Background/Objectives: Safe disposal of unused medicines represents an increasing public health and environmental concern. Until 2024, Romanian community pharmacies collected expired medicines from the public, though implementation was inconsistent. Using a knowledge-attitude-practice (KAP) framework, this study assessed community pharmacists' self-reported involvement in pharmaceutical waste prevention in Bihor County, Romania, one year after new legislation transferred collection responsibilities to hospital-based centers. Methods: A cross-sectional survey was conducted in May 2025 using a self-administered questionnaire comprising 22 items covering socio-demographics, professional practices, knowledge, and attitudes. Eligible participants were community pharmacists (N = 285). Results: Respondents reported high awareness and favourable attitudes toward pharmaceutical waste management: 98.2% indicated awareness of current legislation, 94.4% reported receiving training on the new regulations, 99.6% acknowledged health and environmental risks, and 98.9% expressed agreement that patient education is important. However, 55.4% reported providing disposal information only when patients requested it, while 89.8% indicated that patients rarely asked about medicine disposal. Self-reported proactive counseling increased with patient request frequency (χ2(3) = 7.914, p = 0.048), with pharmacists in the high-request group reporting substantially higher proactive counseling than those in the low-request group (83.3% vs. 42.9%). In an adjusted logistic regression, low request frequency was associated with lower odds of proactive counseling (aOR = 0.21, 95% CI: 0.05-0.98, p = 0.047). Most respondents (94.6%) perceived waste-related responsibilities, though these perceptions were only weakly related to reported counseling behaviors. Conclusions: Pharmacists reported high awareness and positive attitudes toward pharmaceutical waste management, but counseling remained reactive. Patient demand was a key correlate of counseling proactivity, underscoring the need for structured education within Romania's hospital-based take-back system.
Amid climate change and extreme weather, non-tailpipe air pollution from asphalt surfaces significantly contributes to urban air pollution. This study integrates laboratory experiments, field data, and computational modeling to show that humidity is a key driving factor that increases polar VOC emissions from asphalt by up to 46% when relative humidity rises from near-dry conditions (RH < 0.1%) to humid conditions (50% RH) at 50 °C. These VOCs also form SOAs, posing health and environmental risks. FTIR, MD simulations, and DFT calculations reveal that humid conditions enhance VOC-water interactions at the asphalt surface, increasing the abundance of oxygenated functional groups and hydrophilicity. This, combined with solar radiation, accelerates surface degradation through a self-reinforcing cycle. Analyzing a dataset of over 5000 observations from 1400 U.S. road segments spanning more than three decades, we develop a panel model that highlights the interaction between humidity range and solar exposure in accelerating asphalt deterioration. The nonlinear humidity term is statistically significant (p = 0.024), and the humidity-sunshine interaction is strongly positive (p < 0.001). Results highlight humidity's critical role in both degradation and emissions, emphasizing the need to explicitly consider humidity and its interaction with solar radiation in climate-resilient pavement design and air quality management strategies. TEASER: The Hidden Role of Humidity in Increasing Toxic VOC Emissions and Accelerating Asphalt Pavement Deterioration.
Romania is aligning its healthcare AI ecosystem with the European Union's AI Act (2024/1689), through its own National AI Strategy. Despite a growing volume of research in medical AI, significant gaps remain in translating this output into patents and domestically developed high-risk medical devices. This study assesses Romania's research productivity, patenting activity, and commercial solutions in medical AI. We conducted an analysis combining bibliometric data, patent information, and medical device databases, and analyzed 619 Romanian-authored articles on medical AI, 272 patent records, and identified domestic AI-powered software providers. Romania's publication output in medical AI has surged post-2018, primarily driven by academic institutions in Bucharest and Cluj. Patents are predominantly filed by multinationals, indicating a potential disconnect between research and industrial output. Six AI medical software solutions were identified, most under the low-risk classifications. While Romania is expanding its medical AI research, it faces barriers in converting academic output into innovation. The dominance of foreign corporations in patent filings, reliance on international funding for high-impact research, and the scarcity of domestically developed high-risk medical AI solutions highlight important gaps. Addressing these disparities is essential for national alignment in the AI medical innovation space.
