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МЕДИЦИНСКИЕ НАУКИ
INFLUENCE OF ENVIRONMENTAL FACTORS ON SUICIDES COMMITTED IN THE REGION OF SMOLYAN, REPUBLIC OF BULGARIA, OVER THE PERIOD 2000-2009
Bivolarski Iliya Petrov
Assistant - Department of General and Clinical Pathology and Forensic Medicine, Medicine Faculty, Medical University,
Plovdiv, Bulgaria Raykova Ekaterina Lyubenova
Assist. Prof. - Department of Health Care Management, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
Mihaylova Vanina Krasteva
PhD, Assoc. Proff. Social Medicine and Healthcare and Pharmacy at the Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief Assistant Department of Healthcare Management, Faculty of Public Health, Medical University,
Plovdiv, Bulgaria
Suicide is one of the major medical and social problems of modern society and is therefore an object of thorough studies (6, 9, 12, 14, 16, 17, 18). As an invariable part of biosphere, man depends of the changes that occur in it. Climate, temperature, atmospheric pressure, seasons, months, and even days of the week are risk factors for a number of diseases and apparently affect suicidality, too. The effect of chrono-biological and environmental factors on the suicide rate has been in the focus of the studies in recent years (1, 2, 5, 7, 8, 9, 10, 13, 14, 15, 17, 18).
The AIM of this study is to establish the influence of environmental factors and chrono-biological cycles (seasons, months, days of the week and parts of twenty-four-hour periods) on suicidality in the Region of Smolyan.
MATERIAL AND METHODS: The main methods used in the study are the historical and statistical methods (3, 4). Use has been made of information from the suicide autopsies conducted at the Department ofForensic Medicine ofDr. Br. Shukerov Multi-Profile Hospital for Active Treatment AD, Smolyan, over a period of 10 years.
RESULTS: The Region of Smolyan is a mountainous area with mixed population and increased migration, in which in 2009 suicide index had the highest rate (11). Over the period 2000-2009, 143 cases of suicide were registered in the Region of Smolyan (11).
SEASONAL DISTRIBUTION OF SUICIDES
Figure 1
SEASONAL DISTRIBUTION OF SUICIDES BY GENDER
Figure 2
40,00% 35,00% 30,00% 25,00% 20,00% 15,00% 10,00% 5,00% 0,00%
WINTER SPRING SUMMER AUTUMN
□ MEN »WOMEN
The cases are unevenly distributed in the seasons and two clearly outlined tendencies can be seen in their dynamics: the highest percentage of suicides is observed in autumn (30.07%), and the lowest - in winter (16.08%) (Fig. 1).
The relative share of male and female suicides during the different seasons varies broadly. The dynamics of male suicides in spring (28.57%), summer (27.73%) and autumn
(27.73%) shows steadiness, reaching its lowest value in winter (15.97%). Two peaks can be observed regarding female suicides - the higher one in autumn (41.67%) and a smaller one in spring (29.17%) (see fig. 2).
The maximum level of suicidality is reported for November (14.00%). During the spring and summer months, relatively close suicide rates (9-11%) are reported (see fig. 3).
SUICIDALITY DYNAMICS DURING THE MONTHS OF THE YEAR
Figure 3
MONTHLY DISTRIBUTION OF SUICIDES COMMITTED BY THE THREE MOST COMMON SUICIDE METHODS
Figure 4
In the Region of Smolyan, 79.72±3.36% of all suicides from the 10-year period under investigation were committed by hanging, whereas the cases of suicide by using firearms were 6.99%, and suicides by jumping from heights - 6.29%. Suicide dynamics has great variations during the different
months, reaching its maximum level in November (14.5%), whereas firearm suicides show maximum and same levels in June and July (19.5% each), and peak levels for suicides by jumping off heights are observed in February, October and November (22.5% each) (see fig. 4).
DISTRIBUTION OF SUICIDES AMONG THE DAYS OF THE WEEK
Figure 5
The distribution of suicides among the days of the week shows that their number is the largest in the middle of the week - on Thursday (21.68%), and the smallest on Saturday (8.39%) (fig. 5).
During different parts of the 24-hour-period: in the morning (06:00-12:00), in the afternoon (12:00-18:00), in the
evening (18:00-24:00) and during the night hours (24:0006:00), the number of suicides varies. In the Region of Smolyan, the largest number of suicides are committed in the morning (36.96%), and the smallest - during the night hours (13.04%) (fig. 6).
DISCUSSION
Seasonality in suicidal behaviour is an arguable matter with partial correspondence. Research shows different seasons of occurrence of suicide maximum rates, where the spring and summer seasons include the majority of the cases. Studies conducted in Bulgaria confirm this data (5, 8). In the Region of Plovdiv, a peak in suicides is observed in the spring and summer seasons (1, 5, 6, 10). The information gathered about the Region of Smolyan determine 2 seasonal peaks of suicides - spring and autumn. Despite of the fact that both regions (Smolyan and Plovdiv) are in the South Central Area of the country, they are characterized by different climatic conditions, which is reflected on the seasonal distribution of suicides. With the arrival of autumn and the deterioration of weather conditions, neurotic, psychotic and other health problems appear and worsen, and they could be one of the reasons for suicidality.
Certain differences have been established in the distribution of male and female suicides during the different seasons. Medical literature informs of a male suicide peak in the spring and of two peaks of female suicides - in the spring and autumn (9, 15, 18). In the Region of Smolyan, almost equal distribution is found of male suicides in the spring, summer and autumn. Female suicides have two peaks - a higher one in the autumn and a lower one in the spring, which is close to the figures presented in medical literature.
