Human echinococcosis in Bulgaria: a comparative epidemiological analysis. (1/159)

The present article describes the importance of human echinococcosis as a public health problem in Bulgaria, outlines the control measures carried out and evaluates comparatively the situation over three periods spanning 46 years (1950-1995). During the first period (1950-62), a total of 6469 new surgically confirmed cases of hydatid disease were recorded in Bulgaria, with an annual incidence of 6.5 per 100,000 population, and the infestation rate in domestic animals and dogs was high. Echinococcosis was endemic throughout the country. The organization of a control campaign, initiated in 1960, led to a considerable improvement in the situation during the second period (1971-82). Morbidity among humans gradually decreased, with an average incidence of 2.0 per 100,000, and the proportion of infected animals also fell. The distribution of echinococcosis was characterized as sporadic or of low endemicity. During the third period (1983-95), owing to administrative irregularities and economic changes, funds for supporting the campaign were reduced and control structures were dismantled. As a result, the incidence rose to 3.3 per 100,000. Echinococcosis again became endemic, in some regions hyperendemic. The findings provide convincing evidence that cessation of control measures or reduction of campaign activity can lead to intensification in the transmission of Echinococcus granulosus and to a resurgence in echinococcosis to previous levels.  (+info)

Patterns of smoking in Bulgaria. (2/159)

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.  (+info)

Health hazards in the production and processing of some fibers, resins, and plastics in Bulgaria. (3/159)

Results of the toxicological studies of working conditions, general and professional morbidity, and complex examinations carried out on workers engaged in the production of polyamides, polyacrylonitrile fibers, polyester fibers and poly (vinyl chloride) resin, urea-formaldehyde glue, glass fibre materials and polyurethane resins are given. An extremely high occupational hazard for workers in the production of poly (vinyl chloride) resin and porous materials from polyurethane resins and urea-formaldehyde glue has been established. Cases of vinyl chloride disease, poisoning from formaldehyde, isocyanates, and styrene were noted. Prophylactic measures were taken in Bulgaria to lessen the occupational hazard in the productions as set forth included limitation of the work day to 6 hr, free food, additional bonus and leave, and annual physical examinations of workers.  (+info)

Q fever in Bulgaria and Slovakia. (4/159)

As a result of dramatic political and economic changes in the beginning of the 1990s, Q-fever epidemiology in Bulgaria has changed. The number of goats almost tripled; contact between goat owners (and their families) and goats, as well as goats and other animals, increased; consumption of raw goat milk and its products increased; and goats replaced cattle and sheep as the main source of human Coxiella burnetii infections. Hundreds of overt, serologically confirmed human cases of acute Q fever have occurred. Chronic forms of Q fever manifesting as endocarditis were also observed. In contrast, in Slovakia, Q fever does not pose a serious public health problem, and the chronic form of infection has not been found either in follow-ups of a Q-fever epidemic connected with goats imported from Bulgaria and other previous Q-fever outbreaks or in a serologic survey. Serologic diagnosis as well as control and prevention of Q fever are discussed.  (+info)

Patterns of alcohol consumption in Bulgaria. (5/159)

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.  (+info)

A founder mutation in the GK1 gene is responsible for galactokinase deficiency in Roma (Gypsies). (6/159)

Galactokinase deficiency is an inborn error in the first step of galactose metabolism. Its major clinical manifestation is the development of cataracts in the first weeks of life. It has also been suggested that carriers of the deficiency are predisposed to presenile cataracts developing at age 20-50 years. Newborn screening data suggest that the gene frequency is very low worldwide but is higher among the Roma in Europe. Since the cloning of the galactokinase gene (GK1) in 1995, only two disease-causing mutations, both confined to single families, have been identified. Here we present the results of a study of six affected Romani families from Bulgaria, where index patients with galactokinase deficiency have been detected by the mass screening. Genetic linkage mapping placed the disease locus on 17q, and haplotype analysis revealed a small conserved region of homozygosity. Using radiation hybrid mapping, we have shown that GK1 is located in this region. The founder Romani mutation identified in this study is a single nucleotide substitution in GK1 resulting in the replacement of the conserved proline residue at amino acid position 28 with threonine (P28T). The P28T carrier rate in this endogamous population is approximately 5%, suggesting that the mutation may be an important cause of early childhood blindness in countries with a sizeable Roma minority.  (+info)

Birthweight and infant mortality in Bulgaria's transition crisis. (7/159)

Between 1988 and 1991, years of political and economic crisis, Bulgaria reported a 25% increase in infant mortality. From 1991 to 1995, the rate then dropped slightly. Analysis of detailed unpublished vital statistics shows that the reported increase could not have been a result of more complete reporting of early neonatal mortality for very low-weight births. Old reporting practices continue unchanged. Rather, these statistics reveal an increase in the proportion of low-weight births, combined with rising death rates, particularly for low-weight births in the postneonatal period, but also for normal-weight babies.  (+info)

Primary and combined resistance to four antimicrobial agents in Helicobacter pylori in Sofia, Bulgaria. (8/159)

The aim of this study was to evaluate the primary and combined resistance of Helicobacter pylori against four antimicrobial agents by a screening agar method (SAM) and a modified disk diffusion method (MDDM) alone and in combination. Pre-treatment H. pylori isolates from 192 consecutive H. pylori-positive patients at three hospitals in Sofia were investigated. MDDM was performed with disks containing metronidazole (5 microg), clarithromycin (15 microg) or erythromycin (15 microg), ciprofloxacin (5 microg) and tetracycline (30 microg). Resistance was determined by an inhibitory zone of <16 mm for metronidazole and < or =30 mm for other agents tested. The cut-off concentrations used to define resistance by SAM were: metronidazole >8 mg/L, clarithromycin >2 mg/L, tetracycline >4 mg/L and ciprofloxacin >1 mg/L. Primary resistance rates in H. pylori were: metronidazole 28.6%, clarithromycin 9.7%, metronidazole + clarithromycin 2.8%, ciprofloxacin 3.9%, metronidazole + ciprofloxacin 2.3%, tetracycline 1.9% and metronidazole + tetracycline 1.2%. Among metronidazole-resistant isolates, combined resistance to clarithromycin, ciprofloxacin and tetracycline was present in 11.4% (5 of 44 strains), 8.3% (3 of 36) and 4.9% (2 of 41), respectively. Two strains exhibited triple resistance to macrolides, metronidazole and either ciprofloxacin or tetracycline. Three tetracycline-resistant strains were detected in 1999; however, resistance rates to other agents were relatively stable during the 6 years. Primary H. pylori resistance to metronidazole is moderate and resistance to clarithromycin and to ciprofloxacin is considerable in comparison with results in most other countries. The alarming appearance of strains harbouring combined resistance or multiresistance provides the motivation for continued surveillance of H. pylori at global, national and regional levels.  (+info)

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