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

საქართველოს თამბაქოს კონტროლის პოლიტიკა არომატიზირებული თამბაქოს ახალი ნაწარმების კუთხით - შედარება ევროპულ მიდგომებთან

Introduction: The use of novel tobacco products, such as heated tobacco products (HTPs) and electronic cigarettes (referred to as an electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery systems (ENNDS)), is increasing among the youth globally. Among the key factors contributing to increased use is tobacco marketing, including advertising emphasizing flavored products, which influences perceptions, especially among youth. In Georgia, recent efforts have strengthened tobacco control, with the "new generation" tobacco control legislation adopted in 2017. Consequently, the trend of individual tobacco product (for example cigarettes) consumption has decreased. However, 2019 researches shows that the trend of using novel tobacco products among young people is increasing. The share of novel tobacco products in the market of Georgia started to grow largely in 2019. Perhaps relatedly, youth continue to show high rates of tobacco consumption in Georgia. The primary aim of this study is to investigate/analyze Georgia\u27s responses to addressing tobacco use in youth and identify gaps and challenges of Georgian policy regarding the regulation of novel tobacco products through comparisons with European policy approaches. Methods: This study identified policy documents specifying legislation (e.g., laws and bylaws, government documents, including state strategies and working plans, official announcements, and minutes from official meetings), through Internet search engines, official legislative web pages, and Ministry websites. Comparative analysis was used to identify challenges in the tobacco control policy of Georgia and assess its alignment with international standards. We compared the features of the Georgian policy with key measures for regulating novel tobacco products outlined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and European Union (EU) legislation (e.g Regulating tobacco product content and disclosure; Packaging and labelling of tobacco products; Tobacco advertising, promotion and sponsorship, tobacco industry interfare in tobacco control policy, etc.). Results: Considering the analysis of effective policy characteristics for preventing tobacco use among young people, as outlined by the WHO and the EU, it is evident that Georgia\u27s tobacco control legislation has significant gaps. Youth prevention policies addressing these products are relatively weak. The current legislation does not include restrictions on marketing of novel tobacco products emphasizing flavors, nor does it include restrictions or limitations on using flavorings/additives in any type of tobacco. Only the concentration of emitted substances in cigarettes and amount of nicotine in e-cigarette liquid is limited. However, compliance with these requirements has never been assessed; There is no local laboratory that tests any kind of tobacco product and no samples have ever been sent to any laboratory abroad. ENNDS represent a particular policy challenge, as they are not considered as tobacco products, and no tobacco control legislative requirements apply to them. Tobacco industry interference with Georgia’s tobacco legislation has also been documented to be high; Thus, it is likely that introduction of the control policies on novel product will be met with great resistance, especially since no research has yet been conducted recent years to reveal rates of novel tobacco products use by youth. Conclusions: This study provides the first assessment regarding how Georgia has responded to the growing popularity of novel tobacco products, such as e-cigarettes and HTPs, indicating that its tobacco control legislation has mainly addressed traditional tobacco products but largely neglected these novel products. The tobacco industry has taken advantage of the policy loopholes, and Georgia has become a favorable market for the novel tobacco product industry in recent years. Current findings provide evidence for decision-makers to inform the development of effective regulation and enformcement mechanism of flavored novel tobacco products, as gaps in the current regulations will likely will lead to increased use, particularly among youth.