Reductions in spice lead levels in the republic of Georgia: 2020-2022

Spice adulteration using yellow lead chromate-based pigments has been documented as a growing global health concern. Spices from the Republic of Georgia with extremely high levels of lead, up to an order of magnitude higher than any other spices worldwide, have been implicated as sources of child lead poisoning. The objectives of this study were to 1) evaluate lead concentrations in spices sampled across the country of Georgia between 2020 and 2022, and 2) assess factors associated with spice adulteration, specifically the role of spice quality and regulatory enforcement. Spice samples were collected from 29 cities nationwide. The most populous cities were selected in each administrative region as well as those of importance to the spice supply chain. Sampling was carried out at the largest spice bazaars in each city. The regions of Adjara and Imereti were the focus of qualitative interviews conducted in 2021 with key businesspeople selling spices with very high and low levels of lead. The same cities and bazaars were visited at each of three sampling periods between 2020 and 2022. In total, 765 spice samples were collected. Lead concentrations in spices decreased over time, with a maximum of 14,233 μg/g in 2020 down to 36 μg/g in the final sampling round of 2022. A logistic regression determined that sampling round, region and spice type were associated with elevated lead in samples. Samples from Adjara and those containing marigold had the highest lead levels. Interviews with eighteen prominent spice vendors revealed difficulties sourcing sufficient quantities of high quality, brightly colored marigold, and concerns about adulteration. Interviews with two authorities from the National Food Authority highlighted the increased attention on regulating lead in spices since 2018. Continued monitoring and periodic regulatory enforcement may adequately disincentivize further adulteration with lead chromate in the spice industry in Georgia.

The potential range of west Asian apple species Malus orientalis Uglitzk. under climate change

The wild relatives of cultivated apples would be an ideal source of diversity for breeding new varieties, which could potentially grow in diverse habitats shaped by climate change. However, there is still a lack of knowledge about the potential distribution of these species. The aim of the presented work was the understand the impacts of climate change on the potential distribution and habitat fragmentation of Caucasian crab apple (Malus orientalis Uglitzk.) and the designation of areas of high interest according to climatic conditions. We used the MaxEnt models and Morphological-Spatial Analysis (MSPA) to evaluate the potential distribution, suitability changes, habitat fragmentation, and connectivity throughout the species range in Turkey, Armenia, Georgia, Russia, and Iran. The results revealed that the potentially suitable range of M. orientalis encompasses 858,877 km², 635,279 km² and 456,795 km² under the present, RCP4.5 and RCP8.5 scenario, respectively. The range fragmentation analysis demonstrated a notable shift in the edge/core ratio, which increased from 50.95% in the current scenario to even 67.70% in the future. The northern part of the range (Armenia, northern Georgia, southern Russia), as well as the central and western parts of Hyrcania will be a core of the species range with suitable habitats and a high connectivity between M. orientalis populations and could work as major refugia for the studied species. However, in the Zagros and central Turkey, the potential range will shrink due to the lack of suitable climatic conditions, and the edge/core ratio will grow. In the southern part of the range, a decline of M. orientalis habitats is expected due to changing climatic conditions. The future outlook suggests that the Hyrcanian forest and the Caucasus region could serve as important refuges for M. orientalis. This study helps to understand spatial changes in species' range in response to climate change and can help develop conservation strategies. This is all the more important given the species' potential use in future breeding programs aimed at enriching the gene pool of cultivated apple varieties.

Evaluating Health Care Professionals' Readiness for e-Health Adoption in the Context of the COVID-19 Pandemic: A Georgian Perspective

Background: The COVID-19 pandemic has accelerated the adoption of Electronic health (e-Health), leveraging technologies such as telemedicine, electronic health records, artificial intelligence, and patient engagement platforms. This transformation underscores e-Health's role in providing efficient, patient-centered care. Our study explores health care professionals' readiness for these technologies, emphasizing the need for tailored education in this evolving landscape. Methods: In our study, conducted between February and March 2023, we administered a questionnaire-based survey to 500 staff members (82.4% female, 17.6% male) aged 25-70 from medical universities in Tbilisi, Georgia. The structured questionnaire covered topics such as computer literacy, telemedicine awareness, patient data security, and ethical considerations. We employed SPSS v21.0 for data analysis, encompassing descriptive statistics and thematic analysis of open-ended responses. Results: Our study included 500 participants categorized into five age groups. Notably, 31% considered themselves computer "experts," while 69% rated their skills as "intermediate" or "advanced." Furthermore, 85% used computers professionally, with 33% having practical computer training. Interestingly, 59% expressed interest in information technology training. Regarding e-Health, 15% believed it involves remote communication between health care professionals and patients, while 42% considered it "correct," and 37% "might be correct." Concerning its application in managing patients, opinions varied. In terms of e-Health's integration into Georgia's health care, responses ranged. Regarding patient data safety, participants exhibited diverse views. Finally, opinions on the necessity of informed consent for e-Health applications varied among participants. Conclusions: Our study explores health care professionals' readiness for e-Health adoption during the COVID-19 pandemic. It reveals varying computer literacy levels, a willingness to learn, differing views on e-Health applications, and mixed opinions on its integration into Georgian health care. These findings emphasize the need for clear e-Health terminology, education, tailored approaches, and a focus on data privacy and informed consent. Overall, e-Health's transformative role in modern health care is underscored.

Contact tracing in Austria, Georgia, Kyrgyzstan, Ukraine, and Kosovo† during the COVID-19 pandemic: response review and good practices

BACKGROUND

During the COVID-19 pandemic, effective contact tracing was recognized as a crucial public health response to mitigate the spread of SARS-CoV-2 and reduce COVID-19-related morbidity and mortality, particularly before widespread vaccination. The World Health Organization (WHO) recommended implementing active surveillance strategies to trace and quarantine contacts of confirmed or suspected COVID-19 cases.

METHODS

A detailed review and analysis of the COVID-19 contact tracing responses was conducted in five European countries and territories, between March 2021 and August 2022. The countries and territories were selected to ensure geographical representation across the WHO European Region and applied a mixed-methods approach of in-depth interviews with various stakeholders across different administrative levels to identify good practices in COVID-19 contact tracing. The interviews covered 12 themes, including methods and procedures for COVID-19 contact tracing, information technology, quality assurance and key performance indicators.

RESULTS

The findings demonstrate that the policy approach, digitalization capabilities and implementation approach varied in the countries and territories and were dynamic throughout the pandemic. The analysis revealed that some practices were applicable across all countries and territories, while others were context-specific, catering to each country's and territory's unique needs. The study highlighted a need for all countries to institutionalize contact tracing as an essential function of existing health systems, to digitalize contact tracing practices and processes, and to build and retain contact tracing capacities for better pandemic preparedness.

CONCLUSION

The lessons related to COVID-19 contact tracing should be utilized to strengthen future outbreak response operations as part of epidemic and pandemic preparedness.

SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study

BACKGROUND

Georgia experienced an increase in maternal deaths (MD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. This study aimed to assess associations between timing of SARS-CoV-2 infection during pregnancy and MD, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery.

METHODS

We performed a national birth registry-based cohort study of pregnant women who had completed 22 weeks of gestation and delivered between February 28, 2020, and August 31, 2022. The data were linked to coronavirus disease 2019 (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery; confirmed infection within 30 days before or at delivery; and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

RESULTS

Among 111,493 pregnant women, 16,751 had confirmed infection during pregnancy, and 7,332 were fully vaccinated against COVID-19 before delivery. Compared to the reference group, those with confirmed infection within 30 days before or at delivery experienced increased odds of MD (aOR: 43.11, 95% CI, 21.99-84.55), post-delivery ICU admission (aOR: 5.20, 95% CI, 4.05-6.67), and CS delivery (aOR: 1.11, 95% CI, 1.03-1.20).

CONCLUSIONS

Pregnant women in Georgia with confirmed SARS-CoV-2 infection within 30 days before or at delivery experienced a considerably higher risk of MD and post-delivery ICU admission and a slightly higher risk for CS delivery. Additionally, the results highlighted that most pregnant women were not vaccinated against COVID-19. These findings should alert stakeholders that adherence to public health preventive measures needs to be improved.

ADVANCES IN MINIMALLY INVASIVE SURGERY FOR PECTUS EXCAVATUM: ENHANCING OUTCOMES AND PATIENT CARE

Pectus excavatum, also called sunken chest, is the most common deformation of the sternum (90%). The deformation is caused by the depression of the sternum and costal cartilages, which causes reduction of the chest cavity and dysfunction of cardio-pulmonary systems in it. Sunken chest is more common in males than females, prevalence is 5/1. Most of the cases appear in the first year of life, however severity of the pathology is formed during puberty. Etiopathogenesis, genetic factors, and associated diseases of Pectus Excavatum are various and are still the subject of study. The manifestation of the disease is determined by the degree of chest deformation, which is calculated using the "Haller index". Providing that a high degree of deformation can lead to pathological functioning of the cardiovascular and respiratory systems. The treatment of this condition is an urgent, complex, and developing issue. The main method of treatment for sunken chest is surgical intervention; However, in cases of mild degrees of the mentioned deformation, different approaches are used. Our goal is to discuss contrasting treatment techniques and present our improved repairing technique for sunken chest, which is performed in Georgia.

Adapting national data systems for donor transition: comparative analysis of experience from Georgia and China

Health management information systems (HMISs) are essential in programme planning, budgeting, monitoring and evidence-informed decision-making. This paper focuses on donor transitions in two upper-middle-income countries, China and Georgia, and explores how national HMIS adaptations were made and what facilitated or limited successful and sustainable transitions. This comparative analytical case study uses a policy triangle framework and a mixed-methods approach to explore how and why adaptations in the HMIS occurred under the Gavi Alliance and the Global Fund-supported programmes in China and Georgia. A review of published and grey literature, key informant interviews and administrative data analysis informed the study findings. Contextual factors such as the global and country context, and health system and programme needs drove HMIS developments. Other factors included accountability on a national and international level; improvements in HMIS governance by establishing national regulations for clear mandates of data collection and reporting rules and creating institutional spaces for data use; investing in hardware, software and human resources to ensure regular and reliable data generation; and capacitating national players to use data in evidence-based decision-making for programme and transition planning, budgeting and outcome monitoring. Not all the HMIS initiatives supported by donors were sustained and transitioned. For the successful adaptation and sustainable transition, five interlinked and closely coordinated support areas need to be considered: (1) coupling programme design with a good understanding of the country context while considering domestic and external demands for information, (2) regulating appropriate governance and management arrangements enhancing country ownership, (3) avoiding silo HMIS solutions and taking integrative approach, (4) ensuring the transition of funding onto domestic budget and enforcing fulfilment of the government's financial commitments and finally (5) investing in technologies and skilled human resources for the HMIS throughout all levels of the health system. Neglecting any of these elements risks not delivering sustainable outcomes.

External technical assistance and its contribution to donor transition and long-term sustainability: experience from China and Georgia

External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of 'graduating' from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor-recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries.

Engaging stakeholders to level up COPD care in LMICs: lessons learned from the "Breathe Well" programme in Brazil, China, Georgia, and North Macedonia

BACKGROUND

Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned.

MAIN BODY

Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice.

CONCLUSION

Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.

Breast Cancer Screening in Georgia: Choosing the Most Optimal and Cost-Effective Strategy

OBJECTIVES

To define the optimal and cost-effective breast cancer screening strategy for Georgia.

METHODS

We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses.

RESULTS

Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (€16 218/QALY), well above the willingness-to-pay threshold of €12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of €12 507.

CONCLUSIONS

Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.

Trends in cost and consumption of essential medicines for non-communicable diseases in Azerbaijan, Georgia, and Uzbekistan, from 2019 to 2021

BACKGROUND

Access to medicines is a global priority. Azerbaijan, Georgia, and Uzbekistan have different approaches to pricing policies for pharmaceuticals. The aim of this study was to analyze recent trends in the consumption and prices of non-communicable disease (NCD) medicines in Azerbaijan, Georgia, and Uzbekistan, in the outpatient setting.

METHODS

We included medicines for asthma and COPD, cancer, cardiovascular disease, diabetes, epilepsy, and mental disorders. Sales data for pharmaceutical products in community pharmacies were extracted from a commercial database. Changes in consumption and prices were analyzed across all included NCD medicines, by disease category and pharmacological group.

RESULTS

Consumption of NCD medicines was highest in Georgia, at twice the levels in Azerbaijan, and four times levels in Uzbekistan. Average prices of NCD medicines, weighted by consumption, increased by 26% in Georgia, but decreased by 3% in Azerbaijan and by 0.1% in Uzbekistan. Prices increased for all disease groups in Georgia (from +13% for epilepsy medicines to +86% for cancer), varied by group in Uzbekistan (from -22% for epilepsy medicines to +47% for cancer), while changes in Azerbaijan were smaller in magnitude (from -4% for medicines for cardiovascular disease to +11% for cancer). Cancer medicines had markedly higher prices in Uzbekistan, and asthma and COPD medicines had markedly higher prices in Azerbaijan and Uzbekistan.

CONCLUSIONS

Georgia showed the highest outpatient consumption of NCD medicines, suggesting the broadest access to treatment. However, Georgia also saw marked price increases, greater than in the other countries. In Georgia, where there was no price regulation, widespread price increases and increases in consumption both contribute to increasing pharmaceutical expenditures. In Azerbaijan and Uzbekistan, increases in outpatient pharmaceutical expenditures were primarily driven by increases in consumption, rather than increases in price. Comparing trends in consumption and pricing can identify gaps in access and inform future policy approaches.

NURSES' AWARENESS AND ATTITUDES TOWARDS INFLUENZA VACCINATION: A STUDY IN GEORGIA

This study aimed to investigate the attitudes and awareness of nurses in Georgia towards influenza vaccination, especially in light of the mandatory vaccination policy introduced for medical personnel. A cross-sectional survey was conducted with a sample of 455 Level 5 nurses, chosen from a population of 19000 registered nurses in Georgia. Participants completed a 16-question mixed-format questionnaire assessing demographic information, knowledge about mandatory influenza vaccines, and attitudes towards vaccination. Data analysis employed quantitative methods using SPSS, focusing on statistical measures such as mean, relative frequencies, standard deviation, and chi-square tests. The study found that 56% of nurses had received training on flu vaccination, but a significant portion (36.6%) had not, leading to varied levels of self-assessed knowledge. Over 61% of nurses had been vaccinated for the current season. Reasons for not receiving the flu shot included personal health concerns (14.7%), time constraints (14.7%), and fear of adverse effects (16.5%). Despite these concerns, 83.8% believed in the vaccine's effectiveness. Regarding mandatory vaccination, 50% supported voluntary vaccination, while 24.6% supported mandatory policies. The study also noted regional differences in vaccine uptake and found that a significant proportion of those opposed to mandatory vaccination had nonetheless been vaccinated. The research underscores a need for improved educational initiatives to address the misconceptions about vaccine risks among nurses. Despite concerns over adverse events, the actual risk associated with influenza vaccination is low. The study advocates for enhanced communication strategies to bridge the gap between perceived and actual risks and to increase influenza vaccination uptake among nurses.

Genetic Analysis of Mingrelians Reveals Long-Term Continuity of Populations in Western Georgia (Caucasus)

To elucidate the population history of the Caucasus, we conducted a survey of genetic diversity in Samegrelo (Mingrelia), western Georgia. We collected DNA samples and genealogical information from 485 individuals residing in 30 different locations, the vast majority of whom being Mingrelian speaking. From these DNA samples, we generated mitochondrial DNA (mtDNA) control region sequences for all 485 participants (female and male), Y-short tandem repeat haplotypes for the 372 male participants, and analyzed all samples at nearly 590,000 autosomal single nucleotide polymorphisms (SNPs) plus around 33,000 on the sex chromosomes, with 27,000 SNP removed for missingness, using the GenoChip 2.0+ microarray. The resulting data were compared with those from populations from Anatolia, the Caucasus, the Near East, and Europe. Overall, Mingrelians exhibited considerable mtDNA haplogroup diversity, having high frequencies of common West Eurasian haplogroups (H, HV, I, J, K, N1, R1, R2, T, U, and W. X2) and low frequencies of East Eurasian haplogroups (A, C, D, F, and G). From a Y-chromosome standpoint, Mingrelians possessed a variety of haplogroups, including E1b1b, G2a, I2, J1, J2, L, Q, R1a, and R1b. Analysis of autosomal SNP data further revealed that Mingrelians are genetically homogeneous and cluster with other modern-day South Caucasus populations. When compared with ancient DNA samples from Bronze Age archaeological contexts in the broader region, these data indicate that the Mingrelian gene pool began taking its current form at least by this period, probably in conjunction with the formation of a distinct linguistic community.

Identifying Sources of Lead Exposure for Children in the Republic of Georgia, with Lead Isotope Ratios

In the Republic of Georgia, a 2018 national survey estimated that more than 40% of children aged 2-7 years had a blood lead concentration (BLC) of more than 5 µg/dL. The objective of this study was to document the feasibility of employing lead isotope ratios (LIRs) to identify and rank the Pb (lead) exposure sources most relevant to children across Georgia. A cross-sectional survey between November 2019 and February 2020 of 36 children previously identified as having BLCs > 5 µg/dL from seven regions of Georgia involved the collection of blood and 528 environmental samples, a questionnaire on behaviours and potential exposures. The LIRs in blood and environmental samples were analysed in individual children and across the whole group to ascertain clustering. A fitted statistical mixed-effect model to LIR data first found that the blood samples clustered with spices, tea, and paint, then, further isotopically distinct from blood were sand, dust, and soil, and lastly, milk, toys, pens, flour, and water. Analysis of the LIRs provided an indication and ranking of the importance of Pb environmental sources as explanatory factors of BLCs across the group of children. The findings support the deployment of interventions aimed at managing the priority sources of exposure in this population.

Diversity, taxonomy and phylogenetic relationships of the Niphargus borutzkyi ingroup (Crustacea: Amphipoda: Niphargidae) in Western Georgia, SW Caucasus

Two new Caucasian species of the genus Niphargus Schidte, 1849 (Crustacea: Amphipoda: Niphargidae), N. rachalechkhumensis sp. nov. and N. tvishiensis sp. nov., are described from the stygobiotic habitats of the Racha-Lechkhumi and Kvemo Svaneti karst systems in Western Georgia. Both newly described species belong to the southwestern Caucasian Niphargus borutzkyi ingroup related to the European carphaticus species complex and can be clearly separated from the congeners by morphological features, mostly in uropod III and epimeral plates, and genetically. Identification key for all known species to the Niphargus borutzkyi ingroup is provided, as well as their phylogenetic relationships, the estimated time of the origin and the current distribution of the ingroup in the Colchis lowland of the southwestern Caucasus are also discussed.

Countries' vulnerability to food supply disruptions caused by the Russia-Ukraine war from a trade dependency perspective

Disruptions of key food and fertilizer exports from Russia and Ukraine have exposed many countries to challenges accessing some commodities since these countries' war began. We evaluated the short-term, external, and direct impacts of disruptions of six food commodities and three types of fertilizer supplies from Russia and Ukraine on food access for all trading partners of the two countries by applying a set of trade and socioeconomic indicators. We found that the external food supplies of 279 countries and territories were affected to varying degrees; 24 countries-especially Georgia, Armenia, Kazakhstan, Azerbaijan, and Mongolia-are extremely vulnerable because they depend almost entirely on a variety of food imports from Russia and Ukraine. Access to fertilizers was affected in 136 countries and territories, particularly Estonia (potassic fertilizer), Mongolia (nitrogenous fertilizers), Kazakhstan (mixed fertilizers), and Brazil, the United States, China, and India (all types of fertilizers). An integrated assessment of countries' import types, purchasing power parity per capita, and populations indicated that the Democratic Republic of the Congo, Ethiopia, Egypt, and Pakistan are most vulnerable to such supply disruptions. Development of research into diversification and decentralization strategies for food access is needed to guide stable food supply policies.

A counterexample to secularization theory? Assessing the Georgian religious revival

Secularization theory allows for transitory religious revivals under certain conditions, such as extreme societal crises or state weakness. The country of Georgia has witnessed the largest religious revival of Orthodox countries and one of the most striking religious resurgences worldwide. This paper gives both a statistical and historical description of this revival and asks whether it is a counterexample to secularization theory. We show that the main thrust of the religious revival in Georgia lasted 25 years and seized the entire society in what was mainly a period effect. The most significant cause for the revival was a major societal and economic crisis starting in 1985 combined with a very weak state, creating massive individual insecurity. In these circumstances, the Georgian Orthodox Church was able to provide identity for individuals and legitimacy for governments. Other possible causes of the revival-state funding, too rapid modernization, or emigration-can be excluded as primary drivers of the process. The Georgian case shows a situation in which secularization theory expects transitory revivals and is thus not a counterexample.

Knowledge, attitudes, and beliefs of cardiovascular disease prevention in young adults in the country of Georgia

INTRODUCTION

Cardiovascular disease (CVD) accounts for 46% of all mortality in the country of Georgia (former Soviet Union). Young adults in that country have not been studied regarding CVD and a need exists to understand lifestyle modifications to promote cardiovascular health.

DESIGN

An interpretive description qualitative design was used to explore Georgian young adults' knowledge, attitudes, and beliefs of CVD preventative practices and life experiences.

METHODS

A convenience sample of 19 ethnic Georgian participants (18-40 years old) who were fluent in either English, Georgian, or Russian from a local private university was used. Semi-structured interviews were conducted via video conferencing utilizing an interpreter.

RESULTS

Four themes were identified: (1) CVD and risk factor knowledge, (2) prevention attitudes, beliefs, and gender differences, (3) health literacy influences, and (4) culture and societal impacts. CVD knowledge was limited and influenced by health literacy and the current healthcare system in Georgia.

CONCLUSION

Cultural and societal gender norms influence cardiovascular health behaviors.

CLINICAL IMPLICATIONS

Georgian nurses can play a key role in CVD education and screening for young adults in Georgia.

First records of cave-dwelling pseudoscorpions of the genus Ephippiochthonius Beier, 1930 (Arachnida: Pseudoscorpiones: Chthoniidae) from the Caucasus, with description of three new species from Abkhazia and taxonomic comments on the genus

Three new hypogean Ephippiochthonius species from karst caves of Abkhazia (Western Caucasus) are described, including detailed diagnoses and illustrations: Ephippiochthonius kovali sp. nov., E.vargovitshi sp. nov. and E.dbari sp. nov. These are the first cave-dwelling species of the genus described from the Caucasus. The taxonomic significance of the position of the intermediate setae ih3 and ih4 on the antiaxial side of chelal hand in the genus Ephippiochthonius is discussed. Based on this and other features, the heterogeneity of the tetrachelatus-group is demonstrated. Given the presence of seta ph3, the following new combinations are proposed for the species formerly assigned to Ephippiochthonius: Occidenchthonius kemza (uri, Lee et Makarov, 1993) comb. nov. from Pecina u Kozuvarskoj Glami Cave, Serbia and Occidenchthonius romanicus (Beier, 1935) comb. nov. from Comana, Romania (all ex Ephippiochthonius).

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

BackgroundBetween May 2015 and February 2022, 77,168 hepatitis C virus (HCV)-infected people in Georgia have been treated through an HCV elimination programme. To project the programme's long-term impacts, an HCV infection model was initially developed, based on data from surveys among people who inject drugs and a national serosurvey in 2015.AimAccounting for follow-up surveys in 2021, we validate and update projections of HCV infection prevalence and incidence.MethodWe assessed the initial model projections' accuracy for overall prevalence, by age, sex, and among people who ever injected drugs, compared with 2021 serosurvey data. We used 2021 results to weight model fits and to recalculate the national programme's impact leading up to March 2022 on HCV infection incidence rates. Cases and deaths averted were estimated. The impact of reduced treatment rates during the COVID-19 pandemic was assessed.ResultsThe original model overpredicted adult (≥ 18 years old) chronic HCV infection prevalence for 2021 (2.7%; 95% credible interval (CrI): 1.9-3.5%) compared with a 2021 serosurvey (1.8%; 95% confidence interval (CI): 1.3-2.4%). Weighted model projections estimated a 60% decrease in HCV infection incidence by March 2022, with an absolute incidence of 66 (95% CrI: 34-131) per 100,000 person-years (overall population). Between May 2015 and March 2022, 9,186 (95% CrI: 5,396-16,720) infections and 842 (95% CrI: 489-1,324) deaths were averted. The COVID-19 pandemic resulted in 13,344 (95% CrI: 13,236-13,437) fewer treatments and 438 (95% CrI: 223-744) fewer averted infections by March 2022.ConclusionResults support the programme's high effectiveness. At current treatment rate (406/month), 90% reductions in prevalence and incidence in Georgia are achievable by 2030.

"How can you kiss and touch this child and show affection towards her? What kind of woman are you?": Provider perspectives on stigma towards native and ethnic minority street-connected youth in the Republic of Georgia

The Republic of Georgia has experienced a rapid growth in the number of youth working and/or living on the street (YWLS). Although research indicates that YWLS are highly stigmatized, few studies have examined perceptions of stigma among Georgian social service providers who serve YWLS. We conducted in-person in-depth interviews with key informants recruited from governmental institutions and social service organizations in Tbilisi and Rustavi, two large urban areas. A semi-structured interview guide was used to explore provider perspectives on the social contexts surrounding the delivery of services to YWLS. Trained coders conducted a thematic analysis of the data in Dedoose. Twenty-two providers (68% female; 32% male) were interviewed, representing diverse professional roles. Providers perceived that YWLS are subjected to strong public stigma and social exclusion at multiple social-ecological levels, with Roma and Kurdish-Azeri youth experiencing the strongest levels of social hostility, discrimination, and exclusion. Providers perceive that these dynamics prevent YWLS from developing trusting relationships with social service, health and educational institutions. Furthermore, we find that providers report encounters with courtesy stigma, i.e., stigma directed towards the people who serve or are associated with a stigmatized group, when working with YWLS, especially those from ethnic minority groups, which they characterize as a stressor. At the same time, we find that some providers reported negative stereotypes about ethnic minority YWLS. While campaigns have targeted public awareness on the plight of YWLS, study findings suggest that additional efforts are needed to address stigma directed towards YWLS, with a specific need to address stigma directed towards ethnic minority young people who work and/or live on the street.

THE STUDY OF VDR FOKI RS2228570 SNP IN AUTOIMMUNE THYROIDITIS

Autoimmune thyroid disease (AITD) is a common organ-specific autoimmune disease. A strong influence of genetic and epigenetic modifications has been demonstrated to take part in the development and progression of autoimmune thyroid diseases. The linkage between the Vitamin D receptor (VDR) polymorphism and several autoimmune disorders, including the AITD. In this article, we aim to investigate the Frequency of VDR Fokl (rs2228570) genotypes (CC, CT, TT) and alleles (C,T) in autoimmune thyroiditis. The investigation of VDR Fokl (rs2228570) was conducted on 150 samples (control (75 healthy women) and diseased women (75 diseased with autoimmune thyroiditis)) patients from the Adjara (Georgia) Population. It also examined some clinical and laboratory characteristics of the study population. Autoimmune thyroiditis's disease was diagnosed by measuring blood antibodies, determining the level of thyroperoxidase, and conducting an ultrasound examination. Anti-TPO and TSH were studied using the ELISA method. The genomic DNA was extracted from the peripheral blood. The polymerase chain reaction was evaluated to examine the VDR Fokl rs2228570 SNP polymorphism. According to VDR Fokl (rs2228570) genotypes (CC; CT, TT) frequency, in the control group, the Frequency of CC-genotype is 48%, CT-heterozygous genotype is 29.33%, and TT-genotype is 22.67%; in the diseased population, the Frequency of CC-genotype is 57.33%, CT-genotype is 34.67%, and TT-genotype is 8%. According to VDR Fokl (rs2228570) alleles (C, T), the Frequency of the C-allele is high, and the Frequency of the T-allele is low in both populations. The Frequency of the CC and CT genotypes of VDR Fokl (rs2228570) is high in the population with autoimmune thyroiditis compared to the control group; the TT genotype is relatively low in the population suffering from autoimmune thyroiditis; According to VDR Fokl (rs2228570) alleles (C, T), the Frequency of C-allele is high both population.

Formal and informal solid waste management in Kutaisi, Georgia: A status quo report based on material flow analysis

The goal of this study is a qualitative and quantitative evaluation of processes and flows within the solid waste management (WM) system in Kutaisi, Georgia, and the wider Imereti region. The applied methodology based upon data collected through customized questionnaires enabled both the formal and informal sectors (IS) to be characterized. Moreover, waste composition studies in the region's rural and semi-urban areas revealed that the share of recyclables is higher in urban areas and commercial centres. A material flow analysis was used to transparently consolidate the collected data, showing that dumping and landfilling still play a major role within the Georgian WM system. The total amount of waste landfilled on 'Nikea' landfill in 2019 equals 58,000 tonnes year^-1, from where around 55,500 tonnes year^-1 is formally collected municipal solid waste, and 2,503 tonnes year^-1 is commercial and industrial waste. According to the findings, the size of the IS in Kutaisi is 0.07-0.15% of the city's population, whose supposed cumulative income is estimated GEL 0.57-1.13 million (EUR 180-360 thousand) in 2019. Informally collected recyclables are estimated 870-1,750 tonnes year^-1, comprising 6-11% of recyclables landfilled in Kutaisi in 2019. The study provides a basis for decision-makers. Replicating the applied methodologies and approaches to create this sound database could support the WM system across whole Georgia. The study further reveals the importance of the need to stop neglecting the IS and recognizes the importance of its role in the WM system of Kutaisi and the wider Imereti region, respectively.

Feasibility of a pulmonary rehabilitation programme for patients with symptomatic chronic obstructive pulmonary disease in Georgia: a single-site, randomised controlled trial from the Breathe Well Group

OBJECTIVES

To assess the feasibility of delivering a culturally tailored pulmonary rehabilitation (PR) programme and conducting a definitive randomised controlled trial (RCT).

DESIGN

A two-arm, randomised feasibility trial with a mixed-methods process evaluation.

SETTING

Secondary care setting in Georgia, Europe.

PARTICIPANTS

People with symptomatic spirometry-confirmed chronic obstructive pulmonary disease recruited from primary and secondary care.

INTERVENTIONS

Participants were randomised in a 1:1 ratio to a control group or intervention comprising 16 twice-weekly group PR sessions tailored to the Georgian setting.

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility of the intervention and RCT were assessed according to: study recruitment, consent and follow-up, intervention fidelity, adherence and acceptability, using questionnaires and measurements at baseline, programme end and 6 months, and through qualitative interviews.

RESULTS

The study recruited 60 participants (as planned): 54 (90%) were male, 10 (17%) had a forced expiratory volume in 1 second of ≤50% predicted. The mean MRC Dyspnoea Score was 3.3 (SD 0.5), and mean St George's Respiratory Questionnaire (SGRQ) 50.9 (SD 17.6). The rehabilitation specialists delivered the PR with fidelity. Thirteen (43.0%) participants attended at least 75% of the 16 planned sessions. Participants and rehabilitation specialists in the qualitative interviews reported that the programme was acceptable, but dropout rates were high in participants who lived outside Tbilisi and had to travel large distances. Outcome data were collected on 63.3% participants at 8 weeks and 88.0% participants at 6 months. Mean change in SGRQ total was -24.9 (95% CI -40.3 to -9.6) at programme end and -4.4 (95% CI -12.3 to 3.4) at 6 months follow-up for the intervention group and -0.5 (95% CI -8.1 to 7.0) and -8.1 (95% CI -16.5 to 0.3) for the usual care group at programme end and 6 months, respectively.

CONCLUSIONS

It was feasible to deliver the tailored PR intervention. Approaches to improve uptake and adherence warrant further research.

TRIAL REGISTRATION NUMBER

ISRCTN16184185.

Home-based hepatitis C self-testing in people who inject drugs and men who have sex with men in Georgia: a protocol for a randomised controlled trial

INTRODUCTION

Globally, it is estimated that more than three-quarters of people with chronic hepatitis C virus (HCV) are unaware of their HCV status. HCV self-testing (HCVST) may improve access and uptake of HCV testing particularly among key populations such as people who inject drugs (PWID) and men who have sex with men (MSM) where HCV prevalence and incidence are high and barriers to accessing health services due to stigma and discrimination are common.

METHODS AND ANALYSIS

This randomised controlled trial compares an online programme offering oral fluid-based HCVST delivered to the home with referral to standard-of-care HCV testing at HCV testing sites. Eligible participants are adults self-identifying as either MSM or PWID who live in Tbilisi or Batumi, Georgia, and whose current HCV status is unknown. Participants will be recruited through an online platform and randomised to one of three arms for MSM (courier delivery, peer delivery and standard-of-care HCV testing (control)) and two for PWID (peer delivery and standard-of-care HCV testing (control)). Participants in the postal delivery group will receive an HCVST kit delivered by an anonymised courier. Participants in the peer delivery groups will schedule delivery of the HCVST by a peer. Control groups will receive information on how to access standard-of-care testing at a testing site. The primary outcome is the number and proportion of participants who report completion of testing. Secondary outcomes include the number and proportion of participants who (a) receive a positive result and are made aware of their status, (b) are referred to and complete HCV RNA confirmatory testing, and (c) start treatment. Acceptability, feasibility, and attitudes around HCV testing and cost will also be evaluated. The target sample size is 1250 participants (250 per arm).

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the National Centers for Disease Control and Public Health Georgia Institutional Review Board (IRB) (IRB# 2021-049). Study results will be disseminated by presentations at conferences and via peer-reviewed journals. Protocol version 1.1; 14 July 2021.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04961723).

Branchiopodataenia bazaletica sp. n., a Parasite of the Black Tern (Chlidonias niger) from Georgia

INTRODUCTION

Branchiopodataenia bazaletica sp. n. (Cestoda, Cyclophyllidea) is described from the black tern, Chlidonias niger L., after re-examination of material deposited in the helminthological collection of the Institute of Zoology, Ilia State University, Institute of Zoology in Tbilisi, Georgia.

METHODS

The cestodes were collected from Bazaleti Lake in Georgia and originally identified as Wardium cirrosa, as labeled on the slides. Cestodes were examined using light microscopy.

RESULTS

Detailed examination of the morphology of these specimens showed that they belong to the genus Branchiopodataenia and are described as a new species. The presence of 10 aploparaksoid hooks with an elongate handle, three testes, and chitinoid latch-like structure in the copulative part of the vagina support the assignment of the new species to Branchiopodataenia. The new species has rostellar hooks 48-52 in length, a long, armed cirrus, and long copulative part of the vagina. Branchiopodataenia bazaletica sp. n. differs from its congeners by the size of rostellar hooks and by the shape of the cirrus and vagina.

COMPARATIVE ANALYSIS OF CURRENT SURGICAL APPROACHES TO THYMIC TUMORS TREATMENT

The aim of the work was a comparative analysis of scientific sources, covering current surgical approaches in the treatment of thymus tumors, as well as the analysis of the results of own experience in minimally invasive surgery for thymus neoplasm. Thymic hyperplasia include tumor-like disorders, cysts and thymic tumors, the latter compose for 60-90% of all thymic lesions. Over the past ten years, due to the development of technologies, a new trends of surgical treatment of thymic tumors has been proposed - minimally invasive techniques, which all over the world changes the historical dogmas concerning thymus surgery, since associated with shorter hospital stays, less intraoperative bleeding, the best aesthetic outcomes. There are four key problems are discussed in thymus surgery today: the role of minimally invasive surgery, the role of lymph node dissection, extension of resection in the case of nonmyasthenic thymoma, treatment of locally advanced tumors of the thymus with pleural defeats. A retro- and prospective analysis of the results of minimally invasive surgery was carried out in 18 patients with thymic tumors in our research, who received surgical therapy during 2018 and 2021 in the department of thoracic surgery (,,New Hospitals", Tbilisi, Georgia). The average age of patients was 51.4±13.2 (M±SD), 3 men (22.2%), 15 women (77.8%). All patients were performed thymectomy by videothoracoscopic method, there were no postoperative crises of myasthenia gravis and other complications in any case. Research results demonstrate high efficiency minimally invasive thymus surgery in clinic practice, which be of help to optimal management and allows to reduce the socio-economic loading on health service.

THE SHORT- AND LONG-TERM IMPACTS OF INTRAOSSEOUS CATHETERIZATION TRAINING ON MEDICAL STAFF'S READINESS TO STABILIZE CRITICAL PATIENTS AT THE PEDIATRIC EMERGENCY DEPARTMENT

The introduction of intraosseous injection methodology is very important in critically ill patients, with whom peripheral venous catheterization is impossible and there is not enough time to access a central vein due to a life-threatening condition of the patient. To carry out the relevant methodology in Georgia, for the first time in 2016 and then in 2017, the USA Mayo Clinic Emergency Care Physicians held trainings in Intraosseous Catheterization, which included both theoretical (indications, contraindications, complications, etc.) and practical trainings (techniques for using a special tool on manikin bone).A team of emergency physicians from two Pediatric Clinics of Georgia was later selected to undergo the above-mentioned training (theoretical and practical). Both teams were tested before and after the training. The results were compared. For two years, a certain number of physicians performed appropriate manipulation in patients. The aim of our further study was to determine whether physicians possessed theoretical and practical skills two years after training. Doctors were divided into two groups: those who performed this manipulation during this period and those who did not. The results of the testing ahve shown the need for periodic intraosseous catheterization training so that physicians who have not practiced this manipulation would not lose the relevant skills and perform this manipulation safely when needed.

ENDO-ACAB EARLY POSTOPERATIVE PERIOD RESULTS: ANALYSIS AND COMPARISON

Endoscopic atraumic coronary artery bypass grafting (EndoACAB) is a novel approach in the treatment of ischemic heart disease compared to traditional coronary artery bypass grafting (CABG). Analyzing the early and late outcome of EndoACAB is very important. EndoACAB was performed in "Tbilisi Heart and Vascular Clinic" for the first time in Georgia in 2015. The study aim was to analyze early postoperative period results and compare them with the research carried out at some leading international cardiothoracic centers. 162 patients underwent EndoACAB in 2015-2017. We studied preoperative and intraoperative characteristics of patients as well as early postoperative outcome. No intraoperative mortality was detected. Lethal outcome in early postoperative period was seen in 1,2%. Intraoperative switch from Endo-ACAB to CABG was seen in 2,5%. Pneumon was diagnosed in 0.6%, atrial fibrillation and flutter - 1,9%, no surgical wound infection nor stroke was detected. mean days of hospital stay was 4,8 days±1.2. There was no statistically significant difference in our results and mortality rate compared to the results of foreign referral centers. We assume that EndoACAB which is a novelty for Georgian medical society is successfully implemented and its early outcome is the same as operations performed in leading international centers.

AWARENESS AND ATTITUDE TOWARDS COVID-19 AMONG STUDENTS OF MEDICAL UNIVERSITIES IN TBILISI, GEORGIA

On December 31st, 2019, a disease, now known as COVID-19, caused by novel coronavirus was detected in Wuhan, China. Since then, new cases of COVID-19 emerge all over the world each day, having a fatal outcome chiefly in those who belong to high risk groups. In order to prevent the disease spread, health regulations have been brought in by the authorities. They have become obligatory to follow in numerous countries, including Georgia, which confirmed its first case in Tbilisi on February 26. During the pandemic, it is crucial for people, especially health care workers to have access to reliable information regarding the disease and its spread. One of the most important groups in this field are the medical students. The purpose of this study was to evaluate awareness and attitude towards COVID-19 among medical students in Tbilisi, Georgia. An online survey was conducted using Google forms and posted in Facebook groups. There were 18 questions in total and the language used was Georgian. All questions were marked as "required" to encourage completion. In total, 178 participants completed the questionnaire from 4 different medical universities of Tbilisi. Answers were compared to a study done locally among the Georgian population regarding knowledge and attitude towards COVID-19, as well as a survey conducted among Iranian medical students concerning the same topic. Our results showed that majority of participants had a high degree of knowledge about the coronavirus transmission, high proportion of students reported practicing social distancing, however some students struggled with distinguishing between coronavirus and influenza. This is the first study estimating COVID-19 knowledge among medical students in Georgia, however it needs further research to assess the situation in other medical universities and attain a larger sample to see a more accurate picture. It would also be interesting to conduct an updated version of the survey, in order to evaluate whether there has been an increase in awareness about this subject.

