Management In Health, MIH (National School of Public Health, Management, Romania)
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Migratia asistentelor medicale: cazul Romaniei
No full textIn healthcare sector, human resource is the main category of resources absolutely necessary to ensure the provision of healthcare services. In Western countries, providing an optimal rate of specialized medical staff is one of the health policies subjects and development and quality improvement in nursing field is a major component of government health policies.In Romania, it highlights a lack of regulation in this area and also territorial inequalities and a shortage number of nurses determined by the inadequate planning of the medical staff and also by the increase of the phenomenon of migration to countries where their profession and human being are respected and where they can live in better conditions.Keywords: nursing, density of nurses, legal framework, training capacity.In domeniul sanitar, resursa umana reprezinta principala categorie a resurselor absolut necesare pentru asigurarea si furnizarea serviciilor medicale. In tarile occidentale, asigurarea unei rate optime a personalului medical specializat constituie subiect al politicilor sanitare iar dezvoltarea si imbunatatirea calitatii in domeniul nursing-ul reprezinta o componenta majora a politicilor sanitare guvernamentale.In Romania, se evidentiaza o lipsa a reglementarii in acest domeniu, precum si inegalitati teritoriale si o penurie a numarului de cadre medicale cu pregatire medie determinata atat de o planificare inadecvata a personalului medical, cat si de crestere a fenomenului de migrare a acestora catre tari in care profesia si persoana sunt respectate si unde conditiile de trai sunt mai bune. Cuvinte cheie: nursing, asigurarea populatiei cu asistenti medicali, cadru de reglementare, capacitate de formar
Studiu privind nevoile bolnavilor cu TBC in judetul Maramures
No full textTuberculosis represents one of the major public health problems at world level. Treatment of the disease needs the active and sustained involvement of the individual, and a sustained compliance regarding the therapeutic measures and the actual drug treatment. Besides the health care services an important role in the detection, treatment and counseling of the patient is represented by the participation of organizations such as local authorities, school, church, NGO’s and social services. Stigma and discrimination accompany the patients in the places where they receive treatment, in public places in their relationships with colleagues, with the authorities and even the family. The role of the community in fighting stigma and discrimination and facilitating the integration of patients into society becomes very important in the treatment and rehabilitation of the TB patient.Keywords: needs of the Tb patient, compliance, stigma.Tuberculoza, boala vindecabila, reprezinta inca, in anumite zone de pe glob, una dintre problemele de sanatate publica intalnita la toate grupele de varsta. Tratamentul bolii necesita implicarea activa si sustinuta a individului, care trebuie sa fie compliant la masurile terapeutice impuse de tratamentul riguros al bolii. In afara serviciilor de sanatate, un rol important in depistarea, tratarea, dar mai ales consilierea pacientului este reprezentat si de participarea unor organizatii precum: administratia locala, scoala, biserica, organizatiile non-guvernamentale, serviciile sociale. Cu toate ca, discriminarea persoanei este un fenomen care nu ar trebui sa existe, pacientii cu tuberculoza percep ca sunt discriminati inca din locurile in care sunt tratati, in locuri publice, in relatiile cu colegii, cu autoritatile si chiar cu familia. In acest sens, rolul societatii in reducerea stigmatizarii si facilitarea integrarii pacientului in societate devine de mare importanta in tratarea si recuperarea bolnavului cu TBC.Cuvinte cheie: nevoi ale bolnavilor cu tuberculoza, complianta la tratament, stigmatizare
Main Features of Prevalence and Severity of Major Depressive Episode in Romania
Get PDFThe 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
Managementul crizei economice si financiare in sectorul ingrijirilor de sanatate din Lituania
