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1.
Echo Res Pract ; 5(4): K67-K72, 2018 Dec 01.
Article in English | MEDLINE | ID: mdl-30496123

ABSTRACT

Neck venous malformations and their potentially life-threatening complications are rarely reported in the available literature. Cases of aneurysmal or hypo-plastic jugular vein thrombosis associated with systemic embolization have not been frequently reported. We present the case of a 60-year-old male, without any known risk factors for thromboembolic disease, admitted for sudden onset dyspnea. The physical examination was remarkable for a right lateral cervical mass, expanding with Valsalva maneuver. Thoracic CT with contrast established the diagnosis of bilateral pulmonary embolism and raised the suspicion of superior vena cava and right atrial thrombosis. Bedside transthoracic echocardiography confirmed the presence of a large right atrial thrombus, with intermittent protrusion through the tricuspid valve. Systemic thrombolysis with Alteplase was initiated shortly after diagnosis, in parallel with unfractionated heparin, with complete resolution of the intracavitary thrombus documented by echocardiography. The patient showed significant improvement in symptoms and was later started on oral anticoagulation. Computed vascular tomography of the neck was performed before discharge, showing hypoplasia of the left internal jugular vein and aneurismal dilation of the contralateral internal jugular vein, without thrombosis. There were no identifiable systemic causes for thrombosis. Surgical resection of the aneurismal jugular vein was excluded, because of its potential to cause intracranial hypertension. The preferred therapeutic option in this case was long-term oral anticoagulation. Learning points: Internal jugular venous malformations, such as aneurisms or hypoplasia, could be associated with an increased risk of thrombosis and major embolic events. Systemic thrombolysis can be an efficient solution in cases of pulmonary embolism with right heart thrombosis. Multimodality imaging is greatly valuable in clarifying the diagnosis of atypical cases.

3.
Neth Heart J ; 24(2): 156-8, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26728050
4.
Neth Heart J ; 24(2): 152-3, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26689924
5.
Eur Heart J ; 36(46): 3268-3275, 2015.
Article in English | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1062613

ABSTRACT

AIM:To assess clinical outcomes, efficacy, and safety according to sex during anticoagulation with apixaban compared with warfarin in patients with atrial fibrillation.METHODS AND RESULTS:Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) was a randomized, double-blind, placebo-controlled, multicentre trial that included 11 785 (64.7%) men and 6416 (35.3%) women with atrial fibrillation or flutter randomized to receive either warfarin or apixaban. The primary efficacy endpoint was stroke or systemic embolism; secondary efficacy endpoints were death from any cause and cardiovascular death. The primary safety endpoint was major bleeding; secondary safety endpoints were a composite of major bleeding and non-major clinically relevant bleeding. The risk of stroke or systemic embolism was similar in women vs. men [adjusted hazard ratio (adjHR): 0.91; 95% confidence interval (CI): 0.74-1.12; P = 0.38]. However, among patients with history of stroke or transient ischaemic attack, women had a lower risk of recurrent stroke compared with men (adjHR: 0.70; 95% CI: 0.50-0.97; P = 0.036). Women also had a lower risk of all-cause death (adjHR: 0.63; 95% CI: 0.55-0.73; P < 0.0001) and cardiovascular death (adjHR: 0.62; 95% CI: 0.51-0.75; P < 0.0001), and a trend towards less major bleeding (adjHR: 0.86; 95% CI: 0.74-1.01; P = 0.066) and major or non-major clinically relevant bleeding (adjHR: 0.89; 95% CI: 0.80-1.00; P = 0.049). The efficacy and safety benefits of apixaban compared with warfarin were consistent regardless of sex.CONCLUSION:In the ARISTOTLE trial, women had a similar rate of stroke or systemic embolism but a lower risk of mortality and less clinically relevant bleeding than men. The efficacy and safety benefits of apixaban compared with warfarin were consistent in men and women...


