Minority Rights in Bulgaria and Greece, and the Impact of European Integration Process

2011/2012La presente tesi ha come oggetto di studio i diritti delle minoranze in Bulgaria e in Grecia e il conseguente impatto sul processo di Integrazione Europea. Fornisce dettagli su come queste minoranze siano divise dai confini e su fino a che punto il concetto di nazionalismo influisce sull’adozione di un equo regime di tutela dei diritti delle minoranze per conto degli Sati-Nazione. Il contributo dell’Integrazione Europea viene valutato in termini di progresso raggiunto nel campo dei diritti delle minoranze e della cooperazione transfrontaliera. Subito dopo le rispettive dichiarazioni di indipendenza, entrambi i Paesi hanno firmato accordi bilaterali con l’Impero Ottomano esprimendo il loro impegno a rispettare i diritti delle minoranze turche/musulmane presenti nel territorio. Tuttavia, con il passare del tempo e soprattutto a causa dell’irruzione delle due guerre mondiali e delle prese di posizione nazionalistiche in entrambi i paesi, la situazione delle minoranze turco-musulmane é drammaticamente cambiata. Nel corso della storia, il trattamento di queste minoranze in Bulgaria e in Grecia ha creato una serie di problemi nelle relazioni con la Turchia, che rappresenta lo “stato di riferimento” (kin-state) di queste minoranze in entrambi i Paesi. Il nazionalismo Greco con le sue forti caratteristiche di esclusivitá ha giá in varie occasioni escluso la popolazione turco-musulmana dal processo costititutivo della nazione, classificando le minoranze musulmane come “altre”, “estranee”. Con lo scambio demografico tra popolazioni greche e turche, sancito dal Trattato di Losanna, il riconoscimento dell’esistenza della minoranza turco-musulmana é stata limitato soltanto al territorio della Tracia occidentale. Esaminando d’altro lato la situazione della Bulgaria, il trattamento delle minoranze turche ha lí seguito un cammino differente. Comparato con quello greco, il nazionalismo bulgaro ha adottato un approccio relativamente piú inclusivo, soprattutto con riferimento alla popolazione Pomaks, conosciuti oggi anche come musulmani che parlano correntemente bulgaro. Con la fioritura del nazionalismo bulgaro durante il regime comunista, l’inclusione prese la forma di assimilazione e il risultato fu la conversione dei Pomaks in “bulgari”. Per quanto riguarda la minoranza turca poi, la situazione si riveló altrettanto poco esemplare. In molte occasioni i Turchi furono forzati ad emigrare in Turchia, per poter bilanciare l’ alterazione demografica in Bulgaria. Nel frattempo, con la campagna di assimilazione intrapresa nel 1984-1985, i nomi delle minoranze turche in Bulgaria furono sostituiti con nomi bulgari e la Bulgaria arrivó a negare completamente l’esistenza della minoranza turca. Quando i Turchi si opposero a questa politica di assimilazione forzata, furono nuovamente costretti ad emigrare. La discussione intrapresa sui diritti delle minoranze nell’ambito del processo di Integrazione Europea, ha apportato cambiamenti significativi in entrambi i Paesi. Tuttavia, si é verificata una certa limitazione dell’impatto delle politiche dell’Unione Europea in quest’area, derivante da alcuni problemi di natura storica. La Grecia ad esempio, in quanto giá membro effettivo dell’Unione Europea, non dovette passare attraverso un processo europeo di valutazione del trattamento delle minoranze, laddove invece la Bulgaria dovette seguire specifiche procedure di accesso preliminari, necessarie per poter permettere la sua adesione all’Unione Europea. Le dinamiche di cambiamento del discorso sulla democrazia resero inapplicabili alcune restrizioni previamente accettate, per cui un processo di democratizzazione nell’area dei diritti delle minoranze divenne inevitabile. Di fronte all’esistenza di tali problemi, questo processo di democratizzazione suscitó effetti positivi in entrambi i Paesi. Risolvere il problema di democratizzazione non ha portato automaticamente ad una soluzione di tutti i problemi esistenti. Stabilire una collaborazione transfrontaleria tra Bulgaria e Grecia fu il primo problema ad essere discusso dopo la caduta del Comunismo. Tuttavia questo progresso non é avvenuto in maniera semplice e armoniosa. Nuovamente si puó affermare che la prospettiva di un integrazione Europea rappresentó il principale catalizzatore dello sviluppo della cooperazione fra i due Paesi, nonostante la presenza di alcuni problemi in alcune parti del confine, dovuti alla presenza della minoranza turca, il cui “stato di riferimento” é la Turchia. La percezione tradizionale dei confini come barriere di esclusione continua ancora ad essere presente in alcune aree del Sudest Europa, e potrá essere cambiata soltanto attraverso un rinsaldamento dell’integrazione Europea. Per concludere, rispetto al loro trattamento delle minoranze turco-musulmane, Bulgaria e Grecia hanno creato differenti politiche di integrazione. Mentre in Grecia, la partecipazione politica e sociale della minoranza turco-musulmana fu limitata attraverso la creazione di una comunitá separata dal resto della popolazione, in Bulgaria tale partecipazione fu maggiormente incoraggiata proprio per evitare tale segregazione. Tuttavia, questa politica di non-segregazione é stata condotta spesso di pari passo con il non-riconoscimento del carattere etnico della minoranza turca, trasformandosi finalmente in assimilazione durante gli anni ’80. Con il ristabilimento della democrazia in Bulgaria, sono state adottate nuove politiche di integrazione, poi denominate “Modello Etnico Bulgaro”. Conseguentemente, il modello di prevenzione di un conflitto etnico in Bulgaria ha attirato l’attenzione di alcuni Paesi dell’area dei Balcani che hanno sperimentato simili problemi nel corso della loro storia.XXIV Ciclo198

Workgroup D. Artificial Green Floating Islands

The project aims at reducing the gap between the Eastern and Western part of the Danube River, regarding economic disparities and environmental problems. This gap can be reduced by introducing Artificial Green Floating Islands in the Danube region, with the following objectives: improvement of water quality using specific plants that purify the water to be used in agriculture, attraction of tourists to the less developed countries to make a profit, opening of new jobs for young and inexperienced people, creation for the local people of public places where they can get together and socialize. The introduction of the Artificial Green Floating Islands would also change how people and countries of the area perceive the Danube River turning it from a natural border into a centre for social interaction between different coastal states

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

1945 SONRASI BULGARİSTAN TÜRKLERİNE YÖNELİK ASİMİLASYON POLİTİKASI

Bu tezin yazılma amacı 1945 sonrası süreçte Bulgaristan'da komünistlerin iktidara gelmelerini takip eden süreçte uyguladıkları asimilasyon politikalarının incelenmesidir. Bulgaristan Türklerinin yaşamış olduğu zorluklar asimilasyon politikasının sürekliliğine ve sistematik bir biçimde uygulanışına bağlanmıştır. 1945 sonraki süreç değerlendirilirken gerek Osmanlı döneminde gerekse Türkiye Cumhuriyeti'nin ilk yıllarında imzalanmış olan anlaşmalardan faydalanılmıştır. Tezdeki argümanları desteklemek amacıyla dönemin Komünist Parti toplantı tutanaklarından ve Politbüro kayıtlarından yararlanılmıştır. Bu belgeler ışığında 1984'ten sonra uygulamaya konan uyanış sürecinin altyapısının 1945'ten sonra atılmaya başlandığı savunulmuştur. Kanıtları kuvvetlendirmek amacıyla Bulgarca, Türkçe ve İngilizce kaynaklar kullanılmıştır. Bulgaristan'ın istikrarsız bir seyir izleyen azınlık politikası ve Türkiye'nin verdiği tepkiler incelenmiştir. 1951, 1968 ve 1989 göçlerinin arkasındaki nedenler detaylı bir şekilde sıralanmış ve bunlar Komünist Parti'nin asimilasyon politikalarıyla açıklanmaya çalışılmıştır. Tezde değerlendirilen bir diğer konu da Bulgar Milliyetçiliğinin gelişimi ve asimilasyon politikasına etkisi olmuştur. Yapılan araştırma sonucunda komünistlerin meşruiyetlerini arttırmak amacıyla milliyetçiliği kuvvetlendirmeye çalıştıkları görülmüştür. Tek bir etnik temele dayalı komünist Bulgar milletini oluşturma amacına hizmet etmek için Türklerin ve ülkedeki diğer azınlık mensuplarının isimlerini değiştirip Bulgarlaşmalarını sağlama konusunda ciddi bir planı uygulamaya koymuşlardır. Başta Pomaklar olmak üzere Tatar ve Çingenelere yönelik asimilasyon politikası başarılı bir şekilde sonuçlanınca sıradaki hedef olarak Türkleri görmüşlerdir. Ancak isimleri Bulgar adlarıyla değiştirilen Türkler bunu kabullenememiş ve protesto gösterilerine başlamışlardır. Bu durum kitlesel bir hal alınca da Bulgaristan'daki komünist iktidar zor anlar yaşamıştır. İlk olarak Türklerin Türkiye'ye göç etmesine izin verilmiş ardından da Türklere isimleri geri verilmiştir. Türklerin göç etmesini takip eden süreçte girdiği ekonomik kriz sonucu Bulgaristan'da komünist iktidar dönemi sona ermiş ve demokratik yeni bir yönetim kurulmuştur. Uyanış sürecinin sorumluları ise kesin bir şekilde bulunamamıştır. Bazı göstermelik tutuklamalar yapılmasına rağmen Todor Jivkov ve çevresindeki birkaç kişiye hafif cezalar verilmiştir.The main aim for which this thesis has been written is to evaluate assimilation policy implemented during the communist era in Bulgaria. Difficulties faced by the Bulgarian Turks have been linked with the sistematic and intense assimilation policies of the Bulgarian government. While