2-Ethylhexyl salicylate (EHS), homomenthyl salicylate (HMS), and ethylhexyl methoxycinnamate (EHMC) are three commonly used organic ultraviolet filters (OUVFs) that exhibit environmental persistence and bioaccumulation potential. They are widely distributed in surface water, wastewater, sediment, soil, air, and dust, as well as in organisms. Their concentrations vary significantly across matrices, spatiotemporal scales, and species. In surface water, the concentrations of the three OUVFs are notably higher in industrial and tourist-influenced waters, with the mean concentration of HMS reaching 215.4 ng/L at Waikiki Beach and EHS averaging 203 ng/L along Romania's Black Sea coast. In wastewater, EHMC occurred at hundreds of ng/L in the dissolved phase, while its particulate-phase concentration peaked at 65,500 ng/g. Their atmospheric concentrations are predominantly in the pg/m3 range, with median values reaching hundreds of pg/m3. Moreover, OUVF concentrations in urban soils remain relatively elevated in soils of industrial areas. Their mean bioaccumulation factors (BAFs) were 1432 L/kg for EHS, 21,642 L/kg for HMS, and 447 L/kg for EHMC, with HMS posing the greatest ecological risk. These three OUVFs elicit diverse toxic effects (e.g., endocrine disruption, plant growth inhibition) and exert compound-specific toxicity through five core pathways: the hypothalamic-pituitary-thyroid (HPT) axis, hypothalamic-pituitary-gonadal (HPG) axis, oxidative stress, lipid metabolism, and apoptosis. Their environmental risks show distinct spatiotemporal and species-specific differences, with maximum exposure risk quotients (RQex) of 33 for EHS and 22 for HMS in summer along the western Mediterranean coast. Considerable uncertainties remain regarding their environmental occurrence, toxicological mechanisms and risk assessment. This paper aims to review the pollution characteristics, ecotoxicity and risk profiles of the three compounds to inform future studies and regulatory decision-making.
Asphalt-surfaced areas are increasingly recognized as non-combustion sources of non-methane volatile organic compounds (NMVOCs), yet their oxidative fate and particle-forming potential remain poorly constrained. We performed controlled chamber experiments (313 K) on a representative asphalt VOC mixture to compare daytime hydroxyl radical (OH) oxidation with nighttime nitrate radical (NO3) oxidation under contrasting relative humidity (RH = 20% vs 80%). OH produced broad, non-selective depletion across the VOC spectrum, whereas NO3 exhibited strong selectivity, rapidly consuming phenolics (catechol) and related oxygenated aromatics. Both oxidants formed abundant ultrafine particles (UFPs < 100 nm), with PM₁ yields of 11-14% (OH) and 16-41% (NO₃) with respect to total VOCs consumption observed in particle analysis, and disproportionate particle formation from low-volatility precursors, such as catechol. Higher RH delayed nucleation and suppressed selected gas-phase product yields, indicating humidity-dependent oxidation pathways and gas-particle partitioning. These results establish strong day-night contrasts in asphalt emission reactivity and identify low-volatility binder constituents, particularly phenolic oxygenates, as key particle precursors. Our results also signify that low volatility polar compounds strongly partition to the particle phase, and their elimination from asphalt binders would diminish secondary pollution formation, from asphalt pavements. Incorporating asphalt evaporation into urban emission inventories and reformulating binders to minimize such reactive species could reduce exposure to hazardous ultrafine particles and improve urban air quality.
Alternative meat products, including plant-based, insect-based products, and cultured meat, are gaining momentum as sustainable food innovations. Yet, the perceptions of political and institutional actors, key players in shaping regulation, legitimacy, and public discourse, remain poorly understood. This study fills this gap by examining how Romanian policymakers and public institutional actors understand sustainable protein transition using the SPECT framework (Social, Policy, Environmental, Commercial, Technological dimensions). Using qualitative thematic analysis of semi-structured interviews with 18 political and institutional actors, the research provides the first in-depth account of how governance elites in an Eastern European context interpret the sustainability, risks, and legitimacy of meat alternatives. The originality of this research lies in reframing political and institutional actors as active co-authors, rather than passive implementers, of sustainable food transition. The findings reveal a cautious but structured hierarchy of acceptance: plant-based products are perceived as "palatable bridges" to sustainability, whereas insect-based and cultured meat products provoke reactions ranging from curiosity to strong symbolic rejection. Concerns extend beyond health or naturalness to include food sovereignty, fairness for domestic producers, and the preservation of culinary identity. Findings highlight the concept of trust as the "currency of transition," showing that acceptance depends on credible institutions, transparent certification, and communication strategies grounded in local food traditions rather than globalist or "eco-elitist" narratives. Within the SPECT framework, social and policy dimensions proved more influential than technological or commercial ones, highlighting the primacy of cultural identity and institutional trust in shaping actors' perceptions. By situating Romania's case within the broader debate on just and inclusive food transition, the research provides new empirical evidence on how national identity, smallholder farming structures, and policy skepticism influence the political feasibility of adopting meat alternatives. The study concludes that aligning innovation with national food priorities through trust-based, inclusive policy design is essential for enabling a culturally embedded protein transition. Although the findings offer insights relevant to broader debates on sustainable protein transitions, their transferability to other national contexts is limited by Romania's specific cultural, institutional, and agri-food structures.