KNOWLEDGE OF GEORGIAN POPULATION TOWARDS AIR POLLUTION AND HEALTH EFFECTS OF LEAD CONTAMINATION

The goal of this study was to assess the level of knowledge about air pollution and the health effects of lead exposure among the population of Georgia. In 2019, a project entitled "Protect Environment" was conducted by the National Center for Disease Control and Public Health and the Health Research Union. The online survey was carried out using a Facebook advertisement, which included the title, body text, the banner, and a link to the questionnaire. The target population was the entire country and the language used was Georgian. We collected information on knowledge about health problems caused by polluted air, diverse environmental pollutants (such as the smoke of burning leaves, cigarette butts and smoke, effects of lead), and the effectiveness of a face mask to filter pollutants. Finally, we assessed awareness of the informational website www.air.gov.ge. The study was conducted over 3 days among 349 respondents in October 2019. Most (90.3%) of the respondents correctly answered the question related to air pollution causing different types of diseases, a similar proportion were concerned about the impact of environmental pollution and the impact of exposure to lead (76.8%). These findings indicate the importance of promoting educational websites that provide detailed information about various contaminants, as well as different preventive measures to mitigate environmental pollution. This study provides important information about the level of awareness among the Georgian population regarding air pollution and lead poisoning, research which is still very nascent. These findings should inform the development of educational campaigns to raise awareness about air pollution.

A QUALITATIVE STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS TB IN GEORGIA

TB remains to be the major public health concern in Georgia. TB awareness and knowledge is usually low in the general population, which leads to delayed referral to a medical facility, which in turn hinders timely initiation of diagnostic and treatment interventions. Lack of knowledge also contributes much to the widespread stigma in the society. The aim of the study was to qualitatively explore TB knowledge, attitudes and practice, as well as related barriers and facilitators by conducting FGDs among representatives of general population as well as TB risk groups. The qualitative data was collected through FGDs among different target groups: (1) TB patients; (2) TB contacts; (3) Injecting drug users; (4) health care providers and (5) students. FGD recordings were transcribed using a predefined coding scheme and followed by contextual analysis. According to the study results, there is a good level of TB knowledge and awareness among current/former TB patients, their contacts, and health care providers, which is linked to their practice and experience. IDUs receive sufficient information on the disease within the educational component of the Needle and Syringe program. A significant lack of TB knowledge was revealed in a segment of the general population such as students. Lack of TB knowledge among general population is highly linked to the stigmatized attitude towards TB patients. Accurate TB knowledge is an important prerequisite determining positive attitude towards the disease and supporting stigma reduction. Correct information on TB should be disseminated through all possible channels and the process should have permanent nature.

KNOWLEDGE RELATED TO HIV/TB/HCV AMONG PRIMARY HEALTH CARE WORKERS AND THE INTEGRATED SCREENING IN KVEMO KARTLI REGION

Integration of TB/HIV/HCV screening into primary health care has been implemented in Georgia since 2018. The aim of the program is to strengthen TB, HIV/HCV screening and early detection capabilities in the primary health care, as early detection and treatment are considered to be the most effective strategies to prevent these infections. The goal of the study was to evaluate and compare the baseline and follow-up knowledge about TB, HIV and HCV infectious among primary health care workers in Kvemo Kartli Region. The study instrument was a self-administered questionnaire. A total of 459 primary HCWs from Kvemo Kartli region were surveyed. The proportion of HCWs correctly knowing MDR TB definition increased from 34.6% to 82.8% and this difference was statistically significant (p<0.01). Nurses were less informed about HIV infection. Only 70.7% of them knew modes of HIV transmission, while 89.3% of physicians answered this question correctly (p<0.001). An assessment of knowledge among primary health care workers (PHC) providers is important, as they represent the first level of community contact with health care. The post-test after the training showed significant improvement in knowledge among trained HCWs. Follow-up knowledge and practice surveys are needed to understand the long-term impact of training on the rate screening referrals by PHC providers.

A Cross Sectional Sampling Reveals Novel Coronaviruses in Bat Populations of Georgia

Mammal-associated coronaviruses have a long evolutionary history across global bat populations, which makes them prone to be the most likely ancestral origins of coronavirus-associated epidemics and pandemics globally. Limited coronavirus research has occurred at the junction of Europe and Asia, thereby investigations in Georgia are critical to complete the coronavirus diversity map in the region. We conducted a cross-sectional coronavirus survey in bat populations at eight locations of Georgia, from July to October of 2014. We tested 188 anal swab samples, remains of previous pathogen discovery studies, for the presence of coronaviruses using end-point pan-coronavirus RT-PCR assays. Samples positive for a 440 bp amplicon were Sanger sequenced to infer coronavirus subgenus or species through phylogenetic reconstructions. Overall, we found a 24.5% positive rate, with 10.1% for Alphacoronavirus and 14.4% for Betacoronavirus. Albeit R. euryale, R. ferrumequinum, M. blythii and M. emarginatus were found infected with both CoV genera, we could not rule out CoV co-infection due to limitation of the sequencing method used and sample availability. Based on phylogenetic inferences and genetic distances at nucleotide and amino acid levels, we found one putative new subgenus and three new species of Alphacoronavirus, and two new species of Betacoronavirus.

Unity in diversity-food plants and fungi of Sakartvelo (Republic of Georgia), Caucasus

BACKGROUND

The Republic of Georgia is part of the Caucasus biodiversity hotspot, and human agricultural plant use dates back at least 6000 years. Over the last years, lots of ethnobotanical research on the area has been published. In this paper, we analyze the use of food plants in the 80% of Georgia not occupied by Russian forces. We hypothesized that (1) given the long tradition of plant use, and the isolation under Soviet rule, plant use both based on home gardens and wild harvesting would be more pronounced in Georgia than in the wider region, (2) food plant use knowledge would be widely and equally spread in most of Georgia, (3) there would still be incidence of knowledge loss despite wide plant use, especially in climatically favored agricultural regions in Western and Eastern Georgia.

METHODS

From 2013 to 2019, we interviewed over 380 participants in all regions of Georgia not occupied by Russian forces and recorded over 19,800 mentions of food plants. All interviews were carried out in the participants' homes and gardens by native speakers of Georgian and its dialects (Imeretian, Rachian, Lechkhumian, Tush, Khevsurian, Psavian, Kakhetian), other Kartvelian languages (Megrelian, Svan) and minority languages (Ossetian, Ude, Azeri, Armenian, Greek).

RESULTS

The regional division was based primarily on historic provinces of Georgia, which often coincides with the current administrative borders. The total number of taxa, mostly identified to species, including their varieties, was 527. Taxonomically, the difference between two food plant groups-garden versus wild-was strongly pronounced even at family level. The richness of plant families was 65 versus 97 families in garden versus wild plants, respectively, and the difference was highly significant. Other diversity indices also unequivocally pointed to considerably more diverse family composition of wild collected versus garden plants as the differences between all the tested diversity indices appeared to be highly significant. The wide use of leaves for herb pies and lactofermented is of particular interest. Some of the ingredients are toxic in larger quantities, and the participants pointed out that careful preparation was needed. The authors explicitly decided to not give any recipes, given that many of the species are widespread, and compound composition-and with it possible toxic effects-might vary across the distribution range, so that a preparation method that sufficiently reduces toxicity in the Caucasus might not necessary be applicable in other areas.

