National Statistics Institute Research Articles

Survival in very elderly patients with severe aortic stenosis submitted to TAVI compared to the general population

Abstract Introduction Severe aortic stenosis (AS) is the most common acquired valvular heart disease. Transcatheter aortic valve implantation (TAVI) is indicated as an alternative to surgery in patients (pts) with severe AS above 75 years old (yo) regardless of surgical risk. The prevalence of severe AS increases with age. In the very elderly, i.e. > 85yo, the presence of severe AS is often accompanied with important comorbidities and frailty. To improve pts assessment in the heart team, it is essential to characterize the outcomes of previous interventions in this challenging group of patients and that was the goal of the present study. Methods Single-center retrospective analysis, on prospectively collected data, of consecutive patients ≥85yo undergoing TAVI between 2015 to 2021. Successful TAVI, major procedural complications and 1-year mortality rates were defined according to the VARC-3 definition. Observed survival was compared to an age-matched population using life expectancy tables available at the portuguese National Statistics Institute. Simulated survival curves for an age-matched population were performed using an expected hazard rate of 0.14. This was a conservative approach assuming that mortality rate remained constant in the population during follow-up. Results A total of 767 pts underwent TAVI during the study period. Of these, 349 pts were ≥85yo and were included in our study. Median age was 87yo [IQR 86-89], 60% female (n = 211) with a median Euroscore II of 5% [IQR 4-7]. A total of 98 pts (28%) had previous coronary artery disease, 300 pts (85%) had chronic kidney disease and 22 pts (6%) had a previous stroke. Median mean aortic valve gradient was 49mmHg [IQR 42-60] and left ventricle ejection fraction was 55% [IQR 50-56]. 268 pts (77%) underwent an elective TAVI and the remaining 23% were urgent procedures after hospital admission. The transfemoral approach was used in 334 pts (96%) and 258 pts (74%) implanted a self-expanding valve. Median in-hospital time was 6 days [IQR 4-11] and most common complications were permanent pacemaker implantation (n=59, 17%) and major access-related complications (n=17, 5%). All-cause mortality at 30 days and 1 year were 2.1% (n=7) and 13.1% (n=46), respectively. This compares similarly to the group of younger pts (<85yo) which presented a 30 day and 1 year mortality of 2.8% and 12.8%, respectively. Among very-elderly, 35 pts (10%) were readmitted in the first-year post TAVI. The mean survival time in our cohort was 4.9 years compared to expected 6.2 years (figure, log-rank < 0.01). The mortality rate at one year was 13% (n = 46) in our cohort compared to expected mortality of 14% (n = 50), not statistically significant. Conclusion In this study, very old patients submitted to TAVI had a 1-year mortality rate similar to age-matched population and a mean survival time of more than 4 years, albeit inferior to an age-matched population.

Noise inequalities and cardiovascular diseases in Bulgaria

Abstract Background Social determinants of health in the physical environment are among the social determinants that greatly impact population health. At very high levels, noise can cause permanent changes in a person’s psyche but, even at lower levels, it can cause stress and disorders. Global burden of diseases studies arrange noise on the second position among the environmental risk factors, related to sleep disturbance, cardiovascular effects etc. The study aims to analyse noise pollution in Bulgaria and measure its association with cardiovascular diseases. Methods National Statistical Institute and Eurostat data were used to analyse the noise pollution in Bulgaria. The 28 regions were compared according to the proportion of surveyed points above permissible limits and the death rates due to CVD, /2022/. Data were statistically processed with SPSS v.26. To establish the correlation, the Pearson coefficient was used. Results Data provided by Eurostat reveal that 9% of the total population suffers from noise but there is a very positive trend - from 17.7% /in 2005/ to 8.7% /in 2023/. The share of surveyed points above permissible limits shows a continuing trend of maintaining a high percentage - 71.80% /2011/ and 68.62%/2022/. The district comparison shows significant variations - Blagoevgrad -17.65% and Silistra, Kyustendil and Razgrad with shares above 80%. The study found that almost all districts with the highest share of surveyed points above permissible limits have higher levels of death rate due to CVD. The results of statistical data analysis show that there is a positive moderate linear correlation between the share of surveyed points above permissible limits and the death rate due to CVD - Pearson coefficient 0.423 (p = 0.025). Conclusions The study found a moderate correlation between noise pollution and the death rate due to cardiovascular disease. CVD have a multifactorial genesis, but reducing noise in urban areas would help prevent these diseases. Key messages • As a result of the performed analysis, it can be concluded that the investigated indicators determining the degree of discomfort during the daily period remained high in Bulgaria. • The established health inequalities between regions and the increasing mortality from CVD are one of the factors for the deteriorating level of public health in Bulgaria.

