Southeastern Europe Research Articles

Economic Performance of Balkan Countries

The issue of analyzing the factors of the dynamics of the economic performance of each economy, which means the countries of the Balkans (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, North Macedonia, Montenegro, Romania, Serbia, Slovenia, Greece and Turkey), Southeastern Europe, is continuously very current, challenging, significant and complex. Adequate control of key factors can have a significant impact on the achievement of the target economic performance of each economy, including the Balkan countries. The application of multi-criteria decision-making methods enables adequate control of the key factors of the economic performance of the economies of the Balkan countries. In terms of economic performance, Serbia is in a better position than Croatia and Slovenia. Kosovo is in the worst economic position. The target economic performance of the countrymen of the Balkans can be achieved by managing inflation, and unemployment, and receiving personal remittances as effectively as possible.

A nineteenth-century urban Ottoman population micro dataset: Data extraction and relational database curation from the 1840s pre-census Bursa population registers

In recent decades, the “big microdata revolution” has transformed access to transcribed historical census data for social science research. However, the population records of the Ottoman Empire, spanning Southeastern Europe, Western Asia, and Northern Africa, remained inaccessible to the big microdata ecosystem due to their prolonged unavailability. This publication marks the inaugural release of complete population data for an Ottoman urban center, Bursa, derived from the 1839 population registers. The dataset presents originally non-tabulated register data in a tabular format integrated into a relational Microsoft Access database. Thus, we showcase the extensive and diverse data found in the Ottoman population registers, demonstrating a level of quality and sophistication akin to the censuses conducted worldwide in the nineteenth century. This valuable resource, whose potential has been massively underexploited, is now presented in an accessible format compatible with global microdata repositories. Our aim with this dataset is to enable historical demographic studies for the Ottoman realm and beyond, while also broadening access to the datasets constructed by our large research team.

Affordability of cigarettes in ten Southeastern European countries between 2008 and 2019

BackgroundThe empirical evidence shows that tobacco consumption is strongly associated with its affordability. The nominal growth in tobacco prices imposed by taxation should exceed or at least keep pace with...

Analyzing the Associations between Physical Literacy, Physical Activity Levels, and Sedentary Behavior: Cross-sectional Study in Preadolescent Children

Physical literacy (PL) is considered an important determinant of physical activity level (PAL), but studies have rarely examined the associations between PL and PAL in preadolescents. This study aimed to evaluate associatios between PL, PAL and sedentary behavior (SB) in preadolescents from southeastern Europe. The participants were 9- to 11-year-old children from Croatia and Bosnia and Herzegovina (n=333, 52% girls) who were tested for PL, PAL and SB. The PLAYself questionnaire was used for the evaluation of PL, while PAL was estimated by data provided throughout the Physical Activity Questionnaire for Children (PAQ-C). Pearson’s correlations and multiple regressions were calculated to identify the associations between study variables. The results revealed a significant correlation between PL and PAL in the total sample (16% of the common variance) among boys (10% of the common variance) and girls (25% of the common variance), which was additionally confirmed by multiple regression calculated between the PL subdomains and PAL (R2=0.23, 0.15, and 0.31 for total sample, boys and girls, respectively). The SB was not significantly correlated with PL (<2% of the common variance; p>0.05) or with PAL (<1% of the common variance; p>0.05). The results indicated a stronger association between PL and PAL in girls than in boys, indicating the possible influence of the types of physically demanding activities children are involved in on the studied associations. To explore causality more specifically, intervention studies are warranted.

The influence of Turkish cuisine in Romania

Romania is a major country in south-eastern Europe, located in the northern region of the Balkans. Due to Romania's proximity to Western European countries and the transit routes that reach these countries, various peoples have settled in Romanian lands since ancient times. Between 1400 and 1878, the Ottoman Empire ruled Romania. The Turks brought their unique cuisine along with the other customs and traditions to the places they conquered. In Romania, and particularly in the Dobruja region, we see the interplay of Turkish names in kitchenware and food and drink.