evaluating post 1945 years, treaties signed during the Ottoman era and in the early years following the creation of the Republic of Turkey were also used. In order to support arguments of this thesis wide range of documents have been analysed among which are written reports of the Bulgarian Communist Party meetings and Politburo summits. In light of these documents it has been defended that the infrastructure of the Awakening Process which took place in 1984 begun to be created after 1945. Bulgarian, Turkish and English sources of information have been used in order to support these ideas. Bulgarian incosistent minority policy and Turkish reactions were evaluated in this work. Immigration waves in 1951, 1968 and 1989 were linked with the assimilationist policies of the Communist Party. Another issue which has been analysed as part of this work is the progress of the Bulgarian nationalism and its effect on the assimilation efforts. As a result of the comprehensive research it has been noted that the Communist Party tried to strengthen Bulgarian nationalism in order to enhance its legitimacy level. To create pure Bulgarian Communist Nation based on unique-Bulgarian ethnicity, an important name changing campaign has been launched on ethnic minorities and mainly Turks which aim was Bulgarization of all minority groups in Bulgaria. After the successful results of the assimilation campaigns towards Pomaks, Tatars and Gipsies the next step was Turkish minority. But the Turks could not accept the given Bulgarian names and mass protests took place against the name changing campaign of the Bulgarian Communist Party. These protests put the government in a trouble which after Turks were given the right first to travel-immmigrate to Turkey and second their Turkish names were turned immediately after the end of Jivkov era. Following the migration of Turks, Bulgaria entered into an economic crisis which marked the end of the communist rule and the creation of the democratic regime. Responsibles of the awakening process could not be find beacause the lack of proofs. There was some weak punishments toward perpetrators of the process like Todor Jivkov and his key staff

Clinical features of generalized lipodystrophy in Turkey: A cohort analysis

Aim: To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow-up. Methods: This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean ± SD follow-up was 86 ± 78 months. Results: The Kaplan–Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan–Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (≥ 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan–Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan–Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow-up period. Causes of death were end-stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. Conclusions: Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL

The epidemiology and economic impact of varicella-related hospitalizations in Turkey from 2008 to 2010: a nationwide survey during the pre-vaccine era (VARICOMP study)

Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (< 0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was$856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children < 1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization

The epidemiology and economic impact of varicella-related hospitalizations in Turkey from 2008 to 2010: a nationwide survey during the pre-vaccine era (VARICOMP study)

Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (< 0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was$856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children < 1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization