The use of digital devices in the field of healthcare in Bulgaria

Background

The opportunities that information and communication technologies provide in the field of healthcare are many and constantly growing. Thanks to them, consumers have access to health information, consultations and remote treatment and connection with medical centers. They help to improve health promotion activities, whose mission is to promote health as a core value. The aim of the present study is to explore the attitudes regarding the use of digital devices in the field of healthcare of Bulgarian population.

Methods

A direct anonymous survey was conducted among 356 respondents, randomly selected and with an average age of 38.26 ± 0.15 (110 men and 246 women). The study was conducted from October 2018 to April 2019. The data analysis was performed using the statistical software SPSS v.23.0.

Results

The results showed that 78.9% of respondents have used or are willing to use digital devices to search for and record health information. A statistical gender difference was found in the answer to the question of using a digital device for self-registration of information (χ2 = 28.6, P < 0.05), as women are more likely to do so. More than 75% of respondents are willing to share health information with a medical professional in real-time via the internet. Older people are more reserved and hesitant about providing health information to a state agency (66.7%). The smartphone and computer/laptop are among the most preferred digital modalities in the healthcare field, with men and younger respondents more likely to use digital devices in relation to their health (χ2=39.9, P < 0.05). Women are more critical about the use of information and communication technologies in healthcare (χ2=48.2, P < 0.05).

Conclusions

The present study found a positive attitude among all respondents towards the introduction of modern technologies in the healthcare field and the opportunity of remote contact with medical professionals, using personal digital devices.

Key messages

The opportunities that information and communication technologies provide in the field of healthcare are many and constantly growing. The aim of the present study is to explore the attitudes regarding the use of digital devices in the field of healthcare of Bulgarian population.

Assessment of Cognitive Reserve: a pilot study for Bulgarian Population

Background

The Cognitive Reserve (CR) is a concept used to represent the individual differences in processing cognitive tasks, allowing to cope with the pathology of the brain. CR describes the individual brain potential as a result of various activities during the lifespan. The study of this construct could open one more “door” on the path to the prevention of diseases associated with cognitive dysfunctions in human aging. The objective of this pilot study was to assess the CR as a part of a project aimed to evaluate the effectiveness of various options for stimulating active aging.

Methods

The Cognitive Reserve Index Questionnaire (CRIq) was translated into Bulgarian and was administered to 114 healthy participants (84,2% female and 15,8% male), aged 23 to 84 years (M = 52,40 SD = 16.81), divided into three age groups (up to 44, 45- 69 and over 70 years old). An individual CRI-level was calculated based on the subscores for education, working activity and leisure time. Non-parametric tests (Chi-square, Mann-Whitney U-test, and Kruskal-Wallis test) were used for statistical analysis.

Findings

The CRI-level depends significantly on age (χ2=31.834, (df = 6), p < 0.001) but does not depend on gender (p = 0.257). Significant difference was found in three age groups for the total CRI-score (p < 0.001), CRI-Education (p < 0.001) and CRI-WorkingActivity (p < 0.001) except for CRI-LeisureTime score (p = 0.547). The total CRI-score significantly correlate with CRI-Education (r = 0.863), CRI-WorkingActivity (r = 0.809) and CRI-LeaisureTime (r = 0.414).

Key messages

The CRIq is an easy to administer instrument that could help the assessment of the cognitive reserve in Bulgarian population. The cognitive reserve depends on human behavior through the life span and this fact gives new opportunities for prevention of diseases associated with cognitive dysfunctions in human aging.

Protein and mRNA levels of YKL-40 in high-grade glioma

Malignant gliomas are the most common type of primary malignant brain tumours, characterized by extreme proliferation and aggressive invasion. There is evidence for over-expression of the YKL40 gene in high-grade gliomas. The high serum levels of the glycoprotein are associated with poor prognosis of various inflammatory and tumour processes. We investigated the YKL40 mRNA level and protein expression in the tumour site and in the serum of high-grade glioma patients. The YKL-40 expression in 36 patients with glial tumours (astrocytoma grade III, glioblastoma) and 33 age-matched healthy persons was measured by gene analysis, immunohistochemistry and ELISA. YKL-40 serum levels in high-grade glioma patients compared to healthy subjects were significantly increased (P ≤ 0.05). A wide range of variability in YKL40 mRNA expression was found. YKL-40 staining in situ was more abundant in glioblastoma tissue than in anaplastic astrocytoma, with the lowest level in normal brain tissue. Our gene analysis revealed that in general, YKL40 mRNA in glioma patients was over-expressed versus normal brain. A significant correlation between YKL40 transcript and protein levels was observed (P ≤ 0.05). It could be speculated that the YKL-40 protein might contribute to glioblastomas' specific biological characteristics that distinguish them from grade III gliomas. A complex investigation of YKL40 expression was performed at the molecular and cellular levels in human high-grade gliomas. Serum YKL-40 concentrations increased with tumour grade and correlated positively with transcript rate, being the highest in glioblastoma. We provide evidence for a relationship between YKL40 expression and the malignancy of glial tumours.