CONCLUSIONS

Relationships among the regions in the case of wild food plants show a different and clearer pattern. Adjacent regions cluster together (Kvemo Zemo Racha, and Zemo Imereti; Samegrelo, Guria, Adjara, Lechkhumi and Kvemo and Zemo Svaneti; Meskheti, Javakheti, Kvemo Kartli; Mtianeti, Kakheti, Khevsureti, Tusheti. Like in the case of the garden food plants, species diversity of wild food plants mentioned varied strongly. Climate severity and traditions of the use of wild food plants might play role in this variation. Overall food plant knowledge is widely spread all-across Georgia, and broadly maintained.

Reduction in Blood Lead Concentration in Children across the Republic of Georgia following Interventions to Address Widespread Exceedance of Reference Value in 2019

In recent years, reports of lead contamination have dramatically increased in Georgia. Given concerns about the exposure of children to lead (Pb), the National Multiple Indicator Cluster Survey (MICS-2018) included a blood sampling component. The results showed that 41% of the children that participated had blood Pb levels (BLL) ≥ 5 µg/dL and that BLL in children living in Western Georgia were higher than those in Eastern regions. In response to these findings, NCDC implemented written and verbal advice to the families of children who participated in the MICS-2018 on how to reduce Pb exposure. From August 2019 onwards, the state program of clinical follow-up was implemented. The design of this study was a longitudinal study. The intervention of interest was the public health advice and medical follow-up, and the outcome was defined as the difference in BLL between the MICS-2018 survey and the state program follow-up. We observed a significant overall reduction in median BLL between MICS-2018 and state program follow-up in both August 2019 and the latest results (until December 2019). However, we did not observe any significant further reduction between August and the most recent BLL results. In the Georgian setting, written and verbal communication targeting individual households, alongside home visits to the most exposed, effectively reduced BLL in children.

New insights into the Upper Palaeolithic of the Caucasus through the study of personal ornaments. Teeth and bones pendants from Satsurblia and Dzudzuana caves (Imereti, Georgia)

The region of western Georgia (Imereti) in the Southern Caucasus has been a major geographic corridor for human migrations during the Middle and Upper Paleolithic. Data of recent research and excavations in this region display its importance as a possible route for the dispersal of anatomically modern humans (AMH) into northern Eurasia. Nevertheless, within the local research context, bone-working and personal ornaments have yet contributed but little to the Upper Palaeolithic (UP) regional sequence's characterization. Here we present an archaeozoological, technological and use-wear study of pendants from two local UP assemblages, originating in the Dzudzuana Cave and Satsurblia Cave. The ornaments were made mostly of perforated teeth, though some specimens were made on bone. Both the manufacturing marks made during preparation and use-wear traces indicate that they were personal ornaments, used as pendants or attached to garments. Detailed comparison between ornament assemblages from northern and southern Caucasus reveal that they are quite similar, supporting the observation of cultural bonds between the two regions, demonstrated previously through lithic techno-typological affinities. Furthermore, our study highlights the importance attributed to red deer (Cervus elaphus) by the UP societies of the Caucasus in sharing aesthetic values and/or a symbolic sphere.

[STUDY OF THE CYTOTOXIC ACTIVITY OF INDOLE ALKALOIDS FROM THE ABOVEGROUND ORGANS OF VINCA ROSEA L. INTRODUCED IN WESTERN GEORGIA]

The objects of this research were the aboveground and underground parts of Vinca rosea L., a species of periwinkle introduced in Western Georgia. The sum of alkaloids and biologically aactive fractions of monomeric alkaloids were obtained by liquid-liquid extraction, precipitation with petroleum ether (I), polybuffer distribution (II) and 10% acetic acid (III). 14 known compounds were identified by LC-MS/MS and GC/MS: Low molecular weight compounds (М+226, М+202, №1,2, М+168) and alkaloids Ajmalicine, Tetragidroalstonine, C20-dihydrova llesiahotamine, C19-C20 Vallesiahotaminole, Vallesiahotamine lacton, Polyneuridine, Pericy clivine, Lochnerame, Norharmane, Vidorosine, Vindolinine, Isovindolinine, Akuammicine. The cytotoxicity of monomeric alkaloids was evaluated for A-549 (cells of the lung cancer line), DLD-1 (cells of the rectal adenocarcinoma line) and W-1 (cells of the normal human fibroblast line). All three substances (I, II, III) showed pronounced cytotoxic activity.

Measuring the Thinking Styles: Psychometric Properties of the Georgian Version of the Cognitive Distortion Scale

The current study presents the psychometric investigation of the Georgian version of the Cognitive Distortion Scale (G-CDS) (Covin et al., 2011). The Cognitive Distortion Scale measures the 10 cognitive distortions in interpersonal and achievement domains. Altogether 941 individuals, across seven samples (37 clinical participants amongst them) participated in the standardization of the instrument. Confirmatory factory analysis demonstrated good model fit with a 10-factor solution. The G-CDS exhibited acceptable internal reliability and correlated in expected directions with other clinically relevant inventories. Although women scored higher than men on one factor (Should Statements) there were no other gender differences. There were significant differences in all cognitive distortions scores between clinical and control group. Given its respectable psychometric properties, the G-CDS appears to have a high degree of both clinical and research potential.

EVALUATION OF THYROID DISEASE DETECTION AMONG FEMALE POPULATION WITH BREAST PATHOLOGIES IN KVEMO KARTLI REGION (GEORGIA)

to investigate the prevalence of thyroid diseases in women, 35-65 of ages diagnosed with breast pathology in the Kvemo Kartli region and to assess the epidemiological situation; The objectives of the study: to promote the early detection and prevention of thyroid cancer in the Kvemo Kartli region; to reduce the morbidity and mortality rates of breast and thyroid diseases; to evaluate the access and/or barriers to healthcare services to optimize women's health and health care needs. Cross-sectional (prevalence) research was held in several medical institutions in Rustavi with a high number of patients. Consequently, only 103 (53%) of the respondents among the female population with breast pathologies (n=194) in Kvemo Kartli underwent thyroid examination. 169 (87%) of respondents were not informed that early detection of thyroid diseases at breast pathologies is of great importance. Breast cancer was reported in 49 (25%) of respondents, 40 (83%) of respondents belonged to the age category of 50-65 years. Only 18 (37%) of respondents with breast cancer underwent thyroid examination. Respondents utilizing the insurance packages are twice as likely to pass thyroid examination. Most patients were referred for thyroid screening by mammologists (54%) endocrinologists (32%) and family doctors (14%).The women with breast diseases in Kvemo Kartli should be exposed to timely diagnosis and treatment of thyroid diseases by screening; ensuring early detection and prevention of breast and thyroid cancers by eliminating barriers to accessing medical services and early detection of breast and thyroid diseases.

[THE LEGAL STATUS OF A PSYCHIATRIC EXPERT DURING A FORENSIC PSYCHIATRIC EXPERTISE]

The purpose of the article is to determine the feasibility and necessity of the mandatory participation of a psychiatrist in the conduct of a forensic psychiatric examination under the legislation of Ukraine and Georgia. The task is to outline the ways of improving the norms of the criminal law of both countries in the legal and medical spheres based on the analysis of the norms of the Criminal Procedure Code of Ukraine and the Criminal Procedure Code of Georgia. It has been established that the constitutional provision of the right to human health (in particular the researched one) in Ukraine and Georgia is contained not only in the codes and medical legislation of both states, but also in a number of international legal acts that have been ratified by their parliaments. The analysis of the relevant norms carried out in the article revealed the imperfection of concepts and terms, methods and methods of implementing the norms that should reflect the specified right. The authors of the article found that the main problem of realizing the human right to full legal and medical protection in the conduct of forensic psychiatric examination, as well as in the exercise of the rights and duties of an expert psychiatrist, is the lack of a clear procedure for the participation of a doctor in the conduct of judicial and investigative actions. Scientific research has established that the Criminal Procedure Code of Ukraine, the Criminal Procedure Code of Georgia and methodological recommendations regarding the participation of a psychiatrist in carrying out procedural measures to collect evidence in the commission of a crime have common features, wording and requirements. The authors of the article revealed that the requirements of international legal norms and a certain specificity of the situation for conducting a forensic psychiatric examination dictate the need to amend the criminal procedural legislation of Ukraine and Georgia. Changes in the legislation of these countries should be aimed at a clearer formulation of the basic concepts and terms of the doctor's participation in the conduct of judicial and investigative actions. These new norms of the law will act as a guarantee for the realization of the right to health, meet the basic international principles and requirements in the field of health care and law.

[STUDY OF LIPIDS AND ACCOMPANYING BIOLOGICALLY ACTIVE COMPOUNDS OF SOME PLANTS GROWING GEORGIA]

The aim of the study was to determine the content of lipids and some biologically active substances in the seeds of hypericum perforatum L. , Zea mays L. and overground plants of Equisetum orvense L. ; from the investigated objects there was obtained the sums of neutral and polar lipids with the expedient percent (%) outcome. There is established common classes in them, there is analysed some physical - chemical constants, there was used GC mas-spectroscopic analytical methods. In the sums of neutral lipids qualitafively and quantitatively were identified saturated, unsaturated and polyunsaturated fetty acids with high per cent content. In the suns of polar lipids quantitatively and quantitativel are confirmed phospholipids.On the basis of investigatios in the definited objicts the were established consist of some biologically active compounds- carotenoids and aminoacids.

Phage Therapy Experience at the Eliava Phage Therapy Center: Three Cases of Bacterial Persistence

In this retrospective descriptive study we focus on cases of three patients who underwent phage therapy procedures at Eliava Phage Therapy Center (EPTC) in Tbilisi, Georgia. Patients with chronic infectious diseases related to Pseudomonas aeruginosa (two patients, lower respiratory tract infection (LRTI)) and Klebsiella pneumoniae (one patient, urinary tract infection (UTI)) are among those very few EPTC patients whose pathogens persisted through phage therapy. By looking at bacterial strains and personalized phages used against them we tried to point towards possible adaptation strategies that are employed by these pathogens. Genome restriction-based Pulsed Field Gel Electrophoresis (PFGE) profiling of strains isolated before and after phage therapy hints towards two strategies of adaptation. In one patient case (Pseudomonas aeruginosa related lung infection) bacterial strains before and after phage therapy were indistinguishable according to their PFGE profiles, but differed in their phage susceptibility properties. On the other hand, in two other patient cases (Pseudomonas aeruginosa related LRTI and Klebsiella pneumoniae related UTI) bacterial adaptation strategy seemed to have resulted in diversification of infecting strains of the same species. With this work we want to attract more attention to phage resistance in general as well as to its role in phage therapy.

Molecular profiling and characteristics of non-small-cell lung cancer patients in Georgia

Aims: In patients with advanced non-small-cell lung cancer, the correlation between histopathology, smoking status, driver oncogene mutations and PD-L1 overexpression were investigated. Patients and methods: A total of 202 patients were identified. Research was done in Georgia. Results: EGFR mutations were detected in 6% of the tested cases (12/187) and five out of 12 EGFR+ cases had histology consistent with squamous cell carcinoma. No statistically significant correlation was observed between PD-L1 expression, smoking status and clinicopathological characteristics. However, the correlation between smoking status and histology was statistically significant (p = 0.0264), as never-smokers had a higher incidence of adenocarcinoma histology. Conclusion: The study showed a small percentage of EGFR mutations associated with adenocarcinoma histology and revealed a solid existence of this mutation in squamous cell carcinoma histology. A higher incidence of adenocarcinoma histology was observed in never-smokers.

[LEGAL, MORAL AND PHILOSOPHICAL PROBLEMS OF EUTHANASIA]

The purpose of this study is to discuss and present authors' vision of problems of euthanasia legal regulation in legislation with due consideration of human rights and liberties. The study was performed considering a set of disciplines: medicine, jurisprudence, religion, philosophy. A number of international documents were generalized, practice of European Court of Human Rights, Criminal Codes of Ukraine, Georgia and a number of other countries, relating to the question under study, views of scholars on moral and legal aspects, juridical and philosophical comprehension of this agenda. The following scientific methods were applied: systemic legal method, comparative legal method, philosophical legal method, logical method, as well as analysis and synthesis method. The authors developed proposals in solution of problems connected with this subject matter. Legalization of euthanasia is found to be possible by allowing its application to be reflected in Article 52, Law of Ukraine "Fundamentals of Ukrainian Legislation on Public Health". We determined that execution of euthanasia belongs to rights of physician, not his/her duties. In this we noted that this novelty will rule out any possibility of subsequent introduction of a special norm to Ukrainian Criminal Code stipulating criminal responsibility of physician for execution of euthanasia and, as a subsequence, will preclude any pre-trial and trial judicature (Articles 214, 215, Code of Criminal Procedure of Ukraine).

PHYSICAL AND FUNCTIONAL CHANGES IN MIDDLE AND LONG DISTANCE RUNNERS UNDER VARIOUS CONDITIONS

The changes in the physical properties and functional shifts of middle and long distance runners in Tbilisi and Bakuriani conditions during the identical physical exercises are given in this paper. For comparison the analogous data of judokas are presented. The difference between the background indices (Tbilisi) and in the conditions of Bakuriani has been established during training and the state of rest. Based on the relief peculiarities of Georgia, the action of trainings conducted at different heights (Tbilisi - 550 m and Bakuriani - 1750 m from sea level) on heart rate and respiratory rate, lung vital capacity at the state of rest, the hand and lumbar muscles strength, general and special endurance of the high qualification sportsmen (among them 32 athletes and 40 judokas) have been studied. The above-said data were recorded in accordance with the training processes (preparatory, basic and transition) at the state of rest and in the intervals between physical exercises (warming up, control and official competitions) and in the first minutes of recovery period after completing the exercises. Also, the duration of adaptation period was established at the state of rest and physical training of sportsmen, and there were almost no data in the literature about this till conducting Olympic Games in Mexico City (1968). The observations were conducted on athletes and judokas in Tbilisi (550 m from sea level) and Bakuriani (1750 m). The training sessions lasted 20-22 days. Thus, the features of physical and functional shifts in athletes are revealed, depending on various types of sports employment, training periods, rest and climatic conditions that must be taken into account when conducting sports training.

BAYESIAN MODELLING AND INFERENCE OF MIXTURES OF DISTRIBUTIONS OF MICRONUCLEAR BUCCAL CELLS IN THE POPULATION OF SACHKHERE DISTRICT'S VILLAGES

Malignant tumors are one of the leading courses of mortality in the world, and it is believed that 19% of malignant tumors are associated with environmental risk factors. The aim of the study was to establish the spectrum of distributions of an informative biomarker of the unfavorable (genotoxic) effect of the external environment on the body by determining the level of micronuclei (LMN) in buccal epithelium cells in populations of villages of the Sachkhera region (Georgia). In the inhabitants of the Sachkhere district (both sexes, 50-65 years old) living in the villages of Sareki, Sairkhe, and Chorvila, LMN was determined in the cells of the buccal epithelium. The statistical significance of the difference in LML between the village population was assessed using the analysis of variance (ANOVA). Dixon's Q test was used to identify abnormal micronuclei. The χ2 criterion was used to assess the normality of LMN distributions among residents of the villages. The distribution of the population by LMN indicators in each individual village was described as the distribution of a two-component mixture. The statistical significance of the difference between the Gaussian means of the mixture components was assessed using the Z-test. To analyze the data and visualize the results, the SPSS and Open BUGS software packages were used. Differences in the LMN of the buccal epithelium in the studied populations were revealed, which may be due to the influence of external environmental factors: in Sareki, the effect of a certain (unidentified) clearly expressed genotoxic factor (both in terms of intensity and scale of exposure) was revealed, which is accompanied by a sharp increase in LMN, while in Chorvila and Sairkhe the presence of an inducing factor is not recorded and LMN remained practically within the norms. The identification of the causal relationship between the nature of the distributions of the used biomarkers and the specificity of the incidence of the population in the villages, as well as the possible contribution of unfavorable environmental factors, is the subject of further research.

How do participatory methods shape policy? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia

OBJECTIVES

This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt.

METHODS

Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders' assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these.

SETTING

The study was conducted in Tbilisi, Georgia.

PARTICIPANTS

A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops.

RESULTS

Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement.

CONCLUSIONS

Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders' knowledge and expertise on TB service delivery and RBF to codesign a new policy.