INDICATORS OF PHYSICAL ACTIVITY IN THE YOUTH.

The rate of physical activity among young people worldwide has changed in recent decades. A sharp change in physical activity is observed in young people after they finish school and start studying at universities. This study showed the main patterns of the physical activity among the medical students in Georgia, as well as the effect of the global events. Incentive and inhibitory factors have also been identified that significantly determine the rate of increase and decrease. The aim of the study was to assess the physical activity rates of students at Tbilisi State Medical University. The physical activity level was studied by using the self-reported assessment by means of the specially developed questionnaire. The questionnaire was based on literary sources and expert opinion, and tested among peers. 34 questions covered demographic information (8), lifestyle and physical activity (16), exercising (5) and impact of COVID-19 (4). The survey through Google Forms was anonymous. Epidata 3.1 was used for data entry. The data were analysed in Stata 14.0. Descriptive statistics was used to generate frequencies, percentages and proportions. Where relevant, the Chi-square test was used to determine any statistical significance. Sampling frame consisted of the students of Tbilisi State Medical University. Respondents were chosen by the cluster random sampling method. Random cluster sampling was used with confidence interval/margin of error 10 and confidence level 95%. A total of 265 students participated in the study (Faculty of Medicine - 63.77%, Faculty of Public Health - 35.4%; first-year students - 41.13%, fourth-year students - 58.11%). More than 57.4% of the respondents consider themselves physically passive. 74.7% of them make less than 10,000 steps per day. 79.5% do not exercise regularly. Students explain their low level of physical activity by various reasons, such as COVID-19 pandemic (65.5%), smartphone use (56.6%), lack of free time (79.2%), lack of finances (40.8%) and motivation (54.3%). On the other hand, a relatively small proportion of respondents (30.6%) answered that they are physically active. They go by foot (26.3%), make 6,000 to 10,000 steps a day (17.4%) and prefer taking stairs (57.5%). They engage in a variety of physical activities, such as: sports, football, basketball, gym and home gym, swimming, aqua aerobics, dancing, cycling and walking. This study is the first on the lifestyle and physical activity of young people in Georgia during the Covid Pandemic. Trends related to the physical activity of students living in Georgia are similar in different countries around the world. Young people have common problems, obstacles or incentives.

ALPHA- AND BETA-GLOBIN GENE MUTATIONS IN GEORGIA AND ARMENIA.

Georgia and Armenia are situated at the northern rim of the thalassemia belt and bordering to countries with a known high prevalence of thalassemias. In this study we assessed the carrier frequency and potential spectrum of alpha- and beta-globin mutations among 202 and 190 unselected Georgian and Armenian subjects, respectively. We found four alpha-globin mutations (-3.7del, -4.2del, anti-3.7 triplication, poly-A2) in 9 Armenians (4.74%) and 4 Georgians (1.78%). The heterozygous beta-globin codon 8 [-AA] mutation was detected in one individual from Armenia only. Overall, carrier frequencies seem to be low in both countries, supporting the notion that thalassemias are not a major health problem there.

PECULIARITIES OF NUTRITION AMONG MEDICAL UNIVERSITY STUDENTS.

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

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

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

THE GLOBAL POINT PREVALENCE SURVEY (PPS) OF ANTIMICROBIAL USE AND ANTIMICROBIAL RESISTANCE AMONG HOSPITALIZED CHILDREN IN GEORGIA.

The aims of our study were to determine antibiotic prescribing rates for prevention and treatment of infections in pediatric units, to evaluate the number and type of antimicrobial agents and administration route, reveal commonly used antibiotic subgroups and identify targets for improving the quality of antimicrobial prescribing. A 1-day PPS (Point Prevalence Study) on antibiotic use in hospitalized children was performed in Georgia from 2015 to 2019. 18 clinics in different regions of Georgia were included in the survey. Antimicrobial prevalence rates increased over the years from 60.1% in 2015 to 92.6% in 2018. The most commonly, antibiotics were prescribed for lower respiratory tract infections (LRTI). In 2015 25.1% of LRTI were treated by ampicillin-sulbactam but the next year it replaced with ceftriaxone (37.1% in 2017 and 38.2% in 2018). In pediatric surgical ward, the antibiotics were commonly prescribed for surgical prevention (54.1% in 2015, 32.3% in 2018). The most common conditions treated with antibiotics in neonates were sepsis (30.1%) and LRTI (45.3%). The most used antibiotic was ceftriaxone (33.3% in 2015). Ampicilin-sulbactam was prescribed in 28.1% of pneumonia case in neonates in 2018. In 2015 antibiotics were mainly prescribed empirically (98.0%). In 2018 resistance of MRSA was 8.1%, and resistance to the third-generation cephalosporin 17.3%. Prevalence rate of antibiotics for prevention and treatment of infection disease in pediatric units increased in 2018. Main feasible targets for optimization of antibiotic prescribing have been identified: high use of broad-spectrum antibiotics in hospitals, high frequency of empirical treatment, rarely performed culture tests, prolonged antibiotic prophylaxis in surgery patients and an alarming raise of resistant strains. The implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and improve antibiotic prescription patterns in neonatal and pediatric inpatients over time.

