CC BY
5
МЕДИЦИНСКИЕ НАУКИ
DYNAMICS OF SUICIDE RATES IN THE REGIONS OF PLOVDIV, KARDZHALI AND SMOLYAN IN THE REPUBLIC OF BULGARIA OVER THE PERIOD 2000 - 2009
Raykova Ekaterina Lyubenova
Assistant Professor at the Department of Healthcare Management, Faculty of Public Health, Medical University, Plovdiv,
Bulgaria
Bivolarski Iliya Petrov, Peshev Zhivko Vladimirov
Assistant - Department of General and Clinical Pathology and Forensic Medicine, Medicine Faculty, Medical University,
Plovdiv, Bulgaria
Ekaterina Lyubenova Raykova, Medical University Plovdiv, Department of Healthcare Management, Faculty of Public Health, Republic of Bulgaria
Iliya Petrov Bivolarski, Medical University, Plovdiv,Department of General and Clinical Pathology and Forensic Medicine,Medicine Faculty, Bulgariaq15a Vasil Aprilov Blvd.
Suicide is an important social, medical and psychological problem of modern society. A number of studies have focused on the wide range of risk factors determining suicidal behavior [2,8,9,10,13,14]. In the majority of the cases, suicide is committed by mentally sane persons, which proves that the suicide death rate for a particular territory can be interpreted as an indicator of the social welfare of the population [15].
One of the factors affecting the suicide rate is poverty or financial stress. The social and economic condition of individual areas significantly determines the distribution of suicides [2,11,12,13].
The highest suicide rates in the Republic of Bulgaria are registered in the South central area, which is also the largest one [2,7]. Its territory includes the Region of Plovdiv, which is the largest region, the Regions of Kardzhali and Smolyan, which being the smallest in the area are most strongly affected by the overall deterioration of the economic situation in the country.
The aim of this study is to examine the main tendencies in the dynamics of the suicides committed in the Regions of Plovdiv, Kardzhali and Smolyan over the period 2000 - 2009.
°/oooo
Material and methods
The object of this study is the committed suicides which were registered in the Regions of Plovdiv, Kardzhali h Smolyan over the period 2000 - 2009.
The historical method of choice has been used for the collection of input information. The statistical data used is courtesy of the National Statistical Institute, the Employment Agency, as well as from literature sources [1, 2, 9, 10, 11, 12, 18, 19]. Alternative, variation and graphical analysis has been used in the statistical processing of information [3, 4].
Results
The suicide situation in the Republic of Bulgaria over the period 2000 - 2009 is characterized by a gradual decrease in the suicide index rates (%ooo). Comparative analysis of the suicides in the regions of Plovdiv, Kardzhali and Smolyan and comparison with the national rate shows high levels of suicide index at the beginning of the period under investigation. The registered suicide rates for the three regions go down with certain fluctuations until 2007 - 2008, followed by a rise, which is contrary with the observed tendency for Bulgaria (Diagram 1).
2000 2001 2002 2003 2004
2005 2006 2007 2008 2009
Bulgaria
region of Plovdiv
region of Kardzhali
region of Smolyan
Diagram 1. Dynamics of the suicide index in the Republic of Bulgaria and the Regions of Plovdiv, Kardzhali and Smolyan
over the period 2000 - 2009
The analysis of the results in this study shows that in the three regions suicides are committed significantly more frequently by men than women. In the Regions of Plovdiv and Kardzhali, the percentage distribution of suicides by gender
has similar values, but the domination of suicides in the population of men is more prominent in the Region of Smolyan (Diagram 2). The men to women suicide index ratio is 2.4: 1.0 for the Region of Plovdiv; 2.9: 1.0 in the Region of Kardzhali and 5.0: 1.0 in the Region of Smolyan.
region Plovdiv region Kardzhali region Smolyan
Diagram 2. Gender structure of suicides in the regions of Plovdiv, Kardzhali and Smolyan over the period 2000 - 2009.
The comparative analysis of the data presented in Diagram 3 shows that the majority of suicides in the Region of Plovdiv live in cities and only 1/3 of them are rural inhabitants.
In the Region of Kardzhali, significantly higher rates of suicides are established in rural areas, whereas in the Region of Smolyan no significant difference is registered (Diagram 3).
The analysis of the age structure data of the suicides committed in the Regions of Plovdiv and Smolyan certifies
that persons in active working age (45-64) prevail among the suicides, and in the Region of Kardzhali suicides are within the 20-44 age range. As is obvious from Diagram 4, the suicides committed by children and adolescents (0-19) are insignificant in terms of number in all three regions under investigation (Diagram 4).
100 90 80 70 60 50 40 30 20 10 0
55,24%
144,76%
^ J ■---- * у/
region of Plovdiv region of Kardzhali region of Smolyan
в town и village
Diagram 3. Distribution of suicides by place of residence over the period 2000 - 2009.
