Examining smoke-free coalitions in Armenia and Georgia: baseline community capacity

Local coalitions can advance public health initiative but have not been widely used or well-studied in low- and middle-income countries. This paper provides (i) an overview of an ongoing matched-pairs community-randomized controlled trial in 28 communities in Armenia and Georgia (N = 14/country) testing local coalitions to promote smoke-free policies/enforcement and (ii) characteristics of the communities involved. In July-August 2018, key informants (e.g. local public health center directors) were surveyed to compare their non-communicable disease (NCD) and tobacco-related activities across countries and across condition (intervention/control). More than half of the informants (50.0-57.1%) reported their communities had programs addressing hypertension, diabetes, cancer and human papilloma virus, with 85.7% involving community education and 32.1% patient education programs. Eleven communities (39.3%) addressed tobacco control, all of which were in Georgia. Of those, all included public/community education and the majority (72.7-81.8%) provided cessation counseling/classes, school/youth prevention programs, healthcare provider training or activities addressing smoke-free environments. Informants in Georgia versus Armenia perceived greater support for tobacco control from various sectors (e.g. government, community). No differences were found by condition assignment. This paper provides a foundation for presenting subsequent analyses of this ongoing trial. These analyses indicate wide variability regarding NCD-related activities and support across communities and countries.

PECULIARITIES OF NUTRITION AMONG MEDICAL UNIVERSITY STUDENTS

Healthy nutrition helps to prevent development of chronic diseases and contributes to optimal functioning of the body. Dietary habits mainly are being established during the late adolescence and young adulthood. Aim - to study nutritional habits of the medical university students in Georgia. A questionnaire containing 73 questions was developed in English and Georgian. Sampling frame consisted of students of the 1st and 4th years of the Tbilisi State Medical University (TSMU). Random cluster sampling was used and total number of participants was 427 (34.4% male and 65.6% female). Mean age 20.6±1.9. Cross-sectional study was performed. The survey was anonymous and self-administered. Principles of Declaration of Helsinki were followed. Data analysis was done in Stata 14.0. Majority of the respondents have 3-4 meals a day and have hot meals several times or once a day. 193 (45.20%) refuse drinking alcohol at all. 112 (26.23%) almost never eat breakfast. 196 (45.67%) of the students get up at nights to eat. 233 (54.57%) do not consume meals at regular times. 183 (42.86%) do snack between the meals. 326 (76.35%) read or watch TV while eating. 190 (44.5%) eat white bread once a day or few times a day; 102 (23.89%) never eat buckwheat, oats. 326 (76.35%) add sugar to tea or coffee; 231 (54.10%) add salt to the already cooked food. 97 (22.71%) never eat fish. 166 (39.11%) and 172 (40.28%) correspondingly eat red meat and white meat 1-3 times per month or once a week. Only 159 (37.24%) eat fruits once a day or few times a day. 61 (14.29%) and 69 (16.16%) never eat correspondingly raw and cooked vegetables. Our findings are more or less in line with available international data. We think that the situation is similar in the non-medical students and the youth, in general. It might be advisable to perform additional investigations in this direction.

HEPATITIS B VACCINATION: KNOWLEDGE AND ATTITUDE AMONG WOMEN OF REPRODUCTIVE AGE IN GEORGIA

Georgia is a country with high prevalence of hepatitis B. Based on a 2015 population serosurvey, the prevalence of hepatitis B surface antigen (HBsAg) is 2.9% and prevalence of anti-HBc is 25.5% in general population. Hepatitis B vaccine has been included in the national immunization schedule of Georgia only since 2002. Thus, most reproductive aged women were not vaccinated during young childhood. Cross-sectional study was conducted in the capital of Georgia, Tbilisi. Reproductive aged women were randomly selected and then recruited from three maternity care centers during prenatal care. The self-administered questionnaire included questions on socio-demographic information, hepatitis B vaccination status and awareness of HBV infection status. A total of 2185 reproductive aged women were enrolled in the study. The mean age was 28.5 (age range 17-46) years. Most (76.4%) had a bachelor and/or master's degree. 20.0% of respondents never heard about HBV. Very few (3.3%) knew they were infected with HBV. We could not determine if women were chronically infected or were exposed and developed antibodies. HBV knowledge was limited: 57.5% were not aware of available HBV treatment; 51.6% didn't know HBV infection could be prevented (35.8% named HBV vaccination, 29.3% named condom use). Only 10% of study participants reported being vaccinated for HBV. Awareness of HBV infection was higher among women over age 25 (72.1%) compared to women aged 25 years or less (27.9%) (P<0.0001). Among women who reported having an HBV infection, 40.6% did not name vaccine as a prevention method and 38.2% did not have information about availability of HBV treatment (P<0.05). Based on our study results, knowledge about HBV infection and vaccination is very low among reproductive aged women in Georgia. Women's health centers can be a good place to reach reproductive aged women for counseling on HBV infection and promote vaccination against hepatitis B.

