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Breast cancer”: new diagnostic possibilities


Projects from Gabrovo Initiative for Better Health Workshop – June 2004


Projects from PSBH Seminars - Pleven, June and September 2004



A PSBHN Workshops was held in Stara Zagora on June 3-5, 2004. The workshop was organized by Dreyfus Health Foundaition, New York, USA, the Association for Better Health - Pleven, Medical University - Pleven, and the Medical Faculty of Thracian University - Stara Zagora. Nurses, trained in the bachelor degree course attended, as well as nurses from Plovdiv University Hospital and hospitals in Sliven, Yambol, Pazardjik, Nova Zagora, Radnevo, Aitos.

The participants were addressed by Assoc. Prof. Zhivko Karakolev, MD, PhD, Dean of Medical Faculty of Thracian University and Assoc. Prof. Yuliana Marinova.


With the assistance of Mrs. Shelagh Murphy, international nursing program consultant - Dreyfus Health Foundation, and the local facilitators Assoc. Prof. Maria Alexandrova, Assoc. Prof. Angelika Velkova, Mrs. Yanka Tzvetanova, , Mrs. Evgeniaya Dimitrova (Medical University - Pleven), Mrs. Polya Zhivkova (Alexandrovska Hosptal - Sofia), Mrs. Gergana Momova (Medical University - Varna) and Assoc. Prof. Yuliana Marinova and Mrs. Slava Rousseva (Medical Faculty - Stara Zagora ), the participants prepared the following plans of action:


 ·        Training skills for combined rehabilitation and nursing care to nurses and rehabilitation specialists staff in a ward for patients with severe stroke - Anna Todorova

·        Reorganizing the activities of staff to improve on the psychomotor development of 7 institutionalized children aged 6-12 months - Bissera Ivanova

·        A training program for 10 members of teaching staff at the Medical Faculty in Stara Zagora to quit smoking - Boryana Parashkevova

·        A training program for nursing staff in a neurology clinic to manage in emergency situations at the clinic - Darina Ivanova

·        Educational program on proper diet for diabetics to hospital readmission rates - Diana Christova

·        Organizing a support group for patients with unexpected onset of blindness to reduce stress and improve on adaptation - Elena Dimitrova

·        Increasing the level of knowledge of cardiac patients on appropriate life styles - Elka Minkova

·        Health-education for medical staff in a surgery ward on proper hand disinfection - Galina Ilieva

·        Health education for diabetic patients to prevent diabetic foot complications - Galina Todorova

·        Raising the level of awareness of healthy life styles through introduction of health promotion in the regular training program of medical students - Galya Chamova

·        Education and training of nursing and support staff to prevent and reduce decubital ulcers in stroke patients - Galya Ivanova

·        Health education for 20 diabetic patients on proper diet, treatment and exercise regiment to early complications of diabetes mellitus - Ginka Dineva

·        Additional training for nursing staff to improve quality of nursing care - Iren Milenkova

·        Training nurses safe techniques of placing peripheral intravenous pathway - Irina Zhivkova

·        Training patients with colostomy to reduce complications and readmissions to hospital - Ivanka Koleva

·        An educational and training program for families of schizophrenic patients on the importance of continuing drug therapy after discharge from hospital - Joanna Gerova

·        Training nurses to improve skills in collecting peripheral blood from children - Katya Stefanova

·        An educational program for patients with bone fractures aged 65+ on proper exercise regimen - Krassimira Radicheva

·        A training program for nurses on the proper preparation of patients for angiography - Kunka Momchilova

·        Health education for hypertensive patients aged 40 – 60 - Lilka Koleva

·        An educational program for parents of children with chronic kidney diseases - Maiya Koleva

·        A program to reduce stress among hemodialysis patients and nursing staff - Maria Kostadinova

·        Increasing the level of knowledge on pain control among families of 100 cancer patients - Milena Direkova

·        Introduction of a standard protocol of nursing colostomy patients - Nedka Staikova

