Training of psychiatrists in Eastern Europe: problems and solutions.

The analysis of the training of mental health professionals in WPA Zone 10 was performed based on a comparison of data of a specifically designed questionnaire comprising 29 questions on undergraduate education, 34 questions on postgraduate training, and six questions on training of general practitioners to work in the field of mental health. The project involved National Associations of psychiatrists of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, Uzbekistan, and Ukraine. This comparison provides an opportunity to identify ways to improve psychiatric training in Eastern Europe.

The TB Portals: an Open-Access, Web-Based Platform for Global Drug-Resistant-Tuberculosis Data Sharing and Analysis.

The TB Portals program is an international consortium of physicians, radiologists, and microbiologists from countries with a heavy burden of drug-resistant tuberculosis working with data scientists and information technology professionals. Together, we have built the TB Portals, a repository of socioeconomic/geographic, clinical, laboratory, radiological, and genomic data from patient cases of drug-resistant tuberculosis backed by shareable, physical samples. Currently, there are 1,299 total cases from five country sites (Azerbaijan, Belarus, Moldova, Georgia, and Romania), 976 (75.1%) of which are multidrug or extensively drug resistant and 38.2%, 51.9%, and 36.3% of which contain X-ray, computed tomography (CT) scan, and genomic data, respectively. The top Mycobacterium tuberculosis lineages represented among collected samples are Beijing, T1, and H3, and single nucleotide polymorphisms (SNPs) that confer resistance to isoniazid, rifampin, ofloxacin, and moxifloxacin occur the most frequently. These data and samples have promoted drug discovery efforts and research into genomics and quantitative image analysis to improve diagnostics while also serving as a valuable resource for researchers and clinical providers. The TB Portals database and associated projects are continually growing, and we invite new partners and collaborations to our initiative. The TB Portals data and their associated analytical and statistical tools are freely available at https://tbportals.niaid.nih.gov/.

Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study.

BACKGROUND: One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions. METHODS: A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors. RESULTS: Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities. CONCLUSION: The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need.

[Taxonomic status of the Artashat virus (ARTSV) (Bunyaviridae, Nairovirus) isolated from the ticks Ornithodoros alactagalis Issaakjan, 1936 and O. verrucosus Olenev, Sassuchin et Fenuk, 1934 (Argasidae Koch, 1844) collected in Transcaucasia].

The Artashat virus (ARTSV) was originally isolated fom the Ornithodoros alactagalis Issaakjan, 1936 (Argasidae Koch, 1844), which were collected in the burrow of small five-toed jerboa (Allactaga elater Lichtenstein, 1825) in Armenia in 1972. Later, the ARTSV was isolated from the O. verrucosus Olenev, Sassuchin et Fenuk, 1934 collected in the burrows of Persian gerbil (Meriones persicus Blanford, 1875) in Azerbaijan. Based on the virion morphology, the ARTSV was assigned to the Bunyaviridae viruses. In this work, the ARTSV genome was partially sequenced (GenBank ID: KF801650) and it was shown that the ARTSV is a new member of the Nairovirus genus. ARTSV has from 42% (Issyk-Kul virus) to 58% (Raza virus, Hughes group) similarity with the nairoviruses for nucleotide sequence of part of RNA-dependent RNA-polymerase (RdRp). The similarity on the amino acid level is 65-70%. Low level of homology and the equidistant position of the ARTSV on phylogenetic tree indicate that the ARTSV is a new prototype species of the Nairovirus genus (Bunyaviridae) forming a separate phylogenetic branch.

The Caucasus as an asymmetric semipermeable barrier to ancient human migrations.

The Caucasus, inhabited by modern humans since the Early Upper Paleolithic and known for its linguistic diversity, is considered to be important for understanding human dispersals and genetic diversity in Eurasia. We report a synthesis of autosomal, Y chromosome, and mitochondrial DNA (mtDNA) variation in populations from all major subregions and linguistic phyla of the area. Autosomal genome variation in the Caucasus reveals significant genetic uniformity among its ethnically and linguistically diverse populations and is consistent with predominantly Near/Middle Eastern origin of the Caucasians, with minor external impacts. In contrast to autosomal and mtDNA variation, signals of regional Y chromosome founder effects distinguish the eastern from western North Caucasians. Genetic discontinuity between the North Caucasus and the East European Plain contrasts with continuity through Anatolia and the Balkans, suggesting major routes of ancient gene flows and admixture.