Unlike other studies conducted in Bulgaria indicating the month of May, (5, 8), the current study shows that the largest number of suicides in the Region of Smolyan are committed in November. Risk months for the Region of Plovdiv are the months of May, June and July (1, 6, 10).
The three most popular suicide methods in the Region of Smolyan: hanging, firearm injury and jumping off heights, vary in their distribution over the months and differ from the data about the city of Plovdiv. Just like in the Region of Plovdiv, hanging deaths in the Region of Smolyan have almost equal distribution during all of the months, but differ by the month of occurrence of their maximum number. The number of suicides committed by using firearms and by jumping from height is small, so the data gathered is not subject to accurate interpretation.
The day in which the largest number of suicides are committed in the Region of Smolyan is Thursday, which concurs with the findings of other studies, but does not
correspond to the information published about the Region of Plovdiv (5, 8, 7).
In the Region of Smolyan, the suicide maximum is observed during the morning hours, which corresponds to the published information about the country and abroad (1, 6, 7, 16).
Conclusions
1. The most suicides in the Region of Smolyan are committed in the autumn, more specifically in November.
2. The day of increased suicide risk is Thursday.
3. The most suicides are committed in the morning and evening hours of the day.
4. The dynamics of male suicides shows a minimum in the winter and has higher and more stable rates in the other seasons, whereas female suicides have a high peak in the autumn.
Literature
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2. Baltov M. Forensic and social aspects of suicides committed by jumping off heights in the Region of Plovdiv over the period 2000-2009. Scientific works of the Union of Scientists in Bulgaria - Plovdiv, 2013, Series G, v. XIV, 217-222. ISSN:1311-9427
3. Dimitrov I. Principles of scientific research in medicine, Methods and methodology, Medical publishing house ET "Vasil Petrov" Plovdiv, 2007
4. Dimitrov I. Medical statistics, "Pygmalion", Plovdiv, 1996
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6. Madzhirova N., Baltov M. Chrono-diagnostics and chrono-prophylaxis in suicidal patients. "Medicart" 2013, No. 2, 61 - 62. ISSN:1312-9384
7. Spasova Z. Influence of weather and climate on suicides. "Problems of geography", 2000, 3-4: 78-97.
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13. Christodoulou C., Papadopoulos IN., Douzenis A., Kanakaris N., Leukidis C., Gournellis R., Vlachos K.,
Papadopoulos FC., Lykouras L. Seasonality of violent suicides in the Athens greater area. Suicide Life Threat. Behav. 2009; 39 (3): 321 - 31.
14. Lester D. Blood types and national suicide rates. Crisis, 2004; 25: 140.
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СОВРЕМЕННЫЕ ПОДХОДЫ НАУЧНЫХ ИССЛЕДОВАНИИ КАЧЕСТВА ОКАЗАНИЯ
МЕДИЦИНСКОЙ ПОМОЩИ
Айвазян Шогик Грандовна
аспирант кафедры общественного здоровья и здравоохранения № 1 с курсом истории медицины, ГБОУ ВПО
«Ростовский государственный медицинский университет», г.Ростов
MODERN APPROACHES OF RESEARCH OF THE QUALITY OF MEDICAL CARE
АННОТАЦИЯ
В статье обсуждаются современные подходы научных исследований качества оказания медицинской помощи. Рассмотрены концепции исследований современных паттернов профессиональной роли врача в междисциплинарном поле социологии медицины, с использованием количественных (анкетирование, опрос, контент-анализ) и качественных (включенное наблюдение, кейс стади) социологических методов, а также антропометрических методик и психодиагностического инструментария. Особое внимание уделено интеграции техники SWOT-анализа, которая раскрывает новые возможности в определении качества медицинской помощи. При этом возможна не только оценка качества оказания медицинских услуг, но и применение метода для личностного анализа профессионалов в контексте профессионального отбора и аттестации.
Ключевые слова: медицинская услуга, качество оказания медицинской помощи, профессиональная роль врача, SWOT-анализ.
ABSTRACT
The article discusses current approaches of research of quality of medical care. The concept studies of modern patterns of professional role of the doctor in the interdisciplinary field of sociology of medicine, using quantitative (questionnaires, survey, content analysis) and qualitative (participant observation, case studies) sociological methods and anthropometric techniques and psycho-diagnostic tools. Particular attention is paid to the integration of the SWOT-analysis techniques, which opens up new opportunities in determining the quality of care. This is possible not only to assess the quality of medical services, but also for the personal use of the method of analysis professionals in the context ofprofessional selection and certification.
Keywords: medical services, quality of care, professional role of the doctor, SWOT-analysis.
Оценка качества оказания медицинской помощи неоднозначное отношение к нему [11, c.47; 13,c.59]. Паци-населению остается одной из приоритетных задач совре- ента в большинстве случаев не интересует количество менных научных исследований, решение которой требует койко-дней, на которое сократилось лечение некоего комплексного подхода в междисциплинарном поле меди- (даже социально значимого заболевания) в неком ЛПУ. цинских, юридических, экономических, социологических Пациент, как услугополучатель, приходит на прием к кон-наук[9,с.86]. Введение в правовое поле понятия «меди- кретному врачу и требует к себе определенного отноше-цинская услуга» Федеральным Законом «Об основах здо- ния, которого в большинстве случаев его не получает[8, ровья граждан в Российской Федерации» (№323 ФЗ 0т с.130]. Даже прием пациента по стандарту (протоколу) не 2011 г.), определяет юридический подход к оценке ее ка- гарантирует удовлетворение пациентов качеством оказа-чества. Проблема оценки качества оказания медицинской ния медицинской помощи. услуги обусловлена ее психолого-социологическим контентом, и, поэтому, экономический подход вызывает
