FALL RELATED GERIATRIC TRAUMA TRENDS IN GEORGIA.

The main of the study was to examine the overall trends and epidemiologic characteristics of fall-related hospitalizations in the population aged 65 years and above in Georgia. For this observational study Hospital database was used. Data were collected from all hospitalized patients aged 65 years and above during 2015-2021 in the country. The number of geriatric patients hospitalized with fall-related injuries increased in 2021 compared with 2015. The upward trend in hospitalizations from 2015 to 2021 was reversed only during the Covid-19 pandemic in 2020. Fall-related hospitalizations are more frequent in women (p<0.001), the women-to-men ratio is 2:1. The highest hospitalization rate of 23% (n=6768) was in the 80-84 age group, followed by the 75-79 and 65-69 age groups at 22% (n=6517) and 21% (n=6146), respectively. The frequency of hospitalizations increases with age (p<0.001). In all other age groups except for the 65-69 age group (OR 0.99; 95% CI, 0.94-1.04, p=0.747) the number of fall-related hospitalizations was significantly higher in women than in men. During the study period about half of hospitalizations (51%) were caused by hip injuries. According to age groups, the longest average hospital stay was recorded in the 85+ and 80-84 age groups (5.6 ± 4.5 and 5.3 ± 5.1days, respectively). The number of male fatalities was higher than that of female fatalities (OR 2.57; 95% CI, 2.23 - 2.97). The highest in-hospital mortality was in the 85+ age group (5%). Falls presented the leading mechanism for hospitalization of elderly patients admitted with geriatric trauma. The key epidemiologic characteristics identified in the 7-year study of fall-related geriatric trauma trends provide an evidence-based framework for the development of more effective patient management strategies and appropriate preventive interventions among the population aged 65 years and above.

Implementation and evaluation of a syringe vending machine trial in Tbilisi, Georgia.

BACKGROUND: Syringe vending machines (SVM) have proven to be an effective vehicle for providing an uninterrupted supply of sterile equipment to PWID, but they have not been implemented or disseminated broadly. The aim of this study was to implement and evaluate outcomes of introducing SVM in Tbilisi, Georgia. METHODS: We installed SVM at five HIV prevention sites in 10 locations in Tbilisi, Georgia and studied implementation over 20 months. We used the RE-AIM framework to assess outcomes across four RE-AIM domains: reach, effectiveness at providing syringe access, adoption and implementation. RESULTS: Reach. SVM reached 8% of the target population. Effectiveness at Providing Syringe Access. SVM dispensed 14% of all syringes distributed by HIV prevention services. Using SVM was associated with PWID receiving more sterile syringes from HIV prevention outlets. Adoption. All HIV prevention sites (N=5) invited to implement SVM agreed to participate. Sixty one percent of PWID who received SVM access cards used SVM at least once. Women and young PWID were more likely to use SVM compared to other PWID. IMPLEMENTATION: At some sites adherence of the outreach staff to the operational protocol was suboptimal. CONCLUSIONS: SVM are an acceptable, feasible and effective intervention for improving access to sterile injection equipment for PWID. Future research will need to elaborate approaches to build the sense of ownership and improve motivation of the field staff to engage with the new intervention, and to examine strategies for attracting groups of PWID who are not in contact with prevention and treatment services.

Research Capacity Training on Environmental Health and Noncommunicable Diseases in the Country of Georgia: Challenges and Lessons Learned during the COVID-19 Pandemic.

COVID-19 presented challenges for global health research training programs. The Clean Air Research and Education (CARE) program, which aims to enhance research capacity related to noncommunicable diseases and environmental health in the country of Georgia, was launched in 2020-as the COVID-19 pandemic began. At its foundation is mentorship and mentored research, alongside formal didactic training, informal training/meetings, and other supports. Current analyses examined CARE's initial 1.5 years (e.g., program benefits, mentorship relationships) using data from an evaluation survey among trainees and faculty in January 2022. Trainees (100% response rate: n = 12/12; 4 MPH, 8 PhD) and faculty (86.7% response rate: n = 13/15; 7 Georgia-based, 6 United States-based) rated factors related to mentor-mentee relationships highly, particularly mutual consideration of each other's thoughts, opinions, and perspectives; one major challenge was completing goals planned. Trainees and faculty identified several growth experiences and program benefits (e.g., skills development, expanding professional network) but also identified challenges (e.g., meeting program demands, communication gaps, unclear expectations)-exacerbated by the pandemic. Findings underscore the importance of strong mentorship relationships and that the pandemic negatively impacted communication and clarity of expectations. Given the likely ongoing impact of the pandemic on such programs, program leaders must identify ways to address these challenges.

The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the Republic of Georgia.

OBJECTIVES: In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN: Retrospective analytic study. METHODS: We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS: In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.

The impact of the COVID-19 pandemic on illicit drug supply, drug-related behaviour of people who use drugs and provision of drug related services in Georgia: results of a mixed methods prospective cohort study.