Analysing compliance of cigarette packaging with the FCTC and national legislation in eight former Soviet countries.

AIM: To analyse compliance of cigarette packets with the Framework Convention on Tobacco Control (FCTC) and national legislation and the policy actions that are required in eight former Soviet Union countries. METHODS: We obtained cigarette packets of each of the 10 most smoked cigarette brands in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia and Ukraine. The packets were then analysed using a standardised data collection instrument. The analysis included the placing, size and content of health warning labels and deceptive labels (eg, 'Lights'). Findings were assessed for compliance with the FCTC and national legislation. RESULTS: Health warnings were on all packets from all countries and met the FCTC minimum recommendations on size and position except Azerbaijan and Georgia. All countries used a variety of warnings except Azerbaijan. No country had pictorial health warnings, despite them being mandatory in Georgia and Moldova. All of the countries had deceptive labels despite being banned in all countries except Russia and Azerbaijan where still no such legislation exists. CONCLUSIONS: Despite progress in the use of health warning messages, gaps still remain-particularly with the use of deceptive labels. Stronger surveillance and enforcement mechanisms are required to improve compliance with the FCTC and national legislation.

A review of the subgenus Cladoconnus Reitter of the genus Euconnus Thomson (Coleoptera: Staphylinidae: Scydmaeninae) from the Balkan Peninsula, Turkey and Caucasus.

The subgenus Cladoconnus Reitter, 1909 of the megadiverse genus Euconnus Thomson, 1859 is redescribed and revised for the Balkan Peninsula, Turkey and Caucasus. The following species are described: Euconnus (Cladoconnus) gagranicus sp. nov., E. (C.) ispartaensis sp. nov., E. (C.) meybohmi sp. nov., E. (C.) brachati sp. nov. and E. (C.) croaticus sp. nov. Lectotypes are designated for E. (C.) anatolicus Franz, 1997, E. (C.) dodecanicus Franz, 1966, E. (C.) robustus Reitter, 1882 and E. (C.) winneguthi Apfelbeck, 1907. Euconnus (Cladoconnus) major (Motschulsky, 1851) is placed as a junior synonym of E. (C.) motschulskii (Motschulsky, 1837). Two species groups, schlosseri and denticornis are defined; identification keys to the groups and species are given.

New chronology for the Middle Palaeolithic of the southern Caucasus suggests early demise of Neanderthals in this region.

Neanderthal populations of the southern and northern Caucasus became locally extinct during the Late Pleistocene. The timing of their extinction is key to our understanding of the relationship between Neanderthals and anatomically modern humans (AMH) in Eurasia. Recent re-dating of the end of the Middle Palaeolithic (MP) at Mezmaiskaya Cave, northern Caucasus, and Ortvale Klde, southern Caucasus, suggests that Neanderthals did not survive after 39 ka cal BP (thousands of years ago, calibrated before present). Here we extend the analysis and present a revised regional chronology for MP occupational phases in western Georgia, based on a series of model-based Bayesian analyses of radiocarbon dated bone samples obtained from the caves of Sakajia, Ortvala and Bronze Cave. This allows the establishment of probability intervals for the onset and end of each of the dated levels and for the end of the MP occupation at the three sites. Our results for Sakajia indicate that the end of the late Middle Palaeolithic (LMP) and start of the Upper Palaeolithic (UP) occurred between 40,200 and 37,140 cal BP. The end of the MP in the neighboring site of Ortvala occurred earlier at 43,540-41,420 cal BP (at 68.2% probability). The dating of MP layers from Bronze Cave confirms that it does not contain LMP phases. These results imply that Neanderthals did not survive in the southern Caucasus after 37 ka cal BP, supporting a model of Neanderthal extinction around the same period as reported for the northern Caucasus and other regions of Europe. Taken together with previous reports of the earliest UP phases in the region and the lack of archaeological evidence for an in situ transition, these results indicate that AMH arrived in the Caucasus a few millennia after the Neanderthal demise and that the two species probably did not interact.

Geographic patterns of histone H1 encoding genes allelic variation in Aegilops tauschii Coss. (Poaceae).

