SWOT analysis of Eastern Medicine developments in Bulgaria

Geographically, Bulgaria is situated in the heart of the Balkans, bridging Western European and Eastern (Asian) cultures. In this article, Eastern Medicine (EM) developments in Bulgaria are investigated. EM is a heterogeneous concept that comprises many curing methods (focused therapies), or complete medical therapeutic systems (like Traditional Chinese Medicine, Ayurveda, Tibetan medicine), which are native for Asia and applied worldwide. In order to explore the current status, needs and expectations in the field of EM in Bulgaria, we have carried out the classical SWOT analysis (Strengths, Weaknesses, Opportunities and Threats). Contrary to popular belief, SWOT analyses must follow strict guidelines in order to be a credible instrument of change. We therefore describe the theoretical backgrounds and rationale of such analysis before proceeding to its application to the Bulgarian EM situation. Our analysis reveals that there are both strengths and opportunities for the modern developments of EM in Bulgaria. They must, however, outweigh the weaknesses and threats to such a development. In our view, increased international collaboration, more awareness of the EM effectiveness and public health benefits shall enhance the chances of EM to be fluently integrated in the Bulgarian national health care system. The development of more outward-looking public health stakeholders could enhance the chances of the rapid establishment of modern schools for EM in the country

Conceptual and methodological approaches to quality of life - a public health perspective

Quality of life is a major goal in the context of public health. It is important, both as a needs assessment tool and as an outcome measure in health promotion interventions. QoL has been frequently measured but seldom explicitly defined. The aim of this article is to discuss a wide range of conceptual and methodological issues related to QoL. The classical Being-Belonging-Becoming approach is presented. Further, the methodology for QoL assessment covers a wide range of topics. It involves the taxonomy of QoL definitions, a classification of QoL instruments, and recommendations how to choose the right questionnaire with the relevant psychometric properties. There is a need for more research based on carefully selected measures of QoL chosen as being of particular importance to individuals and to the hypotheses being tested. Measuring health rather than disease is a methodological challenge which has recently received more attention and should be further explored in target-setting exercises at a community level

For the leader, writer and researcher - Prof. Dr Petar Tzonov

Words for the late Editor in chief of the Journal Social Medicine

Integrative medicine—designing holistic conceptual model

Introduction: Integrative approaches in medicine are becoming increasingly popular due to the health promotion revival and the evidence-based clinical efficacy and cost-effectiveness of complementary and alternative medicine (CAM). Therefore, a clear definition of the “integrative medicine” realm is fundamental. In medical science, models are created for research, educational and health policy reasons.Aim: The aim is to present a holistic conceptual model of integrative medicine, created as the first stage of a mixed-methods study in an educational context.Materials and Methods: Conceptual modelling is applied after a review in PubMed with keywords: “integrative medicine,”, “concept“, “model“; targeted qualitative content analysis of the existing definitions and models of integrative medicine.Presenting the Holistic Conceptual Model of Integrative MedicineThe created model includes five building blocks: medical education, evidence-based medicine, conventional medicine, CAM, and health promotion. The model is defined according to the three characteristics of integrative medicine such as philosophy, structure, and process. Three principles are synthesized that support and would ensure the sustainability of the model—coherence; heterogeneity, equality, tolerance; efficiency and effectiveness. Conclusion: Integrative medicine is not just a combination medicine (between CAM and conventional medicine), but a highly organized system using all possible methods for the benefit of personal and public health. Today, integrative health encompasses also the health promotion idea of “One Health” and the theory of the exposome

Quality of life of individuals with disabilities - concepts and concerns

Introduction: The number of people with disabilities has grown tremendously for the last 15 years in Bulgaria. Standardized quality of life instruments can be helpful in the development of public policies which target the needs of this population. The quality of life (QoL) paradigm is a challenging perspective for considering, planning and implementing changes within the area of disabilities. Moreover, an interview with a disabled person about her/his subjective health is a human care with a positive impact on the overall well-being of the individual. This paper aims at stimulating a debate on these topics by investigating the `QoL` and `disability` territories. Further, a study on QoL of individuals with disabilities is presented. The objectives of this study are: (1) to measure the QoL of a representative sample of 305 individuals with disabilities, who are patients from a general Territory Expert Medical Commission - TEMC* (St. Marina University Hospital, Varna) by using the WHO generic questionnaire (WHOQOL-BREF) - 26 questions; four-domains structure: Physical health, Psychological health, Social relationships,  Environment. (2) To define the influence of the four domains on QoL. (3) To analyze the relationship between QoL and socio-demographic characteristics. (4) To assess the influence of physical pain on QoL.Methods: A cross-sectional study was conducted in 2011 using a representative sample of the register of a general TEMC (n=305, >18 years old). Respondents were selected through the method of multi-stage random selection.Results: As a result of multiple-regression analyses it was found out that all the domains have influence on QoL but the most influential is the `Environment` domain (0.394), followed by `Physical health` domain (0.354), `Psychological health` domain (0.261) and `Social relationships` domain (0.169). The total multiple regression coefficient - R is 0.984 (R2=0.969). The patients who reported higher levels of pain - 95.80 % - have lower QoL. No relations were found between socio-demographic characteristics of the patients and their QoL. Nowadays, the TEMC mission has to cover not only expert assessment and integration of persons with disabilities into society. The TEMC mission should also involve the improvement of QoL of the people with disabilities. A medico-social approach for handicap-assessment is proposed as a prerequisite for sustainable development of the public health policies concerning people with disabilities.