No full textThe aim of the study is to evaluate the impact of the economic and financial crisis on the health care sector during 2008 and 2009 in Lithuania. Methods. Comparative analysis of the data from 2008 and 2009 were used in order to compare the changes of the indicators before and after financial economic crisis. Three types of possible impact were assessed: financial impact, quality of life impact indicators and political decisions impact. Facts and findings. In financial terms, health care budget in 2009 remained the same as in 2008. Cost-sharing and out-of-pocket payments have increased. Funding of health prevention and health promotion programs was increased, as well as for long term care. There was no major increase of unemployment rate in health care sector. Access to health care was not changed. The death rate was decreasing from the most courses of deaths. Avoidable deaths courses show positive tendency. Quality of life indicators were improving due to the alcohol policy and traumas prevention measures in the country. Political decisions on the reform of social and health insurance systems were taken by involving all persons in payment of separate health insurance contribution. Some political decisions concerning alcohol consumption, tobacco and accidents prevention were accepted. The plans of restructuring health care institutions and also improvement of the access to medicines and new price policy has been prepared and started. Reorganization of public health and institutions was performed. Conclusion. The impact of financial and economic crisis and the first round of economic stability measures for the 2009 had very small impact on health care sector, but the plans for restructuring health care sector might affect it in the future.Scopul studiului este sa evalueze impactul crizei economice si financiare asupra sectorului de ingrijiri de sanatate din Lituania in perioada 2008 si 2009. Metode. A fost utilizata analiza comparativa a datelor din 2008 si 2009 pentru a compara modificarile indicatorilor inainte si dupa criza financiar-economica. Au fost evaluate trei tipuri de impact posibile: impactul financiar, indicatorii de impact asupra calitatii vietii si impactul deciziilor politice. Situatie de fapt si rezultate. In termeni financiari, bugetul din 2009 pentru sanatate a ramas la fel ca in 2008. Aportul la costuri si platile directe din buzunar ale pacientilor au crescut. A sporit finantarea programelor de preventie si de promovare a sanatatii, precum si finantarea ingrijirilor de sanatate de lunga durata. Nu a avut loc o crestere majora a ratei somajului din sectorul ingrijirilor de sanatate. Accesul la serviciile de sanatate nu a fost afectat. Rata mortalitatii a scazut la majoritatea cauzelor de deces. Decesele evitabile indica un trend pozitiv. Indicatorii de calitate a vietii s-au imbunatatit datorita politicilor din domeniul alcoolului si masurilor de prevenire a traumelor adoptate la nivel national. Deciziile politice de reforma a sistemului social si al asigurarilor de sanatate au vizat implicarea tuturor persoanelor in plata unei contributii separate pentru asigurarile de sanatate. Au fost acceptate unele decizii politice privind consumul de alcool si tutun si de prevenire a accidentelor. Au fost pregatite si demarate planuri de restructurare a institutiilor de ingrijiri de sanatate si, de asemenea, pentru imbunatatirea accesului la medicamente si noi politici de pret. S-a realizat reorganizarea institutionala si a sanatatii publice.Concluzie. Impactul crizei financiare si economice si prima runda de masuri pentru stabilitate economica pe anul 2009 au avut un impact infim asupra sectorului de ingrijiri de sanatate, dar planurile de restructurare a acestui sector ar putea avea consecinte in viitor
Spitalizari evitabile pentru cazurile de pneumonie, intr-un spital orasenesc de pediatrie din Ucraina
No full textBackground. In order to evaluate the quality of primary care, avoidable hospitalization indicators or hospitalization indicators for ambulatory care sensitive conditions are used, among which is pneumonia. Objectives. To evaluate the status of pediatric hospitalization due to pneumonia and factors connected with primary care delivery to these patients. Methods. A cross-sectional study of hospital episodes and hospitalized children (aged 0-17 years) admitted and readmitted due to pneumonia to Lviv city children’s hospital in connection with the ways of inpatients’ referral and diagnosing at primary level was conducted. Information was obtained from medical record forms of children discharged from the hospital during 2008 year, with diagnosis of pneumonia. Results. During year 2008, there were 486 children with pneumonia discharged from the hospital, which accounted for 494 episodes of hospitalization with average length of stay (ALOS) of 11.7 days.The boys prevailed among the hospitalized patients (60.3%). Mean age of patients was 4.7. The number of hospitalized persons decreased while the patients’ age increased. LOS of boys was positively correlated with their age. There were registered 1.02 episodes per one hospitalized child. Readmissions had lower LOS (9.4 days), than primary episodes (11.8 days) (p = 0.049).Only in 30.8% of episodes, patients were referred to hospital by primary care physicians (PCP) of territorial health care institutions, where children live. In 20.9% of episodes, physicians of Lviv city children’s hospital referred children to their hospital. Every fourth child was hospitalized by request of parents, and one in five was delivered by ambulance, although the percentages of emergency episodes were low − accordingly 36.4% of episodes hospitalized by parents request and 42.7% of episodes delivered by ambulance. Conclusions. The study has shown that LOS of children discharged from Lviv city children’s hospital due to pneumonia was higher than in other countries, but lower than LOS of other Ukrainian hospitals. Half of the patients were hospitalized bypassing the primary care level. For every fourth episodes at Lviv city children’s hospital, the referral diagnosis was different from the discharge diagnosis “Pneumonia”.Indications to emergency or non-emergency didn’t influence the distribution of hospitalization episodes by the ways children were referred to the hospital, as well as misdiagnosing made by physicians at referral time.Further investigations should be carried out for identifying the proportion of avoidable pneumonia hospitalizations and revealing preventable factors connected with primary health care provision in Ukraine.Context. Pentru a evalua calitatea asistentei primare se utilizeaza indicatori ai spitalizarilor evitabile sau indicatori de spitalizare pentru afectiuni tratabile ambulatoriu – printre care si pneumonia. Obiective. Evaluarea situatiei spitalizarilor pediatrice determinate de pneumonie si factorii legati de furnizarea ingrijirilor primare acestor pacienti. Metode. In acest scop s-a realizat un studiu transversal privind episoadele de spitalizare si numarul copiilor (in varsta de 0-17 ani) internati si reinternati pentru pneumonie in Spitalul Orasenesc de Pediatrie Lviv, in functie de tipul trimiterii si de diagnosticarea pneumoniei la nivelul asistentei primare. Informatiile au fost obtinute prin consultarea fiselor medicale ale copiilor cu diagnostic de pneumonie, externati din spital in anul 2008. Rezultate. Pe parcursul anului 2008 au fost inregistrati 486 copii cu pneumonie externati din spital, totalizand 494 episoade de spitalizare si avand o durata medie de spitalizare (DMS) de 11,7 zile. In randul copiilor spitalizati, baietii au fost mai numerosi (60,3%). Varsta medie a pacientilor a fost de 4,7 ani. Numarul persoanelor spitalizate a scazut, in timp ce varsta pacientilor a crescut. DMS pentru baieti s-a corelat pozitiv cu varsta. S-au inregistrat 1,02 episoade per copil spitalizat. Reinternarile au avut DMS mai mica (9,4 zile) decat episoadele primare (11,8 zile; p = 0.049 ).Numai in 30,8% dintre episoadele de spitalizare, pacientii au venit la spital cu trimitere de la medicii generalisti (MMG) ai institutiilor din raza teritoriala de rezidenta a copilului. In 20,9% dintre episoade, trimiterea copilului a fost facuta chiar de catre medici din spitalul orasenesc de pediatrie Lviv catre propriul spital. Un sfert dintre copii au fost spitalizati la cererea parintilor si 20% au fost adusi de ambulanta, desi proportia episoadelor de internare in urgenta a fost scazuta – si anume de 36,4% din episoadele de spitalizare la cererea parintilor si de 42,7% din cazurile aduse de ambulanta. Concluzii. Studiul a aratat ca DMS a copiilor externati din Spitalul Orasenesc de Pediatrie Lviv ca urmare a pneumoniei a fost mai mare decat in alte tari, dar mai mica decat DMS inregistrata in alte spitale din Ucraina. Jumatate dintre pacienti au fost spitalizati ocolind nivelul asistentei medicale primare. Pentru fiecare al patrulea episod de spitalizare, diagnosticul de trimitere a fost diferit de diagnosticul la externare, acela de pneumonie. Indicatia de urgenta sau non-urgenta nu a influentat distributia episoadelor de spitalizare in functie de tipul de trimitere a copilului catre spital, nici diagnosticarea eronata a medicilor la momentul trimiterii. Ar fi necesare investigatii ulterioare pentru identificarea proportiei de spitalizari evitabile pentru pneumonie si a factorilor prevenibili care tin de sectorul asistentei medicale primare din Ucraina
Aspecte evolutive, variatii ale activitatii spitalicesti si ale practicii chirurgicale -per ansamblu si din perspectiva unor grupuri vulnerabile de pacienti