შესავალი: თამბაქოს ახალი პროდუქტების, როგორიცაა გასახურებელი თამბაქო (HTP) და ელექტრონული სიგარეტი (მოხსენიებული, როგორც ნიკოტინის ელექტრონული მიწოდების სისტემები (ENDS) და უნიკოტინო ელექტრონული მიწოდების სისტემები (ENNDS)) პოპულარობა ახალგაზრდებს შორის სულ უფრო იზრდება მსოფლიოში. აღნიშნულის  გამომწვევი მნიშვნელოვანი ფაქტორი თამბაქოს მარკეტინგია, მათ შორის არომატიზატორების გამოყენების გზით, რაც გავლენას ახდენს ადამიანთა, და განსაკუთრებით, ახალგაზრდების აღქმაზე. ბოლო პერიოდში თამბაქოს კონტროლის გაძლიერებისთვის საქართველოში გაწეული ძალისხმევის შედეგად, განსაკუთრებით 2017 წლის წლის შემდეგ, როდესაც საქართველოს პარლამენტმა მიიღო „ახალი თაობის“ თამბაქოს კონტროლის კანონმდებლობა, ცალკეული თამბაქოს ნაწარმის (მაგალითად სიგარეტის) მოხმარების მაჩვენებელი შემცირდა. თუმცა, 2019 წლის კვლევებიდან ჩანს, რომ მზარდია თამბაქოს ახალი ნაწარმების გამოყენების ტენდენცია ახალგაზრდებში.  საქართველოს ბაზარზე თამბაქოს ახალი ნაწარმების წილმა ზრდა მეტწილად 2019 წლიდან დაიწყო, რის გამოც, ამ პერიოდის შემდეგ თამბაქოს მოხმარების მაჩვენებელი საქართველოს ახალგაზრდებში სავარაუდოდ კვლავ გაიზარდა.        წინამდებარე სტატიით წარმოდგენილი კვლევის მიზანია გამოიკვლიოს/გაანალიზოს საქართველოს პასუხი ახალგაზრდებში მოწევის მზარდი მაჩვენებლის მიმართ და გამოავლინოს თამბაქოს ახალი პროდუქტების კონტროლის პოლიტიკის ხარვეზები და გამოწვევები საქართველოში, ევროპულ მიდგომებზე დაყრდნობით. მეთოდოლოგია: კვლევის ფარგლებში გამოყენებულია დოკუმენტური და აღწერითი სამართლებრივი კვლევის, შედარებითი ანალიზის, და ასევე, პოლიტიკის კვლევის მეთოდები. პოლიტიკის დოკუმენტები მოიძებნა ინტერნეტის საძიებო სისტემებში, ოფიციალურ საკანონმდებლო და სამთავრობო ვებგვერდებზე. მოიძიებული დოკუმენტები მოიცავს კანონებს, კანონქვემდებარე აქტებს, სამთავრობო დოკუმენტებს, მათ შორის, სახელმწიფო სტრატეგიებს და სამუშაო გეგმებს, სტატისტიკურ ინფორმაციებს, ოფიციალურ განცხადებებს და შეხვედრის ოქმებს. თამბაქოს კონტროლის არსებული გამოწვევების და საერთაშორისო მიდგომებთან მისი შესაბამისობის გამოსავლენად, შედარებითი ანალიზის საფუძველზე საქართველოს პოლიტიკის მახასიათებლები შედარებული იქნა ჯანმრთელობის მსოფლიო ორგანიზაციის თამბაქოს კონტროლის ჩარჩო კონვენციითა და ევროკავშირის კანონმდებლობით დადგენილ თამბაქოს ახალი პროდუქტების კონტროლის ძირითად ზომებთან (მაგ.: თამბაქოს ნაწარმის შემადგენლობის კონტროლი, რეკლამის, სპონსორობის და პოპულარიზაციის აკრძალვა, თამბაქოს ინდუსტრიის ჩაურევლობა თამბაქოს კონტროლის პოლიტიკაში, და სხვა). კვლევის შედეგები: ახალგაზრდებში თამბაქოს მოხმარების პრევენციისკენ მიმართული ეფექტური პოლიტიკის იმ მახასიათებლების ანალიზის გათვალისწინებით, რომლებიც ჯანმრთელობის მსოფლიო ორგანიზაციის და ევროკავშირის მიერაა დადგენილი, საქართველოს თამბაქოს კონტროლის კანონმდებლობა შეიცავს ბევრ ხარვეზს და ახალგაზრდების მიერ ამ პროდუქტების გამოყენების პრევენციის პოლიტიკა სუსტია.  ქართული კანონმდებლობა არომატიზატორების გამოყენების გზით თამბაქოს ნაწარმის მარკეტინგის აკრძალვას არ ითვალისწინებს. მოქმედი რეგულირება თამბაქოს არც ერთ პროდუქტში არ ზღუდავს არომატიზატორების/დანამატების გამოყენებას. დადგენილია მხოლოდ სიგარეტებიდან გამოფრქვეული ნივთიერებების ზღვრული ოდენობები და ნიკოტინის მაქსიმალური ოდენობა ნიკოტინის შემცველი ელექტრონული სიგარეტის სითხეებისთვის, თუმცა ამ მოთხოვნებთან შესაბამისობა არასოდეს შემოწმებულა. არ არსებობს ადგილობრივი ლაბორატორია, რომელიც შეამოწმებს თამბაქოს რომელიმე ნაწარმის შემადგენლობას. არც უცხო ქვეყნის ლაბორატორიაში გაგზავნილა ოდესმე თამბაქოს რომელიმე ნაწარმის ნიმუშები. თამბაქოს კონტროლის პოლიტიკის დიდი გამოწვევაა უნიკოტნო ელექტრონული სიგარეტები, რომელიც არ განიხილება თამბაქოს ნაწარმად და მათზე არ ვრცელდება თამბაქოს კონტროლის კანონმდებლობის მოთხოვნები. ქვეყანაში თამბაქოს კონტროლის პოლიტიკის საკითხებში თამბაქოს ინდუსტრიის ჩარევის საგანგაშოდ მაღალი ინდექსის გათვალისწინებით, სავარაუდოა, რომ თამბაქოს ახალ პროდუქტზე კონტროლის პოლიტიკის დანერგვას დიდი წინააღმდეგობა შეხვდება, მით უფრო იმის გათვალისწინებით, რომ ბოლო წლებში ჩატარებულა კვლევა ახალგაზრდების მიერ თამბაქო ახალი ნაწარმის მოხმარების მაჩვენებლის გამოსავლენად. დასკვნა: ეს კვლევა წარმოადგენს პირველ შეფასებას საქართველოში იმის შესახებ, თუ როგორ რეაგირებს ქვეყანა თამბაქოს ახალი პროდუქტების (ელექტრონული სიგარეტი, გასახურებელი თამბაქო) მზარდ პოპულარობაზე. საკითხის ანალიზმა აჩვენა, რომ საქართველოს თამბაქოს კონტროლის პოლიტიკა  ძირითადად მორგებულია თამბაქოს ტრადიციულ პროდუქტებზე, ხოლო ახალი პროდუქტები, ცალკეული რეგულაციების ფარგლებს მიღმაა. თამბაქოს ინდუსტრიამ კარგად ისარგებლა პოლიტიკის ხარვეზებით და საქართველო ბოლო წლებში თამბაქოს ახალი ნაწარმის ინდუსტრიისთვის გახდა ხელსაყრელი ბაზარი. კვლევის ფარგლებში გამოვლენილი დასკვნები კარგი ინსტრუმენტია გადაწყვეტილების მიმღებებისთვის - შექმნან არომატიზირებული თამბაქოს ახალი ნაწარმის ეფექტური რეგულირება და აღსრულების მექანიზმი საქართველოში, რადგან არსებული რეგულირების ხარვეზები სავარაუდოდ გამოიწვევს თამბაქოს მოხმარების მაჩვენებლის ზრდას, განსაკუთრებით ახალგაზრდებშ

Breast Cancer Screening in Georgia:Choosing the Most Optimal and Cost-Effective Strategy

Objectives: To define the optimal and cost-effective breast cancer screening strategy for Georgia. Methods: We used the Microsimulation Screening Analysis-Breast (MISCAN-Breast) model that has been adapted to the Georgian situation to evaluate 736 mammography screening strategies varied by interval (biennial and triennial), starting ages (40-60 years), stopping ages (64-84 years), and screening modality (with and without clinical breast examination [CBE]). Quality-adjusted life-years (QALYs) and additional cost (healthcare perspective) compared with no screening per 1000 women were calculated with 3% discount. Major uncertainties (eg, costs) are addressed as sensitivity analyses. Results: Strategies using a combination of mammography and CBE yielded in substantially higher costs with minimal differences in outcomes compared with mammography-only strategies. The current screening strategy, biennial mammography screening from the age of 40 until 70 years with CBE, is close to the frontier line but requires high additional cost given the QALY gains (€16 218/QALY), well above the willingness-to-pay threshold of €12 720. The optimal strategy in Georgia would be triennial mammography-only screening from age 45 to 66 years with an incremental cost-effectiveness ratio of €12 507. Conclusions: Biennial screening strategies are resource-intensive strategies and may not be feasible for Georgia. By switching to triennial mammography-only strategy from the age of 45 until 66 years, it is possible to offer screening to more eligible women while still gaining substantial screening benefits. This is to address capacity issues which is a common barrier for many Eastern European countries.</p

Changes in Mental Health Needs during COVID-19 in the Republic of Georgia: A Longitudinal Follow-up Study

BACKGROUND: To examine changes in COVID-19 stressors and symptoms of mental disorders in the Republic of Georgia. METHODS: A longitudinal design was used. Following on from our study of May-June 2020, this follow-up study in January-March 2021 was conducted at: (i)an individual level with the same respondents involved in the May-June 2020 study (repeat responders/cohort); and (ii) at a population-wide level, using non-probabilistic sampling. Questionnaire sections covered: (i)demographic, socio-economic characteristics; (ii)level of burden caused by COVID-19-related stressors/concern; and (iii)symptoms of anxiety(GAD-7), depression(PHQ-9), PTSD(ITQ), adjustment disorder(ADNM8). Descriptive and multivariable regression analyses were conducted. RESULTS: Among population-level survey respondents(N=1195), the probability of reporting mental ill health symptoms increased in 2021 compared to 2020 for PTSD(OR1.82), depression(OR1.40), adjustment disorder(OR 1.80), and marginally for anxiety(OR1.17). For the individual repeat respondents(N=455), the probability increased for depression(OR1.88) and adjustment disorder(OR2.56). The perceived burden of pandemic concern worsened in 2021 compared to 2020 for almost all stressors, particularly around access to health care, infecting others, and conflict in the home. PTSD was associated with an increased concern score from 2020 to 2021. CONCLUSION: Our study highlights the need to strengthen response strategies to address the elevated mental health needs related to COVID-19 in Georgia. It recommends increasing accessibility of early interventions and the need to modernise mental health services to strengthen access to care. It also calls for monitoring patterns of mental health disorders for better understanding and responses to mental health needs in Georgia

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017

Objectives: As unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the sources of unrecorded alcohol, and the proportion of unrecorded of total alcohol consumption. We also investigate associated sociodemographic characteristics and drinking patterns. Design: Cross-sectional data on overall and unrecorded alcohol use in the past 7 days from WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) surveys. Descriptive statistics were calculated at the country level, hierarchical logistic and linear regression models were used to investigate sociodemographic characteristics and drinking patterns associated with using unrecorded alcohol. Setting: Nine NIS (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) in the years 2013–2017. Participants: Nationally representative samples including a total of 36 259 participants. Results: A total of 6251 participants (19.7%; 95% CI 7.9% to 31.5%) reported alcohol consumption in the past 7 days, 2185 of which (35.1%; 95% CI 8.2% to 62.0%) reported unrecorded alcohol consumption with pronounced differences between countries. The population-weighted average proportion of unrecorded consumption in nine NIS was 8.7% (95% CI 5.9% to 12.4%). The most common type of unrecorded alcohol was home-made spirits, followed by home-made beer and wine. Older (45–69 vs 25–44 years) and unemployed (vs employed) participants had higher odds of using unrecorded alcohol. More nuanced sociodemographic differences were observed for specific types of unrecorded alcohol. Conclusions This contribution is the first to highlight both, prevalence and composition of unrecorded alcohol consumption in nine NIS. The observed proportions and sources of unrecorded alcohol are discussed in light of local challenges in policy implementation, especially in regard to the newly formed Eurasian Economic Union (EAEU), as some but not all NIS are in the EAEU

Evaluation of sex differences in dietary behaviours and their relationship with cardiovascular risk factors:a cross-sectional study of nationally representative surveys in seven low- and middle-income countries

Background: Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk. Methods: From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences. Results: Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes. Conclusion: Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases

Association between characteristics at birth, breastfeeding and obesity in 22 countries: the WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017

Objectives: It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children. ----- Method: Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed. ----- Results: The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies. ----- Conclusion: The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025

ESPAD Report 2019: Results From European School Survey Project on Alcohol and Other Drugs

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use and other forms of risk behaviour among 15- to 16-year-old students in order to monitor trends within, as well as between, countries. Between 1995 and 2019, seven waves of data collection were conducted across 49 European countries. This report presents selected key results. The full set of data on which the current report is based, including all of the standard tables, is available online (http://www.espad.org). All tables can be downloaded in Excel format and used for further analysi

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice : insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries

Objective: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician’s advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Design: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Settings: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Participants: Nationally representative samples of 30 455 adults aged 25–65 years. Results: HBP awareness, treatment and control varied substantially by education. The coverage of physician’s advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician’s advice on salt reduction. Conclusions: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries