Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “BULGARIA”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2002

Understanding informal payments for health care: the example of Bulgaria.

INTRODUCTION: Throughout the 1990s, in response to funding deficits, out-of-pocket payment has grown as a share of total expenditure in countries in transition. A clear policy response to informal payments is, however, lacking. The current study explores informal payments in Bulgaria within a conceptual framework developed by triangulating information using a variety of methodologies. OBJECTIVE: To estimate the scale and determinants of informal payments in the health sector of Bulgaria and to identify who benefits, the characteristics and timing of payments, and the reasons for paying. DESIGN: Data were derived from a national representative survey of 1547 individuals complemented by in-depth interviews and focus groups with over 100 respondents, conducted in Bulgaria in 1997. Informal payments are defined as a monetary or in-kind transaction between a patient and a staff member for services that are officially free of charge in the state sector. RESULTS: Informal payments are relatively common in Bulgaria, especially if in the form of gifts. Informal cash payments are universal for operations and childbirth, clear-cut and life-threatening procedures, in hospitals or elite urban facilities or well-known physicians. Most gifts were given at the end of treatment and most cash payments-before or during treatment. Wealthier, better educated, younger respondents tend to pay more often, as a means of obtaining better-quality treatment in a de facto two-tier system. Since the transition, informal payments had become frequent, explicit, solicited by staff, increasingly in cash, and less affordable. Informal payments stem from the low income of staff, patients seeking better treatment; acute funding shortages; and from tradition. Attitudes to informal payments range from strongly negative (if solicited) to tolerant (if patient-initiated), depending on the circumstances. CONCLUSIONS: The study provides important new insights into the incidence and nature of informal payments in the health sector in Bulgaria. Payments were less than expected, very complex, organised in a chaotic, although adaptive, system, and relatively equitable. The timing of payment and the presence of compulsion is a key factor in distinguishing between informal payments given in gratitude or as a bribe, and the latter are seen as problematic, needing to be addressed. Paying informally appeared to be a product of socio-economic reality rather than culture and tradition. The study showed that the principle of comprehensive free coverage existing in Bulgaria until 1989 has been significantly eroded. Initiating a public debate on informal payments is important in a health care reform process that purports to increase accountability.

Bulgaria↗
PubMedDate not supplied

Terrorism in Bulgaria.

The Republic of Bulgaria is one of the smallest countries in southeastern Europe and has little experience with terrorist acts. During the past 20 years, only nine terrorism-related events have been recorded in Bulgaria, and no unconventional weapons have been used. Factors contributing to terrorism in Bulgaria have been: (1) Communist Party domination of the government and political process from 1944 to 1989; (2) ethnic and religious conflicts between the Bulgarian Orthodox Christian majority and the Turkish Muslim minority from 1983 to 1987; and (3) the relatively high level of organized crime after the Communist regime ended in 1990. The structure and function of the Disaster Relief System in Bulgaria not only are focused on the prevention of terrorism, but also on preparedness for the emergency response to terrorism-related events. Institutional components of the Disaster Relief System structure responsible for the emergency response to terrorism-related events include: (1) the Government of Bulgaria; (2) the State Agency for Civil Protection with 28 regional directorates; (3) the Ministry of Health with five national hospitals, 28 regional hospitals, and 28 EMS systems; (4) the Ministry of Defense with special military units for response to unconventional terrorist events, including nuclear, biological, and chemical weapons; (5) the Ministry of Internal Affairs with 28 police departments, 28 fire departments, and specialized anti-terrorist units; and (6) the Bulgarian Red Cross. A major future challenge in Bulgaria is the prevention of terrorism through political stability, economic prosperity, ethnic and religious tolerance, and more effective measures against organized criminal activities. A related challenge will be to improve the level of preparedness of all components of Disaster Relief.

Bulgaria↗
PubMed1998

Patterns of smoking in Bulgaria.

BACKGROUND: Although the rate of smoking-related deaths in Bulgaria is still relatively low, in international terms, it has been rising rapidly. This is likely to become worse in the future as Bulgaria faces growing pressure from transnational tobacco companies. There is, however, little information on patterns of smoking, which is necessary for development of effective policies to tackle tobacco consumption. OBJECTIVE: To describe the pattern of smoking in Bulgaria and its relationship with sociodemographic factors. DESIGN: Multivariate analysis of data on patterns of tobacco consumption from a multi-stage nationwide survey of 1550 adults. SETTING: Bulgaria, in 1997. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: 38.4% of men and 16.7% of women smoke. Smoking rates are strongly associated with age, with 58% of men and 30% of women aged 30-39 smoking whereas only 5% of men aged 70 years and older and almost no women of this age smoke. Smoking is more common in cities, among those who are widowed or divorced, or who do not own their home. There is no clear association with household income or, for men, with education, although there is a suggestion that smoking may be more common among more highly educated women. CONCLUSIONS: The observed pattern of smoking indicates the need for a robust policy to tackle smoking in Bulgaria, especially among the young in large cities, informed by a better understanding of why smoking rates vary among different groups.

