Search

INTRODUCTION: Injury is a major health problem worldwide and a leading cause of death and disability. Disability caused by traumatic injury is often severe and long-lasting. Injuries place a large burden on societies and individuals in the community, both in cost and lost quality of life. Progress in developing effective injury prevention programs in developing countries is hindered by the lack of basic epidemiological injury data regarding the prevalence of traumatic injuries. The aim of this research was to describe the epidemiological characteristics of injury in all hospitals in Georgia. METHODS: The database of the National Center for Disease Control and Public Health of Georgia for 2018, which includes all hospital admissions, was used to identify injury cases treated in hospitals. Cases were included based on the S and T diagnosis coded of ICD-10. RESULTS: A total of 25103 adult patients were admitted for an injury, of whom 14798 (59%) were males and 10305 (41%) were females, between the ages of 18 and 108 years old. The highest prevalence was among the age group 25–44 years old (n=8654; 34%), followed by 45–64 years old (n=6852; 27%). The main mechanism of injury was falls (n=13932; 55%) and exposure to mechanical forces (n=2701; 11%). Over 1,50% (n=379) of injuries resulted in death after hospitalization. The median hospital length of stay (LOS) was 2 days. There was a significant association between age, mechanism of injury, type of injury, performed surgical interventions, and longer LOS. CONCLUSION: Injuries are prevalent throughout the life course and cause substantial hospitalization time. This research can help focus prevention efforts can focus on the demographic and injury causes that are most prevalent.

Background To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. Methods Total, sex- and age-specific weekly all-cause mortality for 2015–2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015–2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. Results Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the Conclusions This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.

BackgroundLow-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries.MethodsA prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country.ResultsAmong 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9–11) or severe injury (GCS 0–8) (pConclusionsImplementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

Eka Burkadze,1 Ketevan Axobadze,1 Nino Chkhaberidze,1 Nino Chikhladze,1 Madalina Adina Coman,2 Diana Dulf,2 Corinne Peek-Asa3 1Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia; 2Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania; 3Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USACorrespondence: Eka BurkadzeDepartment of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, 1 Chavchavadze Ave, Tbilisi, 0179, GeorgiaTel +995 591 11 80 90Email eka.burkadze@tsu.gePurpose: Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality worldwide, disproportionally affecting low- and middle-income countries (LMICs). Epidemiological characteristics of TBI at a national level are absent for most LMICs including Georgia. This study aimed to establish the registries and assess causes and outcomes in TBI patients presenting to two major trauma hospitals in the capital city –Tbilisi.Patients and Methods: The prospective observational study was conducted at Acad. O. Gudushauri National Medical Center and M. Iashvili Children’s Central Hospital from March, 1 through August, 31, 2019. Patients of all age groups admitted to one of the study hospitals with a TBI diagnosis were eligible for participation. Collected data were uploaded using the electronic data collection tool –REDCap, analyzed through SPSS software and evaluated to provide detailed information on TBI-related variables and outcomes using descriptive statistics.Results: Overall, 542 hospitalized patients were enrolled during the study period, about 63% were male and the average age was 17.7. The main causes of TBI were falls (58%) and struck by or against an object (22%). The 97% suffered from mild TBI (GCS 13– 15). Over 23% of patients arrived at the hospital more than 1 hour after injury and 25% after more than 4-hours post-injury. Moderate and severe TBI were associated with an increased hospital length of stay. Mortality rate of severe TBI was 54%.Conclusion: This study provides important information on the major epidemiological characteristics of TBI in Georgia, which should be considered for setting priorities for injury management.Keywords: traumatic brain injury, injury epidemiology, registry, Georgia

