ERGONOMIC PRACTICE IN DENTAL CLINICS AND MUSCULOSKELETAL DISORDERS AMONG DENTISTS IN GEORGIA.

The dental profession is associated with occupational health problems. The working environment of a dentist is associated with ergonomic risk factors that can significantly reduce the dentist's working ability and even cause the termination of his/her professional activity. Numerous studies have been conducted in different countries (Sweden, Denmark, Germany, Poland, Australia, etc.) to assess the prevalence of musculoskeletal disorders in dentists, though no studies related to the principles of ergonomics in dentistry have been carried out in Georgia. The study aimed to assess the ergonomics of the working environment of dentists in Tbilisi (capital city of Georgia) clinics and to identify the prevalence of musculoskeletal disorders among them. An observational descriptive study was conducted in April-July 2023 in Tbilisi. A special questionnaire of 40 questions was designed based on international experience. The survey was conducted by random sampling in selected dental clinics. Dentists were asked to fill out the questionnaire during their free time between patient appointments. Those who agreed to participate were provided with electronic versions of the questionnaire. Five hundred dentists were invited to participate in the survey, of whom 314 (62.8%) agreed to fill out the questionnaire. A total of 291 fully completed questionnaires were used for the descriptive statistical analysis. Our study shows that in Tbilisi clinics dentists work on average for 5-6 days (48.8% - 6 days, 37.1% - 5 days) or 40-48 hours a week. A majority of respondents said their workplace met the requirements of ergonomics (it had a good lighting, the chair had a back, instruments could be easily reached), yet most of them rarely lean on the backrest, never or rarely use the hand rest method, and never or rarely do light physical exercise during breaks. The survey shows that 53.6% of dentists most frequently suffer from pain in the back, followed by pain in the neck (50.9%), shoulders (47.9%) and lower back (47.1%). Most of them said they had to work less because of the pain. Introduction of the principles of ergonomics in dental profession is vital for preventing occupational musculoskeletal disorders. It is important to provide continuing professional development programs and information booklets for dentists and thematic online webinars for the management of dental clinics in Georgia.

EPIDEMIOLOGICAL STUDY OF INJURIES IN THE EMERGENCY DEPARTMENT OF THE UNIVERSITY HOSPITAL OF GEORGIA.

Injuries represent a significant burden on societies, resulting in deaths and health care costs incurred during Emergency Department visits and hospitalizations. This research aimed to estimate the burden of traumatic injury of patients treated and evaluated in the Emergency Department of the University Hospital in Georgia. A retrospective study was conducted at the University Hospital of Georgia for all trauma patients from January 1, 2018 to June 30, 2018. Visits were identified from existing electronic medical records, using the iCREATE Registry as a model. Data collected included patient demographics, injury characteristics, and injury costs. To estimate the direct costs of trauma treatment, data were obtained from the cost accounting database. A total of 2445 injured patients aged 0 to 91 years were medically examined during the study period and about 65% of them were male. Most of the injured patients were school-age children (31%). The leading mechanism of injury in the Emergency Departments were falls (45%). Most of the patients (78%) suffered from moderate injuries and needed only outpatient treatment. The total direct costs for all patients were $248 628. Fall-related injury costs accounted for most direct medical costs (51%), followed by road traffic crashes related costs (23%). Road traffic injured patients had the highest total mean costs ($269). Injuries result in a substantial number of Emergency Department visits and significant medical costs in Georgia. Understanding the characteristics of these injuries is essential for targeting injury prevention.

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.

TRACKING PREGNANCY OUTCOMES: DATA FROM BIRTH REGISTER OF GEORGIA.

Reliable and high quality data are critical to identify issues related to maternal health and factors affecting the reproductive health as well as to measure progress towards the Sustainable Development Goals. In 2016, an electronic case-based system for antenatal and obstetric services, so called "Georgian Birth Registry" (GBR), which provides continuous monitoring of pregnant women from the first antenatal visit until childbirth, was introduced in Georgia. GBR gave the possibility to describe maternal and child health, as well as reproductive health issues in correlation with different social factors, which influenced the fertility and pregnancy outcomes. In Georgia there is a lack of study addressing pregnancy outcomes. The aim of the research is to study influence of education, employment status and place of residence on pregnancy outcomes among women in Georgia. Methods. GBR data from 2018 has been used for this study. Results. The most important overall findings are: pros - high percent of timely initiation of first visit (from 70% to 80% and more) for all observed women, cons - the high rates of unplanned pregnancies (52%), particularly in adolescents (47%), high rates of abortions (31%), high percent of C-Sections, without indication in adolescents (25%). Tracking pregnancies and their outcomes trough registry system is an innovative approach for LMICs, which gives an opportunity to correlate some social-economic and behavioral characteristics in female population that can help in determining the preventive interventions aimed to reduce maternal and perinatal morbidity and mortality in LMICs.

