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Telemedicine allows healthcare professionals to assess, diagnose and treat patients remotely using information and telecommunications technologies. Telemedicine is an evolutionary discovery that is increasingly becoming an important part of medical science and practice. Objectives: To study and analyze the opinion of physician assistants for telemedicine as a predictor for overcoming the barrier in the process of treatment of elderly people living in small and remote settlements. Methods: We conducted a survey of the opinion of 80 physician assistants on telemedicine as a predictor for overcoming barriers in the treatment of elderly and senile people living in small and remote settlements. Results: According to the analysis of the data on the benefits of the introduction of telemedicine and because it is a predictor for overcoming the barrier in the treatment of the elderly and elderly, the following was found: Medical professionals providing medical care to geriatric patients face a number of challenges that require a timely and adequate response, and telemedicine is a predictor of overcoming the barrier in the process of their treatment. In hard-to-reach and remote settlements, there is often a lack of general practitioners, enough outpatient clinics and places to perform activities for the treatment of geriatric patients. In these cases, the application of telemedicine would be adequate. This will increase the possibility of access to adequate medical care. Patients will receive precise and clear instructions. This will reduce the need for transportation or time for patients to access hospitals. Conclusion: The study allows us to draw the following inferences: Telemedicine is an opportunity to improve and enhance the professional activity of physician assistants working with geriatric patients and the implementation of telemedicine will increase the quality of medical care and health care for the elderly population in remote areas and small settlements.

During the training process, nurse students acquire knowledge, skills and competencies to work with different groups of patients. Working with elderly people has its difficulties and specificities. The acquisition of practical skills by students for planning and documenting individual health care for the elderly people is a process in which teachers and mentors have a leading role. Objectives: To identify the factors which make it difficult for nurse students to work with elderly people. Methods: The study involved 52 3rd year nurse students – from the Faculty of Medicine of Trakia University in Bulgaria. A questionnaire was used, including open-ended and closed-ended questions, allowing more than one answer. The data was processed mathematically and graphically. Results: The main difficulties for students in working with the elderly people are as follows: the process of communication (92.16%), difficult perception of new information (80.64%) and memory impairment in the elderly patient (61.44%); The main difficulties related to the organization of activity - insufficient experience in working with geriatric patients (92.16%); insufficient time for communication with patients (94.08%); lack of comfort in the patient's home (57.60%); a "Diary for tracking and self-monitoring of the condition" of an elderly person - it is very useful for 90.24% of students so that they can monitor the condition of the elderly person; It was found that 65.28% of students do not want to work with elderly people, as 46.09% of them indicate the motive for this as mental strain. Conclusion: The teacher and the mentor are leading figures in preparing students to work with elderly people. The practical preparation for planning and documenting individual health care for elderly people is very important in the training process of nurse students.

Bulgaria is the second-fastest aging nation in Eastern Europe and fifth in the world. Older people are the largest and ever-growing group of people in health care. The most common diseases in this age group are circulatory, endocrine, digestive, musculature, neoplasms, and respiratory systems. Some of the main reasons for these diseases include an unhealthy diet, a sedentary lifestyle, and obesity. One hundred twelve adult patients with chronic diseases were interviewed. The aim of the study is to establish the awareness of older people about overweight-related problems. In order to increase their knowledge and improve their quality of life and independence, we prepared a training program (Table4).

