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The Journal of School and University Medicine is an open-access journal that aims to encourage the publishing of studies on children and adolescents' health, promote health education, and develop medical services in schools.

The Journal of School and University Medicine publishes high-quality original research articles, reviews, case reports, short communication, and letters to the editor. Information about legislation, health education, statistics, and current school medical offices' everyday activities are also acceptable as non-indexed publications. The editorial board is paying particular attention to interdisciplinary studies. 

The Journal is published every three months: October-December, January-March, April-June, and July-September, in printed version and online on the website http://www.revista-medicina-scolara.ro, https://medicinascolara.eu/

The publication language is English. Publishing an article in the journal is free of charge.

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Articles shareViewsDownloads
EVALUATION OF THE ACTIVITY OF THE UNIVERSITY MEDICAL CABINETS FROM CLUJ-NAPOCA
Nicoleta Ancuta Pintea
Pages: 5-14

DOI: 10.51546/JSUM.2022.9301

DOI URL: https://doi.org/10.51546/JSUM.2022.9301

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19
14
A DESCRIPTIVE CROSS-SECTIONAL STUDY TO ASSESS THE KNOWLEDGE AND IMPORTANCE OF HAND WASHING AND ITS TECHNIQUE AMONG SCHOOL CHILDREN IN A SEMI URBAN PLACE IN SOUTH INDIA
Santosh Kumar Kamalakannan, Kishore Narayan
Pages: 15-19

DOI: 10.51546/JSUM.2022.9302

DOI URL: https://doi.org/10.51546/JSUM.2022.9302

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5
13
PERIPHERAL NEUROLOGICAL COMPLICATIONS DURING COVID-19 PANDEMIC. SHORT REVIEW
Madalina Stetca, Cristina Burlacenco, Andreea Ördög, Nicoleta Tohanean
Pages: 20-23

DOI: https://doi.org/10.51546/JSUM.2022.9303

DOI URL: https://doi.org/https://doi.org/10.51546/JSUM.2022.9303

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6
13
ANOTHER FACE OF PARKINSON’S DISEASE: PERIPHERAL INVOLVEMENT
Nicoleta Tohanean, Laura Grosu, Andreea Dit-Filipas, Lacramioara Perju-Dumbrava
Pages: 24-27

DOI: 10.51546/JSUM.2022.9304

DOI URL: https://doi.org/10.51546/JSUM.2022.9304

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5
13
Articles shareViewsDownloads
THE RELATIONSHIP BETWEEN PARENTING STYLES, PERCEIVED SOCIAL SUPPORT AND BULLYING: A CROSS-SECTIONAL RETROSPECTIVE STUDY UPON A SAMPLE OF ROMANIAN STUDENTS
Alina Vlazan, Sebastian Pintea
Pages: 5-13

DOI: 10.51546/JSUM.2021.8101

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8101

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53
249
EDUCATION IN ROMANIA IN THE SARS-CoV-2 PANDEMIC
Paraschiva Chereches-Panta
Pages: 5-9

DOI: 10.51546/JSUM.2020.7401

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7401

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40
213
THE EFFECT OF SMARTPHONE ADDICTION ON SLEEP QUALITY IN YOUNG PEOPLE
Gulsum GUNDOGDU, Phd, RN, Gulsun AYRAN, PhD, Nurten ARSLAN ISIK
Pages: 5-13

DOI: 10.51546/JSUM.2021.8301

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8301

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37
249
VISION SCREENING OF FOUR-AND FIVE-YEAR-OLD CHILDREN IN CLUJ COUNTY: RECOMMENDATIONS FOR NATIONWIDE IMPLEMENTATION
Jan Kik, Mandy Nordmann, Daniela Rajka, Mihai Mara, Simona Cainap, Oana Teodosescu, Alin Vladescu, Aurel Mocan, Anna Horwood, Maria Fronius, Cristina Vladutiu, Huibert Jan Simonsz
Pages: 5-23

DOI: 10.51546/JSUM.2021.8401

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8401

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35
38
ASPECTS REGARDING THE REOPENING OF SCHOOLS IN THE CONTEXT OF THE COVID19 PANDEMIC
Gabriela Brisan
Pages: 13-19
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33
212
ORAL HEALTH BEHAVIOR CHANGE FRAMEWORK IN PRESCHOOLERS: SYSTEMATIC REVIEW
Pahrur Razi, Muhammad Rusdi, Asni Johari, Syahrial
Pages: 40-49

DOI: 10.51546/JSUM.2021.8404

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8404

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32
31
EMOTIONAL ABUSE & EMOTIONAL NEGLECT OF CHILDREN - FORMS OF MALTREATMENT WITH PERSISTENT CONSEQUENCES ON CHILDRENS AND ADULTS HEALTH
Dr. Corina Demian
Pages: 5-11
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31
218
PSYCHOLOGICAL CONCERNS OF NOURISHMENT WITH SPECIAL FOCUS ON TRANSGENERATIONAL TRAUMA
Tibor Kökény, Borbála Zala, Ákos Széles, Márton Horváth, Eniko Tóth, László Tóth
Pages: 34-44

DOI: 10.51546/JSUM.2020.7404

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7404

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31
212
THE ANTI COVID-19 VACCINATION INTENTION OF MEDICAL PERSONNEL FROM ROMANIA
Dr. Daniela Rajka
Pages: 10-16

DOI: 10.51546/JSUM.2020.7403

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7403

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28
210
FROM FUNCTIONAL DYSPEPSIA TO CELIAC DISEASE. CASE REPORT
Adriana Ciocalteu, Mircea Ionescu
Pages: 5-8

DOI: 10.51546/JSUM.2021.8201

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8201

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24
223
FACTORS THAT CAN INFLUENCE IN ROMANIA THE PARENTS’ DECISION REGARDING THE ANTI COVID-19 VACCINATION OF CHILDREN AND ADOLESCENTS AGED 12-15
Petru Sandu, Daniela Rajka, Ancuta Pintea, Kristina Moldovan, Sebastian Pintea, Tudor L Pop
Pages: 19-29

DOI: 10.51546/JSUM.2021.8204

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8204

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23
221
THE FOOD INVESTIGATION CALCULATOR, A USEFUL TOOL IN MEDICINE OFFICES FROM KINDERGARTENS
Elena Teodora Ionescu
Pages: 14-18

DOI: 10.51546/JSUM.2021.8102

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8102

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21
214
Exposure to Peer Violence Among Romanian High School Students And Its Relationship With Internet Use And Other Health Risk Behaviors
Lucia Maria Lotrean, Ioana Trifescu, Mira Florea, Rodica Cornean, Romana Vulturar, Codruta Lencu
Pages: 5-10

DOI: 10.51546/JSUM.2022.9101

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9101

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21
34
THE EFFECT OF AN EDUCATION PROGRAM ON RECOGNIZING CHILD ABUSE AND NEGLECT IN TURKEY
Nurten ARSLAN ISIK
Pages: 24-33

DOI: 10.51546/JSUM.2021.8402

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8402

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20
31
EVALUATION OF THE ACTIVITY OF THE UNIVERSITY MEDICAL CABINETS FROM CLUJ-NAPOCA
Nicoleta Ancuta Pintea
Pages: 5-14

DOI: 10.51546/JSUM.2022.9301

DOI URL: https://doi.org/10.51546/JSUM.2022.9301

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19
14
FINAL EXPERTISE AND ATTITUDE TOWARDS VISION SCREENING IN HEALTH CARE PROFESSIONALS ENROLLED IN THE EUSCREEN PROJECT
Oana Teodosescu , Mihai Mara, Cristina Vladutiu, Simona Cainap, Daniela Rajka
Pages: 17-24

DOI: 10.51546/JSUM.2020.7402

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7402

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18
216
DIAGNOSTIC APPROACH TO ABDOMINAL PAIN IN SCHOOL-AGE CHILDREN
Tudor Lucian Pop
Pages: 19-26

DOI: 10.51546/JSUM.2021.8103

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8103

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17
212
MINORS RIGHT TO CONFIDENTIALITY AND LEGAL DEROGATIONS
Irina Georgiana IOSIF,Maria ALUAS
Pages: 5-11
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16
213
VERACITY IN PEDIATRIC PRACTICE
Rajka Mária
Pages: 20-22

DOI: 10.51546/JSUM.2022.9103

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9103

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14
21
PREVIOUS EXPERTISE AND INITIAL ATTITUDE TOWARDS VISION SCREENING IN HEALTH CARE PROFESSIONALS ENROLLED IN EUSCREEN PROJECT
Cristina Vladutiu, Simona Cainap, Oana Teodosescu, Raluca Maria Ursu, Simona Anca Sevan, Daniela Rajka, Mihai Mara
Pages: 12-17
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13
217
EVALUATION OF EUSCREEN - VISION SCREENING – DATA
Oana Teodosescu , Mihai Mara, Cristina Vladutiu, Simona Cainap, Daniela Rajka
Pages: 36-42

DOI: 10.51546/JSUM.2021.8303

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8303

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13
220
GENETIC LACTOSE INTOLERANCE, ADULT-TYPE. CASE REPORT
Ruxandra-Claudia Pop-Kun, Bianca Simionescu
Pages: 10-13

DOI: 10.51546/JSUM.2021.8201

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8202

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12
223
THE EFFECT OF PARENTS’ STRESS LEVELS RELATED TO THE COVID-19 PANDEMIC ON DIGITAL PARENTING AWARENESS, IN TURKEY
Semra KÖSE ,Gülsün AYRAN,Sibel Küçükoglu
Pages: 5-13

DOI: 10.51546/JSUM.2022.9201

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9201

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11
20
Feeding and eating disorders associated with anxiety and depression to a adolescent – case study –
Voichita Ana Soldan, Adriana Neghirla
Pages: 5-14
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10
215
THE ROLE OF THE SCHOOL MEDICAL OFFICE
Dr. Daniela Rajka
Pages: 27-34
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9
209
ARTERIAL HYPERTENSION IN PRE-SCHOOL CHILDREN AND SOME RISK FACTORS - PROSPECTIVE STUDY
Dr. Adriana Neghirla, Dr. Mihaela Onose, As. Gabriela Moldovan, As. Cristina Sandru, As. Daniela Claudia Botos, As. Veturia Luca, As. Ioana Truta, As. Liliana Prunas, As. Iacobina Claudia Rus
Pages: 5-15
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9
211
MINORS’S RIGHT TO CONFIDENTIALITY IN REPRODUCTIVE HEALTH CHOICES
Irina IOSIF, Maria ALUAS
Pages: 25-33

DOI: 10.51546/JSUM.2020.7405

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7405

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9
210
THERMOMETRY: BETWEEN EFFICIENCY AND INEFFICIENCY IN THE EPIDEMIOLOGICAL TRIAGE, IN THE PREVENTION OF COVID-19 IN PRESCHOOL AND STUDENTS
Lia Vlaicu, Mirela Simona Coporan
Pages: 27-30

DOI: 10.51546/JSUM.2021.8104

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8104

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9
210
MULTISYSTEM INFLAMMATORY SYNDROME ASSOCIATED SARS-COV-2. A NOVEL SPECTRUM OF PEDIATRIC ILNESS
Simona Cainap, Alexandra Mititelu, Oana Pantar, Diana Lazar
Pages: 36-40

DOI: 10.51546/JSUM.2021.8106

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8106

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9
217
INVESTIGATING SENSITIVITY OF FATHERS TOWARDS VIOLENCE AGAINST CHILDREN
Gülsün AYRAN, Semra KÖSE, Ayda ÇELEBIOGLU
Pages: 11-19

DOI: 10.51546/JSUM.2022.9102

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9102

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9
23
PSYCHO-EMOTIONAL HEALTH OF STUDENTS DURING THE COVID-19 PANDEMIC. THE ROLE OF THE SCHOOL IN IDENTIFYING STUDENTS AT RISK
Sorina Irimie, Petru Sandu
Pages: 31-35

DOI: 10.51546/JSUM.2021.8105

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8105

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8
211
HOW BODY IMAGE AFFECTS CANCER PATIENTS' COPING WITH THE DISEASE: BASED ON WILLIAMS LIFESKILLS PROGRAMME EXPERIENCES
Csilla Szava, Csaba Degi
Pages: 43-60

DOI: 10.51546/JSUM.2021.8304

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8304

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8
220
THE USE OF ELECTRONIC CIGARETTES – A NEW EPIDEMIC AMONG ROMANIAN CHILDREN AND TEENAGERS
Remus Gaga, Tudor Lucian Pop
Pages: 50-53

DOI: 10.51546/JSUM.2021.8405

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8405

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8
16
EVALUATION OF THE FIRST 24 MONTHS OF THE EUSCREEN PROJECT FROM THE PERSPECTIVE OF THE IMPLEMENTATION TEAM
Oana Teodosescu, Raluca Maria Ursu, Mihai Mara,Daniela Rajka,Simona Cainap,Cristina Vladutiu
Pages: 20-26
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7
214
HEALTH ASSESSMENT OF FOREIGN STUDENTS AND PUPILS IN STUDENT AND SCHOOL MEDICAL OFFICES
Dr. Pintea Nicoleta Ancuta
Pages: 20-28
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7
212
CONTEMPORARY TEENAGER AND THE RISK OF NON-COMMUNICABLE DISEASES
Ana Georgeta Negrea, Alina Grama, Claudia Sirbe, Tudor Lucian Pop
Pages: 15-20
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7
212
CURRENT STATE OF KNOWLEDGE ON THE VALUE OF INFORMATION AND COMMUNICATION TECHNOLOGY IN HEALTH EDUCATION
Ioannis Delimaris
Pages: 14-18

DOI: 10.51546/JSUM.2021.8203

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8203

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7
218
THE ASSOCIATIONS BETWEEN INTER-PREGNANCY INTERVAL AND MATERNAL AND NEONATAL OUTCOMES IN CHENNAI
Santosh Kumar
Pages: 22-27

DOI: 10.51546/JSUM.2022.9203

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9203

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7
10
SCHOOL MEDICINE IN THE COVID-19 PANDEMIC PERIOD
Dr. Daniela Rajka, Dr. Kristina Moldovan
Pages: 37-41
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6
211
FAMILY ROUTINES: IMPLICATIONS FOR WELL-BEING
Diana Georgiana Culea, Sebastian Pintea
Pages: 14-35

DOI: 10.51546/JSUM.2021.8302

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8302

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6
222
SOME RECENT DATA ON THE USE OF DRUGS IN EUROPE AND ROMANIA AMONG YOUNG ADULTS AND STUDENTS, REGARDING ADMISSIONS TO TREATMENT AND EMERGENCIES ASSOCIATED WITH THE USE OF DRUGS. SOME TENDENCIES AND CORRELATIONS
Corina Demian
Pages: 34-39

DOI: 10.51546/JSUM.2021.8403

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8403

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6
15
PERIPHERAL NEUROLOGICAL COMPLICATIONS DURING COVID-19 PANDEMIC. SHORT REVIEW
Madalina Stetca, Cristina Burlacenco, Andreea Ördög, Nicoleta Tohanean
Pages: 20-23

DOI: https://doi.org/10.51546/JSUM.2022.9303

DOI URL: https://doi.org/https://doi.org/10.51546/JSUM.2022.9303

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6
13
ROLES OF DIETARY FIBRES IN THE PREVENTION OF NONCOMMUNICABLE DISEASES
Maria Nitescu, Mirela Nedelescu
Pages: 14-27
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5
217
Study of a Q fever focus in an university medical office
Dr. Pintea Nicoleta Ancuta, Dr. Baciu Simina, Dr. Carmen Varodi
Pages: 5-10
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5
211
Practical concepts on the measurement of visual activity within the EUSCREEN, European project of early detection of vision and hearing impairment in children
Prof. Dr. Cristina Vladutiu, Dr.Simona Sevan, Dr.Oana Teodosescu, Dr. Raluca-Maria Ursu
Pages: 22-29
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5
214
Efficient parents - efficiennt children - case study -
Voichita Soldan,Adriana Neghirla
Pages: 0-0
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5
211
A DESCRIPTIVE CROSS-SECTIONAL STUDY TO ASSESS THE KNOWLEDGE AND IMPORTANCE OF HAND WASHING AND ITS TECHNIQUE AMONG SCHOOL CHILDREN IN A SEMI URBAN PLACE IN SOUTH INDIA
Santosh Kumar Kamalakannan, Kishore Narayan
Pages: 15-19

DOI: 10.51546/JSUM.2022.9302

DOI URL: https://doi.org/10.51546/JSUM.2022.9302

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5
13
ANOTHER FACE OF PARKINSON’S DISEASE: PERIPHERAL INVOLVEMENT
Nicoleta Tohanean, Laura Grosu, Andreea Dit-Filipas, Lacramioara Perju-Dumbrava
Pages: 24-27

DOI: 10.51546/JSUM.2022.9304

DOI URL: https://doi.org/10.51546/JSUM.2022.9304

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5
13
Nervous anorexia. A case study
Dr. Pintea Ancuta
Pages: 17-22
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4
211
Arterial hypertension in adolescents - prospective study
Adriana Neghirla, Iacobina Rus, Cornelia Hategan, Mihaela Onose, Liliana Heinrich, Dumitrita Barsan, Natalia-Stela Dalalau-Rus, Anica Oroian, Mariana Samsudean
Pages: 5-15
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4
209
The motivational interview - An instrument for helping patients to adopt healthy behaviors
Dr. Demian Corina
Pages: 30-36
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4
209
SCHOOL CHILDREN IN E-CAMPUS - NEW INSIGHT
Kishore Narayanan,Benjamin M Sagayaraj,Nidhi Sharma, Santosh Kumar Kamalakannan
Pages: 14-21

DOI: 10.51546/JSUM.2022.9202

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9202

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4
6
HEALTHY SCHOOLS – A GLOBAL PERSPECTIVE
Dr. Rodica Nicolescu
Pages: 14-19
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3
212
A RARE CASE OF VON HIPPEL-LINDAU DISEASE IN A STUDENT
Pintea Ancuta
Pages: 5-8
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3
209
The influence of psychosocial stress in the early childhood on physical and mental health in adulthood
Dr. Corina Demian
Pages: 20-24
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3
215
GENETIC ASPECTS IN TYPE 1 DIABETES MELLITUS
Zara Radu
Pages: 28-33

DOI: 10.51546/JSUM.2022.9204

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9204

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3
7
THE WELL-BEING OF CLUJ COUNTY HIGH SCHOOL STUDENTS, IN THE CONTEXT OF THE STRESS GENERATED BY THE COVID-19 PANDEMIC
Sorina Irimie, Ioana Beldean-Galea, Alexandra Viman, Petru Sandu
Pages: 34-53