KozhukhovaE.I., MustafinKh.Kh., SemenovV.A., UchanevaE.N. Reconstructing Ethnocultural Processes in the Sausken Valley (Tuva) during the Later Half of the 1st Millennium BC

The article represents findings of the group research devoted to reconstructing ethnocultural processes of the second half of the 1st millennium BC (Sausken Terrain Feature, Tuva). The research comprehensively studies local population groups who left behind their burial monuments in Eerbek River Valley. The study engages geneticist, ancient technologies experts, anthropologists and archaeologists. Kurgans of the middle and late Uyuk-Sagly Culture (5th–2nd century BC) were excavated in 2011–2016 by Tuva archaeological expedition arranged by the Russian Academy of Sciences Institute for the History of Material Culture. Nearly all burials in the kurgans had been robbed back in the ancient days. The study analyses above-ground structures and internal layouts of the kurgans, the burial ritual and tools (weapons, mirrors, belt accessories, bone items, embellishments). It allows to conclude that the kurgans have varying cultural attributions. The research also implies instrumental process analysis of glass and stone beads, chromatography of fabrics and proteomic analysis of archaeological leather. The paper reveals radiocarbon dating (14C) and correlations with other burial monuments of the Scythian Tuva. Craniological materials analysed allow to determine populations that could have been related to the aliens who arrived at the Eerbek River Valley in the Uyuk times. The Ozen-Ala-Belig groups differ from their peers from other territories in Tuva. It might be explained through the Uyuyk migrants mixing with the Eerbek Valley people who had been living there since the late Bronze Age. The paleogenetic study of 19 items especially focuses on researching the Y-chromosome DNA. For many researched samples the study determines haplogroups Q1b1a3-L330 and R1a1a1b2-Z93 (or its subgroups). The area of spread for these haplogroups is Soviet Central Asia, Central Asia, West and South Siberia. One samples is assigned to I2a1b1-M223 haplogroups with the area of spread in the Balkans and South-Eastern Europe. The obtained findings may indicate that the Western and Eastern nomads kept in touch during the researched period. The archaeological, anthropological and genetic data lead to a conclusion that the Scythian cultures in the given region is complex and multi-faceted.

Catalogue of Sceliphron destillatorium (Illager, 1807) (Hymenoptera, Sphecidae) specimens deposited in the State Museum of Natural History NASU, Lviv, Ukraine

Representatives of the genus Sceliphron Klug, 1801 are found in almost all biogeographical regions of the world (Yuan, 2022). At present, 35 species of this genus have been known (Pulawski, 2020). Of these, six species have been recorded from the territory of Ukraine as follows: three invasive species: Sceliphron caementarium (Drury, 1773); Sceliphron curvatum (Smith, 1870) and Sceliphron deforme (F. Smith, 1856) (Kletʹonkin, 2023); and three native species: Sceliphron destillatorium (Illiger, 1807); Sceliphron madraspatanum (Fabricius, 1781) and Sceliphron spirifex (Linnaeus, 1758) (Tymkiv et al., 2015). The most common is Sceliphron destillatorium (Illiger, 1807), which occurs throughout the territory of Ukraine. Representatives of the genus Sceliphron Klug, 1801 belong to two subgenera: Sceliphron and Hensenia. Although species of both subgenera take care of their offspring and feed the larvae with spiders, their nests differ in shape and number of mud cells. Wasps of the subgenus Hensenia build a certain number of single-celled mud nests in shape of jugs. Instead, wasps of the subgenus Sceliphron build cells that joint into large mud nest. S. destillatorium is the South–Palaearctic species. Its range covers the Mediterranean region (southern and south-eastern Europe, northern Africa and south-western and southern Asia) (Wisniowski et al., 2013). S. destillatorium is a solitary wasp. It belongs to the family Sphecidae (Insecta: Hymenoptera) of the subgenus Sceliphron (Gülmez1 et al, 2017). S. destillatorium female builds a nests of the moist soil material, which she collects and transports herself. The nest consists of tubular cells placed side by side, the number of which varies (Chatenoud et al., 2012). After building the first cell, the female hunts spiders to feed her offspring (Pytel-Huta, 2023; Yuan, 2022). Female S. destillatorium brings the paralysed spider into the cell, lays an egg and continues to hunt. Each cell stores a certain number of spiders. The number depends on the size of the victims and the sex of the future generation. Once the cells have been built, the female S. destillatorium covers them with an additional layer of soil (Polidori, 2005). In the wild, females build their nests in shady, sheltered places (rock ledges, empty tree trunks, etc.). However, at present, they are increasingly nesting in people's houses (usually under roofs, attics, etc.) (Yuan, 2022). Adult wasps feed on angiosperm nectar. The collection of the State Museum of Natural History, National Academy of Sciences in Lviv contains 14 specimens of this species collected in the western part of Ukraine and one specimen collected in the central part. A few samples (4) of this species were collected in 1922, 1923 and 1926, collector – J. Noskiewicz. The date and place of collection of the remaining specimens are unknown. All data have been entered into the web resource Data Centre “Biodiversity of Ukraine” http://dc.smnh.org/.

Influence of atmospheric rivers on extreme precipitation in western Ukraine

Formulation of the problem. In recent years, interest in the atmospheric river (AR) phenomenon is growing, as more and more researchers associate it with extreme precipitation. Relatively few works are devoted to the assessment of the influence of atmospheric rivers on precipitation in Eastern Europe. The purpose of the article is to assess the occurrence of atmospheric river events during extreme precipitation in the western regions of Ukraine (Lviv and Volyn regions) and to analyze the geographical features of the spatial distribution of atmospheric river bends during extreme precipitation. Methods. We used the catalog of atmospheric rivers identified according to the methodology of D. Walliser and B. Guan to analyze the occurrence of atmospheric river events on the territory of the western part of Ukraine. Also, we used the sample of days with extreme precipitation (greater than 95th percentile for each meteorological station and each month) in the Lviv and Volyn oblasts of Ukraine to match it with AR episodes. It is shown that in most cases extreme precipitation events were accompanied by the atmospheric river phenomenon detected on the territory of Ukraine or the bordering territories. Results. The typical shape of atmospheric river bends during extreme precipitation most often is arc-shaped while the typical spatial coverage stretched from North Africa through the Mediterranean Sea and Turkey to the territory of Ukraine. Less often, the form of detected AR area had the form of a meridional bend extending from the eastern part of the Mediterranean Sea towards Ukraine. However, the analysis showed that the presence of atmospheric river phenomenon is not the exceptional reason for extreme precipitation. Part of the extreme precipitation events is associated with specific synoptic situations (precipitation caused by cold fronts or occluded fronts) whereas conditions for atmospheric river detection are not fulfilled (bend size, meridional flow component, flow intensity). Atmospheric river episodes were not observed at most of the days of general sample (on average 72.36%) within the study area based on the period of 1991-2020. At the same time, precipitation events in the absence of AR were recorded on average in 32.2% of days (relative to the total number of days). In the presence of AR, precipitation was not recorded in about a third of cases. In the sample of days in the absence of AR and in the presence of AR, the proportion of precipitation of different gradations is as follows: for 10-20 mm is 2.73% and 2.64% respectively; for 20-50 mm is 1.37% and 1.63%; more than 50 mm is 0 .19% against 0.16%. In the spring, there is a certain consistency with the negative daily value of the NAO index and the AR axis orientation from the southwest to the territory of Ukraine. Thus, within 5 days before the localization of AR on the territory of Ukraine, values of the NAO index <-0.5 are noted, but the index changes in the process of the pressure field change. Based on a limited sample of extreme precipitation (94 cases), we assessed the correspondence of the precipitation rate to the area of atmospheric rivers and their features of the spatial orientation. ARs extending from the southwest (north of Africa) and the south (western part of the Mediterranean Sea) are characterized by the greatest recurrence. No regularities were found either concerning the dependence of the precipitation rate on the orientation of the AR, or concerning the dependence of the number of stations with extreme precipitation on the orientation of the AR. No linear dependence was found for the area of atmospheric rivers within both the study region and the territory of Eastern and Southeastern Europe with daily precipitation in the western regions of Ukraine.

