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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. [ABSTRACT FROM AUTHOR]

INTRODUCTION Since March 2022, Armenia introduced a comprehensive smoking ban on all types of tobacco products in indoor and outdoor areas of hospitality venues. We aimed to rapidly appraise the implementation of the ban in the dining areas of the capital Yerevan and explore any differences in compliance and enforcement patterns between indoor and outdoor areas of the venues. METHODS We used a mixed-methods approach through quantitative air quality monitoring, qualitative observations, and in-depth interviews (IDIs). We visited one venue in each remote district of the city and more venues from the central districts that have a much higher density of dining areas. Overall, we made 24 measurements of PM2.5 particles, 24 unobtrusive observations in the 19 visited venues, and 11 IDIs with six visitors and five workers. We used Stata13 for the analysis of numerical data and completed direct deductive content analysis of the textual data. RESULTS Active tobacco use was observed in 12 out of 24 venues (50.0%) with more cases of smoking in outdoor areas (10 out of 12; 83.3%). No warning by workers or no reports to the police were observed. We detected elevated levels of PM2.5 particles in indoor and outdoor areas. The IDIs revealed predominantly negative attitudes towards the outdoor ban and the lack of awareness of and readiness to engage in the enforcement measures. The lack of enforcement by the owners and the respective bodies was mentioned as a contributor to continued violations of the ban. The change in the dynamic and the characteristics of the visitors, cleaner air, and less unpleasant work were mentioned as important positive aftermaths of the ban. CONCLUSIONS The Government of Armenia should enhance the monitoring and enforcement activities and organize tailored awareness-raising campaigns to inform the general public and the hospitality industry of the health and social implications of the ban. [ABSTRACT FROM AUTHOR]

Aim: To assess the perception of the nursing profession in Armenia from the perspective of multiple stakeholders, including nurses and the general public. Background: Nurses' role perception is a complex phenomenon defined by multiple stakeholders. Methods: The assessment used a convergent parallel mixed‐methods design, with a dominant qualitative status. We conducted the qualitative phase through focus group discussions and in‐depth interviews with 235 people and collected quantitative data in a cross‐sectional telephone survey with 389 participants. Results: The nursing profession has been influenced by medical hierarchy and subordination, and none of the participants recognized nursing as an autonomous health care profession. The quantitative survey findings were largely consistent with the qualitative results. Our findings highlighted empathy and compassion as inherent qualities of nurses in Armenia. Conclusion: To change opinions about the nursing profession and highlight nurses' meaningful contribution to the provision of health care services, it is important to develop a national definition of nursing and introduce higher educational opportunities for nurses in Armenia. Implications for nursing management: The paper highlights the importance of quality education for preparing highly competent nurse managers who can become role models in promoting nurses' roles in health care systems and improving the professional and public image of nursing. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia. Methods: We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software. Results: Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf. Conclusion: The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment. [ABSTRACT FROM AUTHOR]

Socioeconomically disadvantaged adolescents who are exposed to social norms related to violence against women are more likely to experience or be perpetrators of intimate partner violence. This study evaluated factors hypothesized to be associated with acceptance of wife beating among 240 male and female adolescents aged 10-16 years participating in a World Vision program in Armenia. Acceptance of wife beating was associated with relational victimization, perceived social support, and parent and community boundaries and expectations, but was not associated with overt victimization or aggression. These findings highlight several areas that may be important for violence prevention research. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance has become one of the major problems facing humanity. The need for new antimicrobials has been increased dramatically. Plants are considered as one of the most promising sources for new antimicrobials discovery. Despite relatively small area, Armenia has large diversity of flora with many endemic species. In Armenian folk medicine plant materials have been used to treat various microbial diseases since ancient times. The goal of our research was to evaluate antimicrobial efficiency of different parts of five wild plants species which are commonly used in Armenian traditional medicine. Methods: Plant crude extracts were obtained with maceration technique using five solvents separately: distilled water, methanol, chloroform, acetone, and hexane. Agar well diffusion assay was used for initial evaluation of antimicrobial properties of plant materials against five bacterial and two yeast strains. Minimum inhibitory concentrations of the most active plant parts were determined by broth microdilution method. Results: Crude extracts of all five tested plants expressed antimicrobial activity against at least four test strains at 500 µg ml-1 concentration. Minimum inhibitory and bactericidal/fungicidal concentrations of selected plant parts were determined. Crude acetone and hexane extracts of Hypericum alpestre and acetone extract of Sanguisorba officinalis inhibited the growth of P. aeruginosa even at 64 µg ml-1 concentration. Chloroform and acetone extracts of Sanguisorba officinalis exhibited cidal activity against P. aeruginosa till 256 µg ml-1. Acetone was the most effective solvent for solubilizing antimicrobial compounds for almost all tested plant materials. Conclusions: Thus, antimicrobial activity of some medicinal plants used in Armenian traditional medicine was evaluated. Some of the plants had rather low minimum bacteriostatic/bactericidal concentrations and therefore they have prospective for further more inclusive studies. [ABSTRACT FROM AUTHOR]