Nexus between Gross Fixed Capital Formation, Household Loans and Savings in Bulgaria

The goal of this article is to analyze the impact of household savings and household loans on gross fixed capital formation in Bulgaria. The research is carried out on the basis of quarterly data for the 2010-2023 period. The sources of the data are the National Statistical Institute (NSI) and the Bulgarian National Bank (BNB). The algorithm of the empirical research includes: checking for stationarity by means of the extended Dickey-Fuller test; determining the optimal lag of the model; Johansen cointegration test; specification of vector error correction model (VECM). As a result of the research, it has been established that there is a long-term relationship between the variables gross fixed capital formation, household savings and household loans. At the same time, about 39.2% of the disequilibrium between the studied variables in a certain quarter is compensated in the next one.

ENVIRONMENTAL NOISE AND CARDIOVASCULAR DISEASES IN BULGARIA

Purpose: Noise has emerged as a leading environmental nuisance. Cardiovascular diseases rank first among the causes of death on a global scale and one of the possible effects of noise impact on the human organism. The study aims to analyze the level of noise pollution in Bulgaria and to measure its association with cardiovascular diseases. Methods: Data provided by the National Statistical Institute, Eurostat and other databases were used to analyze the noise pollution in Bulgaria. The 28 regions in Bulgaria were compared according to the proportion of surveyed points above permissible limits and the death rates due to cardiovascular diseases, /2022/. Data were statistically processed with SPSS v.26. Results: A positive fact is the absence of high values of noise levels in the range of 78-82 dB(A) and over 82 dB(A) and the decrease in the share of surveyed points with noise levels in this range during the analyzed period- from 27.3% in 2006 to 18.56% in 2022. The study found that almost all districts with the highest share of surveyed points above permissible limits have higher levels of death rate due to CVD. There is a positive moderate correlation between the share of surveyed points above permissible limits and the Death rate due to CVD - coefficient of Pearson is 0.423 (p=0.025). Conclusion: Cardiovascular diseases have a multifactorial genesis, but the reduction of noise in urban areas would help prevent these diseases.

Patterns and trends in melanoma mortality in Spain (1999-2022).

To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

Mobility patterns in Austrian and Italian municipalities in the decade before and during the COVID‐19 era

AbstractIn European countries, where the demographic transition has reached advanced stages and the natural increase has fallen below zero, migration constitutes a significant component of local population change. We investigate to what extent the dynamics of international migration and internal mobility changed during the first waves of the COVID‐19 pandemic, compared to the previous decade. We focus on Austrian and Italian municipalities to assess the contribution of migration components to local population growth, using official data provided by National Statistical Institutes on inflows and outflows of migrant and native populations, from 2010 to 2020. The adoption of harmonized degrees of urbanization allows us to profile spatial and demographic patterns of mobility, in the Austrian and Italian territories. We apply Bayesian‐Geostatistical models, and Artificial Neural‐Networks to investigate the potential determinants of mobility variability. The results reveal Austrian and Italian population‐specific migration trends. Overall, the trends observed in the decade before the pandemic were either confirmed or further accentuated during the COVID‐19 era. Although rural‐urban mobility generally persisted in both countries, counter‐urbanization trends were detected among Austrian populations during the initial period of the COVID‐19 pandemic. Conversely, urban and intermediate municipalities in Italy maintained their attractiveness and capacity to retain Italian populations. These findings offer new empirical insights into urbanization dynamics in a comparative perspective, which are particularly relevant for the definition of European regional policy aimed at matching local needs with national social cohesion goals.

