in Romania within the framework of the WHO European Evidence-informed Policy Network. It was prepared by the Public Health Research Centre of the Department of Public Health and Management, in partnership with the (1st) Department of Microbiology, from the Carol Davila University of Medicine and Pharmacy in Bucharest. The working group identified, selected, appraised, and synthesized relevant research evidence on the problem, three options for tackling it and considerations in implementing them. The three options are: consolidate and coordinate the legal framework for antimicrobial resistance in Romania, focusing on two layers (first, the legal framework for antimicrobial resistance control at national level, and second, a national antibiotic stewardship programme at the operational level); align funding arrangements to facilitate antimicrobial resistance control, antibiotic stewardship programmes and infection prevention and control programmes; and develop and implement programmes to provide information, improve education and strengthen communication among medical professionals and the public.

Reflections on fertility dynamics in Romania.

Aims to highlight the changes occurred in the evolution of the fertility phenomenon in Romania, focusing on developments in the general fertility rate, total fertility rate, number of live births, and on the construction of specific indicators to reveal the source of demographic change. Several theories on the factors that may cause fertility decline it were outlined, underlining the presence of these factors during fertility dynamics in our country. After 1990, population decline may be explained by a close inter-relationship between economic theories (worsening economic conditions lead to decreased fertility) and the second demographic transition (postponement of births, fertility change model).