STUDENTS POPULATION'S ATTITUDE CONCERNING ENVIRONMENTAL ISSUES IN GEORGIA

The aim of this study were to investigate the attitude of university students on the environmental issues, analyze the information received and develop measures for the participation of students in environmental health-improving and preventive activities.. The qualitative study was conducted by using face to face interviewing method with university students. Environmental pollution is one of the most important threats in Georgia and arount the world. The immediate objects of pollution are land, water, soil, air, which directly affects human health and worsens it. The participants have favorable attitudes toward the environment, but they are less involved in environmental activities. Basically these measures are limited to the so-called one-time campaigns. Based on the results, it is recommended the development of integrated measures and schemes to stimulate student participation in the implementation of socially active algorithms to improve the environment.

[RESULTS OF THE PRELIMINARY STUDY OF PLANTS OF GEORGIAN FLORA FOR THE CONTENT OF FLAVONOIDS AND TRITERPENOIDS]

The aim of the study was a preliminary study of plant samples collected by targeted expeditions of the department of pharmacobotany (Department of Phytochemistry) of the IG Kutateladze Institute of Pharmacochemistry for the period 2016-2017. In total, 341 objects from (106 various) plants belonging to 36 families and 93 genus were analyzed. The objects were obtained polar and non-polar fractions; flavonoids and triterpenoids were found in them qualitatively. To characterize used P /CH and TLC analysis in various solvent systems. Flavonoids were isolated from Geranium ibericum and Polygonum carneum, which were identified as quercetin-3-0-β-D-galactopyranoside-hyperin (G. ibericum), 3 5, 7 ', 3'.4' pentahydroxy-flavone - quercetin (G. ibericum, P. сarneum) and quercetin-3-0-rutinozide - rutin (P. сarneum). G. ibericum and P.carneum flora of Georgia are found and studied for the first time. Representatives of the family Asteraceae, Fabaceae, Helleboraceae, Polygonaceae, Scrophula riaceae deserve a particular interest in the content of triterpenoids.

SURVEY OF PRACTICES, KNOWLEDGE AND ATTITUDE CONCERNING ANTIBIOTICS AND ANTIMICROBIAL RESISTANCE AMONG MEDICAL UNIVERSITY STUDENTS

Antimicrobial resistance (AMR) has become a global problem and is considered an emerging threat to public health worldwide. Aim - to assess knowledge, attitude and practice (KAP) regarding antimicrobial resistance and antibiotics among medical students in Georgia. KAP questionnaire containing 50 questions was developed in English and Georgian. Sampling frame consisted of students of the 4th year of the Tbilisi State Medical University (TSMU). Random cluster sampling was used and total number of participants was 212 (31.13% - International Faculty of Medicine, 45.75% - Faculty of Medicine, 23.11% - Faculty of Public Health). Mean age 22.95 (sd=0.52) with almost equal gender distribution. Cross-sectional study was performed. The survey was anonymous and self-administered. Principles of Declaration of Helsinki were followed. Data analysis was done in Stata 14.0. 79.25% think that antibiotics can cure bacterial infections, 57.08% think that antibiotics can not cure viral infections (statistically significant difference by faculties p<0.0001). 34.43% think that bacteria cause common cold and influenza (by gender p=0.01 and by faculties p=0.03). 83.02% have heard of antibiotic resistance (by faculties p<0.0001). 83.96% agree that antibiotics resistance has become a problem. 75.00% agree that the abuse of antibiotics has become the main cause leading to bacterial resistance. 60.38% consider that antibiotic resistance affects them and their family's health. 93.40% agree that it is necessary to get more education about antibiotics. 31.61% of the students in Georgia always and often stop taking antibiotics if they start feeling better. 43.40% never keep the remaining antibiotics. Obtained results are in line with the international findings. There was seen a statistically significant difference between public health and medical faculties (both English and Georgian) in responses on knowledge. In the attitude and practical behaviour sections all three groups provided similar results, only some questions were provided significantly different responses by faculties.