The prognostic value of clinical and laboratory parameters in patients with chronic lymphocytic leukemia

PURPOSE

Chronic lymphocytic leukemia (CLL) is heterogeneous in its clinical course. The aim of the present study was to identify some clinical and laboratory parameters with prognostic value in relation to survival of patients with CLL.

PATIENTS AND METHODS

One hundred thirty one patients with CLL, treated in the Clinic of Hematology, Plovdiv, between 1992 and 2003 were studied. The patients' survival was analyzed by using the Kaplan-Meier method. Log-rank test was used to compare cumulative survival functions between different groups of patients. The parameters studied were: age, sex, Rai clinical stage, ECOG Performance status (PS), FAB morphological type, mediastinal lymphadenopathy, abdominal nodal mass, extranodal localization, absolute lymphocyte count, autoimmune hemolytic anemia, and response to therapy.

RESULTS

The mean survival of patients was 76 months (95% Confidence Interval, 64-87). The following factors were found to carry significant prognostic value in relation to survival: Rai clinical stage, ECOG PS, mediastinal lymphadenopathy, extranodal localization, FAB morphological type and response to initial standard treatment.

CONCLUSION

The prognostic factors identified in the present study can be easily applied in the clinical practice and may be used as a basis for creating mathematical prognostic models.

Non-Hodgkin lymphomas and carrier state of viral hepatitis B and C

PURPOSE

To establish the characteristics and prognosis of newly diagnosed patients with non-Hodgkin lymphoma (NHL), who were carriers of hepatitis B (HBV) and C (HCV) viral infection.

METHODS

542 patients with NHL, diagnosed and treated in the University Hospital "Sv. Georgi", Plovdiv, were retrospectively analysed. Two NHL patient groups were created - the study group, consisting of 33 patients with NHL positive for HBV and HCV, and the control group, consisting of 40 randomly assigned patients with NHL and negative serology for hepatitis. Study and control groups were compared for basic characteristics and survival.

RESULTS

The prevalence of hepatitis B surface antigen (HBsAg) among newly diagnosed patients was 5.72% and of HCV 1.84 %. Association with hepatitis viruses was more frequent in indolent than in aggressive NHLs (p=0.044). Liver dysfunction was registered more often in the study group (p=0.002). Reactivation of HBV infection was registered in 5 patients (12.19%) from the study group. There was no statistically significant difference between survival rate of patients in the study group and in the control group (p=0.738).

CONCLUSION

Hepatitis virus carrier state did not alter significantly the clinical course and disease prognosis (remission rates and survival) in our patient group. We recommend the routine testing for hepatitis infection in patients newly diagnosed with NHL in order to collect more data needed for the establishment of a possible causal relationship between hepatitis viruses and NHL. Since antiviral prophylaxis could positively impact the course of lymphoma treatment, national guidelines for the management of patients with hepatitis infection and NHL will prove to be necessary for the clinical practice.

[Radiological evaluation of transverse maxillofacial disparity]

Graphical model is established based on frontal cephalometric for differential diagnostic of transverse morphological and functional abnormalities of the mandible. Eight graphical models are made which cover and dinstinguish possible transverse variations of mandible position and morphology taking into account the asymmetry of the mandible, rotation and translation of the joints and the combinations thereof. With these eight detailed models an orthodontist can accurately differentiate the problem and choose an adequate treatment plan.

Relationship of asymmetric dimethylarginine with flow-mediated dilatation in subjects with newly detected severe hypercholesterolemia

BACKGROUND

Little is know about the relationship between asymmetric dimethylarginine (ADMA) and percent flow-mediated dilatation (%FMD) in subjects with severe hypercholesterolemia (HH).

AIM

The aim of the present study was the evaluation of the relationship of ADMA to %FMD, as well as to lipid parameters and other markers of endothelial dysfunction in newly detected subjects with severe HH.

METHODS

One hundred and twenty asymptomatic patients with severe, newly detected HH and 100 controls were evaluated. The plasma level of ADMA was tested by ELISA and total homocysteine (tHcy) - through fluid chromatographic analysis. The %FMD was evaluated by the diameter of brachial artery with 7.5 MHz transducer of HP SONOS 5500.

RESULTS

Significant difference was found between patients and controls, (P<0.05) regarding lipid total cholesterol, triglycerides, high-density lipoprotein, low-dencity lipoprotein, atherogenic indices) and non-lipid markers (ADMA, sICAM-1, sVCAM-1), as well as the endothelium dependent %FMD in contrast to flow independent vasodilation. (P>0.05) No significant difference was found between the groups with respect to tHcy, P-selectine and E-selectine. (P>0.05) A strong negative correlation was found between %FMD and ADMA. (r(xy) = -0.895; P<0.001), Apolipoprotein-B (r(xy )= -0.687; P<0.0001, tHcy (r(xy) = -0.560; P<0.001) and Apolipoprotein index -B/A1 (r(xy) = -0.518; P<0.001). The subsequent linear and multiple regression analysis selected ADMA as the most significant factor in relation to %FMD.

CONCLUSION

It is concluded that ADMA is the basic modulator of %FMD among all tested atherogenic risk biomarkers in in newly detected subjects with severe HH.

[Diagnostic value of the serum tumor markers CEA and CYFRA 21-1 in patients with non-small cell lung cancer]

SUMMARY

There is growing evidence that tumor markers can provide valuable diagnostic and prognostic information in patients with non-small cell lung cancer.Two of the most important markers are CEA and CYFRA 21-1.

MATERIALS AND METHODS

We present 70 patients, operated at our clinic between 01.07.2007 and 01.03.2008 (57 male, 81.4% and 13 female, 18.6%), age range: 46-75 years. Serum levels of the tumor markers were measured preoperatively.

RESULTS

We found elevated levels of CEA at 26 patients (37.1%), and elevated levels of CYFRA 21-1 at 48 patients (68.5%).

CONCLUSIONS

CYFRA21-1 is a valuable tumor marker in patients with lung cancer. It has better sensitivity and diagnostic value in comparison with CEA in patients with non-small cell lung cancer.

[The effect of contraceptive with 20 ug ethinylestradiol and 150 ug desogestrel on some acute phase proteins]

BACKGROUND

We present the influence of monophasic combined oral contraceptive with 20 mmicrog ethinylestradiol /150 microg desogestrel upon some acute phase proteins: C- reactive protein, fibrinogen, haptoglobin and the connection between the proinflammatory effect of oestrogens

METHODS

Forty clinically healthy young women between 18 and 35 years, using oral contraceptives in the duration of 12 months, are included in this study.

RESULTS

We don't find statistically significant differences in the plasma concentrations of C--reactive protein, fibrinogen, haptoglobin on the 12th month of the using of the oral contraceptives in comparision with the initial levels of the variables, before starting the study.

CONCLUSION

The reduction of the dose of ethinylestradiol, definitely reduces the effects of oral contraceptives upon acute phase proteins and eventually the increased risk of cardiovascular disease.

[C-reactive protein in women with pre-eclampsia]

Preeclampsia is a disorder associated with generalized dysfunction of endothelial cells probably as a result of systematic inflammatory maternal reaction. CRP is a positive marker of inflammation higher at overt preeclampsia than in normal pregnancy. The aim of the present study is to observe the variations of the acute phase protein CRP at women with preeclampsia and those with normal pregnancy in the third trimester.

MATERIAL AND METHODS

Sixty women are included in the study, separated into two groups; group A (n = 30), consisted of women with overt preeclampsia and group B (n = 30)- women with normal pregnancy. Plasma levels of CRP are measured by using immunoturbidimetric method and the results are statistically calculated by variative analysis.

RESULTS

We found statistically significant difference in plasma concentration of CRP between pregnant women with preeclampsia and those with normal pregnancy (t = 2.92, P < 0.01).

CONCLUSION

In conclusion our data about the significantly higher values of CRP at women with preeclampsia are in agreement with the statement for presence of pronounced inflammation at preeclampsia compared with normal pregnancy.

Influence of family tradition on reproductive behavior of Gypsy population

INTRODUCTION

Stability of traditional opinion in different ethnic communities determines to a great degree the demographic behavior of their members.

AIM

To analyze the influence of family traditions and system of values on the reproduction of gypsy population.

MATERIALS AND METHODS

The opinions of 495 Gypsy women in reproductive age was studied by direct individual questionnaire. The answers characterizing the reproductive behavior of two successive generations were analyzed. The following statistical analyzes were applied: descriptive statistics, chi-square and t-tests. All p-values are two-tailed. The statistical analyses were made on a PC using SPSS 5.0.2.

RESULTS

Mean age at marriage in different generations under study was similar (it is 15.50 +/- 0.10 years in the present generation vs. 15.58 +/- 0.09 years in the previous generation, p > 0.05). The same is valid for the mean age at the first birth (16.98 +/- 0.11 years vs. 17.04 +/- 0.10 years, respectively, p > 0.05). However, there was a statistically significant difference in the mean number of live-births between the generations (2.37 +/- 0.05 vs. 4.10 +/- 0.09, respectively, p < 0.001). The latter finding might be explained by fact that the women from the present generation are still in their reproductive period.

CONCLUSION

It is obvious that family traditions may have, to a certain extent, an influence on the patterns of reproductive behavior in gypsy population. These traditions represent an indispensable part of their lifestyle and their intentions to have many children.

Survival of patients with surgery for lung cancer

INTRODUCTION

Lung cancer is the leading cause of death in oncological diseases all over the world. It is a major health problems in Bulgaria. Early diagnosis is of great significance for improving survival in this group of patients.

OBJECTIVE

The aim of this study was to analyze survival of patients with surgery for lung cancer.

MATERIALS AND METHODS

Retrospective information for all 86 patients with surgery for lung cancer during the period 1995-1998 was obtained from the surgery protocols in the Clinic of Thoracic and Abdominal Surgery at the Higher Medical Institute (Plovdiv, Bulgaria). However, relevant follow-up data were found only for 50 patients. Medical histories were provided by the Plovdiv Oncological Center. Kaplan-Meier analysis was applied to study survival of patients. The log rank test was used to compare cumulative survival functions between groups of patients with different stage at diagnosis. Univariate Cox regression analysis allowed the development of a model to assess the influence of the stage at diagnosis on cumulative survival.

RESULTS

Survival was assessed till June 1998. Mean survival period was 15 months (95% CI 13, 18). Patients were divided into two sub-groups: group A (stage I and II) and group B (stage III and IV). The analysis showed a marginally significant difference in cumulative survival between two groups (p = 0.0599). The mean survival period of patients from group A was 18 months (95% CI 14, 22) while for group B it was 12 months (95% CI 9, 16). Univariate Cox regression model showed that the relative risk of patients in group B to patients in group A is 3.2 (95% CI 1.11, 9.06). Early diagnosis of lung cancer is of crucial importance for surgery management and prognosis in such patients.

Assistance with generalized net models to the differential diagnosis of some pathologic somatic muscular and neurologic conditions in stomatology

Some somatic pathologic muscular and neurologic conditions in stomatology are difficult to differentiate. For example, the myofascial pain dysfunction syndrome, trigger point muscle pains and a number of temporomandibular joint related pathoses often cause diagnostic difficulties. With the purpose to assist general clinicians and students to understand and differentiate more easily these difficult occasions, the authors try to offer a model simulating the decision-making process in some of the aforementioned pathoses. The model is based on the Generalized Nets Models which represent extensions of Petri's nets and their modifications.

Sexual culture of gypsy population

The number of the gypsy population in Bulgaria has increased with 85,419 persons for the period 1965-1992 that is higher than the prognosis made about a mean rate of increase of 2000 persons per year. The aim of the present study was to describe demographic changes and main problems of intrafamily planning of this population. The primary information was collected by the method of indirect individual inquiry as the opinion of 495 gypsy women at reproductive age was studied. Sexual behaviour of this ethnic group was analysed with the needs and social, economical and cultural status. The results have revealed particular patterns of the sexual behaviour about the beginning of early sexual relationships, use of modern contraceptive methods, number of abortions, etc. It should be noted that only about 61% from the gypsy women use any kind of contraceptive measures but irregularly. The mean number of abortions per woman was 2.41 and about 33% of women had undergone 3 and more abortions-on-demand. The low level of sexual culture and the lack of knowledge about the methods of contraception have led to early first births, high proportion of abortions-on-demand and high rate of increase of the population among gypsies. This may be explained by the life-style traditions of this ethnic group and their intention to the multi-child model of the family. We must emphasize the lack of modern information system for early warning, publicity and formation of sexual habits of this population.