Quantifying the impact of an abrupt reduction in mineral nitrogen fertilization on crop yield in the European Union

Contemporary crop production in Europe relies on nitrogen (N) fertilization. Fertilizer prices soared in 2021–2022, and remained at historical high levels in 2023. These high prices invoked an immediate concern on the possible consequences for Europe's food production.In this study, we use a biogeochemical model framework to estimate the impact of reducing mineral N fertilization on crop yields in the European Union (EU). First, crop yields simulated with the biogeochemical DayCent model are evaluated against subnational yield data averaged for 2015–2018 reported by Eurostat and National Statistical Institutes in the EU for soft wheat, barley, grain maize and rapeseed. Then, we simulate three different scenarios where mineral N fertilization across the EU is abruptly reduced by respectively 5, 15 and 25 %, and compare yields to the projected baseline for contemporary conditions (2019–2022).The model evaluation gives r2 values ranging from 0.28 (rapeseed) to 0.61 (soft wheat) and root mean square errors (RMSE) ranging from 0.6 (rapeseed) to 1.95 t ha−1 (maize). The model shows a reduction in yield per crop at the EU level up to 2.1, 6.4 and 11.2 % with the 5, 15 and 25 % reduction scenario, respectively. Different crops show different percentage reduction in yield following a reduction in mineral N fertilization, showing a legacy effect over the years and depending on the availability of organic fertilizer. The strongest relative yield reduction occurs for soft wheat for all three scenarios. Even with 25 % drop in mineral N fertilization, maize yield in the Netherlands, Belgium and Denmark is not significantly reduced, because of the high N surplus and large share of organic fertilization in these countries.This process-based modelling study provides spatially explicit, high resolution information on the response of crop yields to N fertilizer input reductions, helping policy-makers in decision-making on food security and environmentally-friendly food systems.

Overeducation under different macroeconomic conditions: How Spanish university graduates fit in the labor market?

This paper analyzes a relevant issue for education and labor policymakers, overeducation in the early careers of university graduates. Using Spanish data, we investigate the role played by the business cycle and field of study and their interaction in shaping both the incidence and persistence of overeducation. We also analyze the relevance of specific types of knowledge and skills as driving factors in reducing overeducation risk. Our data come from the Survey on the Labor Insertion of University Graduates (EILU) conducted by the Spanish National Statistics Institute in 2014 and 2019. The survey collects rich information on cohorts that graduated in 2019 and 2014, during the Great Recession and the subsequent economic recovery, respectively. Our results show, first, the relevance of the economic scenario when graduates enter the labor market. Graduation during a recession increases overeducation risk and persistence. Second, a clear heterogeneous pattern is observed across fields of study, with health sciences graduates displaying better performance in terms of both overeducation incidence and persistence and less impact of the business cycle. Third, we find evidence that some transversal skills can help to reduce overeducation risk in the absence of specific knowledge required for the job, thus indicating some kind of compensatory role. Our findings have important policy implications. Overeducation, and more importantly overeducation persistence, imply a non-neglectable misallocation of resources, with serious consequences not only for the affected individuals but for the society as a whole. Therefore, policymakers need to address this issue in the design of education and labor market policies, seeking to ensure that the competencies acquired at university provide graduates with a better fit in the labor market.

Measuring error in the Demographic Index – steps towards a future population statistics system in England and Wales

ObjectiveWe are developing methods to measure the quality of the Demographic Index at a National Statistics Institute. The Demographic Index is the foundational dataset for a future, transformed, population statistics system for England and Wales. It clusters records for individuals across many years of health, education, and tax data, and assigns them a unique ID. Previous research has helped us to conceptualise three types of error in the Demographic Index: clustering error, coverage error, and data measurement error. We are currently working on estimating one type of clustering error, whereby records for two individuals are mistakenly assigned the same ID (“false positive clusters”). ApproachPrevious work has allowed us to identify variables associated with false positive clusters. We are now working on a stratification method, whereby each ID in the Demographic Index is scored according to how likely it is to contain this error. We plan to measure uncertainty using bootstrapping. Results and ConclusionsThis work is ongoing, and we hope to obtain results by summer 2024. ImplicationsIt is vital for us to understand and measure error in the Demographic Index because this is necessary for measuring error in any statistics derived from the Index. And it is crucial that population statistics made by any future system should have measures of error. Assuming that our work shows promise, we will continue by measuring other types of error, and by creating use cases to test how these measures can be fed forward into secondary analyses (e.g. population estimation).