DOI: 10.51546/JSUM.2022.9205

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9205

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3
8
THE NOVEL CORONAVIRUS. ORIGINS, STRUCTURE, CHARACTERISTICS, PREVENTION
Dr. Mihai Mara
Pages: 29-36
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2
210
INFLUENZA PROPHYLAXIS: CURRENT APPROACHES
Bianca-Georgiana Milcu,Dalida-Ana Domuncu, Dorina-Maria Craciun, Daniela Pitigoi, Victoria Arama
Pages: 5-13
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2
211
CONSUMPTION OF FRUITS AND VEGETABLES AMONG SECONDARY SCHOOL STUDENTS FROM CLUJ COUNTY
Tania Lupsa , Lucia Maria Lotrean
Pages: 21-26
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2
209
Management of the extraintestinal manifestations in Crohn disease
Olteanu Ovidiu Andrei, Radu Cristina, Grigorescu Raluca
Pages: 23-26
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2
210
The paediatric pacient with sudden death risk. Case report
Pop-Kun Ruxandra-Claudia
Pages: 16-20
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2
209
The Somatometric Calculator, a useful tool in school medicine offices
Dr. Ionescu Elena Teodora
Pages: 42-47
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2
208
Holistic approach of scoliotic posture to children and adolescent people
Conf. Univ. Dr. Mirela-Lucia Calina, Prof. Univ. Dr. Ligia Rusu
Pages: 11-19
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2
212
Practical aspects of acute upper respiratory tract infections to the school child
Prof. Dr. Sorin C. MAN
Pages: 23-27
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2
209
Depressive syndrome of young adult
Dr. Inna Petrache, Sef lucrari Dr. Mirela Voicu
Pages: 11-15
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2
211
YOUNG PATIENT WITH SPINA BIFIDA OCCULTA – ASSESSMENT AND REHABILITATION
Dr. Rodica Traistaru, Dr. Catalina Voinea,Dr. Diana Kamal,Dr.Carmen Statescu
Pages: 5-13
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2
213
MODERN MINIMALLY INVAZIVE METHODS USED IN TREATMENT OF EARLY DENTAL CARIES. CASE REPORT
André Codoi,Stanca Maria Muresan
Pages: 28-42
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2
212
Evolution of kindergartens` food plan, with and without dietetic intervention
Hadmas Roxana Maria, Neghirla Adriana, Martin Stefan Adrian
Pages: 16-21
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2
215
CÂTEVA DATE RECENTE PRIVIND CONSUMUL DE DROGURI ÎN EUROPA SI ROMÂNIA ÎN RÂNDUL ADULTILOR TINERI SI ELEVILOR, PRIVIND ADMITERILE LA TRATAMENT SI URGENTELE ASOCIATE CONSUMULUI DE DROGURI. CÂTEVA TENDINTE SI CORELATII
Bianca Huluban
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OPTIMIZATION OF TYPE 1 DIABETES THERAPY THROUGH TECHNOLOGY
Morariu Diana
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GYNECOLOGICAL DISEASES IN ADOLESCENTS
Dr. Lia Vlaicu
Pages: 9-13
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Informed consent to adults
Dr. Rajka Mária
Pages: 48-54
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Early dental caries. Developing conditions and methods for stopping its evolution
Codoi André,Dr. Muresan Stanca Maria
Pages: 29-41
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Evaluation of the vaccination situation
in a group of children of school age in Mures county

