Teodora Piroș

Background: Biostatistical competence is essential to evidence-based clinical reasoning, yet biostatistics is often taught as a stand-alone course. This scoping review mapped how biostatistics is taught and assessed in medical and health professions education and when learning outcomes are measured relative to instruction. Methods: Following JBI methodology and PRISMA-ScR, we searched PubMed, Web of Science, and Scopus for English-language studies published from 2015 onward (final search 2 October 2026) and charted instructional approaches, digital tools, assessment instruments, and the timing of outcome measurement. Results: Eighty-six studies were included, with 45 of them in medicine. Non-randomized controlled (21) and cross-sectional (20) designs predominated, and most studies measured end-of-course performance, perceptions, or attitudes with locally developed instruments. Of 15 controlled digital versus non-digital comparisons, 7 reported results favoring the digital format, and 6 reported no statistically significant difference. These comparisons were not critically appraised. Nine studies measured an outcome after instruction ended, mostly within three months. Only four reassessed the same learners, and no study followed learners into clinical practice. Conclusions: Biostatistics is taught and examined extensively, but the included studies rarely measured retention, and none assessed application in clinical practice. Validated measures of applied statistical reasoning and longitudinal designs are needed.

Background/Objectives: Psychosocial difficulties during the menopausal transition, including impaired self-esteem, perceived isolation, and perceived need for support, remain insufficiently characterized in Eastern European populations. This study estimated their prevalence among Romanian midlife women and examined their associations with demographic factors and symptom burden. Methods: This cross-sectional secondary analysis included 306 women aged 45–65 years (65 perimenopausal, 40 recent menopause, and 201 long-standing menopause), recruited voluntarily through an online questionnaire. Participants completed the 44-item Multidimensional Menopausal Burden Questionnaire and three single-item psychosocial questions. Primary analyses used ordinal and binary logistic regression; symptom clustering, mediation, receiver operating characteristic (ROC) analysis, and multinomial regression were exploratory. Results: Menopause-related self-esteem impairment was reported by 45.9% of women, perceived isolation by 47.1%, and a need for external support by 44.1%; 77.6% of women reporting a need did not report having received support, and 41.0% of them stated that they had not sought it. Psychological symptom burden was consistently associated with all three outcomes (adjusted odds ratios 1.18–1.21 per point). Long-standing menopause was associated with self-esteem impairment (OR 2.18, 95% CI 1.01–4.71), although the confidence interval included the null after multiple imputation (OR 2.10, 95% CI 0.99–4.46). In exploratory analyses, a somatic–oral–psychological symptom-burden cluster (21% of participants) showed the highest frequencies of self-esteem impairment (78%) and of need without support received (58%), and a PSY-9 threshold of ≥11 discriminated perceived support need (AUC 0.82; optimism-corrected sensitivity 0.67 and specificity 0.81). Conclusions: Psychosocial difficulties and perceived support needs were common in this voluntary sample and were closely associated with psychological symptom burden. Because the support item did not record help-seeking or access, the gap between perceived need and support received should not be read as evidence of service barriers. The symptom-burden clusters and the PSY-9 threshold are exploratory and require external validation before any clinical use.

Background/Objectives: Rabeprazole differs from other proton pump inhibitors (PPIs) in its activation and lower dependence on CYP2C19. We compared its System Organ Class (SOC)-level reporting profile with those of esomeprazole, pantoprazole, omeprazole and lansoprazole in EudraVigilance individual case safety reports (ICSRs). Methods: Aggregated ICSR counts were retrieved from adrreports.eu (data lock point 4 October 2026). Rabeprazole was compared head-to-head with each comparator using reporting odds ratios (RORs) with 95% confidence intervals across 27 MedDRA SOCs, with Benjamini–Hochberg false discovery rate control over all 108 tests. Bonferroni correction and serious-only analyses were sensitivity analyses; female-only and male-only analyses were exploratory. Results: Of 232,045 ICSRs, 7960 involved rabeprazole. Hepatobiliary disorders were the only SOC reported more often with rabeprazole than with all four comparators (ROR 1.29–1.96); the excess met the Bonferroni threshold and persisted among serious reports (ROR 1.19–1.97) and in both sexes. Skin and subcutaneous tissue disorders were reported more often than with three comparators and, among serious reports, than with all four (ROR 1.14–1.83). Eight SOCs showed consistently lower reporting odds, alongside fewer SOCs per rabeprazole ICSR and a different reporter mix. Conclusions: Rabeprazole showed a consistent hepatobiliary reporting signal within the PPI class, in line with earlier FAERS findings. This is a reporting signal, not a clinical signal: without exposure data, the results describe relative reporting, not incidence, comparative risk or causality, and lower reporting odds do not imply lower clinical risk.

