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PubMed1994

Ophthalmology in Bulgaria.

Bulgaria faces a marked shortage of ophthalmic resources. There are over 600 ophthalmologists for this Balkan nation of 8.9 million, giving Bulgaria a ratio of ophthalmologists to overall population that is similar to that of the United States; however, less than 20% of these ophthalmologists perform surgery. No formal residency or fellowship training programs exist in the country. Ophthalmic textbooks and journals are written predominantly in Russian and are in short supply. Pharmaceutical supplies are extremely limited. The leading cause of blindness in Bulgaria is cataracts that have not been treated surgically. Most cataracts are removed with intracapsular extraction. However, in the major cities, extracapsular cataract extraction with implantation of intraocular lenses is available.

Blindness↗

PubMedDate not supplied

The importance of quality, access and price to health care consumers in Bulgaria: a self-explicated approach.

One approach to the problem of low patient satisfaction in Bulgaria is to identify attributes of health care services that the consumers value most and to focus on their improvement. Based on data from a household survey, this paper examines the importance that health care consumers attach to quality, access and price. The survey was conducted in 2000 among the population of the region of Varna (the third largest city in Bulgaria). The elicitation of attribute importance was based on a self-explicated method. To analyse the data, an ordered logit regression was performed. The analysis shows that clinical quality is the most valued characteristic by Bulgarian health care consumers compared with social quality, access and price. Given the poor quality of health care provision in Bulgaria, the allocation of revenues to its improvement appears to be essential in order to raise patient satisfaction and to enhance social efficiency.

Bulgaria↗

PubMed2004

Introduction of the QF-PCR analysis for the purposes of prenatal diagnosis in Bulgaria--estimation of applicability of 6 STR markers on chromosomes 21 and 18.

OBJECTIVE: The aim of our study was to estimate the observed heterozygosity and informativeness of 6 STR markers on chromosomes 18 and 21 in the Bulgarian population. We have evaluated the applicability of these markers used from other investigators for QF-PCR prenatal diagnosis of the most common autosomal aneuploidies in Bulgaria. METHODS: DNA samples (n = 486) were extracted from different fetal tissues (amniotic fluid cells, chorionic villus samples, and fetal tissue after abortions). PCR amplifications of 4 STR markers located on chromosome 21 (D21S11, D21S1411, D21S1270, and D21S1440) and 2 on chromosome 18 (D18S535 and D18S51) were performed. They were analysed on an automated sequencer, and the allele dosage ratios were calculated. RESULTS: The results indicate the selected markers as highly informative for our population and suitable for QF-PCR prenatal diagnosis in Bulgaria. All samples with trisomy 21 (n = 8), trisomy 18 (n = 4) and triploidy (n = 1) were correctly detected by our analysis. Thus, no false-negative results were observed. CONCLUSION: QF-PCR analysis could be an applicable alternative in prenatal and postnatal diagnosis in cases with a strong suspicion for particular autosomal aneuploidies (including chromosomes 21, 18, and 13) in small countries with limited resources like Bulgaria.

Aneuploidy↗

PubMed2004

The use of irrigation water in Bulgaria's Plovdiv region during transition.

The amount of water Bulgaria uses for irrigation sharply declined during the transition. Large sections of the existing irrigation systems were abandoned, and those still in use are hardly maintained. Crops such as wheat and barley have replaced more water-intensive crops, such as vegetables, rice, and maize. This problem has an impact on the future development of agriculture and the allocation of the country's water resources. The central argument is that land fragmentation in the wake of decollectivization and restitution contributes to the irrigation systems' abandonment. This article focuses on the institutional factors involved, but also considers additional factors that might have influenced the process. Further, it examines the causes driving these changes and analyzes their effect on irrigation. It is based on a review of the relevant legislation as well as fieldwork in 17 villages located in the Plovdiv region of Bulgaria. The article concludes that institutional settings, in addition to changes in large-scale market forces and the state enforcement mechanism, have contributed to the irrigation decline in Bulgaria.

Agriculture↗

PubMed2006

Occurrence of Giardia and Cryptosporidium in water supplies of Russia and Bulgaria.