Measuring Data Quality from Building Registers: A Case Study in Italy

Geographic data quality is a complex issue requiring continuous operational improvements. Considering this to be one of the most topical research and technical issues in official statistics and environmental monitoring, this study re-connects the operational dimension of ‘geographic data quality’ with the broader issue of monitoring the quality of official statistics. By estimating the accuracy of public (spatially explicit) data, this study illustrates an operational framework with an exploratory exercise in estimating the geographic data quality characteristic of a specific information source within the official statistical system (i.e., building registry) in a given European country, namely, Italy. The results of this exercise provide a paradigmatic example of profound innovation in the activities of statistical services in Europe and specifically the Italian National Statistical Institute (Istat), transitioning from independent (and poorly connected) field surveys to an integrated system of registries. Since several studies are based on spatially explicit survey units, it is essential to estimate the quality of geographical data, especially those derived from information sources where space is topical information, such as (local, regional, or national) building registers. Thanks to the results of an empirical exercise applied to Italian building registers, the present article will discuss the issue of data accuracy, considered the main issue related to monitoring geographic data quality, from an official statistics’ perspective. Statistical indicators will be proposed for the assessment of systematic and random errors of spatially explicit measures, possibly enabling a quali-quantitative improvement in the semantic content of building registers that address the inherent requirements of official statistics. Such indicators have some positive implications for the entire system of official statistics in Italy and, for generalization, within the European Statistical System.

REVIEW OF THE PANDEMIC PERIOD, REORGANIZATION OF THE SZEKLERLAND’S TOURISM OFFER

The study seeks to answer the question of how the counties of Szeklerland, Harghita, Covasna and Mureș in Romania have changed in recent years, primarily between 2017 and 2022, in the middle of which period the pandemic which began in 2020, triggered various difficulties. Data from the Romanian National Statistical Institute were used in the research, providing insights into the changes in tourism in Romania and Szeklerland. The data include yearly changes, such as changes in the number of accommodation establishments, their occupancy rates or the number of guests arriving at the establishments, as well as monthly breakdowns, which are mainly necessary for the analysis of seasonality. The results obtained from the secondary data analysis used in the study reflect the nature of the difficulties faced by the tourism sector during the pandemic period and the trends in the efficiency of tourism supply in the period preceding and following the pandemic. The 2010s have clearly been a year of step-by-step development and minor successes in tourism, culminating in 2019 in terms of the turnover of accommodation in Szeklerland. During this period, a number of new tourist units opened their doors, with 35,889 new beds added in Transylvania between 2012 and 2022 and 2,427 new beds added in Szeklerland between 2012 and 2022. After a good period for the sector, a slight change in trend started in 2020, mainly due to the fact that tourists started to prefer trips that require less personal contact with other tourists, but also due to a significant change in their accommodation needs, with an increase in both the number of accommodation units and the number of beds for higher quality accommodation types, while the opposite is observed for lower quality accommodation types.

Epidemiological estimates of paroxysmal nocturnal hemoglobinuria in Bulgaria.

Paroxysmal nocturnal hemoglobinuria is a rare clonal hematopoietic stem cell disorder with debilitating health consequences if untreated. Although cases have been described globally, precise epidemiological distribution is difficult to assess due to geographical underrepresentation in disease reporting. Evaluation of the burden of paroxysmal nocturnal hemoglobinuria in Bulgaria is currently missing. To provide epidemiological estimates, a systematic literature search for publications in the Bulgarian language or by Bulgarian authors was performed for a ten-year period (2013-2022), and clinically relevant information on case presentation was collected. Additionally, data was retrieved from the National Health Insurance Fund and National Statistical Institute on the count of registered cases with ICD-10 code "D59.5" and census for the same period. The estimated prevalence of paroxysmal nocturnal hemoglobinuria is relatively lower in the Bulgarian population than in other countries, and it is estimated to be 2.77 cases per 1,000,000 patient years. The treatment pattern mainly shows conventional blood product support use and is consistent with the pre-complement inhibition era. Underdiagnosis, lack of a reliable disease reporting system, and, until recently, restricted access to complement inhibitor therapy are significant impediments to the management of paroxysmal nocturnal hemoglobinuria in Bulgaria.