Preparing patients for handicap-stage assessment and the challenges for the general medical practice

General Practitioners (GPs) face a variety of administrative challenges during their daily work. One of them is the growing number of patients who demand assessment for a handicap stage from the Territory Expert Medical Commissions (TEMC). The General Medical Practice (GMP) is the starting point of the Expert Decision (ED) procedure. GMP is also the place where the patients come back with questions about the patients` rights which they obtain receiving ED. The people with disabilities have to traverse a difficult way in order to receive a handicap stage (percentage). The key to success is competent preparation of the patient by the GMP for the TEMC-examination. This also is a guarantee of the normal functioning of the whole System for Medical Expertise of Working capacity (MEW). The continuous medical education of the GPs is an opportunity to enrich and update their knowledge and competences about MEW-procedures. The long-term strategy is to guarantee the patient` rights which are explicitly formulated by the law. As a result, justified patients` complains will be avoided. The overall aim of the presented synopsis is to explore the process of preparing patients for handicap stage assessment by GMP and the challenges which face a GMP related to this process. The methods used are: meta-analysis of legal and medical documents for disability assessment; and participatory research method e.g. follow up of the patients` path and the procedures in TEMC. On the bases of this study recommendations are proposed referred to the effectiveness of the MEW-procedure and the role of GMP in the disability stage assessment process

One Health—the origin of the idea, development, and role in the European social policies

INTRODUCTION: One Health as a paradigm is defined in many ways, but at the core is its social role to support cooperation between all societal sectors to protect the environment and the health of people, animals, and plants.THE AIM is two-fold: to trace the historical development of the planetary idea of One Health and to examine its role in European medico-social policies, with an emphasis on dealing with antimicrobial resistance (AMR) as one of the main public health challenges of the XXI century.MATERIALS AND METHODS: A desk review based on a search in PubMed on keywords: “One Health”, “Europe”, and “social policies”, was conducted, as well as targeted qualitative content analysis of One Health definitions and models up to date. Global and European policy documents and strategies related to One Health have been studied, with an additional focus on AMR, including the most recent one since October 2022 issued by the UN Quadripartite coalition for One Health.HISTORY, DATA AND DISCUSSION: One Health is a global movement, which originated at the end of the XIX century in Europe. It recognizes the fundamental connection between the environment and the health of humans, animals, and plants. Today, the Quadripartite coalition of four United Nations organizations outlines the areas where the One Health approach is particularly important: 1) food and water safety; 2) zoonosis control; 3) protection of the environment; and 4) in the actions to combat AMR detailed in the Global Plan as Action Track 5: Curbing the Silent Pandemic of AMR.Nowadays, One Health has a key role in European public health to curb AMR. In Europe, AMR accounts for approximately 33,000 deaths per year. Annually, the social costs of AMR for the European Union (EU) are estimated to be 1.5 billion Еuros. Increasingly, AMR is a responsibility not only to microbiologists and medical professionals but to society as a whole. Specifically, after the COVID-19 pandemic, AMR remains one of the biggest public health threats in the EU. The joint efforts have led to the creation of the EU AMR One-Health Network.CONCLUSION: Antimicrobial resistance will remain the focus of European social policies and practices for the coming decades. The One Health movement is at the heart of the European plan to tackle AMR, which is a serious problem in a national context as well

The impact of pruritus on Quality of Life of Patients with Lichen Simplex Chronicus

AbstractPruritus is a major symptom of a huge variety of dermatoses. It causes a scratch response, starting the itch-scratch cycle, which in turn aggravate the inflammatory response and exacerbate disease severity Lichen Simplex Chronicus (LSC) is a skin disorder affecting patient's psychosocial and functional status. Pruritus is a diagnostic hallmark for LSH. It is the reason for sleep disturbances, anxiety and depression. Therefore, a clinical investigation of pruritus alongside with a study of their self-reported health status is a necessary precondition for successful therapeutic results.The aim of the study is to assess the impact of pruritus on quality of life (QoL) of LSC patients` by evaluating the severity of pruritus and sleep disturbance with visual analogue scale (VAS), and verbal rating scale (VRS) and compared it with results from answers to a standardized dermatology-specific quality of life instrument- Dermatology Life Quality Index (DLQI). (Specially answer to question1- symptoms)