CLINICAL ETHICS COMMITTEES: OVERVIEW OF THE EUROPEAN EXPERIENCE.

Making appropriate medical decisions in the best interest of the patient and in a line with the patient's autonomy, rights, dignity and plurality of values, are very important. In order to reach those goals and develop patient-oriented health service, Clinical Ethics Committees (CECs) support could make a great contribution. European countries (Netherland, Belgium, Italy, Germany, Norway, UK) are experiencing an exponential rise in the number of CECs as a mechanism to address the new ethical dilemmas in clinical settings, however the practice of CECs are facing barriers in transitional countries in central, eastern, and southeastern Europe. Despite the differences across the European countries we have found many similarities in groundwork trends of CECs development in studied countries, which have the most important impetus on the implementation and development of CECs. The most important and common ones are: enforcement of human rights doctrine, pluralistic civil movement, progressive development of medical science and new technologies, transfer of human rights movement in health care, development of bioethics, CECs educational capacity building, arising of complex moral, legal and ethical dilemmas in physicians' daily clinical practice, shifting medical care paradigm from the physician's single obligation to the shared responsibilities with respect of patient's rights, autonomy and dignity. Exploring those trends will lead to the opportunity to identify the most important factors that impact on the strengthening of the CECs practice in transitional countries as well.

PUBLIC ATTITUDES TOWARDS THE USE OF ANIMALS IN BIOMEDICAL RESEARCH IN GEORGIA.

In different societies there are different opinions about moral and ethical aspects of animal testing in biomedical research. Many studies have been conducted worldwide since 1980s to evaluate public perception and attitude towards the animal research. In EU Eastern Neighboring Countries, including Georgia, ethical aspects of animal usage for biomedical experiments have not been well emphasized. There are no ethical-legal regulations on animal use for biomedical research in Georgia neither on national nor on institutional level. At the same time, public attitude concerning the animal testing for scientific research is unclear. The aim of the study has been to explore public attitudes towards the animal research for the first time in Georgia. In this survey quantitative and qualitative research methods had been used. A special questionnaire was developed and an individual interview method was utilized. Totally 750 interviews were conducted and 715 questionnaires were used for analysis. Codified questionnaires were included in the database and then analyzed with SPSS 27 software. The technique of cross-tabulation was used for the bivariate analysis. For most respondents (68.0%) animal use in Biomedical research is acceptable. 82,0% of respondents fully or partly agreed with the concept, that involvement of animals in experiments which comply to the principles of international norms and regulations (reduction of the number of animals, improving the experiment/lowering pain for animals, and using alternative methods) is acceptable. The results of the study have demonstrated that the attitude of the study sample towards the animal testing in biomedical research is influenced by age (Pearson Chi-Square=32.479, df=8, p<0.05; p=0.000), education (Pearson Chi-Square=27.850 df=12, p<0.05; p=0.006) and occupation (Pearson Chi-Square = 37.767 df=16, p<0.05; p=0.002). Gender, place of residence and experience with owning the pet/animal doesn't have statistically significant influence on the public attitude.  The results of our study highlight that animal testing in biomedical research is acceptable for the respondents involved in the study. However, most of the respondent's consider use of International regulations highly important.

Human rights for better quality of life.

This article reviews problems of pain relief for incurable patients, in the context of human rights and international standards in this field. In respect to international and national humans and patients rights, regarding to achieve better quality of life, the governments should identify and determine the problems and obstacles that impede opioid use for medical purposes, in aim rich adequate pain relief for incurable patients. Implementation of newly adopted legislation in Georgia into practice will enable to overcome existing barriers; hence these patients will be able to pass their last path of life under care, as much as possible without pain and with dignity.