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.

The potential range of west Asian apple species Malus orientalis Uglitzk. under climate change

The wild relatives of cultivated apples would be an ideal source of diversity for breeding new varieties, which could potentially grow in diverse habitats shaped by climate change. However, there is still a lack of knowledge about the potential distribution of these species. The aim of the presented work was the understand the impacts of climate change on the potential distribution and habitat fragmentation of Caucasian crab apple (Malus orientalis Uglitzk.) and the designation of areas of high interest according to climatic conditions. We used the MaxEnt models and Morphological-Spatial Analysis (MSPA) to evaluate the potential distribution, suitability changes, habitat fragmentation, and connectivity throughout the species range in Turkey, Armenia, Georgia, Russia, and Iran. The results revealed that the potentially suitable range of M. orientalis encompasses 858,877 km², 635,279 km² and 456,795 km² under the present, RCP4.5 and RCP8.5 scenario, respectively. The range fragmentation analysis demonstrated a notable shift in the edge/core ratio, which increased from 50.95% in the current scenario to even 67.70% in the future. The northern part of the range (Armenia, northern Georgia, southern Russia), as well as the central and western parts of Hyrcania will be a core of the species range with suitable habitats and a high connectivity between M. orientalis populations and could work as major refugia for the studied species. However, in the Zagros and central Turkey, the potential range will shrink due to the lack of suitable climatic conditions, and the edge/core ratio will grow. In the southern part of the range, a decline of M. orientalis habitats is expected due to changing climatic conditions. The future outlook suggests that the Hyrcanian forest and the Caucasus region could serve as important refuges for M. orientalis. This study helps to understand spatial changes in species' range in response to climate change and can help develop conservation strategies. This is all the more important given the species' potential use in future breeding programs aimed at enriching the gene pool of cultivated apple varieties.

A Survival Analysis of Patients with Recurrent Epithelial Ovarian Cancer Based on Relapse Type: A Multi-Institutional Retrospective Study in Armenia

BACKGROUND

Annually, approximately 200 new ovarian cancer cases are diagnosed in Armenia, which is considered an upper-middle-income country. This study aimed to summarize the survival outcomes of patients with relapsed ovarian cancer in Armenia based on the type of recurrence, risk factors, and choice of systemic treatment.

METHODS

This retrospective case-control study included 228 patients with relapsed ovarian cancer from three different institutions.

RESULTS

The median age of the patients was 55. The median follow-up times from relapse and primary diagnosis were 21 and 48 months, respectively. The incidence of platinum-sensitive relapse was 81.6% (186), while platinum-resistant relapse was observed in only 18.4% (42) of patients. The median post-progression survival of the platinum-sensitive group compared to the platinum-resistant group was 54 vs. 25 months (p < 0.001), respectively, while the median survival after relapse was 25 vs. 13 months, respectively; three- and five-year post-progression survival rates in these groups were 31.2% vs. 23.8%, and 15.1% vs. 9.5%, respectively (p = 0.113).

CONCLUSIONS

Overall, despite new therapeutic approaches, ovarian cancer continues to be one of the deadly malignant diseases affecting women, especially in developing countries with a lack of resources, where chemotherapy remains the primary available systemic treatment for the majority of patients. Low survival rates demonstrate the urgent need for more research focused on this group of patients with poor outcomes.

Examining local smoke-free coalitions in Armenia and Georgia: context and outcomes of a matched-pairs community-randomised controlled trial

INTRODUCTION

Local coalitions can advance public health initiatives such as smoke-free air but have not been widely used or well-studied in low-income and middle-income countries.

METHODS

We conducted a matched-pairs community-randomised controlled trial in 28 communities in Armenia and Georgia (N=14/country) in which we helped establish local coalitions in 2019 and provided training and technical assistance for coalition activity promoting smoke-free policy development and enforcement (2019-2021). Surveys of ~1450 households (Fall 2018, May-June 2022) were conducted to evaluate coalition impact on smoke-free policy support, smoke-free home adoption, secondhand smoke exposure (SHSe), and coalition awareness and activity exposure, using multivariable mixed modelling.

RESULTS

Bivariate analyses indicated that, at follow-up versus baseline, both conditions reported greater smoke-free home rates (53.6% vs 38.5%) and fewer days of SHSe on average (~11 vs ~12 days), and that intervention versus control condition communities reported greater coalition awareness (24.3% vs 12.2%) and activity exposure (71.2% vs 64.5%). Multivariable modelling indicated that intervention (vs control) communities reported greater rates of complete smoke-free homes (adjusted Odds Ratio [aOR] 1.55, 95% confiedence interval [CI] 1.11 to 2.18, p=0.011) and coalition awareness (aOR 2.89, 95% CI 1.44 to 8.05, p=0.043) at follow-up. However, there were no intervention effects on policy support, SHSe or community-based activity exposure.

CONCLUSIONS

Findings must be considered alongside several sociopolitical factors during the study, including national smoke-free policies implementation (Georgia, 2018; Armenia, 2022), these countries' participation in an international tobacco legislation initiative, the COVID-19 pandemic and regional/local war). The intervention effect on smoke-free homes is critical, as smoke-free policy implementation provides opportunities to accelerate smoke-free home adoption via local coalitions.

TRIAL REGISTRATION NUMBER

NCT03447912.

Molecular monitoring of insecticide resistance in major disease vectors in Armenia

BACKGROUND

Armenia is considered particularly vulnerable to life-threatening vector-borne diseases (VBDs) including malaria, West Nile virus disease and leishmaniasis. However, information relevant for the control of the vectors of these diseases, such as their insecticide resistance profile, is scarce. The present study was conducted to provide the first evidence on insecticide resistance mechanisms circulating in major mosquito and sand fly populations in Armenia.

METHODS

Sampling sites were targeted based mainly on previous historical records of VBD occurrences in humans and vertebrate hosts. Initially, molecular species identification on the collected vector samples was performed. Subsequently, molecular diagnostic assays [polymerase chain reaction (PCR), Sanger sequencing, PCR-restriction fragment length polymorphism (RFLP), quantitative PCR (qPCR)] were performed to profile for major insecticide resistance mechanisms, i.e. target site insensitivity in voltage-gated sodium channel (vgsc) associated with pyrethroid resistance, acetylcholinesterase (ace-1) target site mutations linked to organophosphate (OP) and carbamate (CRB) resistance, chitin synthase (chs-1) target site mutations associated with diflubenzuron (DFB) resistance and gene amplification of carboxylesterases (CCEs) associated with resistance to the OP temephos.

RESULTS

Anopheles mosquitoes were principally represented by Anopheles sacharovi, a well-known malaria vector in Armenia, which showed no signs of resistance mechanisms. Contrarily, the knockdown resistance (kdr) mutations V1016G and L1014F/C in the vgsc gene were detected in the arboviral mosquito vectors Aedes albopictus and Culex pipiens, respectively. The kdr mutation L1014S was also detected in the sand fly, vectors of leishmaniasis, Phlebotomus papatasi and P. tobbi, whereas no mutations were found in the remaining collected sand fly species, P. sergenti, P. perfiliewi and P. caucasicus.

CONCLUSIONS

This is the first study to report on molecular mechanisms of insecticide resistance circulating in major mosquito and sand fly disease vectors in Armenia and highlights the need for the establishment of systematic resistance monitoring practices for the implementation of evidence-based control applications.

Deciphering the maternal ancestral lineage of Greek Cypriots, Armenian Cypriots and Maronite Cypriots

Cyprus was conquered from several populations because of its special geographical location. In this study, 406 unrelated Cypriot samples were tested based on their mitochondrial DNA. In more detail, 185 were Greek Cypriots, 114 Armenian Cypriots and 107 Maronite Cypriots. This is the first time where the mitochondrial DNA of Greek Cypriots, Armenian Cypriots and Maronite Cypriots is compared with the aim of characterizing the maternal ancestry of Cypriots. The control region of the mtDNA is the most informative in terms of studying maternal ancestry and consists of three hypervariable regions (HVS-I, HVS-II, HVS-III). The hypervariable regions can provide important information regarding the maternal ancestor of the tested samples. The entire control region of the mtDNA was used to determine the mitotypes and subsequently the haplogroups of all the Cypriot DNA samples. Based on the aforementioned analyses, Greek Cypriots were found to be genetically closer to Armenian Cypriots, while Greek Cypriots and Armenian Cypriots showed moderate genetic differentiation with Maronite Cypriots. The most prevalent haplogroups among Cypriots were haplogroups H and U, while R0 is common but in different frequencies for Greek Cypriots, Armenian Cypriots and Maronite Cypriots. It is proposed that the maternal ancestor may have originated during the Neolithic period and/or the Bronze age.