Diagram 4. Age structure of suicides in the regions of Plovdiv, Kardzhali and Smolyan over the period 2000-2009
The tendencies for suicide activity increase found in the regions under investigation are significantly determined by the social and economic situation in the country. The unemployment dynamics in the three regions was on the decrease until 2008, but in 2009 it grew, having its highest rate in the Region of Smolyan (Diagram 5). It is important to point out that the unemployment percentage in the Region of Smolyan is one of the highest in the Republic of Bulgaria.
Discussion
The conducted comparative analysis of the suicide activity data over the period 2000 -2009 shows a decreasing dynamics of the suicide index in the three regions. Most probably
50 40 30 20
10
ф region of Plovdiv —■—region of Kardzhali * region of Smolyan
this finding is related to a certain stabilization of the economic situation in the country, especially after the accession of Bulgaria to the European Union. Regardless of this generally positive dynamics, suicide activity levels in the Region of Plovdiv at the end of the period exceed the national levels. The high rates of suicide activity usually bespeak unfavourable economic situation [2,13]. The increased values of the suicide index are probably the result of the setting economic crisis in Europe, which affects most significantly the economy of poor regions.
27.59 27.85
25,33 17.49 22,45 18,75
14.78 15,59 ЙЙЬ 15,74 13,47 13,9 10.9 14,9 "91)5
15.57 J4.72_ 15.62 10,82 «Ь04.
12,43 10,93 9,91 8,47 6,76 —■»- ---— 5.19 —■ —♦ 6,72
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Diagram 5. Unemployment dynamics in the regions of Plovdiv, Kardzhali and Smolyan over the period 2000 - 2009 (%)
In a number of countries in the world, as well as in different areas in the country, suicides among men dominate over women [2, 6, 10, 14, 16,17]. Differences are registered in the male and female suicide ratio in the three regions under observation. Interestingly, in the Region of Smolyan, registered suicides among women are five times less than male suicides. Probably, this is due to the preserved patriarchal way of living in the region, as well as the influence of religion.
It has been established in a number of investigations that suicides committed by rural inhabitants exceed those committed by urban inhabitants [3, 9, 10, 12,13]. Regardless of the fact that the number of suicides among the rural population in the Region of Plovdiv is smaller than the number of suicides among urban population, due to the depopulation of rural areas, their suicide index is higher [12]. The increased suicide activity in rural areas is determined by the specific nature of life in rural environment: patriarchal remnants, restriction, difficult adaptation, widespread deficiency, etc.
The majority of suicides in the three regions were committed by persons in working age (20-64), which corresponds to the data gathered for other areas of the country [2, 3]. In the Region of Plovdiv - 62.84±2,23%, in the Region of Kardzhali 73.9±1,22% and in the Region of Smolyan - 81.12±1.36% of all suicides committed in the relevant region. The age characteristics of suicide distribution concur to a certain extent with the global tendencies, according to which the highest suicide rate is traditionally registered with the senior age groups (therefore it is accepted to consider the age after 45 as a relative suicide risk factor) [2,3,13]. The increased relative share of suicides committed by retired persons in the Region of Plovdiv could be accounted for with the difficulties they have, insufficient pension size, health conditions, loneliness, loss of close people, etc.
The global economic crisis had its first direct and indirect impact on Bulgarian economy at the end of 2008. Until then, the unemployment rate was on the decrease, which cor-
responds to the decrease of the suicide index in the three regions. In 2009, the unemployment rate went up in the regions, and the suicide index went up along with it too. Unemployment is one of the reasons for the increased number of male suicides and for the suicides committed by persons in working age, because it affects directly the family budget. It is very difficult for men and women above the age of 45 who have been made redundant to find suitable employment and to adapt, therefore the number of suicides committed by this groups is the largest.
Economic problems have a major impact on the suicide rate in the regions of Plovdiv, Kardzhali и Smolyan.
Conclusions
1. Suicide index in the regions of Plovdiv, Kardzhali and Smolyan until 2008, with certain fluctuations, shows a tendency for a decrease, after which its rate goes up.
2. In the three regions, men commit the most suicides, but the highest male to female suicide ratio is found in the Region of Smolyan.
3. The most suicides are committed by the rural population in the Region of Kardzhali, with a relative share of 62,39± 3,22%.
4. The most suicides in working age, 20-64, are committed in the three regions.
5. There is an interconnection between the unemployment dynamics and the suicide index in the regions of Plovdiv, Kardzhali and Smolyan.
Literature
1. Балтов М., Маринов Н. Ретроспективен анализ на самоубийствата в област Кърджали за периода 2000 - 2009 год. В: Доклади на юбилейна научна конференция „Областната болница - регионален модел за качествено лечение и модерно управление", Кърджали 25 - 26.10.2012 г., 150 - 155 с.
2. Балтов М. Някои социални и икономически особеностти на самоубийствата в Североизточния район на Репубрика България за периода 2000 -2009 год. Съюз на учените - Варна, „Медицина и екология" 1(XVni);2013: 69 - 74 с.
3. Балтов М. Количествени показатели на суицидността в Южен централен район за периода 2000-2009 г. Science & Technologies, Medicine 2(1);2012, 139-142 с.
4. Димитров И. Деца и юноши в криза. "Просвета", 2007, 208 с.
