Background: Repeated surveys are essential for tracking trends in smoking prevalence among physicians, especially pulmonologists, who play a pivotal role in cessation counseling. Methods: In 2024, we conducted a descriptive cross-sectional surveillance study during the Romanian National Congress of Pneumology. A total of 332 registered pulmonologists were invited, and 226 (68.1%) provided a complete 30-item online questionnaire. The survey assessed smoking behavior and smoking-cessation counseling practices among Romanian pulmonologists for smokers and users of alternative nicotine products. Results: In a 2024 survey, current smoking rates were 4.9% (11/226) for conventional cigarettes, 2.2% (5/226) for heated tobacco products (HTPs), and 0.9% (2/226) for electronic cigarettes (e-cigarettes). Counseling practices were strongest for the initial steps of the 5A model: 93.4% (211/226) consistently asked about smoking status, and 88.1% (199/226) advised cessation. However, fewer assessed readiness to quit (65%, 147/226), monitored long-term abstinence (66.4%, 150/226), or assisted through referral and treatment. Only 36.3% (82/226) referred patients to the national STOP SMOKING program, and just 15.9% (36/226) declared to recommend Quitline programs. Conclusions: Smoking prevalence among Romanian pulmonologists has declined substantially over the past two decades. Despite high adherence to asking and advising patients, significant gaps remain in assistance and follow-up. Strengthened training and system-level support are needed to optimize cessation counseling.
This study aimed to assess the validity and reliability of the Therapeutic Communication Questionnaire for nurses. This cross-sectional analytical research was conducted in Kashan in 2023. After the translation process, the questionnaire was distributed among the target community. The questionnaire was designed in electronic form (Porsline) and consisted of three sections: demographic information, the Therapeutic Communication Questionnaire for nurses with patients, and a questionnaire on barriers to effective (“nurse–patient”) communication. After completing the questionnaire, the data were entered into SPSS (version 16). Out of 347 participants, 123 (35.47%) were male, with a mean age of 27.07 ± 3.97 years, respectively. The Cronbach's alpha coefficient for the questionnaire was 0.89, and the test–retest reliability (intraclass correlation coefficient, ICC (3,1) was 0.80. The Bartlett's test value was 10368.72, which was statistically significant (P<0.001). The Kaiser-Meyer-Olkin Measure (KMO) index in the results analysis was 0.86. Exploratory factor analysis using principal axis factoring with Promax rotation, combined with scree plot and parallel analysis, supported a three-factor solution explaining 42.46% of the variance. (Only factors 1 and 2 had acceptable reliability.) The questionnaire shows good validity and reliability for Persian speakers. However, cultural differences must be considered, as attitudes influence the nature of communication.
This study explores behavioral and demographic predictors of sustainability engagement in sustainable food choices among Romanian adults, addressing a regional gap in Eastern European sustainability research, based on an online non-probability sample of 406 respondents collected through an online cross-sectional survey, with voluntary response and snowball sampling techniques, conducted between 15 October 2024 and 30 January 2025. From 527 initial responses, 121 questionnaires were excluded due to incomplete or inconsistent answers, resulting in a final analytic sample of 406 respondents. A modified version of the Food Choice Questionnaire (FCQ), termed the Consumers’ Engagement in Food Choices Questionnaire (CEFCQ), was employed to capture sustainability-related behaviors and attitudes. Four hypotheses were tested using multiple linear regression. While snowball sampling is appropriate for exploratory research, we acknowledge its limitations in terms of representativeness at the national level. The respondents haven’t received any incentives, and data privacy and confidentiality were guaranteed. A modified version of the Food Choice Questionnaire (FCQ) was employed to assess sustainability-related attitudes and behaviors, including food label awareness, shopping frequency, and food waste reduction practices. Drawing on existing literature, four hypotheses were formulated and tested using multiple linear regression analysis. Results indicate that label reading behavior and perceived importance of digitalization are positively associated with sustainability engagement, while shopping frequency is negatively associated. Educational attainment and digital marketplace engagement show no significant association after controlling for other variables. The model explains approximately 25% of the variance in sustainability engagement. Given the non-probabilistic sampling design and demographic skew toward female and highly educated respondents, findings are interpreted as exploratory. This study contributes region-specific evidence on sustainable food behavior in Romania and highlights the role of information-oriented behaviors over formal education in predicting sustainability engagement. Implications for consumer education, labeling policy, and targeted interventions aligned with the European Green Deal are discussed.
Burns that affect functional areas present unique challenges in terms of diagnosis and therapy due to their particular mobility and aesthetic importance. In this article, we summarize the current principles in the diagnosis, treatment, and rehabilitation of burns that affect these regions. In this regard, the recent medical literature (clinical evidence) was analyzed to outline management strategies specific to each region. Early and correct evaluation of lesions, along with individualized treatment are essential for maintaining mobility and preventing sequelae. The results obtained are applicable in both civilian and military environments. Superficial burns respond well to conservative care with dressings, splints, and physiotherapy on the one hand, and on the other hand, deep burns benefit from excision and early grafting, the standard modern procedure that shortens hospitalization and greatly improves results. Long-term recovery depends on scar modulation, reconstructive surgery, and multidisciplinary rehabilitation addressing both functional and psychological aspects. Treatment of the burns of functional areas requires prompt, tailored, and multidisciplinary management to restore function and minimize disability. Standardized treatment algorithms and expanded research on long-term rehabilitation remain essential for improving burn care outcomes.