·        A training program on for nurses and support workers to improve on hygiene and epidemiological conditions in a chest surgery clinic - Nevena Angelova

·        Antismoking program for 60 children aged 14- Nonka Nikolova

·        Optimizing sterilization of bed linen in a surgery clinic - Penka Petrova

·        A rehabilitation program (occupation and art therapy) for 20 chronic psychiatric patients - Penka Prodanova

·        Health education on proper exercise regimen for patients after hip joint replacement - Penka Pronenkova

·        A program to improve on the time and quality of disinfection and sterilization of surgical instruments - Penka Vassileva

·        An educational and training program for nursing and support staff on prevention and control of in-hospital infections in a surgery clinic - Petya Gospodinova

·        Introduction of closed system of collection of blood samples for patients on anticoagulation therapy - Petya Srebreva

·        An educational program for diabetics on the importance of precise blood sugar control - Radostina Milkova

·        An educational and training program for nursing and support staff on proper collection and disposal of hospital waste - Reneta Panayotova

·        Health education on proper hygiene and diet for patients with COPD and their families - Rositza Martinova-Manolova

·        Health education on proper diet and exercise and risk factors for diabetic patients - Snezhanka Marokova

·        A training program for staff to improve on their work on integration activities with disabled children - Stanka Nozhdelova

·        A training program for nurses to improve quality of nursing care in a risk pregnancy clinic - Stefka Stoyanova

·        A training program for nurses to improve on teamwork skills - Tanya Prodanova

·        An educational program to increase level of knowledge and cooperation for treatment of parents of children with thalassemia - Tanya Radevska - Karadjova

·        Integration of disabled children aged 0-4 years - Tanya Stoyanova

·        A training program for 40 nurses from 4 intensive care wards on prevention of decubital ulcers - Tzetza Antova- Todorova

·        A program to increase motivation of cancer patients to undergo the full chemotherapy course of treatment and reduce their stress level - Victoria Denkova

·        Improving on the organization of clinical lab procedures to increase patient’ satisfaction with lab services - Victoria Vassileva

·        Improving on communication and integration skills of four orphanage children aged 3-7 - Zoya Dimova

·        Information and training program for nurses on handling cytostatic preparations - Yanka Kryakovska


Follow-up Workshops


A follow-up workshop was held in Gabrovo on June 6th 2005, with participants from the June 2004 PSBHI workshop. Information about projects completed, continued or in progress can be found in this issue, or in the previous issue of the digest.


A follow-up workshop was held in Pleven on June 7th 2005, with participants in the June 2004 and September 2004 PSBHN workshops.

All projects were implemented in crèches, kindergartens and schools in Pleven Municipality and were followed up in collaboration between the Association for Better Health and the Health Department of Pleven Municipality. Funding was provided by Pleven Municipality and sponsors. At the end of the workshop, Dr. Elza Pacheva and Mr. Stefan Zahariev of the Health Department of the Municipality, awarded prizes to project coordinators.

The results achieved by project coordinators make it possible to plan for future collaboration - extend the program and replicate successful projects to reach more children.


Forthcoming events


 A follow-up workshop is to be held in Pleven on November 9, with participants from the April 2004 PSBH workshop on nosocomial infections.

A new PSBH workshop on nosocomial infections is to be held on November 11-13 in Dobritch, with participants from Dobritch Regional Hospital.


Note! You can visit www.livebg.net/psbh-digest, where you can see some pictures from workshops and projects, as well as all previous issues of the digest.


Please send your suggestions and materials which you find useful for improving health, or send materials with experience you would like to share with the recipients of the Digest  - workshop participants, medical schools and  nursing colleges, to abh-psbh-bg@el-soft.com


The board of the Association for Better Health will appreciate your comments, recommendations and consideration for future collaboration



Breast cancer”: new diagnostic possibilities  

G. Baitchev, F. Pandurski, S. Popovska

Pleven University Hospital, Bulgaria


Summary: Early diagnosis has proved extremely important for treatment of breast cancer. The authors present current diagnostic methods and some advantages of thermography performed with Breast CareTM , a heat detecting device which maps and records hot spots or areas of increased blood distribution, in some cases indicative of increased metabolic activity associated with pathological changes

Key words: breast cancer, diagnosis, Breast Care тм.