CORRELATION OF ORAL HEALTH STATUS WITH GENERAL HEALTH IN ELDERLY LIVING AT RESIDENTIAL HOMES IN GEORGIA

The aim of the study was to assess oral health status and its correlations with the general health in older adults living in residential houses in Georgia. The study was conducted in 2017-2018 years based on WHO recommendations. The study got approval from bioethical council of National Center for Disease Control and Public Health, protocol #2017-039, 28.06.2017y. 300 voluntary residents from various residential houses for older people (aged 65 years and more) were observed in regions of Georgia: "Basiliada" (Tbilisi), residential home of municipality of Samtredia, (Imereti), residential home "Carefree old age" (Kakheti). Age groups were divided as following: 65-74; 75-84; 85<. Statistical Package for Social Sciences (SPSS) version 22.0 was used for statistical analysis. DMFT was assessed to be 28.74. Significantly high prevalence of needs of prosthetic treatment 91.1% (p=0.0005), full edentulism 36.2% (p=0.0049), participants with the extraction of more than 20 teeth 81.3% (p=0.0000) and unsatisfactory oral hygiene 39.3% (p=0.0003) were observed. Prevalence of systemic diseases was assessed as the following: cardiovascular disease - 56%, gastroenterologycal diseases - 6%, diabetes - 2.9%, respiratory disease - 8.4%, oncological disease - 6.7%, dementia - 24.2 %.( p<0.005). Cardiovascular system diseases appeared to be one of the most commonly encountered diseases in dental practice. Based on the study results new program was created "Improve of oral hygiene of older adults living in residential homes in Georgia" in order to increase their access to the dental care, including preventive dental care and improve oral health related quality of life.

MENTAL HEALTH AND RELIGION: INTERRELATION AND CHALLENGES IN POST-SOVIET GEORGIA

Anxiety and depression syndrome (STD) are at the forefront of the world mental health priority list. To address this problem, a number of instruments and programs have been developed at both the global and national levels. STD is associated with a socio-political problem and correlates with external or internal instability in the country. In such circumstances, a special place is given to religion. The role of the Church, faith is important in low-or middle-income countries and depends on the authority of the Church as an institution, its activities and activity. At the final stage of the study the recommendations are presented.

RECOMMENDATIONS BY GEORGIAN ASSOCIATION OF SKELETAL METABOLIC DISEASES ON THE INITIATION OF TREATMENT WITH USE OF AGE-DEPENDENT INTERVENTION THRESHOLD BASED ON FRAX IN PATIENTS WITH OSTEOPOROSIS

Treatment criteria based only on bone mineral density do not reflect completely the likelihood of fractures. We reviewed the studies and recommendations on different types of intervention thresholds for the initiation of treatment in patients with osteoporosis. Georgian Association of Skeletal Metabolism Diseases recommends to use age dependent intervention threshold based on 10-year probability of osteoporotic fractures calculated by FRAX algorithm as a diagnostic and treatment criteria for patients with osteoporosis.