The aim of the present study was to investigate water supplies in southern Russia and Bulgaria, in order to estimate the occurrence of Giardia and Cryptosporidium in drinking water resources from these countries. A total of 166 water samples of different origin (surface, tap, bottled, well, spring and waste water) were collected from Rostov (southern Russia), Sofia and Varna (Bulgaria) Greater Areas and screened for the detection of Giardia cysts and Cryptosporidium oocysts. The method incorporated concentration of water samples by filtration and flocculation, sucrose purification, (oo)cyst detection/identification by immunofluorescence test and differential interference contrast. Sixteen out of 166 samples (9.6%) were positive for Giardia and 30 (18.1%) positive for Cryptosporidium. Both Giardia and Cryptosporidium were detected in tap, river, well and waste waters. Giardia cysts were additionally detected in bottled water. Particularly some river, waste and well water samples were highly contaminated with (oo)cysts. This study has shown that drinking water supplies in Russia and Bulgaria are subject to contamination with Giardia and Cryptosporidium, with potential hazards for the public health.

Animals↗

PubMed2004

Characterisation of Trichinella isolates from Bulgaria by molecular typing and cross-breeding.

Trichinella spp. larvae were collected from domestic and wild-life animals in association with 15 human trichinellosis outbreaks registered between 1999-2002 in Bulgaria. Furthermore, Trichinella spp. isolates were obtained from 62 naturally infected wild animals and of a rat. All isolates were subjected to speciation by both multiplex PCR and cross-breeding experiments. Epidemiological and clinical data were collected and analysed using standard protocols for epidemiological surveillance and control of outbreaks. Only two species were identified-Trichinella britovi and Trichinella spiralis. Results obtained by molecular typing fully matched those of cross-breeding. More specifically, parasite isolates obtained upon 15 epidemic outbreaks revealed the predominance of T. britovi (n = 10) when compared to T. spiralis (n = 5). With regard to host origin, the predominant species detected among wild boar was T. britovi (n = 4), and T. spiralis was identified in one wild boar sample only. Among the isolates obtained from domestic pig products, T. britovi was found in five cases and T. spiralis in four cases, respectively. In the naturally infected wild animals not related to epidemics, only T. britovi was demonstrated. The present results provide a strong indication that both T. britovi and T. spiralis operate within domestic and sylvatic cycles in Bulgaria. Geographically, the distribution of T. britovi appears to include Central, Southern, Eastern and Western parts of the country, and wildlife animals from the Mid Balkan Mountains and Mid Sredna Gora Mountains, T. spiralis was found in Western and Southwestern Bulgaria, only.

Animals↗

PubMed1997

Under-the-counter payments for health care: evidence from Bulgaria.

Against a background of falling revenues and increasing expectations, health care systems in central and eastern Europe are facing increasing budgetary gaps. There is extensive anecdotal evidence that these gaps are being filled by informal or 'under-the-table' payments. These are important because of their implications for estimates of future funding requirements, for equity, and for the possible perverse incentives they introduce for those providing and managing health services. There is, however, relatively little information on either their scale or how they are perceived in these countries. We report the results of a small survey from Bulgaria that begins to address these issues. Data were collected by means of an interviewer-administered household survey in which those who had used state-provided health services in the preceding 2 years were identified. The survey took place throughout Bulgaria in 1994. One thousand people were approached and 706 (70.6%) provided information suitable for analysis; 42.9% had paid for services that were officially free. Payments had been for a wide range of services and to differing groups, including medical, nursing and ancillary staff. Payments to individuals during consultations were between 3% and 14% of average monthly income but the average cost of an operation was 83% of mean monthly income. There were large differences in the amounts paid by individuals. Most people were in favour of both official user fees and health care reform, except among the old, the poor, and those in poor health. Despite certain limitations, this study gives some indication of the scale of informal payments in Bulgaria. Several possibilities exist to address them. Contrary to what is often argued, there seems to be a popular willingness for them to be converted into formal co-payments. Before this can be done, there is a need for more research on the impact that this would have on equity and affordability.

Attitude to Health↗

PubMed2004

Reforming health care financing in Bulgaria: the population perspective.

