GIS-Based Assessment Model of Resilient Management and Monitoring of Water Resources

Introduction. The management and efficient use of water resources is a crucial and extremely acute problem. This study focuses on geographic information systems (GIS) as a tool for the resilient management and monitoring of water resources. The objective was to create and implement a GIS-based model for managing and monitoring water resources by developing a system of indicators. This model presents future scenarios for Bulgaria based on the assessment of indicators for resilient management and the efficient use of water resources. Aim and tasks. This study aims to develop and implement a GIS-based model that integrates technical, economic, social, and environmental indicators for the resilient management and monitoring of water resources in Bulgaria. This study focuses on opportunities to improve the effective management and rational allocation of water resources in Bulgaria using geographic information systems. Results. A comprehensive system of indicators for assessing sustainable water management in Bulgaria was developed, considering economic, technical, social, and environmental criteria. The calculation of the composite index showed a low level of efficiency, and the main problems were water losses during transportation of up to 55-60%, a reduction in investments in wastewater disposal by 40% (2016-2023) and a low level of reuse of treated wastewater. The GIS-based model revealed significant territorial differences in the state of water resources and consumption in Bulgaria. Key problems include high losses in the water supply network, water use for hydropower, and poor water infrastructure, which affect the resilience of water management. Irrational consumption and storage may lead to serious water supply issues in key regions of the country. Conclusions. Geographic information systems enable the improvement of water resource management by integrating and processing large amounts of data. In response to the identified research questions, the current state of Bulgaria’s water sector was analysed and assessed. The key factors affecting the sustainable management and use of water resources and territorial imbalances in rational water use were identified. Developing a comprehensive strategy that includes infrastructure modernisation, introducing water-saving technologies and improved management efficiency can overcome structural problems in the water sector and prevent water resource shortages

Association of antihypertensives and Parkinson’s disease in a primary care population matched for underlying diagnosis

Purpose: To examine the association of several antihypertensive medication classes with incidence of Parkinson’s disease (PD), taking into account possible underlying conditions.// Methods: In a case-control study based on a large primary care database and including 21,981 PD cases and 21,981 non-PD controls matched for age, sex, and possible treatment indications associations with different antihypertensive medication groups, including diuretics, betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin-II receptor-blockers and PD were examined.// Results: Antihypertensive medications overall were associated with a lower risk of subsequent diagnosis of PD (OR: 0.94, 95% CI 0.90–0.97), with the negative association most significant for medications acting on the renin–angiotensin–aldosterone system. A positive association with diagnosis of PD was only seen for betablockers and restricted to those with relatively young age and not in those with longer treatment duration.// Conclusion: When taking into account underlying diagnoses, antihypertensive medications overall were associated with a reduced incidence of PD

Assessing Employee Perceptions of Information Technologies in Public Sector Digitalization

Introduction. The increasing role of digitalisation in the public sector is caused by the possibility of improving the quality of public services. However, the effective implementation of digitalisation in public organizations and its use is influenced by technological, organizational, environmental and human factors. Therefore, it is relevant to assess the perception of employees of government bodies and their perception of using information systems and technologies. Aim and tasks. The goal is to study the resilience of public organisations and employee reactions in crises using information systems. The stated goal determined the survey of employees’ opinions on the effects of the implementation and use of information and communications technology (ICT) in terms of improving communication and coordination in the organisation, crisis response capabilities, and satisfaction with the use of the system. Results. The study analysed the responses of representatives of various public administration and administrative management levels in Bulgaria, the results of which were analysed using IBM SPSS Statistics. The survey involved 73 employees of public organisations holding various positions, which made it possible to assess the perceptions and impact of ICT use by employees. In the context of this study, it has been proven that information systems technology supports communication and coordination in public organisations. This affects the system’s perceived usefulness and the employees’ handling of unexpected changes (crises). Resolving crises using information and communication technologies affects employee satisfaction, which contributes to increasing organisational resilience.  Conclusions. This study examines the attitude of employees working in public administration toward the use of information and communication systems and the strengthening of the digitalisation process. Based on rank correlation analysis, research hypotheses were proven. It was found that there is a relationship between the use of ICT, improved organisational coordination and communication, crisis management and satisfaction of public sector employees with the use of ICT. The above factors affect organisational resilience and the ability to adapt in the context of digital transformation

Association Between Hearing and Vision Impairment and Risk of Dementia: Results of a Case-Control Study Based on Secondary Data

