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High concentration levels of air pollutants may cause damage to plants, animals, and the health of some groups of human beings. Therefore, it is important to investigate different topics related to the high air pollution levels and to find reliable answers to the questions about the possible damages, which might take place when these levels exceed some limits. A few of the numerous questions, the answers of which are highly desirable, are listed below: (a) When are the air pollution levels dangerous? (b) What is the reason for the increased air pollution levels? (c) How can the air pollution levels be decreased? (d) Will the future climate changes result in higher and more dangerous air pollution levels? It is necessary to study carefully many issues connected with the distribution of air pollutants in a given region and with the reasons for the increases of the concentrations to high levels, which might be damaging. In order to do this, it is necessary to develop a Digital Twin of all relevant physical processes in the atmosphere and to use after that this tool in different applications. Such a tool, its name is DIGITAL AIR, has been created. Digital Twins are becoming more and more popular). Many complex problems, arising taking place in very complicated surroundings, can be handled and resolved successfully by applying Digital Twins. The preparation of such a digital tool as well as its practical implementation in the treatment of a special problem, the increase of some potentially dangerous ozone levels, will be discussed and tested in this paper. The Unified Danish Eulerian Model (UNI-DEM) is a very important part of DIGITAL AIR. This mathematical model, UNI-DEM, can be applied in many different studies related to damaging effects caused by high air pollution levels. We shall use it in this paper to get a reliable answer to a very special but extremely important question: will the future climatic changes lead to an increase in the ozone pollution levels in Bulgaria and Europe, which can potentially become dangerous for human health? [ABSTRACT FROM AUTHOR]

Bluetongue (BT) is an acute, viral, vector-borne, non-contagious disease of ruminants caused by Bluetonguevirus (BTV). Twenty-six different serotypes have been identified, and the ability of each strain to cause disease varies widely. BTV can infect a wide range of domestic and wild ruminants - sheep, goats, cattle, buffalo, deer, most species of African antelope and camels. For the study period (2011-2021), outbreaks were declared in 21 member states in Europe with predominant serotypes 1, 4 and 8. Based on data from Animal Disease Information System (ADIS) with the present paper we analyzed the distribution of the BTV serotypes within the affected countries and found that particular serotypes tend to spread to particular countries. The development of regulatory measures for prevention, surveillance and eradication of BT is discussed based on the European legislation. [ABSTRACT FROM AUTHOR]

Background Type-2 diabetes (T2D) and hypertension (HTN) are two of the most prevalent non-communicable diseases (NCDs): they both cause a relevant number of premature deaths worldwide and heavily impact the national health systems. This study illustrates the impact of HTN and T2D in four European countries (Albania, Bulgaria, Greece and Spain) and compares their policies towards the monitoring and management of HTN and T2D and the prevention of NCDs as a whole. This analysis is conducted throughout the DigiCare4You Project (H2020)—which implements an innovative solution involving digital tools for the prevention and management of T2D and HTN. Methods The analysis is implemented through desk research, and it is enriched with additional information directly provided by the local coordinators in the four countries, by filling specific semi-structured forms. Results The countries exhibit significant differences in the prevalence of HTN and T2D and available policies and programs targeted to these two chronic conditions. Each country has implemented strategies for HTN and T2D, including prevention initiatives, therapeutic guidelines, educational programs and children's growth monitoring programs. However, patient education on proper disease management needs improvement in all countries, registries about patients affected by HTN and T2D are not always available, and not all countries promoted acts to contain the increasing rates of risk factors related to NCDs. Conclusions While political awareness of the risks associated with HTN, T2D and NCDs in general is growing, there is a collective need for countries to strengthen their policies for preventing and managing these chronic diseases. [ABSTRACT FROM AUTHOR]