The current pathogenicity and potential risk evaluation of Crimean-Congo hemorrhagic fever virus to cause mysterious "Disease X"-An updated literature review.

Crimean-Congo hemorrhagic fever (CCHF) is a severe and potentially lethal illness. Tick bites of the Hyalomma genus are the primary source of transmission of CCHF to humans. The virus responsible for CCHF is the CCHF virus (CCHFV). It is a single-stranded negative sensed RNA virus. The virus belongs to the Orthonairoviridae genus within the Nairoviridae family. It occurs in an extensive geographical area spanning the Middle East, western China, southern Asia, southeastern Europe, and much of Africa. The current study aimed to evaluate the pathogenicity and potential risk of CCHFV to cause a public health emergency of international concern. We searched updated relevant information from PubMed, Google Scholar, and Scopus databases using Crimean-Congo hemorrhagic fever, tick-borne virus, and Nairovirus as keywords. The case fatality rate (CFR) varies by region. It can be more than 30% in some cases. Three segments in the genome of CCHFV (L, M, and S) are different in size and function. It is unknown whether the pathogenicity of CCHFV varied based on the genomic diversity. CCHFV can be transmitted through tick bites, handling of infected ticks, contact with infected humans, contaminated body fluids, and so on. A wide range of severity is associated with CCHF, ranging from a moderate fever with no apparent cause to increased vascular permeability, failure of several organs, bleeding, and shock. Hospitals with high-level isolation units should be the first choice for treating CCHF patients. Individual safety equipment is crucial in healthcare to prevent the spread of the virus. In the farm environment, using integrated pest management techniques, minimizing activity in tick-infested regions, and dressing appropriately in long sleeves and pants will help to reduce the risk of CCHFV infection via tick bites. There are no approved vaccinations or therapeutics for CCHF except supportive therapeutic approaches. Therefore, scientists recommend early ribavirin therapy for cases of high-risk exposures.

Paleoclimate changes and ecosystem responses of the Bulgarian Black Sea zone during the last 26000 years

