Examining the creation of synergy in community coalitions for smoke-free environments in Armenia and Georgia.

Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n = 83) and semi-structured interviews with leaders and members (n = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16 hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy.

Challenges and Opportunities to Advance Adolescent Health Measurement in Armenia: Alignment Between Global Priority Indicators and National Policies, and Feasibility of Collecting Sexual, Reproductive, and Mental Health Indicators.

PURPOSE: To assess alignment of the Global Action for Measurement of Adolescent health (GAMA) draft adolescent health indicators with national policies and explore challenges and opportunities for collecting data on adolescent sexual, reproductive, and mental health in Armenia. METHODS: We reviewed Armenia's national laws, decrees, policies, strategies, and programs for content related to the draft indicators. We conducted three focus group discussions with government and nongovernmental stakeholders and youth representatives on the feasibility of collecting the draft indicators, and analyzed the discussion segments related to sexual, reproductive, and mental health indicators. RESULTS: The policy review included 22 documents. Armenia's national laws, policies, strategies, orders, and decrees mention a range of tracking and monitoring activities in adolescent health, and many draft GAMA indicators are already incorporated into national statistics and are collected in ongoing surveys. However, policies and strategies often lack specificity around how to measure and report indicators. Sexual, reproductive, and mental health indicators were particularly sensitive to collect due to Armenian cultural norms and expectations, especially for younger adolescents under the age of 15 years. DISCUSSION: Guidance should be developed to facilitate the formulation of relevant policies with well-defined indicators and complete tracking and reporting information. Data collection should be further harmonized within the overall health information flow to avoid data overlap. While sensitization work and interviewer training can help address some issues around collecting data on sexual, reproductive, and mental health, it may be necessary to adapt certain indicators to be culturally acceptable in Armenia, such as by limiting the age range to above 15 years for highly sensitive indicators.

Nationwide Rapid Assessment of Avoidable Blindness (RAAB) in Armenia.

PURPOSE: This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. METHODS: The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. RESULTS: Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0-2.1), 1.6% (95% CI: 1.0-2.2) and 6.6% (95% CI: 5.5-7.7), respectively.The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. CONCLUSION: The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia.

Establishing urogynecology subspecialty in Armenia: The Armenia project.

It is well known that there are many countries in the world where Urogynecology is not an existing subspecialty, and women are not receiving appropriate care for their pelvic floor disorders (PFD). One of these countries is the Republic of Armenia. Given the lack of expertise in the field of Urogynecology in Armenia, we conducted a study on the prevalence of PFDs and the degree of bother among women of all ages across the country, which was published in 2020. This led to the creation of the International Urogynecology Association for Armenia, comprising seven physicians from different countries: five from the USA, one urogynecologist from Lebanon, and one urologist from Russia. We implemented hybrid teaching based on Zoom lectures, case presentations, journal clubs, and live visits of mentors to Armenia on a regular basis to see patients and operate with our five fellows. We introduced our fellows to research and statistics by assigning research topics for different projects. Our fellows presented evidence-based presentations and extensive literature reviews on a regular basis. Our program will continue to grow the next 2-3 years. The success of this project holds significance for governmental, public, and healthcare entities in Armenia and across the world, where this subspecialty is non-existent, in preparing future female pelvic surgeons to care for the growing needs of women with these conditions. Replicating this program in other parts of the world will compound the benefits and successes of Urogynecology care across different societies, cultures, and people around the globe.

The trends in death of primary liver cancer caused by specific etiologies worldwide: results from the Global Burden of Disease Study 2019 and implications for liver cancer management.

