High vaccine confidence and strong approval of the mandatory immunization schedule among Bulgarian general practitioners in 2022

In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 vaccines in Bulgaria, this study measures vaccine hesitancy among general practitioners (GPs) in the country, as they are central to forming patients' attitudes. In 2022, a face-to-face survey was conducted through a simple random sample from an exhaustive national database of Bulgarian GPs. This study measured attitudes on vaccine importance, safety, and effectiveness, and attitudes toward the Bulgarian immunization schedule. Information was collected on demographic and GP practice characteristics and possible predictors of vaccine confidence in order to test for associations with attitudes toward immunization. GP attitudes toward vaccines and the immunization schedule in Bulgaria were generally positive. Among 358 respondents, 351 (98%,95%CI96-99%) strongly agreed/agreed that vaccines are important, 352 (98%,95%CI96-99%) that vaccines are effective, and 341 (95%,95%CI93-97%) that vaccines are safe. 347 respondents (97%,95%CI95-98%) affirmed that "it's good that vaccines from the children's immunization schedule are mandatory", and 331 (92%,95%CI89-95%) agreed with the statement "Bulgaria's childhood immunization has my approval". Trust in information from official institutions was among the strongest predictors of vaccine confidence. Respondents' vaccine confidence levels are within the ranges reported by GPs in other European countries and above those reported within the general Bulgarian population. GPs' vaccine confidence is highly associated with trust in official institutions. It is important to maintain trust in official institutions and to support GPs in communicating vaccine knowledge with patients so that vaccine hesitancy in the general population is countered.

Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule

The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.

Facial soft tissue thicknesses in Bulgarian adults: relation to sex, body mass index and bilateral asymmetry

BACKGROUND

The aim of the study is to measure the facial soft tissue thicknesses (STTs) in Bulgarians, to evaluate the relation of the STTs to the nutritional status, sex and bilateral asymmetry, and to examine the correlations between the separate STTs as well as between the STTs and body weight, height, and body mass index (BMI). In the present study, the facial STTs were measured on computed tomography scans of the head of Bulgarian adults.

MATERIALS AND METHODS

The STTs were measured at 7 midline and 9 bilateral landmarks. The measurements were performed in the free software InVesalius in the axial and sagittal planes. The mean, standard deviation, minimum and maximum values, median and coefficient of variation were reported for the STT at each landmark according to the sex and BMI category. The BMI, sex and bilateral differences were assessed for statistical significance. Pearson correlation analysis was applied to assess the strength and direction of the relationships between the STTs and body height, weight and BMI, as well as between separate STTs.

RESULTS AND CONCLUSIONS

The facial soft tissues in Bulgarian adults changed in accordance with the nutritional status of the individual and in both sexes all STTs augmented with the increasing BMI. For both normal and overweight BMI categories, males had more soft tissue at the majority of facial points than females, as the only exceptions were observed in the cheek zone, where STTs were thicker in females. Significant bilateral differences were observed in either sex and BMI category. Stronger correlations were established for the STTs in the jaw region and between the cheek and jaw soft tissues. Besides, the correlations between the homologous bilateral landmarks were among the strongest ones.

The digital revolution in phenotyping

Phenotypes have gained increased notoriety in the clinical and biological domain owing to their application in numerous areas such as the discovery of disease genes and drug targets, phylogenetics and pharmacogenomics. Phenotypes, defined as observable characteristics of organisms, can be seen as one of the bridges that lead to a translation of experimental findings into clinical applications and thereby support 'bench to bedside' efforts. However, to build this translational bridge, a common and universal understanding of phenotypes is required that goes beyond domain-specific definitions. To achieve this ambitious goal, a digital revolution is ongoing that enables the encoding of data in computer-readable formats and the data storage in specialized repositories, ready for integration, enabling translational research. While phenome research is an ongoing endeavor, the true potential hidden in the currently available data still needs to be unlocked, offering exciting opportunities for the forthcoming years. Here, we provide insights into the state-of-the-art in digital phenotyping, by means of representing, acquiring and analyzing phenotype data. In addition, we provide visions of this field for future research work that could enable better applications of phenotype data.

EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

ABH blood group antigen significance as markers of endothelial differentiation of mesenchymal cells

The expression pattern of A, B and H blood group antigens was evaluated by staining frozen sections with specific monoclonal antibodies developed by us and using the indirect immunoperoxidase method. The expression of blood group antigens was ubiquitously upregulated in the endothelial cells of fetal organs. In the process of their differentiation to endothelial naive embryonic mesenchymal cells expressed cytoplasmic ABH antigens. They were assumed as products of the activation of the respective genes. ABH antigen expression was considered as suggestive evidence for the assumption that blood group antigens could serve as early immunomorphologic markers of endothelial differentiation of mesenchymal cells, thus specifying the location of future blood vessels. Extending the conceptual framework of blood group antigens' significance we consider them as being possibly involved in the process of fetal morphogenesis.

Wavelets as alternative to short-time Fourier transform in signal-averaged electrocardiography

The paper reports experience of using the wavelet transform to build time-frequency distributions of the terminal portion of the QRS-complex. We used wavelets of Morlet at 12 scales, grouped in three sets, to analyse the frequency range 33-404 Hz. On the same patient data we applied the short-time Fourier transform and compared the results. Both representations reflected the time-frequency contents and detected irregular structures in the terminal portion of the QRS complex. The wavelet transform revealed more adequately QRS prolongations characteristic of patients prone to ventricular tachycardia. We may conclude that the wavelet transform can be a flexible alternative to short-time Fourier transform.

[Determination of the turbidity temperature of solutions of the nonionogenic surface-active agent LF-57 after the action on urinary calculi in uric acid]

Non-ionogenic surfactant LF-57 contributes solving of urinary calculi from uric acid and is a component of the drug Pharmalit for curing kidney-stone disease. Turbidity temperature was determined of the solution LF-57-78, 1C, and in the presence of uric acid--80.2C.

[Clinical multiplicity of cerebrovascular disorders in childhood]

A group of 107 children with vascular diseases of the nervous system aged 3-14 years have been studied. In 100 children of the study group acute disturbances of the brain blood circulation have been found, out of which 37 children were with transitory ischemic attacks; 29 were found to be with brain ischaemia; 22-with haemorrhages (7 cases with subarchnoidal, 9 cases with intracerebral and 6 cases with subarachnoidal-parenchimatose); 5 children had wenous thromboses; 7 children were with spinal strokes. In other 7 children we found the presence of Sturge-Weber syndrome. Congenital vascular malformations have been found in 32 children (30%), out of which 16 children (15%) with loops and stenosis of the extracranial segments of the internal carotid artery, and another 16 children (15%) with AV-malformations. Congenital and acquired heart diseases are found to be primary cause for the strokes in 12 children (11%). Considerable is the rate of the epileptic seizures in the acute stage of the strokes as well as of the residual epileptic syndromes.

[Genealogic studies in genuine partial epilepsy]

Clinical--electroencephalographic (EEG) investigation was performed in 12 families. In the study were included 12 epileptics with partial seizures in whom the katamnestic follow up from 2 to 6 years provided clinical, EEG and genetic data for the so called primary partial epilepsy 24 parents and 14 siblings. In four of the Children with epilepsy the seizures were of the "Rolandic" type; in 5--"psychomotor"; and in 3--hemiconvulsive. No data for structural brain lesion investigation were found. Rapid and long lasting therapeutic effect was achieved in all of the cases. The EEG showed focal paroxysmal activity in all of the diseased and in 11 of the siblings, in 5 of them were found epileptic seizures of the same type as in the probands. The possibilities of a genetic predisposition to development of an epileptogenic focus and its clinical Expression in members of the families in discussed.