Integrating word embedding and topic modeling for sentiment analysis: A case study on the social mood on economy

In recent years, textual analysis and embedding spaces have become essential and complementary tools for sentiment analysis in National Statistics Institutes’ research, owing to their ability to summarize discussed topics effectively. Istat has developed an innovative tool, wordembox, which allows external users to explore the outputs of popular word embedding algorithms, such as Word2Vec and FastText. This tool enriches the analysis with a novel graph functionality, enabling users to discover clusters of words and facilitating implicit topic modeling. This article focuses on Social Mood on Economy (SME) posts over a period in which the index recorded a strong downward trend: the first month of the Russia-Ukraine conflict at the beginning of 2022. We compare findings from wordembox with standard topic modeling techniques, including Bayesian Latent Dirichlet Allocation (LDA), Top2Vec, and BERTopic, recent methods that extract clusters from word embedding spaces. These techniques show coherent results, and their combined use in textual analysis may create a synergy that enhances the informative content of synthetic indexes such as ‘Social Mood on Economy Index (SMEI)’.

Organizational sustainability to support Trusted Smart Statistics: Istat’s experience

The datification processes have driven National Statistical Institutes (NSIs) to explore new data sources with the goal of enhancing the quality of statistical information. The creation of innovative statistical products, known as Trusted Smart Statistics (TSS), necessitates new production processes that integrate with traditional methods, maintaining levels of relevance, quality, and trust. To facilitate this transition in statistical production, NSIs must embark on change management initiatives involving all organizational dimensions engaged in statistical processes. In the scientific debate, sustainability has assumed a broad connotation. This paper delves into the organizational aspect, viewing sustainability as a paradigm that encompasses all organizational areas and their interactions crucial to supporting the shift to new statistical production models, without compromising traditional practices. The paper explores the path taken by Istat in this direction, the organizational solutions implemented, the benefits realized, and investments in research and innovation initiated years ago on new data sources, aligning with developments in the European statistical community. Istat has been at the forefront of big data experimentation in Europe for over a decade, implementing a modernization program and establishing research infrastructures. Istat took a significant step by founding the TSS Center to guide organizational adaptation at technological, methodological, legal, communication, and human resources levels toward the new production system.

Selective editing for asymmetry analysis in intra-EU trade Micro-Data Exchange (MDE)

Since January 2022, the Regulation on European Business Statistics (EU 2019/2152) requires EU Member States to compulsorily share microdata on intra-EU exports. Establishing intra-EU export Micro-Data Exchange (MDE) provides National Statistical Institutes with a new data source to compile intra-EU import statistics. The availability of MDE tackles two key challenges: diminishing the overall response burden on data providers and meeting user expectations regarding the quality of the produced statistics. However, transitioning to a data production system based on MDE data requires the assessment of the coherence and comparability between MDE and National import data. To identify asymmetries between the two data sources, Istat developed an innovative application designed to foster cooperation among Member States. The tool was developed using the Shiny package in R. The implemented solution allows users to perform exploratory analysis, systematic error detection, and selective editing. The most relevant asymmetries are identified through relative contribution and the asymmetry suspicion indices assessed by user-defined thresholds. Sharing the open tool within the European Statistical System enhances interoperability, promotes method harmonization, and encourages the adoption of official statistical standards.

Predicting Tourist Arrivals: A Google Trends-Based Model for Destination Management

In this paper, a review of the scientific literature on the importance and knowledge of the tourist destination for the formation of a correct strategy for its development and promotion is made. The possibility of managing the tourist destination by modeling with Google Trends data is represented. A review of studies using the mentioned tool in the field of tourism is conducted. The potential benefits of using Google Trends data on searches for a city as a keyword in combination with archival data are summarized. The possibilities for modeling the visits of tourists using data from Google Trends are investigated, as a result of which a model is built by applying polynomial regression to predict the overnight stays of foreign citizens in the city of Veliko Tarnovo based on archival data from the National Statistical Institute and Google Trends data. Through data analytics with Google Trends, it is concluded that key value is created for the external and internal environment, influencing the destination. The data creates conditions for the development of management strategies for attracting tourists based on primary and secondary data for analysis. The application of the received data sets through data analysis are also important for tourism organizations and institutional bodies in tourism (macro- and meso-level). The resulting analysis affects issues related to the management and marketing of the destination, and on the other hand, it directly affects the segmentation of the market and the distribution of products and services to the end user (micro level).

Socioeconomic Status and Rate of Poverty in Overweight and Obesity among Spanish Children and Adolescents.

