Occupational and Environmental Medicine

• Identify the major sources of occupational and environmental illness in the Cluj region, including within local industry and health care settings.
• Improve detection and prevention of occupational hazards through education, diagnosis and care of affected individuals.
• Improve health and safety conditions on the factory floor by assessing work sites in the Cluj district, and exchanging information on guidelines for occupational and hazard control.
• Safeguard the health of health care workers by improving the health care setting, including development of protocols for safe handling of radioisotopes, chemical hazards and biological hazards.
• Improve techniques of ambient monitoring and patient surveillance.
• Improve techniques for patient care, case management and rehabilitation.

Pulmonary Medicine

• Improve the prevention, diagnosis, treatment and research of respiratory diseases resulting from occupational and environmental factors by increasing levels of competency in specific areas of pulmonary medicine.

Nursing

• Increase role and skills of nurses in the clinical setting and increase interaction between physicians and nurses.

Informatics

• Develop an Internet-based medical surveillance module that will be accessible to all occupational medicine physicians throughout Romania.

• The Cluj-Philadelphia partnership was officially launched at a Memorandum of Understanding signing ceremony held at the Ministry of Health in Bucharest, Romania on October 24.

• Partnership representatives attended AIHA's First Annual CEE Partnership Conference. The conference was held in Budapest, Hungary from May 1 to 3.
• In September, an Information Coordinator from each of the Romanian partnership institutions attended AIHA's first workshop for CEE information coordinator, held in Tallinn, Estonia, as part of AIHA's Learning Resource Center project. AIHA staff presented a training curriculum that included instruction on the use of Internet applications such as Netscape and Eudora, copies of which were distributed at the workshop. The curriculum also covered Web searching and Web page design. During the workshop, information coordinators started creating Web pages for their own institutions. AIHA staff also introduced the Learning Resource Center Project workplan and led "training-of-trainers" group exercises to emphasize the need to make Internet access universally available at their institutions.
• Six Romanian partners participated in the 25th International Congress on Occupational Health held in Stockholm, Sweden from September 15 to 20. This congress, held once every three years, is the largest gathering of occupational health care specialists in the world and drew almost 6,000 participants from more than 100 countries.
• In December, 24 physicians, administrators, and nurses from the three Romanian partnership institutions participated in the first of a two-part series of health management workshops held in Tihuta, Romania, and taught by faculty from the US Association of University Programs in Health Administration and Romanian faculty from AIHA's health management education partnership in Bucharest. The workshop covered topics such as leadership, team building, strategic and financial planning, information management, and human resources. Health professionals from districts outside of Cluj-Napoca also participated, providing a unique opportunity for Romanians from urban and rural areas to discuss common challenges and solutions in health care management. Participants developed managerial projects tailored to their individual professional needs.

• In February, Romanian partners participated in a two-day EPA Environmental Response Training Program (a condensed version of EPA's standard five-day course), specially designed for the Romanians. During the course held in Philadelphia, the group took part in a field exercise that required them to identify and measure hazardous material and utilize proper equipment.
• US and Romanian partners attended AIHA's Second Annual CEE Partnership Conference in Zagreb, Croatia in May. The conference theme was evidence-based medicine.
• In July, Romanian partners participated in a follow-up health management workshop held in Tihuta. Participants received additional management training and gave reports on the implementation and development of their managerial projects.
• A team of ten TJU partners participated in Romania's 9th Congress of Occupational Health and the Annual Scientific Meeting of the Institute of Public Health, held in September. Three TJU partners delivered lectures and participated in round-table discussions on national occupational health programs, hazard pay for factory workers, heavy metals poisoning, and medical surveillance. At the same time, information specialists from TJU presented a two-day interactive workshop for approximately 30 Romanian partners on information technology, with a focus on use of the Internet.
• Also in September, partners held a Conference on Nursing and Occupational and Environmental Hygiene. US and Cluj partner nurses presented lectures on nursing in the acute care setting in the US, industrial nursing, tuberculosis communication in nursing, and professionalism in nursing.

Occupational and Environmental Medicine

• Romanian partners were trained in techniques of occupational risk assessment and management, and air monitoring. They visited a water pollution control plant in Philadelphia and participated in a vendor fair where four occupational health and environmental safety products companies donated synthetic latex gloves (unavailable in Romania), safety goggles, respirator face pieces and particulate filters.
• A new ambulatory service was established in the Clinic for Occupational Diseases. The admittance policy was changed so that after screening tests, the patient is admitted or is treated in the ambulatory service. The Clinic now involves a higher number of nurses and doctors in these ambulatory activities.
• Cigarette smoking was banned from the Clinic for Occupational Diseases.
• Partners at the Clinic reported that the quality of patient care improved as a result of the partnership. Medical staff put more time and effort into educating their patients about their illnesses, its characteristics and treatment.
• The Inspectorate for Public Health reported an increased efficiency in their operations by decreasing the amount of time spent in providing such services as authorizations, bulletins, and medical check-ups.
• The professional relationship between partner institutions and other medical institutions improved with an increased interest in working on collaborative projects. As a result, local institutions established the Transylvanian Occupational Medicine Association aimed at standardizing the working methodology and disseminating results.
• Partners lobbied with the Ministry of Health and the Ministry of Labor and Social Protection in order to stop the payment system related to hazard pay, whereby workers receive additional pay to compensate for working under hazardous conditions.
• The Romanian partners noted improved communication regarding occupational disease between the factories and the policy makers as a result of the partnership.

Pulmonary Medicine

• At the Clinic for Occupational Diseases, a respiratory symptom questionnaire was designed for the pulmonary function testing laboratory that provides bronchi-specific and/or nonspecific hyperactivity.
• The partnership-purchased portable spirometer has had a profound impact on the respiratory function testing of workers conducted at the Institute of Public Health. The testing is reported to be easier and the quality of the procedure improved, and the workload has decreased.
• The Clinic for Occupational Diseases also received a spirometer and pulmonary function test equipment and, as a result, the staff are able to test an increased number of patients, and the Clinic has become the leading respiratory function testing laboratory in the Transylvania region of Romania. For example, 3,200 patients were tested in 1993 and in the first half of 1998, over 2,400 patients had been tested, resulting in a 50% increase in the number of tests performed.
• After being introduced to a standardized treatment of asthma and cardiac deficiency, the Clinic for Occupational Diseases established an allergy center to increase their diagnostic capabilities.

Nursing

• At the Inspectorate of Public Health, a nurse trained through the partnership was designated to coordinate implementation of new concepts of nursing in occupational medicine.
• The Delta Rho chapter of Sigma Theta Tau, the National Honor Society of Nursing inducted one of the Romanian partner nurses as a member in 1998.
• The Romanian partner nurses actively participated in activities of AIHA's CEE Nursing Task Force and made presentations at the annual meetings of the Task Force.
• After the end of the official partnership, AIHA continued to support limited nursing activities, including nursing management workshops and establishment of a Nursing Resource Center which opened in Cluj in May 1999. The Cluj nurses successfully applied for a grant from the Soros Foundation for supplemental support for the Center.

Informatics

• TJU and Romanian partners launched a new Web site featuring two instructional modules: one providing information on medical surveillance and one on medical informatics. The medical surveillance module outlines a step-by-step process for conducting surveillance in the workplace, reporting and analyzing the resulting data, and developing protocols on asbestos and lead exposure. The medical informatics module offers tutorials on evidence-based medicine and MEDLINE, and features two case studies illustrating how to perform on-line searches to help diagnose and treat patients with lead poisoning and respiratory distress. The site also provide links to more than 90 international and government agencies, journals, listservers, clinical practice guidelines and professional associations related to environmental and occupational health. (http://jeffline.tju.edu/CWIS/DEPT/OEM/JOEMP/).
• Each of the three Romanian partner institutions established a Learning Resource Center (LRC) as part of AIHA's LRC Project. Information Coordinators were identified to operate the LRCs and to receive training from AIHA. The Information Coordinators have been active in training their colleagues on using computers and the Internet, in using the Internet to find medical articles related to occupational health issues and establishing databases of medical articles and information accessed on the Internet, and in establishing databases to manage and analyze patient information.

Hospital Management

• Although it was not an explicit goal of the partnership, training in care management and hospital management provided through the partnership program resulted in a reduction of the average length of stay in the Clinic for Occupational Diseases from 13.6 days in 1994 to 10.8 days in 1997. At the Clinic, teams of doctors and nurses were created with the goal of decreasing the average hospital stay. The teams made tests at their place of work, took lab tests, and admitted only the cases that could not be resolved in ambulatory services. This was done in collaboration with the Institute of Public Health and the Inspectorate of Public Health, at their respective institutions.
• Also at the Clinic, hospital administrators applied managerial principles of hiring qualified personnel and dismissing individuals who do not achieve the required performance objectives.
• Based on management training received through the partnership, managers at the Inspectorate of Public Health designated individual staff members to implement new management concepts related to nosocomial infections and to coordinate computer training. Also patients' consumption of drugs in the Clinic for Occupational Diseases is now monitored more closely to reduce cost.