Projects from Gabrovo Initiative for Better Health Workshop – June 2004


Improving the quality of life of disabled people in Gabrovo

Stefka Racheva, Union of Disabled People – Gabrovo Region


The aim of the project was to improve the quality of life of disabled people by increasing the level of knowledge among them regarding their rights.

The project was started in September 2004, with preparing a series of workshops for members of the union in Gabrovo region. Information materials were prepared, and lecturers invited from various organizations – Bulgarian Union of Disabled People, Agency for Social Assistance, Regional Health Insurance Fund, Regional Social Insurance Organization, Regional Medical Board for Assessment of Capacity for Work, National Center for Social Development.

On October 10, the first workshop was organized on problems of social rights and integration of disabled people with 30 participants from 30 places in Gabrovo Region. After the workshop, meetings were organized in 12 towns and villages, at which meetings disabled people received information and were given consultations by experts.

Meetings were held with the mayors of these 12 places, during which problems of disabled people were discussed, as well as ways to solve them.

A second information workshop was organized in April with 30 new participants.

The results from the project activities were made by an inquiry aiming to assess the level of information among the participants regarding the rights of disabled people: 80% of them showed good level of information.

Because of its social relevance the project will be continued by activists of the Union of Disabled People in Gabrovo, with the help of sponsors from Gabrovo region and from Pravetz, Sofia region.



Health educational program to reduce the risks of reinfarction

Katerina Taneva


The project was started in August 2004 at the ICU of Gabrovo regional hospital. The target group was of 10 AMI patients were selected, and a control group was formed of other ten AMI patients who did not participate in the program.

An initial inquiry was made to assess the level of knowledge on factors increasing the risk for re-infarction in both target and control groups. The inquiry showed that the level of knowledge in both groups was unsatisfactory.

An information brochure was prepared and give to patients in the target group, aiming to give answers to questions most frequently asked by myocardial infarction patients. Six meetings were organized with patients from the group, at which a cardiologist gave talks on risk factors, course and prevention of myocardial infarction.

The health status of the patients from the target group was clinically assessed. Individual advice was given to these patients regarding diet and exercise after AMI.

The results were assessed in December 2004 and in May 2005.

Results: During the period August 2004 – May 2005, two of the patients in the target group had a second infarction, while they were four in the control group.

The level of knowledge among the patients from the target group was higher. Two of the patients in the target group quit smoking.

The team – nurses and doctors plan to continue with the program on a regular basis, as part of the treatment provided at the unit. All newly diagnosed AMI patients will be invited to participate the program.



A health educational program to build basic hygiene skills in street children visiting the Center of Bulgarian Red Cross in Gabrovo

Dr. Nelia Kouzeva, Gabrovo Municipality


The project aimed at to improve on the level of health knowledge and train build basic hygiene skills in a target group of 60 children registered at the center.

The project was started in July 2004, with a group of 60 children aged 3 to 18. Over a period of six months, the team worked with the children. The status of the children, when enrolled in the target group was as follows: 90% of them had head lice and 50% were diagnosed with helminthiases, and 85% were lacking basic hygiene skills.

All children were seen by a pediatrician upon admission to the center, laboratory tests were made and treatment was provided for children with parasitoses.

A poster was placed in the dining room to remind the children to wash hands before meals. They were all included in a program for individual training and health education carried out by pedagogues, medical professionals and volunteers.

Apart from these, three talks were organized for all children and a video was shown on prevention of parasitoses.

The training and health educational program was carried out with the active support and participation of specialists from the Regional Institute of Public Health Control in Gabrovo, and the institute also provided hygienic materials, detergents, health information brochures and leaflets.  On the day of Christian Family, a quiz with prizes from the Regional Office of Bulgarian Red Cross and entertaining games on personal hygiene were organized for the children.