BACKGROUND: In the context of health education, the lifestyle of each individual includes social and behavioral factors that are potentially manageable and preventable in general. A health-educated person adheres to healthy lifestyle, which is characterized by the presence of: active attitude to his own health, positive health motivation, skills for health protection and strengthening, and useful health habits. Stimulating one of them is the systematic monitoring and registration of the main vital indicators, as a good prerequisite for active monitoring of the health condition. As of December 31, 2019 the population of Bulgaria is 6,951,482 people, and the people, aged 65 and over are 1,504,088, or 21.6% of the country’s population. AIM: The objective of this study was to establish the degree of personal commitment and responsibility for their health of people over 65-year-old, living in Bulgaria. Tasks: (a) To make a questionnaire, (b) Processing of the received information and analysis of results, (c) Formulation of conclusions regarding awareness, health motivation and lifestyle of the respondents, (d) Reporting the degree of responsibility for their health of the respondents. METHODS: Mathematical-statistical – dispersion, comparative analysis, Spearman’s rank correlation coefficient/p/;desk research; interview. Contingent: 113 people; average age – approx. 68.168 ± 8.80 years. Time: 2019. RESULTS: (1) A statistically significant relationship was found: p = 0.001 and x2 = 21.886. The respondents with two chronic diseases – 40.5% are well aware of the normal values of the measured indicators. (2) Two thirds of the respondents/74.3%/are well informed about the normal and pathological values of the main vital indicators, which they can measure and register themselves. (3) 76% of the respondents have received the necessary health information from the medical team/partnership model. (4) Only half of the older respondents in the study/51.4%/follow a diet complied with their health status. CONCLUSION: In our professional medical care for the elderly people in Bulgaria, we must place emphasis on their preventive and prophylactic commitment to their own health. The useful and practical combination of properly received and internalized medical information from the elderly people is an important prerequisite for their informed commitment to their own health.

An anonymous random survey of 186 diabetic patients over 65 years of age with Type 2 diabetes (105 women, 81 men) from Stara Zagora, Bulgaria, was randomly conducted. The opin-ion of the diabetic patients has been studied about the need of help (health and social) to improve their quality of life with diabetes; their desire to be consulted by a health care professional in a home environment; the topics they would like to be consulted; their awareness of the complica-tions of untreated diabetes; the degree of awareness of the symptoms of hypoglycaemia and hy-perglycaemia; their rediness to be included in training to acquire knowledge of a life with diabe-tes and preferred learning themes. It turns out that elderly with diabetes report having a need for health care and social support to improve the quality of their life. More than half of the surveyed respondents (52%) over the age of 65 who were diagnosed with diabetes need health and social assistance and nursing home patronage to improve their quality of life. A high percentage (60%) of those surveyed also need information with regard to the treatment; 50% with regard to nutri-tion, 39% with regard to exercise and 50% with regard to the complications from diabetes.Было проведено анонимное анкетное исследование с выборкой, сформированной по случайному принципу, у 186 больных сахарным диабетом 2-го типа (из них 105 женщин и 81 мужчина) из города Стара Загора, Болгария. Целью исследования было изучение мнения опрошенных лиц с сахарным диабетом о необходимости предоставления им всесторонней помощи и социальной поддержки для повышения качества жизни, об их желании проконсультироваться на дому со специалистом патронажа больных диабетом, о тех темах, по которым они хотят пройти консультацию, а также об уровне их информированности насчет осложнений нелеченного сахарного диабета, симптомов гипогликемии и гипергликемии, о готовности опрошенных лиц пройти обучение для приобретения знаний о том, как жить с диабетом и на какие темы они предпочитают пройти обучение. Стало ясным, что у пожилых людей с диабетом появляется потребность в уходе за здоровьем, в социальной поддержке для повышения качества жизни. Более половины опрошенных респондентов старше 65 лет (52%) с диагнозом сахарного диабета нуждаются в предоставлении им разного рода помощи, социальной поддержке и патронаже медсестры на дому для целях повышения качества жизни. Бо́льшая доля (60%) опрошенных лиц хотят быть проинформированными насчет их лечения, тогда как 50% — насчет питания, 39% — насчет двигательной активности, а 50% — насчет осложнений диабета.