This article presents research and findings related to the Second Chance Schools - an innovative approach which is gaining strength and popularity in recent years but is almost unknown in Bulgaria. The documentary research, the analysis of interviews of the various actors and the online surveys during the project revealed a set of characteristics of Second Chance Schools common to most countries in Europe. The study reveals that in the countries where the SCS approach has been applied, early school leavers’ rates are going down. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the Coronavirus disease 2019(COVID-19) vaccine policies disparities and effectiveness in Germany, Denmark and Bulgaria, with a view to providing lessons for global vaccination and response to possible outbreak risks. Methods: This study analyzed big data through public information on the official websites of the Ministries of Health of the European Union, Germany, Denmark and Bulgaria and the official websites of the World Health Organization. We systematically summarized the COVID-19 vaccine policies of the three countries, and selected the following six indicators for cross-cutting vaccination comparisons: COVID-19 vaccine doses administered per 100 people, COVID-19 vaccination rate, the share of people with fully vaccinated, the share of people only partly vaccinated, cumulative confirmed COVID-19 cases per million, cumulative confirmed COVID-19 deaths per million. Meanwhile, we selected the following four indicators for measuring the effectiveness of COVID-19 vaccine policy implementation: daily cases per million, daily deaths per million, the effective reproduction rate (Rt), the moving-average case fatality rate (CFR). Results: Although these three EU countries had the same start time for vaccination, and the COVID-19 vaccine supply was coordinated by the EU, there are still differences in vaccination priorities, vaccination types, and vaccine appointment methods. Compared to Germany and Denmark, Bulgaria had the least efficient vaccination efforts and the worst vaccination coverage, with a vaccination rate of just over 30% as of June 2023, and the maximum daily deaths per million since vaccination began in the country was more than three times that of the other two countries. From the perspective of implementation effect, vaccination has a certain effect on reducing infection rate and death rate, but the spread of new mutant strains obviously aggravates the severity of the epidemic and reduces the effectiveness of the vaccine. Among them, the spread of the Omicron mutant strain had the most serious impact on the three countries, showing an obvious epidemic peak. Conclusions: Expanding vaccination coverage has played a positive role in reducing COVID-19 infection and mortality rates and stabilizing Rt. Priority vaccination strategies targeting older people and at-risk groups have been shown to be effective in reducing COVID-19 case severity and mortality in the population. However, the emergence and spread of new variant strains, and the relaxation of epidemic prevention policies, still led to multiple outbreaks peaking. In addition, vaccine hesitancy, mistrust in government and ill-prepared health systems are hampering vaccination efforts. Among the notable ones are divergent types of responses to vaccine safety issue could fuel mistrust and hesitancy around vaccination. At this stage, it is also necessary to continue to include COVID-19 vaccination in priority vaccination plans and promote booster vaccination to prevent severe illness and death. Improving the fairness of vaccine distribution and reducing the degree of vaccine hesitancy are the focus of future vaccination work. [ABSTRACT FROM AUTHOR]

Simple Summary: Little is known about bat diversity in mountains above 2000 m a. s. l. in Europe. Here, we report data from a study carried out in the high-alpine karst landscape of Pirin Mountain, Bulgaria at an altitude ranging from 2300 to 2600 m a. s. l. Twenty bat species were detected using three inventory methods. Furthermore, we describe the highest bat swarming site in Europe, located at an altitude of 2600 m a. s. l. The study describes a pilot survey on bats in the highest areas of Pirin Mountain. The methods included examining subfossil bone remains, mist-netting, and recording echolocation calls. The study was conducted in August 2002 and 2013 and from 2019 to 2020. While in general, bat diversity tends to decrease with increasing altitude due to harsher environmental conditions, the present study, despite a short period, reveals high diversity. Twenty species, more than half of the Bulgarian bat fauna, were detected. The recording and analysis of vocal signatures proved to be the best way to inventory bat diversity. At least 13 species were detected by this method. Vespertilio murinus and Tadarida teniotis together make up more than 60% of all reliably determined echolocation sequences. Significant activity was found for Myotis myotis/blythii, Plecotus auritus, Eptesicus serotinus, and E. nilssonii. The registration of the latter species is of considerable faunistic interest. It was previously only known from a single specimen at one location in the country. The sex and age structure of the bat assemblage suggests that it is likely a swarming assemblage. The area is the highest swarming location in Europe. The results provide valuable information on bat ecology and behaviour, which can be used to inform management and protection efforts. [ABSTRACT FROM AUTHOR]

Background: The databases of children's anthropometric parameters are often outdated, rarely representative and are not always available at an international level. Objectives: To present children's anthropometric parameters in six European countries that contributed to the Feel4Diabetes project and find country-specific differences. Design/Setting: The Feel4Diabetes study was performed between 2016 and 2018, targeting children in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. The current study presents data from the baseline and the yearly follow-up anthropometric measurements. Subjects: In total, 20,832 measurements of children (48.7% boys) between 6 and 10 years of age were conducted. Main outcome measure: weight, height, BMI. Results: Belgian boys had the lowest body weight and height, while Greek boys had the highest body weight, and Finnish had the highest body height. The highest proportion of overweight (percentile above 85%) and obese boys (percentile above 95%) was in Greece, followed by Hungarian, Spanish, Bulgarian and Finnish boys. In contrast, Belgian boys had the lowest ratio in both categories. Among girls, Greece had the highest; Belgium had the lowest body weight; Finland was the highest in all age categories. The ratio in the overweight range was the highest in Greece, followed by Spanish, Bulgarian and Hungarian girls, who were second in the obese category. Finnish girls had lower and Belgian girls had the lowest ratio in both BMI categories. All the detailed data are presented in tables, and the trends are figures. Conclusions: Our study presents fresh and comparable anthropometric data of children between 6 and 10 years of age in six European countries, supporting the need for appropriate obesity prevention. [ABSTRACT FROM AUTHOR]

Background: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. Results: Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. Conclusions: According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care. [ABSTRACT FROM AUTHOR]