Multi-proxy analysis (spore-pollen, dinoflagellate cysts, other non-pollen palynomorphs (NPPs), radiocarbon dating and lithology) was performed on marine sediments from three new cores retrieved during the two cruise expeditions on board the Research Vessel “Akademik” in 2009 and 2011. The Varna transect comprises three cores extending from the outer shelf, continental slope and deep-water zone. The record spans the last 26000 years (all ages obtained in this study are given in calendar years BP (cal. yrs BP)). The pollen record reveals the spreading of steppe vegetation dominated by Artemisia and Chenopodiaceae, suggesting cold and dry environments during the Late Pleniglacial – Oldest Dryas (25903–15612 cal. yrs BP). Stands of Pinus and Quercus reflect warming/humidity increase during the melting pulses (19.2–14.5 cal. ka BP) and the Late Glacial interstadials Bølling and Allerød. The Younger Dryas (13257–11788 cal. yrs BP) coldest and driest environments are clearly demonstrated by the maximum relative abundance of Artemisia and Chenopodiaceae. During the Early Holocene (Preboreal and Boreal chronozones, 11788–8004 cal. yrs BP), Quercus appeared as a pioneer species and, along with other temperate deciduous arboreal taxa, formed open deciduous forests as a response to the increased temperature. The rapid expansion of these taxa indicates that they survived in Glacial refugia in the coastal mountains. During the Atlantic chronozone (8004–5483 cal. yrs BP), optimal climate conditions (high humidity and increased mean annual temperatures) stimulated the establishment of species-rich mixed temperate deciduous forests. During the Subboreal chronozone (5483–2837 cal. yrs BP), Carpinus betulus and Fagus expanded simultaneously and became more important components of mixed oak forests and probably also formed separate communities. During the Subatlantic chronozone (2837 cal. yrs BP to pre-industrial time), climate-driven changes (an increase of humidity and a cooling of the climate) appear to be the main drivers of the specific vegetation succession expressed by increased abundance of Alnus, Fraxinus excelsior and Salix along with lianas, suggesting formation of flooded riparian forests (so called ‘Longoz’) lining the river valleys along the Black Sea coast. The first indicators of farming and other human activities have been recorded since 7074 cal. yrs BP. The dinoflagellate cyst (dinocyst) assemblages have been analysed to assess the changes in the Black Sea environment over the last 26000 years in terms of fluctuation in paleoproduction and surface water conditions related to changes in climate, freshwater input and Mediterranean water intrusion. Two major dinocyst assemblages were distinguished: one dominated by stenohaline freshwater/brackish-water species and a successive one dominated by euryhaline marine species. The changes in the composition of the assemblages occurred at 7668 cal. yrs BP. The abrupt decrease of stenohaline freshwater/brackish-water species Pyxidinopsis psilata and Spiniferites cruciformis was followed upwards by a gradual increase in euryhaline marine species, such as Lingulodinium machaerophorum, Spiniferites belerius, S. bentorii and acritarch Cymatiosphaera globulosa. The first occurrence of euryhaline marine species took place synchronously with the onset of sapropel deposition. Modern marine conditions were established after 6417 cal yrs BP when an abundance of Mediterranean-related species, such as Operculodinium centrocarpum and Spiniferites mirabilis, along with other heterotrophic species, occurred. After the stable cold and dry environment during the Last Glacial Maximum, the phytoplankton record of core AKAD 11-17 shows that Pediastrum boryanum var. boryanum has a cyclical abundance associated with the deposition of four red-brown clay layers between 19.2 and 14.5 cal. ka BP. This event is associated with the major melting phase of European Ice drained by the Danube and Dnieper Rivers in response to climate warming observed after the end of the Last Glacial Maximum. During the Early Holocene, P. psilata, characterised by a preference to warmer temperatures, demonstrates its ecological optimum for growth concerning SST reaching maximum relative abundance of 94% between 11072 and 8638 cal. yrs BP. This maximum was interrupted by an abrupt significant short-term decrease in the relative abundance of P. psilata centred between 8500 and 8300 cal. yrs BP reflecting cold conditions similar to those of Younger Dryas. This finding, also confirmed by the rapid significant decrease of arboreal pollen, particularly of Quercus in the same studied core, is considered a regional expression of the well-known ‘8.2 ka cold event’ which is commonly linked to a meltwater-related perturbation of the Atlantic Meridional Overturning Circulation (AMOC) and associated collapse of oceanic northward heat transport. Our fossil pollen and dinocyst data confirm that the high amplitude temperature anomaly associated with ‘the 8.2 ka cold event’ may have also occurred in south-eastern Europe, at lower latitudes of the western Black Sea coastal area, most probably due to atmospheric transition and/or river discharge.

Childhood internal migration in Europe: Developments across cohorts and countries

AbstractInternal migration is the driving force behind population re‐distribution within countries. Although internal migration has been extensively studied among adults, little is known about patterns in childhood migration, and even less so in a comparative manner. This study, therefore, adopts a child‐centred approach and contributes to the literature by exploring cross‐national changes in childhood migration across birth cohorts. Moreover, it examines how patterns of childhood migration relate to the postponement of childbearing. Drawing on retrospective residential histories from the SHARE survey, we analyzed childhood migration trajectories of 178,476 individuals born between 1935 and 1994 in 28 European countries. Cohort analyses confirm a country gradient in childhood migration, with the highest migration rates in Northern Europe and the lowest in Southeastern Europe. Nonetheless, across nearly all countries, childhood migration has consistently declined since the 1970s. Furthermore, when children relocate, it happens at increasingly younger ages. Finally, we find that these patterns are related to the increasing childbearing age across Europe. Our results thereby highlight the interplay between childhood migration and adult family life's changing dynamics, offering a novel perspective on the link between these two demographic components.

Reconstructing historical road landscapes along the corridors of early 20th-century road networks in Northern Greece

The paper aims to reconstruct historical road networks, focusing on an area of South-Eastern Europe (specifically on a part of northern Greece) and to contribute to the research for cultural heritage landscapes promotion. By the proposed approach, ignored cultural corridors would be revealed, paving the way for significant management and the emergence of cultural landscapes. Geographical Information Systems (GIS) tools, textual references and historical maps are utilised to identify the historical roadways. The spatial information is mined from the historical maps, whilst the descriptive information is mined from both the textual sources and the maps as well. The combination of the maps and the narratives supported an integrated classification of the roads for all periods, according to the construction style/technique, allowing the interpretations of the historical roads’ landscapes. The suggested approach and the consequent maps could serve as a valuable contribution to the enhancement of heritage management of historical landscapes.

International attitudes towards medical and planned oocyte cryopreservation.

This study aims to better understand the knowledge and attitudes of men and women internationally towards oocyte cryopreservation (OC). An online 25-question survey was distributed internationally via email and social media. Knowledge and attitudes towards OC among different regions and genders were assessed. The study population consisted of adults from North America (NA, 15.7%), Southeastern and Eastern Europe (SE, 34.7%), Central and Western Europe (CWE, 12.7%), Asia (12.7%), and Middle East (ME, 8.9%). A total of 496 respondents initiated the survey and the completion rate was 80.2%. The mean (SD) age was 35.2 (12.1) years. Over 70% were aware of OC, but only 4.8% had previously undergone the procedure. Most considered ages 26-31 as optimal for OC and correctly identified conditions that could impact the chance of spontaneous conception. Significant differences were observed regarding etiologies that would render OC acceptable. Only in NA and ME did solid majorities strongly agree that it is acceptable to proceed with OC to allow more time to find the right partner or for professional opportunities. More similar opinions were observed between genders. When medical conditions existed, large majorities across all nationalities and genders strongly agreed that OC is acceptable. In NA, SE, and ME most respondents would consider or recommend OC for any reason, whereas most respondents in CWE and Asia would do that only for certain social reasons or medical necessity. A good understanding of OC was observed. Nationality appeared to impact opinions on appropriate indications for this procedure, though overall positive attitudes were documented.

Response of beech and fir to different light intensities along the Carpathian and Dinaric Mountains.

Predicting global change mitigations based on environmental variables, like temperature and water availability, although yielding insightful hypothesis still lacks the integration of environmental responses. Physiological limits should be assessed to obtain a complete representation of a species' fundamental niche. Detailed ecophysiological studies on the response of trees along the latitudinal gradient are rare. They could shed light on the behaviour under different light intensities and other studied traits. The forests of the Dinaric Mountains and the Carpathians represent the largest contiguous forest complexes in south-eastern Europe. In uneven-aged Carpathian (8 plots) and Dinaric Mountain (11 plots) forests, net assimilation (Amax) and maximum quantum yield (Φ) were measured for beech and fir in three predefined light intensity categories according to the indirect site factor (ISF%) obtained by the analysis of hemispherical photographs in managed and old growth forests, all located above 800 m a.s.l. The measurements were carried out under fixed environmental conditions in each light category per plot for three consecutive years. Data from the last 50-year average period from the CRU TS 4.01 dataset were used for the comparison between Amax, Φ, and climate. The highest Φ for beech were observed in the central part of the Dinaric Mountains and in the south westernmost and northwesternmost part of the Carpathians for both beech and fir, while they were highest for fir in the Dinaric Mountains in the northwesternmost part of the study area. The Φ-value of beech decreased in both complexes with increasing mean annual temperature and was highest in the open landscape. For fir in the Carpathians, Φ decreased with increasing mean annual temperature, while in the Dinaric Mountains it increased with higher temperature and showed a more scattered response compared to the Carpathians. Short-term ecophysiological responses of beech and fir were consistent to long-term radial growth observations observed on same locations. The results may provide a basis and an indication of the future response of two tree species in their biogeographical range to climate change in terms of competitiveness, existence and consequently forest management decisions.