This study presents a comprehensive and updated epidemiological and public health assessment of human immunodeficiency virus (HIV) in Romania during 2022-2024, situated within the wider European context. For this retrospective descriptive study, we analyzed national surveillance data from the National Institute of Infectious Diseases "Prof. Dr. Matei Balș" and European Centre for Disease Prevention and Control (ECDC) reports, between 1985-2024, focusing especially on 2022-2024 period. Key indicators included incidence, mortality, transmission routes, age and gender distribution, and treatment coverage. Comparative analyses were performed between Romania and European Union (EU)/Eastern Europe data. Between 1985 and 2024, Romania registered a cumulative total of 28,793 HIV cases, with 18,768 individuals living with HIV (PLHIV) as of 2024. In that year, 810 new HIV cases were diagnoses, indicating a modest uptick compared with 2022-2023. Heterosexual transmission continued to predominate (59.4%), followed by cases among men who have sex with men (MSM) (30.5%) and intravenous drug users (IDUs) (5.2%). Men represented more than three-quarters of all new infections. Mortality displayed considerable year-to-year variability, increasing from 125 HIV-related deaths in 2023 to 193 in 2024. Despite this, treatment coverage improved steadily, with 16,464 individuals receiving antiretroviral therapy (ART) by the end of 2024. At 2.51 cases per 100,000 population, Romania's incidence remained below the European average of 3.5 per 100,000. Nonetheless, the proportion of infections attributable to MSM transmission rose sharply-from 3.91% in 2007 to 32% in 2024-bringing Romania's epidemiological profile increasingly in line with broader trends observed in Eastern Europe. These findings suggest that although Romania maintains a comparatively lower HIV incidence than the European average, the evolving transmission dynamics-most notably the substantial increase in MSM-related cases-signal a shifting epidemiological landscape that warrants strengthened, population-specific prevention measures and continued investment in comprehensive treatment and monitoring frameworks.
Mental health screening is important across sports cultures, yet recommended tools primarily exist in English. Several translations of the Sport Mental Health Assessment Tool-1 have been published and supported by validation studies; however, it is the Athlete Psychological Strain Questionnaire (APSQ) score that determines whether athletes should continue with the screening process. We aimed to investigate the validity of the Romanian APSQ within a representative population and examined the associations between the APSQ score and a range of well-being measures. 206 Romanian-speaking elite athletes from Romania's national and Olympic teams completed an online questionnaire that included demographic and relevant questions, followed by the APSQ-Ro, the second step of SMHAT-1, and the WHO-5 Well-Being Index. The APSQ-Ro demonstrated good internal consistency, suitable parameters for factorial analysis, a one-factor model with acceptable fit indices, and significant divergent validity with the WHO-5. The APSQ cut-off demonstrated a good sensitivity for depression, anxiety, and sleep disturbances, though with low specificity for all mental health problems assessed during SMHAT's second step. When analysing the range of APSQ values, good diagnostic ability (as measured by the area under the curve values) was detected for anxiety and depression. In contrast, poor overall AUC values and AUC at threshold were both identified for drug use and disordered eating. The limited diagnostic capacity for certain problems and the non-significant correlation between the explored variables may be attributed to several factors, including cultural influences.
