The antibiotic knowledge, attitudes and behaviors of patients, doctors and pharmacists in the WHO Eastern European region - a qualitative, comparative analysis of the culture of antibiotic use in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan.

BACKGROUND: To reduce antimicrobial resistance (AMR), initiatives such as surveillance activities and activities to increase knowledge about how and why antibiotics (ABs) are (mis)used are needed. More surveillance systems are in place in the WHO Western European region than in the Eastern region, and only sparse knowledge exists about the current culture of AB use in the Eastern European countries. OBJECTIVE: To investigate AB knowledge, attitudes and behaviors in countries in the WHO Eastern European region in order to identify overall similarities and differences across the region and how AB knowledge, attitudes and behavior patterns may be influenced by the national health care system. METHODS: Semi-structured interviews were conducted in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan with patients, doctors and pharmacists. In total, 80 interviews were carried out. A directed content analysis was applied, followed by a comparative analysis, identifying the similarities and differences in AB attitudes, knowledge and behaviors between the countries and discussing how the national health care systems might influence these patterns. RESULTS: Cross-national patterns were identified regarding patients seeking ABs over-the-counter (OTC), patient variations in their requests for ABs when consulting doctors, and, finally, doctors and pharmacists appearing knowledgeable about ABs and their uses, with doctors displaying careful attitudes towards AMR. Indications of national differences between the countries included the ability of patients to afford ABs, prescribing practices of doctors and pharmacist attitudes towards selling ABs without prescriptions. Multiple aspects involved in patient and pharmacist AB decision making were detected, such as various rationales involved in buying/selling ABs OTC, implying that these processes are more complex than previously reported in the literature. CONCLUSIONS: Similarities across the Eastern European region could be seen in patient needs and uses of antibiotics obtained OTC at community pharmacies, whereas doctors appeared more influenced by specific structures of the national healthcare system.

The Influence of Globalization on Adolescents' Conceptions of Self and Future Self in Rural and Urban Armenia.

Globalization is affecting the identity of adolescents worldwide. Armenia, a country beset by many challenges since 1895, remained isolated after it separated from the Soviet Union in 1991. Widespread poverty limited Armenia's access to technology until recently. This chapter reports the influence of globalization on rural and urban Armenian adolescents' selves and future selves through Internet use. Participants included 92 rural and 80 urban adolescents (Mage = 15.9 years). Using KagitÒ«ibasi's (2007) model of family change, we found that rural adolescents, who used the Internet less frequently, identified more closely with traditional cultural attitudes and reflected a family model of interdependence and a heteronomous-related self. Urban adolescents, who used the Internet more frequently, were developing global identities through their greater exposure to worldwide media, while also retaining the essence of their Armenian heritage. This research begins to fill a gap in the limited literature on human development from post-Soviet countries.

Prevalence and Predictors of Diabetes Mellitus and Hypertension in Armenian Americans in Los Angeles.

Purpose The purpose of this study was to describe the prevalence of diabetes mellitus (DM) and hypertension (HTN) along with associated risk factors among Armenian Americans living in Los Angeles. Methods After Institutional Review Board approval, a sample of 877 Armenian Americans was collected for 5 consecutive years (2011-2015) at a health fair. Collected data included: sociodemographic variables; cardiometabolic data, including systolic (SBP) and diastolic (DBP) blood pressure, glucose (Glu), and lipids; anthropometric data, including height (Ht), weight (Wt), body mass index (BMI), waist circumference (WC), and hip circumference (HC). Retrospective descriptive correlation, test of significance, and logistic regression analyses were performed. Results Findings showed that about 50% of the participants had abnormal waist/hip ratio and approximately one-quarter of the subjects had glucose levels that were indicative of high risk for DM. Logistic regression analysis revealed that high SBP ( P = .04), above normal WC ( P = .03), and high triglycerides ( P = .04) were significant in predicting DM. Moreover, age ( P =.0001), family history of cardiovascular disease ( P= .01), and above normal WC ( P = .04) were found to be significant predictors of HTN. Conclusion Waist circumference indicated to be a strong predictor for DM and HTN. Early detection and timely interventions are important to prevent DM and HTN and their associated complications. For an underserved population, health fairs become one effective avenue for screening, referral, and evaluation.

Genetic Structure of the Armenian Population.

Located at the crossroads of Europe and the Middle East, the Armenian Highland served as a transition corridor for major waves of prehistoric and historic migrations. The genetic history of Armenians as an indigenous population of the region attracts keen scientific interest to resolve the puzzle of ancient Middle Eastern populations' expansion and the spread of Indo-European languages. Here, we review the current state of studies on the genetic structure of both modern and ancient inhabitants of the Armenian Highland and outline further steps to be fulfilled in this regard.

Dental caries among children in Georgia by age, gender, residence location and ethnic group.

OBJECTIVE: To provide prevalence data for dental caries in Georgia. METHODS: This World Health Organization pathfinder survey was conducted among 1,351 (6, 12 and 15 year-old) Georgian children, representing the main ethnic groups in urban and rural locations. Caries was analysed at univariate and multivariate levels, according to age, gender, urban/rural locality and ethnic group. RESULTS: Caries experience levels among 6-year-olds were dmft = 4.57, sd 3.42 (14.8% caries-free); DMFT = 2.04 (sd 2.02) among 12-year-olds (31.1% caries-free); and DMFT = 3.51 (sd 3.14) for the 15-year-olds (17.7% caries-free). Urban children at ages 6 and 12 years were more likely to be caries-free and have both lower levels of caries-experience and higher levels of filled or restored teeth. In multivariate regression analyses, most age groups showed a significant contribution from residence location. No differences were found by age and no consistent differences were detected by ethnic group. CONCLUSION: These data should provide the baseline for formulating and conducting public oral health efforts in Georgia, with emphases on rural residence locations.

The impact of diabetes self-management education on glucose management and empowerment in ethnic Armenians with type 2 diabetes.

PURPOSE: The purpose of this study was to investigate the impact of diabetes self-management education on glycemic control and perceptions of empowerment in Armenian American immigrants diagnosed with type 2 diabetes. METHODS: A quasi-experimental pre and post design was used to investigate the impact of using education on self-management as measured by A1C levels and empowerment scores. Nine hours of diabetes self-management education classes were offered in the Armenian language to 75 clients at 2 adult health day care centers over 6 weeks. The participants were mostly first-generation Armenian immigrants aged 65 years and older. A1C results, the 8-item Diabetes Empowerment Scale (DES), and the 15-item Armenian Ethnic Orientation Questionnaire-Revised (AEOQ-R) were used to determine the impact of education on self-care management. RESULTS: After institutional review board approval was obtained, 75 participants completed the study. A paired t test indicated that the postintervention mean A1C level was significantly lower than the preintervention mean A1C level. The postintervention mean DES score was significantly greater than the preintervention mean DES score. No mediating effects of age, gender, acculturation, and number of years with the disease were identified for either A1C or DES score. CONCLUSIONS: The findings demonstrate the efficacy of the diabetes self-management education classes in improving diabetes self-care management skills.

Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients: a cross-sectional study with regression analysis of ethnic Swedish and immigrant women.

BACKGROUND: Determinants of vitamin D status measured as 25-OH-vitamin D in blood are exposure to sunlight and intake of vitamin D through food and supplements. It is unclear how large the contributions are from these determinants in Swedish primary care patients, considering the low radiation of UVB in Sweden and the fortification of some foods. Asian and African immigrants in Norway and Denmark have been found to have very low levels, but it is not clear whether the same applies to Swedish patients. The purpose of our study was to identify contributors to vitamin D status in Swedish women attending a primary health care centre at latitude 60°N in Sweden. METHODS: In this cross-sectional, observational study, 61 female patients were consecutively recruited between January and March 2009, irrespective of reason for attending the clinic. The women were interviewed about their sun habits, smoking, education and food intake at a personal appointment and blood samples were drawn for measurements of vitamin D and calcium concentrations. RESULTS: Plasma concentration of 25-OH-vitamin D below 25 nmol/L was found in 61% (19/31) of immigrant and 7% (2/30) of native women. Multivariate analysis showed that reported sun holiday of one week during the last year at latitude below 40°N with the purpose of sun-bathing and native origin, were significantly, independently and positively associated with 25-OH-vitamin D concentrations in plasma with the strongest association for sun holiday during the past year. CONCLUSIONS: Vitamin D deficiency was common among the women in the present study, with sun holiday and origin as main determinants of 25-OH-vitamin D concentrations in plasma. Given a negative effect on health this would imply needs for vitamin D treatment particularly in women with immigrant background who have moved from lower to higher latitudes.