Evaluating consumer self-medication practices, pharmaceutical care services, and pharmacy selection: a quantitative study

BACKGROUND

The primary objectives of this study were the evaluation of consumer self-medication practices, the assessment of pharmaceutical care provided by pharmacy employees, and the analysis of consumer satisfaction with such care. The research was also aimed at examining the main criteria that consumers consider important when selecting a pharmacy in Armenia.

METHODS

The survey was based on an anonymous questionnaire and carried out between March 2020 and November 2021. It was aimed at providing a comprehensive assessment of pharmaceutical care services and consumer pharmacy choice by investigating two distinct groups: pharmacy consumers and pharmacy employees.

RESULTS

The research reveals that many residents in Armenia engage in self-medication without consulting professional sources, which can lead to potential risks and result in dangerous consequences. This is partly due to a lack of trust in pharmacy employees, which is primarily due to their inability to provide adequate information and advice. This study highlights a significant need for improvement in the quality of service provided by pharmacy employees. Despite these challenges, the majority of consumers reported having a preferred pharmacy, and that employee knowledge is the most important criterion when choosing a pharmacy.

CONCLUSIONS

Consumer distrust, in this context, is based on the incomplete knowledge or incompetency of pharmacy employees. Collective actions should be taken to improve the role of pharmacy employees and consequently improve the public trust in them, which can ensure better control of self-medication and reduce the instances of mistreatment.

MANIFESTATION OF CREATIVITY AMONG MODERN MANAGERS AS A FACTOR IN PROMOTING PERSONAL MATURITY AND MENTAL HEALTH

The purpose of this article is to investigate the manifestation of creativity levels and criteria, conditioned by the ratio of personal qualities, motivational orientation, and contributing and hindering factors. These elements are regarded as pivotal factors in ensuring mental health and socio-psychological maturity. The study involved 300 managers from the private and public sectors of the Republic of Armenia. The research contributes to the academic discourse by introducing novel correlations between scientific concepts of creativity, enriching the theoretical foundations of creativity and motivation, creativity and personal qualities, and creativity and its contributing and hindering factors. Findings suggest a high level of creativity among managers, characterized by fluency, flexibility, and originality. Notably, power and altruism emerge as significant motivational orientations within the manager's psychological profile. Moreover, modern managers do not perceive reward or competition as hindrances to creativity. Essential factors conducive to creativity include dominance, competition, reward, freedom of thought, and a willingness to take risks in decision-making. The proposed creativity research and development model holds promise for informing a scientific approach to the psychological selection and training of managers.

Psychological distress and voting behaviour in nine countries of the former Soviet Union

Poorer mental health is linked to a lower likelihood of voting in elections. However, little is known about this association in non-Western settings. This study examined the association between psychological distress and voting in nine countries of the former Soviet Union (FSU). Data were analysed from 18,000 respondents aged ≥ 18 in Armenia, Azerbaijan, Belarus, Georgia, Moldova, Kazakhstan, Kyrgyzstan, Russia and Ukraine collected during the Health in Times of Transition (HITT) survey in 2010/11. Information was collected on previous voting behaviour and future voting intentions. Psychological distress was assessed with a 12-item scale. In pooled multivariable logistic regression analyses psychological distress was significantly associated with 'never voting' (not having voted previously or intending to vote in future) and 'past voting only' (having voted previously but not intending to vote in future). In stratified analyses psychological distress was linked to never voting in women and working-age adults. The significant association between psychological distress and voting was observed only in hybrid political regimes. Psychological distress is associated with a reduced likelihood of voting in FSU countries especially among women, working-age adults and those in hybrid political regimes.