Kinga Balasa, Cristina Golea, Adriana Neghirla
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Physiological puberty and precocious puberty. Particular aspects in school and student medical cabinet
Dr. Pintea Ancuta
Pages: 25-31
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Contraception at teenagers
Dr. Deca Greta- Luisa, Dr. Stefan Diana, Dr. Voinea Catalina
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The patients' rights
Dr. Rajka Mária
Pages: 49-51
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ASPECTS REGARDING THE REOPENING OF SCHOOLS IN THE CONTEXT OF THE COVID19 PANDEMIC
Bianca Huluban
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PSYCHOLOGICAL CONCERNS OF NOURISHMENT WITH SPECIAL FOCUS ON TRANSGENERATIONAL TRAUMA Tibor Kökény1, Borbála Zala1, Ákos Széles2, Márton Horváth1, Enik? Tóth3, László Tóth1 1Department of Psychology and Sport Psychology, University of Physical Education, Hungary, 2University of Leipzig, Leipzig, Germany, 3ELTE Eötvös Loránd University, Savaria University Centre Szombathely, Hungary Abstract BACKGROUND: This paper presents a special segment of Hungarian nutritional habits in connection to psychological backgrounds. We aim to describe the characteristics of the types of nourishment among subjects and group them into distinctive categories. According to the basic concept that was used to create the inquiry, the changes of different types of nourishment are led by different motives. Our concept is also that there is a connection between the inheritance of transgenerational traumas of the family and the choices in the nutrition of those family members wishing to have a change from pathologic functions after the trauma. METHODS: The data was collected from a questionnaire containing 49 items within 5 main themes. To sort the relevant parameter, the Information Values were taken into consideration using SAS Enterprise Miner software. We examined the distribution of the strong variables in each group (Vegetarians - Essentially-Vegetarians - Non-Vegetarians) and tested it by Spearman's correlation on the ordinal variables and by chi-square or exact chi-square tests on the nominal variables. RESULTS: The results suggested creating 3 groups containing 95% of the participants – vegetarians, essentially-vegetarians, and not vegetarians. There were 5% of the participants who were not interested in nutrition and health. There are 3 types of origins or motivations of nutritional health focus, ethical consideration, and social influences. CONCLUSIONS: According to the results, the main aspects of nutrition are not only limited to health but can also be a solution to life-style changes alongside family traditions and contribute to the management of transgenerational issues. KEYWORDS: healthy nourishment, vegetarianism, nutrition, society, transgenerational trauma Introduction Plain English summary This paper presents a special segment of Hungarian nutritional habits connected to psychological backgrounds. Its aim is to describe the characteristics of the types of nourishment among subjects and group them into distinctive categories. According to the basic concept that was used to create the inquiry, the changes of different types of nourishment were led by different motives. The preliminary concept was as well that there was a connection between the inheritance of transgenerational traumas of the family members and the choices in nutrition of those members who wish to have a change from pathologic behavior after the trauma. It appears from the data that the change of life due to traumatic life events and the search for problem-solving due to transgenerational traumas is part of the treatment of pathologies in most people choosing ethical nutrition. This appears despite the need to defy family and environmental hostility. Background The average human nutrition is called mixed nutrition that includes regular consumption of meat that can originate from different sources, as mammals, birds, fish or nonvertebral living beings. The form of nutrition that leans toward vegetarianism is the so-called health-conscious that includes the maximum consumption of meat 4-5 times a week (McEvoy et al. 2012). The plant-based (or vegetarian) nutrition excludes meat, fish, poultry. There are different types of this form of nutrition and there are transitory states towards mixed nutrition. The types of plant-based nutrition are: Vegan, that excludes all types of animal products, Lacto-vegetarian, that is plant-based mixed with dairy products, Ovo-lacto-vegetarian, that is plant-based and includes dairy and eggs. The effects of health-conscious nutrition Below there is a list of effect of nourishment with pros and contras concerning vegetarianism. These results based on meta-analyzes of vegetarian literature. Iron status is worse in vegetarians than in omnivores (Heider 2018). Vegetarian lifestyle may contribute to bone loss, low height, and low weight based on existing evidence (Li et al. 2020, Iguacel et al. 2019). Vegan or vegetarian diets were related to a higher risk of depression and lower anxiety scores, but no differences for other outcomes were found (Iguacel et al. 2020). Health-conscious nourishment decreases the ratio of body fat and obesity (Mangels et al., 2003). Vegetarian diets reduces mean body weight, suggesting potential value for prevention and management of weight-related conditions (Neal et al. 2018, Huang et al. 2016). Inflammation markers are lower only at long term vegetarians (Haghighatdoost et al. 2017). This study provides evidence that vegetarian-based dietary patterns are associated with lowered serum C-reactive protein, fibrinogen, and total leukocyte concentrations. Although we have to mention that insufficient data were identified for a meta-analysis of intervention studies (Craddock et al. 2019). Risk for type 2 diabetes is decreased in groups of vegetarians by an international meta-analysis (Lee & Park 2017). Consumption of vegetarian diets is associated with improved glycemic control in type 2 diabetes (Yokoyama et al. 2017). Vegetarian dietary patterns improve glycemic control, LDL-C, non-HDL-C, and body weight/adiposity in individuals with diabetes (Viguiliouk 2019). According to the network meta-analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients. (Schwingshackl et al. 2018) In most countries a vegan diet is associated with a more favourable cardio- metabolic profile compared to an omnivorous diet (Benatar & Stewart 2018). A comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (?25%) and incidence from total cancer (?8%). Vegan diet conferred a significant reduced risk (?15%) of incidence from total cancer (Dinu et al. 2017). Results suggest that vegetarians have a significantly lower ischemic heart disease mortality (29%) and overall cancer incidence (18%) than nonvegetarians (Huang et al. 2012). None of the analyses showed a significant association of vegetarian diet and a lower risk of either breast, colorectal, and prostate cancer compared to a non?vegetarian diet. By contrast, a lower risk of colorectal cancer was associated with a semi?vegetarian diet (-14%) and a pesco?vegetarian diet (-33%) compared to a non?vegetarian diet (Godos et al. 2017). A systematic review provides evidence that vegetarian diets effectively lower blood concentrations of total cholesterol, low?density lipoprotein cholesterol, high?density lipoprotein cholesterol, and non–high?density lipoprotein cholesterol (Wang et al. 2015). Yokoyama et al. (2017) adds that plant-based diets are associated with decreased total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, but not with decreased triglycerides. In meta?analyses, the vegetarian diet was associated with a higher risk for dental erosion and a lower decayed, missing and filled teeth (Smits et al. 2019). Nourishment and personality The last decades showed an objective shift towards the identification of personality traits connected to diet and nourishment. Booth (1994) summarized the influencing factors of food choice that can be material and symbolic features. Within material features, he recognized characteristics of foods (like the smell, temperature, and taste) and bodily signals (like the level of blood sugar). Among symbolic features there are concepts of food, concepts of body, and cultural roles. All these features and parts behind the scene are responsible for the connection of the personality and its choices of values, health, and lifestyle including dietary habits. Möttus et al. (2012) linked the five factors of the NEO questionnaire (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) to the healthy or traditional diet. According to their results, higher scores on the health aware diet factor were associated with lower Neuroticism, and higher Extraversion, Openness, and Conscientiousness. Moreover, higher scores on the traditional diet factor were related to lower levels of Openness. Tiainen et al.. (2013) created their approach with the same tool and examined food preference in a more detailed way than Möttus and his research group. According to them the openness in men was associated with higher vegetable and lower confectionery and chocolate intakes. In women, neuroticism was associated with lower fish and vegetables and higher soft drink intakes. Extraversion, in women, associated with higher meat and vegetable intakes, and openness with higher vegetable and fruit intakes. Agreeableness was associated with a lower soft drink and conscientiousness with a higher fruit intake in women. Comparing resilient and non-resilient subjects, resilience in women is associated with higher intakes of vegetables, fruits, fish, and dietary fibre. The base of these recently published connections originates from Kikuchi&Watanabe (2000). Transgenerational patterns The intergenerational transmission of trauma is defined as the unconscious passing of a trauma onto the next generation (Bradfield, 2013). Adverse experiences in early life are risk factors for the development of behavioral and physiological symptoms that can lead to psychiatric and cognitive disorders later in life. Some of these symptoms can be transmitted to the offspring, in some cases by non-genomic mechanisms involving germ cells (Gapp et al. 2016). The individual seems to be the "product" of his/her environment. The basic self is created in the nuclear family and the situation dependent pseudo-self is created during later life. The latter connects to certain traumatic events and can cause a less differentiated state of the personality because of anxiety. The response to the traumatic situation can be seen as functional – concerning the lack of coping potential or lack of energy of the traumatized person. At the same time, the transgenerational behavior as a rigid pattern can dominate the behavior, values, and rules of the family members. The will for changing all these patterns of the family can create the opposition and even anger of the other members of the family (Boszormenyi-Nagy, Spark 2013). The physiological "inheritance" of the symptoms of the transgenerational patterns is obvious when you follow the decreased number of the neural receptors in the case of addictions. These inheritances are not guided genetically but behaviourally between members of the generations (Máthé 2003). Most research suggest that parents’ symptoms of posttraumatic stress disorder (PTSD) are associated with children’s psychological difficulties. More specifically, parents’ PTSD symptoms positively correlate with children’s anxiety (Leen-Feldner et al., 2011). The paternal stress exposure impacts future generations which manifest in behavioral changes and molecular adaptations (Manners et at., 2019). Neither PTSD nor maternal traumatic experiences were directly associated with symptoms of anxiety, depression, or antisocial and aggressive behaviour in the children (Roth, Neuner, & Elbert, 2014). Large-group (ethnic, national, religious) identity is defined as the subjective experience of thousands or millions of people who are linked by a persistent sense of sameness while also sharing numerous characteristics with others in foreign groups (Kállay, 2011). The main task that members of a large group share is to maintain, protect, and repair their group identity. A `chosen trauma' is one component of this identity. The term `chosen trauma' refers to the shared mental representation of a massive trauma that the group's ancestors suffered at the hand of an enemy. When a large group regresses, its chosen trauma is reactivated in order to support the group's threatened identity. This reactivation may have dramatic and destructive consequences (Volkan, 2001). The recognition that the violence and suffering experienced by one generation can have effects on subsequent generations provides an important insight into the origins of mental health problems. However, the kinds of adversity faced by each generation differ, and the construct of trauma does not capture many of the important elements that are rooted in structural problems, including poverty and discrimination. Understanding the ways in which trauma impacts mental health requires a broader view of identity, community, adaptation and resistance as forms of resilience. The trauma is not a natural kind or category but rather a specific way to punctuate both the temporal stream and spatial distribution of events with political, moral, and practical implications (Kirmayer, Gone & Moses, 2014). Hypotheses The hypotheses of the current study were as follows: According to the basic concept that was used to create the inquiry, (1) the different types of diets are based on different motives (Kökény, 2005, Arora et al., 2017). (2) We supposed that motives can be grouped in three categories such as health driven, socially determined, and ethically driven. (3) The third hypothesis was that there is a connection of food choices and traumatic events in the personal life and/or the family. Material and methods The data is extracted from the questionnaire that was created and recorded in May-June 2017. It was filled in by 249 people on the Internet, contains 49 items and its main themes are the following: Demography, Consumption habits related to different food stuffs, Lifestyle, The orientation of the family members towards nourishment, Habits and values. Among those who took part in this study 77 (31%) were men, and 172 (69%) were women. The ratios of distribution according to age and place are shown by Figure 1 and Figure 2. Age is distributed in 5 years groups (except the 18-25 group) since it seemed to be a more precise approach than grouping by decades. It was also a possibility to join the age groups to the possible crises terms where changes may occur, but the 5 years grouping included the crises option. (Especially within 31-40 group it would distort the data if decade grouping would have been applied.) Urban distribution seemed to be necessary based on the urban-rural consumption and lifestyle differences. Data processing To sort out the relevant parameters, the Information Values were taken into consideration using SAS Enterprise Miner software. Examining the distribution of the strong variables in each group (Veg - Essentially Veg - Non-Veg) and tested it by Spearman's correlation on the ordinal variables and by chi-square or exact chi-square tests on the nominal variables if they statistically were significant at the 5% level. There was a statistically significant difference for each of the variables highlighted in the study. About SAS Enterprise Miner statistical procedures. Interactive grouping node computes the weight of evidence for each attribute for every characteristic: the weight of evidence measures the relative risk of an attribute or group level. The value depends on the value of the binary target variable, which is either "non-event" (target = 0) or "event" (target = 1). Information Value. The predictive power of a characteristic (that is, its ability to separate the vegetarian group from non-veg or essentially-veg groups) is assessed by its Information Value. The Information Value is a weighted sum of the weight of evidence of the characteristic's attributes. The weight is the difference between the conditional probability of an attribute given an event and the conditional probability of an attribute given a non-event. Results The first step in the process of interpreting the raw data was to group subjects. According to the answers given to the questions "How often do you consume the following foods? [Meats, processed meat products, lard, chitterlings]" and "How do you evaluate the next types of nourishment? [vegetarian, lacto vegetarian, ovo-lacto vegetarian]" the participants were placed into three groups. Most of the participants were motivated by health consciousness, only 5% said that health was not important for them. Among vegetarians, a major part (48%, Confidence Interval – CI: 0.35-0.61), are long term vegetarian (more than 20 years) who are motivated by healthy nourishment. The same value is 13% (CI: 0.08-0.18) among omnivores (non-vegetarians) and 27% (CI: 0.09-0.46) among essentially-vegetarians. These findings fit the summary works on vegetarian nutrition of Sabaté (2001). The results were structured based on the above-mentioned hypothesis (3 types of motivations and transgenerational trauma connected to choices of nourishment) on these lines: motivations, social background and changes connected to the life periods, and the role of transgenerational patterns. Motivations The motivations are revealed by the answers given to the question "Have you changed your nourishment noticeably to your environment or influenced them, and if yes, based on what consideration?". According to our expectations, there are many more people who did not change among non-vegetarians compared to vegetarians since the multigenerational vegetarian families are relatively rare. Among those who changed their nourishment, the motivation connected to the ethics-religion-environment protection group was the strongest in the groups of vegetarians and essentially-vegetarians (67% (CI: 0.54-0.79) and 70% (CI: 0.5-0.9)) (Rejinders, 2001). The most frequent reasons for the change among people with mixed nourishment are preventive healthcare (59% CI: 0.5-0.69), losing weight (44% CI: 0.34-0.53), illness (28% CI: 0.19-0.36), and in a smaller ratio (10% CI: 0.1-0.32) the nicer appearance or the enhancement of the efficiency. Beyond the aspect of ethics-religion-environment protection (shortly: ethics) a similar ratio among vegetarians and essentially-vegetarians, the motivation was preventive healthcare (35% CI: 0.14-0.56 and 33% CI: 0.20-0.46) but reasons such as increased beauty, higher efficiency, and reduction in illness are more present in the group of essentially-vegetarians. (We can suppose that those who have a spiritual path, ethics, the protection of the environment, and the preventive healthcare is present and all the other motives are not. Among essentially-vegetarians, the variability of the reasons is higher since more appear from secular existence). The change based on illness is 30% (CI: 0.12-0.54) among essentially-vegetarians while only 9% (CI: 0.02-0.17) among vegetarians (Mangels et al., 2003, Pomerleau et al., 2002, Sabaté, 2003). The question "How important are the following aspects of eating/nourishment to you? [ethical, environmental aspects]" shows that the ethical and environmental aspects of nourishment are the most important for vegetarians and it is averagely important to essentially-vegetarians (Sabaté, 2001). It is totally or quite important for 81% (CI: 0.71-0.91) of vegetarians, 68% (CI: 0.49-0.88) of essentially-vegetarians and 45% (CI: 0.37-0.52) of mixed diets – see Figure 3. The question "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when choosing your choice? [Body shaping]" gave the result that on a five-degree scale this was the least important to vegetarians, slightly more important for essentially-vegetarians, and more important for those with mixed eating (not vegetarians). In the mixed eating group, 10% have this motivation "totally" and only 31% (CI: 0.22-0.36) answered that it is "not at all important". In the vegetarian group, this was 0% and 52% (CI: 0.39-0.65) and in the essentially-vegetarian group, this was 0% and 45% (CI: 0.25-0.66) - see Figure 4. The question "How important are the following aspects of eating/nutrition to you? [Health considerations]" showed that in the "totally" answer category, there was a significant difference between vegetarians, essentially-vegetarians, and the mixed diet group: 43% (CI: 0.30-0.56), 41% (CI: 0.20-0.61), and 27% (CI: 0.20-0.34) respectively (Mangels et al., 2003, Pomerleau et al., 2002, Sabaté, 2001). Interestingly, as with the ethical-environmental aspect, the image is a bit different here when asked about the importance of the nutritional aspect, or if we ask, "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when choosing your choice?" From the health point of view, the difference between vegetarians and participants of mixed diet decreases when asked as to the reason for the choice of nutrition. (The "Totally important" results: mixed nourishment, essentially-vegetarian, and vegetarian: 23% (CI: 0.05-0.40), 34% (CI: 0.27-0.41) and 34% (CI: 0.22-0.44) respectively.) We found exactly the opposite of the ethical-environmental response, so we can assume that health is an important aspect, but many other trends could be chosen from this point of view. On certain spiritual paths, only the vegetarian diet can be fitting to the follower of a given spiritual path, health is an "extra" for many of the ethical-environmental aspect rules. Eventually we can state that the different types of diets are based on different motives and health and ethical considerations were separated apparently (part of hypothesis 1.) (Kökény, 2005, Arora et al., 2017) Social background The answers to the question "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when choosing? [Family tradition]" shows that as expected, the importance of family tradition for vegetarians in nutrition is low. A practical reason for this may be the lack of a multigenerational plant-based family, so cutting out meat alone will not allow you to fully follow the family tradition. However, there may be a kind of subconscious or conscious urge to keep a distance from the family tradition, in which case vegetarianism is only a form, and deviation from family tradition is not a practical consequence. Figure 5 shows the distributions of family tradition among the three groups. The item "How often do you rely on the following resources for cooking in your current family or your current life? [Family tradition]" is less typical of vegetarians, but it is probably a consequence of the lack of multiple generations of vegetarians, so it is difficult to follow, although flavours can also be copied without meat. There is the result of the vegetarian group 34% (CI: 0.22-0.44), of the essentially-vegetarian 32% (CI: 0.12-0.51), and the non-vegetarian 33% (CI: 0.26-0.40) when we merged the responses "often or always". There are the questions: "Is there anyone in the family who has deliberately changed their diet before you?" and "If there is or was anyone who consciously changed their diet, why did they do so?". The responses show that the proportion of family members who changed diet is about the same: 31% and 34%. Among the three groups, there is a significant difference in weight loss and ethical-religious-environmental aspects for those who changed. At the vegetarian and essentially-vegetarian group, it is 32% (CI: 0.17-0.46) and 27% (CI: 0.07-0.55) of the ratio in the family who switched to ethical-religious-environmental considerations before the subject who answered our questions. In the case of mixed diets, this is 14% (CI: 0.07-0.20). This group is largely the relatives of vegetarians (children, spouses) who have not become vegetarians. In the family of our subjects, the ratio of changes due to weight loss is the lowest in the case of vegetarians: 16% (CI: 0.04-0.27). At essentially-vegetarians it is 20% (CI: 0.04-0.48), and in the mixed diet group, it is 36% (CI: 0.27-0.45) (Sabaté & Blix, 2001). There are the questions: "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when making your choice? [Belonging to the Community]" There is a big difference between the three groups in the answers. The essentially-vegetarian group is a kind of transition. Here, it is also evident that spiritual behavior is an important aspect of committed vegetarianism and that of belonging to the community. Essentially-vegetarians differ significantly from vegetarians in this. For vegetarians, the categories 'quite important' or 'completely important' are 40% (CI: 0.27-0.52) of the answers although the essentially-vegetarians response rate is only 9% (CI: 0.01-0.3) and the mixed diet group is only 4% (CI: 0.00-0.06). The 'not at all important' answer at the question of belonging to the community is 35% in the vegetarian group, 54% in the essentially-vegetarian group, and 76% in the mixed diet group – see below Figure 6. There was a question "How did the environment you live in respond to your change in nutrition?" Within the group who changed their nutrition, more people with mixed nutrition have found that everyone has supported them or that the environment is at least neutral. The essentially-vegetarians had more, and vegetarians even more hostile reactions. Based on these responses, we can refer to transgenerational traumatic patterns. The rigid and repetitive way of the solution of the old trauma becomes a tradition in the family, and family members seeking to resolve this will become renitent in the eyes of those who represent the family system, which is manifested in hostility (Manners et at., 2019). Summary of the hypotheses The above mentioned results prove the third hypothesis that there is a connection of food choices and traumatic events in the personal life and/or the family. Eventually we can state that the different types of diets are based on different motives since health and ethical considerations were separated apparently (part of hypothesis No. 1.) About the different permanency of motives we could see that ethical-environmental aspects are more durable while health considerations also can be lasting at least till the end of symptoms. The more fragile decision and motive is body shaping since it is following an outer trend and it seems not to be incorporated into the value system of the person (hypothesis No. 2.). Changes in life stages (Erikson's psychosocial crises) Question: "Is the importance of healthy eating linked to a life event or a life cycle?" The responses show that the highest proportion of people with mixed diets is "not linked to any stage or event of life" (28% CI: 0.21-0.35). For vegetarians and essentially-vegetarians, this is 3% (CI: 0.00-0.08) and 23% (CI: 0.08-0.45). The next part that is important for healthy eating and can be linked to some stage of life and the event of life. The mixed diet group is fairly balanced, most often their reason is their own or family member's disease (31% CI: 0.22-0.39), or some new stage of life (adolescence, adulthood, retirement), 37% (CI: 0.28-0.46), or for the birth of children (18% CI: 0.12-0.26), new, important relationships, jobs (16% CI: 0.09-0.23), belonging to a community (7% CI: 0.03-0.12), and 7% (CI: 0.02-0.11) from childhood. More than half of the essentially-vegetarians cite their own or a family member's illness for turning to healthy eating (53% CI: 0.29-0.77), the next most important impact is belonging to a community (41% CI: 0.18-0.67). Among vegetarians, the change in the health caused by disease is much lower 23% (CI: 0.12-0.34) much less than in the previous groups, and the motivation of belonging to the community (55% CI: 0.42-0.68) is higher. In the vegetarian group, the relationship and workplace play a role similar to that of mixed diets. Vegetarians and essentially-vegetarians are similar in that approx. 12% (CI: 0.01-0.36) of them bring these motivations from childhood, and 23% (CI: 0.12-0.34) are tied to a new phase of life (too). It confirms the aforementioned statement that some of the essentially-vegetarians, although the spiritual path and the belonging to the community are an inspiration as much as for vegetarians, but are not 100% committed. The other group who does not interact with vegetarian inspirational motivations through a community start with the motives of health, environmental protection, childhood patterns, performance enhancement, or weight loss (Erikson, 1980). Transgenerational patterns and distresses There was the question "Have you experienced chronic physical or psychological/mental illness in your youth or childhood (under 25 years of age) among you and your brothers and sisters?" In the vegetarian group, the highest rate of chronic illness in childhood was 19% (CI: 0.08-0.29) (4.5% (CI: 0.00-0.23) and 3% (CI: 0.00-0.06) in the group of essentially-vegetarians and mixed nourishment). There was the question "Which of the following occurred in the family back to your great grandparents, to the best of your knowledge?" The multiple-choice answers were converted into binary (whether trauma or not), and according to this result, the vegetarians had the highest rate (60% CI: 0.47-0.73), where trauma was present (55% (CI: 0.34-0.75) and 39% (CI: 0.31-0.46) among essentially-vegetarians and mixed nourishment). Our interpretation tends to see these facts as the family load from previous generations produce stresses from specific life events that appear in the life of the following generation. Handling those inherited stresses can have different ways, including destructive and constructive components (Kállay, 2007, Culda et al., 2018). Choosing such a way as changing lifestyle that includes nourishment can be a "brave" move although it can confront the family's helplessness or inertia for security needs. In such cases, the resistance of the other family members is understandable however they might be hostile (Boszormenyi-Nagy, 1985). Discussion The topics discussed in this paper overrun the basic biological function of diet. Among the motivations of nourishment, there is weight loss with a biological and social background (body forming) and the ethics-religion-environment protection that is more sophisticated and broader than only a biological aspect. While preventive health care and disease are biological, the former is more conscious and targeted, while the latter is a compelling force. The results show that prettiness and performance enhancement i.e. in sports, fit to social expectations (Mangels et al. 2003). It appears from the data that the change of life due to traumatic life events and the search for problem-solving due to transgenerational traumas are part of the trials treating the pathologies in most ethical type of nutrition changes (Rejinders, 2001, Boszormenyi-Nagy, 1985). This exists despite the need to defy family and environmental hostility. This data makes it possible to find a link between the two points of our hypothesis, i.e. the intention of change (on the transgenerational traumatic pattern that was passed on) and the nutritional mode. However, further studies are needed to clarify the hypothesis that could be collected, for example, through deep interviews. There is a further need to clarify the accuracy of the answers in the questionnaire since subjectivity and reliability could not be controlled. The research aimed to collect and process data on nourishment. We could distinguish three groups among the subjects, namely vegetarians, essentially-vegetarians, and omnivores. We were interested in their motivations, social background, changes in different life periods, and the role of transgenerational patterns. Among those who changed their nourishment, the motivation connected to the ethics-religion-environment protection group was the strongest in the groups of vegetarians and essentially-vegetarians (67% (CI: 0.54-0.79) and 70% (CI: 0.50-0.90)). The most frequent reasons for the change among people with mixed nourishment were preventive healthcare (59% (CI: 0.50-0.69)), losing weight (44% (CI: 0.34-0.53)), illness (28% (CI: 0.19-0.36)), and in a smaller ratio (10%(CI: 0.00-0.23)) the nicer appearance or the enhancement of the efficiency. Among the three groups, there was a significant difference in weight loss and the ethical-religious-environmental aspects for those who changed. At the vegetarian and essentially-vegetarian group it was 32% (CI: 0.17-0.46) and 27% (CI: 0.07-0.55) the ratio in the family who changed based on ethical-religious-environmental considerations. In the case of mixed diets, this was 14% and in this group largely the relatives of vegetarians (children, spouses) were presented who did not become vegetarians. In the family of vegetarians, the ratio of changes due to weight loss is the lowest: 16%. At essentially-vegetarians it is 20%, and in the mixed diet group, it is 36% (CI: 0.27-0.45). Some of the essentially-vegetarians, although the spiritual path and the belonging to the community were inspirational similar to vegetarians, they were not 100% committed. The other part, who did not interact with vegetarian inspirational motivations through a community, started with the motives of health, environmental protection, childhood pattern, performance enhancement, or weight loss. Concerning the transgenerational field, vegetarians had the highest rate (60% CI: 0.46-0.73) where family trauma occurred. (55% (CI: 0.34-0.75) and 39% (CI: 0.31-0.46) among essentially-vegetarians and mixed nourishment.) These results reflected the above-mentioned status of vegetarians where a higher level of repressed aggression was present. These facts were interpreted as the family load from the previous generation stresses from specific life events inherited into the lives of next generations. Handling those inherited stresses can have different ways including destructive and constructive components. Limitations and strength The data makes it possible to find a link between the two points of our hypothesis, i.e. the intention of change (on the transgenerational traumatic pattern that was passed on) and the nutritional mode. However, further studies are needed to clarify the hypothesis that could be collected, for example, through deep interviews. There is a further need to clarify the accuracy of the answers in the questionnaire since subjectivity and reliability could not be controlled. References Arora, A. S., Bradford, S., Arora, A., & Gavino, R. (2017). Promoting vegetarianism through moralization and knowledge calibration. Journal of Promotion Management, 23(6), 889-912. Benatar, J.R., Stewart, R.A.H. (2018) Cardiometabolic risk factors in vegans; A meta-analysis of observational studies. PLOS ONE 13(12): e0209086. Boszormenyi?Nagy, I. (1985). Commentary: Transgenerational solidarity—therapy's mandate and ethics. Family process, 24(4), 454-456. Boszormenyi-Nagy, I., Spark, G.M. (2013). Invisible Loyalties: Reciprocity in Intergenerational Family Therapy. New York, US: Routledge Booth, D.A. (1994): Psychology of Nutrition. London, UK: Taylor and Francis Bradfield, B. C. (2013). The intergenerational transmission of trauma as a disruption of the dialogical self. Journal of trauma & dissociation, 14(4), 390-403. Craddock, J.C., Neale, E.P., Peoples, G.E., Probst, Y.C. (2019): Vegetarian-Based Dietary Patterns and their Relation with Inflammatory and Immune Biomarkers: A Systematic Review and Meta-Analysis, Advances in Nutr, 10(3):433–451, https://doi.org/10.1093/advances/nmy103 Culda, G. L., Opre, A. N., & Dobrin, A. D. (2018). Victim blaming by women and men who believe the world is a just place. Cognition, Brain, Behavior, 22(2). Dinu, M., Abbate, R., Gensini, G.F., Casini, A. & Sofi, F. (2017): Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies, Critical Reviews in Food Science and Nutrition, 57(17): 3640-3649 Dwyer, J. T. (1988). Health aspects of vegetarian diets. The American journal of clinical nutrition, 48(3), 712-738. Erikson, E. (1980). Identity and the Life Cycle. London, England: W. W. Norton&Co. Gapp, K., Bohacek, J., Grossmann, J., Brunner, A. M., Manuella, F., Nanni, P., & Mansuy, I. M. (2016). Potential of environmental enrichment to prevent transgenerational effects of paternal trauma. Neuropsychopharmacology, 41(11), 2749-2758. Godos, J., Bella, F., Sciacca, S., Galvano, F. & Grosso, G. (2017): Vegetarianism and breast, colorectal and prostate cancer risk: an overview and meta?analysis of cohort studies. J Hum Nutr Diet. 30, 349–359. Haghighatdoost, F., Bellissimo, N., Totosy de Zepetnek, J., & Rouhani, M. (2017). Association of vegetarian diet with inflammatory biomarkers: A systematic review and meta-analysis of observational studies. Public Health Nutrition, 20(15), 2713-2721. Haider, L.M., Schwingshackl, L., Hoffmann, G., & Ekmekcioglu, C. (2018) The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis, Critical Reviews in Food Science and Nutrition, 58:8, 1359-1374, Huang, T., Yang, B., Zheng, J., Li, G., Wahlqvist, M.L., Li, D. (2012): Cardiovascular Disease Mortality and Cancer Incidence in Vegetarians: A Meta-Analysis and Systematic Review. Ann Nutr Metab, 60:233-240. Huang, RY., Huang, CC., Hu, F.B. Chavarro, J.E. (2016): Vegetarian Diets and Weight Reduction: a Meta-Analysis of Randomized Controlled Trials. J Gen Intern Med 31, 109–116. Iguacel, I., Miguel-Berges, M.L., Gómez-Bruton, A., Moreno, L.A., Julián, C. (2019): Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis, Nutrition Reviews, 77(1): 1–18. Iguacel, I., Huybrechts, I., Moreno, L.A., Michels, N. (2020): Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis. Nutr Rev, nuaa030 Kállay, É. (2007). Posttraumatic growth: A brief review. Psychology Review, 24, 76-98. Kállay, É. (2011): Trauma: From pathology to growth. Cluj-Napoca, Romania: Editura ASCR Kikuchi, Y., Watanabe, S. (2000): Personality and Dietary Habits. 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Bone loss, low height, and low weight in different populations and district: a meta-analysis between vegans and non-vegans. Food & Nutrition Research, 64, 10.29219/fnr.v64.3315. Mangels, A. R., Messina, V., & Melina, V. (2003). Position of the American dietetic association and dietitians of Canada: Vegetarian diets. Journal of the American Dietetic Association. Manners, M. T., Yohn, N. L., Lahens, N. F., Grant, G. R., Bartolomei, M. S., & Blendy, J. A. (2019). Transgenerational inheritance of chronic adolescent stress: Effects of stress response and the amygdala transcriptome. Genes, Brain and Behavior, 18(7), e12493. McEvoy, C., Temple, N., & Woodside, J. (2012). Vegetarian diets, low-meat diets and health: A review. Public Health Nutrition, 15(12), 2287-2294. Neal, D.B., Levin, S.M., Yokoyama, Y., (2018): A Systematic Review and Meta-Analysis of Changes in Body Weight in Clinical Trials of Vegetarian Diets. J Acad Nutr Diet, 115(6): 954-969. Rodriguez, N. R., DiMarco, N. M., & Langley, S. (2009). Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. Journal of the American Dietetic Association, 109(3), 509-527. Roth, M., Neuner, F., & Elbert, T. (2014). Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide. International journal of mental health systems, 8(1), 12. Pomerleau, J., McKee, M., Lobstein, T., & Knai, C. (2003). The burden of disease attributable to nutrition in Europe. Public health nutrition, 6(5), 453-461. Reijnders, L. (2001). Environmental impacts of meat production and vegetarianism. Vegetarian nutrition, 441-462. Sabaté, J. (2003). The contribution of vegetarian diets to health and disease: a paradigm shift?. The American journal of clinical nutrition, 78(3), 502S-507S. Sabaté, J. (Ed.). (2001). Vegetarian nutrition. CRC press. Sabaté, J., Blix, G. (2001): Vegetarian Diets and Obesity Prevention. in: Sabaté, J. (ed): Vegetarian nutrition. pp. 91-108. New York, US: CRC Press Schwingshackl, L., Chaimani, A., Hoffmann, G., Carolina Schwedhelm & Heiner Boeing (2018): A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol 33, 157–170. https://doi.org/10.1007/s10654-017-0352-x Smits K P J, Listl S, Jevdjevic M. (2020): Vegetarian diet and its possible influence on dental health: A systematic literature review. Comm Dent Oral Epidemiol, 48:7-13. Springmann, M., Godfray, H. C. J., Rayner, M., & Scarborough, P. (2016). Analysis and valuation of the health and climate change cobenefits of dietary change. Proceedings of the National Academy of Sciences, 113(15), 4146-4151. Tiainen, A. M. K., Männistö, S., Lahti, M., Blomstedt, P. A., Lahti, J., Perälä, M. M., ... & Eriksson, J. G. (2013). Personality and dietary intake–findings in the Helsinki Birth Cohort Study. PloS one, 8(7), e68284. Viguiliouk, E., Kendall, C.W.C., Kahleová, H., Raheli?, D., Salas-Salvadó, J., Choo, V.L., Mejia, S.B., Stewart, S.E., Leiter, L.A., Jenkins, D.J.A., Sievenpiper, J.L. (2019): Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials, Clin Nutr, 38(3): 1133-1145. https://doi.org/10.1016/j.clnu.2018.05.032. Volkan, V. D. (2001). Transgenerational transmissions and chosen traumas: An aspect of large-group identity. Group Analysis, 34(1), 79-97. Wang, F., Zheng, J., Yang, B., Jiang, J., Fu, Y., Li, D. (2015): Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta?Analysis of Randomized Controlled Trials. J Am Heart Assoc, 4(10) Yokoyama, Y., Barnard, N. D., Levin, S. M., & Watanabe, M. (2014). Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovascular diagnosis and therapy, 4(5), 373–382. https://doi.org/10.3978/j.issn.2223-3652.2014.10.04 Yokoyama, Y., Levin, S.M., Barnard, N.D. (2017): Association between plant-based diets and plasma lipids: a systematic review and meta-analysis, Nutrition Reviews, Volume 75, Issue 9, September 2017, Pages 683–698. https://doi.org/10.1093/nutrit/nux030
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Aspecte genetice în diabetul zaharat de tip 1 Genetic aspects in type 1 diabetes mellitus Zara Radu Student, anul VI, facultatea Medicin? nr. 1, Universitatea de Stat de Medicin? ?i Farmacie "Nicolae Testemi?anu" din Republica Moldova Email: zara.radu00@gmail.com Rezumat Diabetul zaharat (DZ) de tip 1 este considerat la ora actual? ca o afec?iune autoimun? cu etiologie multifactorial?, produs? de o interac?iune complex? a mai multor factori genetici, epigenetici ?i de mediu, a c?ror consecin?? este distruc?ia progresiv? a celulelor beta-pancreatice (cele care sintetizeaz? insulina) ?i în final, deficitul absolut de insulin? endogen?. Aproximativ 5-10% din to?i pacien?ii cu diabet au diabet zaharat de tip 1. DZ de tip 1 este mediat imun în peste 90% din cazuri ?i poate ap?rea la orice grup? de v\ rst?, dar este cel mai frecvent la copii ?i adul?i tineri, de asemenea are un grad ridicat de concordan?? ridicat? în r\ ndul gemenilor monozigo?i (33 p\ n? la 42%) ?i se manifest? puternic în familii (15% din cazurile de DZ prezint? agregare familial?) cu risc mare pentru rudele de gr I (6-7% familie vs 0,4% popula?ia general?) cu o amprent? parental? (7-8% tat?-copil vs 2-4% mam?-copil), riscul între fra?i fiind de aproximativ 10 ori mai mare dec\ t riscul în popula?ia general?. Studiile geneticii DZ de tip 1 au dezv?luit contribu?ia cheie a regiunii antigenului leucocitar uman (HLA) la susceptibilitatea DZ de tip 1, abord?rile de familie ?i studiul genelor candidate au descoperit înc? cinci loci asocia?i cu DZ de tip 1, iar studiile de asociere la nivelul genomului (GWAS) a crescut num?rul de loci la peste 60. Identificarea si studiul ac?iunii genelor de susceptibilitate pentru DZ de tip 1 ar putea s? pun? în eviden?? depistarea precoce a prediabetului ?i formelor necomplicate dar ?i elaborarea unor noi ?inte ?i strategii terapeutice ?i elaborarea unui plan de tratament personalizat. Cuvinte cheie: Diabet zaharat, diabet zaharat de tip 1, gene, risc, susceptibilitate genetic? Abstract Type 1 diabetes mellitus is currently considered to be an autoimmune condition with a multifactorial etiology, caused by a complex interaction of several genetic, epigenetic, and environmental factors, resulting in the progressive destruction of beta-pancreatic cells (those that synthesize insulin) and finally, the absolute endogenous insulin deficiency. About 5-10% of all patients with diabetes, have type 1 diabetes. Type 1 diabetes is immune mediated in over 90% of cases and can occur in any age group, but is most common in children and young adults also has a high degree of high concordance among monozygotic twins (33 to 42%) and is strongly manifested in families (15% of cases of diabetes have family aggregation) with high risk for first grade relatives (6-7% family vs. 0.4% of the general population) with a parental footprint (7-8% father-child vs. 2-4% mother-child), the risk between siblings being about 10 times higher than the risk in the general population. Genetic studies of type 1 diabetes have revealed a key contribution of the human leukocyte antigen (HLA) region to the susceptibility of type 1 diabetes, family approaches and the study of candidate genes found five more loci associated with type 1 diabetes, and genome-wide association studies (GWAS) increased the number of loci to over 60. Identification and study of the action of susceptibility genes for diabetes type 1 could highlight the early detection of prediabetes and uncomplicated forms but also the development of new targets and therapeutic strategies and the development of a personalized treatment plan. Key words: diabetes mellitus, type 1 diabetes mellitus, genes, risk, genetic susceptibility Obiective Definirea, clasificarea ?i caracteristica DZ Stabilirea rolului factorilor genetici, epigenetici în etiologia ?i patogenia DZ tip 1 Identificare genelor majore responsabile de apari?ia DZ tip 1 Studierea ?i analiza impactului genomului în apari?ia, manifestarea ?i managementul pacientului cu DZ tip 1 Metodologia de lucru a inclus analiza ?i sinteza literaturii, din surse precum PubMed, Wiley online library, Semantic Scholar, Ghiduri/protocoale na?ionale ?i interna?ionale, iar etapele de cercetare au fost, dup? cum urmeaz?: Definirea problemei; Stabilirea criteriilor de includere a unor studii de meta-analiz?; Identificare studiilor; Studierea ?i analiza publica?iei; Extrac?ia informa?iei; Sistematizarea publica?iei, anul, sursa, metoda de cercetare, rezultatele, concluziile; Includerea în cercetare a informa?iei ?i sinteza rezultatelor ob?inute. Introducere Diabetul zaharat este un sindrom complex ?i eterogen, care induce modific?ri profunde în metabolismul glucidic, proteic, lipidic, echilibrul ionic ?i mineral, ce stau la baza apari?iei unui spectru larg de complica?ii cronice, care afecteaz? mai mult sau mai pu?in toate ?esuturile. De-a lungul anilor, prevalen?a diabetului zaharat a crescut la nivel global ?i este clasificat? drept una dintre principalele cauze de morbiditate ?i mortalitate ridicat? ?i cea mai frecvent? cauz? a dializei. Dup? Organiza?ia Mondial? a S?n?t??ii (OMS) diabetul zaharat se clasific? în DZ tipul 1, at\ t formele autoimune, c\ t ?i neautoimune cu distrugere a celulelor beta, DZ tipul 2 cu grad diferit de rezisten?? la insulin? ?i hiposecre?ie de insulin?, ?i un grup aparte numit alte tipuri specifice de DZ, unde cauza este mai bine definit?, ?i DZ gesta?ional. [1] Diabetul zaharat de tip 1 reprezint? circa 5-10% din toate cazurile de diabet,[2] acesta reprezint? rezultatul distrugerii autoimune a celulelor beta pancreatice ale organismului, care produc hormonul de insulin?. F?r? hormonul de insulin?, organismul nu poate regla controlul glicemiei. [3] DZ tip 1 rezult? din interac?iuni complexe ale factorilor genetici ?i de mediu, probabilitatea apari?iei DZ la o persoan?, este condi?ionat? în mare m?sur? de factorul genetic (heritabilitatea - 20% - 60%). [4] Existen?a predispozi?iei genetice în DZ determin? posibilitatea ?i necesitatea efectu?rii screening-ului direc?ionat pentru determinarea grupurilor de risc, depistarea precoce a prediabetului ?i formelor necomplicate de diabet, ini?ierea unor tratamente personalizate, prevenirea complica?iilor. Susceptibilitatea genetic? a DZ de tip 1 Componenta genetic? în DZ tip 1 este puternic?, riscul mediu de prevalen?? este de 0,4% pentru copiii f?r? antecedente familiale de DZ tip 1, dar ~6-7% atunci c\ nd unul dintre p?rin?i are DZ tip 1 ?i >30% atunci c\ nd ambii p?rin?i sunt afecta?i. Exist?, de asemenea, o mare diferen?? în ceea ce prive?te ratele de concordan?? între gemenii dizigo?i (7-11%) ?i cei monozigo?i (33-42%). Este interesant faptul c?, riscul de mo?tenire a DZ tip 1 difer? în func?ie de p?rintele care este afectat, cu aproximativ risc dublu dac? se mo?tene?te de la tat? (7-8%) dec\ t de la mam? (2-4%), iar riscul între fra?i fiind de aproximativ 10 ori mai mare dec\ t riscul în popula?ia general?. [4] Gene responsabile de apari?ia DZ tip 1 Riscul DZ de tip 1 este puternic influen?at de multipli loci genici, îns? aceast? predispozi?ie genetic? la distrugerea autoimun? a celulelor beta este, de asemenea, legat? de factorii de mediu care sunt înc? slab defini?i. Acest tip de DZ este puternic influen?at anume de genele care controleaz? sistemul imunitar plus, mul?i al?i loci de predispozi?ie, care interac?ioneaz? între ei ?i care au o anumit? influen?? asupra susceptibilit??ii la DZ [1]. Studiile geneticii DZ de tip 1 au început în anii 1970 ?i au dezv?luit contribu?ia cheie a regiunii antigenului leucocitar uman (HLA) la susceptibilitatea DZ de tip 1 [5]. Gena HLA codific? complexul major de histocompatibilitate (MHC) la om, aceasta fiind ?i responsabila pentru p\ n? la 50% din riscul genetic de DZ tip 1. Moleculele HLA sunt proteine de suprafa?? celular? care se leag? ?i prezint? antigene peptidice la limfocitele T. HLA este clasificat în dou? clase(I ?i II). Moleculele din clasa I (A, B ?i C) constau dintr-un lan? polipeptidic care formeaz? un heterodimer cu \�-2 microglobulina care nu este codificat? de complexul HLA. Moleculele din clasa II (DR, DQ ?i DP) constau dintr-un heterodimer creat din dou? polipeptide (\a ?i \�). Moleculele de clas? I prezint? peptide din interiorul celulelor ?i activeaz? celulele T citotoxice, în timp ce moleculele de clas? II prezint? antigeni extracelulari celulelor T-helper care stimuleaz? celulele B s? produc? anticorpi. Legarea peptidelor ?i, prin urmare, prezentarea antigenului, este determinat? de forma ?i sarcinile electrice ale ?an?ului de legare a peptidelor ?i de capacitatea receptorului celulelor T de a se lega de complexul HLA-peptid?. [4] Regiunea HLA prezint? un dezechilibru de leg?tur? puternic, astfel înc\ t, în cadrul unei popula?ii, alelele individuale se g?sesc, de obicei, doar în una sau c\ teva combina?ii de haplotipuri. Cel mai mare risc de DZ tip 1 este atribuit locilor de clasa II HLA-DR3-DQ2 ?i HLADR4-DQ8. Aproape 90% dintre copiii diagnostica?i cu DZ tip 1 în Scandinavia au fie haplotipurile HLA-DR3-DQ2, fie HLA-DR4-DQ8. Asocierea dintre HLA ?i diabet pare s? fie legat? de riscul de a dezvolta primul autoanticorp, astfel înc\ t copiii homozigo?i pentru HLA-DR3-DQ2 au mai multe ?anse de a avea anticorpi GADA(Anticorpi anti-decarboxilaza acidului glutamic) ca prim anticorp, iar copiii cu haplotip HLA-DR4-DQ8 au mai multe ?anse de a avea mai înt\ i autoanticorpii de insulin?. [6] Alte haplotipuri de clasa II au fost, de asemenea, asociate cu riscul de DZ tip 1 cu efecte mai mici, de exemplu, locusul DPB1 este asociat at\ t cu protec?ia (DPB1*04:02), c\ t ?i cu susceptibilitatea (DPB1*03:01 ?i DPB1*02:02) fa?? de DZ tip 1.[7] Alelele de risc HLA difer?, de asemenea, între popula?ii. Haplotipul HLA-DR7 care include DRB1*07:01 este protector în popula?ia european?, dar confer? risc la africani. În mod similar, un haplotip DR3 specific african (DRB1*03:02-DQA1*04:01- DQB1*04:02) protejeaz? împotriva DZ tip 1. [4] Cu toate acestea, mecanismele biologice exacte prin care alelele genelor care codific? HLA contribuie la riscul de DZ de tip 1 r?m\ n evazive. De fapt, regiunea HLA este cea mai polimorf? sec?iune a genomului uman, cu 22.362 de alele unice [5]. Abord?rile de familie ?i studiul genelor candidate au descoperit înc? cinci loci care pot fi asocia?i cu DZ de tip 1. În 1984, gena insulinei (INS) a fost identificat? ca al doilea locus asociat cu DZ de tip 1. [5] Gena insulinei (INS) este primul ?i cel mai puternic locus non-HLA cu un OR 2,4 (Odds Ratio). S-a constatat c? regiunea promotorului are un num?r variabil de repet?ri (VNTR) care marcheaz? alele cu expresie diferit? a genei INS, despre care se presupune c? afecteaz? susceptibilitatea prin modularea expresiei timice a insulinei ?i prin afectarea educa?iei celulelor T. Locii de susceptibilitate în regiunile CTLA4, PTPN22 ?i IL2RA au fost identifica?i în studiile privind genele candidate. [4] În 1996 a fost descoperit? gena cytotoxic T-associated protein 4 (CTLA4) ?i a fost recunoscut? ca al treilea locus. Un alt studiu caz-control din 2004 a raportat c? proteina tirozin fosfataz?, gena non-receptor de tip 22 (PTPN22) este asociat? cu susceptibilitatea la DZ de tip 1, iar în 2005 sa raportat gena receptorului interleukinei 2 alfa (IL2RA) ca al cincilea locus asociat cu DZ de tip 1, al ?aselea candidat fiind gena domeniului 1 helicaza C indus? de interferon (IFIH1).[5] Încep\ nd din 2007, Studiile de asociere la nivelul genomului (GWAS) a crescut dramatic num?rul de loci asocia?i cu DZ de tip 1 la peste 60, a?a cum este prezentat în Fig. 1. Ace?ti loci g?zduiesc multe gene noi despre care nu se credea anterior c? sunt candida?i eviden?i pentru susceptibilitatea DZ de tip 1 înainte de era GWAS. [5] Ace?ti loci explic? ~80% din heritabilitatea în sens restr\ ns a DZ de tip 1. Unul dintre cele mai mari eforturi a fost cel al Consor?iului de genetic? a diabetului de tip 1 (T1DGC), o colaborare interna?ional? prin care au fost colectate ?i genotipate >14.000 de probe. Dintre locii identifica?i, doar PTPN22 ?i IL2RA au OR mai mare de 1,5; majoritatea sunt în intervalul 1,1-1,3, subliniind importan?a regiunii HLA cu un OR de 2,4. [4] Recunoa?terea unui antigen specific ?i a HLA de c?tre receptorul de celule T poate avea ca rezultat un atac autoimunitar, care ar putea fi poten?at ?i mai mult de variantele genice care afecteaz? prezentarea antigenului sau semnalizarea celulelor T. Cunoa?terea func?ional? a rolului locilor de susceptibilitate la DZ de tip 1 a ar?tat c? multe gene candidate sunt implicate în func?ii legate de r?spunsul imunitar adaptativ mediat de celulele T ?i de mecanismele de toleran??, precum ?i de imunitatea înn?scut? implicat? în recunoa?terea antigenelor celulelor \�. Multe asocieri genetice sunt, de asemenea, împ?rt??ite cu alte boli autoimune. De exemplu, o alel? comun? de pierdere a func?iei în locusul tirozin-fosfatazei PTPN22 scade riscul de boal? Crohn, dar cre?te riscul de artrit? reumatoid? ?i DZ de tip 1. Interesant este faptul c? cel pu?in 50% dintre genele candidate identificate, inclusiv CTRB1/2, IFIH1, GLIS3 ?i PTPN2, sunt, de asemenea, exprimate în celulele beta, sus?in\ nd conceptul c? susceptibilitatea genetic? la DZ de tip 1 influen?eaz? at\ t sistemul imunitar, c\ t ?i func?ia celulelor beta. Pentru majoritatea locilor post-GWAS înc? r?m\ n s? fie realizate cartografierea fin? ?i caracterizarea func?ional?, [8] Îns? o bun? parte din genele asociate cu DZ de tip 1 sunt deja descifrate ?i este cunoscut mecanismul prin care poate duce la apari?ia acestei maladii (Tabelul 1). Fig. 1 Locusuri de susceptibilitate la diabetul de tip 1 (DZ de tip 1). a) Cronologia descoperirii: locii sunt prezenta?i dup? anul c\ nd au fost asocia?i pentru prima dat? în DZ de tip 1. Genele prezentate în ro?u sunt asociate cu complica?ii specifice DZ de tip 1. [5]. Gena Locus Func?ia genei PTPN22 1p13.2 Reglarea r?spunsului imunitar înn?scut, a activ?rii celulelor T ?i a prolifer?rii celulelor natural killer IL10 1q32.1 Citokine ?i r?spunsul inflamator AFF3 2q11.2 Reglarea transcrip?iei IFIH1 2q24.2 Activarea sistemului imunitar inert NF-κB STAT4 2q32.3 Calea de semnalizare mediat? de citokine CTLA4 2q33.2 Activarea celulelor T CCR5 3p21.31 Dezvoltarea celulelor Th1 ?i calea de semnalizare mediat? de chemokine IL21, IL2 4q27 Citokine ?i r?spunsul inflamator ?i celulele Th1 sau Th2 diferen?iere IL7R 5p13.2 Citotoxicitatea mediat? de celulele T, produc?ia de imunoglobulin? ?i legarea antigenului BACH2 6q15 Transcriere TNFAIP3 6q23.3 R?spunsul inflamator TAGAP 6q25.3 Transduc?ia semnalului IKZF1 7p12.2 Reglarea celulelor imunitare GLIS3 9p24.2 Reglarea transcrip?iei IL2RA 10p15.1 Splicing alternativ ARNm Splicing alternativ Diferen?ierea celulelor Th1 sau Th2 PRKCQ 10p15.1 Procesul apoptotic, r?spunsul inflamator, r?spunsul imunitar înn?scut, ?i calea de semnalizare a receptorilor de celule T NRP1 10p11.22 Transduc?ia semnalului INS 11p15.5 Calea de semnalizare a insulinei BAD 11q13.1 Apoptoza CD69 12p13.31 Transduc?ia semnalului ITGB7 12q13.13 R?spunsul la virus ?i reglarea r?spunsului imunitar ERBB3 12q13.2 Reglarea transcrip?iei, a r?spunsului imunitar înn?scut ?i a lipidelor metabolismul lipidic CYP27B1 12q14.1 Metabolismul lipidelor, al lipoproteinelor, al hormonilor steroizi ?i al vitaminei D SH2B3 12q24.12 Transduc?ia semnalului GPR183 13q32.3 R?spunsul imunitar umoral DLK1 14q32.2 Reglarea expresiei genice RASGRP1 15q14 R?spunsul inflamator la stimulii antigenici ?i produc?ia de citokine CTSH 15q25.1 Calea de semnalizare de reglare a r?spunsului imunitar Citotoxicitate mediat? de celulele T R?spuns imunitar adaptativ CLEC16A 16p13.13 Necunoscut IL27 16p11.2 R?spunsul inflamator ?i reglarea r?spunsului de ap?rare împotriva virusurilor ORMDL3 17q12 Legarea proteinelor PTPN2 18p11.21 Semnalizarea citokinelor ?i diferen?ierea celulelor B ?i T CD226 18q22.2 Imunoreglarea ?i sistemul imunitar adaptativ TYK2 19p13.2 Cale de semnalizare mediat? de citokine, semnal intracelular transduc?ie ?i calea de semnalizare a interferonului de tip I FUT2 19q13.33 C?i metabolice UBASH3A 21q22.3 Reglarea produc?iei de citokine, reglarea c?ii de semnalizare a receptorilor de celule T C1QTNF6 22q12.3 Calea de semnalizare a receptorilor de celule B, calea de semnalizare a chemokinei ?i citotoxicitatea mediat? de celulele natural killer Tabelul 1: Gene candidate propuse ca fiind importante pentru patogeneza diabetului zaharat de tip 1. [9] Mecanisme epigenetice Multe procese implicate în DZ tip 1 ar putea fi influen?ate de mecanisme epigenetice, inclusiv dezvoltarea, metabolismul ?i regenerarea celulelor beta. R?spunsurile imunitare, inclusiv activarea celulelor T ?i inducerea celulelor T reglatoare, se bazeaz? pe reglarea epigenetic?. S-a demonstrat c? structura a patru situsuri CpG(5'—C—fosfat—G—3') proximale fa?? de situsul de început al transcrip?iei genei INS difer? între pacien?ii cu DZ tip 1 ?i cei de control, trei situsuri fiind mai pu?in metilate ?i unul mai metilat. [10] În mod similar, situsurile CpG din promotorul IL2 au fost mai dens metilate la pacien?ii cu DZ tip 1 dec\ t la grupul de control. Modific?rile histonice pot fi, de asemenea, relevante pentru DZ tip 1, De exemplu, studiile caz-control au eviden?iat niveluri diferite de acetilare a histonei H4 sau de acetilare a H3K9(histonei H3) la pacien?ii cu DZ tip 1 în compara?ie cu grupul de control, [11] Un num?r tot mai mare de observa?ii sugereaz? c? miARN-urile(micro ARN) pot contribui, de asemenea, la dezvoltarea DZ tip 1. Studiile experimentale pe modele animale ?i pe celule cultivate au furnizat dovezi conving?toare c? miARN-urile pot participa la controlul autoimunit??ii deteriorarea celulelor \�, reglarea sintezei ?i secre?iei de insulin?. [12] S-a demonstrat, de asemenea, c? expresia unor miARN-uri specifice în s\ nge ?i în limfocite difer? între pacien?ii cu DZ tip 1 ?i controalele ?i c? este corelat? cu severitatea bolii. Prin urmare, m?surarea acestor miARN-uri poate fi util? pentru identificarea persoanelor cu risc de a dezvolta DZ tip 1 ?i pentru prevenirea bolii. [13] Complica?ii Diabetul de tip 1 este o afec?iune cronic? care poate duce la numeroase complica?ii microvasculare ?i macrovasculare pe termen lung. Diabetul este o cauz? principal? a bolii renale în stadiu terminal, a orbirii, a amput?rii picioarelor ?i a picioarelor ?i a bolilor cardiovasculare. Incertitudinile privind cadrul patogenetic care st? la baza complica?iilor diabetice reprezint? un obstacol major în dezvoltarea unor modalit??i de tratament optimizate. [14] Referitor la apari?ia complica?iilor s-a demostrat c? controlul conven?ional al glicemiei, în compara?ie controlul intensiv al glicemiei, a fost asociat cu mai pu?ine complica?ii microvasculare at\ t în cazul diabetului de tip 1, c\ t ?i în cazul diabetului de tip 2, precum ?i cu o sc?dere a complica?iilor coronariene. [15]. O mai bun? cunoa?tere a markerilor genetici de risc pentru aceste complica?ii va fi un instrument important în definirea mecanismelor patogenetice cheie ?i va contribui la generarea de ?inte terapeutice. Chiar dac? au fost raportate gene asociate cu complica?ii diabetice specifice diabetului de tip 1, cum ar fi un control mai slab al diabetului sau o insuficien?? insulinic? mai sever?, studiile ?i e?antioanele de dimensiuni reduse, precum ?i problemele legate de redefinirea fenotipurilor nu au înregistrat niciun progres semnificativ în ceea ce prive?te definirea susceptibilit??ii genetice la complica?ii. [9] Concluzie DZ tip 1 este produs de o deficien?a absolut? în secre?ia de insulin?, ca rezultat al distrugerii celulelor beta insulare ale pancreasului, iar mecanismul principal este susceptibilitatea genetica la autoimunitate sub ac?iunea unor factori de mediu declan?atori. Rolul major al predispozi?iei genetice in DZ 1 este atribuit alelelor complexului MHC, genei INS, genelor PTPN2, IL2RA, CTLA4, UBASH3A, IFIH1 responsabile de r?spunsul imun. Identificarea si studiul ac?iunii genelor de susceptibilitate la DZ tip 1 pot contribui la predic?ia si preven?ia bolii, de asemenea aceasta va permite prezervarea celulelor beta ramase nealterate, elaborarea unor noi ?inte si strategii terapeutice, in stadiul preclinic al bolii, sau personalizarea interven?iilor in func?ie de profilul lor genetic, blocarea progresiei spre DZ tip 1, prin stimularea activ? la o toleran?? asupra celulelor self, imunoterapie specifica sau regenerarea celulelor beta. Bibliografie 1. Marklova, E., Genetic aspects of diabetes mellitus. Acta Medica (Hradec Kralove), 2001. 44(1): p. 3-6. 2. Babe?, A.P., Ghid de management al diabetului zaharat, M. s?n?t??ii, Editor. 2021: Monitorul Oficial Nr. 997 bis din 19 octombrie 2021. p. 240. 3. Skyler, J.S., et al., Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis. Diabetes, 2017. 66(2): p. 241-255. 4. Bonora, E. and R. DeFronzo, Diabetes. Epidemiology, Genetics, Pathogenesis, Diagnosis, Prevention, and Treatment. 2018. 5. Bakay, M., et al., The Genetic Contribution to Type 1 Diabetes. Curr Diab Rep, 2019. 19(11): p. 116. 6. Ilonen, J., et al., Patterns of \�-cell autoantibody appearance and genetic associations during the first years of life. Diabetes, 2013. 62(10): p. 3636-40. 7. Noble, J.A., Immunogenetics of type 1 diabetes: A comprehensive review. J Autoimmun, 2015. 64: p. 101-12. 8. Bergholdt, R., et al., Identification of novel type 1 diabetes candidate genes by integrating genome-wide association data, protein-protein interactions, and human pancreatic islet gene expression. Diabetes, 2012. 61(4): p. 954-62. 9. Pociot, F. and Å. Lernmark, Genetic risk factors for type 1 diabetes. Lancet, 2016. 387(10035): p. 2331-2339. 10. Fradin, D., et al., Association of the CpG methylation pattern of the proximal insulin gene promoter with type 1 diabetes. PLoS One, 2012. 7(5): p. e36278. 11. Miao, F., et al., Profiles of epigenetic histone post-translational modifications at type 1 diabetes susceptible genes. J Biol Chem, 2012. 287(20): p. 16335-45. 12. Zheng, Y., Z. Wang, and Z. Zhou, miRNAs: novel regulators of autoimmunity-mediated pancreatic \�-cell destruction in type 1 diabetes. Cell Mol Immunol, 2017. 14(6): p. 488-496. 13. Zullo, A., et al., Epigenetics and type 1 diabetes: mechanisms and translational applications. Transl Res, 2017. 185: p. 85-93. 14. Ahlqvist, E., et al., The genetics of diabetic complications. Nat Rev Nephrol, 2015. 11(5): p. 277-87. 15. Insel, R.A., et al., Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care, 2015. 38(10): p. 1964-74.
Radu Zara
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STAREA DE BINE A ELEVILOR DIN JUDETUL CLUJ IN CONTEXTUL STRESULUI GENERAT DE PANDEMIA DE COVID-19
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DOI: 10.51546/JSUM.2020.7404

