Inequality and Public Policy: A Country Study for Bulgaria

This paper is an attempt for measuring the impact of public policy on the inequality in Bulgaria. An analysis based on the Bulgarian Household Budget Surveys shows that the tax burden in Bulgaria, nevertheless increasing in the upper quintiles, declined between the beginning of the transition period and the year before the EU accession. Using different inequality measures we have found that despite the limited possibilities of the data, taxation policies also contribute to some extend to inequality reduction in Bulgaria. As regards the social transfers, unemployment benefits and child allowances are found to be the main social payments reducing the inequality among Bulgarian households. Using quantile regression is found that the coefficients of the effective tax rates increase across the quintiles for the entire period. The coefficients associated with the share of VAT expenditures in the total income decrease as one moves from the lowest to the highest quintile of the consumption distribution.

Health insurance transitions of SCHIP-eligible children in response to higher public premiums

This is the first study to explore the impact of premium variation across individuals, states, and time on enrollment in the State Children's Health Insurance Program and their transitions to private insurance or uninsurance in response to higher premiums. With a sample of income-eligible children from the Medical Expenditure Panel Survey, I evaluate the effect of premium changes on public and private insurance enrollment and uninsurance using a wide array of methods: Regression-Discontinuity Design for the study of the within-state variations in premiums, cross-sectional analysis for evaluating the response using across-state variation in premiums, and difference-in-differences strategies that exploit temporal variations in premiums. The main regression-discontinuity estimates point to significant declines in public enrollment along with significant increases in private take-up and no change in the rate of uninsurance. The cross-sectional results support the finding that higher premiums are associated with statistically important decrease in public enrollment and increase in private. I find no evidence of increases in the rate of uninsurance as a result of public premium increases. These results are reinforced by the longitudinal findings. They indicate a statistically significant decline in public enrollment, significant increase in private and no change in uninsurance for children in the higher-income group in response to a per dollar increase in premium over the course of 2003 year

Assessment of the practical application of the students’ knowledge and skills as part of the training in the Rehabilitation Therapist program

Introduction: The training of students in the Rehabilitation Therapis program is multidisciplinary and conditionally divided into theoretical and clinical parts. The three-year training period provides an opportunity to form the necessary knowledge, skills and habits to build and improve the professionally significant competences of the future rehabilitators.Aim: The purpose of the scientific study is to evaluate the possibilities for applying the knowledge and skills of the students from the Rehabilitation Therapis program at the training and practical facilities of the Medical University of Varna.Materials and Methods: An anonymous blind survey was conducted from February to April 2019. Forty-two students from 2nd and 3rd year at the Medical College of Varna were interviewed.Results: According to the surveyed students, the highest rating of the practical application of the acquired knowledge and skills as part of the education at the Medical College of Varna was at the St. Marina Medical Center, which was indicated by 53.6% of the second-year students and 46.4% of the third-year students. In the study of the mentors' attitude towards the students, the mentors from the Clinic of Orthopedics and Traumatology, St. Marina University Hospital, had the highest score - 73.8%.Conclusion: Students are aware of the importance of a high level of practical training for their future professional career and appreciate the role of mentors in the process of their training as future rehabilitators

Which rating system is better – qSOFA or SIRS?

IntroductionThe definitions of sepsis and septic shock were redefined in 2016. This study compares the performance of qSOFA with that of SIRS criteria for the diagnosis of sepsis and prediction of 30-day mortality.AimThe aim of this article is to assess the severity of the infection of patients using SIRS and qSOFA scales and to compare their specificity and predictive value. Materials and MethodsA prospective, non-interventional single-center clinical trial was conducted at St. Marina University Hospital in Varna. The sample included 87 patients with sepsis and septic shock. The criteria for inclusion in the study were laboratory constellation for systemic exposure; over 18 years of age; with or without co-morbidities; no malignancies. Pregnancy, neoplasia and the age of under 18 were the criteria for exclusion. Logistic regression was used to test the predictability of both scales. ROC curve analysis determined the sensitivity and specificity of SIRS and qSOFA.ResultsOur analysis showed that both SIRS and qSOFA are significant predictors of mortality of septic patients. The SIRS scale had a 2.050-fold probability of predicting the death of the patient (p = 0.004, 95% CI 1.255 - 3.349), whereas the qSOFA score was 2.581 times more likely to predict mortality in patients with sepsis and septic shock (p = 0.0001, 95% CI 1.557 - 4.279). Cut-off values for SIRS higher than 2.5 points showed 91% sensitivity and  60% specificity - (AUC 0.80, 95% CI - 0.712 - 0.907), whereas qSOFA scores greater than 1.5 points indicated sensitivity of 82.2% and  specificity of 70.3% (AUC 0.85, 95% CI 0 0.770 - 0.934).Conclusion SIRS and qSOFA criteria for early detection of sepsis are useful clinical tools for mortality reduction and predictability. 

Relation between Metopic Suture Persistence and Frontal Sinus Development

The frontal bone develops as two halves, which further unite in a single bone by the closure of the mid-sagittal metopic suture, typically by the end of the first postnatal year. The frontal sinus begins to expand into the orbital and vertical plates of the frontal bone postnatally and reaches the level of the nasion by the fourth year of age. At this time, the metopic suture is usually entirely closed. However, in the cases of failed closure of the metopic suture, its relationship to the frontal sinus development is still obscure. Here, we review the relevant literature and discuss the frontal bone development and maturation, from the viewpoint of the frontal sinus pneumatization in relation to the metopic craniosynostosis and failed closure of the metopic suture. The peculiar to the metopic skulls frontal bone configuration is rather an expression of the underlying neural mass demands than a consequence of the metopic suture persistence. Furthermore, the persistent metopic suture is frequently associated with a frontal sinus underdevelopment. It seems that the metopic suture does not inhibit the frontal sinus pneumatization itself, but rather both traits are an expression or an aftereffect of a certain condition during the early development

The impact of CHIP premium increases on insurance outcomes among CHIP eligible children

Abstract Background Within the United States, public insurance premiums are used both to discourage private health policy holders from dropping coverage and to reduce state budget costs. Prior research suggests that the odds of having private coverage and being uninsured increase with increases in public insurance premiums. The aim of this paper is to test effects of Children’s Health Insurance Program (CHIP) premium increases on public insurance, private insurance, and uninsurance rates. Methods The fact that families just below and above a state-specific income cut-off are likely very similar in terms of observable and unobservable characteristics except the premium contribution provides a natural experiment for estimating the effect of premium increases. Using 2003 Medical Expenditure Panel Survey (MEPS) merged with CHIP premiums, we compare health insurance outcomes for CHIP eligible children as of January 2003 in states with a two-tier premium structure using a cross-sectional regression discontinuity methodology. We use difference-in-differences analysis to compare longitudinal insurance outcomes by December 2003. Results Higher CHIP premiums are associated with higher likelihood of private insurance. Disenrollment from CHIP in response to premium increases over time does not increase the uninsurance rate. Conclusions When faced with higher CHIP premiums, private health insurance may be a preferable alternative for CHIP eligible families with higher incomes. Therefore, competition in the insurance exchanges being formed under the Affordable Care Act could enhance choice