Nikolina Radeva

Background: Workplace violence (WPV) is a pervasive occupational hazard in healthcare that undermines staff safety and quality of care. In Bulgaria, WPV remains widespread and underreported, despite recent legislative initiatives. This study assessed healthcare professionals’ perceptions of the effectiveness of WPV prevention strategies and examined how prior exposure shapes these perceptions. Methods: A nationwide cross-sectional online survey was conducted in December 2024 with 944 healthcare professionals from multiple sectors. Participants rated the perceived effectiveness of 11 prevention strategies, including environmental/security measures, organizational, and national-level interventions, on a three-point scale. Friedman ANOVA with Kendall’s W assessed overall strategy rankings, while Mann–Whitney U tests with rank-biserial correlations compared specific effectiveness ratings between subgroups defined by WPV exposure (experienced or witnessed vs. not exposed in the previous 12 months). Results: In the previous 12 months, 34.7% of respondents reported direct WPV, and 43.4% had either experienced or witnessed incidents. Friedman ANOVA indicated significant differences in perceived effectiveness across strategies (Kendall’s W = 0.13), with stronger differentiation among violence-exposed respondents (W = 0.37) than among non-exposed respondents (W = 0.09). National-level interventions and security/response measures were consistently ranked the highest. Mann–Whitney tests showed significantly higher endorsement of most strategies among violence-exposed professionals, with large effect sizes for security measures and enforcement of sanctions. Conclusions: Bulgarian healthcare professionals view WPV prevention as requiring a multicomponent approach that integrates robust national policy with organizational and environmental measures. Direct exposure to violence is associated with stronger support for security-focused and national interventions. These findings inform context-specific, evidence-based WPV prevention programs for Bulgarian healthcare facilities.

Background: Bulgaria had the highest road mortality rate among European Union members in 2023, having previously ranked second after Romania. Research has consistently demonstrated that prompt pre-hospital care can significantly reduce the adverse effects of road traffic accidents. Thus, we conducted a cross-sectional study to explore the involvement of trained road traffic casualties and bystanders in administering first aid. Methods: The study, carried out between April and December 2021, collected data via an online survey administered to members of the Scientific and Academic Cooperation Council by the State Agency Road Safety. The survey encompassed a range of topics, including first aid training, involvement in traffic accidents, behaviour of bystanders, administration of first aid, and sociodemographics. Results: Among the 292 respondents, a sizeable proportion (90%) reported having received first aid training. Of these, 35.1% (95% CI 29.2-41.1%; p < 0.001) had personally experienced a road traffic accident, and 64.5% (95% CI 58.1-70.1%; p < 0.001) had witnessed one. It is noteworthy that a fifth of those involved in accidents had employed the skills acquired from first aid training, which included applying a dressing to a wound, bleeding control, and immobilising a fracture. Correspondingly, an equivalent percentage of bystanders administrated aid, with the majority of them performing basic airway management. However, the findings revealed that a significant proportion of participants (79.3%) did not engage in providing first aid. The primary rationale stated was the assessment that it was nonessential. Conclusions: Despite the growing road safety challenges and many respondents witnessing or being involved in accidents, only a quarter of those trained in first aid actually provided assistance. Considering the increasing number of deaths and severe injuries, it is crucial to assess the need for frequent first aid training and the population’s proficiency in first aid. Key messages: • Bystanders’ competence in administrating first aid can mitigate the adverse effects of road traffic accidents. • Among other road safety measures, investments in first aid training can be beneficial in reducing fatalities and severe injuries.

Impact Of Marine Pollution On Human Health

Climate Change: Impacts on World Ocean and Biodiversity

Background: Bulgaria faced significant COVID-19 morbidity and mortality rates, but many people underestimated the risk of transmission and severity of infection. Rising vaccine-related fear and misinformation exacerbated existing hesitancy and mass vaccination remained a challenge. This study aims to investigate the factors influencing COVID-19 vaccination uptake in Bulgaria. Methods: A cross-sectional study was conducted in April 2022 in a sample of 1,200 respondents. Data were collected via an online self-administered questionnaire, measuring perceived risk of COVID-19, vaccine attitudes, trust in health system, and sociodemographics. Results were analyzed using bivariate and multivariate statistical methods. Results: Bivariate analyses showed that the majority of vaccinated respondents (81.9%) expressed concern about infection, compared to 47.1% of non-vaccinated. Significant differences were related to perceived risk of COVID-19 vaccine: 61.0% of vaccinated assessed risk as small versus 7.4% of refusers. Non-vaccinated participants demonstrated distrust in vaccine benefits and lack of trust in health system, science and pharmaceutical companies. The multivariable regression revealed associations between age, income, vaccine perception, and vaccination uptake. The 45-54 and 55-64 age groups were less likely to refuse vaccination compared to the youngest age group (OR = 0.34, p = 0.009 and OR = 0.38, p = 0.036). Odds of refusing the COVID-19 vaccine decreased as income increased (OR = 0.33, p = 0.036). A high perceived risk of adverse effects increased the odds of vaccine refusal by 7.02 (p<.001). Conclusions: The lack of confidence in the vaccine safety and effectiveness, coupled with an underestimation of the coronavirus disease, formed a critical barrier to the vaccine uptake. The misinformation fueled vaccination fear. Public health campaigns should address vaccine-related concerns and promote vaccination adherence in more consistent manner targeting also the spread of fake news. Key messages:

Natural and anthropogenic disasters become more frequent worldwide. As technology advances, the risk of major industrial accidents increases. Often accidents in the chemical and oil industry, in agriculture, or during transportation, lead to mass poisoning and extensive environmental pollution. The particularities of the medical support in case of such chemical incidents are challenging the healthcare system. The article aims to analyze the chemical accidents and the measures taken to reduce their effect in Bulgaria and in the Black sea aquatory. Historical and documentary methods have been used to gather information on disasters and accidents in Bulgaria, where toxic chemicals have been released into the environment, causing material damage and human casualties. We have researched and analyzed various articles and publications in Bulgarian and foreign scientific journals on the subject. Major industrial and transport accidents in the last 50-60 years on land and water had been selected from the literature sources. Both the reasons that led to them and the measures which were taken to eliminate the consequences were discussed. The major industrial accidents with a release of industrial toxic substances into the environment are relatively common and result in contaminating large areas and many casualties. Chemical accidents at sea are indicative of the need for joint action by different organizations to quickly overcome and avoid environmental impact. The risk of industrial poisonous substances entering the environment is significant and measures to avoid such accidents have to be taken, as well as training of a wide range of health professionals and the general public on the proper behaviour in case of a chemical disaster.