Health financing reform in Bulgaria has been characterised by lack of political consensus on reform direction, economic shocks, and, since 1998, steps towards social insurance. As in other eastern European countries, the reform has been driven by an imperative to embrace new ideas modelled on systems elsewhere, but with little attention to whether these reflect popular values. This study explores underlying values, such as views on the role of the state and solidarity, attitudes to, and understanding of compulsory and voluntary insurance, and co-payments. The study identifies general principles (equity, transparency) considered important by the population and practical aspects of implementation of reform. Data were obtained from a representative survey (n=1547) and from 58 in-depth interviews and 6 focus groups with users and health professionals, conducted in 1997 before the actual reform of the health financing system in Bulgaria. A majority supports significant state involvement in health care financing, ranging from providing safety net for the poor, through co-subsidising or regulating the social insurance system, to providing state-financed universal free care (half of all respondents). Collectivist values in Bulgaria remain strong, with support for free access to services regardless of income, age, or health status and progressive funding. There is strong support (especially among the well off) for a social insurance system based on the principle of solidarity and accountability rather than the former tax-based model. The preferred health insurance fund was autonomous, state regulated, financing only health care, and offering optional membership. Voluntary insurance and, less so, co-payments were acceptable if limited to selected services and better off groups. In conclusion, a health financing system under public control that fits well with values and population preferences is likely to improve compliance and be more sustainable. Universal health insurance appears to attract most support, but a broader public debate involving less empowered people is needed to resolve misunderstandings and create realistic expectations.

Adult↗

PubMed2003

Childhood bacterial meningitis in Bulgaria: a population-based retrospective study in six regions during 1992-96.

OBJECTIVES: We conducted a study to provide information on the importance of bacterial pathogens causing childhood meningitis in Bulgaria. METHODS: A 5-year population-based retrospective survey for bacterial meningitis in children <5 years of age was performed at all hospitals in the six largest regions of Bulgaria. RESULTS: There were 297 cases of meningitis reported, of which 211 (71.0%) were classified as bacterial in origin. The most common causes were Neisseria meningitidis (49 cases) and Haemophilus influenzae type b (Hib) (44 cases), accounting for 36% and 32% of etiologically confirmed cases. Thirty-one cases (70.5%) of Hib meningitis occurred in children <2 years of age, and 26 (59.1%) occurred in children 6-23 months of age. Average annual incidence rates of Hib meningitis based on the population of children <5 years of age for each region ranged from 1.3 to 9.8 per 100,000 (mean 5.9/100,000). CONCLUSION: The estimated incidence rates from this study were similar to those reported from southern European and Mediterranean countries. Further studies are planned to provide information on appropriate strategies for preventing childhood meningitis in Bulgaria.

Bulgaria↗

PubMed2000

Epidemiology of pemphigus in Sofia, Bulgaria. A 16-year retrospective study (1980-1995).

BACKGROUND: Pemphigus is a disease showing an uneven geographical distribution. In Bulgaria pemphigus has always represented a substantial part of diagnosed bullous diseases, but previous epidemiological data are incomplete. Our purpose was to evaluate retrospectively the incidence and prevalence of pemphigus in the district of Sofia (the capital of Bulgaria; population 1 200 000) for a sixteen-year period. METHODS: The files of all the newly registered patients with pemphigus in the City Hospital of Dermatology in Sofia during the period Jan 1 1980 to Dec 31 1995, were collected and analysed with regard to personal statistics, ethnic origin, profession, history of the disease including age and season of onset, symptoms, clinical diagnosis, severity, laboratory findings, associated illnesses, therapy, and cure rate. Special attention was paid to smoking, alcohol abuse, and the presence of triggering factors such as emotional stress, drug intake, underlying diseases, neoplasias, or others. RESULTS: During the 16-year period studied, 74 newly diagnosed cases of pemphigus occurred in the district of Sofia, giving a prevalence of 0.38 per 100 000 inhabitants and a mean incidence of 0.47/100 000/year for the overall population and 0.51/100 000/year for the population aged above 20 years. The most common clinical variant is pemphigus vulgaris, frequently occurring in the fifth-sixth decades. The vast majority of the patients are workers or professionals. CONCLUSIONS: The results of the present retrospective study reveal a relatively high prevalence and incidence of pemphigus in Bulgaria, compared to that encountered in other countries. Our data is similar to that reported from Greece. Whether the Balkan Peninsula represents a focus of population groups with high susceptibility to pemphigus is a problem which could be highlighted by further epidemiological studies in this geographic area.

Adult↗

PubMed2002

Emergency health services in Bulgaria.