Subject(s)
Stroke/prevention & control , Anticoagulants , Atrial Fibrillation , Sex , Warfarin
6.
Int J Clin Pract ; 67(6): 516-26, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23557519

ABSTRACT

Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, and is the most prevalent factor for cardioembolic stroke. Vitamin K antagonists (VKAs) have been the standard of care for stroke prevention in patients with AF since the early 1990s. They are very effective for the prevention of cardioembolic stroke, but are limited by factors such as drug-drug interactions, food interactions, slow onset and offset of action, haemorrhage and need for routine anticoagulation monitoring to maintain a therapeutic international normalised ratio (INR). Multiple new oral anticoagulants have been developed as potential replacements for VKAs for stroke prevention in AF. Most are small synthetic molecules that target thrombin (e.g. dabigatran etexilate) or factor Xa (e.g. rivaroxaban, apixaban, edoxaban, betrixaban, YM150). These drugs have predictable pharmacokinetics that allow fixed dosing without routine laboratory monitoring. Dabigatran etexilate, the first of these new oral anticoagulants to be approved by the United States Food and Drug Administration and the European Medicines Agency for stroke prevention in patients with non-valvular AF, represents an effective and safe alternative to VKAs. Under the auspices of the Regional Anticoagulation Working Group, a multidisciplinary group of experts in thrombosis and haemostasis from Central and Eastern Europe, an expert panel with expertise in AF convened to discuss practical, clinically important issues related to the long-term use of dabigatran for stroke prevention in non-valvular AF. The practical information reviewed in this article will help clinicians make appropriate use of this new therapeutic option in daily clinical practice.


Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Benzimidazoles/administration & dosage , Pyridines/administration & dosage , Stroke/prevention & control , Administration, Oral , Anticoagulants/adverse effects , Benzimidazoles/adverse effects , Dabigatran , Drug Interactions , Dyspepsia/chemically induced , Dyspepsia/prevention & control , Electric Countershock/adverse effects , Hemorrhage/chemically induced , Hemorrhage/prevention & control , Humans , Myocardial Infarction/chemically induced , Patient Selection , Pyridines/adverse effects , Randomized Controlled Trials as Topic , Stents , Treatment Outcome
7.
Int J Cardiol ; 168(3): 2272-7, 2013 Oct 03.
Article in English | MEDLINE | ID: mdl-23453444

ABSTRACT

BACKGROUND: The determinants of maximal exercise capacity (MEC) in aortic stenosis (AS) are, in large part, unknown. We hypothesized that the left ventricular (LV) global hemodynamic load--as assessed by the valvulo-arterial impedance (Zva)--is one of the main determinants of MEC and we sought to evaluate the factors associated with reduced MEC in AS. METHOD AND RESULTS: Asymptomatic patients with moderate or severe AS (n=62, aortic valve area <1.5 cm(2), 65 ± 13 years, 68% men) and preserved LV systolic function (ejection fraction>50%) were prospectively referred for comprehensive resting echocardiography and cardiopulmonary exercise test. Absolute peak VO2 was 19.5 ± 5.7 mL/kg/min (median 19.6 mL/kg/min; range 7.2-33.1 mL/kg/min). There were significant correlations between peak VO2 and: age, body mass index, LV stroke volumes, cardiac output, mean flow rate, mitral annulus s' and e' wave velocities, E/e' ratio and left atrial diameter (all p<0.05). Indexed mean flow rate and Zva were the strongest univariable echocardiographic determinants of peak VO2 (r=0.44, p<0.001 and r=-0.39, p=0.002, respectively). In addition, patients with reduced MEC (peak VO2

Subject(s)
Aortic Valve Stenosis/physiopathology , Exercise Tolerance , Heart Ventricles/physiopathology , Hemodynamics/physiology , Aged , Aortic Valve Stenosis/diagnosis , Diastole , Echocardiography , Exercise Test , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Severity of Illness Index , Systole , Ventricular Function, Left
8.
Eur J Echocardiogr ; 12(2): E11, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20876188