[Family care provided by immigrant women and its impact on the quality of care and health]. / El cuidado familiar prestado por mujeres inmigrantes y su repercusión en la calidad del cuidado y en la salud.

OBJECTIVE: To understand the effects of care within the family provided by live-in female immigrants on elderly dependents and their families and the carers themselves in Seville (Spain). METHODS: We designed a qualitative study using in-depth interviews of key informants, immigrant care workers, elderly dependents and their families, and discussion groups composed of health professionals. The study was carried out in Seville between 2006 and 2008. The observation unit consisted of the families of elderly dependents with a live-in female immigrant care worker. The analysis units were health, care, dependence, gender, ethnicity and social class. Category analysis was carried out using QSR-NUD*ISTVivo1.3. After saturation, we triangulated among disciplines, researchers, sources and techniques to validate the results. RESULTS: The most important factors for carers' health were the migration process and care tasks. Interpersonal relationships constituted the principal factor affecting the health of all involved. CONCLUSIONS: The care tasks provided by immigrant women, together with the migration process, have an important impact on their health. Good and egalitarian interpersonal relationships are a protective factor for health.

Neolithic patrilineal signals indicate that the Armenian plateau was repopulated by agriculturalists.

Armenia, situated between the Black and Caspian Seas, lies at the junction of Turkey, Iran, Georgia, Azerbaijan and former Mesopotamia. This geographic position made it a potential contact zone between Eastern and Western civilizations. In this investigation, we assess Y-chromosomal diversity in four geographically distinct populations that represent the extent of historical Armenia. We find a striking prominence of haplogroups previously implicated with the Agricultural Revolution in the Near East, including the J2a-M410-, R1b1b1(*)-L23-, G2a-P15- and J1-M267-derived lineages. Given that the Last Glacial Maximum event in the Armenian plateau occured a few millennia before the Neolithic era, we envision a scenario in which its repopulation was achieved mainly by the arrival of farmers from the Fertile Crescent temporally coincident with the initial inception of farming in Greece. However, we detect very restricted genetic affinities with Europe that suggest any later cultural diffusions from Armenia to Europe were not associated with substantial amounts of paternal gene flow, despite the presence of closely related Indo-European languages in both Armenia and Southeast Europe.

HLA-A, HLA-B, and HLA-DRB1 allele distribution in a large Armenian population sample.

Human leukocyte antigen (HLA)-A, HLA-B, and HLA-DRB1 gene frequencies were investigated in 4279 unrelated Armenian bone marrow donors. HLA alleles were defined by using PCR amplification with sequence specific primers (PCR-SSP) high- and low-resolution kits. The aim of this study was to examine the HLA diversity at the high-resolution level in a large Armenian population sample, and to compare HLA allele group distribution in Armenian subpopulations. The most frequently observed alleles in the HLA class I were HLA-A*0201, A*0101, A*2402, A*0301, HLA-B*5101, HLA-B*3501, and B*4901. Among DRB1 alleles, high frequencies of DRB1*1104 and DRB1*1501 were observed, followed by DRB1*1101 and DRB1*1401. The most common three-locus haplotype found in the Armenian population was A*33-B*14-DRB1*01, followed by A*03-B*35-DRB1*01. Our results show a similar distribution of alleles in Armenian subpopulations from different countries, and from different regions of the Republics of Armenia and Karabagh. The low level of genetic distances between subpopulations indicates a high level of population homogeneity, and the genetic distances between Armenians and other populations show Armenians as a distinct ethnic group relative to others, reflecting the fact that Armenians have been an 'isolated population' throughout centuries. This study is the first comprehensive investigation of HLA-allele group distribution in a subset of Armenian populations, and the first to provide HLA-allele and haplotype frequencies at a high-resolution level. It is a valuable reference for organ transplantation and for future studies of HLA-associated diseases in Armenian populations.

Collective trauma transmission and traumatic reactions among descendants of Armenian refugees.

BACKGROUND: It has been suggested, mainly by case reports, that the collective trauma generated by mass calamities may be transmitted to, and have long-lasting effects on, new generations. AIMS: To investigate the psychological impact on contemporary Armenians of traumatic events suffered by Armenians during the period 1914-1918. METHODS: A descriptive, cross-sectional study investigating demographic and cultural characteristics of a population of 689 people of Armenian origin, residents of Greece and Cyprus. Subjects were recruited during a range of Armenian cultural, athletic or charitable events. The participants completed a version of the Post-Traumatic Stress Disorder (PTSD) (Self-Rating) Scale and a questionnaire including ad hoc questions regarding their relationship to the Armenian community, their attitudes and their source of information about the 1914-1918 events. RESULTS: Over a third (35.7%) of participants presented at least sub-clinical forms of such reactions during long periods of their lives. Women, older people, participants with a close relative lost during the events and those with strong connections to the Armenian community were more vulnerable. CONCLUSION: The results are indicative of a long-lasting (though gradually fading) cross-generational traumatizing effect of the discussed events. Clinicians having to deal with patients belonging to cultural or ethnic groups that suffered persecutions in the past should take into account the probable effects caused by a trauma-transmission mechanism.

Reading Mustafa Kemal Atatürk on the Armenian genocide of 1915.

The debate on where Mustafa Kemal Atatrk, the founder of modern Turkey and universally known as the "Father of the Turks," stood in regard to the colossal violence committed against Armenians during the First World War has become a fiercely contested part of the Turkish-Armenian reconciliation process, especially within the past few years. Ulgen aims to clear away the clouds of dust surrounding Kemal by delving into his texts and examining his role in the reification of Turkish denial of the destruction of Ottoman Armenians. Based on a textual analysis of his entire corpus, including Nutuk-the Great Speech of 1927 and the master-narrative of modern Turkish history and national identity-her article examines and documents how his charismatic leadership helped to consolidate both the myth of "murderous Armenians" and that of the Turks as an "oppressed nation" (mazlum millet), monumentalizing both in official Turkish historiography. Ulgen argues that Kemal's portrayal of Armenians and the Armenian Question was generally consistent across the years and in various political documents, as well as being consistent with contemporary Turkish representations of the events of 1915. What really tips the balance towards Turkish innocence in Kemal's representation of the conflict is not his framing of the issue per se but the stark difference in the rhetoric he deploys in depicting Armenian and Turkish atrocities and, hence, Armenians and Turks. The undeniable authority of this discursive regime is central to the resilience of Turkish denial today.

The prevalence of Behçet's syndrome, familial Mediterranean fever, HLA-B51 and MEFV gene mutations among ethnic Armenians living in Istanbul, Turkey.

OBJECTIVES: We investigated the prevalence of Behçet's syndrome (BS) among the ethnic Armenians in Istanbul using Familial Mediterranean Fever (FMF) as a comparator disease. We also studied HLA-B51 and MEFV mutations among a group of healthy Armenians and a non-Armenian population. METHODS: The prevalence study was conducted in 2 parts in the Armenian primary schools in Istanbul, using the enrolled students as index cases to study the core family. In Part I, a questionnaire seeking only whether either parent had previously been diagnosed as having BS or FMF by a physician was distributed to a total of 1873 index students registered at 10 schools. A total of 1380 parents filled in the questionnaire, yielding a response rate of 37% (1380 / 3746). In Part II, eight schools participated with a response rate of 83 % (1183/1428). Also, genomic DNA samples of 108 healthy (14 M/94 F) Armenians and 97 (45 M/ 52 F) non-Armenians, were studied for HLAB51 and MEFV gene mutations. RESULTS: In Part I, none of the parents turned out to have been diagnosed as BS, whereas a total of 12 / 1380 (870/105) had been diagnosed as FMF. In the second part the estimated prevalence of BS was 90 /105 and that of FMF was 760/ 105. HLA-B51 carrier rate was found to be similar between the Armenian (27%, 29/108) and the non-Armenian participants (19%, 18/97), (p=0.158). Overall carrier rate of MEFV gene mutations was significantly higher in the Armenian group (36% vs. 20%, p=0.015). CONCLUSIONS: The genetic load for FMF is considerably higher among the Armenians when compared to the load for BS among the same ethnic group. On the other hand, the rather low frequency of BS among the Armenians when compared to the frequency among the general population living in the same environment is further evidence for a genetic predisposition to BS. HLA- B51 does not seem to play a dominant role in the said predisposition. Finally, as we have used an unorthodox epidemiological methodology in data collection our results might need to be further verified by more conventional methods.

Tackling tensions and ambivalences: Armenian girls' diasporic identities in Russia.

Research on diasporic youth identities in the British and American context has stressed hybridity, heterogeneity and multiplicity. This paper draws upon ethnographic research undertaken with Armenian girls to explore some of the tensions and ambivalences of negotiating diasporic identities in the Russian context. Diasporic identities are constructed through gender, and this paper illustrates how research participants negotiate their identities in relation to both belonging to the Armenian community and wider Russian society. At the same time, this paper examines how research participants draw differently on diasporic identifications in order to overcome tensions and ambivalences in their everyday lives. The paper shows that research participants are not inclined to reject their cultural roots in favor of new hybrid identities, but are able to recognize and appropriate different cultures in their identity negotiations.

The League of Nations' rescue of Armenian genocide survivors and the making of modern humanitarianism, 1920-1927.

The essay centers of the efforts by the League of Nations to rescue women and children survivors of the 1915 Armenian Genocide. This rescue -- a seemingly unambiguous good -- was at once a constitutive act in drawing the boundaries of the international community, a key moment in the definition of humanitarianism, and a site of resistance to the colonial presence in the post-Ottoman Eastern Mediterranean. Drawing from a wide range of source materials in a number of languages, including Turkish, Armenian, and Arabic, the essay brings the intellectual and social context of humanitarianism in initiating societies together with the lived experience of humanitarianism in the places where the act took form. In so doing, it draws our attention to the proper place of the Eastern mediterranean, and its women and children, in the global history of humanitarianism. The prevailing narrative of the history of human rights places much of its emphasis on the post-World War II era, the international reaction to the Holocaust, and the founding of the United Nations. yet contemporary human rights thinking also took place within practices of humanitarianism in the interwar period, and is necessarily inseparable from the histories of refugees, colonialism, and the non-West.

Cultural appropriateness of the Family Assessment Device (FAD) in the case of ethnic Armenian adolescents in Lebanon.

BACKGROUND: The purpose of this study is to report on the cultural appropriateness of the 60-item Armenian version of the Family Assessment Device (FAD) among ethnic Armenian adolescents in the ethnically and religiously pluralist Lebanon. METHOD: A total of 558 Armenian adolescents in Grades 10, 11 and 12 completed the Armenian FAD scale and the Self-Family Closeness (SFC) scale in a randomized order. The internal consistencies and intercorrelations of the Armenian FAD domains were examined, as were their correlations with the SFC ratings. RESULTS: The Armenian FAD and its General Functioning subscale showed excellent internal consistencies (alpha = 0.89 and alpha = 0.80, respectively), whereas the reliabilities were satisfactory for the family domains of Communication and Role functioning but less than satisfactory for the Affective Responsiveness , Problem Solving, Affective Involvement and Behaviour Control domains. The Armenian FAD scale and its subscales correlated with each other and with SFC ratings (r = -0.55 for Armenian FAD scale; r = -0.57 for General Functioning), and showed sensitivity to gender differences, females reporting better family functioning than males. CONCLUSIONS: Overall, the findings support the cultural appropriateness of the 12-item Armenian FAD General Functioning subscale and its advantage over the 60-item scale. The findings also suggest the need to rethink the items of the four Armenian FAD domains with low internal consistencies for their increased cultural relevance in the case of Armenian adolescents in Lebanon.

[Refractive disorders in a group of the Lebanese population of Armenian descent: a pilot study]. / Troubles réfractifs dans un groupe de la population Libanaise d'origine Arménienne: etude pilote.

AIM: To calculate the prevalence of emmetropia, myopia, hyperopia, and amblyopia. METHOD: Cross sectional, descriptive, population-based study, studying 212 randomly selected Lebanese patients of Armenian origin, aged from 15 to 45 years, from June 1st till September 30th 2003. The patients presenting with no exclusion factors are examined, before and after cycloplegia. Mean keratometry and mean ocular axial length are measured for each eye. RESULTS: 212 patients are examined. Mean age is 33.6 years. Sex ratio F/M is 1.94. The prevalence of hyperopia, emmetropia and myopia is 14.6%, 51%, and 34.4% before cycloplegia, and 50%, 16.5% and 33.5% after cycloplegia, respectively. 14.9% of patients wearing myopic corrections were not found myopic after cycloplegia. The prevalence of amblyopia is 19.8%. Most of hyperopic patients do not wear eyeglasses (p = 0.00000101), whereas most of the myopic patients wear eyeglasses (p = 0.00000024). CONCLUSION: Prevalence of hyperopia is very high (50%) in this group of Lebanese Armenian population, as well as amblyopia (19.8%). Moreover, 6.7% of myopic patients wearing eyeglasses are not truly myopic.