5. Димитров И. Основи на научните проучвания в медицината, Методика и методология. Медицинско издателство ЕТ "Васил Петров"- Пловдив, 2007.
6. Иванов А. Наръчник за наблюдение и оценка на суицидни намерения, Институт по психология - М В Р, София, 2006, 3-8 с.
7. Левенова И., Бакалова В., Телчалова Г., Тодорова Н., Богатинова М. Динамика на самоубийствата в Пловдивска област след 2000 година. Социална медицина Х11(4); 2004 - 20 с.
8. Михайлова В. Негативната информация при комуникацията с пациента - подходи за управление. Социална медицина 2/3;2012,55-58 с.
9. Невмятулин А. Ш. Комплексное изследование самоубийств в Республике Марий Эл (дисертация) - Киров, Федеральное агенство по здравоохранению и социальному развитию, ГОУВПО "Ки-ровкая государственая медицинская академия", Руска Федерация, 2006.
10. Цонева-Пенчева Л., Вуков М., Дикова К. Самоубийства и опити за самоубийства в Република
България: демографски, социално - психологически и метеотропни фактори. Рецептор III, 4, 2006 54 - 62 с.
11. Baltov M. A few forensics aspects of the suicide cases observed in Plovdiv district, Republic of Bulgaria. 22nd Congress of the International Academy of Legal Medicine, 30.06 - 04.07.2012, Istanbul-Turkey.
12. Baltov M. Retrospective analysis of suicides in Bulgaria for the period 2000-2009. Presentations from the 22nd Congress of the International Academy of Legal Medicine, Istanbul, Turkey, 5-8 July, 2012 Copyright 2013 by MEDIMOND s.r.l. 40065, 43-49, Italy, ISBN 978-88-7587-676-0 ISSN: 0937-9827.
13. Baltov M., Bivolarsski I., Mihaylova V. Certain social and economic aspects of suicides committed in the region of Smolyan, Republic of Bulgaria, over the period 2000-2009. Евразийский Союз Ученых, Медицинские науки, 7(3)2014 15-19с.
14. Henderson Jp., Mellin C., Patel F. Suicide - a statistical analysis by age, sex and method. J. Clin. Forensic Med. 2005; 12 (6): 305 - 9.
15. Trejos J.G.C. Aspectos medico legales del suicido en Costa Rica. Epidemiologia del siucido en Costa Rica del 2000 al 2004. Revista Medicina Legal de Costa Rica, 2007, 24(2):67 - 80.
16. WHO. Preventing suicide: a global imperative.2014. URL: http://www.who.int/mental_health/suicidepre-vention/world_report_2014/en/
17. W H O - Suicide Statistics, Geneve 2010; www.who.int/en/
18. www.az.government.bg.
19. www.nsi.bg.
NEUROVEGETATIVE MECHANISMS OF ADAPTATION IN CHILDREN WITH CH. TRACHOMATIS FETAL INFECTION ASSOCIATED WITH UREOPLASMIC INFECTION
Shoira Agzamova
The Doktor of Medical Sciences, the Professor of the Chair of Ambulatory medicine of Tashkent Pediatric Medical Institute,
Tashkent, Republic of Uzbekistan
SUMMARY
The aim of the research is to study spectral characteristics of cardiac rhythm variability (CRV) with its correlation interrelations in young children with fetal Ch. trachomatis infection associated with ureaplasmic infection. Methods of the research. In our work we used the complex examination results of 35 children born from mothers with chronic TORCH infections. The main group included children (n=10), fetally infected Ch. trachomatis and associated with ureaplasmic infection. The control group involved non-infected children (n=25). Results and conclusion of the research. There are defined regular neurovegetative and reliable spectral values of Ch. trachomatis fetal infection. The detected regular correlation and rank links of Ch. trachomatis marker and CRV parameters in children provided the possibility of that method application for stratification and non-invasive screening of fetal infection.
АННОТАЦИЯ
Цель. Изучение спектральных характеристик вариабельности сердечного ритма (ВСР) с её корреляционными взаимосвязями у детей раннего возраста, внутриутробно инфицированных Ch. trachomatis и ассоциированной с ней уреаплазменной инфекции. Методы исследования. В работе использованы результаты комплексного обследования 35 детей, родившихся от матерей с хроническими TORCH - инфекциями. В основную группу вошли дети (n=10), инфицированные внутриутробно Ch. trachomatis и ассоциированной с ней уреаплазменной инфекцией. Контрольную группу составили неинфицированные дети (n=25). Результаты и выводы исследования. Установлены закономерные нейрове-гетативные и достоверные спектральные признаки внутриутробного инфицирования Ch. trachomatis, которые дают возможность использовать данный метод для стратификации и неинвазивного скрининга внутриутробного инфицирования.
Key words: variability of cardiac rhythm, young children, fetal infection, Ch. trachomatis associated with ureaplasmic infection.
Ключевые слова: вариабельность сердечного ритма, дети раннего возраста, внутриутробное инфицирование, Ch. trachomatis и ассоциированной с ней уреаплазменной инфекции.
