Study of Epidemiological Characteristics of Fatal Injuries Using Death Registry Data in Georgia

Objective

This study aimed to evaluate epidemiological aspects of fatal injuries in Georgia.

Methods

This was a retrospective, descriptive study that included all traumatic injury deaths in Georgia from January 1 to December 31, 2018. The National Center for Disease Control and Public Health of Georgia's Electronic Death Register database was utilized in this research.

Results

Of the study fatal injuries, 74% (n=1489) were males. 74% (n=1480) of all fatal injuries were caused by unintentional injuries. Road traffic accidents (25%, n=511) and falls (16%, n=322) were the primary causes of mortality. During the research year, the number of Years of life lost (YLL) was associated with injuries and was increased to 58172 for both sexes (rate per 1000 population: 15.6). Most of the years were lost in the age group of 25-29 years (7515.37). Road traffic deaths accounted for 30% (17613.50) of YLL.

Conclusion

Injuries are still a major public health problem in Georgia. In 2018, 2012 individuals died from injuries across the country. However, mortality and YLL rates of injury varied by age and cause of injury. To prevent injury-related mortality, it is crucial to conduct ongoing research on high-risk populations.

EVALUATION OF RESIDUAL LESIONS FOLLOWING CONSERVATIVE TREATMENT OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA

The purpose of this study was to determine the diagnostic value Pap smear test and colposcopy in Georgian National Screening Center, evaluation of efficiency of the excisional treatment and determining the main risk factors for prediction of residual/recurrent disease in patients with high-grade cervical intraepithelial neoplasia. We retrospectively analyzed 613 patients, who underwent excisional treatment of the cervix (LEEP). Follow-up was performed by Pap smear test, colposcopy and histamorphological examinations. Accuracy of Pap smear test and colposcopy prior to the the excisional treatment revealed Pap: Se 83.4%; Sp 76.4%; PPV 72.6%; NPV76.8%; Colposcopy: Se 83.4%; Sp 69.4%; PPV 69.3%; NPV 80.6%; After the excisional treatment: Pap: Se 82.8%; Sp 92.3%; PPV 61.5%; NPV 97.3%; Colposcopy: Se 62.1%; Sp 80.4%; PPV 32.1%; NPV 93.4%. After LEEP colposcopy is less sensitive than before LEEP. After LEEP sensitivity of the Pap smear test exceeds the sensitivity of the colposcopy. Forty one (18.4%) of 223 patients had residual/recurrent lesion during follow-up. According to univariate analysis the patient's age ≥40 years (p<0.01) OR 3.2 (95% CI 1.3-8.4), transformation zone type III (p<0.01) OR 5.0 (95% CI 2.1-11.5), endocervical gland involvement (p<0.01) OR 6.2 (95% CI 2.7 - 15.1 ), smoking status (p<0.001) OR 7.7 (95% CI 3.336-17.8), major abnormal cytology (p<0.05) OR 2.72 (95% CI 0.963-9.512) were significant risk factors for residual/recurrent disease. However, gravidity, parity, severity of disease and positive margins were not relevant factors for the residual/recurrent disease (P>0.05). Consideration and implementation of these predictive factors in patient surveillance protocol will allow avoiding delayed treatment or overtreatment.

Impact of Ambiguous and Restrictive Regulations on Opioid-Prescribing Practice in Georgia

CONTEXT

Chronic pain management with opioids in incurable patients remains a challenge of modern medicine regardless of the evidence-based effectiveness of opioids and recommendations of authorities such as the World Health Organization and International Narcotics Control Board. Many countries, including Georgia, maintain overly restrictive regulations that contribute to inadequate pain management.

OBJECTIVE

To identify barriers to pain management in Georgia caused by legislation, administrative issues, and physicians' lack of knowledge and understanding of legislative aspects governing opioid use, and their impact on opioid-prescribing practice.

METHODS

We conducted a survey among 550 primary health care physicians. In total, 302 physicians completed the questionnaire. Overall, 289 questionnaires were analyzed statistically with SPSS version 20 (Armonk, NY: IBM Corp.).

RESULTS

We found that 38% of the physicians avoid prescribing opioids and only one-third of the physicians make an independent decision to treat the patients with opioids. About one-third of the physicians know the updated liberalized legislation and even fewer follow it. Those who apply more liberal legislation and have better medical practice are investigated three to five times more by legal authorities for prescribing morphine to incurable patients than those who do not.

CONCLUSION

Ambiguous legislation negatively influences opioid-prescribing practice. Most of the physicians believe that the legislation is restrictive. Physicians who have better medical and legal knowledge and understanding are controlled and investigated more because of their opioid-prescribing practice. Physicians who are concerned that they might be investigated are less inclined to prescribe opioids or use liberalized regulations.

Human rights for better quality of life

This article reviews problems of pain relief for incurable patients, in the context of human rights and international standards in this field. In respect to international and national humans and patients rights, regarding to achieve better quality of life, the governments should identify and determine the problems and obstacles that impede opioid use for medical purposes, in aim rich adequate pain relief for incurable patients. Implementation of newly adopted legislation in Georgia into practice will enable to overcome existing barriers; hence these patients will be able to pass their last path of life under care, as much as possible without pain and with dignity.

Background radiation of the territory of some military objectives in Georgia

Background radiation on the territory of some military objects in Georgia has been investigated with the help of "DRPB-03" (dosimeter-radiometer) according to the specially created instruction. Background radiation of investigated objects varied from 0,09 to 0,28 mkZv/h; in average 0,18 mkZv/h. The maximal level was measured on the 8th object -0,28 mkZv/h, minimal on the 2nd object -0,09 mkZv/h, in average near the - 0,18 mkZv/h. The maximal level of the annual doze of radiation was measured on the 8th object -0,49 mZv/y; and minimal on the 2nd -0,15 mZv/y. The analysis of investigations showed, that the level of background radiation on the territory of the investigated military objects exceeds the level of European countries and South Caucasus (except Armenia). This could be explained by the peculiarities of our country: geomorphological structure and disposition of soil (altitude, latitude). These reasons could cause the high levels of natural background radiation. The level of background radiation is higher in Black Sea coast area, which may be the result of the Chernobyl Accident (contamination with artificial radionuclides). The comparatively high level of background radiation indicates that the personnel sustain relatively high radiation doses from natural radiation origins.