ASSESSMENT OF NUTRITIONAL STATUS AND MALNUTRITION RISK IN HEALTHY ELDERLY GEORGIANS

The aim of the research was: evaluation of nutritional status and malnutrition risks of Georgian healthy elderly, to use modern assessment methods according to our research goal, development and adaptation of adequate approach considering specificity of Georgian population. Our research is the first study of nutritional status in Georgian elderly. Study group ≥ 60 y (n=75): men (n=14), women (n=61); Subgroup <75 y (n=64): men (n=9), women (n=55); Subgroup 75+ y (n=11): men (n=5), women (n=6). We first time used the standard and alternative anthropometric measurements, SF-BIA and validated equations for FFM (Kyle et al.) and TBW (Vache et al.); clinical, laboratory and dietary (adapted questionnaire) assessment. Estimated energy requirement (EER) was calculated using validated equation, research group was divided into 4 subgroups based on the diet energy intake to EER ratio (over 100%, >75 and ≤100%, >50 and ≤ 75%, ≤ 50%.). The findings of our study have shown the number of research participants with malnutrition according to different indicators: BMI - 0; MUAC - 0; AMA - 4; FFMI - 1; Albumin - 12; TLC - 38. Independet samples T test and ANOVA, Multiple Comparisons, Bonferroni, Paired Samples T test were used to compare variables. The difference between four subgroups was not revealed, except for nutrients and energy consumption indicators. Although there is the undernutrition of protein and energy in certain groups of participants, neither malnutrition screening tool (MNA-SF score 12-14) nor BMI and FFMI as the highest trustworthy diagnostic criteria do not reflect real condition. Predictively significant malnutrition can be left unattended, overlooked and undiagnosed without of energy intake assessment in practically healthy elderly. Therefore, he comparison of recent energy intake and estimated energy requirement is the best criterion for defining malnutrition.

An evaluation of the hepatitis C testing, care and treatment program in the country of Georgia's corrections system, December 2013 - April 2015

BACKGROUND

The country of Georgia has a high burden of chronic hepatitis C virus (HCV) infection, and prisoners are disproportionately affected. During 2013, a novel program offering no cost screening and treatment of HCV infection for eligible prisoners was launched.

METHODS

The HCV treatment program implemented a voluntary opt-in anti-HCV testing policy to all prisoners. Anti-HCV positive persons received HCV RNA and genotype testing. Transient elastography was also performed on prisoners with positive HCV RNA results. Prisoners with chronic HCV infection who had ≥F2 Metavir stage for liver fibrosis and a prison sentence ≥ 6 months were eligible for interferon-based treatment, which was the standard treatment prior to 2015. We conducted an evaluation of the HCV treatment program among prisoners from the program's inception in December 2013 through April 2015 by combining data from personal interviews with corrections staff, prisoner data in the corrections database, and HCV-specific laboratory information.

RESULTS

Of an estimated 30,000 prisoners who were incarcerated at some time during the evaluation period, an estimated 13,500 (45%) received anti-HCV screening, of whom 5175 (38%) tested positive. Of these, 3840 (74%) received HCV RNA testing, 2730 (71%) tested positive, and 880 (32%) met treatment eligibility. Of these, 585 (66%) enrolled; 405 (69%) completed treatment, and 202 (50%) achieved a sustained virologic response at least 12 weeks after treatment completion.

CONCLUSIONS

HCV infection prevalence among Georgian prisoners was high. Despite challenges, we determined HCV treatment within Georgian Ministry of Correction facilities was feasible. Efforts to address HCV infection among prison population is one important component of HCV elimination in Georgia.

Designing and evaluating provider results-based financing for tuberculosis care in Georgia: a realist evaluation protocol

INTRODUCTION

In 2016, Georgian researchers and policymakers were developing a policy to improve the performance of the national tuberculosis (TB) control programme. The research programme 'Designing and Evaluating Provider Results-Based Financing for Tuberculosis Care in Georgia: Understanding Costs, Mechanisms of Effect and Impact (Results4TB)' was initiated to inform the policy formulation phase, document the policy implementation and assess the effectiveness, cost-effectiveness and the processes of change. To achieve this, the research team intends to combine an impact evaluation, a cost-effectiveness study and a realist evaluation (RE) within an overarching theory-informed design. This protocol is the RE component of the programme.

METHODS

A realist methodological approach will be adopted to guide the research design and evaluation. RE answers the question of 'what works in which conditions for whom?' and starts with the development of an initial programme theory (IPT). The IPT will feed into other phases of the realist research cycle (study design, data collection, data analysis and synthesis and theory refinement). Data will be collected in a multiple embedded case study design (five intervention and three control sites) through document reviews, in-depth interviews, non-participant observations and context mapping at facility and national levels. Additional data from other research components (cost-effectiveness and impact evaluation) will aid data triangulation.

ETHICS AND DISSEMINATION

The Institutional Review Boards of the National Centre for Disease Control and Public Health in Georgia (ref. IRB # 2018-019) and the Institute of Tropical Medicine, Antwerp (ref. IRB #- 1240/18) have granted ethical approval to the study.

TRIAL REGISTRATION NUMBER

ISRCTN14667607.

