Democracy, economy and happiness in post-Soviet States (1995-2014)

Defining and measuring happiness has been a major topic for many generations of scholars. The contemporary discussion tackles upon the main predictors of happiness and their influence on the subject. This paper focuses on the influence of democracy and economy towards happiness, using the fifteen post- Soviet countries as cases. The data for the research has been collected from 1995 to 2014 and has been analyzed both on aggregate and individual level. The results show that on individual level both the economic status and the satisfaction with democracy have significant influence towards happiness. However, on aggregate level the income inequality appears to be the only predictor of happiness in both cases where the democracy factor is controlled for or not.http://www.ester.ee/record=b4684123*es

The economy of Bulgarian districts and its effect on environmental performance

The aim of this study is to examine on the relationship between economic growth and environmental performance in the 28 Bulgarian districts for the period between 2010 and 2016. The results show that when in the cases where CO2 emissions are medium, the relationship with the economic growth is very weak. However, for those districts with higher CO2 emissions per capita there is a significant relation with the economic variables. This would mean that economic growth would have a strong effect on the air quality only after certain amount of CO2 emissions

COMPREHENSIBILITY OF TEXT INFORMATION – CONCEPTS AND APPLICATIONS IN CONTEMPORARY STUDIES IN ACCOUNTING

This article presents part of the available arsenal of the developed quantitative and qualitative approaches for the assessment of text comprehensibility (readability) existing in western literature. Special attention is paid to their practical and application function in empirical research related to accounting. A conceptually new integrated approach is presented, the results of which could lead to a more precise metrication of the readability of disclosures of enterprises

Costing of healthcare services in Bulgaria – guidelines for implementing some good practices

Costing of healthcare services is one of the most severe challenges facing hospitals’ accounting and management teams.The article presents the characteristics, advantages, and limitations of three different approaches to costing medical services – Time-Driven Activity-Based Costing, Target Costing, and Micro-Costing. We provide a summary of theinternational experience in their application, and guidelines for their implementation in the Bulgarian context.Aligning the costing systems with current developments in the management accounting field has the potential to improve hospitals’ cost management and their financial condition.At a health system level, accumulating reliable information on the actual cost of medical services would facilitate theprocess of setting fair reimbursement prices and thus result in more effective ways to spend the scarce resources

Clinical pathways - a retrospective view on their application as a financial tool in Bulgarian hospitals.

Abstract IntroductionDuring 2000-2001, CPs were developed and implemented as a temporary solution for financing the hospitals in Bulgaria. The aim of this article is to study and trace the application of clinical pathways as a tool for hospital funding in Bulgaria. Material and methodsIn order to examine the implementation and the progress of CPs in Bulgarian hospitals we have studied Bulgarian and foreign publications. In addition to this, we also include official reports published by the Ministry of Health, Ministry of Finance, National Health Insurance Fund (NHIF), The National Center of Public Health and Analyses (NCPHA) and others.Results and discussionFor the first time, CPs are negotiated and included in the National Framework Contract in 2001. Gradually, the number of CPs increased and reached more than 300 in 2015. The introduction of CPs as a tool for financing the hospital care is related to the need of fixing the prices of the respective CPs. Initially, the NHIF and the Bulgarian Medical Association developed a common methodology for fixing the prices of CPs. Since 2011, an amendment to the Health Insurance Act stipulates that the procedures for valuation and payment of activities by NHIF are defined by explicit methodologies. We have found that not all hospitals submit information to the specialized software for hospitals which is the only tool for analyzing the costs structure in the health care establishments at present.ConclusionThe clinical pathways are not accepted as a sufficient effective mechanism for hospital funding in Bulgaria. Moreover, the lack of accurate and comparable information makes the analyses incomplete and vulnerable