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7404

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HEALTHY SCHOOLS – A GLOBAL PERSPECTIVE
Dr. Rodica Nicolescu
Pages: 14-19
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3
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CONTEMPORARY TEENAGER AND THE RISK OF NON-COMMUNICABLE DISEASES
Ana Georgeta Negrea, Alina Grama, Claudia Sirbe, Tudor Lucian Pop
Pages: 15-20
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Holistic approach of scoliotic posture to children and adolescent people
Conf. Univ. Dr. Mirela-Lucia Calina, Prof. Univ. Dr. Ligia Rusu
Pages: 11-19
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2
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MODERN MINIMALLY INVAZIVE METHODS USED IN TREATMENT OF EARLY DENTAL CARIES. CASE REPORT
André Codoi,Stanca Maria Muresan
Pages: 28-42
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DIAGNOSTIC APPROACH TO ABDOMINAL PAIN IN SCHOOL-AGE CHILDREN
Tudor Lucian Pop
Pages: 19-26

DOI: 10.51546/JSUM.2021.8103

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8103

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17
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SCHOOL MEDICINE IN THE COVID-19 PANDEMIC PERIOD
Dr. Daniela Rajka, Dr. Kristina Moldovan
Pages: 37-41
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6
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INFLUENZA PROPHYLAXIS: CURRENT APPROACHES
Bianca-Georgiana Milcu,Dalida-Ana Domuncu, Dorina-Maria Craciun, Daniela Pitigoi, Victoria Arama
Pages: 5-13
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2
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Study of a Q fever focus in an university medical office
Dr. Pintea Nicoleta Ancuta, Dr. Baciu Simina, Dr. Carmen Varodi
Pages: 5-10
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ARTERIAL HYPERTENSION IN PRE-SCHOOL CHILDREN AND SOME RISK FACTORS - PROSPECTIVE STUDY
Dr. Adriana Neghirla, Dr. Mihaela Onose, As. Gabriela Moldovan, As. Cristina Sandru, As. Daniela Claudia Botos, As. Veturia Luca, As. Ioana Truta, As. Liliana Prunas, As. Iacobina Claudia Rus
Pages: 5-15
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Nervous anorexia. A case study
Dr. Pintea Ancuta
Pages: 17-22
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4
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Depressive syndrome of young adult
Dr. Inna Petrache, Sef lucrari Dr. Mirela Voicu
Pages: 11-15
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2
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Efficient parents - efficiennt children - case study -
Voichita Soldan,Adriana Neghirla
Pages: 0-0
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5
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PSYCHO-EMOTIONAL HEALTH OF STUDENTS DURING THE COVID-19 PANDEMIC. THE ROLE OF THE SCHOOL IN IDENTIFYING STUDENTS AT RISK
Sorina Irimie, Petru Sandu
Pages: 31-35

DOI: 10.51546/JSUM.2021.8105

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8105

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THE NOVEL CORONAVIRUS. ORIGINS, STRUCTURE, CHARACTERISTICS, PREVENTION
Dr. Mihai Mara
Pages: 29-36
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THE ANTI COVID-19 VACCINATION INTENTION OF MEDICAL PERSONNEL FROM ROMANIA
Dr. Daniela Rajka
Pages: 10-16

DOI: 10.51546/JSUM.2020.7403

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7403

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Management of the extraintestinal manifestations in Crohn disease
Olteanu Ovidiu Andrei, Radu Cristina, Grigorescu Raluca
Pages: 23-26
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2
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Contraception at teenagers
Dr. Deca Greta- Luisa, Dr. Stefan Diana, Dr. Voinea Catalina
Pages: 28-31
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1
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The patients' rights
Dr. Rajka Mária
Pages: 49-51
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1
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MINORS’S RIGHT TO CONFIDENTIALITY IN REPRODUCTIVE HEALTH CHOICES
Irina IOSIF, Maria ALUAS
Pages: 25-33

DOI: 10.51546/JSUM.2020.7405

DOI URL: http://dx.doi.org/10.51546/JSUM.2020.7405

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THERMOMETRY: BETWEEN EFFICIENCY AND INEFFICIENCY IN THE EPIDEMIOLOGICAL TRIAGE, IN THE PREVENTION OF COVID-19 IN PRESCHOOL AND STUDENTS
Lia Vlaicu, Mirela Simona Coporan
Pages: 27-30

DOI: 10.51546/JSUM.2021.8104

DOI URL: http://dx.doi.org/10.51546/JSUM.2021.8104

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OPTIMIZATION OF TYPE 1 DIABETES THERAPY THROUGH TECHNOLOGY
Morariu Diana
Pages: 20-22
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1
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GYNECOLOGICAL DISEASES IN ADOLESCENTS
Dr. Lia Vlaicu
Pages: 9-13
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1
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A RARE CASE OF VON HIPPEL-LINDAU DISEASE IN A STUDENT
Pintea Ancuta
Pages: 5-8
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THE ROLE OF THE SCHOOL MEDICAL OFFICE
Dr. Daniela Rajka
Pages: 27-34
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CONSUMPTION OF FRUITS AND VEGETABLES AMONG SECONDARY SCHOOL STUDENTS FROM CLUJ COUNTY
Tania Lupsa , Lucia Maria Lotrean
Pages: 21-26
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2
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The paediatric pacient with sudden death risk. Case report
Pop-Kun Ruxandra-Claudia
Pages: 16-20
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2
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Early dental caries. Developing conditions and methods for stopping its evolution
Codoi André,Dr. Muresan Stanca Maria
Pages: 29-41
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1
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Practical aspects of acute upper respiratory tract infections to the school child
Prof. Dr. Sorin C. MAN
Pages: 23-27
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2
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Arterial hypertension in adolescents - prospective study
Adriana Neghirla, Iacobina Rus, Cornelia Hategan, Mihaela Onose, Liliana Heinrich, Dumitrita Barsan, Natalia-Stela Dalalau-Rus, Anica Oroian, Mariana Samsudean
Pages: 5-15
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4
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The motivational interview - An instrument for helping patients to adopt healthy behaviors
Dr. Demian Corina
Pages: 30-36
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The Somatometric Calculator, a useful tool in school medicine offices
Dr. Ionescu Elena Teodora
Pages: 42-47
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2
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Informed consent to adults
Dr. Rajka Mária
Pages: 48-54
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1
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Evaluation of the vaccination situation
in a group of children of school age in Mures county