The project was carried out and completed by the team with great enthusiasm – the final inquiry showed that 80% of the children had acquired habits to maintain proper personal hygiene and all children were highly motivated to maintain better hygiene on the premises of the center.

The project team plans to carry out the program at a school for children with special needs in Gabrovo.



A program for additional training of hygiene support workers at the ICU of Gabrovo regional hospital on problems of hospital hygiene and disinfection

Galia Petrova, Intensive Cardiology Unit


      A six-month training program was organized to increase knowledge and improve skills of support workers to use newly introduced disinfection preparations and maintenance of proper hygiene in the unit. Ten training sessions were organized with a group of 5 support workers.

Demonstrations were made how to prepare disinfection solutions of new preparations. Specific tasks of support workers in the maintenance of hygiene in the unit were discussed.

Results: after the training, all of them can prepare solutions with the required concentration, and regularly use protective gear (gloves). The end-of-program test showed increased knowledge on disinfection and hygiene.

Additional results from the program: use of detergents became more cost effective. Several checks of hygiene levels in the unit proved lower levels of microbial agents.



Information program for parents of children admitted for treatment at the pediatric unit of Gabrovo Regional Hospital

Raina Alexandrova


The project activities were oriented to provide the parents about admission, daily regimen and procedures and requirements in the unit, for which purpose a brochure and a map of the ward was prepared.

Results: the information brochure helped to improve working conditions for the staff. Reduced the number of conflicts, and reduced the level of stress due to lack of information among parents. 

For parents of lower education, the information was provided by a nurse upon admission of children. 

The project activities covered the parents of 200 children treated at the unit. An inquiry shoed that all parents were highly satisfied with the initiative to provide information on the ward and its activities, and stress reduction was found in 20% of the parents.

The project is to be continued with resources provided by the hospital and become routine part of the staff activities.



A program to increase fitness and prevent upper respiratory tract infections in kindergarten children aged 3-5

Pavlina Yanakieva


The project activities started in June 2004 at Mickey Mouse kindergarten in Gabrovo. The team included ten teachers, 5 assistants and the kindergarten nurse.

A program was prepared with activities to improve the general health and fitness with the children, depending on the season, and the guiding principles of the program included gradation and systematic and individual approach to each child.

During a meeting with parents in July, the program was presented and a talk was given on the importance of fitness as an effective means to prevent upper respiratory infections. Information brochures were provided by the Health Promotion Department of Regional Institute of Public Health Control in Gabrovo. The team was additionally trained to work on the project.

Activities with 130 children started in the middle of July 2004 with air-,  sun- and water bathing. Sports games and competitions were organized, adapted to the children’s ages. Parallel to these, various health education activities were organized – a puppet theatre show, reading of stories, fairy tales and nursery rhymes. 

In December, a second training was organized for parents on principles of healthy diet for children, with the assistance of Gabrovo Municipality Department of Health Protection and Social Activities.

The results were assessed on the basis of registration and analysis of dynamics of upper respiratory infections in the children according to age groups (3, 4, 5 and 6 years).

After six months, data was compared to the period from the previous year.

Results: Over the 6-month period, the number of children suffering from upper respiratory infections were reduced by 20%.



A health-educational program in basic hygiene skills in newly admitted crèche children

Stefka Deneva


Initially, activities were planned to build basic hygiene skills in all children (aged 1-3 years) attending Slaveiche Creche in Gabrovo. Because of difficulties that arose in providing the necessary resources, the project coordinator changed her plan and activities were planned to work with newly admitted children.

The educational program was organized for the parents of 20 newly admitted children. Three talks were organized for the parents with demonstrations how children could be helped with toilet training, and independent eating and hand-washing skills. 

All parents showed interest in the project, and willingly helped with training these skills to children when at home, along with abandoning diapers and pacifiers.

To evaluate the results, initial and final assessment of the children’s skills was made. The final assessment proved that 14 out of the 20 children (70%) had acquired the hygiene skills.

The project is to continue as a routine program in the crèche, and funding is to be provided by the crèche and donors.



“Clean environment – better health for everybody”

Vassil Grancharov, Center for Social Services - Gabrovo


The project aimed to improve on the hygiene and environment in the area around the Club of  Disabled People in Gabrovo.

Cleaning the area was organized four times, and both disabled people and citizens volunteered. Sports activities were organized.

Very good co-operation was established between the members of the club and people living near it. Hygiene on the playground and the park area was maintained by the members of the club and volunteers participating in the project.

Apart from these activities, health professionals and ecologists were invited to talk on tick-borne diseases and the harmful effect of pesticides on environment and health. Health education brochures were provided for the members of the club and healthy individuals who participated in the project activities.

The inquiry at the end of the program, in which 80 people participated showed satisfaction with the activities, and expressed their willingness to continue with the program.


  Projects from PSBH Seminars - Pleven, June and September 2004

Reduction of upper respiratory infection rates in kindergartens children aged 3-6

Lilyana Karadjova


The project aimed to decrease the rate of acute upper respiratory infections in 23 children aged 4 and attending “Prolet” kindergarten in Pleven for a period of one school year (September 2004 – May 2005.  

The project was implemented with the support of the director of the kindergarten, the teachers and the parents. The health educational materials for the teachers and parents were provided by the Department of Health Promotion at the Regional Public Health Control Centre in Pleven.

The fitness program was organized according to the general principles of increasing fitness and the age and general health status of each child. Special attention was paid to children who frequently suffer from of acute upper respiratory infections.

The program started with providing proper conditions – regular check of temperature in the rooms and regular airing. Special attention was given to make sure the children were not overdressed. The requirements regarding room temperature, airing and dressing were made known to teachers and parents, to make sure these were provided when the children were at home.

Results: In the group of 23 children, 48 episodes of acute upper respiratory infections had been registered during the previous school year. For the period, when the program was carried out the episodes were 28, i.e the episodes were reduced by 42%.

Te results obtained convinced the team and the whole staff at the kindergarten to gradually expand the program to cover all the children attending.



Organizing activities to improve physical fitness of children aged 5 years

Danka Stoyanova


The program was implemented during July and August 2004, with a group of 25 children aged 5-6 years, attending “Sinchetz” kindergarten in Pleven. The team included a nurse, two teachers and a nanny.

The aim was to reduce the average duration of absence because of acute respiratory infections by 15% through introduction of various activities every day – air and water bathing, outdoor activities - games, walks, physical exercises.

Parents were informed about the activities planned, and individual records were kept for each child concerning episodes of infection and days of absence. Assessment of  daily “performance” was registered on a special board.

The goals of the project were achieved. The team plans to continue the program as routine practice, and extend it to other children attending the kindergarten.



Weight-reduction health program for children aged 3-6years

Valentina Tzvetkova


The project aimed, through implementing a health-educational program for the parents of 20 overweight children attending “Iglika” kindergarten in Pleven to achieve reduction of weight in 2 children, and normal body weight in 4 children for the period July 2004 – July 2005.

With the support of the director, and consent from parents, the following activities were carried out:

·        the diet of children was revised by a nutritionist from the Department of Health Promotion at the Regional Public Health Control Centre in Pleven;

·        additional physical training exercises were introduced in the daily program;

·        ten children were enrolled in a group of folk dancing at the kindergarten;

·        the weight of the children was checked every three months.

As of June 2005, the results were as follows:

·        the program was carried out with 19 children;

·        weight reduction was achieved in 8 children;

·        weight reduction to normal weight was achieved in 8 children;

·        in three children there were no changes in body weight..

The excellent results have motivated the team to continue with the program on a regular basis.



Adaptation of pre-school group children aged 5-6 years to school environment

Iva Tzvetkova


The project aimed to help improve the adaptation of 10 pre-school children attending the school of foreign languages in Pleven to school environment and schedule, thus preparing them for entering the first grade the following school year.

The implementation was approved by the school authorities. Observations, inquiries, talks with children and parents helped to identify the problems of adaptation to school environment and schedule. A daily regimen including all activities of children at school and at home was prepared by a team of a nurse, a psychologist and a teacher.

Depending on progress children made, parents were consulted and offered individual approach to their children so as to help them overcome the difficulties during the adaptation period.

In December 2004, assessment of adaptation was made on the basis of questionnaires for the parents, and a projective test based on the children’s drawings.

Results: nine of the ten children were found to be quickly adapting to the school environment and schedule – children willingly participated in class work, and managed to cope very well with assignments.



A health education program on basic hygiene skills to reduce the rates of parasitic and gastrointestinal diseases in 30 children aged 3

Stefka Kuneva Ouzunova


The project was started at “Slaveiche” kindergarten in Pleven with 30 children aged 3 to 4 years and their parents. The health education program was focused on basic hygiene skills and specifically reduction of gastrointestinal infections and parasitic diseases by 3%.

The project activities started in October, after coordinating the plan of action with director of the kindergarten and building up a team of two teachers, a nurse and a nanny. Talks with parents on problems related to prevention of parasitic and infectious diseases and hygiene skills were organized, and posters and drawings were hung up with illustrations and photos of activities.

Results: in May 2005 the team analyzed the end results. Preventive check-ups for gastrointestinal parasitic infections proved all children were negative. Satisfaction of parents was measured with questionnaires and found higher than expected.

The results from activities, active participation of children and high satisfaction of parents have encouraged the team to continue the program, with hope to be additionally funded by the health department of the municipality.



A health-educational program to reduce levels of aggression in children

Petranka Velikova


The project was started in June 2004 and completed in June 2005. The target group included ten children aged 3 with high levels of aggression, attending Latinka crèche in Pleven. Parents also participated in the program.

A team of six nurses and a pedagogical advisor organized the activities and conducted the program. The aims of the project were presented to the staff of the crèche and the Department of Health at Pleven municipality.

The neurophysiological development of the children was assessed at the beginning, and then on a monthly basis. Depending on the results of assessments, different activities were planned: together with routine daily activities, children had to perform individual tasks aimed at overcoming aggression. Good performance was stimulated. Puppet theatre performances were organized to teach children basic hygiene skills, work, mutual assistance, friendly behaviors. For Christmas and the International Chidren’s Day, toys and cassette players were purchased by parents.

Results: thanks to the systematic and highly responsible work of the team, aggression was reduced in eight of the ten children.



Improvement of oral hygiene habits in children aged 4-6 years

Antoaneta Zlatkova


The project was started in October 2004, with 140 children attending “Snezhanka” kindergarten in Pleven. The aim was to contribute to improve on the children’s dental health. What made the team start the project were the results from a study which showed that in each five children under seven, there were averagely six teeth with caries. Thus, building sound dental hygiene skills and knowledge on their importance for general health became a major concern of the team – a nurse, teachers, a specialist on health promotion, and a dentist.

The target group included 52 children, instead of the 20 originally planned. The aim was to reduce the number of those with caries by 50%. Otherwise, all the 140 children attending the kindergarten participated in all activities. Parents were also involved. Activities included:

·        gala days

·        quizzes

·        games to teach children tooth-brushing techniques

·        dental check ups

·        providing and distribution of brochures with information on dental health and proper diet for children and parents.

All funds needed for the project were provided by sponsors.

Results: during the school year (October 2004 – April 2005) the level of knowledge and skills improved, and the dental health status of 27 children (51%) improved. Parents were also satisfied with the results.

The results have convinced the team that the program should be continued, and newly admitted ones should also be included in the program.


Raising the level of knowledge on the harmful effect of alcohol in high school students (15-18) in a vocational school

Nadya Nedyalkova


After informing the director of the school about the aims of the project and activities planned, a team was built that included the school nurse, four  class teachers, and the teachers of biology and chemistry.

A series of lectures and talks (once a month) were organized, and brochures with information on the problem was provided for the students by the Department of Health Promotion. A poster was made with relevant information.

The main difficulty the team experienced was to motivate the students to attend the lectures and participate in discussions. This necessitated individual talks with the students.

Results: the level of knowledge was measured by questionnaires the students filled in October 2004 and April 2005. Their level of knowledge on the harmful effect of alcohol has increased by 85%.



Improvement of adaptation of 15-year-old students, newly admitted to the high vocational school of viticulture in Pleven

Zoya Gincheva


The aim of the project was, through individual approach, to reduce the levels of anxiety in 40 newly admitted students.

The project was started in September 2004, when the level of anxiety of each student from the target group was measured with a psychometric test, which showed high or very high level of anxiety in both boys and girls. Anxiety was attributed to change of school, missing old friends, new teachers.

The project team – a nurse, the class teachers and the school psychologist and the school authorities made efforts to help the students adapt to the new environment through meetings, talks, individual approach to those who experienced more difficulties.

A second assessment was made in December, which showed that 95% of the students had declared that they no longer had the problems they identified at the beginning of the school year. The level of anxiety was lower in the rest 5% of the students. In addition, they reported improvement in relationships with peers. Their levels of academic achievement were also improved.



Prevention of flat foot and spinal deformities in children aged  1.5-3 years attending “Drouzhba” crèche in Pleven

Emilia Taskova


The project was started in September 2004. After informing the director, the staff of the crèche and the health department of Pleven municipality about the aims of the project, a team was built of four nurses, a pedagogical advisor, a tutor in kinesitherapy from the Nursing College in Pleven and students in rehabilitation from the same college.

The target group included 30 children. The physical exercises introduced were in the form of games, specially adapted for the age of the children, and were designed according to multipurpose use: physical impact, exercise load and general psychophysical development. These were performed every day, and integrated into the daily regimen at the crèche.

The progress of each child was assessed every month, and the examination in May 2005 showed the children were in better shape as compared to the previous year. The check up performed by a specialist proved correction of posture in 83% of the children. All data was registered in the files of the children.

The success of the project encouraged the team to compile a manual of specialized exercises, designed to prevent flat foot deformities and spinal deformities in crèche children.

The program is to continue as routine practice in the crèche and the manual is to be distributed to all crèches in Pleven municipality and Pleven region.



Improving the immunization status of school children aged 11-12

Svetlana Marinova


The aim of the project was to improve on the responsibility of both children and parents to present certificates to the school health center regarding immunizations performed by general practitioners. The target group included 109 children from the 5th and 6th grades attending “Vaptarov” elementary school on Pleven.

The director of the school and the teaching staff were informed about the potential benefits, and the aims were presented to the parents at the first meeting in September 2004.

With the assistance of the class teachers, children were reminded to present the documentation from general practitioners regarding check ups and immunizations. To make parents realize the importance of immunizations, special brochures from the Health Promotion Department were provided.

Results: thanks to the joint efforts of the nurse and class teachers, information of immunizations of 92% of the children during the school year was collected (61% for the previous school year). Records also showed that the children had received all immunizations planned according to the immunization calendar of the country.

The project is to continue, with the 1st grade children during the school  year 2005/06.



Introduction of a set of breathing exercises for children from rehabilitation groups at “Mir” crèche in Pleven

Margarita Saikova

Diseases affecting the respiratory system in early childhood are a serious problem and the rates have been increasing during the last years. In view of the medico-social consequences, these should not be neglected. Apart from healthy children, the crèche also enrolls children who often suffer from upper respiratory infections and other respiratory diseases.

The activities were carried out by a team of two nurses and a physiotherapist. The whole staff was also trained to participate in the activities organized. The target group included 24 children with problems who were divided into three groups.

On a daily basis, sets of morning breathing exercises were organized, together with general physical exercises and fitness-improving procedures.

The effectiveness of the program was measured by comparing absenteeism due to acute respiratory infections for the period October 2004 – April 2005 to the period of October 2003 – April 2004, registered in the children’s health records.

Results: the average number of days off due to acute respiratory disease was decreased from an average 9.44 to 5.03 days, i.e. by 52.28%. It is worth noting that most of the days off were of 5 out of the 24 children.



Gathering information about prophylactic check-ups and immunizations of 11th

grade high school students

Anelia Angelova


The aim of the project at Ivan Vazov Comprehensive school in Pleven was to make sure information from general practitioners, regarding general health and immunization status of 100 students aged 17, was made available to the school nurse. The other aim was to make sure and /or follow up whether the students had turned up for scheduled check-ups and immunizations as required.

The director of the school, the teaching staff and parents were also informed about the aims of the project in September, when the school year started.

Posters and health information materials were provided for the students from the target group. Individual talks with some of the children were all aimed to make them realize the importance of check-ups and immunizations. Talks were given on diseases such as tetanus and tuberculosis, as well as the role of immunizations against tetanus and diphtheria.  Contacts were established with the family doctors of the children in the target group.

The class teachers, school authorities, the pedagogical advisor and teachers in physical education and biology helped establish better communication between parents, children in the target group and the school nurse. Health records referred to the school nurse were collected by children, who volunteered to help with the project.

Results: all data from check-ups performed by the family doctors and immunizations was collected from all 100 children.During the previous school year, the percentage was 82 for the students of the same age group.


Weight reduction program for obese high school students

 Lilly Stefanova


The project was started in September 2004. Medical check-ups helped select the target group – 16 overweight children aged 15-17. The aims of the project were then presented to the school authorities, the target group and some members of the teaching staff..

The students were provided with health education materials on proper diet and exercise recommended. Talks and lectures were organized to discuss problems associated with obesity and the role of diet and exercise. After special attention was paid to the choice of food, individual talks revealed a change in the attitudes of students to diet and choice of food in general.

With the assistance of a nutritionist, the quality of food offered  at the school canteen and school cafeteria was improved.          

The project was completed in June 2005. Results: 10 out of 16 students lost an average of 2.5 kg body weight. Plans include implementing the project in other high schools in Pleven municipality.



A program to improve fitness among crèche children aged 2-3 years

Margarita Ivanova


The project was implemented at Drouzhba crèche in Pleven and its aim was to reduce absenteeism among 80 children by 10% for one school year (September 2004 – May 2005).

The team included the director of the crèche, a pedagogue, 12 nurses and support staff.

Activities included:

·        informing the parents of the children in the target group about the program and persuding them to participate in the project;

·        individual talks with parents to improve on the level of information regarding procedures contributing to fitness improvement;

·        carrying out procedures such as physical exercises, avoiding overdressing the children, walks in the open, etc.

·        keeping records of absences because of upper respiratory infections.

Results: the rates of infections were reduced by 10%, as compared to the previous period (September 2003 – May 2004).

The team of the crèche plans to continue the project with newly admitted children.



Early intervention to improve on psychophysiological development of children under 12 months at Shtastlivo detstvo crèche in Pleven

Denka Macheva


A consulting center was set up at the crèche, aiming to train parents of  children under one how to take care of their children – to properly make massage, how to play with and exercise the child and  how to help the neurophysiological development in general.

The team included a pedagogue and students from the nursing college in Pleven, trained in nursing and physical rehabilitation.

Nine children were included in the program aged 2 to 9 months. The parents took a three-day training course on general principles and importance of massage and physical exercise for the proper development of the child.

After six months, the following was achieved:

·        results from visiting the center convinced parents that such instructions were useful for the proper growth and development of children;

·        such advisory and consulting centers are useful and should be organized to help parents;

·        two of the children were diagnosed with retardation in their motor development by a neurologist and were registered for follow-up and further rehabilitation.

Conclusions are that the results should be made known to the public through the local media, and the activities of the center extended to meet the needs of more children.