QUANTITATIVE AND QUALITATIVE ANALYSIS OF CONSUMPTION OF NARCOTIC DRUGS AND PSYCHOACTIVE SUBSTANCE BY THE BENEFICIARIES OF THE CENTER FOR MENTAL HEALTH AND PREVENTION OF ADDICTION LLC IN 2013-2017

Our research aims to produce qualitative and quantitative analysis of the use of narcotic drugs and psychoactive substances in 2013-2017 and their impact on drug abuse in the country. We studied 1519 medical cards of hospitalized beneficiaries. According to the obtained results, 'pharmacy' drug addiction is still widespread in Georgia. According to our data, it is hardly possible to determine, whether drug addicts consume the agents obtained at Georgian pharmacy network, or use the smuggled psychoactive substances. Regrettably, the consumption of opiates- 'Black tar' and heroin has increased again. It should be noted that beneficiaries don't indicate the consumption of ecstasy and similar-type preparations without a special survey, since the patients apparently do not classify them as narcotic drugs, as in the case of marijuana. Georgia's drug policy is focused more on reducing the drug supply, rather than its demand. Based on the analysis of the present material we can conclude that the imposition of criminal liability and toughening of the administrative measures are hardly enough to achieve an optimal goal in terms of drug use reduction. It is necessary to implement, at appropriate scale, a set of complex measures that will be tailored to administrative measures, including preventive, remedial and rehabilitation measures.

IMPACT OF ACCESS TO DENTAL SERVICES ON DENTAL CARIES RISK IN ADULT POPULATION OF GEORGIA

The objectives of the present paper are to outline the oral disease burden globally and to describe the influence of major socio-behavioral risk factors and the deficit of dental services, associated with the oral health in Georgian population. One thousand and twenty-seven subjects from 6 regions of Georgia were examined. Caries prevalence and oral hygiene status was assessed among the five age groups: I- (35-44), II-(45-54), III-(55-64), IV- (65-74), V- (75-84). A questionnaire was used to evaluate general health condition, alcohol and tobacco consumption, oral hygiene habits and dental service accessibility. High prevalence (100%) of the dental caries and intensity of DMF=10.96 were recorded. There is high prevalence of the dental caries in the investigated areas of Georgia. Positive correlation between the dental caries and accessibility to dental services was noted.

CLOSTRIDIUM DIFFICILE INFECTION IN CHILDREN WITH EXPOSURE TO ANTIBIOTICS

Clostridium difficile represents an example of healthcare-associated pathogen causing disease in community and hospital setting. The number of clinical studies determining risk factors for Clostridium difficile infection in children is limited as compared to adult patients. The aim of this study was to determine the association between antibiotic exposure in hospital setting and risk of Clostridium difficile infection in children. Systematic review of the electronic databases was used to update the literature, collect secondary data, critically appraise research studies, and synthesize study result from our institutions with available literature. Paper aimed to provide a complete, exhaustive summary of current literature relevant to our research question. A systematic review of the literature using databases PubMed (1935-2018) was conducted to compare our study results with available literature and determine significant differences and similarities that might impact clinical decisions in the country Georgia. The study of the association of several factors with the development of Clostridium difficile infection showed that the age more than 4 years old represented independent risk-factors of the development of Clostridium difficile infection, while the gender and ethnicity was not associated with the infection. Antibiotic exposure within the month preceding the onset of diarrhea was statistically significantly associated with an increased risk of Clostridium difficile infection. The risk was greatest with cephalosporins, followed by penicillins, carbapenems and macrolides. Antibiotic exposure in children is associated with increased risk of Clostridium difficile infections in hospital setting.

SNP genotyping elucidates the genetic diversity of Magna Graecia grapevine germplasm and its historical origin and dissemination

BACKGROUND

Magna Graecia is the ancient name for the modern geopolitical region of South Italy extensively populated by Greek colonizers, shown by archeological and historical evidence to be the oldest wine growing region of Italy, crucial for the spread of specialized viticulture around Mediterranean shores. Here, the genetic diversity of Magna Graecia grape germplasm was assessed and its role in grapevine propagation around the Mediterranean basin was underlined.

