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.

Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases.

Preventing zoonotic diseases requires coordinated actions by government authorities responsible for human and animal health. Constructing the frameworks needed to foster intersectoral collaboration can be approached in many ways. We highlight 3 examples of approaches to implement zoonotic disease prevention and control programs. The first, rabies control in Ethiopia, was implemented using an umbrella approach: a comprehensive program designed for accelerated impact. The second, a monkeypox program in Democratic Republic of the Congo, was implemented in a stepwise manner, whereby incremental improvements and activities were incorporated into the program. The third approach, a pathogen discovery program, applied in the country of Georgia, was designed to characterize and understand the ecology, epidemiology, and pathogenesis of a new zoonotic pathogen. No one approach is superior, but various factors should be taken into account during design, planning, and implementation.

Health research capacity building in Georgia: a case-based needs assessment.

OBJECTIVES: Research capacity building in the health sciences in low- and middle-income countries (LMICs) has typically focused on bench-science capacity, but research examining health service delivery and health workforce is equally necessary to determine the best ways to deliver care. The Republic of Georgia, formerly a part of the Soviet Union, has multiple issues within its healthcare system that would benefit from expended research capacity, but the current research environment needs to be explored prior to examining research-focused activities. The purpose of this project was to conduct a needs assessment focused on developing research capacity in the Republic of Georgia with an emphasis on workforce and network development. STUDY DESIGN: A case study approach guided by a needs assessment format. METHODS: We conducted in-country, informal, semi-structured interviews in English with key informants and focus groups with faculty, students, and representatives of local non-governmental organizations. Purposive and snowball sampling approaches were used to recruit participants, with key informant interviews scheduled prior to arrival in country. Documents relevant to research capacity building were also included. Interview results were coded via content analysis. Final results were organized into a SWOT (strengths, weaknesses, opportunities, threat) analysis format, with the report shared with participants. RESULTS: There is widespread interest among students and faculty in Georgia around building research capacity. Lack of funding was identified by many informants as a barrier to research. Many critical research skills, such as proposal development, qualitative research skills, and statistical analysis, were reported as very limited. Participants expressed concerns about the ethics of research, with some suggesting that research is undertaken to punish or 'expose' subjects. However, students and faculty are highly motivated to improve their skills, are open to a variety of learning modalities, and have research priorities aligned with Georgian health needs. CONCLUSIONS: This study's findings indicate that while the Georgian research infrastructure needs further development, Georgian students and faculty are eager to supplement its gaps by improving their own skills. These findings are consistent with those seen in other developing country contexts.

Identity processes and statuses in post-Soviet Georgia: Exploration processes operate differently.

Identity formation is one of the main developmental tasks of emerging adulthood. Based on quantitative data on a five-dimensional model of identity formation, we concluded that the identity formation process has some different features in the Republic of Georgia than it does in many Western countries. Results obtained from young Georgian adults (N = 295, 82.6% female) yielded four exploration processes instead of three, which is in line with the recent Swiss findings. A key difference between Georgia and the Western contexts, however, is that exploration in breadth is highly correlated with ruminative exploration. Cluster analysis, which produced six identity clusters, also supported this pattern. Achievement, the most adjusted cluster in Western contexts, was relatively low on exploration in breadth. We discuss ways in which the Georgian transition from Soviet communism to a more globalized society may contribute to limited opportunities for identity exploration and may add some tension to the identity development process.

Sociodemographic and Occupational Factors Associated with Low Early Uptake of COVID-19 Vaccine in Hospital-Based Healthcare Workers, Georgia, March-July 2021.

In Georgia, an upper-middle income European country, the COVID-19 vaccine rollout began on 15 March 2021 with health workers (HWs), a priority group for vaccination. We assessed the factors associated with COVID-19 vaccination among HWs at six large hospitals in the early stages of the vaccine rollout (March−July 2021). Among 1533 HWs, 274 (17.9%) had received one dose of the COVID-19 vaccine. Strong independent predictors of early vaccine uptake were age > 40 years, especially 50−59 years old (aOR 2.40, 95% CI 1.50−3.88), considering the vaccine as "somewhat effective" or "very effective" rather than "not effective" (aOR 6.33, 95% CI 2.29−26.3 and aOR 10.9, 95% CI 3.88−45.70, respectively), and previous vaccination against seasonal influenza (aOR 2.98, 95% CI 2.19−4.08). Previous SARS-CoV-2 infection was negatively associated with receiving the vaccine (aOR 0.6, 95% CI 0.40−0.80). Compared to physicians, nurses/midwives (aOR 0.22, 95% CI 0.15−0.32), administrative staff (aOR 0.36, 95% CI 0.22−0.56), and ancillary staff (aOR 0.07, 95% CI 0.04−0.15) were less likely to have received the COVID-19 vaccine. Tailoring the COVID-19 vaccine communications campaign to younger and non-physician HWs, and emphasizing the benefits of the COVID-19 vaccine, could help further increase vaccine coverage among HWs in Georgia.

A transdiagnostic psychosocial prevention-intervention service for young people in the Republic of Georgia: early results of the effectiveness study.

Background: The decade between the ages of 14 and 25 is a particularly vulnerable period for the development of mental health problems, especially of common mental disorders. Mental health and psychosocial prevention and support services for young people in the Republic of Georgia have been extremely limited, leaving a wide treatment and care gap. Club Synergy was designed as an innovative, pragmatic solution that is responsive to the needs of young people and incorporates all necessary levels of care required (prevention, early identification & intervention, and treatment) into a single, trauma-informed service that uses a transdiagnostic approach. This paper presents preliminary findings from the pilot phase of establishing and running the service. Aim: To examine the characteristics of young people presenting to Club Synergy and the effectiveness of contact with the service. Methods: Quantitative evaluation of a consecutive series of young people seen by Club Synergy between November 2019 and July 2020. Demographic information was analysed using descriptive statistics. Pre-post outcomes for anxiety (GAD-7), depression (PHQ-9) and health-related quality of life (EQ-5D-5L) were analysed using the Wilcoxon signed-rank test. Results: Hundred and seventy-four young people were included. The majority (68.9%) self-referred, with referral from The Ministry of Justice due to conflict with law (23%) accounting for most of the other young people seen. Emotional disturbance (73.6%), anxiety (60.3%), problems in interpersonal relationships (57.5%) and low mood (49.4%) were the commonest presenting symptoms. Seventy-three per cent reported 4 or more adverse childhood experiences. After engaging in transdiagnostic modules, median baseline scores for depression and anxiety reduced by 40% and 45%, respectively, and self-rated health improved by 14%. Conclusions: Preliminary analysis indicates that Club Synergy's trauma-informed model of care, based on a transdiagnostic approach, has the potential to provide an effective service to young people in Georgia at risk of developing and with mental health problems. HIGHLIGHTS: This pragmatic study of a newly established mental health service for young people in Georgia suggests that a trauma-informed approach, using transdiagnostic modules, has the potential to effectively prevent and treat common mental health presentations.

Unity in diversity-food plants and fungi of Sakartvelo (Republic of Georgia), Caucasus.

BACKGROUND: The Republic of Georgia is part of the Caucasus biodiversity hotspot, and human agricultural plant use dates back at least 6000 years. Over the last years, lots of ethnobotanical research on the area has been published. In this paper, we analyze the use of food plants in the 80% of Georgia not occupied by Russian forces. We hypothesized that (1) given the long tradition of plant use, and the isolation under Soviet rule, plant use both based on home gardens and wild harvesting would be more pronounced in Georgia than in the wider region, (2) food plant use knowledge would be widely and equally spread in most of Georgia, (3) there would still be incidence of knowledge loss despite wide plant use, especially in climatically favored agricultural regions in Western and Eastern Georgia. METHODS: From 2013 to 2019, we interviewed over 380 participants in all regions of Georgia not occupied by Russian forces and recorded over 19,800 mentions of food plants. All interviews were carried out in the participants' homes and gardens by native speakers of Georgian and its dialects (Imeretian, Rachian, Lechkhumian, Tush, Khevsurian, Psavian, Kakhetian), other Kartvelian languages (Megrelian, Svan) and minority languages (Ossetian, Ude, Azeri, Armenian, Greek). RESULTS: The regional division was based primarily on historic provinces of Georgia, which often coincides with the current administrative borders. The total number of taxa, mostly identified to species, including their varieties, was 527. Taxonomically, the difference between two food plant groups-garden versus wild-was strongly pronounced even at family level. The richness of plant families was 65 versus 97 families in garden versus wild plants, respectively, and the difference was highly significant. Other diversity indices also unequivocally pointed to considerably more diverse family composition of wild collected versus garden plants as the differences between all the tested diversity indices appeared to be highly significant. The wide use of leaves for herb pies and lactofermented is of particular interest. Some of the ingredients are toxic in larger quantities, and the participants pointed out that careful preparation was needed. The authors explicitly decided to not give any recipes, given that many of the species are widespread, and compound composition-and with it possible toxic effects-might vary across the distribution range, so that a preparation method that sufficiently reduces toxicity in the Caucasus might not necessary be applicable in other areas. CONCLUSIONS: Relationships among the regions in the case of wild food plants show a different and clearer pattern. Adjacent regions cluster together (Kvemo Zemo Racha, and Zemo Imereti; Samegrelo, Guria, Adjara, Lechkhumi and Kvemo and Zemo Svaneti; Meskheti, Javakheti, Kvemo Kartli; Mtianeti, Kakheti, Khevsureti, Tusheti. Like in the case of the garden food plants, species diversity of wild food plants mentioned varied strongly. Climate severity and traditions of the use of wild food plants might play role in this variation. Overall food plant knowledge is widely spread all-across Georgia, and broadly maintained.

Comprehensive Women-Centered Treatment for Psychoactive Substance Use in the Republic of Georgia: Outcomes of a Randomized Clinical Trial.

This study aimed to assess the impact of a culturally sensitive, comprehensive women-centered intervention on psychoactive substance use among women in the Republic of Georgia. Study participants included 128 women who had injected psychoactive substance(s) in the past 30 days and had enrolled in a randomized controlled trial that compared Reinforcement Based Treatment and the Women's CoOp (RBT+WC) to usual care (UC). RBT+WC provided a structured 12-session intervention designed to reduce HIV/HCV risk and psychoactive substance and alcohol use, and to improve mental and physical health; whereas UC provided information booklets on the same topics and case management for 12 sessions. Urine drug screening was conducted at baseline, treatment completion, and 3-month follow-up. The findings showed that RBT+WC was not more effective than UC, although both treatments positively impacted opioid, benzodiazepine, and amphetamine/methamphetamine use. The findings suggest that RBT+WC represents a promising comprehensive women-centered intervention for reducing substance use and HIV risks for Georgian women who use substances.

Examining the complementarity of 'children's rights' and 'bioethics' moral frameworks in pediatric health care.

The United Nations Convention on the Rights of the Child has inspired numerous initiatives to recognize children's health-related rights. Whereas children's rights have served as the dominant moral framework for child health concerns in Europe, pediatric bioethics has emerged as the principal framework used in North America. Despite their similarities, these two frameworks differ significantly. Children's rights initiatives tend to be universalist, highlighting substantive standards for all children, while pediatric bioethics has developed norms, models, and procedures for the ethical analysis and management of individual cases. The aim of this article is to critically examine the respective contributions and intersections of children's rights and pediatric bioethics moral frameworks in child health. We describe our collaboration bridging our work with these two frameworks to address pediatric health-care concerns in the Republic of Georgia. We conclude with recommendations for how the complementarity of these two frameworks can be further bridged and promoted internationally.

A comparative ethnobotany of Khevsureti, Samtskhe-Javakheti, Tusheti, Svaneti, and Racha-Lechkhumi, Republic of Georgia (Sakartvelo), Caucasus.

BACKGROUND: The Republic of Georgia (Sakartvelo in Georgian language) is part of the Caucasus biodiversity hotspot, and human agricultural plant use dates bat at least 6000 years. However, little ethnobiological research has been published from the region since the 1940s. Given the lack of recent research in the region, the present study we report on plant uses in Skartvelo (Republic of Georgia), Caucasus. We hypothesized that, (1) given the long tradition of plant use, and the isolation under Soviet rule, plant use both based on homegardens and wild harvesting would be more pronounced in Georgia than in the wiser region, (2) the Soviet occupation would have had broad influence on plant use, and (3) there would still be incidence of knowledge loss despite wide plant use. METHODS: Fieldwork was conducted in Khevsureti, Samtskhe-Javakheti, Tusheti, Svaneti, and Racha in July-August 2013, July-August 2014, and September-October 2015. Interviews using semi-structured questionnaires were conducted with 170 participants (80 women and 90 men) after obtaining their oral prior informed consent. All interviews were carried out in the participants' homes and gardens by native speakers of Georgian and its local dialects (Svan, Tush, Khevsur, Psav), or, where participants spoke these as their native language, Armenian, Russian, or Greek. RESULTS: In the present study we encountered 480 plant species belonging to 249 genera of 95 families being used in the research region. The highest number of species and of unique species were reported from the remote Tusheti-Khevsureti region. Informant consensus and number of use reports were highest for each region in the food and medicinal use categories. Of the 480 plants being used in the research region 282 species were exclusively wild-harvested, 103 were grown in homegardens, and 84 were both grown in gardens and sourced in the wild. CONCLUSIONS: Plant species, and uses, found in our study, both for Georgia in general, as well as for its regions, showed clear relations to the wider Caucasus - Asia Minor - Balkans cultural complex. However, plant use in Georgia was much more diverse than reported in other studies from Eurasia.

Comparative Proteomic Studies of Yersinia pestis Strains Isolated from Natural Foci in the Republic of Georgia.

Yersinia pestis, the causative agent of plague, is a highly virulent bacterium responsible for millions of human deaths throughout history. In the last decade, two natural plague foci have been described in the Republic of Georgia from which dozens of Y. pestis strains have been isolated. Analyses indicate that there are genetic differences between these strains, but it is not known if these differences are also reflected in protein expression. We chose four strains of Y. pestis (1390, 1853, 2944, and 8787) from the National Center for Disease Control and Public Health collection for proteomic studies based on neighbor-joining tree genetic analysis and geographical loci of strain origin. Proteomic expression was analyzed using two-dimensional gel electrophoresis and mass spectrometry. Select Y. pestis strains were grown under different physiological conditions and their proteomes were compared: (1) 28°C without calcium; (2) 28°C with calcium; (3) 37°C without calcium; and (4) 37°C with calcium. Candidate proteins were identified and the differences in expression of F1 antigen, tellurium-resistance protein, and outer membrane protein C, porin were validated by Western blotting. The in vitro cytotoxicity activity of these strains was also compared. The results indicate that protein expression and cytotoxic activities differ significantly among the studied strains; these differences could contribute to variations in essential physiological functions in these strains.

Methadone and buprenorphine-naloxone are effective in reducing illicit buprenorphine and other opioid use, and reducing HIV risk behavior--outcomes of a randomized trial.

AIMS: Determine the extent to which buprenorphine injectors continue treatment with buprenorphine-naloxone or methadone, and the impact of these treatments on substance use and HIV risk in the Republic of Georgia. METHODS: Randomized controlled 12-week trial of daily-observed methadone or buprenorphine-naloxone followed by a dose taper, referral to ongoing treatment, and follow-up at week 20 at the Uranti Clinic in Tbilisi, Republic of Georgia. Eighty consenting treatment-seeking individuals (40/group) aged 25 and above who met ICD-10 criteria for opioid dependence with physiologic features and reported injecting buprenorphine 10 or more times in the past 30 days. Opioid use according to urine tests and self-reports, treatment retention, and HIV risk behavior as determined by the Risk Assessment Battery. RESULTS: Mean age of participants was 33.7 (SD5.7), 4 were female, mean history of opioid injection use was 5.8 years (SD4.6), none were HIV+ at intake or at the 12-week assessment and 73.4% were HCV+. Sixty-eight participants (85%) completed the 12-week medication phase (33 from methadone and 35 from buprenorphine/naloxone group); 37 (46%) were in treatment at the 20-week follow-up (21 from methadone and 16 from the buprenorphine/naloxone group). In both study arms, treatment resulted in a marked reduction in unprescribed buprenorphine, other opioid use, and HIV injecting risk behavior with no clinically significant differences between the two treatment arms. CONCLUSIONS: Daily observed methadone or buprenorphine-naloxone are effective treatments for non-medical buprenorphine and other opioid use in the Republic of Georgia and likely to be useful for preventing HIV infection.

Access to treatment for substance-using women in the Republic of Georgia: socio-cultural and structural barriers.

BACKGROUND: In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services. METHODS: This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services. RESULTS: The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistance. CONCLUSION: Within the context of orthodox Georgian society, low self-esteem, combined with severe family and social stigma play a critical role in creating barriers to the use of both general health and substance-use-treatment services for women. Education of the public, including policy makers and health care providers is urgently needed to focus on addiction as a treatable medical illness. The need for more women centred services is also critical to the provision of effective treatment for substance-using women.