Background The World Health Organization predicts a striking rise in the burden of traumatic brain injury (TBI) burden in the next decades. A disproportionately large increase is predicted in low- and middle-income countries, which have brain injury rates 3 times higher than high-income countries. The aim of this study was to identify current TBI practices and treatment capacity in 3 low- and middle-income countries: Republic of Armenia, Georgia, and Republic of Moldova. Methods After a national inventory of hospitals treating TBI, a situational analysis was conducted in the highest volume adult and pediatric hospital in each country. The situational analysis included key informant interviews with content analysis and a quantitative checklist of treatment resources. Results All 3 countries follow international, national, and hospital protocols for TBI treatment, and the in-hospital management of patients with TBI is similar to international standards in all 3 countries. Although health care specialists were well trained, however, lack of proper equipment, a scant number of hospitals outside the capital region, lack of specialized personnel in regional areas, and lack of rehabilitation services were mentioned as difficulties in interviews from all 3 countries. Conclusions Particular gaps were found in pre-hospital and rehabilitative care, as well as national leadership and data collection. Surveillance and standardized data collection are important measures to fill treatment gaps and reduce the burden of TBI.

Georgia is an upper middle-income country, which has lower cancer survival rates than most of the countries in the World Health Organization European region, as well as compared to many other post-Soviet states and upper middle-income countries. The purpose of our study was to analyse the cancer stage distribution data of Georgia as a first step towards identifying the areas of early cancer detection in the country that might need improvement or require further research.Descriptive analysis of the population-based cancer registry of Georgia was performed using the data for the period of 01.01.2018-31.12.2019.Around 57 % of cancers in males and 56 % of cancers in females were amenable to early detection. At least 35.7 % of these cancers in males and 44.2 % in females were detected early. 15.2 % (n = 964) of male and 35.3 % (n = 3179) of female cancer patients met the age criteria for the respective cancer screening programmes. Breast, colorectal, cervical and stomach cancers contributed to 58.7 % of all late-stage cancers in females. Lung, prostate, colorectal, laryngeal and stomach cancers made up 72.4 % of all late-stage cancer cases among males. At least 83.8 % (n = 1438) of thyroid cancers in females and 84.2 % (n = 246) of thyroid cancers in males were diagnosed at stage I. Moreover, stage I thyroid cancer cases made up 50.7 % of all stage I cancer cases detected in women and 25.6 % of all stage I cancers in men. At least 42.4 % of stage I thyroid cancers in females and 37.4 % of stage I thyroid cancers in males were papillary microcarcinomas.The potential of early cancer detection is underutilised in Georgia and there is a need to strengthen screening and especially early diagnosis in the country. The possibility of thyroid cancer overdiagnosis requires further investigation.

Burn related injuries represent a significant global health problem. These injuries can be cause of high mortality and morbidity throughout the world, as well as different kinds of disabilities. More than 180,000 people die from burn injuries every year. Injuries related to burns can seriously affect patients’ quality of life. These injuries can also lead to serious psychological disorders. Despite the fact that injuries associated with burns are more common in developing countries, especially among the population with low socioeconomic status, burn injuries are widespread in the developed and high-income countries as well. The types and causes of burn injuries are correlated with age, gender, established safety standards, education levels as well as traditional customs. The habits and typical traditions established among different populations, reflect on the causation and types of burns which are widespread in that country or region. The studies conducted in different countries indicate that children are mostly exposed to the risk of getting burn injuries throughout the world. Unintentional burn injuries are one of the leading causes for childhood deaths. Due to these injuries, more than 100,000 children are hospitalized every year in the world. Hot liquid scalds are most frequent causes of pediatric burn injuries. Burn injuries can be preventable, therefore more epidemiological researches need to be conducted about this issue in order to plan preventive measures.

The article discusses the fall as a significant public health problem. According to the World Health Organization, approximately 37.3 million cases of medically related falls occur each year. Human age is one of the major risk factors. Along with the "aging" trend of the society, the number of elderly people is increasing. Consequently, the number of falls and traumatic injuries caused by it increases for this quota.In developed countries, special attention is paid to studying the epidemiological characteristics of the fall in the population aged 65 and older. Such attention is that it is possible to plan and implement various preventive measures specifically for the target group and develop relevant recommendations to improve quality of life.The fall is one of the most common geriatric syndromes that threatens the independent lifestyle of older people and is related not only to medical but also social and economic aspects. However, epidemiological data of the fall are not properly studied in developing countries, including Georgia.Therefore, to reduce the traumatic injuries caused by falls in Georgia, it is essential to conduct appropriate epidemiological studies, identify the most critical risk factors, raise public awareness, and develop and implement appropriate preventive measures.