BACKGROUND: Over past decades, epidemiological patterns of liver cancer (LC) have changed dramatically. The Global Burden of Disease (GBD) study provides an opportunity for tracking the progress in cancer control with its annual updated reports at national, regional and global level, which can facilitate the health decision-making and the allocation of health resources. Therefore, we aim to estimate the global, regional and national trends of death caused by liver cancer due to specific etiologies and attributable risks from 1990 to 2019. MATERIALS AND METHODS: Data was collected from the GBD study 2019. Estimated annual percentage changes (EAPC) were used to quantify the trends of age-standardized death rate (ASDR). We applied a linear regression for the calculation of estimated annual percentage change in ASDR. RESULTS: From 1990 to 2019, the ASDR of liver cancer decreased globally (EAPC = - 2.23, 95% confidence interval [CI]: - 2.61 to - 1.84). Meanwhile, declining trends were observed in both sexes, socio-demographic index (SDI) areas, and geographies, particularly East Asia (EAPC = - 4.98, 95% CI: - 5.73 to - 4.22). The ASDR for each of the four major etiologies fell globally, while liver cancer caused by hepatitis B had the largest drop (EPAC = - 3.46, 95% CI: - 4.01 to - 2.89). China has had dramatic decreases in death rates on a national scale, particularly when it comes to the hepatitis B etiology (EAPC = - 5.17, 95% CI: - 5.96 to - 4.37). However, certain nations, such as Armenia and Uzbekistan, saw a rise in liver cancer mortality. Controlling smoking, alcohol, and drug use contributed to a drop in LC-related mortality in the majority of socio-demographic index areas. Nevertheless, the excessive body mass index (BMI) was portrayed as the underlying cause for LC fatalities. CONCLUSION: From 1990 to 2019, there was a worldwide decrease in deaths caused by liver cancer and its underlying causes. However, rising tendencies have been observed in low-resource regions and countries. The trends in drug use- and high BMI-related death from liver cancer and its underlying etiologies were concerning. The findings indicated that efforts should be increased to prevent liver cancer deaths through improved etiology control and risk management.

Risk assessment of dietary exposure to trace elements that are reproductive toxicants: Lead, molybdenum and nickel. The case study of Armenia.

The research aimed to assess dietary exposure to developmental toxicants (Mo, Ni, Pb) among the Armenian adult female population of reproductive age (18-49 years). Commonly consumed foods with a daily intake of more than 1 g in Armenia have been selected to assess the occurrence of Mo, Ni, and Pb. Food consumption data among the adult population in Armenia were collected in the frame of the national survey via 24-h recall method. Estimated daily intakes (EDI) and associated potential health risks for both mean and high (95 percentile) consumers were assessed based on the health-based guidance values (HBGVs). None of the EDI values for the developmental toxicants via individual food consumption exceeded the HBGVs, however, the EDI of Pb in the case of aggregate consumption of all food products exceeded HBGV of 0.5 µg/kg b.w./day, indicating possible concerns for the neurodevelopmental effects. Noticeably, the intake of Pb through some individual food items (cheese curd, beef and veal, pelmeni and khinkali, black coffee, tap water) and the aggregate consumption of all the studied foods led to a Margin of Exposure lower than 10 compared to HBGV.This study is the first one carried out on dietary exposure to developmental toxicants among women of fertile age in a Caucasus country. The outcomes prompt the need to investigate sources of Pb pollution in foods consumed in Armenia (natural or human-derived environmental pollution, as well as food contact materials, etc.) and may pave the way for similar studies in the Caucasus region.

Assessment of Heme and Non-Heme Iron Intake and Its Dietary Sources among Adults in Armenia.

Adequate dietary iron (Fe) intake is crucial for preventing Fe-deficient anemia, a recognized global public health concern which is important in Armenia. This study aimed to analyze the intake of Fe, both heme (from animal tissues) and non-heme (more prevalent, but less efficiently absorbed), as well as the Fe dietary sources, among adults in a representative national sample in Armenia. The study was conducted on 1400 individuals aged 18-80 and above, who were enrolled from all regions of Armenia. The Fe intake was assessed through a 24 h dietary recall survey, while Fe occurrence was determined through atomic absorption spectrophotometry (AAS). The results showed a high proportion of adults with a Fe intake lower than the average requirements set by EFSA (65%, 80% and 85% of males, total females and females at fertile age, respectively). Main Fe sources were bread, fruits and vegetables; heme Fe accounted only for <5% of total Fe intake. Compared to males, females had a lower intake of all forms of Fe (p < 0.05). Significant differences were observed in the intake of different forms of Fe between regions (p < 0.05), while the age-group 36-55 years had higher intakes of total Fe. Our data call for comprehensive nutritional security strategies in order to reduce iron deficiency in Armenia, that represents a public health concern.

COMPARATIVE ASSESSMENT OF ATHLETES' AUTONOMIC REACTIVITY BY HRV INDICATORS IN FUNCTIONAL TESTS OF VARIOUS DIRECTIONS.