ABSTRACT

Mitral valve repair for significant mitral regurgitation (MR) is preferred to valve replacement, whenever feasible. Freedom from re-operation is high, reaching 92% at 15 years. However, high-risk patients develop more complications and may be refused surgery. The results from the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) II showed they might benefit from the percutaneous edge-to-edge mitral valve repair using MitraClip(®) system (Evalve, Inc., Menlo Park, CA, USA). We present a case of a ventilator-dependent 57-year-old man with ischaemic A2, A3 prolapse and severe MR causing persistent haemodynamic instability and pulmonary oedema. Attempts to wean the ventilator failed during the 7 month period. High predicted surgical mortality ruled out surgical mitral repair. The percutaneous mitral valve repair became the only option. The use of real-time three-dimensional transoesophageal echocardiography (RT 3D-TOE) to navigate through the cardiac chambers has been previously described. Here, the precise positioning and placement of a second clip, after failure of the first one, was facilitated by 3D-TOE. These images provided 'en-face' views of the mitral valve from both the atrial and ventricular perspective, allowing safe advancement and positioning of the second clip delivery system. Failure of the second clip would have resulted in emergency open heart surgery. This case demonstrates the incremental value of RT 3D-TOE images for a percutaneous double clip mitral repair with the MitraClip(®) system in a patient with no other treatment options.


Subject(s)
Echocardiography, Three-Dimensional/instrumentation , Heart Valve Prosthesis Implantation/instrumentation , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Prolapse/diagnostic imaging , Mitral Valve/diagnostic imaging , Heart Valve Prosthesis Implantation/methods , Hemodynamics , Humans , Male , Middle Aged , Mitral Valve/pathology , Mitral Valve/surgery , Mitral Valve Insufficiency/pathology , Mitral Valve Insufficiency/surgery , Mitral Valve Prolapse/pathology , Mitral Valve Prolapse/surgery , Respiration, Artificial , Risk Assessment , Risk Factors
9.
J Clin Endocrinol Metab ; 91(6): 2126-32, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16537677

ABSTRACT

CONTEXT: Subclinical hypothyroidism (SCH) is associated with increased risk of cardiac disease; its impact on arterial function is less clear. OBJECTIVE: The objective of the study was the assessment of arterial and cardiac function. DESIGN: The study was a 6-month controlled observational study using pulse wave analysis and tissue Doppler dobutamine stress echocardiography. SETTING: The study was conducted at a thyroid clinic. PATIENTS: Nineteen female SCH patients with raised TSH, normal free T(4), and no cardiovascular disease [aged 49.2 +/- 3.8 yr; body mass index (BMI) 29.9 +/- 6.7 kg/m(2)] were recruited from the thyroid clinic, and 10 female controls (aged 50.2 +/- 3.4 yr; BMI 29.7 +/- 7.2 kg/m(2)) also participated in the study. INTERVENTIONS: Incremental doses of l-thyroxine were used. MAIN OUTCOME MEASURES: Indices of vascular stiffness and left ventricular echocardiographic function were measured. RESULTS: Baseline augmentation gradient was elevated in SCH, compared with controls [10.3 +/- 5.1 (sd) mm Hg vs. 8.0 +/- 4.2, P < 0.05]; when euthyroid (mean T(4) dose 114 mug/d), it fell to 8.8 +/- 5.3 mm Hg (P < 0.05). Heart rate-corrected augmentation index was 26.7 +/- 9.9 vs. 18.8 +/- 9.9% (P < 0.02), falling to 19.7 +/- 9.6% (P < 0.001) after treatment. Time of travel of the reflected wave was 139.3 +/- 11.7 msec, compared with 141.5 +/- 8.8 msec in controls (P < 0.05), increasing to 144.9 +/- 11.9 msec (P < 0.05). There were no differences in resting global, regional left ventricular function, or regional myocardial velocities during maximal dobutamine stress between SCH patients and controls, or in treated patients, compared with baseline. CONCLUSIONS: Arterial stiffness was increased in SCH and improved with l-thyroxine, which may be beneficial, whereas myocardial functional reserve was similar to controls and remained unaltered after treatment.