The emergency care system in Bulgaria is evolving as a hybrid of the former "Soviet-style" health service and western-style emergency medicine. Bulgaria like other "Eastern bloc" Communist nations has undergone a sweeping socioeconomic transformation during the past 10 years. These changes have had profound consequences including the development of emergency services and the recognition of emergency medicine as a specialty in Bulgaria.

Bulgaria↗

PubMedDate not supplied

Patterns of alcohol consumption in Bulgaria.

Alcohol is increasingly being recognized as a major cause of the greater burden of disease and premature death in eastern Europe than in the west. This requires a robust policy response but, in most countries in the region, there is little empirical data on patterns of consumption on which to base such a response. Until now, there has been no information on prevalence of drinking among the Bulgarian population. This paper describes a survey that seeks to address this weakness by describing the pattern of drinking in Bulgaria and its relationship with socio-demographic factors. It uses a multivariate analysis of data on patterns of alcohol consumption from a multi-stage nationwide survey of 1550 adults in Bulgaria, in 1997 which found that overall 50.7% of men and 13.6% of women drink at least weekly. In both sexes, drinking is least common among the elderly and those living in villages. It is also less common among those reporting their financial status as poor. Muslims are less likely to drink than are orthodox Christians. Drinking is most common among those living in cities, with higher education and high incomes. Heavy drinking, defined as 80 g/day or more, is rare among women, but is ascribed to 18.2% of men. Heavy drinking was much more common among men living in Sofia and was less common among those whose financial situation was poor. At the levels of drinking reported, it can be expected that alcohol is making a substantial contribution to the burden of disease and premature mortality in Bulgaria. A coordinated, effective policy response is required. Although some of the legal prerequisites are in place, they are poorly enforced and there is no overall strategy to address this issue.

Adolescent↗

PubMedDate not supplied

A study on the current situation in the biomedical technology and clinical engineering sector in Bulgaria--advances, trends and needs.

A survey of the clinical engineering sector in Bulgaria was carried out, within the context of the 1996 Phare Partnership Program, with the aim to provide a reflection of the current situation concerning the management of biomedical technology and investigate the relevant needs in hospitals. The survey was initiated by the Institute of Biomedical Technology (INBIT) in Patras, Greece, with the active support of national organizations, educational institutions and other parties that share involvement in the overall management of medical devices in Bulgaria. This paper summarizes the results of the survey, giving an insight into the situation in the field and providing the basis for a more thorough study on the Biomedical Technology and Clinical Engineering sectors in Bulgaria.

Biomedical Engineering↗

PubMed2006

Spatial and temporal distribution of bluetongue and its Culicoides vectors in Bulgaria.

Surveillance of Culicoides (Diptera: Ceratopogonidae) biting midges was carried out between 2001 and 2003, at 119 sites within a 50 x 50-km grid distributed across Bulgaria, using light trap collections around the time of peak adult midge abundance. Sentinel and ad hoc serum surveillance of hosts susceptible to bluetongue infection was carried out at around 300 sites between 1999 and 2003. Following the initial incursion of bluetongue virus 9 (BTV-9) into Bourgas province in 1999, affecting 85 villages along the southern border, a further 76 villages were affected along the western border in 2001, with outbreaks extending as far north as 43.6 degrees N. The BTV-9 strain in circulation was found to have a low pathogenicity for Bulgarian sheep populations, with less than 2% of susceptible individuals becoming sick and seroconversions detected up to 30 km from recorded outbreaks in the south. The major Old World vector Culicoides imicola Kieffer was not detected among over 70,000 Culicoides identified in summer collections, suggesting that BTV-9 transmission in Bulgaria was primarily carried out by indigenous European vectors. The most likely candidates, the Palaearctic species complexes - the Culicoides obsoletus Meigen and C. pulicaris L. complexes - were widespread and abundant across the whole country. The C. obsoletus complex represented 75% of all individuals trapped in summer and occurred in high catch sizes (up to 15,000 individuals per night) but was not found across all outbreak sites, indicating that both Palearctic complexes probably played a role in transmission. Within the C. pulicaris complex, only C. pulicaris s.s., C. punctatus Meigen and C. newsteadi Austen were sufficiently abundant and prevalent to have been widely involved in transmission, whilst within the C. obsoletus complex most trapped males were C. obsoletus s.s. Adult vectors were found to be largely absent from sites in west Bulgaria for a period of at least 3 months over winter, which, taken along with the spatiotemporal pattern of outbreaks in the region between years, indicates the virus may be overwintering here by an alternative mechanism - either by covert persistence in the vertebrate host or possibly by persistence in larval stages of the vector.

Animals↗

PubMed1995

The story of a 'maverick': Bulgaria's fertility decline.

Analysis of the fertility decline in Bulgaria shows that the perception of Bulgaria as an 'anomaly' in terms of its demographic development is based on a conservative interpretatiion of the demographic transition theory. The features that distinguish Bulgaria from the western European countries (faster decline, persistence of early and universal marriages, etc.) are generally accounted for by the specific social, economic, cultural, and political conditions. These findings suggest that the speed of the fertility decline and the means through which it is achieved are affected by a complex interaction between cultural and economic factors that are often difficult to distinguish in terms of primacy.

Bulgaria↗

PubMed1999

Cancer incidence in Republic of Bulgaria aircrew, 1964-1994.

BACKGROUND: This study includes all cases of cancer among Republic of Bulgaria Air Force and civil aviation aircrew. Cancer incidence, Standardized Incidence Ratios (SIRs) and 95% confidential intervals were calculated for the pilots, using data about cancer incidence in the same age groups of the male population of the Republic of Bulgaria for the same period of time, taken from the National Cancer Register. RESULTS: The results show a considerable difference in the structure of cancer among males in Bulgaria, as compared to male pilots (r<0.0001). While cancer of the respiratory system has the greatest incidence among the civil population, cancer of the bladder has the greatest incidence among pilots, followed by testicular and skin cancer. For the period under consideration there is a lower risk of malignant diseases in pilots as compared to the rest of the population. There is a higher risk of testicular cancer only in civil aviation pilots. For Air Force aircrew there is a 10-fold higher risk of bladder cancer as compared to the rest of the population. CONCLUSION: We established an interdependence between age and cancer incidence, cancer incidence being higher among pilots in the age group from 20-40 yr. For the remaining age groups, cancer incidence among the civil population is approximately 2.5 times higher. Of the pilots with cancer, 73.53% returned to a flying career after an average of 7 mo treatment.

Adult↗

PubMed1999

Antibacterials: spontaneous report analysis for a six years period in Bulgaria.

The pharmacovigilance started in Bulgaria in 1975. The doctors had to send the filled so called "yellow cards" for the suspected Adverse Drug Reactions to the Centre for Drug Safety at the National Drug Institute. In Bulgaria a spontaneous reporting on the adverse drug reactions has been studied during the period 1991-1996 for Antibacterials. The total number of the reports was 2409 and 18% of this number related to the Antibacterials. The reporting rate varied from 0.3 to 1.8 per 100,000 inhabitancy. As a whole 29% of the adverse drug reaction reports concerned the patients in the age groups of 0-5 year old. Amoxicillin is a drug with a majority of reports for the period. This article reveals the limits of the operating spontaneous reporting system in Bulgaria and suggests some possible measures to improve and refine it in a connection to the WHO and EMEA requirements.

Adverse Drug Reaction Reporting Systems↗

PubMed1999

Ancient evidence for the origin and early development of chronobiology and biometeorology in Bulgaria.

Chronobiology and biometeorology have developed since ancient times of world history (China, Greece, etc.). Different authors have studied the origin and early development of medicine and related sciences in Bulgaria (Apostolov et al 1982, Georgiev 1987, etc.). They have reported that early medical postulates have incorporated the notion of temporal patterns of health and disease and their dependence on the environment. However, these authors have neither emphasized the above relationships nor considered them possible origins of both chronobiology and biometeorology in Bulgaria. The aim was to present evidence for the possible origin and early development of chronobiological and biometeorological perceptions in ancient Bulgaria. Different sources from ancient Bulgarian history were searched and analyzed. Ancient sources from Bulgarian history, relevant to the aim of this study, were reviewed. The evidence on chronobiological and biometeorological understandings in ancient times was obtained from the "Protobulgarian Calendar", Preslav's Rosette, etc. Here, only the most important of Protobulgarian, Thracian and Slavonic sources were presented. It was concluded that chronobiology and biometeorology had also their origin and early development in ancient Bulgarian times.

Bulgaria↗