Madalina Adina Coman

School principals are prone to mental health problems due to work demands. During the COVID-19 pandemic, school principals were additionally tasked with managing challenging responsibilities, i.e. implementing hygiene regulations, communicating frequent policy updates, and transitioning to online teaching. This international study aimed to assess school principals’ COVID-19 health literacy (HL) levels as a resource during the pandemic and to examine associations with well-being and psychosomatic complaints. The COVID-19 Health Literacy School Principal Survey was jointly conducted in 11 countries during 2021 and 2022. N = 8644 school or vice principals completed the online survey. Well-being was assessed using the WHO-5 Well-Being Index, psychosomatic complaints with a subscale of the Burnout Assessment Tool and self-reported COVID-19 HL through the HLS-COVID-Q22. HL levels were computed using Rasch analysis. Multiple linear regression analysis was conducted to investigate the association of school principals’ COVID-19 HL with well-being and psychosomatic complaints while controlling for sociodemographic and school-level factors. Overall, 0.1% of school principals had insufficient COVID-19 HL, 3.3% problematic, 65.7% sufficient, and 30.9% excellent. COVID-19 HL significantly predicted well-being and psychosomatic complaints even after controlling for sex, age, position, school type, teaching load, and working hours. Despite the small explained variance, the findings emphasize a need to invest in school principals’ HL as a resource during times of crisis and beyond. Health promotion interventions should be developed to enhance HL and hence health, especially of female and younger school principals, who reported lower well-being and more frequent psychosomatic complaints.

BACKGROUND The internet and Artificial Intelligence (AI)-based tools are increasingly shaping how individuals access and interpret health information. In Romania, nationally representative evidence on health information-seeking behavior remains limited, particularly regarding the use of conversational chatbots. OBJECTIVE This study aimed to characterize health information-seeking (HIS) behavior among adults in Romania by examining overall seeking frequency, the active use of specific information sources, and the adoption of online HIS strategies—including AI-based chatbots— as well as their socio-demographic and health-related determinants. METHODS A cross-sectional national survey was conducted in 2025 among Romanian adults aged 20–65 years using a hybrid design combining computer-assisted web interviewing and tablet-assisted personal interviewing. HIS frequency was measured using the Health Information Seeking Frequency Score (HISFS). Multivariable linear and binary logistic regression models identified predictors of overall seeking frequency, active use of 8 information sources, and use of 5 online strategies (search engines, websites, social media, YouTube, and chatbots). Latent class analysis (LCA) was performed to identify distinct patterns of source use and online strategy adoption. Weighted descriptive and regression analyses were conducted; LCA was conducted without sampling weights. RESULTS We evaluated 1,031 adults. The mean HISFS was 18.9 (SD = 5.7; theoretical range 8–32). Physicians (34.6%) and the internet (31.9%) were the most frequently used sources (reported as “often”), followed by family members (22.4%); all other sources were reported as often by ≤12% of respondents. Among online seekers, Google was used by 79.2%, followed by chatbots (31.2%), websites (29.8%), YouTube (23.9%), and social media (20.2%). Chronic disease burden was the most consistent correlate across behavioral domains and was associated with higher seeking frequency (B = 4.932; 95% CI, 3.378–6.486; P < .001), broader source repertoires, and adoption of most online strategies. Overall, seeking frequency was higher among younger adults, women, and urban residents. Socio-demographic predictors showed channel-specific rather than uniform associations. AI-based chatbots emerged as the most socially patterned online strategy. LCA identified 5 profiles of information source use and 5 profiles of online strategy adoption, ranging from selective to broad, multi-source engagement, including a chatbot-centric class. CONCLUSIONS Health information seeking among Romanian adults is a heterogeneous practice shaped by health need, social position, and access to diverse information channels. Individuals engage in patterned combinations of sources and strategies rather than relying on a single mode. The emergence of chatbot-centric engagement underscores the growing role of AI-based tools, with implications for clinical communication, public health strategies, and digital health governance.

In addition to the infectious disease, the COVID-19 pandemic was accompanied by an infodemic that worsened the outbreak. Increased digital health literacy (DHL) skills and information-seeking behaviors are crucial for accessing, understanding, and evaluating online health information, especially during a pandemic, where misinformation imposes immediate health consequences. This study explores the predictors of DHL among Romanian students and their information-seeking behaviors during the COVID-19 pandemic. Data was collected through a cross-sectional study design over 3 months (December 2020–February 2021) and a self-reported web-based questionnaire from 1,381 university students from Romania assessing DHL and information-seeking behaviors. We used descriptive statistics, Cronbach Alpha coefficients, and univariate and multivariate binary logistic regressions to explore DHL’s predictors in the Romanian sample. Results showed that overall, the study sample had high levels of DHL. However, almost half of the respondents reported having problems assessing whether the information searched related to coronavirus is reliable or not, and 95% shared someone else’s private information online. Age, subjective social status, gender, and chronic diseases were identified as predictors for DHL. Students’ DHL skills need to be strengthened using tailored educational programs and interventions emphasizing the quality, accuracy, and timely provision of online information on official public health platforms. Additional actions include fostering collaborations between educational institutions and public health authorities, alongside developing smartphone applications for real-time guidance on health topics. It is of the utmost importance to address the spread of the infodemic through different strategies, to combat misinformation among university students.

Aim: The aims of this study were to evaluate the demographics and crash profiles of road traffic-related traumatic brain injury (TBI) patients treated at two emergency departments in the Republic of Moldova, and to identify areas for prevention. Materials and methods: A prospective study was conducted using data from the medical records of a pilot TBI registry from the emergency departments of two large hospitals in Moldova. The study sample included patients with TBI related to road traffic mechanisms from March 1 to August 31, 2019. Results: During the study period, 368 patients were included in the TBI registry, with 113 (30.7%) of them having TBIs caused by traffic. Children under the age of 18 (44.2%), people aged 30-49 (18.6%), and males (71.7%) were the largest proportions of the road traffic-related TBI patient population. Most (78.8%) of the TBI injuries occurred in a transportation area (street, road, highway, etc.), among children under age of 18, while walking (36.7%) or riding in a passenger vehicle (68.4%). Pedestrians (42.5%) accounted for the most cases, followed by passengers (33.6%) and drivers (23.9%). Over two-thirds of all cases were tested for alcohol. Most cases were in June (20.4%) and between 2 pm and 6 pm (29.2%) within the research period. Conclusions: This is the first study to examine the road traffic-related traumatic brain injuries in the Republic of Moldova, which underlines the high burden of injuries among males, children, and the middle-aged population. Results from this study will help to support the development of a country’s national TBI registry and can argue for the running of comprehensive measures in road injury prevention targeted to the most affected populations

The Global Burden of Disease Study (GBD) 2019 reveals an increasing prevalence of Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. This study delves into the role of dietary risk factors across different demographic and socioeconomic groups. Utilizing data from the GBD 2019, it analyzes age-adjusted T2DM metrics—death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs)—stratified by age, sex, and region. The study employed Estimated Annual Percentage Changes (EAPCs) to track trends over time. The results show that in 2019, 26.07% of T2DM mortality and 27.08% of T2DM DALYs were attributable to poor diets, particularly those low in fruits and high in red and processed meats. There was a marked increase in both the death rate and DALY rate associated with dietary risks over this period, indicating the significant impact of dietary factors on the global T2DM landscape. Geographic variations in T2DM trends were significant, with regions like Southern Sub-Saharan Africa and Central Asia experiencing the most substantial increases in Age-Standardized Mortality Rate (ASMR) and Age-Standardized DALY Rate (ASDR). A positive correlation was noted between Socio-Demographic Index (SDI) and T2DM burden due to dietary risk factors. The study concludes that targeted public health initiatives promoting dietary changes could substantially reduce the global T2DM burden.

The Global Burden of Disease Study (GBD) 2019 reveals an increasing prevalence of Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. This study delves into the role of dietary risk factors across different demographic and socioeconomic groups. Utilizing data from the GBD 2019, it analyzes age-adjusted T2DM metrics—death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASR)—stratified by age, sex, and region. The study employed Estimated Annual Percentage Changes (EAPCs) to track trends over time. Results show that in 2019, 26.07% of T2DM mortality and 27.08% of T2DM DALYs were attributable to poor diets, particularly those low in fruits and high in red and processed meats. Geographic variations in T2DM trends were significant, with regions like Southern Sub-Saharan Africa and Central Asia experiencing the most substantial increases in Age-Standardized Mortality Rate (ASMR) and Age-Standardized DALY Rate (ASDR). A positive correlation was noted between Socio-Demographic Index (SDI) and T2DM burden due to dietary risk factors. The study concludes that targeted public health initiatives promoting dietary changes could substantially reduce the global T2DM burden.

This study investigates food literacy-related abilities and adherence to dietary recommendations in relation to sociodemographic characteristics and health-related features (health literacy, self-rated health and morbidity) in the North-Western region of Romania. This is a secondary analysis of cross-sectional data collected in 2019 from a representative and randomised sample of 1572 individuals. A questionnaire was employed to record participants’ sociodemographic characteristics, food-related and health-related features. Most participants were non-adherent to dietary recommendations for fruit and vegetables (83.5%), fish and seafood (61.3%), and water intake (67.9%). However, most participants reported an adequate ability to understand the connection between nutrition and health (89.1%), to distinguish between healthy and less healthy options (84.4%), and to acquire nutrition information (75.6%). Non-adherence to dietary recommendations and low food literacy abilities were more prevalent in disadvantaged groups (older age, rural settings, retirement or social welfare, low educational attainment, formerly married). Health literacy was negatively associated with not adhering to dietary recommendations and poor self-rated food literacy abilities. The study suggests that low socioeconomic status negatively impacts food literacy and adherence to dietary recommendations among Romanian adults. Identifying target populations to improve food-related abilities and health literacy can aid public health services in improving health outcomes.