Subject(s)
Arteries/physiopathology , Hypothyroidism/physiopathology , Ventricular Function, Left , Echocardiography, Doppler , Echocardiography, Stress , Female , Humans , Muscle, Smooth, Vascular/physiopathology , Systole , Thyroxine/therapeutic use , Tunica Intima/pathology
10.
Arch Mal Coeur Vaiss ; 98(11): 1166-70, 2005 Nov.
Article in French | MEDLINE | ID: mdl-16379116

ABSTRACT

The end-point of this retrospective study was to evaluate the standard of care in terms of in-hospital morbidity and mortality for patients with acute myocardial infarction (AMI) treated by thrombolysis within the first 12 hours from the start of the symptoms in five cardiology centers from Bucarest for a period of 5 years (2000-2004). This retrospective registry on a central database included 1814 patients (73.63% men, mean age 59.9 +/- 11.8 years), presented in an average time of 211.63 minutes from pain start. The most frequently used fibrinolitic was streptokinase (66.21%), administered most often in 30 minutes and for a subgroup in 20 minutes--accelerated regimen, with a good efficiency for the reperfusion of the culprit vessel evaluated non-invasively (clinical, electrical and biological methods). The global in-hospital mortality was 11.1%. The only predictors of in-hospital mortality were female gender and advanced age (>75 years) [p < 0.05]. The rate of haemorrhagic complications was not different from the one described by other clinical studies. The treatment by anticoagulants, antiaplatelets agents like aspirin, ACE inhibitors and statins were significant determinants of in-hospital survival. In the subgroup followed-up for 1 year (315 patients), the most frequent complication was the heart failure. In conclusion, in Bucarest, where availability of primary angioplasty in AMI was limited, thrombolysis with streptokinase was still very much used, with acceptable low in-hospital mortality and relatively high rate of artery reperfusion appreciated by non-invasive methods.


Subject(s)
Fibrinolytic Agents/therapeutic use , Myocardial Infarction/drug therapy , Myocardial Infarction/mortality , Thrombolytic Therapy , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Anticoagulants/therapeutic use , Female , Hospital Mortality , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Prognosis , Registries , Retrospective Studies , Romania/epidemiology , Sex Factors
13.
Postgrad Med J ; 78(915): 40-2, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11796872

ABSTRACT

Adenosine stress echocardiography was performed in nine patients (58 (+/-3) years, eight women) with documented microvascular angina. Global ventricular function was assessed by Tc(99m) blood pool imaging and Doppler, whereas longitudinal ventricular function was assessed by simultaneous tissue Doppler echocardiography of the lateral mitral annulus. Adenosine was infused incrementally to onset of chest pain in all patients. There was no significant change in global or longitudinal systolic function. Adenosine induced global diastolic dysfunction, demonstrated by blood pool imaging and by Doppler of the transmitral flow. All patients had long axis diastolic dysfunction at peak adenosine, revealed by a ratio of early to late diastolic velocity of lateral mitral annulus <1, which was absent at rest. Adenosine, as a stress agent, provokes regional and global diastolic dysfunction in microvascular angina, which may be a consequence of subendocardial ischaemia. Long axis diastolic dysfunction can be easily revealed by tissue Doppler of the lateral annular motion.


Subject(s)
Adenosine , Microvascular Angina/complications , Vasodilator Agents , Ventricular Dysfunction, Left/diagnosis , Adenosine/adverse effects , Diastole/drug effects , Diastole/physiology , Echocardiography, Doppler, Pulsed/methods , Echocardiography, Stress/methods , Female , Gated Blood-Pool Imaging/methods , Humans , Male , Microvascular Angina/physiopathology , Middle Aged , Pilot Projects , Vasodilator Agents/adverse effects , Ventricular Dysfunction, Left/chemically induced , Ventricular Dysfunction, Left/physiopathology
14.
Am J Cardiol ; 88(1): 53-8, 2001 Jul 01.
Article in English | MEDLINE | ID: mdl-11423058

