The current review aims to summarize published research on nutrition transition patterns (depicting changes in dietary consumption) in European populations over the last three decades (1990–2020), with a focus on East-West regional comparisons. Pubmed and Google-Scholar databases were searched for articles providing information on repeated dietary intakes in populations living in countries across Europe, published between January 1990 and July 2021. From the identified 18,031 articles, 62 were found eligible for review (17 from Eastern and 45 from Western European populations). Overall, both in Eastern and Western Europe, there have been pronounced changes in dietary consumption patterns over the last three decades characterized by reductions in average reported intakes of sugar, carbohydrates and saturated fats and increases in reported fruit and vegetable consumption. There has also been a tendency toward a reduction in traditional foods, such as fish, observed in some Mediterranean countries. Overall, these data suggests that European countries have undergone a nutrition transition toward adopting healthier dietary behaviors. These processes occurred already in the period 1990–2000 in many Western European, and in the last decades have been also spreading throughout Eastern European countries. Firm conclusions are hampered by the lack of standardized methodologies depicting changes in dietary intakes over time and the limited coverage of the full variety of European populations. Future studies based on standardized dietary assessment methods and representative for the whole range of populations across Europe are warranted to allow monitoring trends in nutrition transition within and among European countries.

Introduction: There has been wide recognition of the health divide between Western Europe and the former socialist countries from Central and Eastern Europe. However, these have not been assessed in terms of burden of disease, and the effect of stroke has not been fully elucidated, especially in terms of time trends. Methods: The West-Eastern European stroke burden was analysed using data from the Global Burden of Stroke (GBD) Study 2019 in terms of disability-adjusted life years lost (DALYs) and years of life lost (YLL) over the period 1990–2019 by gender. Data were extracted on a regional (West, Central, and East Europe) and country level for the twenty former socialist countries from Central and East Europe according to GBD regional definitions. We focused on the trends of age-standardized stroke DALY rates across the three decades and compared them with the average rates for West Europe. Main Findings: All Central and East European countries experienced a decline in all-cause disease burden between 1990 and 2019, and a gap was confirmed between the East, the Central, and the West European region for men but not for women. The age-standardized stroke DALY rates declined in the three European regions and in all twenty Central and East European countries but at a different pace. The stroke DALY rates among women exhibited the greatest decline in the West −59% (95% UI [−60; −57]) followed by the Central European region −48% (95% UI [−53; −42]) and lowest among women in East Europe −37% (95% UI [−43; −29]). The decline in men was even higher than among women −61% (95% UI [−63; −60]), while in Central Europe it was −43% (95% UI [−50; −37]) and in the East −25% (95% UI [−34; −14]), leading to widening of the gap between East, Central, and West Europe in relation to stroke burden. YLL represented more than 70% of stroke DALYs and more than 90% of DALYs for men in East European countries. Conclusions: The burden of stroke contributes to the European health gap through preventable premature stroke deaths. There are some very successful countries in stroke burden management from both Central (Slovenia, Czech Republic, and Hungary) and East Europe (Estonia), suggesting that closing the health gap between East and West is a realistic aim.

Diabetic retinopathy (DR) is a leading cause of preventable vision impairment and blindness in the European Region. Despite the fact that almost all European countries have some kind of prophylactic eye examination for people with diabetes, the examinations are not properly arranged and are not organized according to the principles of screening in medicine. In 2021, the current COVID-19 pandemic moved telemedicine to the forefront healthcare services. Due to that, a lot more patients could benefit from comfortable and faster access to ophthalmology specialist care. This study aimed to conduct a narrative literature review on current DR screening programs and registries in the European Union for the last 20 years. With the implementation of telemedicine in daily medical practice, performing screening programs became much more attainable. Remote assessment of retinal pictures simultaneously saves countries time, money, and other resources.

Background: Diabetic retinopathy (DR) is a leading cause of visual impairment globally among working-aged individuals. This study aims to update data on DR prevalence in Bulgaria. Methods: The present cross-sectional study was conducted between 1 January 2022 and 1 January 2023, using a local diabetes registry from the city of Varna as a sampling framework. In total, 587 diabetic patients underwent DR examination. Data included demographics, diabetes type/duration, treatment, and ophthalmic history. DR status was assessed using indirect slit-lamp biomicroscopy or digital fundus photography, graded by the International Clinical Diabetic Retinopathy Scale. Results: Of 587 participants, 13 were excluded due to cataract-related ungradable images. The median age was 65 years (IQR 56–73), with a slight female predominance (54%). The overall prevalence of any DR was 39.9% (95% CI 35.9–44.0), with non-proliferative DR (NPDR) at 27.5%, proliferative DR (PDR) at 7.3%, and macular edema (DME) at 5%. Type 1 diabetes patients had significantly higher DR prevalence (68.8%) than type 2 (34.1%, p < 0.001). Men exhibited higher DR prevalence. Age and diabetes duration correlated positively with DR prevalence. Insulin treatment was associated with higher DR prevalence (55.6%) than oral antidiabetic treatment (22.5%, p < 0.001) for type 2 diabetes patients. Among those diagnosed with DR, 70.9% received treatment, mainly laser therapy. Conclusions: These findings provide epidemiological insights for future research and emphasize the need for a comprehensive national DR screening program in Bulgaria. Technological advancements enable proactive measures to mitigate DR-related visual impairment and blindness, including widespread screening, even in rural areas.

Purpose: Malignant eyelid tumours are the most common malignancies in ophthalmic practice. We report here the incidence of non-melanoma eyelid malignancies in Bulgaria, for the period 2000-2015. Methods: All cases coded with the International Classification of Diseases (ICD) code C 44.1, received from the Bulgarian National Cancer Registry, were used for estimating crude incidence rates by age and sex. In addition, directly age standardized incidence rates for non-melanoma eyelid malignancies are presented based on the European Standard population (year 2013) for Bulgaria and the region of Varna. Results: Over the 16-year period there were 3,046 cases in total, of which 1,457 (47.8%) were among men. The age standardized rate (ASR) of non-melanoma eyelid malignancies in men was 2.9 per 100,000 (95% CI 2.79-3.11), in women it was 2.4 per 100,000 (95% CI 2.30-2.54), and the mean ASR was 2.6 per 100,000 (95% CI 2.53-2.73) for both sexes during the period. The ASR increased for women and for both sexes combined. The risk of eyelid malignancies was higher for men than for women with RR of 1.21 (95% CI 1.08-1.41) during the whole period. The risk was higher in women up to the age of 55 and over 55 years it was higher in men. Conclusion: We report results for the incidence of eyelid non-melanoma malignancies in a south-eastern European country, Bulgaria. They are comparable with earlier reports from other European countries.

Diabetes is one of the leading causes of health losses among the Bulgarian population. Diabetic neuropathy (DN) occurs in at least 34 % of people with type 1 diabetes after 25 years of disease duration and 20 % - 30 % of newly diagnosed patients with type 2 diabetes, increasing to 50 % after 10 years of disease duration. The treatment of DN is challenging. There is growing interest in non-pharmacological forms of treatment. High-power lasers have increasingly been used in the practice of physical and rehabilitation medicine. However, clinical trials testing their effectiveness in DN are scarce. Purpose: The aim of this single blinded, placebo-controlled field trial is to investigate the effect of a multiwave locked system (MLS laser) on sensory perception and electroneurographic parameters of sensory and motor nerves in patients with diabetic sensorimotor neuropathy of lower limbs. Material/Methods: A total of 69 patients were randomly assigned laser treatment (n=41) or placebo treatment (n-28) for three weeks, totaling 9 procedural sessions. Vibration sense was measured three times per session. Neurophysiological evaluations were conducted at baseline and on day 90. Results: On day 21, vibration sense increased bilaterally at all sites in the laser group, with statistically significant differences (p < 0.05 for all sites) compared to the placebo group, persisting through day 90. Nerve conduction velocity and amplitude of the sural, peroneal, and tibial nerves improved by day 90 from baseline, with superior results in the sural nerve. Conclusions: Deep tissue laser therapy can be considered a safe, non-pharmacological adjunct to the standard for managing diabetic neuropathy.