RESULTS

A large collection of grapevines from Magna Graecia was compared with germplasm from Georgia to the Iberian Peninsula using the 18 K SNP array. A high level of genetic diversity of the analyzed germplasm was determined; clustering, structure analysis and DAPC (Discriminant Analysis of Principal Components) highlighted the genetic relationships among genotypes from South Italy and the Eastern Mediterranean (Greece). Gene flow from east (Georgia) to west (Iberian Peninsula) was identified throughout the large number of detected admixed samples. Pedigree analysis showed a complex and well-structured network of first degree relationships, where the cultivars from Magna Graecia were mainly involved.

CONCLUSIONS

This study provided evidence that Magna Graecia germplasm was shaped by historical events that occurred in the area due to the robust link between South Italian and Greek genotypes, as well as, by the availability of different thermal resources for cultivars growing in such different winegrowing areas. The uniqueness of this ampelographic platform was mainly an outcome of complex natural or human-driven crosses involving elite cultivars.

EUROPEAN CARDIAC RESYNCHRONIZATION THERAPY SURVEY II: COMPARISON OF RESULTS IN GEORGIA WITH OTHER COUNTRIES

Cardiac resynchronization therapy (CRT) is an important treatment modality for patients with heart failure with a reduced ejection fraction and interventricular conduction delay which is supported by current guidelines from major medical societies. One of the largest international clinical practice surveys regarding the CRT - CRT Survey II was conducted from October 2015 to December 2016 in 42 ESC member countries. We compared the outcome data of the CRT Survey II with the Georgian cohort, where 24 patients were enrolled from 2 participating medical centers of Georgia. Despite CRT II Survey analysis did show us some similarities, there were also multiple, notable differencies between Georgian population and all other European countries' data, which can be explained by a number of socio-economic or healthcare-related factors.

Genetic and Phenotypic Characterization of Cryphonectria hypovirus 1 from Eurasian Georgia

Cryphonectria hypovirus 1 (CHV-1) infects the chestnut blight fungus Cryphonectria parasitica and acts as a biological control agent against this harmful tree disease. In this study, we screened the recently characterized C. parasitica population in Eurasian Georgia for the presence of CHV-1. We found 62 CHV-1 infected C. parasitica isolates (9.3%) among a total of 664 isolates sampled in 14 locations across Georgia. The prevalence of CHV-1 at the different locations ranged from 0% in the eastern part of the country to 29% in the western part. Sequencing of two specific regions of the viral genome one each in ORFA and ORFB revealed a unique CHV-1 subtype in Georgia. This subtype has a recombinant pattern combining the ORFA region from the subtype F2 and the ORFB region from subtype D. All 62 viral strains belonged to this Georgian CHV-1 subtype (subtype G). The CHV-1 subtype G strongly reduced the parasitic growth of C. parasitica isolates from Georgia, with a more severe effect on the European genepool compared to the Georgian genepool. The CHV-1 subtype detected in Georgia provides a valuable candidate for biological control applications in the Caucasus region.

Aspects of Morality and Law Enforcement in Today's Science in Post-Soviet Countries

Many reports independently confirm that even more than a quarter of a century after the collapse of the Soviet Union, the results of research and development in those countries that were under its influence are insufficient in comparison to the rest of the world. Given that human intelligence is not distributed unevenly and that science is a powerful driving force for the future of an economy, there is a hidden problem, which, if it can be resolved, may release great economic potential. The first generation of researchers from Armenia, Czech Republic, Georgia, Slovakia and Ukraine, who successfully completed their education after the political revolution, were surveyed. The survey revealed many similarities with regards to ethics, but that there is mounting evidence that the main cause of the current situation is the state of the local legal systems. The conclusion was drawn that a conceptual change in staffing within the relevant legal systems is required to release potential and stimulate wealth creation.