No full textThe whole modern health management aims to shift the healthcare from hospitals to outpatient care. During last decades, EU reduced the number of hospital beds, the length of stay, trying to improve the efficiency of the health system. Is this possible to be done, preserving in the same time the equal coverage with health services, limiting the practice variations? The present study presents the evolution of the main indicators for the volume of hospital and surgical activity; some of differences recorded among regions or patient groups, and identifies features of the surgical practice concerning some vulnerable age groups of patients: children and elderly. The conclusions point out that the hospital activity increased, but varied among districts and age groups. There are some surgical interventions that occur very often in children or consume many hospital days in elderly that might need special analysis in order to evaluate their appropriateness or efficiency.Intregul management medical modern isi propune sa redirectioneze ingrijirile de sanatate din spitale catre asistenta extraspitaliceasca. In ultimele decade, UE a redus numarul paturilor de spital, in incercarea de a imbunatati eficienta sistemului de sanatate. Este posibil sa se intample aceasta, pastrand in acelasi timp acoperirea echitabila cu servicii de sanatate, limitand variatiile de practica? Studiul prezinta evolutia principalilor indicatori de volum ai activitatii spitalicesti si chirurgicale, unele diferente intre regiuni si grupe de varsta, identificand caracteristici ale activitatii chirurgicale din perspectiva unor grupe vulnerabile de pacienti: copiii si batranii. Concluziile arata ca activitatea spitaliceasca a crescut, dar a variat intre judete si grupele de varsta. Exista unele interventii chirurgicale foarte frecvente la copii sau care consuma un numar mare de zile de spitalizare la pacientii varstnici, acestea putand necesita analize speciale care sa le evalueze adecvarea sau eficienta
Morbiditatea spitaliceasca prin cancer de col uterin - Romania, 2009
No full textCancer is responsible for a large share of deaths, worldwide as well as in Romanaia, and induces high costs (for individuals, health system and society), proved to be one of the most burdensome diseases.Lately, problems induced by cancer in women are increasing, due to the raise in incidence, but mainly to the high mortality rate of cervix cancer. Hospitals having obstetrics-gynecology departments are the main medical units who provide specialized services for diagnosis, staging and treatment of cervix cancer; the most of cervix cancers cases are recorded in hospital care sector, and the analysis of hospital morbidity may offer a pretty fair picture of the phenomenon. The present paper presents some results of the analysis of the hospital morbidity trough cervix cancer, in hospitals who reported clinical data at patient level, during the first eight months of the year 2009.Key words: geographic distribution of hospitalizations, the profile of hospitalization, surgical procedures for cervix cancer in hospitalCancerul este responsabil pentru o mare parte dintre decese, atat la nivel mondial, cat si in Romania, si induce costuri mari (la nivel individual, sistem de sanatate si societate), dovedindu-se a fi una dintre cele mai impovaratoare afectiuni. Problematica indusa de cancer in randul femeilor cunoaste o amploare crescuta in ultimul timp, ca urmare a incidentei in crestere, dar mai ales a ratei mari de mortalitate pe care localizarea la nivelul colului uterin o determina. Spitalele in care exista o sectie de obstetrica-ginecologie reprezinta principalele unitati medicale in care se acorda servicii specializate, in vederea diagnosticarii, stadializarii si tratarii cancerului de col uterin; cea mai mare parte a cazurilor de cancer de col uterin sunt inregistrate in asistenta spitaliceasca, iar analiza morbiditatii spitalicesti poate oferi o imagine destul de fidela a fenomenului. Articolul de fata prezinta rezultate ale analizei morbiditatii spitalicesti prin cancer de col uterin, la nivelul spitalelor care au raportat date la nivel de pacient, in primele 8 luni din anul 2009.Cuvinte cheie: distributia teritoriala a spitalizarilor, profilul spitalizarilor, interventii chirurgicale in cancerul de col spitalizat
Studiul de sanatate mintala - Romania 2007. Prevalenta in ultimele 12 luni, severitatea si tratamentul tulburarilor mintale, conform clasificatiei DSM-IV