While air pollution is a major global environmental challenge, its current status and recent changes remain insufficiently explored in many countries worldwide, including Romania. This study provides the first comprehensive and nationwide assessment of the current patterns and recent spatio-temporal trends (1990-2022) for nine major air pollutants (NOx, SOx, CO, NMVOC, NH3, BC, PM2.5, PMc, and PM10) in Romania. In this context, we performed a Geographic Information Systems (GIS)-based spatial analysis integrated with robust statistical methods to evaluate the current spatial distribution and total amounts of air pollutants, as well as to detect their long-term spatio-temporal trends at the pixel level. More precisely, the multifaceted atmospheric pollution was examined based on its current spatial patterns (derived from mean multiannual values and other metrics) and total emission amounts (expressed in Mg or metric tons), while the spatio-temporal trends of air pollutants were investigated using Sen's slope estimator and the Mann-Kendall test, to detect their magnitude and statistical significance from national to regional (territorial) scales. Our geospatial findings highlight complex geographic patterns of air pollution in terms of mean spatial distribution, dominated by urban pollution hotspots, in contrast to the mountain (Carpathian) areas hosting the lowest national pollution levels. Quantitatively, the results reveal that Romania released over 83 million Mg of air pollutants since 1990, of which most emissions were represented by CO (nearly 40% of the total), followed by SOx (17%), NMVOC (12%) and NOx (12%). Dynamically, however, our findings revealed widespread (generally >50% of Romania's area) statistically significant negative trends for SOx, NOx, CO, NMVOC, and NH3, alongside large-scale (>60-70%) positive trends for BC and particulate matter. The results provide a robust, inventory-based foundation for assessing air pollution in Romania, serving as a strategic framework for optimizing future air quality policies and national pollution control measures.
Breast cancer (BC) is the most common malignant disease in women in Romania, with incidence and mortality rates among the highest in Europe. This consensus statement aims to ensure equitable access to care for human epidermal growth factor receptor 2-negative metastatic BC (HR+/HER2- mBC) and triple-negative mBC (mTNBC) in Romania. Between December 2024 and June 2025, a scientific board of 11 oncologists, in collaboration with the Romanian National Society for Medical Oncology (SNOMR), developed national recommendations based on ESMO/NCCN/ABC guidelines, clinical expertise, and local conditions. A modified Delphi survey was conducted among medical oncologists to evaluate acceptance of recommendations with greatest clinical impact. Key recommendations included: mandatory biopsy at metastasis with ER/PgR/HER2 retesting, HER2-low assessment, and molecular profiling (BRCA, PIK3CA, AKT1/PTEN, ESR1, plus PD-L1 testing in mTNBC); for HR+/HER2- mBC, first-line endocrine therapy plus CDK4/6 inhibitor, followed by targeted agents, chemotherapy, or antibody-drug conjugates based on progression and visceral crisis; for mTNBC, first-line immune checkpoint inhibitor plus chemotherapy in PD-L1-positive, PARP inhibitors in BRCA-positive patients, and sacituzumab-govitecan or trastuzumab-deruxtecan later; systematic toxicity monitoring; and integrated supportive and palliative care. Sixty-one oncologists completed the survey, with >90% overall agreement, suggesting broad acceptance of recommendations as Romania's national standard for mBC care.
Apolipoprotein E (APOE) plays a tissue-specific role in diet-induced obesity: brain-expressed APOE promotes obesity, while hepatic APOE appears protective. Physiological plasma APOE levels facilitate clearance of atherogenic lipoproteins; however, supraphysiological levels induce hypertriglyceridemia and impair cholesterol clearance. APOE-induced hypertriglyceridemia has been linked to its carboxyl-terminal region (amino acids 260-270), particularly residues L261, W264, F265, L268, and V269. A bioengineered APOE4 variant, APOE4mut1, where these residues are substituted with alanine, promotes cholesterol clearance without inducing hypertriglyceridemia at any level of expression. This study examined APOE4mut1 effects on adipose tissue metabolism in vivo. Wild-type (C57BL/6) and APOE4knock-in mice were fed a Western-type diet for varying periods and infected with adenoviruses expressing APOE4 (AdAPOE4), APOE4mut1 (AdAPOE4mut1), or only the green fluorescent protein (GFP) (AdGFP). AdAPOE4mut1 infection of C57BL/6 mice fed a Western-type diet for 8 or 24 weeks stimulated brown adipose tissue (BAT) metabolism by inducing non-shivering thermogenesis and oxidative phosphorylation. In contrast, AdAPOE4 suppressed thermogenesis in this tissue. In white adipose tissue (WAT), AdAPOE4mut1 was able to stimulate thermogenesis after 24 weeks of feeding. This stimulatory effect in WAT was dominant over wild-type APOE4, since APOE4mut1 similarly enhanced mitochondrial activity in WAT of APOE4knock-in mice. These findings suggest that amino acid residues 260-270 of APOE4 critically regulate adipose tissue metabolism, in addition to their previously reported role in APOE-induced hypertriglyceridemia. Targeted mutagenesis within this region offers a potential therapeutic strategy for addressing hypertriglyceridemia and obesity in metabolic syndrome.
