Preconception care (PC) is relatively new area of practice. While the volume and quality of PC activities depend on local settings, the awareness of women is critical for the successful promotion of PC services. The aim of this study was to examine the preconception-health-related attitudes and experiences of Bulgarian women of reproductive age. A qualitative study conducted among 20 women aged 18 to 49 years was performed between May and July 2022. Two focus groups were used with mixed samples of nulligravida, pregnant, and postpartum women. The participants thought that the Internet and their obstetrician-gynecologist were the only places where they could learn about getting pregnant. Only two of them discussed their PC plans with their physicians. Women pointed out that general practitioners (GPs) need to be more proactive in promoting PC. All respondents outlined the need for a web-based educational platform that could serve as a primary source of health information for future families. The role and functions of GPs in the continuum of PC should be reconsidered. We recommend targeted educational measures for all stakeholders, including women and GPs. In this regard, an easily accessible, knowledge-based web platform could enhance Bulgarian women’s awareness and perceptions of PC.

BACKGROUND:For patients with hereditary coagulopathies such as hemophilia, the most common dental problem is spontaneous oral bleeding caused by daily oral hygiene habits like tooth brushing. Because of fear of bleeding, children with hemophilia often skip routine oral hygiene procedures, which can lead to dental caries and periodontal diseases. This case control study aimed to evaluate the oral hygiene awareness and hygiene practices of children with hemophilia from 6 to 18 years of age in Bulgaria. MATERIAL AND METHODS:This study was conducted over 4 years and included 31 patients (children). A sociological approach was used, with direct individual questionnaires for self-assessment of dental habits. Statistical analyses were performed using SPSS. RESULTS:There was no significant difference between groups in methods of oral hygiene. The duration of oral hygiene procedures was 1 min (n=5, 16.13±6.61%) or 2 min (n=13, 41.94±8.86%), which was considered insufficient for proper oral hygiene. Children who had received oral hygiene advice by a dentist brushed their teeth significantly longer (n=9, 69.23±12.80%) than those who had not. There was a considerable difference between the reasons for the last dental visit between the groups of children (χ²=5.18, P<0.05). CONCLUSIONS:Children with hemophilia have high awareness of oral hygiene methods; however, more attention should be focused on additional individual educational methods at the dental office. Frequent professional and self-assessment of the oral hygiene routine of children with hemophilia could identify the factors compromising dental status in this vulnerable population.

Background: Human papillomavirus (HPV)-attributable cancers remain largely preventable but continue to generate increasing treatment costs where vaccination and screening coverage are limited. We estimated direct inpatient pharmaceutical reimbursement attributable to HPV-related cancers in Bulgaria and examined the drivers of expenditure growth. Methods: National Health Insurance Fund reimbursement data (2021–2025) were analysed for antineoplastic medicines used to treat eight HPV-associated cancer sites. Site-specific population-attributable fractions (PAFs) were applied to estimate HPV-attributable expenditure. Uncertainty in PAFs was quantified using 10,000 Monte Carlo simulations and discrete attribution scenarios. Expenditure growth was decomposed into price, volume, and net product-entry/exit effects using Fisher indices. Expenditure was additionally expressed in constant 2021 euros using the Harmonised Index of Consumer Prices. Results: Estimated HPV-attributable inpatient pharmaceutical reimbursement totalled EUR 54.2 million (probabilistic median; 95% uncertainty interval: EUR 53.3–55.0 million). Cervical cancer accounted for 81.8% of the total. Results varied by less than ±6% across attribution scenarios and remained EUR 44.6 million when head-and-neck cancers were excluded. Annual expenditure increased from EUR 3.67 million in 2021 to EUR 19.89 million in 2025, representing a 5.4-fold nominal and 4.2-fold inflation-adjusted increase. Growth was concentrated in cervical cancer and was driven primarily by the introduction of new therapies rather than higher prices or greater use of existing medicines. Net product entry explained 88.8% of total log growth, while reimbursement prices for continuing products declined by approximately 31%. Pembrolizumab, first reimbursed for cervical cancer in 2023, accounted for EUR 16.03 million of cervical cancer expenditure in 2025. Conclusions: These ecological estimates indicate a rapid increase in HPV-attributable inpatient pharmaceutical reimbursement in Bulgaria, largely driven by cervical cancer and the introduction of immunotherapy. The findings have implications for budget forecasting, procurement planning, and economic evaluation of HPV prevention strategies.

Въведение: На 31 декември 2019 г. Световната здравна организация съобщава за пневмония, чийто етиологичен причинител – коронавирус (SARS-CoV-2), впоследствие заразява хиляди лица, а милиарди са поставени под социална изолация. Както при всяко инфекциозно заболяване, засягащо общественото здраве, се повишава заинтересоваността сред хората, които имат придружаващи заболявания или нарушения в коагулацията, като хемофилия и други редки заболявания. Цел: Да се систематизират и анализират данните от литературните източници, които изследват насоките за прием на пациенти с хемофилия в денталната практика по време на пандемия от коронавирус (COVID-19). Материал и методи: Проведено е систематично търсене в литературните данни за насоки и инструкции за работа в дентална практика при извънредно положение на пандемия от COVID-19, насочени към хора с хемофилия. Резултати: По време на извънредно положение на пандемия всички посещения се планират предварително, като медицинският триаж се определя от денталния лекар. На базата на стандартен протокол всеки пациент се оценя за грипоподобни симптоми, контакти със заразени лица и посещения в държави с местно предаване на COVID-19. В случай, че пациентът не е имал такива, дентален преглед и последващо лечение могат да бъдат осъществени, като се вземат предвид мерките за превенция и контрол на вътреболничните инфекции. Дискусия: На този етап не е открита повишена чувствителност към инфекция с коронавирус у пациенти с хемофилия. При попадане на микробни аерозоли в горните дихателни пътища, при пациенти с придружаващи заболявания (диабет, хипертония и др.), тогава биха могли да доведат до по-тежко протичане на инфекцията. Разпространението по аерозолен и капков път на SARS се потвърждава, но по време на дентални процедури не е напълно изяснено. Заключение: Пандемията от COVID-19 не трябва да бъде причина за тревожност у хората, живеещи с редки болести, техните семейства и национални организации. Мерките за намаляване излагането на риск на лица от COVID-19 се промотират активно както на популационно ниво, така и за всички хора с хемофилия.

BACKGROUND: Dentophobia (DF) is unreasonable, irrational, excessive, and socially limiting fear of specific situations related to dental care. The condition is part of the ultimate and pathological cluster of dental anxiety. AIM: Objectives of the present study are: (1) Identification of latent factors in the psychological manifestation of dental fear, anxiety, and phobia and (2) comparison of these factors with the degree of manifestation of the psychological construct and gender differences. METHODS: A cross-sectional online-based survey was conducted. The primary sociological information is collected through a direct individual survey including 32 items divided into four sections. Statistical data processing includes descriptive statistics, non-parametric hypothesis tests, exploratory and confirmatory factor analysis for detection and verification of latent factors, internal validity analysis. DISCUSSION: The presence of a latent factor conditionally describing “pain related fear” is a possible reason for the overlap of DF with other panic disorders related to medical care described in the literature. A study performed for a wider and diverse population sample would produce more credible findings from which to draw more accurate conclusions. CONCLUSION: This study provides a better understanding of how to identify patients who are prone to, or already suffer from dental anxiety and allows dentists and health-care professionals to provide better health. The analysis of this study discovered a significant difference between latent factors from the construct encompassing the pain related fear and social fear.

Въведение: В ежедневната практика на лекарите по дентална медицина присъстват пациенти с нарушения в кръвосъсирването, от които най-често срещаната коагулопатия е хемофилията. Цел: Да се систематизират и анализират данните от публикации, които изследват оралния статус и причините, които биха могли да доведат до орални хеморагии при пациенти с хемофилия. Материал и методи: Проведено е търсене в базата данни с научна литература Pubmed на всички налични публикации до декември 2018 г., които изследват оралния статус при деца и възрастни и причините, които биха могли да доведат до орални хеморагии при пациенти с хемофилия. Резултати: Установява се, че пациентите с хемофилия не се различават значимо или имат по-добър орален статус от контролните групи. В сравнение със здрави контроли, пациентите проявяват по-голямо кървене на гингивата в покой и при дентални инвазивни манипулации, като за превенция на усложненията в денталната практика е необходимо да се въведат специализирани протоколи за работа. Заключение: Хемофилията представлява сериозно предизвикателство в световен мащаб, защото рутинното дентално лечение може да доведе до животозастрашаващи състояния. Затова денталните лекари трябва да обръщат специално внимание и да бъдат запознати с потенциалните рискове от кървене. Последните постижения в контрола на хемофилията позволяват на все повече пациенти да бъдат извършени хирургични и рутинни дентални манипулации в амбулаторна практика.