Statement of purpose Traumatic injuries account for significant global burden of disease, causing 9% of all deaths worldwide and substantial short- and long-term disability. Injury rates are disproportionately high in low- and middle -income countries (LMICs). However, despite the fact that more than 90% of injury related deaths occur in LMICs, most of the research comes from high- income countries. In spite of the overall impact and importance of the topic, emerging economies such as Georgia experience high injury rates yet have little research addressing incidence, characteristics, risk factors, and prevention strategies. Methods/Approach The aim of this research was to describe the epidemiological characteristics of injury in two tertiary teaching hospitals in Georgia. The data was extracted from the official database of the National Center for Disease Control and Public Health for 2018. Results A total of 1494 adults patients were admitted of whom 912 (61%) were males and 582 (39%) were - females. The highest prevalence was among the age group 25–44 years old (36%), followed by 45–64 years old (26%). The main mechanism of injuries were falls (61%) and road traffic incidents (22%). Over 17% of injuries resulted in death after hospitalization. These findings provide empirical bases for future studies. More research is needed to identify injury related factors useful for planning effective prevention strategies. Conclusion The study was conducted with the goal of providing the baseline data to policy makers and other stakeholders to help guide future research, policy and funding agendas.

Background:Over 90% of morbidity and mortality associated with traumatic brain injury (TBI) occurs in low-and middle-income countries. Lack of reliable, high-quality data regarding TBI prevention and care hinders the ability to reduce TBI burden. We sought to identify current TBI data collection practices and capacity in Georgia, focusing on pre-hospital, hospital, and rehabilitation treatment. Methods:The eight level I and two level II Trauma Hospitals in Georgia with the highest number of TBI admissions in 2017 were selected for study. A semi-structured survey about various aspects of TBI care was designed and semi-structured interviews of healthcare providers treating TBI patients (e.g. neurologists, neurosurgeons) were conducted based on this survey. Results:Pre-hospital triage protocols were not routinely used to match patient treatment needs with hospital capacity. All hospitals provided specialist care for TBI 24 hours/day. MRI was available at only three (30%) centers, and in-hospital rehabilitation units were available in only one (10%). No center used a defined protocol for treating TBI patients and no national protocol exists. Conclusion:Even among the largest, most highly specialized hospitals in Georgia, TBI care varies in terms of diagnostic and treatment protocols. While TBI specialists are available, diagnostic equipment often is not. Gaps in pre-hospital coordination and access to rehabilitation services exist and provide areas of focus for future investment in reducing TBI burden

Introduction Injury rates are highest among LMICs. Many of the leading injury causes are increasing disproportionately in LMICs compared with high income countries. Although medical and public health education in each of these countries has been growing over the last several years, injury and violence prevention has not yet been recognized as a priority. The iCREATE project aims to create a critical mass of injury researchers from multiple disciplines and to engage agencies and stakeholders in conducting high impact research that reduces the burden of injuries and violence in the LMICs of Armenia, Georgia, and Rep. of Moldova. Progress Based on priority needs in our partner countries and the expertise of the training team, the project focuses on: road traffic injury prevention, prevention of violence against women and children and acute care. Although it is the first project of capacity building in injury research implemented in these countries, the partnership builds on and translates existing successful infrastructure. The lead of the project (University of Iowa) has conducted similar projects in other countries from Eastern Europe and one of the training sites (Babes-Bolyai University) is currently a partner in the project. Activities include skill-building workshops; summer classes; long-term degree-based and professional development training; focused exploratory research projects; and collaborative data infrastructure projects. The focus is on long-term MPH and PhD training in order to build research and leadership skills focused on injury prevention in the partner institutions. Some results of the first three project years are implementation of Injury prevention Curricula in three medical universities from the partner countries, and a Center of Injury and Violence Prevention established in Armenia. Furthermore, 33 trainees were trained, 8 hospitals implemented injury registries and 12446 registry records were collected so far across 3 countries.