ABSTRACT

To identify new echocardiographic indexes of long-axis function that might differentiate between pathologic and physiologic left ventricular (LV) hypertrophy, we compared 60 subjects with different types of LV hypertrophy (group I: 15 patients with hypertrophic cardiomyopathy, group II: 15 patients with systemic hypertension, and group III: 30 athletes) with 20 normal subjects (group IV). The peak velocities of mitral annular motion at 4 sites were measured from the apex by tissue Doppler echocardiography. There were no differences in mean age and global ejection fraction between groups. Groups I and II had lower long-axis systolic and early diastolic velocities than the athletes (p <0.01) for all 4 sites. The best differentiation of pathologic from physiologic hypertrophy was provided by a mean systolic annular velocity <9 cm/s (sensitivity 87%, specificity 97%). Heterogeneity of annular velocities discriminated between group I and group II. Thus, long-axis systolic and early diastolic velocities are decreased in patients with pathologic hypertrophy, but preserved in athletes. These simple new echocardiographic parameters can differentiate between pathologic and physiologic hypertrophy.


Subject(s)
Echocardiography, Doppler , Hypertension/diagnostic imaging , Hypertrophy, Left Ventricular/diagnostic imaging , Sports/physiology , Adult , Analysis of Variance , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/physiopathology , Diagnosis, Differential , Female , Humans , Hypertension/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Logistic Models , Male , Middle Aged , Sensitivity and Specificity
15.
Heart ; 85(1): 30-6, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11119457

ABSTRACT

OBJECTIVE: To identify variables that could be applied at rest to diagnose subclinical ventricular dysfunction in asymptomatic patients with severe aortic regurgitation. DESIGN: Cross sectional study. PATIENTS: Left ventricular long axis contraction was studied using tissue Doppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class 40%). MAIN OUTCOME MEASURES: Left ventricular ejection fraction (LVEF) at baseline and peak exercise (Weber protocol), cardiopulmonary function, and left ventricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus). RESULTS: In 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decreased by > 5% (from 54 (4)% to 42 (5)%, p < 0.001) (group II). Exercise ejection fraction was < 50% in all patients in group II. At rest, there were no differences between the groups in ejection fraction, left ventricular diameter indices, wall stress, and short axis contraction. However, patients in group II had reduced long axis contraction compared with group I: peak systolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indicator of poor exercise tolerance (sensitivity 90%, specificity 100%). CONCLUSIONS: Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.


Subject(s)
Aortic Valve Insufficiency/complications , Cardiomyopathies/diagnosis , Ventricular Dysfunction, Left/diagnostic imaging , Adult , Aged , Cardiomyopathies/etiology , Cross-Sectional Studies , Diastole , Echocardiography , Exercise Test , Female , Heart Function Tests , Humans , Male , Middle Aged , Myocardial Contraction , Oxygen Consumption , Reproducibility of Results , Sensitivity and Specificity , Stroke Volume , Ventricular Dysfunction, Left/etiology
16.
J Am Soc Echocardiogr ; 12(6): 492-9, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10359921

ABSTRACT

Four hundred and eighty paired recordings obtained from 16 patients (55 +/- 10 yrs; 10 men, 6 women) were analyzed to determine the reproducibility of both acquiring and measuring myocardial velocities recorded by tissue Doppler echocardiography. To assess intraobserver variability, 1 observer recorded and measured the data twice, from the same patients, and to assess interobserver variability, patients were examined by 2 independent observers. For the left ventricle, intraobserver reproducibility was higher when assessing long-axis velocities (+/- 10% to 16%) than short-axis velocities (+/- 14% to 24%). For the right ventricle, intraobserver reproducibility was high for the tricuspid annulus (+/- 9% to 15%), but unsatisfactory for the right ventricular anterior wall (+/- 21% to 25%). The highest interobserver reproducibilities were obtained for systolic and diastolic velocities of the lateral mitral annulus (+/- 9% to 17%) and systolic velocity of the tricuspid annulus (+/-13%). Interobserver reproducibility of the ratio of early-to-late peak diastolic velocities was very low for all investigated sites (+/- 20% to 52%). With the use of current techniques and software, reproducibility of acquiring and measuring tissue Doppler echocardiography is suboptimal for both systolic and diastolic myocardial velocities.