In the past, several enteric outbreaks in 1996, 1998, 1999, and 2003 caused by Salmonella typhi, a Gram-negative bacterium, have occurred in Armenia. This study describes the demographic, epidemiological, and clinical characteristics of febrile hospitalized patients with intestinal infections in Armenia. Using a chart review study design, medical data from adult patients who were hospitalized at the Nork hospital during 2010-2012 were reviewed. A total of 600 medical charts were reviewed. Of these, 51 % were diagnosed with intestinal infections. Among these patients, 59 % had an intestinal infection of known etiology, with three main pathogens identified: Salmonella sp. (32 %), Shigella sp. (32 %), and Staphylococcus aureus (18 %). After controlling for the calendar year, age in years, and gender, patients detected with Salmonella sp. were more likely to reported the presence of a family member with similar signs or symptoms [odds ratio (OR) 9.0; 95 % CI 2.4-33.7] and the lack of a water tap at home (OR 3.9; 95 % CI 1.7-9.5). Evidence indicates that Salmonella sp., Shigella sp., and S. aureus as the most common etiologies reported among febrile hospitalized patients. A high percentage of patients had intestinal infections of unknown etiology; thus, improvement in laboratory capacity (enabling more advanced tests, such as polymerase chain reaction) would increase the identification of the enteropathogens causing disease in Armenia. [ABSTRACT FROM AUTHOR]

Objective: Age related hearing loss (ARHL) or presbyacusis is a complex condition caused by an interaction between environmental and genetic factors and is the most prevalent sensory impairment in the elderly. To date, only few environmental/lifestyle risk factors have been found. Research into risk factors underlying ARHL is increasingly urgent as populations grow older. Here, we investigate the relationship between ARHL and educational/occupational factors in a large cohort of people from isolated villages in Italy, Crimea region, Caucasus and Central Asia. Methods: Two thousand and sixty-eight people (aged 40-95 years) were recruited and analysed. Education was classified at five levels: no education, elementary, secondary, high school and university. Cases and controls were defined after a detailed evaluation of the hearing phenotype. Data were analysed using a mixed-effects logistic regression. Results: A statistically significant association between ARHL and education was detected. People with no education showed a higher association with the condition than people with a higher education ( p < 0.001). Explanations could be many, including individual jobs. A strong correlation (φ > 0.45) between occupation and level of education was also found. Conclusion: Present findings provide a better knowledge of environment/lifestyle factors related to ARHL and might help in defining new preventive strategies for aging people. [ABSTRACT FROM AUTHOR]

