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Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

Background There is an increase in the incidence of scabies in Turkey, which started before the Covid-19 pandemic, and this situation is considered as an epidemic. With this study, we aimed to reveal the prevalence of scabies during the pandemic period and the risk factors that are effective in the transmission of scabies. Methods Our study was performed as a cross-sectional study in 376 patients who applied to our dermatology outpatient clinic between 1st and 30th April 2021. Sociodemographic and socioeconomic characteristics, living space, health behavior, and health care utilization of the patients were questioned. Results The prevalence of scabies was determined as 10.9%. Features such as sex, area of residence, age, formal education status, employment status, total income, number of shower, number of people per room, water source, and heating method, which were found to be significant as a result of the double test, were included in the logistic regression analysis. Scabies was found 2.728 times (CI 1.325–5.557) more in those who live in rural areas than those who live in urban areas, 2.714 times (CI 1.365–5.451) more in men than women, 2.707 times (CI 1.256–5.833) more in nonworking than working, 2.354 times (CI 1.057–5.243) more in those with less than 9 showers per month than those with 9 or more showers per month. Conclusion During the Covid-19 pandemic period, the prevalence of scabies in Turkey is increasing and it is becoming a serious health problem. Our study emphasizes this increase and determines the risk factors for transmission.

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