Cross-Cultural Validation of the Definition of Multimorbidity in the Bulgarian Language.

INTRODUCTION: Multimorbidity is a health issue with growing importance. During the last few decades the populations of most countries in the world have been ageing rapidly. Bulgaria is affected by the issue because of the high prevalence of ageing population in the country with multiple chronic conditions. The AIM of the present study was to validate the translated definition of multimorbidity from English into the Bulgarian language. MATERIALS AND METHODS: The present study is part of an international project involving 8 national groups. We performed a forward and backward translation of the original English definition of multimorbidity using a Delphi consensus procedure. RESULTS: The physicians involved accepted the definition with a high percentage of agreement in the first round. The backward translation was accepted by the scientific committee using the Nominal group technique. DISCUSSION: Some of the GPs provided comments on the linguistic expressions which arose in order to improve understanding in Bulgarian. The remarks were not relevant to the content. The conclusion of the discussion, using a meta-ethnographic approach, was that the differences were acceptable and no further changes were required. CONCLUSIONS: A native version of the published English multimorbidity definition has been finalized. This definition is a prerequisite for better management of multimorbidity by clinicians, researchers and policy makers.

Knowledge and behaviour of tourists towards the sun, as studied in a region of northern Greece.

INTRODUCTION: Melanoma is considered one of the most malignant cancers. Its appearance is related to various factors such as ultraviolet radiation, recurrent sunburn, and phototype. During the summer holidays approximately 14 million tourists from northern European countries visit Greece; this does not include the local tourists. AIMS: To discover the extent of European visitors' awareness of the risk of sunburn. To explore the level of knowledge gained by local and foreign tourists from preventive campaigns related to the harmful effects of sun exposure. PARTICIPANTS: The sample consisted of 802 travelers from northern European countries, and 726 Greeks who departed from the airport 'Megas Alexandros' during August and September 2002. METHODS: A structured questionnaire was used to gain data about demographics, family history of skin cancer, and identification of phototype. Also requested was information about the hours of sun exposure, and the use of sunscreen (the pattern of application and its sun protective factor [SPF]). Comparisons of mean values between groups were made by Student's t-test, and the association between categorical variables was tested by Pearson's chi(2). Regression analysis was performed to examine the influence of different factors on the likelihood of being sunburned. RESULTS: The majority of foreigners belonged to phototype II or III, while the Greek tourists belonged to phototype III. Foreigners had a higher tendency to burn and a lower tendency to tan. Of the total sample, women presented a higher prevalence of sunburn (p <0.05), and they used sunscreen more frequently (p <0.001) than men did (p <0.001), in both groups. The mean SPF used was 17.3 (SD = 8.98) for the foreigners and 16.0 (SD = 2.0) for the Greeks. The media was the main source of information for both groups. Multiple regression analysis showed that skin type was significantly associated with a high probability of sunburn (p <0.001). Moreover, freckles (p <0.05) were a predictive factor for future sunburn. CONCLUSIONS: Our study showed that skin type is the most important predictor of future sunburn. The role of the primary care physician is to promote and encourage healthy habits, including attitude towards sun exposure. Increased susceptibility to sun-induced damage of persons with phototypes I and II mandates their identification as a target group in all media campaigns.