Background Motivation and effective supervision are key factors in postgraduate Public Health Education. On the one hand motivation represents a power that derives and then steers students’ activities in order to achieve their objectives; on the other hand, supervision practices can significantly influence the behavior of students, from encouraging students to endeavor future goals to letting them lose the motivation to continue the study. The aim of this research is to study motivation of PhD students and to explore the supervision practices at the Department of Public Health. Methods A Special questionnaire has been developed and quantitative method has been used for this study. The questionnaires were distributed to all PhD students at TSU Faculty of Medicine. Results A total of 79 completed questionnaires have been used for analyses (response rate 52,6%). The study found that around 90% of the PhD students are generally satisfied with existing supervisory experiences. 87% of respondents mentioned that they have regular meetings with their supervisors and the importance of these meetings are evaluated as important or very important. The study also found that PhD students are more influenced by intrinsic motives and students place priority emphasis on the interest in scientific research and continuing learning experience. At the same time the greatest incentive for deciding to become a PhD student is the possibility of acquiring experience within international partnerships, among them short- or long-term mobility in the Framework of DIKU funded project ,,Georgian-Norwegian Collaborative in Public Health’’ and NIH funded project, ICREATE - Increasing Capacity in Research in Eastern Europe’’. Conclusions The study has provided the insights into supervision practices and PhD students’ motivation. Survey has raised some emerging issues, which are inclined to be improved in order to strengthen the postgraduate Public Health Education. Key messages The research emphasizes the importance of evaluating the motivation and supervision practices in postgraduate public health education for strengthen the public health graduates and workforce. The research highlights the impacts of international collaborative partnerships in transitional countries.

Insomnia is a common sleep disorder which has a 5–6% prevalence rate and shows high social impact. At least 10% of patients with insomnia will see a medical specialist. Hence, 20,000–40,000 people in Georgia require medical help for insomnia. Treatment of insomnia is very effective. Pharmacotherapy is common, but it is recognized that cognitive behavioral therapy (CBT) is a better choice, since it is safe for patients and shows sustainable improvement. CBT of insomnia is not currently available in Georgia. The aim of our study was to evaluate a Georgian version of an innovative, internet-delivered digital CBT (dCBT) for insomnia in terms of therapeutic efficacy, adherence, and ease of handling. The Georgian digital cognitive behavioral therapy for insomnia was developed as an analogue of Dutch dCBT “i-Sleep.” All online materials were made applicable for the Georgian population through translation, validation by translation back to the original language, and adaptation to the Georgian reality, in order to avoid linguistic, cultural, and social pitfalls. Fifty-two adult patients with insomnia were recruited for the study: 34 women and 18 men, aged 18–64 years (mean: 33.5 years). Inclusion criteria included: age over 18, access to internet, and sufficient skills to use electronic devices. The patients who were treated pharmacologically continued their usual medication and received dCBT in addition to this treatment. DCBT was guided by a therapist. Clinical efficacy was evaluated on the basis of Insomnia Severity Index (ISI), measured before the dCBT and one month after its completion. 25 out of 52 patients (48%) completed a full dCBT course. Mean ISI in this group dropped from 22.88 to 8.24 (P, Highlights • Georgian dCBT for insomnia showed significant therapeutic effect within one month after the CBT. • Drop our rate was 52%, being comparable with other dCBT versions. • Insomnia severity at the baseline did not affect patient adherence to the dCBT. • Patients above 50 years, regardless of adherence, would prefer face-to face sessions to dCBT.

Context Chronic pain management with opioids in incurable patients remains a challenge of modern medicine regardless of the evidence-based effectiveness of opioids and recommendations of authorities such as the World Health Organization and International Narcotics Control Board. Many countries, including Georgia, maintain overly restrictive regulations that contribute to inadequate pain management. Objective To identify barriers to pain management in Georgia caused by legislation, administrative issues, and physicians' lack of knowledge and understanding of legislative aspects governing opioid use, and their impact on opioid-prescribing practice. Methods We conducted a survey among 550 primary health care physicians. In total, 302 physicians completed the questionnaire. Overall, 289 questionnaires were analyzed statistically with SPSS version 20 (Armonk, NY: IBM Corp.). Results We found that 38% of the physicians avoid prescribing opioids and only one-third of the physicians make an independent decision to treat the patients with opioids. About one-third of the physicians know the updated liberalized legislation and even fewer follow it. Those who apply more liberal legislation and have better medical practice are investigated three to five times more by legal authorities for prescribing morphine to incurable patients than those who do not. Conclusion Ambiguous legislation negatively influences opioid-prescribing practice. Most of the physicians believe that the legislation is restrictive. Physicians who have better medical and legal knowledge and understanding are controlled and investigated more because of their opioid-prescribing practice. Physicians who are concerned that they might be investigated are less inclined to prescribe opioids or use liberalized regulations.

The study of new aspects of sixteenthand seventeenth-century Georgian-Iranian cultural interrelations is closely linked with the history of both countries. During the reign of the Safavid dynasty, the interest of Persia grew towards the rich, beautiful and strategically important country of Georgia, where Persia's policy of conquest reached its highest point in the seventeenth century, the period of the rule of Shah Abbas the Great (1587-1629). From this century onwards, Georgia, mostly its eastern part, under the political influence of Persia, became much more closely linked with Iranian culture, which influenced not only Georgian secular literature, architecture and book illumination,' but the Georgian way of life as well.2 On the other hand, nearly the same process is traceable in Persia: Georgian themes were introduced into Persian culture apparently at the same time, a clear example of which can be seen in the poetry of the Shirazian poet Abdi Beg Shirazi (1515-1585), where, inter alia, one may find reference to Georgian personages as well. The poet refers to a painting, no longer surviving today, from the Ja'far Abad palace of Shah Tahmasp in Qazvin, one scene of which evidently represented a battle against Georgians, which has been identified with the episode of the destruction of the Vardzia fortress and church at the time of Shah Tahmasp's third invasion of Georgia (1552).3 The Russian scholar Yuri Marr remarks that Georgians were depicted on the frescoes from the palaces of Hasht Behesht and Chehel Sotun in Isfahan as well. Particularly worthy of comment is the fragment from an 'Ali Qapu palace painting, portraying a man whose open book in

Globalize World demands to realize Higher Education for making most competitive and dynamic knowledge-based economy, capable of sustainable economic growth with more and better jobs and greater social cohesion. Higher Education is an important factor in further enhancing research in underpinning Higher Education for the economic and cultural development of our societies and for social cohesion. The effort to introduce structural change and improve the quality of teaching should not detract from the effort to strengthen research and innovation. Ministers meeting in Berlin in September 2003 added an Action Line to the Bologna process entitled "European Higher Education Area and European Research Area "“ two pillars of the knowledge based society" that underlines the key role of research training in this context. Bergen Communique (2005) has chosen 3 priorities including quality assurance (internal/external quality assurance) and appealed to,, Strengthen research, innovation, emphasize the importance of research and research-training''. In London Communique (2007) is marked that,, Higher Education Institutions should continue to develop their internal system of quality assurance''. The task of Higher Medical Education everywhere is the provision of Health Care. Notwithstanding variations, there is a high degree of equivalence of structure, process, and product of medical school worldwide. Research is an integral part of Higher Medical Education: increasing the role and relevance of research to technological, social and cultural evolution and to the needs of Society.