Objective. In this retrospective study, we aimed to analyse bone profile in menopausal women who suffered a low-trauma fall and were found to have an osteoporotic fracture. Methods. This real-life setting included individuals with a fall within the last year before DXA scan [providing bone mineral density (BMD)/T-score], and excluded traumatic falls, prior anti-osteoporosis therapy, diagnosis of osteoporosis, cancers, and bone metabolic diseases. Results. 5-year age-group analysis was statistically significantly different (N=48, p=0.017): in the 70-74 year interval, 75% were in group F (fracture +ve), in the 50-54 year interval, 83.33% were in group nonF (fracture-free). Mineral metabolism assays and bone turnover markers pinpointed a similar profile, except for DXA: femoral neck T-score was lower in group F versus nonF (-1.75±0.72 versus -1.17±0.91, p=0.029). Receiver operating characteristic curve of femoral neck T-score for predicting a fracture showed an area under the curve of 0.691 (p=0.031). Conclusion. Menopausal women with a 1-year fall history with fractures were older, had a longer menopause duration, and had lower femoral neck BMD than fracture-free women. Type 2 diabetes and hypertension had similar prevalence, as did the vitamin D profile and bone turnover markers. Individuals with vertebral fractures (most common types) showed a lower lumbar BMD versus those with non-vertebral fractures.
Objective. In this pilot study, we aimed to analyze the blood irisin levels in relation to glucose and mineral metabolism assays in menopausal women with non-diabetic altered glucose regulation: impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Methods. This was a prospective, transversal, non-interventional, bi-centric (bi-country) study, between December 2024 and October 2025. Results. The patients (N=47) with IGT (N=21) or IFG (N=26) had a similar age (63±9.24 versus 63.46±8.16years, p=0.856), menopause duration (14.05±9.37 versus 16.76±8.07years, p=0.297), and body mass index with mean values within the obesity range (34.84±5.07 versus 31.34±6.46kg/sqm, p=0.765). Average 25-hydroxyvitamin D showed an insufficiency (28.62±8.09 versus 28.06± 6.99ng/mL). The IGT versus IFG group were found with statistically significantly higher 1-hour glycaemia in the oral glucose tolerance test (207.04±34.72 versus 179.40±33.91mg/dL, p=0.009), 2-hour insulin (101.44±67.26 versus 48.97±34.35 µUI/mL, p=001), fasting insulin (13.00±7.38 versus 8.36±3.96µUI/mL, p=0.008); HOMA-IR (3.53±2.32 versus 2.27±1.17; p=0.21) with mean levels sustaining insulin resistance. Conclusion. Circulating irisin was marginally elevated in the IGT versus the IFG group and positively correlated with body mass index in both. We found no correlation with the glucose profile, but with selective mineral metabolism assays. This pilot study requires an expansion of the sample size to pinpoint the potential practical utility of irisin as a biomarker.
Cone-beam computed tomography (CBCT) has expanded from dento-maxillofacial radiology to otorhinolaryngology, being proposed as a low-dose alternative to multidetector computed tomography (MDCT) for evaluating uncomplicated sinonasal disease and for surgical planning. Major guidelines (EPOS, ICAR-RS, ACR) recommend native high-resolution CT for bone and MRI for loco- regional complications, while the role of CBCT remains focused on bone anatomy and the oro-sinusal interface. The objective of this review was to systematically synthesize the evidence on the diagnostic performance, radiation dose, indications/contraindications, and limitations of CBCT in sinonasal pathology, and to propose a practical algorithm for its use. The methodology consisted of searching PubMed/Medline and “gray” literature (professional society positions, guidelines) until September 2025; relevant guidelines/consensuses and original/comparative studies reporting the utility of CBCT for rhinosinusitis (acute/chronic), odontogenic sinusitis, fungal pathology, anatomical variations, pre- and intraoperative planning, doses/technical parameters were included. Papers focused exclusively on non-sinonasal pathology or on contrast-enhanced CBCT were excluded. The synthesis is narrative, oriented towards clinical questions. The key results were: (1) CBCT provides an excellent representation of the bone anatomy of the osteomeatal complex, with superior spatial resolution to MDCT, but with clearly inferior tissue contrast (limiting the evaluation of complications, soft tissues, and perisinusal extension); (2) the effective dose of CBCT for sinuses typically varies ~0.05–0.48 mSv depending on the protocol/FOV, usually below conventional MDCT, but not consistently below ultra-low-dose MDCT or photon- counting CT (PCCT) protocols, which can achieve even lower doses with superior image quality; (3) tor uncomplicated chronic rhinosinusitis (CRS), CBCT correlates well with endoscopy and is adequate for scoring (e.g., LM analog), assessing anatomical variations, and planning FESS; for orbital/intracranial complications, suspected tumors, or invasive fungal rhinosinusitis, CBCT does not replace CT/MRI; (4) In odontogenic sinusitis (ODS), CBCT is the first-line investigation because it finely delineates dental pathology, oro-antral defects, and foreign bodies, and consensus recommendations support its use guided by indications; (5) Intrinsic limitations: poor tissue contrast, uncalibrated/unreliable HU values, metal artifacts, and sometimes restrictive FOV; (6) In the clinical setting, “point-of-care” CBCT shortens the diagnostic pathway and can reduce costs/delays, but careful case selection and adherence to the justification principle are essential. In conclusion, CBCT has robust diagnostic value for uncomplicated rhinosinusal disease and for the dento-sinusal interface, with the advantage of dose and access, but it does not substitute MDCT/MRI in risk/complication scenarios. Responsible implementation, according to guidelines and radioprotection principles, maximizes benefits and minimizes risks.