Introduction: Hearing and vision loss are highly prevalent in elderly adults, and thus frequently occur in conjunction with cognitive impairments. Studies have shown that hearing impairment is associated with a higher risk of dementia. However, evidence concerning the association between vision loss and dementia, as well as the co-occurrence of vision and hearing loss and dementia, has been inconclusive. Objectives: To assess the association between: (i) either hearing or vision loss and the risk of dementia, as well as between; and (ii) the combination of both sensory impairments and the risk of dementia. Methods: This case-control study was based on a 5-year data set that included patients aged 65 years and older who had initially been diagnosed with dementia diseases by one of 1,203 general practitioners in Germany between January 2013 and December 2017. In total, 61,354 identified dementia cases were matched to non-dementia controls, resulting in a sample size of 122,708 individuals. Hearing loss and vision loss were identified using the ICD-10 diagnoses documented in the general practitioners’ files prior to the initial dementia diagnosis. Multivariate logistic regression models were fitted to evaluate the associations between visual and/or hearing impairment and the risk of dementia and controlled for sociodemographic and clinical variables. Results: Hearing impairment was documented in 11.2% of patients with a dementia diagnosis and 9.5% of patients without such a diagnosis. Some form of vision impairment was documented in 28.4% of patients diagnosed with dementia and 28.8% of controls. Visual impairment was not significantly associated with dementia (OR = 0.97, CI = 95% 0.97–1.02, p = 0.219). However, patients with hearing impairment were at a significantly higher risk of developing dementia (OR = 1.26, CI = 95% 1.15–1.38, p < 0.001), a finding that very likely led to the observed significant association of the combination of both visual and hearing impairments and the risk of dementia (OR = 1.14, CI = 95% 1.04–1.24, p = 0.005). Discussion: This analysis adds important evidence that contributes to the limited body of knowledge about the association between hearing and/or vision loss and dementia. It further demonstrates that, of the two, only hearing impairment affects patients’ cognition and thus contributes to dementia risk

Pre-diagnostic presentations of Multiple System Atrophy case control study in a primary care dataset

Background: We here report the pre-diagnostic clinical presentations of patients with Multiple System Atrophy (MSA) from analysis of a large routine clinical care database. Methods: Data were extracted from a primary care database in the German healthcare system for the period between January 2000 and December 2020. We identified 250 patients with new diagnosis of MSA and 250 controls matched for age, sex, and index year. Logistic regression analyses were conducted to assess association between MSA and predefined diagnoses. Results: The greatest rate increase in the 2 years preceding diagnosis of MSA was seen for hypotension and balance impairment but rates of memory problems, urinary dysfunction, dizziness and depression rates were also markedly increased, and ataxia was solely identified in those with a later diagnosis of MSA. Up to 5 years before diagnosis similar patterns were seen, but >5 years before diagnosis only depression rates were increased with a trend for increase in constipation. Conclusions: Presentations that were significantly more common in patients with MSA in the pre-diagnostic phase than in controls were autonomic complaints such as postural hypotension, urinary and bowel dysfunction, and early balance impairment. However, the study also highlights that memory complaints and depression may be early features of MSA years before diagnosis

A new approach to the treatment of female stress urinary incontinence associated with genital prolapse

The study was aimed to evaluate the clinical effectiveness of various methods of surgical treatment of urogenital prolapse in women under University Clinics. There was shown urgical treatment of genital prolapse requires an integrated approach and a combination of individual choice in different ways to treat the disease, adequate types and severity of defects vaginal anatomy and dysfunction of the pelvic organs, taking into account the patient's age as well as the presence of gynecologic and extragenital pathology. Proposed combined method of treatment of patients with genital prolapse effectively restored topographic conditions of uretrovesical segment and proximal urethra as wells as single sphincter mechanisms. Application of autotransplantation of adipose tissue in combination with a platelet-rich plasma into the paraurethral tissue significantly improved functional outcome of surgical interventions

Occupational Therapy After Myocardial or Cerebrovascular Infarction: Which Factors Influence Referrals?

Background: Cardiovascular diseases remain the number one cause of death worldwide, and many survivors suffer lasting disabilities. Occupational therapy can help such patients regain as much function as possible. However, little is known about the factors influencing referrals to occupational therapy after stroke or myocardial infarction (MI). Method: Data from the IMS Disease Analyzer® database were observed for a three-year period. The study population included 7,440 patients who were examined by a cardiologist due to stroke or MI. In addition to baseline characteristics, the presence of certain cardiovascular risk factors or comorbidities was recorded. Cox regression analyses were performed and the Charlson Comorbidity Index (CCI) was utilized. Results: Occupational therapy was received by 1,779 patients; 88.5% had suffered an MI and 11.5% a stroke. In the group without referral (n = 5,661), 60.7% had experienced an MI and 39.3% a stroke. No significant gender-related differences were observed. Younger age, an MI diagnosis, and the presence of hypertension positively influenced referral rate and time, while risk factors, such as adiposity, delayed therapy. The CCI was higher in the group with occupational therapy. Conclusion: The chance of being offered occupational therapy increased with younger age, history of MI, and the presence of hypertension. Future studies should also consider severity of ischemic lesion to account for the degree of remaining impairment

Identification of prodromal presentations of Parkinson's disease among primary care outpatients in Germany

