Romanian Journal of Preventive Medicine

Background: Measles remains a significant public health challenge in Ethiopia, and the country has not achieved measles elimination despite the commitments outlined in the Immunization Agenda 2030. This study assessed inequalities in MCV2 vaccination among children aged 24–35 months in Ethiopia. Methods: This study used nationally representative data from the 2022/23 National Health Equity Survey, which employed a two-stage stratified cluster sampling design across all regions and city administrations. A total of 1987 mothers/caregivers of eligible children were interviewed. Descriptive statistics, bivariable analyses, and multivariable logistic regression were conducted using Stata 17 software, and determinants of MCV2 uptake were identified. Wealth-related inequality was assessed using concentration index analysis. Statistical significance was set at p < 0.05. Results: Overall MCV2 coverage was 60.4%. The multivariable analysis identified a significant inequality in second-dose measles vaccination (MCV2) in Ethiopia. Children born in health facilities had higher odds of vaccination (AOR = 1.88; 95% CI: 1.49–2.38), and maternal age of 25–34 years was associated with increased uptake compared to younger mothers (AOR = 2.03; 95% CI: 1.18–3.48). Postnatal care utilization and vitamin A supplementation strongly improved vaccination coverage, with children receiving vitamin A showing markedly higher odds of MCV2 uptake (AOR = 16.74; 95% CI: 9.61–29.14). Female children were more likely to be vaccinated than males (AOR = 1.50; 95% CI: 1.01–2.24), and higher maternal education (college or above) significantly increased uptake (AOR = 2.78; 95% CI: 1.02–7.73). Wealth status also influenced coverage. Conclusions: Improving MCV2 coverage in Ethiopia requires strengthening of maternal and child health services and promotion of integrated care, including PNC, vitamin A supplementation, and routine immunization. Early and consistent contact with the health system, along with addressing gaps in health education and supporting younger mothers, is essential. Persistent inequalities by place of birth, household wealth, and region highlight the need for targeted interventions. Strengthening equitable immunization services remains critical to achieving national and global measles elimination goals. Full article

The COVID-19 pandemic triggered an unprecedented expansion of telehealth within the Medicare program, raising the question of whether this surge represented a temporary crisis response or a durable shift in care delivery. This study applied supervised machine learning and explainable artificial intelligence methods to national Medicare Telehealth Trends data to model nonlinear adoption dynamics and evaluate differential stabilization across demographic and geographic groups. Using state by quarter by demographic group observations from 2020 through 2025, random forest and gradient boosting models with temporally aware validation were implemented to characterize surge magnitude, peak timing, and post-surge equilibrium levels. Differential saturation was assessed using model predicted plateau estimates across age, race, dual eligibility status, and state. The results revealed a rapid and synchronous surge across demographic strata followed by stabilization into persistent but heterogeneous equilibrium levels. Age and dual eligibility status were associated with substantial divergence in plateau magnitude, while racial differences were comparatively modest after accounting for temporal and geographic factors. Geographic heterogeneity exceeded demographic variation, indicating that state level structural environments exert the strongest influence on long-term telehealth equilibrium. These findings suggest that telehealth has transitioned from emergency expansion to partial institutional embedding within Medicare preventive care delivery. However, uneven stabilization across states highlights structural disparities that may influence continuity of chronic disease management, behavioral health access, and routine preventive services. Strengthening digital infrastructure and policy alignment may therefore be necessary to ensure that telehealth functions as an equitable and durable component of preventive medicine beyond the pandemic period. Full article

Emerging evidence indicates that low-grade chronic systemic inflammation is a key contributor to the onset and progression of numerous chronic diseases. Vanilla planifolia, a globally valued spice recognized for its characteristic sweet aroma and flavor, is primarily derived from its beans and widely utilized in culinary, therapeutic, and medicinal contexts. Beyond its traditional use, vanilla provides essential nutrients and bioactive compounds, including B vitamins such as vitamin B6, niacin, and riboflavin, which are integral to metabolic regulation. In addition to its applications in food and pharmaceuticals, vanilla exhibits complementary medicinal properties. Vanillin, the principal bioactive constituent of vanilla, imparts its distinctive flavor and aroma and is accompanied by other phenolic compounds with notable antioxidant activity. This review highlights the potential of vanillin as a therapeutic agent, shifting its perception from a conventional flavoring compound to a promising bioactive molecule with relevance in chronic disease prevention. Furthermore, the applications of vanillin within the food industry are discussed. Full article

This critical integrative review reassesses the lipid paradigm by systematically mapping 380 influential trials and cohort studies on cholesterol, saturated fats, and statins in relation to cardiovascular and cognitive outcomes. The evidence base reveals a nearly even split between studies supporting and challenging LDL-centric causality, alongside pervasive methodological flaws, including reliance on surrogate lipid markers, ecological inferences, residual confounding, and industry-related reporting biases. Trial-generation comparisons and structured risk-of-bias assessment (ROB 2, ROBINS-I) repeatedly show that substantial pharmacological LDL reductions do not consistently yield proportional reductions in myocardial infarction, stroke, or all-cause mortality. Integrating Mendelian randomization with clinical and metabolomic data, the review advances a Critical Window Hypothesis in which LDL is necessary but not sufficient for atherogenesis, exerting dominant causal influence during early and midlife plaque initiation, while inflammatory, oxidative, and hemodynamic factors become primary drivers in advanced disease. Metabolomic studies of extreme longevity and late-life cohorts demonstrate that bile acids, steroid metabolites, and low-glycemic metabolic profiles—not total cholesterol—better predict survival and cognitive preservation, and that higher LDL in the oldest-old often associates with lower mortality and dementia risk. These findings challenge universal LDL-centric policies and support lifestyle medicine strategies prioritizing systemic metabolic optimization over isolated cholesterol targets. Full article

Tumor necrosis factor alpha (TNF-α) serves as a major regulator of inflammatory responses. The initial, critical release and activation of TNF-α in acute pancreatitis (AP) is primarily triggered within the pancreatic acinar cells through intracellular mechanisms in response to initial injury. This local, acinar cell-derived TNF-α recruits immune cells into the pancreas, which then produce more TNF-α, leading to the amplification of the inflammatory cascade. This opinion emphasises the role of TNF-α-mediated dysfunction of pancreatic β-cells and apoptosis induction through the Bax/Bcl-2/caspase-3 pathway. AP is often diagnosed by autodigestive pancreatic damage and systemic inflammatory response with transient or persistent hyperglycaemia. TNF-α signalling takes place through TNFR1, which initiates apoptotic events that weaken mitochondrial integrity leading to β-cell disruption and diminished insulin secretion. Studies reported TNF-α-mediated increases in Bax expression, anti-apoptotic Bcl-2 suppression and activation of caspase-3. Therapeutic strategies such as TNFR1 inhibitors, Bax/Bcl-2 modulators and BH3 mimetics possess great potential to preserve β-cell integrity. However, TNF-α inhibition requires a careful approach in order to avoid compromising immune defence in AP patients. TNF-α-driven β-cell apoptosis represents a strong link between inflammation and metabolic dysfunction that makes it a suitable target for AP. Future directions should prioritise translational research in human cohorts and developing receptor-specific interventions to balance immune modulation with β-cell preservation. Full article

Background: Gestational diabetes mellitus (GDM) represents a pregnancy-specific associated pathology that bears a heavy burden on patients and also on the healthcare system. GDM displays an increasing incidence and short- and long-term materno-fetal consequences. Its prevention strategies include lifestyle interventions, diet changes, gestational weight gain control, moderate-intensity exercise, and smoking cessation. GDM screening is performed in the second half of pregnancy between 24 and 28 gestational weeks. Treatment options include medical nutrition therapy and pharmacologic therapy. In most cases, optimum glycemic control is obtained by medical nutrition therapy alone. Although there are screening and treatment options, the medical system in Romania lacks homogeneity in the diagnosis and further management of pregnancies complicated with GDM. There is an urgent need to improve the healthcare system and the basic medical knowledge of the population and to find efficient strategies, which include a national diabetes in pregnancy guideline to ensure pregnancy monitoring, GDM screening, and the diagnosis and personalized management of cases in order to promote good pregnancy outcomes and minimize adverse pregnancy events. Full article

Ovarian cancer is a highly aggressive disease with a poor prognosis, largely due to challenges in early detection. Traditional screening methods, including transvaginal ultrasound (TVS) and CA125 testing, have notable limitations in detecting early-stage disease and are not advised for widespread use. This article examines emerging early detection technologies, such as novel biomarkers, circulating DNA, PCR assays from Pap swabs, autoantibodies, microRNAs, and advanced imaging techniques. Future advancements in therapeutic methods may enhance survival outcomes linked to early detection. While general population screening remains unendorsed, targeted screening might be valuable for high-risk groups, such as those with Lynch syndrome, but should not replace risk-reducing surgeries. Developing comprehensive screening guidelines for high-risk individuals is essential for improving early detection and survival rates in ovarian cancer. Full article

This article presents the report of the First International Congress of Preventive Medicine, organized by the Romanian Society of Preventive Medicine (SRMP) in March 2025, in Bucharest, Romania. The congress featured 11 discussion panels and workshops, bringing together over 85 experts from a wide range of medical disciplines, including oncology, vaccination, cardiology, endocrinology, gynecology, gastroenterology, surgery, family medicine, physical therapy, pulmonology, epidemiology, pediatrics, dentistry, pathology, ENT, genetics, pediatric cardiology, psychiatry, dermatology, plastic surgery, urology, infectious diseases, regenerative medicine, and other key stakeholders in preventive healthcare. The event served as a comprehensive platform for addressing critical public health challenges, with a focus on cancer prevention, anti-aging, oral health, genetics in preventive medicine, preventive cardiology and neurology, the correlation between craniofacial dysfunctions and posture, vaccination strategies, management of congenital malformations, neonatal screening, and the prevention of lifestyle-related diseases such as obesity and tobacco addiction. Furthermore, the congress highlighted the importance of interdisciplinary collaboration and evidence-based interventions in improving population health outcomes. It emphasized the urgent need for coordinated actions to address preventable diseases both at the national and international levels. Full article

The Romanian Journal of Preventive Medicine (RJPM) was launched in 2022 as the official publication of the Romanian Society of Preventive Medicine (Societatea Română de Medicină Preventivă), with the aim of serving as a platform for the dissemination of research and best practices in preventive medicine [...] Full article

The etiology of PCOS is complex, and clinical features are heterogeneous, involving metabolic, cardiovascular, dermatological, psychological, and reproductive changes. The diagnosis is applied using the evidence-based International Guidelines 2018, following the Rotterdam Criteria 2003. Evidence-based guidelines 2023 have additionally provided clear evidence of PCOS characteristics, which now include cardiovascular disease, with more solid information regarding the prevalence of sleep apnea and endometrial cancer. They have also included features such as the increased prevalence and severity of mood disorders as significant traits of this syndrome. Developing a lifestyle modification plan associated with individual needs is essential in managing Polycystic Ovary Syndrome. Full article

Aging represents the progressive deterioration of physiological integrity. This natural process leads to atrophy, decreased elasticity, and impaired metabolic and reparative responses in the skin. There is an increasing emphasis on “healthy aging.” Chronic sun exposure leads to recurrent damage caused by the sun’s ultraviolet light, known as photoaging. Environmental factors, in addition to sun exposure, also play a role in photoaging. Numerous studies have confirmed the role of cigarette smoke in accelerating skin aging. There are treatment options available for both types of aging. Full article

Gestational anemia, characterized by a decrease in red blood cell mass during pregnancy, remains a pervasive global health concern, affecting maternal well-being and fetal development. We have described the physiological changes inherent in pregnancy that predispose women to iron deficiency, emphasizing the increased demand for iron to support the growing fetus and the expansion of maternal blood volume. We explored the challenges in diagnosing and managing gestational anemia, considering the nuanced interplay of genetic, dietary, and socioeconomic factors that influence iron status, based on the national guideline recommendations. By enhancing our understanding of these complex dynamics, we aim to provide a comprehensive schematization of the national guideline for improved preventive strategies, early detection, and targeted interventions to optimize maternal and neonatal health outcomes. Full article

Among other benefits, folic acid has proven its role in preventing neural tube defects in the fertile female population. The neural tube defect prevalence is 21.9 in 10.000 births in the Eastern Mediterranean, while in the United States of America, the majority is from 5.5 to 6.5 in 10.000 births. This difference, in favor of the United States, is probably due to the folic acid food fortification program. In Romania, the importance of periconceptional care is still underestimated; women from disadvantaged areas do not seek medical advice before pregnancy, during pregnancy, or even postpartum, and an obstetrician does not monitor most pregnancies. Folic acid supplementation periconceptionally remains a neglected subject in the Romanian population, which could benefit from folic acid food fortification. Full article

Toxoplasma gondii is one of the most widespread parasites worldwide. Although it causes asymptomatic infections in most cases, it can lead to severe disease in immunocompromised individuals. When acquired during pregnancy, it can negatively impact fetal development, resulting in unfavorable outcomes in neonates. The epidemiology of this parasite varies from country to country, leading to a lack of international consensus on screening, diagnosis, and management of congenital toxoplasmosis. This article aims to review aspects related to the modes of transmission, screening, fetal prognosis, management, and prevention of this infection to increase the chances of a favorable fetal outcome. Full article

Developmental dysplasia of the hip, previously known as congenital dislocation of the hip, is the most common congenital disease of the musculoskeletal system in newborns. It corresponds to a complete or partial displacement of the femoral head out of the acetabulum. The incidence is around 1:1000 births and it depends on multiple factors (region, family history, gender, mechanical factors, or some specific neonatal conditions). Screening may be by universal neonatal clinical examination (Ortolani or Barlow maneuvers) with the addition of sonographic imaging of the hip (selecting the patients who present abnormalities detected by physical examination or risk factors, and universal screening in the neonate). This screening is recommended at the discharge of newborns in most maternity hospitals in Romania. Full article

Orthodontics is a branch of medicine that aims to achieve aesthetic and functional improvements through mechanical therapy by moving teeth into an ideal position. Orthodontic treatment can correct a variety of dental problems, including dental crowding and occlusion issues. Many people choose to undergo orthodontic treatment to improve the appearance of their teeth and boost their self-confidence. The braces are chosen according to pathology, following a specialized consultation with an orthodontist. Orthodontic treatment is an important step in achieving a healthy and beautiful smile and can help improve oral health and self-confidence. Full article

In numerous countries, newborns are screened for diseases whose early detection can avoid permanent damage. There tends to be global agreement that the only conditions included in national newborn screening programs are a reliable test and a proven therapy with clear benefits for the child's well-being. Through the National Health Programmes, newborns in Romania are examined for deafness, signs of retinopathy of prematurity and two metabolic disorders (phenylketonuria (PKU) and congenital hypothyroidism). Full article