An electrophoretic analysis of histone H1 of Aegilops tauschii was carried out using the collection of 303 accessions (156 of ssp. tauschii and 147 of ssp. stangulata) representing all the species range. Three, four and six allelic variants were found for Hst1, Hst2 and Hst3 locus, respectively. The level of histone H1 allelic variability in ssp. strangulata was considerably higher than in ssp. tauschii. Expected heterozygosity (H(E)) for the loci Hst1, Hst2 and Hst3 made up 0.066, 0.484 and 0.224 respectively in ssp. strangulata vs. 0.024, 0.051 and 0.214 in ssp. tauschii. Besides the most common haplotype, Hst1 (1000), Hst2 (1000), Hst3 (1000), five other haplotypes with frequencies of occurrence higher than 0.02 were found in ssp. strangulata, and only one such haplotype--in ssp. tauschii. The most part of histone H1 variation in ssp. tauschii was in the western part of the area. In ssp. strangulata, the alleles Hst2 (988) and Hst2 (973) were found only in Caucasia, and the allele Hst1 (1043)--only in Precaspian Iran and south-eastern Azerbaijan. Histone H1 variation patterns in Ae. tauschii are very similar to those of non-coding sequences of chloroplast DNA. Therefore, histone H1 allelic variation in this species seems to be mostly neutral. Nevertheless, the evidences were pointed out, revealing that some part of variation at Hst2 locus in ssp. strangulata could be adaptive. It seems that Hst2 (1026) allele is disadvantageous in western Precaspian Iran, the region with the high annual rainfall, and being eliminated by natural selection.

Patterns of public support for price increases on alcohol in the former Soviet Union.

AIMS: To measure levels of public support for price increases on beer and spirits in nine former Soviet Union countries and to examine the characteristics influencing such support. METHODS: Cross-sectional surveys were conducted in 2010 with 18,000 respondents aged 18+ in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. Descriptive and multivariate logistic regression analyses were used. RESULTS: The lowest level of support for price increases on beer were in Georgia (men 5%, women 9%) and Armenia (men 5%, women 11%); and the highest were in Kyrgyzstan (men 30%, women 38%), Azerbaijan (men 27%, women 37%) and Russia (men 23%, women 34%). The lowest levels of support for price increases on spirits were Armenia (men 8%, women 14%) and Georgia (men 14%, women 21%); and the highest were in Kyrgyzstan (men 38%, 47% women) and Moldova (men 36%, women 43%). Characteristics associated with supporting price increases included gender (women), higher education, good economic situation, lower alcohol consumption and greater knowledge of harmful alcohol behaviour. CONCLUSION: Alcohol price increases are an effective means to reduce hazardous alcohol use. Despite opposition in some groups, there is evidence of public support for alcohol price increases in the study countries.

[Ways of the fleas (Siphonaptera) fauna formation in the Caucasus].

Fleas fauna of the Caucasus is considered, possible ways of its formation are discussed. Caucasian fleas belong to 155 species and 40 genera; 23 species are endemics. Hypothesis on Western Palearctic and Eastern Palearctic sources of the Caucasian fleas' fauna formation are proposed.

[The spread and epidemiological value of mosquitoes (Diptera, Psichodidae, Phlebotominae) of the Caucasus].

The Caucasus mosquito fauna was studied on the basis of the papers published in the 20th century. Due to the new classification developed by M.M. Artemyeva, the presence of 17 mosquito species: P.papatasi, P.sergenti, P.caucasicus, P.alexandri, P.jacusieli, P.kandelakii, P.neglectus, P.per-filiewi, P.tobbi, P.transcaucasicus, P.wenyoni, P.balcanicus, P.brevis, P.halepensis, S.dentate dentate, S.palestinensis, and S.hodsoni pawlowskyi should be considered most significant. The ecology of the mosquito species that are of medical importance is described. Maps of the spread of the mosquitoes that are of epidemiological importance have been complied on the basis of the materials by different authors on the registration of specific mosquito species in the human settlements of the Transcaucasia and North Caucasus. The spread of mosquitoes in the North Caucasus remains inadequately studied today.

Revealing the stygobiont and crenobiont Mollusca biodiversity hotspot in the Caucasus: Part III. Revision of stygobiont microsnails (Mollusca: Gastropoda: Hydrobiidae) from the Russian part of Western Transcaucasia, with the description of new taxa.

