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Description
HE-RO-I, project for investment and development of medical services in Romania for chronic liver diseases, liver cirrhosis and liver cancer, is a pilot project that integrates three major components adapted to the medical needs of our country: rapid response regarding access to medical services-of-the-art for vulnerable groups in Romania, including Roma, long-term access to primary, secondary, tertiary prevention programs, complete diagnosis, monitoring and follow-up for those in need, awareness program for beneficiaries regarding the importance of prevention and continuous medical follow-up.
-Organization in 16 counties included in the project of at least 16 mobile caravans, 1 caravan/county. - Establishing a regional registry for chronic liver diseases and liver cancer.- Establishing a telemedicine system for chronic liver diseases, liver cirrhosis and liver cancer.- Carrying out at least 2 mobilities (experience exchanges) between the two teams of experts (Romania, Iceland) with the aim of professional training of the medical personnel involved in the implementation of the project. The transversal activity involves the exchange of experience and the transfer of knowledge between Iceland and Romania with the aim of good implementation, efficiency and quality improvement of all the activities provided for in the project. The activity will involve continuous Iceland-Romania communication, the organization of regular meetings, the organization of mobilities, the publication in the consortium of at least 5 scientific articles presenting the results of the project. By carrying out the mobilities, the Romanian doctors in the implementation team will benefit from state-of-the-art professional training from the partners in the donor state.
Summary of project results
Chronic liver diseases are defined as a progressive deterioration of liver functions lasting longer than 6 months. In these conditions, the most affected liver functions are the synthesis of coagulation factors, detoxification processes, and, not least, bile excretion. Chronic liver diseases represent a continuous, partially reversible process characterized by inflammation, destruction, and regeneration of the liver parenchyma, which can eventually lead to fibrosis and liver cirrhosis and/or the development of primary liver neoplasms as a consequence of chronic injury.
The spectrum of etiologies for these diseases is broad, including chronic infections with hepatotropic viruses, especially hepatitis B and C viruses, chronic alcohol consumption, metabolic toxins, autoimmune diseases, and genetic disorders. Cirrhosis is the final stage of chronic liver disease, resulting in a global alteration of liver architecture through the formation of micro- and/or macronodules of regeneration, vascular reorganization through neoangiogenesis, and the deposition of an extracellular matrix. The mechanism preceding fibrosis and liver cirrhosis is not yet fully elucidated. Scientific literature indicates that, at the cellular level, hepatic stellate cells and fibroblasts, with fibrogenic roles, are recruited and compete with hepatic stem cells responsible for the continuous regeneration of the liver parenchyma.
Chronic liver disease is a common clinical entity, with a focus on etiopathogenesis, clinical manifestations, and management.
INCIDENCE AND PREVALENCE: According to statistical data, globally, 1.5 billion people suffer from at least one chronic liver disease. Among the most common risk factors are: non-alcoholic fatty liver disease (NAFLD) (60%), hepatitis B virus (HBV) (29%), hepatitis C virus (HCV) (9%), and chronic alcohol consumption (2%) [1]. In Europe, the average prevalence of chronic liver diseases is 833 per 100,000 people, ranging from 447 to 1100. Data regarding the prevalence of cirrhosis in some European countries, especially in disadvantaged regions and countries with limited financial and infrastructural resources, is scarce or even nonexistent; thus, these figures represent only approximate data [2, 3]. Based on official data from the "Global Burden of Disease" study, this is a pathology with an exponentially increasing rate.
The major complications of chronic liver diseases include cirrhosis, with 1.2 million annual deaths, and liver cancer, accounting for 790,000 annual deaths, representing 3.5% of total global deaths [4]. Globally, the incidence of liver cirrhosis in these patients was 20.7 per 100,000 people in 2015, an increase of 13% compared to 2000. The estimated incidence of cirrhosis in Europe is 26.1 per 100,000 people, while in Asia, it varies from 16.5 per 100,000 people in the eastern part of the continent to 23.6 per 100,000 in Southeast Asia [5].
In countries like Japan or Taiwan, implementing national immunization programs against HBV and HAV has led to a decrease in cirrhosis cases. However, in many countries like the USA, which has high rates of obesity, metabolic syndrome, and chronic alcohol abuse, the number of cirrhosis cases remains high [5, 6, 7]. Mortality rates exhibit geographic variability, being lower in East Asia, the Middle East, and the Pacific, and higher in South Asia, the Americas, and Eastern Europe. These disproportionate trends can be explained by differences in implementing national prevention and treatment strategies.
Viral hepatitis remains the leading cause of mortality in chronic liver diseases due to its major complication, cirrhosis. In developed countries with well-defined public health programs, mortality caused by HBV is decreasing due to population immunization and viral hepatitis treatment. Another major risk factor for cirrhosis-related deaths in Europe is chronic alcohol consumption. Mortality rates vary between countries: lower rates are recorded in Austria, Denmark, France, Iceland, Germany, Hungary, while higher rates are observed in Finland, Ireland, the United Kingdom, as well as Eastern European countries, including Romania. Thus, in countries with official registries, national screening programs, vaccination campaigns, and adequate awareness regarding the elimination of risk factors responsible for the onset and progression of chronic liver diseases, the number of cases is significantly decreasing.