PUBLIC ATTITUDES TOWARDS THE USE OF ANIMALS IN BIOMEDICAL RESEARCH IN GEORGIA

In different societies there are different opinions about moral and ethical aspects of animal testing in biomedical research. Many studies have been conducted worldwide since 1980s to evaluate public perception and attitude towards the animal research. In EU Eastern Neighboring Countries, including Georgia, ethical aspects of animal usage for biomedical experiments have not been well emphasized. There are no ethical-legal regulations on animal use for biomedical research in Georgia neither on national nor on institutional level. At the same time, public attitude concerning the animal testing for scientific research is unclear. The aim of the study has been to explore public attitudes towards the animal research for the first time in Georgia. In this survey quantitative and qualitative research methods had been used. A special questionnaire was developed and an individual interview method was utilized. Totally 750 interviews were conducted and 715 questionnaires were used for analysis. Codified questionnaires were included in the database and then analyzed with SPSS 27 software. The technique of cross-tabulation was used for the bivariate analysis. For most respondents (68.0%) animal use in Biomedical research is acceptable. 82,0% of respondents fully or partly agreed with the concept, that involvement of animals in experiments which comply to the principles of international norms and regulations (reduction of the number of animals, improving the experiment/lowering pain for animals, and using alternative methods) is acceptable. The results of the study have demonstrated that the attitude of the study sample towards the animal testing in biomedical research is influenced by age (Pearson Chi-Square=32.479, df=8, p<0.05; p=0.000), education (Pearson Chi-Square=27.850 df=12, p<0.05; p=0.006) and occupation (Pearson Chi-Square = 37.767 df=16, p<0.05; p=0.002). Gender, place of residence and experience with owning the pet/animal doesn't have statistically significant influence on the public attitude.  The results of our study highlight that animal testing in biomedical research is acceptable for the respondents involved in the study. However, most of the respondent's consider use of International regulations highly important.

VISUAL PROCESSING IN GEORGIAN CHILDREN WITH NEURODEVELOPMENTAL DISORDERS

Neurodevelopmental disorders are disabilities that cause impairment in learning, language, or behaviour areas. ADHD and learning disabilities, namely dyslexia have the greatest prevalence among these disorders and very often co-occur together. As visual perception is essential for development of academic abilities, it is very important question whether visual processing is affected in children with neurodevelopmental disorders or not. There are controversial scientific evidences whether visual perceptual deficits are related to neurodevelopmental disorders or not. Here we investigated such aspects of visual processing as visual attention and visual working memory. Three groups of Georgian children participated in our study: children with dyslexia, children having ADHD and dyslexia together and typically developing children. Two types of attentions were evaluated with two different tasks: selective attention using visual search task and sustained attention using Go/NoGo tasks; short-term visual working memory was investigated using Visual N-back Test. We found that performances of all tasks were similar for dyslexia and control groups in simple conditions but performance deteriorated for all three groups as soon as task was complex. Children having ADHD and dyslexia together had worse performance. Our results showed no deficits for children with dyslexia in visual working memory or visual selective and sustained attention even when reaction times are prolonged. But we found deficits for children having more than one neurodevelopmental condition (ADHD+dyslexia). There was not found any correlation between performances of different tasks. We conclude that deficits of visual attention and visual working memory might not be related to impairment of reading skills in dyslexic children. Even when children with more than one neurodevelopmental disorders show some deficits in visual attention and visual working memory, those deficits alone cannot be accounted for specific deficits of complex neurobehavioral disorders.

Emergence of Hepatitis C Virus Genotype Recombinant Forms 2k/1b in Georgia

BACKGROUND

Hepatitis C virus (HCV) evolution is thought to proceed by mutations within the six major genotypes. Studies of HCV recombinant genotypes in different parts of the world have recently been initiated. Only a few cases of recombination have been identified worldwide, predominantly in Eastern Europe and Asia. In 2011 we detected the recombinant form (RF) of a HCV genotype RF_2k/1b in Georgia. Therefore, we reviewed HCV genotyping data of 491 patients with chronic hepatitis C virus infections of our center in Tbilisi over a period of two years.

METHODS

Initially all genotyping analyses were performed with the VERSANT HCV genotype assay (Siemens, LiPA). In a second analysis, parts of the core and the NS5B region were sequenced for all HCV genotypes 2a/2c.

RESULTS

Approximately 2/3 of genotype 2 cases were identified as the recombinant form HCV-RF 2k/1b. Overall, this type represented 19% of all HCV patients who underwent genotyping.

CONCLUSIONS

We can conclude that almost 20% of HCV infected Georgian patients are infected with HCVRF_2k/ 1b.