The CC2D2B is a novel genetic modifier of the clinical phenotype in patients with hereditary angioedema due to C1 inhibitor deficiency

Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) is a rare genetic disorder caused by pathogenic variants in the SERPING1 gene and characterised by swelling and a highly variable clinical phenotype. We aimed to identify novel modifying genetic factors predisposing to the clinical symptoms. We performed whole exome sequencing (WES) and comprehensive bioinformatic analysis in symptomatic and asymptomatic (three duos) family members with HAE-C1-INH. Selected variants identified using WES (present in all asymptomatic and absent in symptomatic patients) were determined using Sanger sequencing. We included 88 clinically well-characterised HAE-C1-INH patients from south-eastern Europe (nine asymptomatic) from 42 unrelated families. We identified 39 variants in 23 genes (ANKRD36C, ARGFX, CC2D2B, IL5RA, IRF2BP2, LGR6, MRPL45, MUC3A, NPIPA1, NRG1, OR5M1, OR5M3, OR5M10, OR8U3, PLCL1, PRSS3, PSKH2, PTPRA, RTP4, SEZ6, SLC25A5, VWA3A, and ZNF790). We selected variants in CC2D2B and PLCL1, which were analysed using Sanger sequencing in the entire group of HAE-C1-INH. We found significant differences in the frequencies of the CC2D2B c.190A>G (rs17383738) variant between symptomatic and asymptomatic patients, where heterozygotes were more common in asymptomatic HAE-C1-INH patients in comparison to symptomatic patients (55 % vs 23%; P = 0.049, OR = 4.24, 95% CI 1.07‐14.69). Our study identified novel genetic factors that modify the clinical variability of HAE-C1-INH. We further demonstrated, in a large cohort, the importance of the CC2D2B gene as a disease-modifying factor. Based on linkage disequilibrium analysis, the CCNJ and ZNF518A genes might also be involved in the clinical variability of HAE-C1-INH.

Influence of honey bee (Apis mellifera) breeding on wing venation in Serbia and neighbouring countries.

In order to improve the productivity of honey bees (Apis mellifera), some of their traits are selected by breeding. On one hand, breeding is mainly based on the natural geographical variation of this species; on the other hand, mass production and distribution of artificially selected queens can significantly affect the natural geographic variation of honey bees. In this study, we have compared honey bee wings originating from breeding and non-breeding populations in Serbia. In the comparison, we have also used data from a large area of south-eastern Europe. The wings were measured using the 19 landmarks indicated on the wing images. The coordinates were analysed using the methodology of geometric morphometrics. We found that honey bees obtained from honey bee queen breeder differed in wing venation from surrounding populations, which are under natural selection. Therefore, we argue against including populations under artificial selection in the analysis of the natural geographical variation of honey bees. In our analysis of non-breeding samples, we found that in south-eastern Europe there is continuous variation in wing venation and no clear boundaries between A. m. carnica, A. m. cecropia, and A. m. macedonica.

Influence of substance use on male reproductive health and offspring outcomes.

The prevalence of substance use globally is rising and is highest among men of reproductive age. In Africa, and South and Central America, cannabis use disorder is most prevalent and in Eastern and South-Eastern Europe, Central America, Canada and the USA, opioid use disorder predominates. Substance use might be contributing to the ongoing global decline in male fertility, and emerging evidence has linked paternal substance use with short-term and long-term adverse effects on offspring development and outcomes. This trend is concerning given that substance use is increasing, including during the COVID-19 pandemic. Preclinical studies have shown that male preconception substance use can influence offspring brain development and neurobehaviour through epigenetic mechanisms. Additionally, human studies investigating paternal health behaviours during the prenatal period suggest that paternal tobacco, opioid, cannabis and alcohol use is associated with reduced offspring mental health, in particular hyperactivity and attention-deficit hyperactivity disorder. The potential effects of paternal substance use are areas in which to focus public health efforts and health-care provider counselling of couples or individuals interested in conceiving.