The purpose of the research is to study and comparatively evaluate the changes in HRV indicators in functional tests of various directions. HRV was studied in 50 elite athletes (athletics, wrestling, judo, football) , at age 20-26 years old. The research was held in the scientific research laboratory of the Armenian State Institute of Physical Culture and Sport using the hardware - software complex "Varikard 2.5.1, Iskim - 6.2. The studies were carried out in the morning, in the preparatory phase of the training process, at rest and during functional testing. In orthotest HRV was recorded at rest 5 min supine followed by 5 min standing. 20 minutes later, a treadmill test was carried out on Treadmill Proteus LTD_7560 with a gradually increasing load (1 km/h per minute) until exhaustion. The duration of test was 13-15 minutes, HRV recorded after test 5 min supine. HRV time indicators - HR(b/m), MxDMn(ms), SI (un) and frequency (spectral) indicators - TP (ms2), HF (ms2), LF (ms2), VLF(ms2) are analyzed. The degree and direction of changes in HRV indicators are connected with the different type of stress factors, their intensity and duration. The HRV time indicators in both tests change unidirectionally: sympathetic activation causes an increase in heart rate, a decrease in the variation range MxDMn and an increase in the stress index SI, with the greatest degree of shifts in the treadmill test. The spectral indicators of HRV in both tests vary in different directions. In orthotest, the vasomotor center is activated, expressed by an increase in LF wave amplitude against the background of a decrease in the HF wave, but without a significant reaction from the total power of the TP spectrum and the humoral-metabolic component VLF. With the treadmill test, there is an energy-deficient state, expressed by a sharp decrease in TP wave amplitude and all spectral indicators reflecting the activity of individual management levels of heart rhythm control. The picture of correlation links emphasizes the balanced functioning of the autonomic nervous system at rest, increased sympathetic activity and regulation centralization in orthotest, as well as an imbalance of autonomic regulation in treadmill test.

Health risks of heavy metals in food and their economic burden in Armenia.

Mining leads to excessive heavy metal contamination of agricultural products in Armenia and can adversely impact human health. We quantify the concentrations of toxic heavy metals (lead, nickel, cadmium, and mercury) in food sampled from local markets of the capital city, Yerevan. We combine these measured concentrations with data from a diet survey of 1,195 people. The results provide an estimate of people's heavy metal intake in a typical day. The study finds that only dietary exposure to lead raises consumer safety concerns. More than 50 % of the population have daily intakes of lead that exceed the benchmark dose level (BMDL10) of 0.63 µg/kg b.w./day established by European Food Safety Authority. Moreover, risk assessment results indicate that approximately 96 % of the population has dietary exposure values for lead that exceed the threshold level, with animal products as the primary source. The lead exposure observed in sampled population has the potential to increase blood pressure on average by 0.54 mmHg, lower IQ levels by 1.2 point, and reduce lifetime earnings by $5000. The study reveals a strong need to determine the specific pathways by which lead enters the food supply, to mitigate the excess exposures, and to reduce the potential or severity of the resulting adverse health impacts.

ASSESSMENT OF THE SOCIAL AND MEDICAL ASPECTS OF SUICIDE IN THE REPUBLIC OF ARMENIA.

The objective of the article is to consider the social and medical factors which contribute to the number of suicides in the Republic of Armenia. The study covers the suicide data for the period of 2011-2020. The article provides statistical data on gender and age aspects of suicide. The paper overviews the works of contemporary authors on the social aspects of the problem. The results of the study will contribute to the further development of the effective methods to prevent suicide. ; Objective - the objective of the study was to investigate and assess the socio-medical aspects of suicide in the RA.; The subject of the study was the data on suicides in the Republic of Armenia in 2011-2020. Standard statistical methods of data analysis were used to compare the data obtained, to assess their reliability, to determine the standard statistical and mean error, reliable difference between absolute and relative values. ; The study revealed 1858 suicide cases, registered in the Republic of Armenia over 10 years. The structure analysis of the suicides by gender in the Republic of Armenia from 2011 to 2020 has shown that males predominated in the structure of suicides over the whole period. Among the motivations of suicide, the ones that deserve attention are diseases, social problems, and bereavement.; The results obtained will contribute to suicide prevention.

