Regional disparities in all-cause mortality in Bulgaria for the period 2000 - 2012

Health inequalities are an exclusive focus of scientific research in all European countries. Subnational studies have the potential to detect regional variations, to evaluate health problems, and to plan policies for reducing them.This study presents regional all-cause mortality disparities in Bulgaria with crude and standardized rates for a period of 13 years, from 2000 to 2012

Stroke in urban and rural populations in north-east Bulgaria: incidence and case fatality findings from a 'hot pursuit' study

BACKGROUND: Bulgaria's official stroke mortality rates are higher for rural than urban areas. Official mortality data has indicated that these rates are amongst the highest in Europe. There has been a lack of studies measuring stroke incidence in urban and rural populations. METHODS: We established intensive notification networks covering 37791 residents in Varna city and 18656 residents (55% of them village-dwellers), all aged 45 to 84, in 2 rural districts. From May 1, 2000 to April 30, 2001 frequent contact was maintained with notifiers and death registrations were scanned regularly. Suspected incident strokes were assessed by study neurologists within a median of 8 days from onset. RESULTS: 742 events were referred for neurological assessment and 351 of these, which met the WHO criteria for stroke, were in persons aged 45 to 84 and were first ever in a lifetime. Incidence rates, standardised using the world standard weights for ages 45 to 84, were 909 (/100000/year) (95% CI 712–1105) and 597 (482–712) for rural and urban males and 667 (515–818) and 322 (248–395) for rural and urban females. Less than half were admitted to hospital (15% among rural females over 65). Twenty-eight day case fatality was 35% (123/351) overall and 48% (46/96) in village residents. The excess case fatality in the villages could not be explained by age or severity. CONCLUSIONS: Rural incidence rates were over twice those reported for western populations but the rate for urban females was similar to other western rates. The high level and marked heterogeneity in both stroke incidence and case fatality merit further investigation

Regional Inequalities in Mortality in Bulgaria // Регионални неравенства в смъртността в България

[EN] Regional mortality differences can be used while making regional health care policy decisions. Aims: To measure regional differences in age-standardized mortality rates from all causes of death, from Class II, IX, X, and XX and different specific causes of death for all 28 regions in Bulgaria for the period 2000-2012. To look for an association between regional mortality variations and socioeconomic factors. Materials and Methods: Data on deaths and number of inhabitants in all 28 regions are obtained from the national statistics. The average aged-standardized mortality rates are estimated with direct age-standardization using the revised European standard population. In addition rate ratios and absolute risk with respective 95% confidence intervals are calculated. Average age-standardized mortality rates are tested for correlation with the different socio-economic indicators. Conclusions: There are significant regional differences in crude and in age-standardized mortality from all causes of death and by specific causes of death. There is a change in the direction of all-cause mortality depending on the used indicators: crude mortality increases, and the age-standardized mortality shows a slight tendency for decrease. Disparities in standardized mortality between the areas remain constant. There are dependencies between socioeconomic indicators and age-standardized mortality from specific causes of death. As a result of the analysis “unhealthy living places” have been determined.[BG] Регионалните различия в смъртността могат успешно да се използват при оценка на здравния статус на населението и вземане на решения, свързани със здравната политика на регионално ниво. Цел: Да се проучат неравенствата в смъртността на регионален принцип в България и социално-икономическите фактори, които ги обуславят. Материал и Методи Проведено е екологично по дизайн проучване, сравняващо смъртността по причини на умиране между 28-те области в България за периода 2000-2012г. Данни за броя на умиранията и населението по области в страната са получени от НСИ. За нуждите на регионалните сравнения е използван пряк метод на стандартизация; за стандарт е използвано Европейското стандартно население ревизирано към 2013г. Изчислени са относителен и абсолютен риск със съответните стандартни грешки и 95% интервали на доверителност. За анализ на зависимостите между социално-икономическите показатели и смъртността е приложен корелационен анализ и линеен регресионен анализ. Изводи Установяват се значителни регионални варирания в нестандартизираната и стандартизираната смъртност. Междурегионалното вариране представено чрез нестандартизирана и стандартизирана смъртност има различна величина. Различията в стандартизираната смъртност между областите за 13-годишния период запазват постоянна величина. Различни социално-икономически фактори имат специфична връзка с разглежданите причини за смърт. Обособяват се региони с неблагоприятни стойности на показателите за смъртност

Vibrational Characterization and Antioxidant Activity of Newly Synthesized Gallium(III) Complex

The gallium(III) complex of orotic acid (HOA) was synthesized and its structure was determined by means of analytical and spectral analyses. Detailed vibrational analysis of HOA, sodium salt of HOA (NaOA) and Ga(III)-OA systems based on both the calculated and experimental spectra confi rmed the suggested metal-ligand binding mode. Signifi cant differences in the IR and Raman spectra of the complex were observed as compared to the spectra of the ligand and confi rmed the suggested metal-ligand binding mode. The calculated vibrational wavenumbers including IR and Raman scattering activities for the ligand and its Ga(III) complex were in good agreement with the experimental data. The vibrational analysis performed for the studied species, orotic acid, sodium salt of orotic acid and its Ga(III) complex, helped to explain the vibrational behaviour of the ligand vibrational modes, sensitive to interaction with Ga(III). The compounds HOA, NaOA and GaOA were investigated for possible antioxidant activity in a model of non-enzyme-induced lipid peroxidation on isolated rat microsomes. On isolated rat microsomes, administered alone, the compounds didn’t revealed pro-oxidant effects. In conditions of non-enzymeinduced lipid peroxidation, only the complex GaOA showed antioxidant activity. HOA and NaOA didn’t reveal antioxidant activity. We suggest that the antioxidant activity of the complex GaOA, might be due to the presence of gallium in the structure of GaOA.</p

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes : a systematic review and meta-analysis of randomised controlled trials

Background Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A1c (HbA1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845. Findings Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a –0·30 (95% CI –0·42 to –0·19) percentage point greater reduction in HbA1c, compared with control group participants. The difference in HbA1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (–0·42% [–0·63 to –0·20]) and via SMS (–0·37% [–0·57 to –0·17]), but not when delivered via websites (–0·09% [–0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall. Interpretation Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension : a systematic review and meta-analysis of randomised controlled trials

Background Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Findings Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a –3·62 mm Hg (95% CI –5·22 to –2·02) greater reduction in systolic blood pressure, and a –2·45 mm Hg (–3·83 to –1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (–2·45 mm Hg [–4·15 to –0·74]); however, there were no statistically significant reductions for SMS interventions (–1·80 mm Hg [–4·60 to 1·00]) or website interventions (–3·43 mm Hg [–7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. Interpretation SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility