The town of Bankya is a balneological resort (spa) situated in a picturesque valley 17 km west from Sofia. It is a place suitable for the treatment of cardiovascular diseases and certain functional diseases of the nervous system. As a national resort, it applies stricter environmental regulations for activities that might endanger the environment, including road transport. The aim of this study was to establish the health status of Bankya townspeople before the pending construction of a highway. The morbidity of the population of Bankya and neighbouring towns and villages was compared to that of the capital Sofia for the period between 1997 and 1999. The data were statistically processed using the non–parametric, chi–square analysis. The results showed similar morbidity in children from Bankya and neighbouring towns and villages, but it was significantly lower than in children from Sofia. The results for adults were also in favour of Bankya – lower morbidity than in the neighbouring towns and villages, and less than 50% of disease cases recorded for Sofia.Grad Bankya nalazi se u kupališnome području smještenom u slikovitoj dolini 17 km zapadno od Sofije. To je mjesto pogodno za liječenje kardiovaskularnih bolesti i nekih funkcionalnih poremećaja živčanog sustava. Budući da se radi o zaštićenome području, ekološki zahtjevi za razvoj proizvodnje koja bi mogla ugroziti okoliš su stroži, a to se odnosi i na povećanje cestovnog prometa. Cilj je ovog istraživanja bio ispitati zdravstveno stanje stanovništva grada Bankyje prije izgradnje autoceste Lyulin. U razdoblju od 1997. do 1999. godine analizirano je pobolijevanje stanovnika grada Bankyje i okolnih gradova i sela i uspoređeno s pobolijevanjem stanovnika Sofije. Dobiveni rezultati statistički su obrađeni neparametrijskom analizom – kriterij χ2. Nađeno je da je pobolijevanje djece u gradu Bankyji slično kao u susjednim gradovima i selima, no da je značajno niže negoli u Sofiji (3379,17‰). Rezultati istraživanja u odrasloj populaciji govore u prilog nižem pobolijevanju u gradu Bankyji u usporedbi sa susjednim gradovima i selima. Štoviše, u usporedbi sa Sofijom pobolijevanje je bilo dva puta manje

Jeni Staykova

Tanya Turnovska

Hrčak - Portal of scientific journals of Croatia

283Staykova J, Turnovska T. PRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAArh Hig Rada Toksikol 2002;53:283–288Short CommunicationPRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAJeni STAYKOVA¹ and Tanya TURNOVSKA²Hygienic and Epidemiologic Inspectorate, Kardzali¹, Medical University, Plovdiv², BulgariaReceived October 2002The town of Bankya is a balneological resort (spa) situated in a picturesque valley 17 km west from Sofia. It is a place suitable for the treatment of cardiovascular diseases and certain functional diseases of the nervous system. As a national resort, it applies stricter environmental regulations for activities that might endanger the environment, including road transport. The aim of this study was to establish the health status of Bankya townspeople before the pending construction of a highway. The morbidity of the population of Bankya and neighbouring towns and villages was compared to that of the capital Sofia for the period between 1997 and 1999. The data were statistically processed using the non–parametric, chi–square analysis. The results showed similar morbidity in children from Bankya and neighbouring towns and villages, but it was significantly lower than in children from Sofia. The results for adults were also in favour of Bankya – lower morbidity than in the neighbouring towns and villages, and less than 50% of disease cases recorded for Sofia.KEY WORDS:  air pollution, balneological resort, morbidity, road transportThe town of Bankya is a balneological resort (spa) situated in a picturesque valley at 640 m above the sea level, 17 km west from Sofia. Its climate is temperate continental, with warm summers and moderately cold winters. The mean annual air temperature is 9.3 °C and the mean annual rainfall is about 670 mm. Western, north–western and partially south–western winds prevail, with mean annual velocity of 1.8–2 m/s. In bio–climatic respects, the resort can be defined as sparing to tonic. Its greatest treasure is mineral water – mildly mineralised, hypothermic, hydrocarbonate and sodium in contents.These characteristics make Bankya a place suitable for treatment of cardiovascular diseases (hypertension, coronary heart disease, valvular defects, atherosclerosis, arteritis, thrombophlebitis, etc.) and certain functional diseases of the nervous system (1). Its status of the national resort imposes stricter environmental regulations on industrial and other activities that might endanger the environment. This is particularly true for construction activities and road networking and transport. According to the national annual report of the Council of Ministers, in 1994 Bulgaria counted over 2.75 million vehicles. The number of automobiles exceeds 1.8 million, and, notwithstanding the drop in country’s economy, their number increases 6.2% every year. Of all cars, only 20% are new and environmentally compliant. However, 46.3% of nitric oxides, 43.8% of carbohydrates and 46.7% of carbon monoxide in the country originate from road vehicle exhausts (2). In 1999, road transport emissions were as follows: 52.6 thousand tonnes of nitric oxides (59.2 thousand tonnes in 1997), 238.1 thousand tonnes of carbon monoxide (195.6 thousand 284tonnes in 1997), and 98.5 tonnes of lead aerosols (86.31 tonnes in 1997) (3,4). It is obvious that the contribution of road transport to atmospheric pollution of the country is substantial. This fact is to be included in all considerations related to the construction of new continental highways which will be passing through the country. One of these highways is “Lyulin”, planned to run near the resort of Bankya. The aim of this study was to establish the baseline health profile of Bankya population before the highway is functional – for future reference.SUBJECT AND METHODSPopulation health was established through morbidity. Morbidity data for the period 1997–1999 were collected and analysed for the population of Bankya and neighbouring towns and villages of Malo Bouchino, Gorna Banya and Suhodol (21st Polyclinic), Filipovtzi (26th Polyclinic) and compared to the country’s capital of Sofia. We selected those classes of diseases which, according to literature, are most associated with road exhaust pollution. We obtained the data from the District Health Protection Centre in Sofia. Prevalence data for children (0–17 years of age) and incidence (number of morbid cases registered) data for the adults (>18 years of age) were collected from official records. The data were statistically processed using the non–parametric, chi–square analysis.RESULTS AND DISCUSSIONTable 1 shows that the prevalence of diseases (classified according to the 9th edition of International Classification of Diseases) among children in Bankya (2790.42‰) was similar to that of neighbouring towns and villages and significantly smaller than in Sofia (3379.17‰). The results for adult population were also in favour of Bankya – lower morbidity than in the neighbouring towns and villages. These data suggest that Bankya population is reasonably healthy, that is, Figure 1 Prevalence of diseases among children (‰) in 1997–99Figure 2 Prevalence of diseases among adults (‰) in 1997–99Staykova J, Turnovska T. PRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAArh Hig Rada Toksikol 2002;53:283–288285Staykova J, Turnovska T. PRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAArh Hig Rada Toksikol 2002;53:283–288Description of diseases ICD* classChildren0–17 yearsAdults18+ years          ‰          P**                    ‰          P**All classes      001–99921st Polyclinic 2752.68 <0.00001 758.14 <0.00001Bankya 2790.42 <0.00001 509.99 <0.0000126th Polyclinic 2349.53 <0.00001 735.77 <0.00001Sofia 3379.17 1291.90Neoplasms      140–23921st Polyclinic 2.50 0.00151 5.17 <0.00001Bankya 0.48 0.01321 6.79 <0.0000126th Polyclinic 2.92 0.01107 10.90 <0.00001Sofia 4.24 15.06Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders     240–27921st Polyclinic 0.94 <0.00001 14.37 <0.00001Bankya 0.00 0.00002 3.75 <0.0000126th Polyclinic 2.61 <0.00001 5.82 <0.00001Sofia 9.35 24.51Diseases of the Nervous System and Sense Organs     320–38921st Polyclinic 213.53 <0.00001 137.97 <0.00001Bankya 152.31 <0.00001 115.66 <0.0000126th Polyclinic 122.89 <0.00001 117.45 <0.00001Sofia 258.21 230.08Diseases of the Circulatory System      390–45021st Polyclinic 22.17 0.00021 88.11 <0.00001Bankya 2.86 <0.00001 38.53 <0.0000126th Polyclinic 11.23 <0.00001 58.67 <0.00001Sofia 17.90 161.07Diseases of the Respiratory System      460–51921st Polyclinic 1946.47 <0.00001 237.76 <0.00001Bankya 2211.65 0.93351 150.74 <0.0000126th Polyclinic 1768.28 <0.00001 261.48 <0.00001Sofia 2206.17 314.34Diseases of the Digestive System      520–57921st Polyclinic 36.84 <0.00001 33.69 <0.00001Bankya 122.16 0.02553 13.03 <0.0000126th Polyclinic 40.59 <0.00001 35.30 <0.00001Sofia 105.23 55.10Diseases of the Skin and Subcutaneous Tissue      680–70921st Polyclinic 151.19 <0.00001 64.68 <0.00001Bankya 103.13 <0.00001 13.14 <0.0000126th Polyclinic 90.86 <0.00001 37.45 <0.00001Sofia 208.20 90.39Congenital Anomalies      740–75921st Polyclinic 0.29 0.00086 0.10 0.00221Bankya 0.95 0.89950 0.00 0.1567326th Polyclinic 0.47 0.00308 0.13 0.01869Sofia 1.29 0.33Injury and Poisoning      800–99921st Polyclinic 107.91 <0.00001 40.31 <0.00001Bankya 68.06 <0.00001 55.90 <0.0000126th Polyclinic 110.46 <0.00001 49.51 <0.00001Sofia 138.75 84.34*ICD – International Classification of Diseases, 9th edition. **P value is calculated toward SofiaTable 1 Baseline morbidity data for Bankya, neighbouring area, and Sofia between 1997 and 1999286 Staykova J, Turnovska T. PRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAArh Hig Rada Toksikol 2002;53:283–288healthier than the population of the capital. However, we noticed an increasing trend in prevalence among children toward the end of the follow–up period (Figure 1). Unlike other locations, Bankya showed a substantial initial drop from 1997 to 1998, and only then did follow an increase in prevalence in 1999. The incidence in adults shows a slight decrease in all locations, with the lowest incidence in Bankya (Figure 2).Analysing morbidity, we found that it was significantly lower in Bankya than in Sofia for all classes of diseases according to the International Classification of Diseases (ICD), with the exception of respiratory diseases in the children of Bankya (ICD class 460–519), but the difference was not statistically significant (P=0.93351).Morbidity data were the most favourable in adult population of Bankya. We believe this finding is very important, because intensified road transport, after the “Lyulin” highway is completed, is likely to increase atmospheric pollution and, consequently the incidence of respiratory diseases which are a good indicator of air pollution (5–9). A number of studies revealed a positive correlation between air pollution and the incidence of cardiovascular diseases (10,11). The levels of carbon monoxide, whose basic source is internal combustion engine, are particularly important, since this pollutant impairs the transport of oxygen to the body tissues and more specifically to the myocardium (12). As we expected the morbidity data for the diseases of the circulatory system (ICD class 390–450), were lower in Bankya, which confirms the beneficent effect of the spa in the treatment of cardiovascular diseases and in prophylaxis of their sequelae. A number of specialized publications point out that vehicle exhausts released in the atmosphere contain great quantities of different chemical compounds which are the products of complete or incomplete fuel combustion. These include carbon dioxide, nitric dioxide, sulphur dioxide, polycyclic aromatic hydrocarbons, soot, petrol vapours, lead and cadmium aerosols, as well as secondary photochemical pollutants. The qualitative and quantitative composition of exhaust gases depends on a number of factors: type and quality of fuel (petrol, diesel, gas), engine, and operating conditions (13–16). Emissions from road traffic have a combined, complex, cumulative and remote harmful effect on organism. Thus, carbon monoxide increases the toxicity of mixed vapours, gases and aerosols which cause irritation of the centre of breathing and hypoxia. The effects of toxic substances and noise may be additive. About 65% of Europeans exposed to noise from road vehicles experience disturbances in sleep (17). Symptoms of the nervous system associated with noise are irritability, neurosis, difficulties in concentration, low work capacity and fatigue (18,19). Even at admissible levels (5, 7, 20–22), road transport pollution may increase respiratory, cardiovascular and neurological morbidity, increase the risk of cancer, and affect the immune reaction. Table 1 shows that the baseline health of Bankya population is favourable with respect to the diseases of the nervous system and sense organs (ICD class 320–389) and to neoplasms (ICD class 140–239). Higher morbidity in the population from the area of the 21st Polyclinic requires further investigation. We believe that the frequency of congenital anomalies (ICD class 740–759) is too small for proper interpretation of Bankya results in children with respect to Sofia and the neighbouring area.Beside pollution, intensified road traffic is expected to increase the number of road accidents, which in turn will lead to an increase in the frequency of injuries (ICD class 800–999). Table 1 shows that injuries and poisoning in Bankya are significantly less frequent than in Sofia.The data analysed in this study suggest that the baseline morbidity of Bankya population (that is, before the construction of the “Lyulin” highway, which is pending) is significantly lower than the morbidity of Sofia population, and is more similar in nature to that of the neighbouring towns and villages.It is very important that the “Lyulin” highway project should include all necessary technological, engineering, sanitary, and organizational precautions to preserve the nature of the resort and the health of its population. Once the highway is operational, it is imperative to have systemic control of the atmospheric and noise pollution of the town of Bankya.REFERENCES1. Kostadinov D, Tzvetkova L, Karakolev D, editors. Bulgarski kurorti (narachnik na kurortnite obekti) [Bulgarian resorts (Guide on resort’s objects), in Bulgarian]. Sofia: Medicina i Fizkultura Publisher; 1976. 2. Godishen doklad za sastoianieto na okolnata sreda prez 1994 (Zelena kniga) [Annual report on environmental conditions during 1994 (Green Book)]. Sofia: Bulgarian Government; 1995. 287Staykova J, Turnovska T. PRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAArh Hig Rada Toksikol 2002;53:283–2883. Doklad za sastoianieto na okolnata sreda prez 1999 (Zelena kniga) [Report on environmental conditions during 1999 (Green Book)]. Sofia: Bulgarian Government; 1999. 4. Doklad za sastoianieto na okolnata sreda prez 1997 (Zelena kniga) [Report on environmental conditions during 1999 (Green book)]. Sofia: Bulgarian Government; 1997. 5. Ciccone G, Forastiere, Agabiti N, Biggeri A, Bisanti L, Chellini E et al. Road traffic and adverse respiratory effects in children. Sidria Colaborative Group. Occup Environ Med 1998;55:771–8. 6. Duhme H, Weiland SK, Keil U, Kraemer B, Schmid M, Stender M, et al. The association between self–reported symptoms of asthma and allergic rhinitis and self–reported traffic density on street of residence in adolescents. Epidemiology 1996;7:578–82. 7. Forsberg BN. Steinberg S. Wall:People can detect poor air quality well below guideline concentrations: a prevalence study of annoyance reactions and air pollution from traffic. Occup Environ Med 1997;54:44–8. 8. Lercher P, Schmitzberger R, Kofler W. Perceived traffic air pollution, associated behaviour and health in an alpine area. Sci Total Environ 1995;169:71–4. 9. Weiland SK, Mundt KA, Ruckmann A, Keil U. Self–reported wheezing and allergic rhinitis in children and traffic density on street of residence. Ann Epidemiol 1994;4:243–7. 10. Babisch W. Epidemiological studies on cardiovascular effects of traffic noise. In: Prasher D, Luxon L, editors. Advances in noise research. Vol 1. Biological effects of noise. London: Whurr Publishers Ltd.;1998. p. 312–27. 11. Balazs T, Hanig J, Herman E. Toxic responses of the cardiovascular system. Chapter 14. In: Klaassen C, Amdur M, Doull J, editors. Casarett and Doull’s Toxicology. New York (NY): Pergamon Press; 1996. p. 311–27. 12. La pollution automobile favoriserait les accidents cardiaques [editorial]: Rev Prat 1997;11:389.13. Bushtueva K. Gigiena atmosfernogo vozduha, v Komunalna higiena [Hygiene of atmosphere, in communal hygiene, in Russian]. In: Akulova K, Bushtueva K, editors. Moscow: Medicina Publisher; 1986. p. 262–339. 14. International Programme on Chemical Safety/World Health Organization (IPCS/WHO). Diesel fuel and exhaust emissions. Environmental Health Criteria 171, Geneva: WHO; 1996. 15. International Programme on Chemical Safety/World Health Organization (IPCS/WHO). Principles and methods for assessing direct immunotoxicity associated with exposure to chemicals. Environmental Health Criteria 180. Geneva: WHO; 1996. 16. Zwirner–Baier, I, Neumann HG. Polycyclic nitroarenes (nitro–PAHs) as biomarkers of exposure to diesel exhaust. Mutat Res 1999;441:135–44. 17. World Health Organization (WHO). Moving towards healthy transport. WHO European Bulletin Environmental and Health 1999;6:5–6.18. Anderson R, Anderson J. Sensory irritation and multiple chemical sensitivity. Toxicol Ind Health 1999;15:339–45. 19. Gomez–Jacinto I, Moral–Toranzo F. Urban traffic and self reported health. Psychol Rep 1999;84:1105–8. 20. Bruske–Hohlfeld I, Mohner M, Ahrens W, Pohlabeln H, Heinrich J, Kreuzer M, et al. Lung cancer risk in male workers occupationally exposed to diesel motor emmissios in Germany. Am J Ind Med 1999;36: 405–14. 21. Burney P, Malmberg E, Chinu S, Jarvis D, Luczynska C, Lai E. The distribution of total and specific serum IgE in the European Community Respiratory Health Survey. J Allergy Clin Immunol 1997;99:314–22. 22. Wongsurakiat P, Maranetra K, Nana A, Naruman C, Aksoruint M, Chalermsanyakorn T. Respiratory symptoms and pulmonary function of traffic policement in Thonburi. J Med Assoc Thailand 1999;82:435–43.288 Staykova J, Turnovska T. PRESERVING THE ENVIRONMENT IN THE RESORT OF BANKYAArh Hig Rada Toksikol 2002;53:283–288REQUESTS FOR REPRINTS:Tanya Turnovska, M.D., Ph.D.Lozengrad 244000 Plovdiv, Bulgaria E–mail: turnovt@yahoo.comSažetakOČUVANJE OKOLIŠA U PODRUČJU GRADA BANKYJEGrad Bankya nalazi se u kupališnome području smještenom u slikovitoj dolini 17 km zapadno od Sofije. To je mjesto pogodno za liječenje kardiovaskularnih bolesti i nekih funkcionalnih poremećaja živčanog sustava. Budući da se radi o zaštićenome području, ekološki zahtjevi za razvoj proizvodnje koja bi mogla ugroziti okoliš su stroži, a to se odnosi i na povećanje cestovnog prometa. Cilj je ovog istraživanja bio ispitati zdravstveno stanje stanovništva grada Bankyje prije izgradnje autoceste Lyulin. U razdoblju od 1997. do 1999. godine analizirano je pobolijevanje stanovnika grada Bankyje i okolnih gradova i sela i uspoređeno s pobolijevanjem stanovnika Sofije. Dobiveni rezultati statistički su obrađeni neparametrijskom analizom – kriterij χ2. Nađeno je da je pobolijevanje djece u gradu Bankyji slično kao u susjednim gradovima i selima, no da je značajno niže negoli u Sofiji (3379,17‰). Rezultati istraživanja u odrasloj populaciji govore u prilog nižem pobolijevanju u gradu Bankyji u usporedbi sa susjednim gradovima i selima. Štoviše, u usporedbi sa Sofijom pobolijevanje je bilo dva puta manje.KLJUČNE RIJEČI:  cestovni promet, ljekovito kupalište, morbiditet, onečišćenje zraka

Očuvanje okoliša u području grada Bankyje

Abstract

Similar works

Full text

Available Versions

Hrčak - Portal of scientific journals of Croatia

HRČAK - Portal of Croatian Scientific and Professional Journals