A taxonomic revision of the stygobiont microsnails from north-western Transcaucasia (Krasnodar Krai, Russia) is presented. Two new generaSchapsugia gen. n. and Tachira gen. n. are established. It is shown that the genus Paladilhiopsis does not occur in this area, and the snails previously assigned to this genus belong to Schapsugia gen. n. Two nominal species Paladilhiopsis orientalis Starobogatov, 1962, and P. subovata Starobogatov, 1962 are considered junior synonyms of Sch. pulcherrima (Starobogatov, 1962), based on a re-examination of their conchological variation. In addition, two more species of Schapsugia are described: Sch. kudepsta sp. nov. and Sch. occultata sp. nov. The anatomical structure of another species, Geyeria valvataeformis Starobogatov, 1962 was studied for the first time. It is revealed that it should be placed in a separate genus (Tachira gen. n.). Thus, the previously proposed placement of the microsnails from north-western Transcaucasia in hydrobiid genera from the Balkan Peninsula (Geyeria, Paladilhiopsis) is rejected.

Prevalence of HIV, HCV and HBV in Central Asia and the Caucasus: A systematic review.

BACKGROUND: Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) are substantial public health threats in the region of Central Asia and the Caucasus, where the prevalence of these infections is currently rising. METHODS: A systematic review of MEDLINE, Embase and PsycINFO was conducted with no publication date or language restrictions through October 2019. Additional data were also harvested from national surveillance reports, references found in discovered sources, and other "grey" literature. It included studies conducted on high-risk populations (people who inject drugs (PWID), female sex workers (FSW), men who have sex with men (MSM), prisoners, and migrants) in Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan; and the Caucasus: Armenia, Azerbaijan, Georgia, and Northern Caucasus region of the Russian Federation. RESULTS: Wide ranges were noted for HIV prevalence: PWID 0-30.1%, MSM 0-25.1%, prisoners 0-22.8%, FSW 0-10.0%, and migrants 0.06-1.5%, with the highest prevalence of these high-risk groups reported in Kazakhstan (for PWID), Georgia (for MSM and prisoners) and Uzbekistan (for migrants). HCV prevalence also had a wide range: PWID 0.3-92.1%, MSM 0-18.9%, prisoners 23.8-49.7%, FSW 3.3-17.8%, and migrants 0.5-26.5%, with the highest prevalence reported in Georgia (92.1%), Kyrgyzstan (49.7%), and migrants from Tajikistan and Uzbekistan (26.5%). Similarly, HBV prevalence had a wide range: PWID 2.8-79.7%, MSM 0-22.2%, prisoners 2.7-6.2%, FSW 18.4% (one study), and migrants 0.3-15.7%. CONCLUSION: In Central Asia and the Caucasus, prevalence of HIV, HCV and HBV remains exceedingly high among selected populations, notably PWID and MSM.

Review of the genus Saropogon Loew, 1847 (Diptera: Asilidae) from Russia, Transcaucasia and Central Asia, with description of three new species.

Nine species of the genus Saropogon Loew, 1847 are reviewed. Saropogon aliyevi Sakhvon sp. nov. (Azerbaijan), S. astakhovi Sakhvon sp. nov. (Armenia) and S. tajikistanensis Sakhvon sp. nov. (Tajikistan) are described and illustrated. The distribution of some species is increased. Saropogon pittoproctus Loew, 1873 is recorded from Russia (Kalmykia) for the first time. Records of prey of some of the Saropogon species are presented. An identification key to males of the species is given.

Genetic structure of Aegilops cylindrica Host in its native range and in the United States of America.

Chloroplast and nuclear microsatellite markers were used to study genetic diversity and genetic structure of Aegilops cylindrica Host collected in its native range and in adventive sites in the USA. Our analysis suggests that Ae. cylindrica, an allotetraploid, arose from multiple hybridizations between Ae. markgrafii (Greuter) Hammer. and Ae. tauschii Coss. presumably along the Fertile Crescent, where the geographic distributions of its diploid progenitors overlap. However, the center of genetic diversity of this species now encompasses a larger area including northern Iraq, eastern Turkey, and Transcaucasia. Although the majority of accessions of Ae. cylindrica (87%) had D-type plastomes derived from Ae. tauschii, accessions with C-type plastomes (13%), derived from Ae. markgrafii, were also observed. This corroborates a previous study suggesting the dimaternal origin of Ae. cylindrica. Model-based and genetic distance-based clustering using both chloroplast and nuclear markers indicated that Ae. tauschii ssp. tauschii contributed one of its D-type plastomes and its D genome to Ae. cylindrica. Analysis of genetic structure using nuclear markers suggested that Ae. cylindrica accessions could be grouped into three subpopulations (arbitrarily named N-K1, N-K2, and N-K3). Members of the N-K1 subpopulation were the most numerous in its native range and members of the N-K2 subpopulation were the most common in the USA. Our analysis also indicated that Ae. cylindrica accessions in the USA were derived from a few founder genotypes. The frequency of Ae. cylindrica accessions with the C-type plastome in the USA (approximately 24%) was substantially higher than in its native range of distribution (approximately 3%) and all C-type Ae. cylindrica in the USA except one belonged to subpopulation N-K2. The high frequency of the C-type plastome in the USA may reflect a favorable nucleo-cytoplasmic combination.

Evolutionary history and postglacial colonization of an Asian pit viper (Gloydius halys caucasicus) into Transcaucasia revealed by phylogenetic and phylogeographic analyses.

It has been generally acknowledged that glacial climates at the time of the Pleistocene altered the patterns of species distributions, prompting latitudinal and altitudinal distribution shifts in several species, including poikilothermic species commonly known for their thermal sensitivity. However, the historical phylogeographic patterns of such species have remained largely unknown. Here, we present the historical biogeographic, phylogenetic, and phylogeographic relationships of the Caucasian pit viper, G. h. caucasicus, based on two mtDNA (cyt b and ND4) and one nDNA (c-mos) genes. This pit viper represents the westernmost member of the Crotalinae subfamily in the Palearctic and occurs in a variety of habitats, from 30 m to 3,000 m above sea level. In Iran, it is distributed on the northern and southern slopes of the Alborz Mountains, rendering it a target for phylogenetic and phylogeographic studies of a terrestrial poikilothermic animal. Our study identified four Iranian lineages of G. h. caucasicus along the northeastern to northwestern slopes of the Alborz Mountains and southern Azerbaijan (Talysh Mountains). Diversification of the Iranian lineages highlights population expansion and subsequent isolation into four plausible refugial areas during the Quaternary paleo-climatic oscillations, confirmed by our molecular dating and historical biogeographic analyses. The results of coalescence-based simulations support the incursion of the species from northeastern Iran to the western end of the Alborz, and then toward Transcaucasia via two directions: northern and southern slopes of the Alborz Mountains. Furthermore, our results clearly implied that G. h. caucasicus should be elevated to species rank and further referred to as G. caucasicus (Nikolsky, 1916).

Epidemiology of Taenia saginata taeniosis/cysticercosis: a systematic review of the distribution in central and western Asia and the Caucasus.

BACKGROUND: The zoonotic parasite Taenia saginata transmits between humans, the definitive host (causing taeniosis), and bovines as the intermediate host (causing cysticercosis). Central and western Asia and the Caucasus have large cattle populations and beef consumption is widespread. However, an overview of the extent of human T. saginata infection and bovine cysticercosis is lacking. This review aims to summarize the distribution of T. saginata in this region. METHODS: A systematic review was conducted, that gathered published and grey literature, and official data concerning T. saginata taeniosis and bovine cysticercosis in central and western Asia and the Caucasus published between January 1st, 1990 and December 31st, 2018. Where no data were available for a country within this period, published data from 1985-1990 were also accessed. RESULTS: From 10,786 articles initially scanned, we retrieved 98 full-text articles from which data were extracted. In addition, two unpublished datasets were provided on the incidence of human taeniosis. Data for human taeniosis and bovine cysticercosis were found for all countries except Turkmenistan. Human taeniosis prevalence varied from undetected to over 5.3%, with regional variations. Where bovine cysticercosis was detected, prevalences varied from case reports to 25%. CONCLUSIONS: The public health burden of T. saginata is assumed to be small as the parasite is of low pathogenicity to humans. However, this review indicates that infection continues to be widespread and this may result in a large economic burden, due to the resources utilized in meat inspection and condemnation or processing with subsequent downgrading of infected carcasses.

Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study.

BACKGROUND: The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance. METHODS: We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan. RESULTS: Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients. CONCLUSIONS: As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.