Achieving the desired high quality of student education is a major goal and task of the higher medical schools. Training is a very factual process involving not only learning and material facilities, but also teaching staff and motivated students. The main objective in the preparation of healthcare students is the quality practical training that modern higher education has to provide. No less important is the student's opinion on the methods and tools used in their training. For this reason, the younger generation sets its requirements in its formation as a medical specialist. The modern lecturer must skillfully pass on knowledge so that a transfer of competences from theory to practice can be successfully accomplished. The purpose: Establish the students' opinion on the quality of the learning process, allowing an effective transfer of competences from theory to practice. Materials and Methods: The analyzes in this report are from an anonymous questionnaire conducted among 145 students from the Thracian University from the professional field "Health Care" - first, second and third courses specialty "Rehabilitator therapist", "Medical Laboratory assistant", "Geriatric Care" and " Nursing "during the summer semester of the school year 2017/18. MSExcel and StatGrafics were used to process the data. Results and Discussion: To achieve effective training, it is imperative for lectures to maintain a high level of competence and constantly get acquainted with developments in medical science. Students highly appreciate as the most important qualities of the teacher's ability to maintain the interest of students "; "Attitude towards students" and its "competence". A significant percentage of those surveyed believe that the theory, in theory, finds real application in practice. A significant percentage of those surveyed believe that the theory, to practice, finds real application in practice. The transfer of knowledge from theory to practice is a two-way information process between lecturers and students of scientific knowledge and practical skills. Finally, we can point out that the transfer of competence from theory to practice is a process influenced by a number of factors such as: the professional competencies of the academic lecturer and the clinical tutor; better collaboration between the higher medical school and the clinical base; organization of training. Maintaining the interest of the students in acquiring the medical profession is an important prerequisite for their subsequent successful realization.

BACKGROUND: Disorders in the metabolism of iron in the direction of iron overload are observed not only in primary hemochromatosis but also in some chronic liver diseases other aetiology. Elevation of serum iron, ferritin and transferrin saturation is reported in nonalcoholic fatty liver disease and alcohol, chronic hepatitis C and liver cirrhosis.AIM: Aim of the study was to evaluate and compare the frequency of the iron serum markers in patients with various chronic liver diseases.MATERIAL AND METHODS: The study included a total of 246 persons -186 patients with chronic liver disease without cirrhosis (-115 men, women -71; average age of 50.41 ± 12.85, from 23 to 77 years) and 60 healthy controls (-30 men, women -30, middle-aged 50.50 ± 11.31, from 29 to 83 years). Medical history, physical examination and demographic data including height, weight, laboratory and instrumental studies were performed.RESULTS: The highest incidence of elevated serum iron, transferrin saturation and ferritin and decreased serum hepcidin found in cases of alcoholic liver disease (ALD), nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CHC).CONCLUSION: Finally, analysis of the changes in serum markers of iron metabolism shows that the difference between healthy and sick with liver disease is primarily due to changes in alcoholic and nonalcoholic fatty liver disease, particularly steatohepatitis, and chronic hepatitis C.

The influx of migrants to European countries, including the Republic of Bulgaria, is constantly increasing from regions experiencing military conflicts and countries that are economically undeveloped. At present, the Republic of Bulgaria is regarded by asylum seekers as a transit state on their route to the economically developed European countries. The people seeking asylum in the European Union have different sociocultural, ethnical, religious, and health cultures. These differences make their adaptation to their new environment difficult and the situation creates economic, social, and health problems for the accepting countries. The enforcement of uniform European standards and laws for social and health integration of migrants facilitates the process and protects the local people from infectious diseases and social-economic problems. The analysis of documents of the European Union, from international and Bulgarian organizations, shows policies have been developed to guarantee the rights of individuals, seeking protection. A major issue for the successful adaptation of migrants is their unwillingness to observe the laws and regulations of the countries where they settle.

Boulatova Marina, Andonova Albena. Sport de haut niveau au féminin en Europe orientale. In: Les Cahiers de l'INSEP, n°32, 2002. Sport de haut niveau au féminin (tome I) pp. 113-120.