Kinga Balasa, Cristina Golea, Adriana Neghirla
Pages: 5-10
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1
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Physiological puberty and precocious puberty. Particular aspects in school and student medical cabinet
Dr. Pintea Ancuta
Pages: 25-31
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1
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ASPECTS REGARDING THE REOPENING OF SCHOOLS IN THE CONTEXT OF THE COVID19 PANDEMIC
Bianca Huluban
Pages: 
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PSYCHOLOGICAL CONCERNS OF NOURISHMENT WITH SPECIAL FOCUS ON TRANSGENERATIONAL TRAUMA Tibor Kökény1, Borbála Zala1, Ákos Széles2, Márton Horváth1, Enik? Tóth3, László Tóth1 1Department of Psychology and Sport Psychology, University of Physical Education, Hungary, 2University of Leipzig, Leipzig, Germany, 3ELTE Eötvös Loránd University, Savaria University Centre Szombathely, Hungary Abstract BACKGROUND: This paper presents a special segment of Hungarian nutritional habits in connection to psychological backgrounds. We aim to describe the characteristics of the types of nourishment among subjects and group them into distinctive categories. According to the basic concept that was used to create the inquiry, the changes of different types of nourishment are led by different motives. Our concept is also that there is a connection between the inheritance of transgenerational traumas of the family and the choices in the nutrition of those family members wishing to have a change from pathologic functions after the trauma. METHODS: The data was collected from a questionnaire containing 49 items within 5 main themes. To sort the relevant parameter, the Information Values were taken into consideration using SAS Enterprise Miner software. We examined the distribution of the strong variables in each group (Vegetarians - Essentially-Vegetarians - Non-Vegetarians) and tested it by Spearman's correlation on the ordinal variables and by chi-square or exact chi-square tests on the nominal variables. RESULTS: The results suggested creating 3 groups containing 95% of the participants – vegetarians, essentially-vegetarians, and not vegetarians. There were 5% of the participants who were not interested in nutrition and health. There are 3 types of origins or motivations of nutritional health focus, ethical consideration, and social influences. CONCLUSIONS: According to the results, the main aspects of nutrition are not only limited to health but can also be a solution to life-style changes alongside family traditions and contribute to the management of transgenerational issues. KEYWORDS: healthy nourishment, vegetarianism, nutrition, society, transgenerational trauma Introduction Plain English summary This paper presents a special segment of Hungarian nutritional habits connected to psychological backgrounds. Its aim is to describe the characteristics of the types of nourishment among subjects and group them into distinctive categories. According to the basic concept that was used to create the inquiry, the changes of different types of nourishment were led by different motives. The preliminary concept was as well that there was a connection between the inheritance of transgenerational traumas of the family members and the choices in nutrition of those members who wish to have a change from pathologic behavior after the trauma. It appears from the data that the change of life due to traumatic life events and the search for problem-solving due to transgenerational traumas is part of the treatment of pathologies in most people choosing ethical nutrition. This appears despite the need to defy family and environmental hostility. Background The average human nutrition is called mixed nutrition that includes regular consumption of meat that can originate from different sources, as mammals, birds, fish or nonvertebral living beings. The form of nutrition that leans toward vegetarianism is the so-called health-conscious that includes the maximum consumption of meat 4-5 times a week (McEvoy et al. 2012). The plant-based (or vegetarian) nutrition excludes meat, fish, poultry. There are different types of this form of nutrition and there are transitory states towards mixed nutrition. The types of plant-based nutrition are: Vegan, that excludes all types of animal products, Lacto-vegetarian, that is plant-based mixed with dairy products, Ovo-lacto-vegetarian, that is plant-based and includes dairy and eggs. The effects of health-conscious nutrition Below there is a list of effect of nourishment with pros and contras concerning vegetarianism. These results based on meta-analyzes of vegetarian literature. Iron status is worse in vegetarians than in omnivores (Heider 2018). Vegetarian lifestyle may contribute to bone loss, low height, and low weight based on existing evidence (Li et al. 2020, Iguacel et al. 2019). Vegan or vegetarian diets were related to a higher risk of depression and lower anxiety scores, but no differences for other outcomes were found (Iguacel et al. 2020). Health-conscious nourishment decreases the ratio of body fat and obesity (Mangels et al., 2003). Vegetarian diets reduces mean body weight, suggesting potential value for prevention and management of weight-related conditions (Neal et al. 2018, Huang et al. 2016). Inflammation markers are lower only at long term vegetarians (Haghighatdoost et al. 2017). This study provides evidence that vegetarian-based dietary patterns are associated with lowered serum C-reactive protein, fibrinogen, and total leukocyte concentrations. Although we have to mention that insufficient data were identified for a meta-analysis of intervention studies (Craddock et al. 2019). Risk for type 2 diabetes is decreased in groups of vegetarians by an international meta-analysis (Lee & Park 2017). Consumption of vegetarian diets is associated with improved glycemic control in type 2 diabetes (Yokoyama et al. 2017). Vegetarian dietary patterns improve glycemic control, LDL-C, non-HDL-C, and body weight/adiposity in individuals with diabetes (Viguiliouk 2019). According to the network meta-analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients. (Schwingshackl et al. 2018) In most countries a vegan diet is associated with a more favourable cardio- metabolic profile compared to an omnivorous diet (Benatar & Stewart 2018). A comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (?25%) and incidence from total cancer (?8%). Vegan diet conferred a significant reduced risk (?15%) of incidence from total cancer (Dinu et al. 2017). Results suggest that vegetarians have a significantly lower ischemic heart disease mortality (29%) and overall cancer incidence (18%) than nonvegetarians (Huang et al. 2012). None of the analyses showed a significant association of vegetarian diet and a lower risk of either breast, colorectal, and prostate cancer compared to a non?vegetarian diet. By contrast, a lower risk of colorectal cancer was associated with a semi?vegetarian diet (-14%) and a pesco?vegetarian diet (-33%) compared to a non?vegetarian diet (Godos et al. 2017). A systematic review provides evidence that vegetarian diets effectively lower blood concentrations of total cholesterol, low?density lipoprotein cholesterol, high?density lipoprotein cholesterol, and non–high?density lipoprotein cholesterol (Wang et al. 2015). Yokoyama et al. (2017) adds that plant-based diets are associated with decreased total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, but not with decreased triglycerides. In meta?analyses, the vegetarian diet was associated with a higher risk for dental erosion and a lower decayed, missing and filled teeth (Smits et al. 2019). Nourishment and personality The last decades showed an objective shift towards the identification of personality traits connected to diet and nourishment. Booth (1994) summarized the influencing factors of food choice that can be material and symbolic features. Within material features, he recognized characteristics of foods (like the smell, temperature, and taste) and bodily signals (like the level of blood sugar). Among symbolic features there are concepts of food, concepts of body, and cultural roles. All these features and parts behind the scene are responsible for the connection of the personality and its choices of values, health, and lifestyle including dietary habits. Möttus et al. (2012) linked the five factors of the NEO questionnaire (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) to the healthy or traditional diet. According to their results, higher scores on the health aware diet factor were associated with lower Neuroticism, and higher Extraversion, Openness, and Conscientiousness. Moreover, higher scores on the traditional diet factor were related to lower levels of Openness. Tiainen et al.. (2013) created their approach with the same tool and examined food preference in a more detailed way than Möttus and his research group. According to them the openness in men was associated with higher vegetable and lower confectionery and chocolate intakes. In women, neuroticism was associated with lower fish and vegetables and higher soft drink intakes. Extraversion, in women, associated with higher meat and vegetable intakes, and openness with higher vegetable and fruit intakes. Agreeableness was associated with a lower soft drink and conscientiousness with a higher fruit intake in women. Comparing resilient and non-resilient subjects, resilience in women is associated with higher intakes of vegetables, fruits, fish, and dietary fibre. The base of these recently published connections originates from Kikuchi&Watanabe (2000). Transgenerational patterns The intergenerational transmission of trauma is defined as the unconscious passing of a trauma onto the next generation (Bradfield, 2013). Adverse experiences in early life are risk factors for the development of behavioral and physiological symptoms that can lead to psychiatric and cognitive disorders later in life. Some of these symptoms can be transmitted to the offspring, in some cases by non-genomic mechanisms involving germ cells (Gapp et al. 2016). The individual seems to be the "product" of his/her environment. The basic self is created in the nuclear family and the situation dependent pseudo-self is created during later life. The latter connects to certain traumatic events and can cause a less differentiated state of the personality because of anxiety. The response to the traumatic situation can be seen as functional – concerning the lack of coping potential or lack of energy of the traumatized person. At the same time, the transgenerational behavior as a rigid pattern can dominate the behavior, values, and rules of the family members. The will for changing all these patterns of the family can create the opposition and even anger of the other members of the family (Boszormenyi-Nagy, Spark 2013). The physiological "inheritance" of the symptoms of the transgenerational patterns is obvious when you follow the decreased number of the neural receptors in the case of addictions. These inheritances are not guided genetically but behaviourally between members of the generations (Máthé 2003). Most research suggest that parents’ symptoms of posttraumatic stress disorder (PTSD) are associated with children’s psychological difficulties. More specifically, parents’ PTSD symptoms positively correlate with children’s anxiety (Leen-Feldner et al., 2011). The paternal stress exposure impacts future generations which manifest in behavioral changes and molecular adaptations (Manners et at., 2019). Neither PTSD nor maternal traumatic experiences were directly associated with symptoms of anxiety, depression, or antisocial and aggressive behaviour in the children (Roth, Neuner, & Elbert, 2014). Large-group (ethnic, national, religious) identity is defined as the subjective experience of thousands or millions of people who are linked by a persistent sense of sameness while also sharing numerous characteristics with others in foreign groups (Kállay, 2011). The main task that members of a large group share is to maintain, protect, and repair their group identity. A `chosen trauma' is one component of this identity. The term `chosen trauma' refers to the shared mental representation of a massive trauma that the group's ancestors suffered at the hand of an enemy. When a large group regresses, its chosen trauma is reactivated in order to support the group's threatened identity. This reactivation may have dramatic and destructive consequences (Volkan, 2001). The recognition that the violence and suffering experienced by one generation can have effects on subsequent generations provides an important insight into the origins of mental health problems. However, the kinds of adversity faced by each generation differ, and the construct of trauma does not capture many of the important elements that are rooted in structural problems, including poverty and discrimination. Understanding the ways in which trauma impacts mental health requires a broader view of identity, community, adaptation and resistance as forms of resilience. The trauma is not a natural kind or category but rather a specific way to punctuate both the temporal stream and spatial distribution of events with political, moral, and practical implications (Kirmayer, Gone & Moses, 2014). Hypotheses The hypotheses of the current study were as follows: According to the basic concept that was used to create the inquiry, (1) the different types of diets are based on different motives (Kökény, 2005, Arora et al., 2017). (2) We supposed that motives can be grouped in three categories such as health driven, socially determined, and ethically driven. (3) The third hypothesis was that there is a connection of food choices and traumatic events in the personal life and/or the family. Material and methods The data is extracted from the questionnaire that was created and recorded in May-June 2017. It was filled in by 249 people on the Internet, contains 49 items and its main themes are the following: Demography, Consumption habits related to different food stuffs, Lifestyle, The orientation of the family members towards nourishment, Habits and values. Among those who took part in this study 77 (31%) were men, and 172 (69%) were women. The ratios of distribution according to age and place are shown by Figure 1 and Figure 2. Age is distributed in 5 years groups (except the 18-25 group) since it seemed to be a more precise approach than grouping by decades. It was also a possibility to join the age groups to the possible crises terms where changes may occur, but the 5 years grouping included the crises option. (Especially within 31-40 group it would distort the data if decade grouping would have been applied.) Urban distribution seemed to be necessary based on the urban-rural consumption and lifestyle differences. Data processing To sort out the relevant parameters, the Information Values were taken into consideration using SAS Enterprise Miner software. Examining the distribution of the strong variables in each group (Veg - Essentially Veg - Non-Veg) and tested it by Spearman's correlation on the ordinal variables and by chi-square or exact chi-square tests on the nominal variables if they statistically were significant at the 5% level. There was a statistically significant difference for each of the variables highlighted in the study. About SAS Enterprise Miner statistical procedures. Interactive grouping node computes the weight of evidence for each attribute for every characteristic: the weight of evidence measures the relative risk of an attribute or group level. The value depends on the value of the binary target variable, which is either "non-event" (target = 0) or "event" (target = 1). Information Value. The predictive power of a characteristic (that is, its ability to separate the vegetarian group from non-veg or essentially-veg groups) is assessed by its Information Value. The Information Value is a weighted sum of the weight of evidence of the characteristic's attributes. The weight is the difference between the conditional probability of an attribute given an event and the conditional probability of an attribute given a non-event. Results The first step in the process of interpreting the raw data was to group subjects. According to the answers given to the questions "How often do you consume the following foods? [Meats, processed meat products, lard, chitterlings]" and "How do you evaluate the next types of nourishment? [vegetarian, lacto vegetarian, ovo-lacto vegetarian]" the participants were placed into three groups. Most of the participants were motivated by health consciousness, only 5% said that health was not important for them. Among vegetarians, a major part (48%, Confidence Interval – CI: 0.35-0.61), are long term vegetarian (more than 20 years) who are motivated by healthy nourishment. The same value is 13% (CI: 0.08-0.18) among omnivores (non-vegetarians) and 27% (CI: 0.09-0.46) among essentially-vegetarians. These findings fit the summary works on vegetarian nutrition of Sabaté (2001). The results were structured based on the above-mentioned hypothesis (3 types of motivations and transgenerational trauma connected to choices of nourishment) on these lines: motivations, social background and changes connected to the life periods, and the role of transgenerational patterns. Motivations The motivations are revealed by the answers given to the question "Have you changed your nourishment noticeably to your environment or influenced them, and if yes, based on what consideration?". According to our expectations, there are many more people who did not change among non-vegetarians compared to vegetarians since the multigenerational vegetarian families are relatively rare. Among those who changed their nourishment, the motivation connected to the ethics-religion-environment protection group was the strongest in the groups of vegetarians and essentially-vegetarians (67% (CI: 0.54-0.79) and 70% (CI: 0.5-0.9)) (Rejinders, 2001). The most frequent reasons for the change among people with mixed nourishment are preventive healthcare (59% CI: 0.5-0.69), losing weight (44% CI: 0.34-0.53), illness (28% CI: 0.19-0.36), and in a smaller ratio (10% CI: 0.1-0.32) the nicer appearance or the enhancement of the efficiency. Beyond the aspect of ethics-religion-environment protection (shortly: ethics) a similar ratio among vegetarians and essentially-vegetarians, the motivation was preventive healthcare (35% CI: 0.14-0.56 and 33% CI: 0.20-0.46) but reasons such as increased beauty, higher efficiency, and reduction in illness are more present in the group of essentially-vegetarians. (We can suppose that those who have a spiritual path, ethics, the protection of the environment, and the preventive healthcare is present and all the other motives are not. Among essentially-vegetarians, the variability of the reasons is higher since more appear from secular existence). The change based on illness is 30% (CI: 0.12-0.54) among essentially-vegetarians while only 9% (CI: 0.02-0.17) among vegetarians (Mangels et al., 2003, Pomerleau et al., 2002, Sabaté, 2003). The question "How important are the following aspects of eating/nourishment to you? [ethical, environmental aspects]" shows that the ethical and environmental aspects of nourishment are the most important for vegetarians and it is averagely important to essentially-vegetarians (Sabaté, 2001). It is totally or quite important for 81% (CI: 0.71-0.91) of vegetarians, 68% (CI: 0.49-0.88) of essentially-vegetarians and 45% (CI: 0.37-0.52) of mixed diets – see Figure 3. The question "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when choosing your choice? [Body shaping]" gave the result that on a five-degree scale this was the least important to vegetarians, slightly more important for essentially-vegetarians, and more important for those with mixed eating (not vegetarians). In the mixed eating group, 10% have this motivation "totally" and only 31% (CI: 0.22-0.36) answered that it is "not at all important". In the vegetarian group, this was 0% and 52% (CI: 0.39-0.65) and in the essentially-vegetarian group, this was 0% and 45% (CI: 0.25-0.66) - see Figure 4. The question "How important are the following aspects of eating/nutrition to you? [Health considerations]" showed that in the "totally" answer category, there was a significant difference between vegetarians, essentially-vegetarians, and the mixed diet group: 43% (CI: 0.30-0.56), 41% (CI: 0.20-0.61), and 27% (CI: 0.20-0.34) respectively (Mangels et al., 2003, Pomerleau et al., 2002, Sabaté, 2001). Interestingly, as with the ethical-environmental aspect, the image is a bit different here when asked about the importance of the nutritional aspect, or if we ask, "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when choosing your choice?" From the health point of view, the difference between vegetarians and participants of mixed diet decreases when asked as to the reason for the choice of nutrition. (The "Totally important" results: mixed nourishment, essentially-vegetarian, and vegetarian: 23% (CI: 0.05-0.40), 34% (CI: 0.27-0.41) and 34% (CI: 0.22-0.44) respectively.) We found exactly the opposite of the ethical-environmental response, so we can assume that health is an important aspect, but many other trends could be chosen from this point of view. On certain spiritual paths, only the vegetarian diet can be fitting to the follower of a given spiritual path, health is an "extra" for many of the ethical-environmental aspect rules. Eventually we can state that the different types of diets are based on different motives and health and ethical considerations were separated apparently (part of hypothesis 1.) (Kökény, 2005, Arora et al., 2017) Social background The answers to the question "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when choosing? [Family tradition]" shows that as expected, the importance of family tradition for vegetarians in nutrition is low. A practical reason for this may be the lack of a multigenerational plant-based family, so cutting out meat alone will not allow you to fully follow the family tradition. However, there may be a kind of subconscious or conscious urge to keep a distance from the family tradition, in which case vegetarianism is only a form, and deviation from family tradition is not a practical consequence. Figure 5 shows the distributions of family tradition among the three groups. The item "How often do you rely on the following resources for cooking in your current family or your current life? [Family tradition]" is less typical of vegetarians, but it is probably a consequence of the lack of multiple generations of vegetarians, so it is difficult to follow, although flavours can also be copied without meat. There is the result of the vegetarian group 34% (CI: 0.22-0.44), of the essentially-vegetarian 32% (CI: 0.12-0.51), and the non-vegetarian 33% (CI: 0.26-0.40) when we merged the responses "often or always". There are the questions: "Is there anyone in the family who has deliberately changed their diet before you?" and "If there is or was anyone who consciously changed their diet, why did they do so?". The responses show that the proportion of family members who changed diet is about the same: 31% and 34%. Among the three groups, there is a significant difference in weight loss and ethical-religious-environmental aspects for those who changed. At the vegetarian and essentially-vegetarian group, it is 32% (CI: 0.17-0.46) and 27% (CI: 0.07-0.55) of the ratio in the family who switched to ethical-religious-environmental considerations before the subject who answered our questions. In the case of mixed diets, this is 14% (CI: 0.07-0.20). This group is largely the relatives of vegetarians (children, spouses) who have not become vegetarians. In the family of our subjects, the ratio of changes due to weight loss is the lowest in the case of vegetarians: 16% (CI: 0.04-0.27). At essentially-vegetarians it is 20% (CI: 0.04-0.48), and in the mixed diet group, it is 36% (CI: 0.27-0.45) (Sabaté & Blix, 2001). There are the questions: "What are the reasons for following the above-mentioned diet? What is the weight of the following considerations when making your choice? [Belonging to the Community]" There is a big difference between the three groups in the answers. The essentially-vegetarian group is a kind of transition. Here, it is also evident that spiritual behavior is an important aspect of committed vegetarianism and that of belonging to the community. Essentially-vegetarians differ significantly from vegetarians in this. For vegetarians, the categories 'quite important' or 'completely important' are 40% (CI: 0.27-0.52) of the answers although the essentially-vegetarians response rate is only 9% (CI: 0.01-0.3) and the mixed diet group is only 4% (CI: 0.00-0.06). The 'not at all important' answer at the question of belonging to the community is 35% in the vegetarian group, 54% in the essentially-vegetarian group, and 76% in the mixed diet group – see below Figure 6. There was a question "How did the environment you live in respond to your change in nutrition?" Within the group who changed their nutrition, more people with mixed nutrition have found that everyone has supported them or that the environment is at least neutral. The essentially-vegetarians had more, and vegetarians even more hostile reactions. Based on these responses, we can refer to transgenerational traumatic patterns. The rigid and repetitive way of the solution of the old trauma becomes a tradition in the family, and family members seeking to resolve this will become renitent in the eyes of those who represent the family system, which is manifested in hostility (Manners et at., 2019). Summary of the hypotheses The above mentioned results prove the third hypothesis that there is a connection of food choices and traumatic events in the personal life and/or the family. Eventually we can state that the different types of diets are based on different motives since health and ethical considerations were separated apparently (part of hypothesis No. 1.) About the different permanency of motives we could see that ethical-environmental aspects are more durable while health considerations also can be lasting at least till the end of symptoms. The more fragile decision and motive is body shaping since it is following an outer trend and it seems not to be incorporated into the value system of the person (hypothesis No. 2.). Changes in life stages (Erikson's psychosocial crises) Question: "Is the importance of healthy eating linked to a life event or a life cycle?" The responses show that the highest proportion of people with mixed diets is "not linked to any stage or event of life" (28% CI: 0.21-0.35). For vegetarians and essentially-vegetarians, this is 3% (CI: 0.00-0.08) and 23% (CI: 0.08-0.45). The next part that is important for healthy eating and can be linked to some stage of life and the event of life. The mixed diet group is fairly balanced, most often their reason is their own or family member's disease (31% CI: 0.22-0.39), or some new stage of life (adolescence, adulthood, retirement), 37% (CI: 0.28-0.46), or for the birth of children (18% CI: 0.12-0.26), new, important relationships, jobs (16% CI: 0.09-0.23), belonging to a community (7% CI: 0.03-0.12), and 7% (CI: 0.02-0.11) from childhood. More than half of the essentially-vegetarians cite their own or a family member's illness for turning to healthy eating (53% CI: 0.29-0.77), the next most important impact is belonging to a community (41% CI: 0.18-0.67). Among vegetarians, the change in the health caused by disease is much lower 23% (CI: 0.12-0.34) much less than in the previous groups, and the motivation of belonging to the community (55% CI: 0.42-0.68) is higher. In the vegetarian group, the relationship and workplace play a role similar to that of mixed diets. Vegetarians and essentially-vegetarians are similar in that approx. 12% (CI: 0.01-0.36) of them bring these motivations from childhood, and 23% (CI: 0.12-0.34) are tied to a new phase of life (too). It confirms the aforementioned statement that some of the essentially-vegetarians, although the spiritual path and the belonging to the community are an inspiration as much as for vegetarians, but are not 100% committed. The other group who does not interact with vegetarian inspirational motivations through a community start with the motives of health, environmental protection, childhood patterns, performance enhancement, or weight loss (Erikson, 1980). Transgenerational patterns and distresses There was the question "Have you experienced chronic physical or psychological/mental illness in your youth or childhood (under 25 years of age) among you and your brothers and sisters?" In the vegetarian group, the highest rate of chronic illness in childhood was 19% (CI: 0.08-0.29) (4.5% (CI: 0.00-0.23) and 3% (CI: 0.00-0.06) in the group of essentially-vegetarians and mixed nourishment). There was the question "Which of the following occurred in the family back to your great grandparents, to the best of your knowledge?" The multiple-choice answers were converted into binary (whether trauma or not), and according to this result, the vegetarians had the highest rate (60% CI: 0.47-0.73), where trauma was present (55% (CI: 0.34-0.75) and 39% (CI: 0.31-0.46) among essentially-vegetarians and mixed nourishment). Our interpretation tends to see these facts as the family load from previous generations produce stresses from specific life events that appear in the life of the following generation. Handling those inherited stresses can have different ways, including destructive and constructive components (Kállay, 2007, Culda et al., 2018). Choosing such a way as changing lifestyle that includes nourishment can be a "brave" move although it can confront the family's helplessness or inertia for security needs. In such cases, the resistance of the other family members is understandable however they might be hostile (Boszormenyi-Nagy, 1985). Discussion The topics discussed in this paper overrun the basic biological function of diet. Among the motivations of nourishment, there is weight loss with a biological and social background (body forming) and the ethics-religion-environment protection that is more sophisticated and broader than only a biological aspect. While preventive health care and disease are biological, the former is more conscious and targeted, while the latter is a compelling force. The results show that prettiness and performance enhancement i.e. in sports, fit to social expectations (Mangels et al. 2003). It appears from the data that the change of life due to traumatic life events and the search for problem-solving due to transgenerational traumas are part of the trials treating the pathologies in most ethical type of nutrition changes (Rejinders, 2001, Boszormenyi-Nagy, 1985). This exists despite the need to defy family and environmental hostility. This data makes it possible to find a link between the two points of our hypothesis, i.e. the intention of change (on the transgenerational traumatic pattern that was passed on) and the nutritional mode. However, further studies are needed to clarify the hypothesis that could be collected, for example, through deep interviews. There is a further need to clarify the accuracy of the answers in the questionnaire since subjectivity and reliability could not be controlled. The research aimed to collect and process data on nourishment. We could distinguish three groups among the subjects, namely vegetarians, essentially-vegetarians, and omnivores. We were interested in their motivations, social background, changes in different life periods, and the role of transgenerational patterns. Among those who changed their nourishment, the motivation connected to the ethics-religion-environment protection group was the strongest in the groups of vegetarians and essentially-vegetarians (67% (CI: 0.54-0.79) and 70% (CI: 0.50-0.90)). The most frequent reasons for the change among people with mixed nourishment were preventive healthcare (59% (CI: 0.50-0.69)), losing weight (44% (CI: 0.34-0.53)), illness (28% (CI: 0.19-0.36)), and in a smaller ratio (10%(CI: 0.00-0.23)) the nicer appearance or the enhancement of the efficiency. Among the three groups, there was a significant difference in weight loss and the ethical-religious-environmental aspects for those who changed. At the vegetarian and essentially-vegetarian group it was 32% (CI: 0.17-0.46) and 27% (CI: 0.07-0.55) the ratio in the family who changed based on ethical-religious-environmental considerations. In the case of mixed diets, this was 14% and in this group largely the relatives of vegetarians (children, spouses) were presented who did not become vegetarians. In the family of vegetarians, the ratio of changes due to weight loss is the lowest: 16%. At essentially-vegetarians it is 20%, and in the mixed diet group, it is 36% (CI: 0.27-0.45). Some of the essentially-vegetarians, although the spiritual path and the belonging to the community were inspirational similar to vegetarians, they were not 100% committed. The other part, who did not interact with vegetarian inspirational motivations through a community, started with the motives of health, environmental protection, childhood pattern, performance enhancement, or weight loss. Concerning the transgenerational field, vegetarians had the highest rate (60% CI: 0.46-0.73) where family trauma occurred. (55% (CI: 0.34-0.75) and 39% (CI: 0.31-0.46) among essentially-vegetarians and mixed nourishment.) These results reflected the above-mentioned status of vegetarians where a higher level of repressed aggression was present. These facts were interpreted as the family load from the previous generation stresses from specific life events inherited into the lives of next generations. Handling those inherited stresses can have different ways including destructive and constructive components. Limitations and strength The data makes it possible to find a link between the two points of our hypothesis, i.e. the intention of change (on the transgenerational traumatic pattern that was passed on) and the nutritional mode. However, further studies are needed to clarify the hypothesis that could be collected, for example, through deep interviews. 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(2001): Vegetarian Diets and Obesity Prevention. in: Sabaté, J. (ed): Vegetarian nutrition. pp. 91-108. New York, US: CRC Press Schwingshackl, L., Chaimani, A., Hoffmann, G., Carolina Schwedhelm & Heiner Boeing (2018): A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol 33, 157–170. https://doi.org/10.1007/s10654-017-0352-x Smits K P J, Listl S, Jevdjevic M. (2020): Vegetarian diet and its possible influence on dental health: A systematic literature review. Comm Dent Oral Epidemiol, 48:7-13. Springmann, M., Godfray, H. C. J., Rayner, M., & Scarborough, P. (2016). Analysis and valuation of the health and climate change cobenefits of dietary change. Proceedings of the National Academy of Sciences, 113(15), 4146-4151. Tiainen, A. M. K., Männistö, S., Lahti, M., Blomstedt, P. A., Lahti, J., Perälä, M. M., ... & Eriksson, J. G. (2013). 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Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovascular diagnosis and therapy, 4(5), 373–382. https://doi.org/10.3978/j.issn.2223-3652.2014.10.04 Yokoyama, Y., Levin, S.M., Barnard, N.D. (2017): Association between plant-based diets and plasma lipids: a systematic review and meta-analysis, Nutrition Reviews, Volume 75, Issue 9, September 2017, Pages 683–698. https://doi.org/10.1093/nutrit/nux030
Rajka Daniela
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Bianca Huluban
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Nurten ARSLAN ISIK
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VISION SCREENING OF FOUR-AND FIVE-YEAR-OLD CHILDREN IN CLUJ COUNTY: RECOMMENDATIONS FOR NATIONWIDE IMPLEMENTATION
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DOI: 10.51546/JSUM.2021.8401

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Exposure to Peer Violence Among Romanian High School Students And Its Relationship With Internet Use And Other Health Risk Behaviors
Lucia Maria Lotrean, Ioana Trifescu, Mira Florea, Rodica Cornean, Romana Vulturar, Codruta Lencu
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THE EFFECT OF AN EDUCATION PROGRAM ON RECOGNIZING CHILD ABUSE AND NEGLECT IN TURKEY
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DOI: 10.51546/JSUM.2021.8402

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ORAL HEALTH BEHAVIOR CHANGE FRAMEWORK IN PRESCHOOLERS: SYSTEMATIC REVIEW
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INVESTIGATING SENSITIVITY OF FATHERS TOWARDS VIOLENCE AGAINST CHILDREN
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VERACITY IN PEDIATRIC PRACTICE
Rajka Mária
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DOI: 10.51546/JSUM.2022.9103

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THE EFFECT OF PARENTS’ STRESS LEVELS RELATED TO THE COVID-19 PANDEMIC ON DIGITAL PARENTING AWARENESS, IN TURKEY
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THE USE OF ELECTRONIC CIGARETTES – A NEW EPIDEMIC AMONG ROMANIAN CHILDREN AND TEENAGERS
Remus Gaga, Tudor Lucian Pop
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SOME RECENT DATA ON THE USE OF DRUGS IN EUROPE AND ROMANIA AMONG YOUNG ADULTS AND STUDENTS, REGARDING ADMISSIONS TO TREATMENT AND EMERGENCIES ASSOCIATED WITH THE USE OF DRUGS. SOME TENDENCIES AND CORRELATIONS
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EVALUATION OF THE ACTIVITY OF THE UNIVERSITY MEDICAL CABINETS FROM CLUJ-NAPOCA
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A DESCRIPTIVE CROSS-SECTIONAL STUDY TO ASSESS THE KNOWLEDGE AND IMPORTANCE OF HAND WASHING AND ITS TECHNIQUE AMONG SCHOOL CHILDREN IN A SEMI URBAN PLACE IN SOUTH INDIA
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DOI: 10.51546/JSUM.2022.9302

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PERIPHERAL NEUROLOGICAL COMPLICATIONS DURING COVID-19 PANDEMIC. SHORT REVIEW
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DOI: https://doi.org/10.51546/JSUM.2022.9303

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ANOTHER FACE OF PARKINSON’S DISEASE: PERIPHERAL INVOLVEMENT
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THE ASSOCIATIONS BETWEEN INTER-PREGNANCY INTERVAL AND MATERNAL AND NEONATAL OUTCOMES IN CHENNAI
Santosh Kumar
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THE WELL-BEING OF CLUJ COUNTY HIGH SCHOOL STUDENTS, IN THE CONTEXT OF THE STRESS GENERATED BY THE COVID-19 PANDEMIC
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GENETIC ASPECTS IN TYPE 1 DIABETES MELLITUS
Zara Radu
Pages: 28-33

DOI: 10.51546/JSUM.2022.9204

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9204

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Kishore Narayanan,Benjamin M Sagayaraj,Nidhi Sharma, Santosh Kumar Kamalakannan
Pages: 14-21

DOI: 10.51546/JSUM.2022.9202

DOI URL: http://dx.doi.org/10.51546/JSUM.2022.9202

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CÂTEVA DATE RECENTE PRIVIND CONSUMUL DE DROGURI ÎN EUROPA SI ROMÂNIA ÎN RÂNDUL ADULTILOR TINERI SI ELEVILOR, PRIVIND ADMITERILE LA TRATAMENT SI URGENTELE ASOCIATE CONSUMULUI DE DROGURI. CÂTEVA TENDINTE SI CORELATII
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Aspecte genetice în diabetul zaharat de tip 1 Genetic aspects in type 1 diabetes mellitus Zara Radu Student, anul VI, facultatea Medicin? nr. 1, Universitatea de Stat de Medicin? ?i Farmacie "Nicolae Testemi?anu" din Republica Moldova Email: zara.radu00@gmail.com Rezumat Diabetul zaharat (DZ) de tip 1 este considerat la ora actual? ca o afec?iune autoimun? cu etiologie multifactorial?, produs? de o interac?iune complex? a mai multor factori genetici, epigenetici ?i de mediu, a c?ror consecin?? este distruc?ia progresiv? a celulelor beta-pancreatice (cele care sintetizeaz? insulina) ?i în final, deficitul absolut de insulin? endogen?. Aproximativ 5-10% din to?i pacien?ii cu diabet au diabet zaharat de tip 1. DZ de tip 1 este mediat imun în peste 90% din cazuri ?i poate ap?rea la orice grup? de v\ rst?, dar este cel mai frecvent la copii ?i adul?i tineri, de asemenea are un grad ridicat de concordan?? ridicat? în r\ ndul gemenilor monozigo?i (33 p\ n? la 42%) ?i se manifest? puternic în familii (15% din cazurile de DZ prezint? agregare familial?) cu risc mare pentru rudele de gr I (6-7% familie vs 0,4% popula?ia general?) cu o amprent? parental? (7-8% tat?-copil vs 2-4% mam?-copil), riscul între fra?i fiind de aproximativ 10 ori mai mare dec\ t riscul în popula?ia general?. Studiile geneticii DZ de tip 1 au dezv?luit contribu?ia cheie a regiunii antigenului leucocitar uman (HLA) la susceptibilitatea DZ de tip 1, abord?rile de familie ?i studiul genelor candidate au descoperit înc? cinci loci asocia?i cu DZ de tip 1, iar studiile de asociere la nivelul genomului (GWAS) a crescut num?rul de loci la peste 60. Identificarea si studiul ac?iunii genelor de susceptibilitate pentru DZ de tip 1 ar putea s? pun? în eviden?? depistarea precoce a prediabetului ?i formelor necomplicate dar ?i elaborarea unor noi ?inte ?i strategii terapeutice ?i elaborarea unui plan de tratament personalizat. Cuvinte cheie: Diabet zaharat, diabet zaharat de tip 1, gene, risc, susceptibilitate genetic? Abstract Type 1 diabetes mellitus is currently considered to be an autoimmune condition with a multifactorial etiology, caused by a complex interaction of several genetic, epigenetic, and environmental factors, resulting in the progressive destruction of beta-pancreatic cells (those that synthesize insulin) and finally, the absolute endogenous insulin deficiency. About 5-10% of all patients with diabetes, have type 1 diabetes. Type 1 diabetes is immune mediated in over 90% of cases and can occur in any age group, but is most common in children and young adults also has a high degree of high concordance among monozygotic twins (33 to 42%) and is strongly manifested in families (15% of cases of diabetes have family aggregation) with high risk for first grade relatives (6-7% family vs. 0.4% of the general population) with a parental footprint (7-8% father-child vs. 2-4% mother-child), the risk between siblings being about 10 times higher than the risk in the general population. Genetic studies of type 1 diabetes have revealed a key contribution of the human leukocyte antigen (HLA) region to the susceptibility of type 1 diabetes, family approaches and the study of candidate genes found five more loci associated with type 1 diabetes, and genome-wide association studies (GWAS) increased the number of loci to over 60. Identification and study of the action of susceptibility genes for diabetes type 1 could highlight the early detection of prediabetes and uncomplicated forms but also the development of new targets and therapeutic strategies and the development of a personalized treatment plan. Key words: diabetes mellitus, type 1 diabetes mellitus, genes, risk, genetic susceptibility Obiective Definirea, clasificarea ?i caracteristica DZ Stabilirea rolului factorilor genetici, epigenetici în etiologia ?i patogenia DZ tip 1 Identificare genelor majore responsabile de apari?ia DZ tip 1 Studierea ?i analiza impactului genomului în apari?ia, manifestarea ?i managementul pacientului cu DZ tip 1 Metodologia de lucru a inclus analiza ?i sinteza literaturii, din surse precum PubMed, Wiley online library, Semantic Scholar, Ghiduri/protocoale na?ionale ?i interna?ionale, iar etapele de cercetare au fost, dup? cum urmeaz?: Definirea problemei; Stabilirea criteriilor de includere a unor studii de meta-analiz?; Identificare studiilor; Studierea ?i analiza publica?iei; Extrac?ia informa?iei; Sistematizarea publica?iei, anul, sursa, metoda de cercetare, rezultatele, concluziile; Includerea în cercetare a informa?iei ?i sinteza rezultatelor ob?inute. Introducere Diabetul zaharat este un sindrom complex ?i eterogen, care induce modific?ri profunde în metabolismul glucidic, proteic, lipidic, echilibrul ionic ?i mineral, ce stau la baza apari?iei unui spectru larg de complica?ii cronice, care afecteaz? mai mult sau mai pu?in toate ?esuturile. De-a lungul anilor, prevalen?a diabetului zaharat a crescut la nivel global ?i este clasificat? drept una dintre principalele cauze de morbiditate ?i mortalitate ridicat? ?i cea mai frecvent? cauz? a dializei. Dup? Organiza?ia Mondial? a S?n?t??ii (OMS) diabetul zaharat se clasific? în DZ tipul 1, at\ t formele autoimune, c\ t ?i neautoimune cu distrugere a celulelor beta, DZ tipul 2 cu grad diferit de rezisten?? la insulin? ?i hiposecre?ie de insulin?, ?i un grup aparte numit alte tipuri specifice de DZ, unde cauza este mai bine definit?, ?i DZ gesta?ional. [1] Diabetul zaharat de tip 1 reprezint? circa 5-10% din toate cazurile de diabet,[2] acesta reprezint? rezultatul distrugerii autoimune a celulelor beta pancreatice ale organismului, care produc hormonul de insulin?. F?r? hormonul de insulin?, organismul nu poate regla controlul glicemiei. [3] DZ tip 1 rezult? din interac?iuni complexe ale factorilor genetici ?i de mediu, probabilitatea apari?iei DZ la o persoan?, este condi?ionat? în mare m?sur? de factorul genetic (heritabilitatea - 20% - 60%). [4] Existen?a predispozi?iei genetice în DZ determin? posibilitatea ?i necesitatea efectu?rii screening-ului direc?ionat pentru determinarea grupurilor de risc, depistarea precoce a prediabetului ?i formelor necomplicate de diabet, ini?ierea unor tratamente personalizate, prevenirea complica?iilor. Susceptibilitatea genetic? a DZ de tip 1 Componenta genetic? în DZ tip 1 este puternic?, riscul mediu de prevalen?? este de 0,4% pentru copiii f?r? antecedente familiale de DZ tip 1, dar ~6-7% atunci c\ nd unul dintre p?rin?i are DZ tip 1 ?i >30% atunci c\ nd ambii p?rin?i sunt afecta?i. Exist?, de asemenea, o mare diferen?? în ceea ce prive?te ratele de concordan?? între gemenii dizigo?i (7-11%) ?i cei monozigo?i (33-42%). Este interesant faptul c?, riscul de mo?tenire a DZ tip 1 difer? în func?ie de p?rintele care este afectat, cu aproximativ risc dublu dac? se mo?tene?te de la tat? (7-8%) dec\ t de la mam? (2-4%), iar riscul între fra?i fiind de aproximativ 10 ori mai mare dec\ t riscul în popula?ia general?. [4] Gene responsabile de apari?ia DZ tip 1 Riscul DZ de tip 1 este puternic influen?at de multipli loci genici, îns? aceast? predispozi?ie genetic? la distrugerea autoimun? a celulelor beta este, de asemenea, legat? de factorii de mediu care sunt înc? slab defini?i. Acest tip de DZ este puternic influen?at anume de genele care controleaz? sistemul imunitar plus, mul?i al?i loci de predispozi?ie, care interac?ioneaz? între ei ?i care au o anumit? influen?? asupra susceptibilit??ii la DZ [1]. Studiile geneticii DZ de tip 1 au început în anii 1970 ?i au dezv?luit contribu?ia cheie a regiunii antigenului leucocitar uman (HLA) la susceptibilitatea DZ de tip 1 [5]. Gena HLA codific? complexul major de histocompatibilitate (MHC) la om, aceasta fiind ?i responsabila pentru p\ n? la 50% din riscul genetic de DZ tip 1. Moleculele HLA sunt proteine de suprafa?? celular? care se leag? ?i prezint? antigene peptidice la limfocitele T. HLA este clasificat în dou? clase(I ?i II). Moleculele din clasa I (A, B ?i C) constau dintr-un lan? polipeptidic care formeaz? un heterodimer cu \�-2 microglobulina care nu este codificat? de complexul HLA. Moleculele din clasa II (DR, DQ ?i DP) constau dintr-un heterodimer creat din dou? polipeptide (\a ?i \�). Moleculele de clas? I prezint? peptide din interiorul celulelor ?i activeaz? celulele T citotoxice, în timp ce moleculele de clas? II prezint? antigeni extracelulari celulelor T-helper care stimuleaz? celulele B s? produc? anticorpi. Legarea peptidelor ?i, prin urmare, prezentarea antigenului, este determinat? de forma ?i sarcinile electrice ale ?an?ului de legare a peptidelor ?i de capacitatea receptorului celulelor T de a se lega de complexul HLA-peptid?. [4] Regiunea HLA prezint? un dezechilibru de leg?tur? puternic, astfel înc\ t, în cadrul unei popula?ii, alelele individuale se g?sesc, de obicei, doar în una sau c\ teva combina?ii de haplotipuri. Cel mai mare risc de DZ tip 1 este atribuit locilor de clasa II HLA-DR3-DQ2 ?i HLADR4-DQ8. Aproape 90% dintre copiii diagnostica?i cu DZ tip 1 în Scandinavia au fie haplotipurile HLA-DR3-DQ2, fie HLA-DR4-DQ8. Asocierea dintre HLA ?i diabet pare s? fie legat? de riscul de a dezvolta primul autoanticorp, astfel înc\ t copiii homozigo?i pentru HLA-DR3-DQ2 au mai multe ?anse de a avea anticorpi GADA(Anticorpi anti-decarboxilaza acidului glutamic) ca prim anticorp, iar copiii cu haplotip HLA-DR4-DQ8 au mai multe ?anse de a avea mai înt\ i autoanticorpii de insulin?. [6] Alte haplotipuri de clasa II au fost, de asemenea, asociate cu riscul de DZ tip 1 cu efecte mai mici, de exemplu, locusul DPB1 este asociat at\ t cu protec?ia (DPB1*04:02), c\ t ?i cu susceptibilitatea (DPB1*03:01 ?i DPB1*02:02) fa?? de DZ tip 1.[7] Alelele de risc HLA difer?, de asemenea, între popula?ii. Haplotipul HLA-DR7 care include DRB1*07:01 este protector în popula?ia european?, dar confer? risc la africani. În mod similar, un haplotip DR3 specific african (DRB1*03:02-DQA1*04:01- DQB1*04:02) protejeaz? împotriva DZ tip 1. [4] Cu toate acestea, mecanismele biologice exacte prin care alelele genelor care codific? HLA contribuie la riscul de DZ de tip 1 r?m\ n evazive. De fapt, regiunea HLA este cea mai polimorf? sec?iune a genomului uman, cu 22.362 de alele unice [5]. Abord?rile de familie ?i studiul genelor candidate au descoperit înc? cinci loci care pot fi asocia?i cu DZ de tip 1. În 1984, gena insulinei (INS) a fost identificat? ca al doilea locus asociat cu DZ de tip 1. [5] Gena insulinei (INS) este primul ?i cel mai puternic locus non-HLA cu un OR 2,4 (Odds Ratio). S-a constatat c? regiunea promotorului are un num?r variabil de repet?ri (VNTR) care marcheaz? alele cu expresie diferit? a genei INS, despre care se presupune c? afecteaz? susceptibilitatea prin modularea expresiei timice a insulinei ?i prin afectarea educa?iei celulelor T. Locii de susceptibilitate în regiunile CTLA4, PTPN22 ?i IL2RA au fost identifica?i în studiile privind genele candidate. [4] În 1996 a fost descoperit? gena cytotoxic T-associated protein 4 (CTLA4) ?i a fost recunoscut? ca al treilea locus. Un alt studiu caz-control din 2004 a raportat c? proteina tirozin fosfataz?, gena non-receptor de tip 22 (PTPN22) este asociat? cu susceptibilitatea la DZ de tip 1, iar în 2005 sa raportat gena receptorului interleukinei 2 alfa (IL2RA) ca al cincilea locus asociat cu DZ de tip 1, al ?aselea candidat fiind gena domeniului 1 helicaza C indus? de interferon (IFIH1).[5] Încep\ nd din 2007, Studiile de asociere la nivelul genomului (GWAS) a crescut dramatic num?rul de loci asocia?i cu DZ de tip 1 la peste 60, a?a cum este prezentat în Fig. 1. Ace?ti loci g?zduiesc multe gene noi despre care nu se credea anterior c? sunt candida?i eviden?i pentru susceptibilitatea DZ de tip 1 înainte de era GWAS. [5] Ace?ti loci explic? ~80% din heritabilitatea în sens restr\ ns a DZ de tip 1. Unul dintre cele mai mari eforturi a fost cel al Consor?iului de genetic? a diabetului de tip 1 (T1DGC), o colaborare interna?ional? prin care au fost colectate ?i genotipate >14.000 de probe. Dintre locii identifica?i, doar PTPN22 ?i IL2RA au OR mai mare de 1,5; majoritatea sunt în intervalul 1,1-1,3, subliniind importan?a regiunii HLA cu un OR de 2,4. [4] Recunoa?terea unui antigen specific ?i a HLA de c?tre receptorul de celule T poate avea ca rezultat un atac autoimunitar, care ar putea fi poten?at ?i mai mult de variantele genice care afecteaz? prezentarea antigenului sau semnalizarea celulelor T. Cunoa?terea func?ional? a rolului locilor de susceptibilitate la DZ de tip 1 a ar?tat c? multe gene candidate sunt implicate în func?ii legate de r?spunsul imunitar adaptativ mediat de celulele T ?i de mecanismele de toleran??, precum ?i de imunitatea înn?scut? implicat? în recunoa?terea antigenelor celulelor \�. Multe asocieri genetice sunt, de asemenea, împ?rt??ite cu alte boli autoimune. De exemplu, o alel? comun? de pierdere a func?iei în locusul tirozin-fosfatazei PTPN22 scade riscul de boal? Crohn, dar cre?te riscul de artrit? reumatoid? ?i DZ de tip 1. Interesant este faptul c? cel pu?in 50% dintre genele candidate identificate, inclusiv CTRB1/2, IFIH1, GLIS3 ?i PTPN2, sunt, de asemenea, exprimate în celulele beta, sus?in\ nd conceptul c? susceptibilitatea genetic? la DZ de tip 1 influen?eaz? at\ t sistemul imunitar, c\ t ?i func?ia celulelor beta. Pentru majoritatea locilor post-GWAS înc? r?m\ n s? fie realizate cartografierea fin? ?i caracterizarea func?ional?, [8] Îns? o bun? parte din genele asociate cu DZ de tip 1 sunt deja descifrate ?i este cunoscut mecanismul prin care poate duce la apari?ia acestei maladii (Tabelul 1). Fig. 1 Locusuri de susceptibilitate la diabetul de tip 1 (DZ de tip 1). a) Cronologia descoperirii: locii sunt prezenta?i dup? anul c\ nd au fost asocia?i pentru prima dat? în DZ de tip 1. Genele prezentate în ro?u sunt asociate cu complica?ii specifice DZ de tip 1. [5]. Gena Locus Func?ia genei PTPN22 1p13.2 Reglarea r?spunsului imunitar înn?scut, a activ?rii celulelor T ?i a prolifer?rii celulelor natural killer IL10 1q32.1 Citokine ?i r?spunsul inflamator AFF3 2q11.2 Reglarea transcrip?iei IFIH1 2q24.2 Activarea sistemului imunitar inert NF-κB STAT4 2q32.3 Calea de semnalizare mediat? de citokine CTLA4 2q33.2 Activarea celulelor T CCR5 3p21.31 Dezvoltarea celulelor Th1 ?i calea de semnalizare mediat? de chemokine IL21, IL2 4q27 Citokine ?i r?spunsul inflamator ?i celulele Th1 sau Th2 diferen?iere IL7R 5p13.2 Citotoxicitatea mediat? de celulele T, produc?ia de imunoglobulin? ?i legarea antigenului BACH2 6q15 Transcriere TNFAIP3 6q23.3 R?spunsul inflamator TAGAP 6q25.3 Transduc?ia semnalului IKZF1 7p12.2 Reglarea celulelor imunitare GLIS3 9p24.2 Reglarea transcrip?iei IL2RA 10p15.1 Splicing alternativ ARNm Splicing alternativ Diferen?ierea celulelor Th1 sau Th2 PRKCQ 10p15.1 Procesul apoptotic, r?spunsul inflamator, r?spunsul imunitar înn?scut, ?i calea de semnalizare a receptorilor de celule T NRP1 10p11.22 Transduc?ia semnalului INS 11p15.5 Calea de semnalizare a insulinei BAD 11q13.1 Apoptoza CD69 12p13.31 Transduc?ia semnalului ITGB7 12q13.13 R?spunsul la virus ?i reglarea r?spunsului imunitar ERBB3 12q13.2 Reglarea transcrip?iei, a r?spunsului imunitar înn?scut ?i a lipidelor metabolismul lipidic CYP27B1 12q14.1 Metabolismul lipidelor, al lipoproteinelor, al hormonilor steroizi ?i al vitaminei D SH2B3 12q24.12 Transduc?ia semnalului GPR183 13q32.3 R?spunsul imunitar umoral DLK1 14q32.2 Reglarea expresiei genice RASGRP1 15q14 R?spunsul inflamator la stimulii antigenici ?i produc?ia de citokine CTSH 15q25.1 Calea de semnalizare de reglare a r?spunsului imunitar Citotoxicitate mediat? de celulele T R?spuns imunitar adaptativ CLEC16A 16p13.13 Necunoscut IL27 16p11.2 R?spunsul inflamator ?i reglarea r?spunsului de ap?rare împotriva virusurilor ORMDL3 17q12 Legarea proteinelor PTPN2 18p11.21 Semnalizarea citokinelor ?i diferen?ierea celulelor B ?i T CD226 18q22.2 Imunoreglarea ?i sistemul imunitar adaptativ TYK2 19p13.2 Cale de semnalizare mediat? de citokine, semnal intracelular transduc?ie ?i calea de semnalizare a interferonului de tip I FUT2 19q13.33 C?i metabolice UBASH3A 21q22.3 Reglarea produc?iei de citokine, reglarea c?ii de semnalizare a receptorilor de celule T C1QTNF6 22q12.3 Calea de semnalizare a receptorilor de celule B, calea de semnalizare a chemokinei ?i citotoxicitatea mediat? de celulele natural killer Tabelul 1: Gene candidate propuse ca fiind importante pentru patogeneza diabetului zaharat de tip 1. [9] Mecanisme epigenetice Multe procese implicate în DZ tip 1 ar putea fi influen?ate de mecanisme epigenetice, inclusiv dezvoltarea, metabolismul ?i regenerarea celulelor beta. R?spunsurile imunitare, inclusiv activarea celulelor T ?i inducerea celulelor T reglatoare, se bazeaz? pe reglarea epigenetic?. S-a demonstrat c? structura a patru situsuri CpG(5'—C—fosfat—G—3') proximale fa?? de situsul de început al transcrip?iei genei INS difer? între pacien?ii cu DZ tip 1 ?i cei de control, trei situsuri fiind mai pu?in metilate ?i unul mai metilat. [10] În mod similar, situsurile CpG din promotorul IL2 au fost mai dens metilate la pacien?ii cu DZ tip 1 dec\ t la grupul de control. Modific?rile histonice pot fi, de asemenea, relevante pentru DZ tip 1, De exemplu, studiile caz-control au eviden?iat niveluri diferite de acetilare a histonei H4 sau de acetilare a H3K9(histonei H3) la pacien?ii cu DZ tip 1 în compara?ie cu grupul de control, [11] Un num?r tot mai mare de observa?ii sugereaz? c? miARN-urile(micro ARN) pot contribui, de asemenea, la dezvoltarea DZ tip 1. Studiile experimentale pe modele animale ?i pe celule cultivate au furnizat dovezi conving?toare c? miARN-urile pot participa la controlul autoimunit??ii deteriorarea celulelor \�, reglarea sintezei ?i secre?iei de insulin?. [12] S-a demonstrat, de asemenea, c? expresia unor miARN-uri specifice în s\ nge ?i în limfocite difer? între pacien?ii cu DZ tip 1 ?i controalele ?i c? este corelat? cu severitatea bolii. Prin urmare, m?surarea acestor miARN-uri poate fi util? pentru identificarea persoanelor cu risc de a dezvolta DZ tip 1 ?i pentru prevenirea bolii. [13] Complica?ii Diabetul de tip 1 este o afec?iune cronic? care poate duce la numeroase complica?ii microvasculare ?i macrovasculare pe termen lung. Diabetul este o cauz? principal? a bolii renale în stadiu terminal, a orbirii, a amput?rii picioarelor ?i a picioarelor ?i a bolilor cardiovasculare. Incertitudinile privind cadrul patogenetic care st? la baza complica?iilor diabetice reprezint? un obstacol major în dezvoltarea unor modalit??i de tratament optimizate. [14] Referitor la apari?ia complica?iilor s-a demostrat c? controlul conven?ional al glicemiei, în compara?ie controlul intensiv al glicemiei, a fost asociat cu mai pu?ine complica?ii microvasculare at\ t în cazul diabetului de tip 1, c\ t ?i în cazul diabetului de tip 2, precum ?i cu o sc?dere a complica?iilor coronariene. [15]. O mai bun? cunoa?tere a markerilor genetici de risc pentru aceste complica?ii va fi un instrument important în definirea mecanismelor patogenetice cheie ?i va contribui la generarea de ?inte terapeutice. Chiar dac? au fost raportate gene asociate cu complica?ii diabetice specifice diabetului de tip 1, cum ar fi un control mai slab al diabetului sau o insuficien?? insulinic? mai sever?, studiile ?i e?antioanele de dimensiuni reduse, precum ?i problemele legate de redefinirea fenotipurilor nu au înregistrat niciun progres semnificativ în ceea ce prive?te definirea susceptibilit??ii genetice la complica?ii. [9] Concluzie DZ tip 1 este produs de o deficien?a absolut? în secre?ia de insulin?, ca rezultat al distrugerii celulelor beta insulare ale pancreasului, iar mecanismul principal este susceptibilitatea genetica la autoimunitate sub ac?iunea unor factori de mediu declan?atori. Rolul major al predispozi?iei genetice in DZ 1 este atribuit alelelor complexului MHC, genei INS, genelor PTPN2, IL2RA, CTLA4, UBASH3A, IFIH1 responsabile de r?spunsul imun. Identificarea si studiul ac?iunii genelor de susceptibilitate la DZ tip 1 pot contribui la predic?ia si preven?ia bolii, de asemenea aceasta va permite prezervarea celulelor beta ramase nealterate, elaborarea unor noi ?inte si strategii terapeutice, in stadiul preclinic al bolii, sau personalizarea interven?iilor in func?ie de profilul lor genetic, blocarea progresiei spre DZ tip 1, prin stimularea activ? la o toleran?? asupra celulelor self, imunoterapie specifica sau regenerarea celulelor beta. Bibliografie 1. Marklova, E., Genetic aspects of diabetes mellitus. Acta Medica (Hradec Kralove), 2001. 44(1): p. 3-6. 2. Babe?, A.P., Ghid de management al diabetului zaharat, M. s?n?t??ii, Editor. 2021: Monitorul Oficial Nr. 997 bis din 19 octombrie 2021. p. 240. 3. Skyler, J.S., et al., Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis. Diabetes, 2017. 66(2): p. 241-255. 4. Bonora, E. and R. DeFronzo, Diabetes. Epidemiology, Genetics, Pathogenesis, Diagnosis, Prevention, and Treatment. 2018. 5. Bakay, M., et al., The Genetic Contribution to Type 1 Diabetes. Curr Diab Rep, 2019. 19(11): p. 116. 6. Ilonen, J., et al., Patterns of \�-cell autoantibody appearance and genetic associations during the first years of life. Diabetes, 2013. 62(10): p. 3636-40. 7. Noble, J.A., Immunogenetics of type 1 diabetes: A comprehensive review. J Autoimmun, 2015. 64: p. 101-12. 8. Bergholdt, R., et al., Identification of novel type 1 diabetes candidate genes by integrating genome-wide association data, protein-protein interactions, and human pancreatic islet gene expression. Diabetes, 2012. 61(4): p. 954-62. 9. Pociot, F. and Å. Lernmark, Genetic risk factors for type 1 diabetes. Lancet, 2016. 387(10035): p. 2331-2339. 10. Fradin, D., et al., Association of the CpG methylation pattern of the proximal insulin gene promoter with type 1 diabetes. PLoS One, 2012. 7(5): p. e36278. 11. Miao, F., et al., Profiles of epigenetic histone post-translational modifications at type 1 diabetes susceptible genes. J Biol Chem, 2012. 287(20): p. 16335-45. 12. Zheng, Y., Z. Wang, and Z. Zhou, miRNAs: novel regulators of autoimmunity-mediated pancreatic \�-cell destruction in type 1 diabetes. Cell Mol Immunol, 2017. 14(6): p. 488-496. 13. Zullo, A., et al., Epigenetics and type 1 diabetes: mechanisms and translational applications. Transl Res, 2017. 185: p. 85-93. 14. Ahlqvist, E., et al., The genetics of diabetic complications. Nat Rev Nephrol, 2015. 11(5): p. 277-87. 15. Insel, R.A., et al., Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care, 2015. 38(10): p. 1964-74.
Radu Zara
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STAREA DE BINE A ELEVILOR DIN JUDETUL CLUJ IN CONTEXTUL STRESULUI GENERAT DE PANDEMIA DE COVID-19
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A descriptive cross-sectional study to assess the knowledge and importance of hand washing and its technique among School Children in a Semi urban place in South India
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PERIPHERAL NEUROLOGICAL COMPLICATIONS DURING COVID-19 PANDEMIC. SHORT REVIEW
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ANOTHER FACE OF PARKINSON’S DISEASE: PERIPHERAL INVOLVEMENT
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EVALUATION OF THE ACTIVITY OF THE UNIVERSITY MEDICAL CABINETS FROM CLUJ-NAPOCA
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