Background: This study aimed to identify clinical features that predate the diagnosis of PD in a primary care setting. Methods: This retrospective case-control study was based on data from the Disease Analyzer database (IQVIA) and included 17,702 patients with Parkinson's disease and 17,702 non-PD controls matched for age, sex, and index year. We analyzed the prevalence of 15 defined diagnoses and symptoms documented within 2 years, ≥2 to <5, and ≥5 to <10 years prior to the index date in patients with and without PD. Logistic regression analyses were conducted to assess the association between PD and the predefined diagnoses. Results: The prevalence of motor, neuropsychiatric and autonomic features was higher in those with a later diagnosis of Parkinson's disease than controls for all three periods except for rigidity in the ≥2 to <5 and ≥5 to <10-year periods and erectile dysfunction in the most recent period before diagnosis. The clinical presentation recorded in the greatest percentage of patients was depression, followed by dizziness, insomnia, and constipation, but these were also common in the control population. The odds ratios were highest for increase in tremor, followed by balance impairment and memory problems, particularly in the latest period before diagnosis, and by constipation particularly in the earliest period examined. Conclusion: The prodromal features of PD could be identified in this large primary care database in Germany with similar results to those found in previous database studies despite differences in methodologies and systems

Possibility of the treatment effects on the dynamics of apoptosis processes in tissues of kidneys in acute pyleonephritis and comparative diabetes mellitus in the experiment

Programmed cell death under conditions of an infectious-inflammatory process plays a biologically exclusively positive role in the elimination of cells. Acute inflammatory process is a phenomenon capable of excessive concentration of aggressive effectors of inflammation. The aim of the work was to assess the dynamics of ultrastructural changes and early signs of apoptosis in the kidney tissues in experimental modeling of acute pyelonephritis (AP) and concomitant diabetes mellitus (DM) of type II and II when conducting complex drug correction. The work was performed on 300 adult Wistar rats, divided into 6 groups. Fragments of the kidneys were studied and photographed in the electron microscope PEM-100-01. In the kidneys of animals of the group, where traditional medical correction was used after the friendly modeling of pyelonephritis and type I diabetes, it was found that the glomerular ultrastructure was more preserved, but part of the capillaries of the glomerulus remained deformed with a narrowed lumen, there are signs of insufficient restoration of the glomerular capillary network. In the group of animals using the proposed complex drug correction, the renal structure was preserved, the capillaries of the glomerular network with unchanged architectonics. It has been established that the traditional medical correction did not sufficiently contribute to the restoration of damaged kidney tissue ultrastructure. After carrying out the complex medical correction proposed by us after a friendly simulation of an OP of DM type II, the ultrastructure of the kidney tissue in form and structure approached that of control animals, signs of a compensatory-restorative process appeared: most of the podocytes were hyperplastic and hypertrophied. The podocytes of the outer leaflet were in the active phase of activity, as evidenced by an increase in contractile function and, possibly, the release of urine from the cavity into the lumen of the proximal tubules. The structure of the tubules and interstitial tissue is close to the structure of the group of control animals, only in the cytoplasm of the podocytes of the proximal tubules there is an increased content of lysosomes. The ultrastructure of the glomeruli was normalized; the number of hypertrophic podocytes of the inner leaflet with signs of enhanced protein synthesis increased. Changes in the structures of the cortical and medulla are similar except for the state of cytotrabeculae, where their size decreased in the medulla and signs of deformation of the plasmolemma appeared. In experimental modeling of PD and DM of types I and II, pronounced ultrastructural changes in the kidney tissues were established, and manifestations of early apoptosis processes are significantly limited. The use of the complex drug correction proposed by us stimulates the development of the reparative processes of the kidney and moderately activates apoptosis. The addition of multi-vector preparations (Armadin and Nuklex) to the complex of treatment intensifies compensatory-restorative changes in the kidneys and apoptosis, which contributes to the elimination from the renal microstructures of excess damaged cells and aggressive effectors of inflammation

Impact of thyroid disorders on the incidence of non-alcoholic fatty liver disease in Germany

Background Studies investigating a potential association between hypothyroidism and non-alcoholic fatty liver disease (NAFLD) showed conflicting results and large-scale population-based data from Germany on this topic are currently missing. Objective It was the aim of this analysis to investigate the impact of thyroid gland disorders on the prevalence of NAFLD in Germany. Methods In this case-control study, using the German disease Analyzer database (IQVIA), NAFLD patients were matched to patients without NAFLD by age, sex, index year, treating physician, diabetes mellitus type II, and obesity. The main outcome of the study was an association between thyroid gland disorders (hypothyroidism, hyperthyroidism and autoimmune thyroiditis) and incident NAFLD and was evaluated using logistic regression analyses. Results 57,483 patients with NAFLD were matched to 57,483 patients without liver disease. Mean age of the cohort was 60.3 years (±14.1) and 52.3% were men. In regression analyses, hypothyroidism (OR 1.17, 95% CI 1.10 - 1.24, p < 0.001) as well as autoimmune thyroiditis (OR 1.53, 95% CI 1.35–1.73, p < 0.001) were associated with a higher risk of NAFLD. In contrast, hyperthyroidism was associated with a lower risk of NAFLD (OR 0.85, 95% CI 0.77–0.94, p < 0.001). The effect of hypothyroidism on the prevalence of NAFLD remained significant across men (OR 1.31, 95% CI 1.15–1.48) as well as women (OR 1.12, 95% CI 1.05–1.21). Conclusion Hypothyroidism seems to be a risk factor for incident NAFLD