To assess the difference of pre- and post-training performance evaluation of continuing medical education (CME) courses in cardio-vascular diseases (CVD) management among physicians at primary health care facilities of Armenian regions we conducted an evaluation survey. 212 medical records were surveyed on assessment of performance before and after the training courses through a self-employed structured questionnaire. Analysis of survey revealed statistically significant differences ( p < 0.05) in a number of variables: threefold increased recording of lipids and body mass index ( p = 0.001); moderate increased recording of comorbidities and aspirin prescription ( p < 0.012); eightfold increased recording of dyslipidemia management plan, twofold increased recording for CVD management plan and fivefold increased recording for CVD absolute risk ( p = 0.000). Missing records of electrocardiography and urine/creatinine analyses decreased statistically significantly ( p < 0.05). Statistically significant decrease was observed in prescription of thiazides and angiotensin receptor blockers/angiotensin converting enzyme inhibitors ( p < 0.005), while prescription of statins and statins with diet for dyslipidemia management showed increased recording ( p < 0.05). Similarly, we observed increased records for counseling of rehabilitation physical activity ( p = 0.006). In this survey most differences in pre- and post-evaluation of performance assessment may be explained by improved and interactive training modes, more advanced methods of demonstration of modeling. Current findings may serve a basis for future planning of CME courses for physicians of remote areas facing challenges in upgrading their knowledge, as well as expand the experience of performance assessment along with evaluation of knowledge scores. [ABSTRACT FROM AUTHOR]

Background: Research suggests that since the collapse of the Soviet Union there has been a sharp growth in the use of complementary and alternative medicine (CAM) in some former Soviet countries. However, as yet, comparatively little is known about the use of CAM in the countries throughout this region. Against this background, the aim of the current study was to determine the prevalence of using alternative (folk) medicine practitioners in eight countries of the former Soviet Union (fSU) and to examine factors associated with their use. Methods: Data were obtained from the Living Conditions, Lifestyles and Health (LLH) survey undertaken in eight former Soviet countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine) in 2001. In this nationally representative cross-sectional survey, 18428 respondents were asked about how they treated 10 symptoms, with options including the use of alternative (folk) medicine practitioners. Multivariate logistic regression analysis was used to determine the factors associated with the treatment of differing symptoms by such practitioners in these countries. Results: The prevalence of using an alternative (folk) medicine practitioner for symptom treatment varied widely between countries, ranging from 3.5% in Armenia to 25.0% in Kyrgyzstan. For nearly every symptom, respondents living in rural locations were more likely to use an alternative (folk) medicine practitioner than urban residents. Greater wealth was also associated with using these practitioners, while distrust of doctors played a role in the treatment of some symptoms. Conclusions: The widespread use of alternative (folk) medicine practitioners in some fSU countries and the growth of this form of health care provision in the post-Soviet period in conditions of variable licensing and regulation, highlights the urgent need for more research on this phenomenon and its potential effects on population health in the countries in this region. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of this qualitative descriptive study was to explore the views of head and staff nurses about nursing practice in the hospitals of Armenia. Background. Armenia inherited its nursing frameworks from the Soviet Union. After the Soviet collapse, many changes took place to reform nursing. However, to date little has been systematically documented about nursing practice in Armenia. Design. Qualitative descriptive design was implemented. Methods. Three major hospitals in Yerevan, the capital city of Armenia, participated in the study. Purposeful sampling was used. Forty-three nurses participated, 29 staff and fourteen head nurses. Data were collected through five focus groups comprised of seven to ten participants. A focus group guide was developed. The researcher facilitated the discussions in Armenian, which were audio taped. The research assistant took notes. Data were transcribed and translated into English, imported into atlas.ti 6.1 qualitative software, and analysed by three authors. Results. Five themes were extracted. Lack of role clarity theme was identified from the head nurse data. The practice environment theme was identified from the staff nurse data. Nursing education, value, respect and appreciation of nursing, and becoming a nurse were common themes identified from both head and staff nurse data. Head nurses lack autonomy, do not have clear roles and are burdened with documentation. Staff nurses practice in challenging work environments with inadequate staffing and demanding workloads. All nurses reported the need to improve nursing education. Conclusions. This is the first study conducted in Armenia exploring nursing practice in the hospitals from the nurses' perspectives. Nurses face challenges that may impact their wellbeing and patient care. Relevance to clinical practice. Understanding challenges nursing practice faces in the hospitals in Armenia will help administrators and care providers to take actions to improve nursing practice and subsequently patient care. [ABSTRACT FROM AUTHOR]