BACKGROUND: This study examines the effects of COVID-19 related restrictions on the supply of illicit drugs, drug-use behaviour among people who use drugs (PWUD) regularly (at least weekly), and drug-related service provision in Tbilisi, Georgia. METHODOLOGY: In this mixed methods study, a cohort of 50 Georgian PWUD recruited through a snow-ball sampling participated in a bi-weekly online survey in April-September, 2020. They also took part in the qualitative telephone interviews at 12- and 24-week follow-up time points. In addition, four key informants (field experts) were interviewed monthly to assess their perceptions of changes in the illicit drug market and drug service delivery. RESULTS: Mean age in the sample was 36 (range 18-60); 39 (78%) were males. Perceived availability of drugs was reduced during the lockdown, and many PWUD switched to alternative substances when preferred drugs were not available. On average, participants used significantly fewer substances over the course of the study, from 3.5 substances in the preceding 14 days to 2.1 (aOR 0.92; 95% CI 0.90-0.94). Consumption of cannabis products declined significantly (aOR 0.89; 95% CI 0.84-0.95), likewise alcohol (aOR 0.94; 95% CI 0.88-1.0), diverted medicinal methadone (aOR 0.85; 95% CI 0.8-0.9) and diverted medicinal buprenorphine (aOR 0.91; 95% CI 0.84-0.99). PWUD cited fewer contacts with drug dealers, the lack of transportation, and the lack of conventional recreational environment as the main reasons for these changes. When access to sterile injection equipment was limited, PWUD exercised risk-containing injection behaviours, such as buying drugs in pre-filled syringes (aOR 0.88; 95% CI 0.80-0.96). Harm reduction and treatment programs managed to adopt flexible strategies to recover services that were affected during the initial stage of the pandemic. CONCLUSIONS: COVID-19-related restrictive measures mediated specific changes in supply models and drug-use behaviours. While adjusting to the new environment, many PWUD would engage in activities that put them under increased risk of overdose and blood-borne infections. Harm reduction and treatment services need to develop and implement protocols for ensuring uninterrupted service delivery during lockdowns, in anticipation of the similar epidemics or other emergency situations.

COVID-19 pandemic-related aspects and predictors of emotional and behavioural symptoms in youth with pre-existing mental health conditions: results from Georgia, Lithuania, Romania, Serbia, and Turkey.

OBJECTIVE: This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey. METHODS: The study included 421 children and adolescents aged 5 - 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020. RESULTS: According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties. CONCLUSIONS: This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms.

Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis.

BACKGROUND: SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19. OBJECTIVE: The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully. METHODS: Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19-related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight. CONCLUSIONS: The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia.

KNOWLEDGE, ATTITUDES AND PERCEPTION AMONG PATIENTS TOWARDS CROSS-INFECTION CONTROL MEASURES IN DENTAL CLINICS IN GEORGIA BEFORE THE COVID-19 PANDEMIC.

Problem of cross-infection and infection in dental practice has become a matter of public concern. Changing public expectations for cross-infection control could improve safety precautions of dental care. Goal of the study was to determine the level of Knowledge, Attitude and Perception (KAP) of Georgian patients attending dental clinics regarding cross-infections and infection control measures in dentistry. A cross-sectional study was conducted among 570 participants from all 10 regions of Georgia and Tbilisi (the capital city) during 2019. A standardized, confidential, self-administered, close-ended questionnaire was used to assess respondents' knowledge, attitudes, self-reported practices, perception and behaviors toward cross-infection control measures in dental clinics. 71.4% (n 407) of participants were females and 28.6% (n 163) were males. 72.6%, 63.2%, and 62.5% of respondents agreed that they can catch during dental treatment HCV, HBV and AIDS/HIV respectively, while 50.5% and 55.8% mentioned about TB and respiratory infectious (RI) diseases respectively. 80% of participants are concerned about the risk to be infected during the dental treatment. 62.5% of participants responded that they would not receive treatment in dental clinic where HIV and HBV/HCV patients are being treated. Overall, the study suggests that participants' knowledge, attitude and perception regarding cross-infection control in dentistry need some improvements. This study will assist in planning more effective interventions to enhance public awareness about infection control in dentistry in Georgia.

The influence of concern about COVID-19 on mental health in the Republic of Georgia: a cross-sectional study.

BACKGROUND: Early evidence indicates increased mental health burden arising from COVID-19 and related control measures. The study aim was to examine concern about COVID-19 and its association with symptoms of mental disorders in the Republic of Georgia. A cross-sectional internet-based survey of adults in Georgia using non-probabilistic sampling was used. Questionnaire topics were: (i) demographic and socio-economic characteristics; (ii) level of burden caused by common causes of COVID-19 related concerns; (iii) strategies used in response to concerns about COVID-19; and (iv) symptoms of mental disorders of anxiety (GAD-7), depression (PHQ-9), PTSD (ITQ) and adjustment disorder (ADNM8). Descriptive and multivariate analyses were conducted. RESULTS: There were 2088 respondents. High levels of symptoms for mental disorders were observed for anxiety (23.9% women, 21.0% men), depression (30.3% women, 25.27% men), PTSD (11.8% women, and 12.5% men), and adjustment disorder (40.7% women, 31.0% men). Factors significantly associated with increased COVID-19 concern included bad/very bad household economic situation, larger household size, current NCD, symptoms of anxiety, adjustment disorder and PTSD. Response strategies significantly associated with reduced mental disorder symptoms included meditation and relaxation exercises, physical exercise, positive thinking, planning for the future, TV/radio, housework/DIY, and working. Drinking alcohol was associated with a greater probability of increased mental disorder symptoms. CONCLUSIONS: High levels of mental disorders were recorded, and they were strongly associated with increased concern about COVID-19. A number of response strategies were identified which may help protect against worse mental health and these could be supported by innovations in mental health care in Georgia.