Purpose Romania has the highest tuberculosis (TB) burden in the European Union/European Economic Area (EU/EEA) comprising almost a quarter (23.4%) of the reported patients in 2017, and a TB notification rate six times higher than the EU/EEA average. Although the overall TB notification rate in Romania declined from 154/100.000 individuals to 66/100.000 individuals in the general population between 2002 and 2017, TB notification rates remain high in certain vulnerable populations groups such as prisoners, the homeless population and among drug users. Patients and Methods We conducted a descriptive study regarding TB monitoring data in Romania, including the aforementioned TB risk groups. Results Analysis regarding notified TB cases among these risk groups indicates that TB rates are 7 to 18 times higher than in the general population. One of the most alarming aspects regards the exceedingly high proportion of HIV-seropositivity among drug users and the high mortality rates among the homeless population and among drug users with TB. Conclusion This data underlines the importance of early identification among social risk groups using outreach active case-finding (ACF) activities, possibly combining TB screening with screening for other common, possibly life-threatening, co-morbidities for which an effective treatment is available. ACF could have a decisive role in TB control and eradication in Romania, when aimed at these high-risk groups.

Performance management in government is at a crossroads. The advent of big data and advances in technological and analytical tools have provided opportunities to measure and track a wider variety of internal and external indicators on a more timely basis. Public leaders require new vision and capacity to design and manage knowledge‐building systems. This article provides two tools: (1) a more comprehensive open systems performance management framework and (2) a model of leadership needed to orchestrate such systems—knowledge brokers who orchestrate the demand for and supply of evidence. This article recommends that public agencies strategically build evidence to better track measures of the effects of governmental actions on public value and their intended and unintended consequences on the ecosystem; articulate, measure, and test the assumptions built into their operating models; and learn from routine monitoring of the dynamic environment in which their organizations strive to achieve their missions.

Background: The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function.Objectives: To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study.Methods: PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires.Results: Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6 ± 50.4 versus 213.9 ± 86.8 mg/dl, P = 0.017), LDL-cholesterol (137.8 ± 45.2 versus 130.7 ± 83.7 mg/dl, P = 0.004) and glomerular filtration rate (96.9 ± 16.8 versus 90.7 ± 19.1 ml/min/1.73 m2, P <0.001) in women and higher triglycerides (170.7 ± 129.8 versus 144.3 ± 94.2 mg/dl, P = 0.007), glomerular filtration rate (97.6 ± 17 versus 90.3 ± 18 ml/min/1.73 m2, P < 0.001) and lower HDL-cholesterol (48 ± 15.5 versus 50.4 ± 14.1 mg/dl, P = 0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01–1.96), P = 0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01–1.91), P = 0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48–0.94), P = 0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P = 0.02), hypertriglyceridaemia (43.6% versus 35.6%, P = 0.01), hypertension (64% versus 56.4%, P = 0.01) and ischaemic vascular disease (40.5% versus 30.9%, P = 0.003) than male non-smokers.Conclusion: The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.

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Issues related to passive smoking have recently been addressed in the specialty literature, and they are particularly relevant from two perspectives: the effects on health and implications in the initiation of smoking among youth. The mechanisms by which tobacco smoke is involved in the pathology of heart disease are numerous, and are based not on a single action, but involve multiple factors. The effects of "second-hand" smoking on the cardiovascular system are evident in cardiovascular disease biomarkers seen in nonsmokers and the increased risk of mortality. In 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control (FCTC), which was negotiated under the auspices of the World Health Organization (WHO) and is an evidence-based treaty promulgated with the intent of implementing effective policies for tobacco control. The effects of such policies have been documented in numerous studies. For example, the number of ER patients presenting with acute coronary events (myocardial infarction) has decreased 27-40 % in the U.S., 13 % in Italy, and 17 % in Scotland. The harmful consequences of passive smoking in cardiovascular and other organ systems must be confronted across the medical community. Cardiologists should unite with other specialists to encourage concerted legal action, economic measures, and public education as we work toward the tobacco endgame.