Pothiti Hantzaroula, Child Survivors of the Holocaust in Greece: Memory, Testimony and Subjectivity

This article reviews Pothiti Hantzaroula's Child Survivors of the Holocaust in Greece: Memory, Testimony and Subjectivity (Routledge, 2020). It highlights how Hantzaroula’s book represents a needed and much welcome addition to the study of child survivors of World War II by offering students and scholars of the Holocaust a comprehensive insight into the specifics of Greece, which can serve as a basis for subsequent comparative or kindred assessments in the case of other Southeastern European countries.

Availability and Access to Orphan Drugs for Rare Cancers in Bulgaria: Analysis of Delays and Public Expenditures.

Rare cancers are defined by an annual incidence of fewer than 6 per 100,000. Bearing similarities to rare diseases, they are associated with substantial health inequalities due to diagnostic complexity and delayed access to innovative therapies. This situation is further aggravated in Southeastern European countries like Bulgaria, where limited public resources and expertise underscore the need for additional policy and translational research on rare cancers. This study aimed to explore the availability and access to orphan drugs for rare cancers in Bulgaria for the period of 2020-2023. We cross-compared data from both the European Union and national public sources to evaluate the number of available and accessible orphan drugs for rare cancers, the delay from market authorization to reimbursement, the dynamics of public expenditures, and regional disparities in access across the country. We juxtaposed the main characteristics of oncological and non-oncological orphan drugs as well. Only 15 out of 50 oncological orphan drugs that were authorized by the European Medicine Agency were accessible for rare cancer patients in Bulgaria. The median delay between market authorization and inclusion in the Bulgarian Positive Drug List was 760 days. The total expenditures for all orphan drugs for rare cancers amounted to EUR 74,353,493 from 2020 to 2023. The budgetary impact of this group rose from 0.24% to 3.77% of total public medicinal product expenditures for the study period. Rare cancer patients represent a vulnerable population that often faces limited to no access to treatment. We call for targeted European and national policies to address this major inequality.

The state of emergency medicine in Greece: at critical momentum

Greece is a parliamentary republic in southeastern Europe populated by over 10 million permanent residents: 9 million reside on the mainland, with almost 4 million in the greater Athens area. The remaining 1 million populate the over 1200 Greek islands. In addition, more than 160,000 asylum-seekers reached Greece in 2022, and more than 25 million tourists have visited Greece in the last two years. Modern Greek Emergency Medicine (EM) is now in its 4th decade. The Greek government has focused the last few years on enhancing the quality of emergency services provided in public hospitals. Emergency Departments (EDs) are being modernized, undergraduate medical education gradually incorporates EM, and a specialty training program in emergency nursing has been established. However, the late recognition of the critical importance of EM as a specialty in Greece has resulted in the subsequent need to create three alternative pathways to EM, none of which are direct from residency. The first is a 24-month Emergency Medicine fellowship after completing a residency in another specialty and then passing the national exam. The second is for physicians who have worked in a public hospital ED (Gr: Ethniko Systima Ygeias (ESY) ESY for at least three years and successfully passed the national exam. The third, which no longer exists, is a ‘grandfather’ pathway for those physicians who worked in an ESY ED for five years prior to the creation of the fellowship training program. As a result, there is a critical shortage of EM-trained physicians, resulting in most care being provided by physicians without formal training in EM. This is further confounded by the country’s challenging geography, with frequent air transfers from the islands to mainland hospitals. Creating an EM Residency training program is a critical next step to overcoming many of the challenges facing EM provision in Greece today: it would address the shortage of EM-trained providers, decrease the need for costly ground and air transfers, and improve the quality of emergency care throughout Greece.