Pathways to socioeconomic health differences in Armenian adolescents: The role of bullying perpetration.

Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior. This study aimed to investigate the role of bullying perpetration in the relationship between SES and health among Armenian adolescents. A nationally representative sample of 3679 adolescents aged 11-15 years (mean = 13.1, standard deviation = 1.6) participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP] and material well-being) and three health outcomes (perceived health status, psychosocial well-being, and psychosomatic symptoms). Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family SEP and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06-3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77). Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration. Consequently, bullying prevention activities in Armenia should focus on both low and high-SES adolescents, considering SES-specific pathways and mechanisms.

Risk assessment of potentially toxic trace elements via consumption of dairy products sold in the city of Yerevan, Armenia.

The study aimed to investigate the potentially toxic trace elements (PTEs) Pb, Cd, Hg, Mo, and Cu in dairy products sold in Yerevan's markets and to assess the related exposure and possible health risks among the adult population residing in the capital city of Armenia, Yerevan. The PTEs contents were determined in widely consumed dairy products (pasteurized milk, sour cream, matsoun and cheese from cow milk) using graphite furnace atomic absorption spectrometry. PTE contents were in the range of 7.90E-04 (Pb in pasteurized milk) to 6.75E-01 (Cu in cheese) mg/kg. Food consumption was assessed by the 24-h dietary recall method. The PTE daily intakes and margin of exposure (MOE) were calculated by the deterministic approach. The results indicated potential health concerns for the contribution of dairy products to the overall dietary intake of Pb and Cd. MOEs of Pb and Cd (8.71 and 8.80, respectively) estimated for high consumers of cheese (90 g/day and more) were lower than 10. The pilot data set provides the first comprehensive appraisal on the dairy products contamination by PTEs in the Caucasus region. The results point out further attention to sources of Pb and Cd in Armenian dairy products, including environment and farm characteristics.

Multifractal features of activity concentration and stochastic risk assessment of naturally occurring and technogenic radionuclides in the soil of Yerevan, Armenia.

Spatial patterns and background ranges of naturally occurring radionuclides (NORs) (i.e. U-238, Th-232, K-40) and Cs-137 were studied in the urban soils of Yerevan, the capital city of Armenia. Multifractal Inverse Distance Weighting (MIDW) was used to generate and analyze distribution patterns of radionuclide activities. Based on Fourier transformation of radioactivity data, a spectral analysis was also applied to separate, where possible, background/baseline patterns from local anomalies: two ranges of background values were found to characterise the Yerevan territory. Specifically, in the south and south-east of Yerevan, the lower background ranges of U-238, Th-232 and K-40 comprised in the intervals 2.60-36.42 Bq/kg, 4.04-30.63 Bq/kg and 147.7-396.7 Bq/kg, respectively, were observed in association with the presence of sedimentary formations. In contrast, the higher ones were found, instead, in the central and northern parts of the city where andesite-basalt lavas and ignimbrite tuffs occur. Here, the background values rise to 142.4 Bq/kg, 138.76 Bq/kg and 1502 Bq/kg, respectively. As for the distribution of artificial Cs-137, its baseline levels in Yerevan seem to depend mostly on the global radioactive fallout and some local technogenic sources. Its distribution patterns partially differ from those of NORs. In the framework of this paper, Radium equivalent activity (RaEq), outdoor absorbed dose rate in air (ODRA) and annual effective dose equivalent (AEDEs) were also determined and mapped. They show a good coincidence of their spatial variations with those of NORs. The Monte Carlo simulation was used to assess excess lifetime cancer risk from a stochastic perspective. The related sensitivity analysis revealed that, among NORs, U-238 and Th-232 give the greatest contribution to the total variance (45.7% 42.8%, respectively). In comparison, K-40 has the lowest share (11.3%). Regarding Cs-137, a highly negligible contribution to the onset of health risks (accounting for 0.02%) was observed.

Psychometric and Logometric Properties of the Armenian Version of Augmentative and Alternative Communication Assessment Questionnaire: Assessing Reliability and Validity.

The study describes the development of the AAC-Arm questionnaire and its initial psychometric and logometric testing for reliability and validity. Psychometric and logometric principles were used to develop an assessment questionnaire capable of evaluating the communication state domains important to patients with neurological disorders. The hypothesized domains were to include (1) auditory function, (2) speech function (3) cognitive functions (4) sensorimotor function, and (5) activities of daily living (ADL). An initial pool of 78 questions was pilot-tested for clarity in 10 patients; following factor analysis, the number of questions was reduced to 39-items. Then the questionnaire was subjected to reliability and validity testing. Factor analysis supported the 5 hypothesized domains. Test-retest reliability using Spearman's correlation demonstrated substantial agreement, ranging from 0.72 for the ADL domain to 0.92 for the auditory function domain. In testing for internal consistency, Cronbach's alphas ranged from 0.86 for-the ADL domain to 0.96 for the cognitive function domain. Correlation between domains gave evidence of construct validity. In comparing similar domains in the AAC questionnaire, a moderate correlation (range 0.33-0.83) for the ADL and sensorimotor function scales were found. The correlation was more positive between the other domains. Testing of reliability for the phraseological, syntactic and semantic competence indices showed good positive correlation between initial and retest scores. The questions in the AAC questionnaire have undergone rigorous psychometric and logometric testing, and the tool is an appropriate instrument for the assessment of neurological patients with communication deficit. The psycholinguistic assessment provides with the main weight of data for successful communication therapy.

Oral health status and indicators in children of Armenia based on the national surveys.

BACKGROUND: The aim of this study was to determine the dynamics and the structure of dental morbidity of the children population of the Republic of Armenia, in order to improve the system of methods of therapeutic and preventive measures. METHODS: In recommended children's key age groups, 5879 WHO assessment forms (1997) were analyzed. Calculated prevalence and intensity of dental caries, the Significant Index of Caries (SiC) and European dental health indicators, and the condition of periodontal tissues were determined with the help of the community periodontal index (CPI) and oral hygiene by OHI-S. The statistical analysis was performed within the SPSS 19 (SPSS Inc., Chicago, IL, USA). The obtained data were statistically processed in the STATISTICA 6.0 (StataCorp LLC, College Station, TX, USA) for Excel program (Microsoft Corp., Redmond, WA, USA). RESULTS: The prevalence of caries of temporary teeth was 91.7% on the average. In 12-year-old schoolchildren the average prevalence of caries of permanent teeth rate was 87.5%. The prevalence of periodontal lesions in children was 47.8% on the average. CONCLUSIONS: In Armenia there was an increase in dental morbidity during the 2009-2019 period, which presumably would be continued unless the factors affecting the development of diseases will be changed. To improve dental health at the population level not only specialists but also health authorities should make efforts introducing appropriate prevention programs.

Managing multiple myeloma in a resource-limited region: Diagnosis and treatment in Armenia.

Multiple myeloma (MM) is the second most common blood cancer in adults leading to 117,000 deaths every year. Major breakthroughs in clinical research of the past decades transformed the diagnosis and treatment of MM improving the survival rates and overall quality of life of patients. Unfortunately, scientific advancements are not distributed equally around the globe leading to disparities in the treatment outcomes between different regions of the world. Management of MM in low- and middle-income countries represents a big challenge for healthcare providers considering the economic, technological, and infrastructural restraints in comparison to developed countries. Many standards of practice, including diagnostic tools and therapeutic regimens, are not available in developing regions of the world. As an example of an upper-middle-income country, Armenia has been witnessing considerable progress in the diagnosis and treatment of MM, including but not limited to the establishment of autologous stem cell transplant (ASCT), accessibility to modern anti-myeloma medications, and improved diagnostic and monitoring workup. Despite significant improvements, there is still a need for refinement in the management of MM. The aim of this review article is to discuss the latest developments and the current diagnosis and treatment of MM in Armenia as an example of a resource-limited region.

Using allocative efficiency analysis to inform health benefits package design for progressing towards Universal Health Coverage: Proof-of-concept studies in countries seeking decision support.

BACKGROUND: Countries are increasingly defining health benefits packages (HBPs) as a way of progressing towards Universal Health Coverage (UHC). Resources for health are commonly constrained, so it is imperative to allocate funds as efficiently as possible. We conducted allocative efficiency analyses using the Health Interventions Prioritization tool (HIPtool) to estimate the cost and impact of potential HBPs in three countries. These analyses explore the usefulness of allocative efficiency analysis and HIPtool in particular, in contributing to priority setting discussions. METHODS AND FINDINGS: HIPtool is an open-access and open-source allocative efficiency modelling tool. It is preloaded with publicly available data, including data on the 218 cost-effective interventions comprising the Essential UHC package identified in the 3rd Edition of Disease Control Priorities, and global burden of disease data from the Institute for Health Metrics and Evaluation. For these analyses, the data were adapted to the health systems of Armenia, Côte d'Ivoire and Zimbabwe. Local data replaced global data where possible. Optimized resource allocations were then estimated using the optimization algorithm. In Armenia, optimized spending on UHC interventions could avert 26% more disability-adjusted life years (DALYs), but even highly cost-effective interventions are not funded without an increase in the current health budget. In Côte d'Ivoire, surgical interventions, maternal and child health and health promotion interventions are scaled up under optimized spending with an estimated 22% increase in DALYs averted-mostly at the primary care level. In Zimbabwe, the estimated gain was even higher at 49% of additional DALYs averted through optimized spending. CONCLUSIONS: HIPtool applications can assist discussions around spending prioritization, HBP design and primary health care transformation. The analyses provided actionable policy recommendations regarding spending allocations across specific delivery platforms, disease programs and interventions. Resource constraints exacerbated by the COVID-19 pandemic increase the need for formal planning of resource allocation to maximize health benefits.

Transgenerational Trauma and Mental Health Needs among Armenian Genocide Descendants.

The trauma of a genocide can be transmitted to subsequent generations though familial mental health, sociopolitical trauma, and cultural narratives, thereby impacting mental health and well-being. Understanding specific mechanisms that are unique to each ethnic group impacted by genocide illuminates cultural, sociopolitical, and individual factors related to the transmission. For the Armenian community, the unresolved historical loss of the Armenian Genocide of 1915, with the threat of acculturation for such a large diasporic population, a continued denial by the perpetrators, as well as subsequent generations' refugee experiences, may further exasperate the impact of transgenerational trauma from the genocide. This literature review explores the mental health needs of Armenian youth in the current sociopolitical context and provides implications for how schools and communities may use this knowledge to inform supports that center Armenian community healing. Future directions for research are also discussed.

THE USE OF THE ARMENIAN VERSION OF COMQ-12 QUESIONNAIRE FOR QUALITY OF LIFE ASSESSMENT IN TEENAGERS WITH OTITIS MEDIA.

The aim of the study was to validate the Armenian language version of the COMQ-12 quality of life (QL) instrument among teenagers with chronic otitis media (COM). A case-control study was conducted in 350 teenagers aged 16 to 18 years: the case group of patients with COM (120) and the control group of practically healthy teenagers (230). Study participants' quality of life was assessed by specific COMQ-12 (Chronic Otitis Media Questionnaire-12) and not specific SF-36 (The Short Form-36) questionnaires. Hospital Anxiety and Depression Scale (HADS) instrument has been used to assess the effect of COM on the emotional field of the patients. The expressiveness of cognitive function was assessed by the Montreal Cognitive Assessment test (MoCA). According to the research data among risk factors which had statistically significant influence on COM morbidity rate in teenagers were: presence of disabled person in a family (OR=8,8), unfavorable psychological atmosphere in the family (OR=2,9), presence of accompanying chronic disease in teenagers (OR=2,1) and presence of chronic ENT diseases in parents (OR=2,1). Use of the non-specific questionnaire showed that COM mostly influences on psychological component of Mental Healthdomain of QL, as well as Social Functioning. The average score of QL in the group with COM was 28,3, and in the practically healthy group it was 3,4 (Mann-Whitney U=1725,0; р <0,01). COM mostly influences on the following scales of the COMQ-12 questionnaire: Q-3, Q-4, Q-6, Q-8, Q-9 Q-12.There was a statistically significant correlation between the parameters of COMQ-12 and SF 36 questionnaires for the following questions: Q-4, Q-6, Q-8, Q-9, Q-12. Anxiety and depression symptoms were recorded in 52,2% of teenagers in the group of cases and in 13,4% in the control one (p<0.001). The correlation analysis has shown that among the patients with COM there is an association between anxious-depressive disorders and cognitive dysfunction. COMQ-12 questionnaire used for the first time in Armenia population among the teenagers with COM showed high reliability, internal consistency and construct validity.