[PHYSICAL DEVELOPMENT OF CHILDREN IN ORPHANAGES].

Aim - to define the parameters of physical development of children in orphanages. 72 children (45 boys, 27 girls) without chronic debilitating diseases and condition aged from 1 to 6 years from Tbilisi and Makhinjauri orphanages (Georgia) were assessed. Height and weight of all subjects were measured and BMI, height SDS (standard deviation score) and weight SDS were calculated. Data were compared to the normal values (national data). The retardation of the physical development were seen along almost all findings. The significant differences regarding age and gender were not revealed. The most expressed tendency to delay was expressed in the height of boys, particularly aged 3-5 years. Our data confirm that institution upbringing has a negative impact on the growth of children of 1-6 years of age. In children aged from 1 to 6 years who are healthy but live in orphanages there is a marked tendency to lag behind in physical development, mainly in height. The above-mentioned confirms the opinion about negative impact of upbringing in orphanages on the physical development of children.

General movements in infants with autism spectrum disorders.

General movements (GMs) are a distinct movement pattern carried out spontaneously without external stimulation and seen in fetuses of 9 weeks gestational age till 21 weeks postterm. GMs are helpful in the early diagnosis of an impaired central nervous system and the specific prediction of later neurological deficits. Autism spectrum disorder (ASD) is a neurodevelopmental disorder involving a life-long deficit in several aspects of the social and communicative behavior. Recently there appeared studies proving that children with ASD demonstrate disorders of motor development. To detect whether abnormalities in spontaneous motor activity can be observed already in the first months of life in infants with ASD. A retrospective study was performed by analyzing the family videos provided by parents of 20 children (male 17, female 3) later diagnosed as ASD. Home videos provided by parents of a control group of healthy children (n=20; male 10, female 10) matched for age with the ASD subjects and recorded in similar conditions were also analysed. In total 70 sequences were studied. Two independent observers, blind of the infants' outcome (ASD or normal), assessed the cases applying a global and a more detailed assessment of GMs. Hence, the age-specific GM pattern (normal or abnormal) as well as motor optimality scores were determined for each video sequence. Cohen kappa was 0.614. During the writhing movement period 70.0% sequences of infants with ASD showed poor repertoire GMs. In the control group, poor repertoire GMs were only seen in 12.5% of the sequences. In the fidgety movement period 20.8% of sequences were assessed as absent fidgety movements, 29.2% as abnormal fidgety movements. The large majority of the videos for the control cases were scored as normal (88.9%), 11.1% had no fidgety movements. According to the Mann-Whitney U test there were significant differences between the ASD and the control groups' optimality scores. The optimality scores were lower in the ASD group. The reduced optimality scores were mainly due to a lack of variable sequences, amplitude and speed of writhing GMs and an altered quality of fidgety and other spontaneous movements in the ASD group. Infants with ASD had more often poor repertoire writhing GMs as well as abnormal or absent fidgety movements than control infants. These data encourage further studies involving a larger number of family videos.

Substance abuse among adolescents in Georgia.

To estimate the substance abuse and thus assess the basic indicators of health risk behavior of the adolescents in Georgia: frequencies of their tobacco, alcohol and drugs consumption. A self-administered anonymous questionnaire was adapted from the Swiss Survey (SMASH2002), translated into Georgian and other languages mainly used in schools (Russian, Armenian and Azeri). It contained 87 questions. Two-stage cluster sampling was devised. Weight was adjusted. A total of 599 classes were selected. Field work took place in 2004. All questionnaires (n=9499; 56,8% filled out by girls, 39,6% - by boys; the mean age was 15,5+/-1,1 years) before being processed into the Epidata were edited. The final data were analysed by SPSS 11.0. 10,4% of adolescents have reported to smoke. The average age of starting to smoke is 13,4 years. 61,2% girls and 67.8% boys drink vine. 56,7% out of the total number of respondents claimed to have been never drunk, 30,0% - answered positively. 2,3% said that they had intravenous drug injection. The drug of preference is cannabis - 6,8%. 72,2% of those who have had intravenous drug injections answered positively to the question "Have you ever been really drunk?" Performed survey is a first one done among adolescents in Georgia. It gave us basic information for planning and implementation of necessary measures in order to improve the health of adolescents and raise awareness of professionals involved in health care and prevention settings for adolescents.

An expert system for differential diagnosis of tall stature syndrome.

There was created medical expert system for differential diagnosis of disorders and diseases manifested by tall stature. They were selected based on the information provided by two major computer databases, LDDB [London Dysmorphology Database] and Orphanet. Clinical signs, i.e. diagnostic criteria were developed according to 7 experts: manuals and textbooks, computer databases and online resources in pediatrics and rare diseases. Linguistic terms expressing the frequency and/or probability of presence of various symptoms were matched to numerical equivalents. The data from different experts were summarized according to the expertons' method and the inference engine was based on the Bayes theorem. An interface was made up by a set of slides with questions accompanied by boxes beside and user is expected to check corresponding boxes. The program was created in Borland C++ Builder. After having processed the entered data, the expert system produces the most probable five diagnostic possibilities and ranks them in order of likelihood.

Adolescents health in Georgia: a national portrait.

The aim of the study was to assess the basic indicators of health of adolescents in Georgia. A self-administered anonymous questionnaire was adapted from the Swiss Survey (SMASH2002), translated into Georgian and other languages mainly used in schools (Russian, Armenian and Azeri). It contained 87 questions. Two-stage cluster sampling was devised. Weight was adjusted. A total of 599 classes were selected. All questionnaires before being processed into the Epidata (www.epidata.dk) were edited. The final data were analysed by SPSS 11.0. General health status was considered as excellent and very good by 34.0+/-0.8% of respondents. 21.5% claimed to never miss the school due to the illness. The frequencies of physical disability and chronic diseases were 8.0% and 5.0% correspondingly. Among health-related problems the most frequent are problems with teeth, headache and acne. 5.9% of girls had some kind of gynecological problems quite often and very often. Performed survey is a first one done among adolescents in Georgia. It gave us basic information for planning and implementation of necessary measures in order to improve the health of adolescents and raise awareness of professionals involved in health care and prevention settings for adolescents. The data can be also used for monitoring of health status of adolescents in Georgia.

Health-related interests of Georgian adolescents.

The aim of the study was to find out what adolescents in Georgia would like to know about health. Pupils of 6-10 grades (11-17 years old) (n=524) of the focus schools (secondary schools where FRESH program is being implemented) were investigated. A method of participatory research (so called social anthropologic approach) was applied. The study was anonymous. It yielded 3756 questions in total. The questions dedicated to health-related issues made up 36.8% for group I (11-13y.o.), 45,75% for group II (14-17y.o.), 40.5% -- total. The interest in different somatic and psychological problems and diseases was the same in both age groups (14,3%). Interest in sexual items was higher in later adolescents (group I -- 10.58+/-0.66%, group II -- 14.97+/-0.90%, p<0.05). Girls have shown more interest in diseases and common medical problems (M -- 27.3+/-3.2%, F - 45.2+/-2.6%; p<0.05). Boys were more interested in sexual behavior (M -- 40.2+/-3.6%, F -- 25.2+/-2.3%; p<0.05). There was shown a purposefullness of applied research methodology.

Application of narrative method to the study of adolescent sexuality.

Sexual life is one of the most important health-related behaviors of adolescents. WHO has proposed the Narrative Research Method, a way to identify adolescents' sexuality as seen by themselves. The aim of the study was to apply the narrative method as a new research method in order to reveal the level of adolescents' knowledge about sexual life and their attitude to it in Georgia. Two groups of adolescents have been investigated. First group (n=69, age 14-16) consisted of students of secondary school in Tkibuli, second group (n=58, age 17-19) -- of students of the Tbilisi State Medical University College. 81.8% of the total number of respondents think that the couple should have some physical intimacy "within the limits"; sexual relationships before marriage were acceptable to 49.6%; in case of unexpected pregnancy or STD almost 50% would have addressed parents; in case of pregnancy 28% would have consider abortion and 55% -- marriage. The study was a pilot one. It has shown the advisability of the narrative research method as an effective approach to the investigation of adolescents sexuality especially in countries where the direct questions are not acceptable because of different reasons.