No full textIn the last years, all over the world, important changes have occurred in the philosophy and practice of mental health treatment. Due to the lack of nationally epidemiological studies in Romania, very little is known about the general population prevalence or severity of DSM-IV mental disorders. The research objective of the present study was to estimate 12-month prevalence, severity, and treatment patterns of DSM-IV anxiety, mood, impulse control, and substance disorders in Mental Health Study Romania 2007.A percent of 8.2% of the adult population in Romania meets criteria for any 12-month DSM mental disorder. The most prevalent 12 months disorder was anxiety, 4.9%, followed by mood disorders, 2.3%. Of 12-months cases, 28.1% were classified as severe. From 12 months disorders almost three fourths (71.7%) carried only a single diagnosis. As number of disorders is increasing, the percent of severity among the cases having certain degree of comorbidity, tend to be higher. Most likely many people with mental disorders in Romania remain either untreated or insufficiently treated, monitored. A better diagnosis and interventions meant to increase awareness about the significance of certain symptoms and signs, to improve addressability and access as well could enhance not only treatment initiation but the treatment quality too.Keywords: Prevalence of 12 months, severity and treatment of mental disordersIn ultimii ani, in lume s-au inregistrat modificari importante in filozofia si practica medicala din domeniul sanatatii mintale, inclusiv privind tratamentul acestora.In Romania, ca urmare a lipsei studiilor epidemiologice la nivel national, se cunosc foarte putine despre prevalenta si severitatea tulburarilor mintale conform DSM-IV in randul populatiei generale. Studiul are ca obiective de cercetare estimarea prevalentei din ultimele 12 luni, severitatea si modelele de tratament pentru tulburarile de anxietate, tulburarile de dispozitie, tulburarile de control al impulsivitatii si tulburarile legate de consumul de substante, conform clasificatiei DSM-IV, in cadrul Studiului de Sanatate Mintala Romania 2007.Un procent de 8,2% din populatia adulta din Romania indeplineste criteriile pentru vreo tulburare mintala in ultimele 12 luni conform DSM IV. Prevalenta cea mai ridicata in ultimele 12 luni s-a intalnit la tulburarea de anxietate (4,9%), urmata de tulburarile de dispozitie (2,3%).Din cazurile cu tulburari in ultimele 12 luni, 28,1% au fost clasificate severe si aproape trei sferturi (71,7%) au avut un diagnostic unic; procentul cazurilor severe creste o data cu numarul co-morbiditatilor.Cu mare probabilitate, multe dintre persoanele cu tulburari mintale din Romania fie sunt netratate fie sunt insuficient tratate sau monitorizate. O diagnosticare mai buna si interventiile menite sa creasca gradul de constientizare privitor la semnificatia anumitor simptome si semne, imbunatatirea adresabilitatii si a accesului, ar putea spori, nu doar initierea tratamentului, dar si calitatea tratamentului.Cuvinte cheie: prevalenta in ultimel 12 luni, severitatea si tratamentul tulburarilor mintal
Perceptia populatiei asupra coruptiei, platilor informale si introducerii coplatii in sistemul public de sanatate din Romania
No full textThis article presents the results of an opinion study realized in 2009 and representative at national level regarding population perception regarding corruption in the health system, informal payments and introducing co-payments for medical services in the public health system, in addition to the existing ones. According to the study findings one of every five respondents considers corruption as the main problem of the Romanian medical system. The vast majority of the participants in the study is against the informal payments and considers that the introduction of co-payments will not necessary lead to corruption or informal payments reduction in the health system, nor to the increase of the health services quality if they are not accompanied by measured directly addressed to these services.Keywords: Public health system, Romania, corruption, informal payments, co-paymentsPrezentul articol prezinta rezultatele unui studiu de opinie realizat in anul 2009, reprezentativ la nivel national, privind perceptia populatiei despre la coruptia din sistemul de sanatate, a platilor informale si a introducerii co-platii pentru servicii medicale in sistemul public de sanatate, suplimentare celor deja existente. Conform studiului, unul din cinci respondenti considera coruptia ca fiind principala problema a sistemului medical romanesc. Marea majoritate a respondentilor se declara impotriva platilor informale si considera ca introducerea de co-plati nu vor conduce neaparat la reducerea coruptiei sau a platilor informale din sistemul de sanatate, nici la cresterea calitatii serviciilor de sanatate, daca nu sunt insotite de masuri adresate direct acestora.Cuvinte cheie: Sistem public de sanatate, Romania, coruptie, plati informal