Background/Objectives: Medication-associated xerostomia is a clinically relevant adverse effect, but its contribution to oral symptom burden in midlife women remains insufficiently characterized. This study investigated the association between xerogenic medication exposure and xerostomia burden across the menopausal transition and whether this association extended to broader oral symptoms. Methods: This cross-sectional study included 306 Romanian women aged 45–65 years. Medication exposure was assessed in two complementary ways: a medication-list-derived definition, in which reported medicines were coded into therapeutic classes with recognized xerogenic potential (n = 54; 17.6%), regarded as the pharmacological reference measure, and participant-reported use of medication potentially associated with dry mouth (n = 39; 12.7%), which additionally reflects patient recognition of xerogenic exposure. Outcomes were a six-item xerostomia symptom score (XSS-6; 0–18) and a nine-item oral symptom score (OSS-9; 0–27), both derived from the MMBQ-44. Associations were evaluated using two-part models adjusted for age, menopausal stage, body mass index, smoking, medication burden, and psychological symptom burden, with complementary sensitivity analyses. Results: Xerostomia symptoms were more frequent among women reporting xerogenic medication (94.9% vs. 71.5%; unadjusted OR 7.36, 95% CI 1.73–31.30), and participant-reported exposure remained associated with greater XSS-6 severity after full adjustment (+1.28 points, 95% CI 0.22–2.34). With the medication-list-derived definition, unadjusted associations were present (rate ratio 1.50, 95% CI 1.08–2.10) but attenuated to near-null estimates after full adjustment (severity difference 0.06 points; rate ratio 1.17, 95% CI 0.79–1.71). Psychological symptom burden was independently associated with both outcomes, and no independent association with OSS-9 was observed for either exposure definition. Agreement between definitions was moderate (85.3%; Cohen kappa 0.43); only 24/54 (44.4%) women identified from medication lists recognized taking medication capable of causing dry mouth. Conclusions: Pharmacologically defined xerogenic exposure showed weak independent associations with xerostomia burden after full adjustment, whereas the stronger associations observed for participant-recognized exposure may partly reflect symptom-driven awareness and should be read as an upper bound. Limited recognition of xerogenic exposure points to a medication-safety communication gap. Prospective studies with verified medication exposure, dose and duration data, and objective salivary measurements are needed to clarify causality.

Oxidative stress contributes substantially to skin aging, while antioxidant-based cosmetics and nutrition-oriented “skin-from-within” strategies are increasingly popular among young adults. However, no validated Romanian instrument integrates antioxidant-related knowledge, attitudes, nutrition/lifestyle behaviors, and cosmetic-use intentions. This study developed the 61-item Romanian Antioxidant Cosmetics and Nutrition Questionnaire (RO-ACNQ), including a 36-item psychometric core covering four hypothesized domains: Knowledge, Attitudes, Behavioral Intention, and Nutrition/Lifestyle. Initial psychometric evaluation used a unified dataset (N = 1013) comprising a reproducible synthetic multicenter benchmark (n = 957) and an observed pilot sample (n = 56). Exploratory factor analysis (KMO = 0.943) identified eight weak or structurally inconsistent items, yielding a refined 28-item, four-factor model with acceptable-to-good internal consistency (α = 0.70–0.89) and good fit in an internal, same-sample CFA evaluation (χ²/df = 1.43, CFI = 0.984, TLI = 0.982, RMSEA = 0.021, SRMR = 0.033). Discriminant validity was generally supported (HTMT ≤ 0.74), although convergent validity remained partial. Within the simulation-based benchmark, theoretically expected known-groups patterns, high synthetic test–retest stability (ICC ≥ 0.97), and a Knowledge → Attitudes → Intention pathway were reproduced. Importantly, the refined domains showed encouraging internal consistency in the observed participants (α = 0.78–0.89; total α = 0.91), while differences between observed and synthetic response distributions identified areas requiring further calibration. These findings support the RO-ACNQ as a promising candidate instrument and establish a refined 28-item structure for prospective multicenter validation in participant-derived data.