Lung cancer remains the leading cause of cancer mortality worldwide, with most cases diagnosed at advanced stages. Conventional tissue biopsy is invasive, and low-dose CT (LDCT) screening-although effective-faces practical and logistical limitations. Liquid biopsy has emerged as a minimally invasive approach to capture tumor-derived material, including circulating tumor DNA (ctDNA), cells, and extracellular vesicles (EVs). Among EVs, exosomes and their microRNA (miRNA) cargo offer a stable, disease-specific signal. Airway-proximal fluids such as bronchial aspirate and bronchoalveolar lavage fluid (BALF) are in direct contact with the tumor microenvironment and may contain higher concentrations of tumor-derived exosomal miRNAs compared with blood. This review synthesizes the limited but promising evidence for exosomal miRNAs in bronchial aspirate and BALF as diagnostic and prognostic biomarkers in lung cancer, examines methodological and standardization challenges, and discusses potential integration into clinical workflows, with particular emphasis on Romania's lung cancer epidemiology and healthcare context. While only two primary studies in the last five years have explored BALF exosomal miRNAs, these data justify further multicenter investigations aligned with MISEV2023 guidelines. Integrating airway-proximal exosomal miRNA analysis into bronchoscopy procedures could enhance diagnostic precision in resource-limited health systems and support the transition towards personalized thoracic oncology.
Romania's health system faces a challenge of health workforce maldistribution, especially in rural and non-university urban areas. A national policy reform was launched in 2024-2025, supported by the National Recovery and Resilience Plan and WHO technical assistance. The reform's objective was to equip and empower local authorities to improve the recruitment, retention, and motivation of health professionals in their communities. The reform involves the development and nationwide dissemination of the "Solutions for Human Resources in Health: Guide of Local Actions". Developed through a participatory, evidence-based process with stakeholders, this guide is a practical toolkit for local authorities and hospital managers. It consolidates underused legal frameworks and curates national and international best practices examples across four main pillars: Education, Incentives, Regulation, and Support. The primary expected outcome is an improvement in the geographical distribution of the health workforce, resulting in better-staffed facilities in underserved regions. A key secondary outcome is the boost in local authorities' administrative capacity and proactive involvement in the health workforce management, which fosters greater ownership and a more sustainable, decentralized approach to addressing staffing challenges. These outcomes will become measurable over the medium-to-long term as local authorities implement the guide's provisions. The collaborative, evidence-based process used for the guide exemplifies a best practice model for stakeholder-driven policy development. The Romanian experience provides a transferable framework for countries with decentralized health systems to empower local actors in addressing health workforce maldistribution, though long-term success depends on local implementation and political will.
Inflammatory bowel diseases (IBD), including Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), are increasingly recognized across Eastern Europe, including Romania, where historical data indicated low incidence. Contemporary real-time epidemiological data for our country are scarce. This study evaluated the short-term frequency and epidemiological characteristics of IBD patients presenting to major Romanian gastroenterology centers. We conducted a prospective, cross-sectional observational study over a 14-day period in November 2024 across 18 university-affiliated tertiary gastroenterology clinical sites in Romania. All consecutive adult patients with confirmed IBD were enrolled using a centralized online platform. Demographics, disease type and phenotype, severity, and treatment were recorded and analyzed descriptively. A total of 1,045 patients were registered: 52.4% CD, 46.9% UC, and 0.7% IBD-U. Geographical distribution revealed a statistically significant variation, with Crohn's disease being more frequent in Southern Romania, while UC predominated in the Eastern and Central-western regions (p=0.0009). Most patients resided in urban areas, and the majority were in clinical remission at presentation. Phenotypic analysis revealed ileocolonic CD (L3) and left-sided/pancolitis UC (E2/E3) as most frequent. Severe disease history was more common in CD, and prior surgery was significantly higher in CD than UC. Smoking and appendectomy were more frequently associated with CD as previously reported. Therapeutic patterns reflected disease type: anti-TNF use predominated in CD, while other biologics and small molecules were more common in UC. Regional differences in therapy were observed, with southern centers showing higher use of novel therapies, likely reflecting a more mature IBD population, with a higher CD prevalence. Notably, the number of IBD diagnoses increased over time, correlating with Romania's GDP growth (R² = 0.89, p < 0.001), suggesting that socioeconomic factors may influence disease recognition and diagnosis. This study offers the most recent snapshot of IBD epidemiology in Romania, highlighting a transition toward medium-incidence patterns and growing clinical complexity. These findings provide evidence for the need to establish nationwide population-based surveillance systems and healthcare planning initiatives aimed at mitigating the rising burden of IBD.
This study examines how the introduction of an abortion ban can shape the next generation’s family formation trajectories, and whether the influence of the ban varies by gender and parental socioeconomic status (SES). Focusing on Romania’s abortion ban period under the Ceaușescu regime, we investigate changes in the probability of being married, the age at leaving the parental home and at first marriage, and spousal age characteristics. Using two complementary datasets, the 2011 Romanian census and the 2005 Generations and Gender Survey, and employing a regression discontinuity design, we find that compared to their counterparts born before the abortion ban, women born under the ban regime left their parental home later, formed their first marriage later, and had a lower probability of being married. This postponement effect was mainly driven by women with lower parental SES. Conversely, we do not observe significant changes in men’s family formation outcomes, except for a higher likelihood of marriage among men with higher parental SES who were born after the ban. The spousal age difference was smaller for both women and men born during the abortion ban. Findings show that abortion restrictions can have lasting effects not only on the individuals who are directly affected by them, but also on the next generation’s family formation trajectories.
The vampire trope's connection to socialism originates in Karl Marx's The Communist Manifesto (1848), where it symbolizes capitalism. This interpretation has dominated vampire studies, often narrowing the discourse on the semantic dimensions of the vampire in communist states. This article examines the evolution of the vampire myth in Eastern bloc cinema from Lenin's 1917 October Revolution to Romania's 1989 communist collapse. By comparing socialist vampire movies to Western counterparts, the study reveals that Eastern European vampires usually embody the haunting legacy of communism's earlier phases. The article's final section contrasts vampire depictions in Poland, Czechoslovakia, Russia, and Romania during the cinema of late communism. While Romania-known as the vampire trope's birthplace-avoided the myth in cinema, other countries embraced it during this period to critique consumerism and shifting gender roles in Soviet societies. Through this exploration, the article illuminates the cinematic interpretations of the vampire across different socialist contexts.
Background and Objectives: Assessing the national burden of chronic wounds is a complex data analytics challenge. Robust estimates in Eastern Europe are scarce, highlighting the need for computational methods to validate cases in large-scale health databases. Materials and Methods: We applied a large-scale data analytics approach to Romania's National Inpatient Database (public hospitals, 2017-2022). A computational case-ascertainment algorithm (validated "≥2 admissions" rule) was used to identify recurrently hospitalized patients, establishing a cohort of 18,856 patients (65,771 hospitalizations). We computed annual prevalence, incidence, and mortality per 100,000 adults, stratified by ulcer categories, age, and sex. Results: Hospital-treated prevalence and incidence showed a clear pre-pandemic peak followed by a marked decline in 2020-2021 and only partial rebound by 2022, consistent with pandemic-related disruption of inpatient care. Population-level mortality remained low, but pressure ulcers, although least frequent, accounted for the highest mortality burden. Venous ulcers were the most common category, and the hospital-treated burden was concentrated in adults aged ≥ 65 years and in men. Conclusions: This nationwide data-analytics framework provides the first validated inpatient indicators of chronic ulcer burden in Romania and demonstrates substantial hospital-treated disease burden with pronounced sensitivity to healthcare access constraints. Clinical Implications: The findings can support health-policy and prevention strategies by prioritizing early detection and integrated hospital-community wound care pathways for high-risk groups (men and older adults) and by strengthening outpatient services to reduce avoidable admissions.
Background and Objectives: Romania's transition from long-stay psychiatric care to more balanced community-oriented care remains incomplete, and comparative patient-level data are limited. The primary objective was to compare mental health-related quality of life, autonomy, perceived coercion, and direct mental health costs across hospital, residential, and community care settings. Secondary objectives were (i) to compare hospital care with deinstitutionalized care taken together (residential + community), and (ii) to examine whether autonomy and perceived coercion were associated with mental health-related quality of life. Methods: In this cross-sectional study, 128 adults with severe mental illness (42 hospital, 43 residential, 43 community) completed the Romanian SF-36 v2.0 and two brief study-specific rating scales for autonomy and perceived coercion. Service-use and cost data for the previous 12 months were extracted from records. Results: Community participants had higher SF-36 mental scores than hospital patients (63.3 ± 7.6 vs. 52.8 ± 9.1) and higher autonomy (72.1 ± 10.0 vs. 53.0 ± 8.6), with lower perceived coercion (4.2 ± 1.3 vs. 6.4 ± 1.5; all p < 0.001). Mean combined direct costs in residential and community settings were approximately USD 1000 lower than in hospital care (USD 2671.6 vs. 3666.2; p < 0.001). When residential and community participants were analyzed together as a deinstitutionalized group, they also had higher SF-36 mental scores (59.7 ± 8.9 vs. 52.8 ± 9.1; p < 0.001). In multivariable models (R2 = 0.316), each 10-point higher autonomy score was associated with a 2.8-point higher SF-36 mental score, whereas each 1-point higher coercion score was associated with a 1.3-point lower score. Exploratory mediation analysis suggested that autonomy statistically attenuated the association between deinstitutionalized care and mental quality of life. Conclusions: In this sample, residential and community arrangements outside hospital wards were associated with better mental health-related quality of life, higher autonomy, lower perceived coercion, and lower direct costs than long-stay hospital care. These findings support the study objective of comparing Romanian care settings and suggest that autonomy is an important correlate to target in future service reconfiguration and longitudinal research.
Romania's rapid population ageing now unfolds primarily in cities, where health, social care, housing and mobility intersect. Within metropolitan areas, older residents face unequal access to community long-term care (LTC), digital services and health-promoting public space. Framed by European Commission and WHO agendas, this brief examines Romania's national strategies on health, ageing and LTC through an urban lens. It identifies a persistent rhetoric-implementation gap: municipal services remain underfunded and fragmented, and prevention or person-centred models are only weakly embedded in urban planning and budgeting. Five priorities could align ageing policy with urban health: intersectoral city governance with transparent equity dashboards; legal and financial recognition of informal caregivers; expansion of community hubs integrating primary care, social work and rehabilitation; digital inclusion programmes for older adults; and health-promoting urban design that improves walkability, thermal comfort and access to green/cool spaces. Converging city governance, LTC reform and urban design can translate policy aspirations into measurable gains in equity, autonomy and healthy life expectancy among older urban residents.
Romania's recent economic growth has positioned it as a competitive player in the European Union. However, this macroeconomic progress contrasts with the persistent labour market challenges faced by recent university graduates, particularly in the outsourced services sector. This study investigates the gendereddimensions of education-job mismatches and emotional labour among young graduates employed in Romanian call centres. This study employs 3 years of ethnographic fieldwork (June 2021-June 2024) to investigate how the organisational structure of outsourced customer support creates and reinforces gender inequities, frequently resulting in unstable and limited career trajectories for female employees. Through participatory observation and semi-structured interviews with customer support representatives (CSRs) and their supervisors, this study identifies the often-invisible mechanisms embedded in daily routines, performance metrics, and management practices that perpetuate structural disadvantages within the digital workplace. The findings argue that the work processes in outsourced call centres are characterised by standardisation, emotional labour, deskilling, and rigid hierarchies, which significantly contribute to gender inequality and precarious career paths, especially for young and educated women. Often, the roles of CSRs do not fully utilise employees' potential, resulting in dissatisfaction, burnout, and high turnover rates. By analysing the intersection of emotional labour and gendered expectations, this study makes a significant contribution to the field of sociology, specifically in the areas of work and employment, offering insights into the structural mechanisms that perpetuate inequality in the contemporary Romanian Business service sector.