This study aimed to analyze the relationship between socioeconomic status (SES), poverty rate, and the prevalence of overweight/obesity or obesity in children and adolescents aged 2-14. Parents or guardians reported the weight and height of participants, used to calculate body mass index (BMI) and BMI z-scores according to the International Obesity Task Force standards. Participants were categorized into "overweight/obesity" and "no overweight/obesity" and further into "obesity" and "no obesity". The rate of poverty rate was determined using data from the National Statistics Institute of Spain, defining it as the percentage of people with income below 60% of the national median. SES was based on the head of household's occupation and categorized into low, medium, and high levels. Adjusted multilevel models showed participants with medium or high SES had lower odds of overweight/obesity compared to those with low SES (medium SES: odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.54-0.73; high SES: OR: 0.59, 95% CI: 0.49-0.70). Participants in the high-poverty group had higher odds of having overweight/obesity (OR: 1.40, 95% CI: 1.13-1.74) compared to the low-poverty group. The study highlights significant socioeconomic disparities in childhood overweight/obesity, emphasizing the potential impact of SES and poverty on health outcomes in Spanish children and adolescents.

Chronic Myeloid Leukemia in Bulgaria in the New Millennium: Identification of Directions for Improvement in Management and Outcomes Reporting

Background: In the last two decades, tyrosine kinase inhibitors (TKIs) and advances in molecular diagnostics have revolutionized management and long-term clinical outcomes in chronic myeloid leukemia (CML). Real-world data from different countries allow for the identification of country-specific issues in the clinical management and development of specific plans for improvement. Here, we aimed to analyze the trend in overall survival in Bulgarian CML patients since 2000. Methods: We retrieved publicly available Bulgarian CML data from several sources such as the Bulgarian National Cancer Registry, Bulgarian National Statistical Institute, and National Health Insurance Fund since 2000. We used the retrieved data of a total of 1513 Bulgarian CML patients to describe the trends in overall survival (OS), conditional overall survival, life expectancy, and life years lost over five time periods. We also described the trends in healthcare expenditures for TKIs and CML patients’ coverage with TKIs since 2014. Results: In both uni- and multivariate models, we found a constant increase in OS over the three 5-year periods until 2014. The period 2015–2019 was not associated with an additional increase in OS. Identical dynamics in the improvement in life expectancy (LE) and in life years lost (LYLs) was observed. Additionally, conditional 5-year survival did not improve during 2015–2019 in comparison to 2010–2014. Population-level data did not show consistent changes in the documented number of deaths due to CML since 2013. The period after 2013 is marked by a constant increase in the annual expenditures for TKIs, reaching to about 2.0 EUR/capita. The number of patients who received at least one TKI also increased during that period. Conclusions: After the initial significant improvement in the clinical outcomes for Bulgarian CML patients until 2014, subsequent periods did not bring further benefit in spite of the improved coverage with second- and third-line TKIs. Multiple factors may contribute to these suboptimal outcomes. Therefore, one can propose several additional measures at the country level, which could lead to additional improvement in the OS of Bulgarian CML patients.

Is creativity a reality in Bulgaria cities? An empirical study in the pre-pandemic period

This study aims to obtain a composite index characterizing Bulgarian districts about their creativity by presenting results for the pre-pandemic. The composite index developed by Rodrigues and Franco (2019), use of quantitative method and multivariate statistical techniques have been used to answer this objective. From the data gathered primarily from NSI- The National Statistical Institute of Bulgaria, the results show that creativity is one of the pillars of economic growth, and financial resources and local and foreign investment for its development are still very limited. The government and cultural organisations supported initiatives to showcase the country's cultural diversity and historical significance. The creative sector, including design, arts, media, and technology started to be seen as a driving force for the country's economic growth. Startups and creative entrepreneurs are increasingly gaining weight, which has led to the creation of creative centers, and co-working spaces. Therefore, this study contributes to the intelligent application of creative cities’ ideas in the creative industries and contemporary cities’ management.

Feelings and alcohol consumption

Consumption choices depend on the feelings experienced in the period preceding a consumer's decisions. We confirm this hypothesis using a large sample of Italian consumers collected by ISTAT (the Italian National Statistics Institute) as part of the multi-purpose survey “Indagine multiscopo sulle famiglie: Aspetti della vita quotidiana” (n = 114,052). Specifically, positive feelings are associated with wine and beer consumption, while negative feelings relate to spirits consumption. The latter pattern is common among men and women, whereas the former is only applicable to male consumers. Additionally, older consumers drink more following a period of positive feelings, whereas younger consumers drink less. Our two-level modelling strategy confirms the mediating role of personal characteristics in explaining the relation between feelings and alcohol consumption.