Background/Objectives: Bakery and confectionery products reformulated with alternative ingredients are increasingly present in the retail food environment, but their contribution to healthier diets depends on whether consumers eat them. This study examined how health consciousness and perceived nutritional value relate to the recent consumption of such products among Romanian consumers, whether food neophobia weakens these associations, and whether consumption differs across dietary patterns. Methods: A cross-sectional online survey of 504 consumers (February to April 2026) measured health consciousness, perceived nutritional value, health and natural-content food choice motives, food neophobia and 30-day consumption on five-point scales. Regression-based mediation and moderated mediation with 5000 bootstrap resamples and Kruskal-Wallis tests were adjusted for age group, sex and education. Results: The scales were reliable (alpha 0.77 to 0.94) and the measurement model fitted acceptably (CFI = 0.968; SRMR = 0.039). Health consciousness partially mediated the association between motives and perceived nutritional value (indirect effect 0.14, 95% CI 0.04 to 0.24). Perceived nutritional value fully mediated the association between health consciousness and consumption (indirect effect 0.17, 95% CI 0.11 to 0.23; direct effect 0.04). The neophobic and neophilic items formed two uncorrelated facets: neophobia lowered consumption directly (β= -0.18) without moderating the mediated path (index of moderated mediation 0.04, 95% CI -0.01 to 0.08), whereas openness to new foods raised it (β = 0.21). Consumption did not differ across dietary patterns (p = 0.130) but declined with age. Conclusions: Perceived nutritional value is the channel through which health orientations reach the consumption of reformulated bakery products. Food neophobia is an additive barrier rather than a condition on that channel, so credible nutritional information and familiar product formats are complementary levers for widening uptake.

Background/Objectives: The transition toward healthier and more sustainable diets has increased the need for reformulated bakery and confectionery products formulated with alternative ingredients. However, validated instruments for assessing consumer acceptance of these products remain limited. This study aimed to develop and psychometrically validate a multidimensional assessment framework integrating food choice motives, green (environmental) values, health consciousness, perceived nutritional value, willingness to pay a premium, and purchase intention. Methods: A cross-sectional survey was conducted among 504 consumers in Romania using an online questionnaire. The instrument was developed by adapting established scales and by developing a new Perceived Nutritional Value scale. Dimensionality was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses. Temporal stability was assessed in an independent test–retest subsample (n = 30; 14-day interval), and the proposed conceptual model was evaluated using Partial Least Squares Structural Equation Modeling (PLS-SEM) with 5000 bootstrap resamples. Robustness was examined through a sensitivity analysis excluding respondents younger than 18 years (N = 441). Results: EFA (KMO = 0.933) and CFA (CFI = 0.965, TLI = 0.959, RMSEA = 0.061, SRMR = 0.033) supported the proposed six-factor structure. All constructs demonstrated excellent internal consistency (Cronbach’s α: 0.898–0.938), convergent validity (AVE: 0.790–0.889), discriminant validity (HTMT < 0.77), and good-to-excellent test–retest reliability (ICC: 0.82–0.91). Perceived nutritional value was positively and significantly associated with both willingness to pay and purchase intention, and willingness to pay partially mediated the association between perceived nutritional value and purchase intention. The structural model explained 46.1% of the variance in purchase intention; all hypothesized relationships were supported, and the findings remained stable in the sensitivity analysis. Conclusions: The proposed framework demonstrated good psychometric performance and provides a theory-informed measurement framework for assessing consumer acceptance of reformulated bakery and confectionery products. It may support future nutrition research, consumer studies, and the evaluation of food reformulation strategies aimed at promoting healthier and more sustainable dietary choices.

Background/Objectives: Current menopause assessment instruments primarily evaluate vasomotor, somatic, and urogenital symptoms, with limited attention to oral, sensory, and integrated psychological domains. Evidence that oral tissues are estrogen-responsive suggests that oral symptoms may represent an important but underrecognized component of menopausal burden. This study aimed to develop and provide initial psychometric validation of the Multidimensional Menopausal Burden Questionnaire (MMBQ-44), a 44-item instrument integrating systemic, oral, and psychological symptoms. Methods: A cross-sectional validation study was conducted in 308 women aged 45–65 years (perimenopausal n = 66, menopausal n = 40, postmenopausal n = 202). The MMBQ-44 combined items from the Menopause Rating Scale (MRS), Xerostomia Inventory (XI), Oral Health Impact Profile-14 (OHIP-14), and psychological measures derived from the PHQ-9, GAD-7, and HADS. Instrument development included expert review, cognitive interviewing, and field testing. Psychometric evaluation assessed item performance, internal consistency, factor structure, discriminant validity, and known-groups validity. Exploratory factor analysis used principal axis factoring with promax rotation, with factor retention determined by parallel analysis. Results: Internal consistency was good to excellent across domains (Cronbach’s α: 0.813–0.941; McDonald’s ω: 0.864–0.953). All corrected item–total correlations exceeded 0.30. The questionnaire showed strong factorability (KMO = 0.931; Bartlett’s χ² = 9006.2, p < 0.001). Parallel analysis identified four factors explaining 48.6% of total variance. Psychological and OHIP domains emerged clearly, whereas several MRS and XI items cross-loaded onto related factors. Most HTMT ratios were below 0.85, supporting discriminant validity. Floor effects were observed for OHIP (37.0%) and XI (23.4%). Known-groups validity was modest, with OHIP scores differing significantly across menopausal stages. Conclusions: The MMBQ-44 demonstrates strong reliability and acceptable construct validity as an integrative screening instrument for menopausal burden. Further confirmatory studies and refinement of oral symptom items are warranted.