History and development of personalized medicine

The development of personalized medicine is associated not so much with the idea of personalization presentedby Hippocrates more than 2400 years ago but with the development and increase of the precision in diagnosisand treatment (Gordon & Koslow, 2011; Sykiotis, Kalliolias, Papavassiliou, 2005).Even then, the „father of medicine“ – Hippocrates discussed how much more important is to be known what kind of aperson has a disease than to know what sort of disease a person has. In addition, Hippocrates also noted that differentmedicines should be given to different patients (Pray, 2008).Today, the term „personalized medicine“ is defined as „providing the right patient with the right drug at the right timewith the right dose“ (FDA).According to the National Institutes of Health (NIH), precision medicine is a „new approach to the prevention and treatmentof the disease and it is based on the individual variability of the genes, the environment and the lifestyle of eachperson.“ This approach enables doctors and scientists – to accurately predict which therapeutic and preventative strategies for a particular disease would have an effect in which groups of people.This is an opposition to the universal approach in which therapeutic and preventive strategies are developed for the„average-statistical“ person, without taking into account the differences between each individual.Personalized medicine is also defined as a „medical model based on the identification of the individual’s phenotype andgenotype (e.g. molecular profiling, medical imaging, lifestyle data, etc.). In order to be created an appropriate therapeuticstrategy for the right person at the right time and/or to identify the predisposition to an illness for timely and focusedprevention „(The European Alliance for Personalized Medicine (EAPM).The aim of the article is to be made a historical review of personalized medicine by examining and defining the mainstages of development – from its emergence to the present.The study is based on a literature review of scientific sources (printed and electronic) related to the article topic.As a result of the study, the following 5 stages of personalized medicine development are defined:• Preparatory stage (1931-1984) – from the idea of individual of treatment to mapping of the human genome. In thisstage, the topic of individualized treatment has begun to be discussed. In addition, the foundations of the creation ofpersonalized medicine are placed in order to be a revolution in medicine today.• The first stage (1984 – 2002) – human genome mapping, approval of first target therapy and first companion diagnosisco-developed with the drug. The term „personalized medicine“ emerged.• Second Stage (2003-2012) – Establishment of companion diagnosis by which medical professionals determine whichtarget therapy is appropriate for patients and at what dosage.• Stage Three (2012-2016) – the final results of the Human Genome project are presented. The essence and the importanceof personalized medicine and companion diagnosis are appreciated. The European Alliance for PersonalizedMedicine (EAPM, 2012), The Bulgarian Association for Personalized Medicine – (BAPEMED,2014) and BulgarianAlliance for Precision and Personalized Medicine (BAPPM, 2016).• Fourth stage (from 2017) – The target therapies and drugs become common and necessary practice. There is tremendousgrowth in the development of personalized medicine. By 2018, the Food and Drug Administration (FDA)approved 115 target cancer therapies (National Cancer Institute, 2018), and 41 target therapies and drugs wereregistered by the (Bulgarian Drug Agency, BDA) in Bulgaria until 2018.In conclusion, today’s personalized medicine is changing the medicine and patient care by providing personalized treatmentbased on the individual genetic characteristics of each patient and his illness

EFFECTIVENESS OF MANUAL THERAPY ADDED TO CONVENTIONAL PHYSIOTHERAPY PROTOCOL IN PATIENTS WITH SURGICALLY TREATED PROXIMAL HUMERAL FRACTURES

Proximal humerus fractures are the third most common fractures in adult patients. In developed economies, there is a tendency to increase the number of these fractures due to the aging population. Physical therapy is recognized as an important component in the management regardless of the fracture type or treatment protocol. The purpose of this blind, randomized study was to compare the effectiveness of two physical therapy interventions on the shoulder range of motion and function after surgical treatment of proximal humerus fracture: 1) supervised therapeutic exercise only (Control group – CG), 2) supervised therapeutic exercise with manual soft tissue mobilization and massage (Experimental group – EG). Ninty-six subjects diagnosed with proximal humerus fracture treated operatively were randomly assigned to one of these two groups. The rehabilitation included four phases, in each of which the patients underwent ten procedures. Shoulder range of motion was assessed with a universal goniometer for flexion, extension abduction, internal rotation and external rotation. International SFTR method of measuring and recording joint motion was used. The results were analyzed with the statistical program SPSS Statistics 19. At the end of the study, we found statistically significant better results in the EG in flexion (152.8° ± 22.3°), abduction (145.3° ± 24.2°), external (61.1° ± 11.8°) and internal (75.3° ± 11.6°) rotations, compared to CG: flexion (140.7° ± 22.0°), abduction (130.6° ± 24.4°), internal (51.8° ± 15.6°) and external (63.5° ± 14.1°) rotations with statistical significance (p < 0.05). The extension showed improvement in both study groups, within the EG results being 52.9° ± 15.9° and in the CG 49.9° ± 5.5° - with no statistically significant difference between them. The DASH (Disabilities of the Arm, Shoulder, and Hand) scale was used for functional assessment of upper extremity. We established that the application of manual soft tissue mobilization with massage in the postoperative rehabilitation of patients with proximal humerus fractures leads to more effective restoration of shoulder joint function