An Alternative Cure: The Adoption and Survival of Bacteriophage Therapy in the USSR, 1922-1955

Felix D'Herelle coined the term bacteriophage in 1917 to characterize a hypothetical viral agent responsible for the mysterious phenomenon of rapid bacterial death. While the viral nature of the "phage" was only widely accepted in the 1940s, attempts to use the phenomenon in treating infections started early. After raising hopes in the interwar years, by 1945 phage therapy had been abandoned almost entirely in the West, until the recent revival of interest in response to the crisis of antibiotic resistance. The use of phage therapy, however, persisted within Soviet medicine, especially in Georgia. This article explains the adoption and survival of phage therapy in the USSR. By focusing on the Tbilisi Institute of Microbiology, Epidemiology and Bacteriophage (now the Eliava Institute), I argue that bacteriophage research appealed to Soviet scientists because it offered an ecological model for understanding bacterial infection. In the 1930s, phage therapy grew firmly imbedded within the infrastructure of Soviet microbiological institutes. During the Second World War, bacteriophage preparations gained practical recognition from physicians and military authorities. At the dawn of the Cold War, the growing scientific isolation of Soviet science protected phage therapy from the contemporary western critiques, and the ecological program of research into bacteriophages continued in Georgia.

The Attitudes, Needs, and Requirements at End of Life in the Republic of Georgia (Comparative Analysis of Groups of Patients With Cancer and Elders)

INTRODUCTION

In developing a model of palliative care, the attitudes, needs, and requirements of its beneficiaries recognizing the limited remaining life expectancy need to be met. We aimed to map and compare these issues at the end of life in the groups of patients with advanced cancer and elderly individuals.

MATERIALS AND METHODS

The prospective study based on the analysis of semistructured interviews was conducted. Fifty individuals aged older than 85 and 50 incurable patients with advanced cancer were studied. Transcripts of interviews were analyzed qualitatively (the interviews were divided into logically completed themes, and the compliance of each with one of the levels of Abraham Maslow pyramid was determined) and quantitatively (data comparisons of 2 groups were tested in bivariate analysis using Pearson χ² or Fisher exact test. Two-sided significance tests were used; P value of <.05 was deemed significant).

RESULTS

It was assumed that 120 themes were relevant to a certain level of Maslow pyramid. Their comparison showed small differences in the narratives of the patients with advanced cancer and elderly individuals aged 85 and older-concerning the past, present, and future terms of lives. In studied themes explicitly prevail the stories that are consistent with satisfaction of the upper levels of the hierarchy of needs and demands of Maslow: social relation (belonging), love, esteem, and transcendence.

CONCLUSION

The attitudes, needs, and requirements at the end of life of the people are basically similar, regardless of what determined the sense of limitation of the remaining life-incurable disease or advanced age.

[PROBLEMS OF IMPROVING ANTENATAL MONITORING OF PREGNANT WOMEN IN THE PRIMARY HEALTH CARE SYSTEM IN GEORGIA]

The purpose of the above work is to study the trends of mothers' health condition according to the implementation of antenatal monitoring of primary healthcare programs in 1996 - 2016 in Georgia. The methodology basis of the research is the qualitative investigation, so called Desk Research: collecting statistical data, description, systematization, comparison, analyses and interpretation. Data about mothers' health indicators were derived from National Center for Disease Control and Social Health and National Service of Georgian Statistics. Dynamic of the following indicators were studied: Number of births at home and the share of births at medical institution received by the qualified medical personnel, percentage of pregnant women's timely application, covering 4 antenatal visits, full time pregnancy, timely births, physiologic and pathologic births, Caesarean sections (planned, urgent); Number and indicator of mother's deaths. In order to study the law basis, the Statements of Georgian Government, normative acts of Labour, Health and Social Security of Georgia have been used for studying. In 1996 - 2016, as the result of Healthcare reforms, implemented in Georgia up to now, several parameters of antenatal monitoring were improved. The share of timely application and covering full, 4 antenatal visits increased; Share of births, received by qualified medical personnel increased; Number of mothers' mortality significantly decreased, but it is much higher when compared with the developed countries. Following the improvement in monitoring parameters and financial and geographical availability of antenatal care services, the unfavorable outcome of the pregnancy was revealed: the percentage of pathologic births increased, share of physiologic births decreased. The share of Caesarean sections is increasing and critically high. The share of early deliveries and incomplete period pregnancies increased. The above mentioned conditions indicate that there are systemic problems in the primary healthcare: In the preconception and then antenatal period, the quality of medical service does not meet the international standard. Assessment of pregnancy and fetal risks, prevention and management are inadequate.