Background/Objectives: Convenience-oriented dietary behaviors acquired during the transition to university life may be associated with overweight and obesity status in young adults. This study aimed to characterize the dietary behaviors of Romanian university students and to evaluate their associations with overweight and obesity. Methods: This cross-sectional study included 921 university students aged 18–24 years (60.6% female; 67.8% urban residents). Self-reported dietary variables included fast-food consumption, sweets intake, fruit and vegetable intake, water intake, and replacement of meals with desserts. BMI categories were classified according to WHO criteria. Associations were evaluated using chi-square tests, Cramer’s V, and multivariable logistic regression adjusted for sex, age group, and residence environment. A five-item Dietary Risk Score (DRS; range 0–5) was constructed as an exploratory composite indicator of cumulative dietary behavioral burden. Cluster analysis was additionally performed to identify dietary behavioral phenotypes. Results: A total of 24.1% of participants were classified as overweight/obese, including 19.4% overweight and 4.7% obesity. Frequent replacement of meals with desserts (aOR 7.20; 95% CI 4.26–12.17) and fast-food consumption ≥3 times/week (aOR 1.98; 95% CI 1.26–3.10) were independently associated with overweight/obesity after adjustment for demographic variables. Male sex, older age, and urban residence were also independently associated with overweight/obesity. Distinct dietary behavioral phenotypes were identified, including a convenience-oriented cluster characterized by higher fast-food and sweets intake and the highest prevalence of overweight/obesity. The DRS demonstrated a dose–response relationship with overweight/obesity prevalence, increasing from 19.8% at DRS = 0 to 50.0% at DRS = 4, with an adjusted OR of 1.43 per one-point increase (95% CI 1.23–1.66; p < 0.001). Conclusions: Frequent meal replacement with desserts, higher fast-food consumption, and greater cumulative dietary behavioral burden were associated with overweight and obesity status among Romanian university students. The findings support the relevance of evaluating cumulative dietary behavioral patterns in young adults; however, the cross-sectional design precludes conclusions regarding causality or temporal directionality.

Background: The transition to university life is characterized by substantial changes in eating behaviors, sleep–wake organization, and lifestyle patterns. Chrononutrition-related behaviors, including meal timing and caloric distribution across the day, may influence metabolic health independently of dietary quantity, yet prospective evidence in university students remains limited. This study aimed to evaluate BMI trajectories during the first academic year and to identify chrononutrition-related behaviors associated with BMI change and clinically significant weight gain in young adults. Methods: This prospective observational study included 921 university students aged 18–24 years. BMI was assessed at university entry and after one academic year, and BMI change (Diff_BMI) was calculated. Chrononutrition-related variables included meal frequency, identity of the main meal, breakfast habits, and late eating. Multivariable linear and logistic regression models were used to evaluate independent associations between chrononutrition-related behaviors, BMI change, and clinically significant weight gain (Diff_BMI > +1 kg/m²). Results: Mean Diff_BMI was −0.45 ± 1.07 kg/m² (95% CI −0.52 to −0.38; p < 0.001). Overall, 48.2% of participants showed BMI reduction, 38.7% remained weight-stable, and 13.1% experienced BMI increases; clinically significant weight gain occurred in 7.2% of the cohort. In multivariable analysis, having dinner as the main meal (vs. lunch) was independently associated with greater BMI gain (β = +0.22 kg/m²; p = 0.004). Male sex was associated with lower BMI gain and lower odds of clinically significant weight increase. Breakfast skipping showed an inverse association with BMI change, whereas meal frequency and late eating were not independently associated with BMI trajectory after adjustment. Conclusions: The temporal distribution of caloric intake, particularly late eating patterns and shifting the principal meal toward later hours of the day, appears more strongly associated with BMI trajectory during the transition to university life than meal frequency alone. These findings support the relevance of chrononutrition-oriented strategies targeting meal timing and circadian eating behaviors in university students.