Objective: To analyze the psychological impact of exposure to conflict zones on active-duty soldiers and to evaluate the role of physical activity as a mitigating factor against stress-related effects. Background: Combat exposure is associated with increased psychological stress, sleep disturbances, and reduced well-being among military personnel. Understanding modifiable protective factors like physical activity is crucial for improving resilience and mental health in operational settings. Method: A total of 261 male Colombian Army personnel participated in the study. Standardized psychological scales (STAI, LES, UCLA Loneliness Scale, AAQ-II, PSS-14) and custom questionnaires assessing sleep, happiness, and physical activity were used. Statistical analyses included t-tests and ANOVAs to examine group differences and correlations. Results: Soldiers exposed to traumatic events or prolonged time in red zones reported significantly lower sleep quality and happiness levels. Those engaging in more than 120 minutes of physical activity per day reported significantly lower perceived stress scores compared to less active peers. Conclusion: Exposure to conflict zones adversely affects psychological well-being, particularly in sleep quality and happiness. However, increased physical activity is associated with lower perceived stress, suggesting its protective role. Application: These findings support the integration of structured physical activity programs as a practical and scalable intervention to promote resilience and reduce stress among active- duty military personnel.
Background: The COVID-19 pandemic exposed substantial shortcomings in emergency hospital systems, demonstrating that conventional linear models fail to accurately depict the intricate interdependencies among clinical, operational, and infrastructural components. This research employs nonlinear and fractal analytical frameworks to characterize and forecast the dynamic behavior of the principal emergency clinical hospital in Iași, Romania, for the years 2020–2022. Methods: The study employed a mixed-methods approach, combining retrospective analysis of hospital risk factors (infection rates, staff absenteeism, and ICU occupancy) with computational simulations. We analyzed time-series data using several nonlinear metrics, including the Higuchi fractal dimension, Lyapunov exponents, Shannon entropy, and multifractal detrended fluctuation analysis (MF-DFA). A modified Lotka–Volterra system was utilized to simulate feedback mechanisms between clinical and operational stressors. Results: The analyzed variables demonstrated nonlinear dynamics and fractal self-similarity across temporal scales (Hurst exponent = 0.73 ± 0.04; D_H = 1.35–1.49). Positive Lyapunov exponents (λ > 0) indicated deterministic chaotic behavior, whereas the multifractal spectrum width (Δα ≈ 0.62) indicated heterogeneous scaling patterns across hospital departments. Increasing fractal complexity was closely associated with diminished clinical efficiency and staff availability. Conclusions: The progression of pandemic-related risk followed a trajectory consistent with self-organized criticality, transitioning from stable to oscillatory and ultimately to chaotic phases as system load intensified. Adding nonlinear markers such as fractal dimension, Lyapunov exponents, entropy, and multifractal parameters to hospital monitoring systems could improve early warning systems and make it easier for healthcare organizations near critical thresholds to manage risk
Mental health stigma (MHS) among military personnel requires a complex approach, as it is influenced by ethical challenges and organizational norms distinct from those in civilian milieus. Stigmatization encompasses multiple dimensions -including social, self, anticipated, cultural, and structural stigma- that must also be examined within military settings. This article presents a conceptual analysis of key research directions in the field of MHS, based on a literature review conducted across three electronic databases (PubMed, Google Scholar, and Clarivate/Web of Science), from the inception of each database up to June 2025. The review focuses on active-duty service members and veterans, and identified six major domains involving MHS: (1) structural stigma within military contexts, (2) risk factors and consequences associated with MHS, (3) self-stigma among active-duty personnel and veterans, (4) the role of military healthcare providers in mitigating stigma, (5) military sexual trauma and its relationship to stigma, and (6) interventions aimed at decreasing MHS among military personnel. Although relevant primary and secondary studies were identified across these domains, significant research gaps remain, particularly in the last three areas. Addressing MHS in military populations is essential not only for improving quality of life, psychological well-being, and daily functioning, but also for maintaining combat readiness, unit cohesion, and peer acceptance.