Subject(s)
Echocardiography, Doppler , Heart Ventricles/diagnostic imaging , Myocardial Contraction , Female , Humans , Male , Middle Aged , Observer Variation , Prospective Studies , Reproducibility of Results , Ventricular Function/physiology
17.
J Am Soc Echocardiogr ; 11(5): 487-90, 1998 May.
Article in English | MEDLINE | ID: mdl-9619623

ABSTRACT

We report a patient whose clinical and echocardiographic findings were compatible with a diagnosis of aortic intramural hematoma, but magnetic resonance imaging demonstrated a prominent and localized periaortic deposit of fat as the cause of the transesophageal echocardiographic appearance. This is a significant caveat that must be borne in mind when interpreting echocardiographic images obtained in patients with suspected intramural aortic hematomas.


Subject(s)
Adipose Tissue/diagnostic imaging , Aortic Diseases/diagnostic imaging , Echocardiography, Transesophageal , Hematoma/diagnostic imaging , Adipose Tissue/pathology , Aortic Dissection/diagnostic imaging , Aorta, Thoracic , Aortic Aneurysm, Thoracic/diagnostic imaging , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Middle Aged
18.
Plan Parent Eur ; 20(1): 24-5, 1991 May.
Article in English | MEDLINE | ID: mdl-12343176

ABSTRACT

PIP: The youth activities of the Romanian family planning association, the Society for Education on Contraception and Sexuality (SECS), center on a youth camp at the seaside resort of Costinesti. A very small consulting room set up 1) to supply education information on contraceptive methods, family planning, STDs, and major sex problems, and 2) supplying condoms. Staff included 11 physicians of whom 3 were obstetrics specialists, 4 nurses, 1 biologist, 1 demographer, 2 economists, and 1 engineer. Within an 80 day period, there were 1345 consultations, or 17/day. 72% were males and 28% females. The explanations for the higher male rate were attributed to reservations of women toward sexual issues, a higher number of sexual problems and STDs among males, and the perceived need for condoms by men. 33.8% were 20-24 years and 17.5% were less than 20 years. 80% of the sexual problems were related to anxiety about unwanted pregnancy and the natural method of coitus interruptus. 77.4% had questions related to contraception. The next highest concern was for STDs at 12%; the negative image of STDs prevails. Other concerns were for sexual problems, anatomy and physiology, pregnancy and birth, and demographic problems in general. AIDs was a disputed topic. 1121 out of 1345 client acquired condoms, 95% of the men and 53% of the women. The requested purpose was primarily contraceptive; men were more worried about STDs than women. A workshop for girls 14-16 was conducted separately which discussed anatomy and physiology. Effective broadcasting from the local radio station increased the number of consultations. Another workshop with representatives from a yoga school also was held; topics were yoga as a contraceptive means, therapy for sexual problems, and benefit to AID's sufferers. The author concludes that knowledge is low and interest high for contraception.^ieng


Subject(s)
Acquired Immunodeficiency Syndrome , Adolescent , Condoms , Delivery of Health Care , Health Education , Health Planning , Health Services Accessibility , Health Services Needs and Demand , Knowledge , Patient Acceptance of Health Care , Perception , Psychology , Radio , Research , Sex Education , Sex Factors , Sexually Transmitted Diseases , Statistics as Topic , Age Factors , Behavior , Communication , Contraception , Demography , Developed Countries , Disease , Economics , Education , Europe , Europe, Eastern , Family Planning Services , HIV Infections , Infections , Mass Media , Organization and Administration , Population , Population Characteristics , Program Evaluation , Romania , Virus Diseases
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