Financial analysis of university hospitals in Bulgaria

Improving the financial condition of university hospitals is a high priority for their owners and stakeholders. One of the most common problems for state-owned hospitals in Bulgaria is their financial instability. The stable financial state of these hospitals is imperative for their increasing development and ensures the success of their socially required functions.The study aims to analyse the financial health of university hospitals in Bulgaria and draw conclusions regarding the hospitals' long-term solvency and level of financial stability.The study covers a period of five years, from 2017 to 2021. Key financial indicators are observed to assess the financial state of the predominantly government-owned university hospitals. The primary information source for this study is the annual financial statements published in the Commercial Register.Results indicate a contrast in the values of financial indicators between hospitals in good and improving financial states and those in deep financial distress. In the latter, there is a high level of dependence on creditors and financial support by the owner. There is a clear correlation between low liquidity and profitability ratios and changes in capital structure, leading to increased indebtedness and deepening processes of reducing owner's equity.The results of the financial analyses are crucial to the hospital management boards. They provide detailed information on the current financial health and have high predictive value. Every responsible health manager should be familiar with the indicators for assessing the financial status of the structure they manage and take measures when alarming trends are present. The financial analysis should be used as a basis for better-informed management decisions

MOLECULAR VIROLOGICAL ANALYSIS OF THE TRANSMISSION CLUSTERS AND RESISTANCE MUTATIONS OF HIV-1 SUBTYPE B IN BULGARIA (2012-2020)

HIV-1 infection in Bulgaria is known for its high level of genetic diversity. Previous studies have indicated that subtype B is the most common strain in Bulgaria, particularly among men who have sex with men, who are at a high risk of transmission. The primary objective of this study was to identify any transmission clusters and transmission resistance in individuals newly diagnosed with HIV-1 who have not yet received antiretroviral therapy (ART). To this end, we sequenced the HIV-1 pol gene in the samples from the study participants using either the Viroseq HIV-1 Genotyping Test (Abbott) and the Applied Biosystems 3130xl genetic analyzer or the TruGene DNA Sequencing System (Siemens Healthcare) and an OpenGene DNA sequencing system. We then subtyped the HIV-1 pol sequences, and further analyzed those that met the criteria for subtype B. The study included a total of 595 HIV-1 subtype B sequences. Our analysis revealed that the majority of those diagnosed with HIV-1 subtype B were male and lived in Sofia region. The most common transmission mode was through sexual intercourse among men who have sex with men, followed by heterosexual transmission. We also observed the presence of multiple transmission clusters , and a low percentage of transmitted drug resistance mutations (TDRMs). Overall, our study confirms that HIV-1 subtype B remains the most dominant strain in Bulgaria

FERROPTOSIS IN CD4+ AND CD8+ T-CELLS IN THE SETTINGS OF HIV INFECTION

Introduction: Elevation of intracellular iron concentration triggers ferroptosis. Understanding the regulation and pathophysiological mechanisms of this process in HIV infection may contribute to antiretroviral therapy (cART) monitoring. Aim: To perform a correlation analysis of the intracellular labile-bound iron pool (LIP) in CD4+ and CD8+ T cells in association with CD4+, CD8+ T cells absolute count (AC) and CD4/CD8 index in HIV+ individuals on continuous cART with sustained viral suppression. Material and methods: Peripheral blood samples (Li heparin, n=34) were collected in the course of the routine immune monitoring of HIV+ individuals at four time points during 24 months. Plasma HIV viral load (VL) was determined with the Abbott Real-Time HIV-1 test (sensitivity 40 copies/ml). AC and percentage of CD4+ and CD8+ T cells were determined by direct flow cytometry (Multitest, BD Trucount, FACS Canto II). The intracellular content of LIP in CD4 and CD8 T cells (LIP CD4, LIP CD8) was measured at the beginning of the study, using acetoxymethyl ester and subsequent incubation with a chelator (Deferiprone). LIP was quantified according to the mean fluorescence intensity (MFI) (FACSCanto II, Diva 6.1.2). Results: In the settings of a higher LIP CD4 , high LIP CD8 correlated with increased CD8AC (Rho=0.70, p<0.05) up to 11 (min. 6, max. 15) months after LIP measurement., and decreased CD4/CD8 ratio correlated inversely with LIP CD8 in all consecutive measurements (Rho= -0.71, p<0.01 for all), Importantly, high LIP CD8 correlated with a lower CD4AC (Rho=-0.65, p<0.05) up to five (min.1, max.8) months after LIP measurement. Conclusion: The increased concentration of intracellular LIP in CD8 cells in HIV+cART individuals could indicate viral activity in the settings of undetectable HIV VL, directly associated with ongoing cell ferroptosis