“THE LONELY SOLDIER OF PREVENTION” (for the book “Enlightenment and Health” and its author)

Presented are articles written in the 1920s and 1930s of the twentieth century, printed in periodic scientific and popular publications (newspapers and medical journals) by Dr. Dimitar Goshev, collected and published in a stand-alone book "Enlightenment and Health" in 2019. Doctor Goshev (1899-1982) studied medicine in Vienna, where he graduated in 1926 and dedicated his life to preventive medicine in the era of dramatic events for the Bulgarian healthcare system

For the Author and the Book

The new book of D. Paskalev is presneted

Integrative Medicine: History, Ideological Development, Informed Choice and Inteligent Investment in the Future

Интегративна медицина: История, идейно развитие, информиран избор и интелигентна инвестиция в бъдещет

Breast cancer screening in the UK: experience transfer to Bulgaria

Breast cancer is currently the most prevalent cancer and the most frequent cause of cancer-induced deaths in women in Europe. Demographic trends indicate a continuing increase in this substantial public health problem and Bulgaria does not differ from these negative trends. Evidence from many European countries shows that sys tem atic early de tec tion through screen ing, ef fec tive di ag nos tic path ways and op ti mal treat ment have the ability to substantially lower current breast cancer mortality rates and reduce the burden of this disease in the population. The achievements of the UK as a `gold standard` country in breast cancer screening, diagnostics and treatment is indisputable and its experience - worthy of exploration. This study aims to comparatively analyze the breast cancer screening practices in the two countries and on that basis to draw out specific recommendations for experience transfer from the UK to Bulgaria. The methods involve comparative analysis of screening practices in the two countries and documentary analysis in the area of breast cancer prevention field. A major emphasis is placed on the NHS Breast Screening Programme. Its main advantages and positive experiences are summarized. The most important ones identified as suitable for transfer to Bulgaria refer to: economic preliminary assessments; effective management process; prioritisation of quality assurance activities; continuous updates of the programme based on research outcomes and evidence-based practice; systematic involvement of the primary health care teams; public and professional education, and political support. In the context of globalizing society and limited resources, experience transfer of the best practices is a rational approach for solving important public health problems.Scripta Scientifica Medica 2007;39(1):79-8

Health status of the Bulgarian population: social determinants, recent dynamics and policy implications

This paper sets out to review the situation with regard to health status of the Bulgarian population and its main determinants. Revealing their recent dynamics, the study also aims to predict the future trends. It tries to interrelate the diseases burden and its determinants with necessary policy responses. High lighting the main challenges it draws out policy implications. The methods involve analysis of the current demographic and health situation and assessment of its dynamics. Some trends are analyzed comparatively for the different gender and residence population groups. The study is based on an analysis of previously published reports and official statistics. It also draws upon a number of national and local health surveys. Targeted and sustained investment is necessary to reverse the negative trends of population health and its social determinants. Clearly formulated, evidence-based, comprehensive and consistent policy is needed for integrated control of risk factors and chronic diseases, emphasizing on prevention and health promotion. Tangible political commitment, multisectoral collaboration and public participation are required for developing, implementing and sustaining healthy public policies.Scripta Scientifica Medica 2008; 40(2): 111-116

Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study

Since school-based interventions are mainly delivered by the school staff, they need to be well-trained and familiarized with the programme's aims, procedures and tools. Therefore, the institute, research group, governmental or non-governmental body in charge of the coordination and implementation of the programme needs to devote time and resources to train the school staff before programme's implementation. This is particularly crucial in multi-centre studies where more than one research teams are involved. Both research teams and school staff need to be trained, using standard protocols and procedures, to ensure that the intervention will be delivered in a standardized manner throughout the intervention centres. The ToyBox-intervention, a multi-component, kindergarten-based, family-involved intervention, focusing on water consumption, snacking, physical activity and sedentary behaviours in preschool children, was implemented over the academic year 2012-2013 in six European countries. As part of this intervention, three teachers' training sessions were delivered to motivate and train teachers in implementing the intervention. The local researchers were trained centrally before delivering the training sessions for the teachers and followed a common protocol using standardized presentations and procedures. The aim of the current paper is to describe the protocol and methodological issues related to the teachers' training sessions conducted within the ToyBox-intervention

Reliability of anthropometric measurements in European preschool children: The ToyBox-study

The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03kg for weight and from 0.07 to 0.20cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71cm during the first training and from 0.05 to 1.11cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed

Tools, harmonization and standardization procedures of the impact and outcome evaluation indices obtained during a kindergarten-based, family-involved intervention to prevent obesity in early childhood: The ToyBox-study

The ToyBox-intervention is a kindergarten-based, family-involved intervention targeting multiple lifestyle behaviours in preschool children, their teachers and their families. This intervention was conducted in six European countries, namely Belgium, Bulgaria, Germany, Greece, Poland and Spain. The aim of this paper is to provide a descriptive overview of the harmonization and standardization procedures of the baseline and follow-up evaluation of the study (and substudies). Steps related to the study's operational, standardization and harmonization procedures as well as the impact and outcome evaluation assessment tools used are presented. Experiences from the project highlight the importance of safeguarding the measurement process to minimize data heterogeneity derived from potential measurement error and country-by-country differences. In addition, it was made clear that continuing quality control and support is an important component of such studies. For this reason, well-supported communication channels, such as regular email updates and teleconferences, and regular internal and external meetings to ensure smooth and accurate implementation were in place during the study. The ToyBox-intervention and its harmonized and standardized procedures can serve as a successful case study for future studies evaluating the efficacy of similar interventions

The effect of a kindergarten-based, family-involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: The ToyBox-study

Background: The ToyBox-study developed an evidence- and theory-based intervention to improve preschoolers' energy balance-related behaviours - including physical activity (PA) - by targeting the kindergarten environment and involving their parents/caregivers. The present study aimed to examine the effect of the ToyBox-intervention on increasing Belgian preschoolers' objectively measured PA levels.Methods: A sample of 472 preschoolers (4.43 ± 0.55 years; 55.1% boys) from 27 kindergartens (15 intervention, 12 control kindergartens) in Flanders, Belgium were included in the data analyses. Preschoolers wore an ActiGraph accelerometer for six consecutive days and were included in the data analyses if they had a minimum of two weekdays and one weekend day, both at baseline and follow-up (one year later). Preschoolers' PA outcomes were estimated for an average day, weekday, weekend day, during school hours, and during after school hours. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample, and for sub-groups (according to sex, kindergarten levels of socio-economic status (SES) and risk groups (low levels of PA at baseline)) of preschoolers.Results: Small intervention effects were found in the total sample. Most intervention effects were found in boys and in preschoolers from high SES kindergartens. Boys from the intervention group had an increase in vigorous PA (ß = 1.47, p = 0.03) and moderate-to-vigorous PA (ß = 1.27, p = 0.03) from baseline to follow-up, whereas PA levels in boys from the control group stagnated or decreased. In preschoolers from high SES kindergartens, the largest effects were found for PA outcomes during school hours and during after school hours.Conclusion: The results from the Belgian sample demonstrate that effects of the PA-component of the ToyBox-intervention on objectively measured PA were found in preschool boys and in preschoolers from high SES kindergartens, which means that the ToyBox-intervention was mainly effective in those sub-groups. Future interventions should search for alternative strategies to increase preschoolers' PA levels in preschool girls and preschoolers from low SES kindergartens, as these are the most important at-risk groups regarding PA