Adult↗
PubMed2001

Prevalence of Parkinson's disease in Bulgaria.

Despite some publications on Parkinson's disease prevalence in Bulgaria, its frequency in the country still remains uncertain. Earlier studies in Bulgaria were carried out on large population groups and were based on medical records without further diagnostic confirmation. The aim of the present study was to perform an epidemiological investigation on Parkinson's disease in Bulgaria, using strict diagnostic criteria in an attempt to obtain a more accurate estimate of its frequency in this country. We studied the prevalence of Parkinson's disease in two small regions of Bulgaria. Cases were ascertained by the medical records and confirmed by personal examination. The prevalence of Parkinson's disease was found to be 164.2 per 100,000 with 47 cases in the first region and 169.8 per 100,000 with 155 cases in the second region. Based on two small population studies, the prevalence ratio in different parts of Bulgaria is not significantly different and is similar to other European countries.

Adolescent↗
PubMed2002

Self-reported health in Bulgaria: levels and determinants.

AIMS: Self-reported health has been widely used in studies of health inequalities in many industrialized countries, but there is still little information on their distribution within populations in countries in Central and Eastern Europe (CEE). There is growing evidence that, since the political transition at the end of the 1980s, income and health inequalities have widened considerably throughout CEE. This paper examined self-perceived health in Bulgaria in relation to financial status (measured by income and self-assessed financial status) after adjustment for other potential explanatory variables. METHODS: Data were derived from a national representative survey of the population of Bulgaria aged over 18, in 1997. Respondents were asked "How would you describe your own health status over the past 12 months on the whole?" with answers "good", "rather good", "rather poor", and "poor". Responses were assessed in relation to a variety of measures including income, education, marital status, and self-perceived financial hardship. RESULTS: As expected, the prevalence of poor/rather poor health increases steeply with age. Those with only primary education are more likely to be in poor/rather poor health than those with secondary or higher education. Self-assessed financial status is a much better predictor of health than is income, with the relationship especially strong among women. There was no association with marital status or urban vs. rural dwelling. CONCLUSIONS: The survey found marked inequalities in self-reported health in Bulgaria. Some of its determinants, such as age and education, are comparable to those seen in the West. Self-reported health is particularly associated with self-perceived financial hardship, a proxy for material deprivation that is sensitive to informal economic exchanges. An accelerated pace of economic and social reforms at the end of the 1990s means that the health divisions in Bulgaria are likely to increase in the short term.

Adult↗
PubMed1993

Field and laboratory analysis of an outbreak of foot and mouth disease in Bulgaria in 1991.

In July 1991, an outbreak of foot and mouth disease (FMD) occurred near Stefan Karadjovo village in Boliarovo (south-east Bulgaria, close to the Turkish border). The virus isolated was identified in Bulgaria as serotype O and this was subsequently confirmed by the World Reference Laboratory for Foot and Mouth Disease in Pirbright (United Kingdom). Serological studies using bovine sera and monoclonal antibody analysis were made. In addition, the sequence of approximately 170 nucleotides at the 3' end of the 1D gene was determined for the field isolate and for vaccine strains used in Bulgaria. These were compared with other sequences of type O FMD viruses from outbreaks in the Middle East. Serum samples were taken from domestic animals in the region close to the outbreak and examined for anti-FMD virus antibodies to assess the extent (if any) of spread of the virus before or after the outbreak. No evidence of infection was found in these animals. The virus involved in the Bulgarian outbreak was antigenically similar to the O1 vaccine strains but probably did not originate from these strains. The virus was closely related genetically to a group of viruses isolated in the Middle East since 1987, suggesting that it may have been introduced into Bulgaria from an area in the Middle East by unidentified means.

Animals↗
PubMed2000

[The dynamics and structure of neonatal mortality in Bulgaria in the period of 1989-1998].

AIM OF THE STUDY: To follow and analyse the state and the structure of neonatal mortality rate (NMR) in the last ten years in Bulgaria. MATERIAL AND METHODS: A retrospective study is fulfilled on the annual data of the National Health Statistic Institute concerning the NMR in a period of last ten years. Along to this the changes in the perinatal infant mortality rate (PIMR) including the stillbirth and the early NMR are studied. The results are analysed by a comparative method and presented graphically. RESULTS: The unfavorable trends in the social and economic development of Bulgaria in the last decade are associated with a constant increase of PIMR--from 10.8% in 1989 to 12.9% in 1998, and of its components respectively: the stillbirth--from 5.9% to 7.4% and of the early NMR--from 4.9% to 5.8%. The NMR has increased from 7.3% since 1989 to 8.3% in 1998, the highest level being in 1991--10.4%. Besides the level of prematurely has increased constantly for the recent ten years--from 6.5% to 9.6%. The leading causes of neonatal mortality in Bulgaria are: perinatal asphyxia, congenital malformations, neonatal respiratory distress syndrome (RDS) and perinatal infections. They have remained the same for the recent five years. From them only the mortality caused by perinatal asphyxia has decreased in 1998--to 41.3% in comparison with 1994--43.7% and by congenital malformations--from 29.4% to 23.4% in 1998, the highest reduction being of the malformations of the neural system (2 folds) and of the gastrointestinal system (5 folds). The NMR of the low-birth weight infants (birth weight < 2500 g) has been 58.1% in 1997 and of the very low birth weight infants (< 1500 g)--276.3%. The NMR of both groups premature infants has decreased in 1998, respectively--to 47.6% and 191.4%. The NMR of the term-born infants has been 13.2% in 1997 and 11.1% in 1998. CONCLUSIONS: The NMR in Bulgaria remains comparatively high, the larger part being on the account of the early NMR, and it has increased for the last ten years. The main causes of NMR have remained the same for the last five years in the leading place been the perinatal asphyxia, the congenital malformations and the neonatal RDS. There is a tendency to a decrease of the perinatal asphyxia and the congenital malformations as a course of NMR in the last five tears. The NMR of the premature infants has decreased in 1998 and is relatively low, but this may be due to the fact that a certain part of the deceased extremely low-birth weight infants (< 1000 g) has been still not registered.

Birth Rate↗
PubMed2004

Gender impact on the socioprofessional identification of women dentists in Bulgaria.

Women comprise 73 percent of all dentists in Bulgaria. Almost all of them started their careers as salaried, and now they are self-employed. The purpose of this study was to show how female dentists in Bulgaria met the challenges of the social and health reforms during the period of transition from totalitarian to democratic rule. A field sociological survey was carried out between October 1996 and June 1997, involving a sample of 842 dentists. The questionnaire was designed to give information on dental demography trends, pattern of participation and practice of female dentists, and their career development. The data were treated statistically using an SPSS package. Results show that for the period 1991-96 women dentists owned more than 50 percent of the newly opened private practices in Bulgaria. They were more interested in improving their qualifications and more successful in obtaining specialty status than male dentists. Dentists in Bulgaria by the late 1990 s, with no gender difference, tend to identify themselves as liberal practitioners within the pluralistic model of dental services delivery. The volume of services delivered and profile of women in professional practice and their social and professional mobility are highly competitive, despite the growing problems of maternity leave coverage and funding to re-enter the profession.

Bulgaria↗
PubMed1993

[Artificial abortions in Bulgaria and their prevention].

Authors go into one extremely important problem for the family, woman, natality and family planning in Bulgaria. Scarcely during the last years it can be observed a slight reduction of the frequency of induced abortions. The average age of women having an abortion is high--about 30, which shows, that induced abortion is still a method of regulation fertility in intergenetic interval. The rate of those who have induced abortion under the age of 19 in Bulgaria is 7.8 to 53.3%, in Czechoslovakia, 6.7%, in DDR--50.0%, Greece--68%, Hungary--8.9%, Sweden--15.8%. The rate of done again induced abortion is higher, that is a result of bad preventing activities during the first abortion. Similar is the tendency of growing number of unmarried women having an induced abortion, as it is in the other countries: from 16.4% in 1980 to 21.7% in 1987. Bulgaria is on the third place in Europe according to the absolute number of dead cases after abortion (maternity death, after Rumania and USSR). It can be mentioned that in Bulgaria women do not use the most modern and safest devices, medicines for interruption of pregnancy.

Abortion, Induced↗
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↗