Projecting cardiovascular deaths averted due to trans fat policies in the Eurasian Economic Union

OBJECTIVE

To demonstrate the potential impact on population health if policies designed to reduce population trans fatty acid (TFA) intake are successfully implemented in the Eurasian Economic Union (EAEU) in line with the WHO's guidelines to lower intake of TFA as a percentage of total energy intake to less than 1 %.

DESIGN

A projection exercise was conducted to estimate reductions in CVD-related deaths in countries of the EAEU if TFA policies are implemented in the EAEU. Plausibly causal, annual effects (in %) of Denmark's TFA policy on the evolution of CVD mortality rates were applied to project the potential effects of recently announced TFA policies in Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation under three TFA exposure scenarios.

SETTINGS

Member States of the EAEU: Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation.

PARTICIPANTS

Data used for the projection exercise were based on estimates from natural experimental evidence from Denmark. National CVD mortality rates used were from WHO and the Organisation for Economic Cooperation and Development datasets.

RESULTS

In all countries and in all scenarios, deaths averted were ≤ 5 deaths/100,000 in year 1 and rose in years 2 and 3. The highest projected impacts in the high-exposure scenario were seen in Kyrgyzstan (39 deaths/100 000), with the lowest occurring in Armenia (24 deaths/100 000).

CONCLUSION

This study demonstrates the potential population health gains that can be derived from effective policies to reduce TFA in line with WHO guidance. Monitoring and surveillance systems are needed to evaluate the effectiveness of the TFA reduction policies in a national context.

CHECK LIST OF ARMENIAN APHIDS (HEMIPTERA: APHIDOMORPHA)

This paper presents a checklist of aphids of Armenia. Nowadays, 203 species of aphids belonging to 83 genera, 10 subfamilies, two families and two superfamilies are known, of which nine species are recognized in Armenia for the first time: Aphis cephalariae Barjadze, A. chloris Koch, A. solanella Theobald, A. urticata Gmelin, A. wellensteini (Brner), Brachyunguis harmalae Das, Macrosiphoniella millefolii (De Geer), Microlophium carnosum (Buckton), and Metopeurum buryatica (Pashtshenko). Twelve alien aphid species are cited in the paper.

Exploring mudbrick architecture and its re-use in Artaxata, Armenia, during the 1st millennium BC. A multidisciplinary study of earthen architecture in the Armenian Highlands

Mudbrick constructions are extremely common in ancient western Asia, including the 1st millennium structures of the southern Caucasus and Armenian highlands. However, in the Caucasus the geoarchaeological study of these materials to provide insight into building practices and social structure is a topic little researched, especially when focusing on the longue durée. Artashat/Artaxata (Ararat region, Armenia) was the capital of the Armenian Kingdom of the Artaxiads, founded in the eighties of the 2nd century BC, but even before this the site was occupied in the Chalcolithic period, (ca. 5200-3500 BC), Early Iron Age (ca. 1200-900 BC) and in the Urartian period (ca. 800-600 BC) as well. All the previous occupation phases showed communities that made extensive use of earthen constructions as determined during past and recent archaeological excavations. This multidisciplinary study seeks to examine mudbrick architecture as a proxy for environmental and social interactions during the 1st millennium BC combining geoarchaeology, archaeobotany and building archaeology. We analyzed changes and continuities in architectural form and practices, alongside reconstruction of technological and social processes, to identify issues of raw material procurement, attestation of re-use, and consistency of building practices. The results of the geoarchaeological analysis of the earthen building materials used in different parts of the ancient city point to a re-use of materials over time.

Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors

BACKGROUND

Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months.

METHODS

Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home.

RESULTS

In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers.

CONCLUSIONS

SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.

The state of the population of narrow-clawed crayfish in Lake Sevan (Armenia) under multiple stress conditions

The narrow-clawed crayfish is a crayfish species that was accidentally introduced into the ecosystem of Lake Sevan in the 1980s. Soon it became one of the most preferred fisheries in the lake and an important link in the food chain by successfully replacing the endemic fish subspecies Sevan khramicarp (Capoeta sevangi, De Filippi, 1865) in the chain of detritivores. However, recently, the stock declines dramatically, associated with two main threats: the impact of burn-spot disease and an increase in fishing pressure on its population. To estimate the state of population under multiple stress conditions, we investigated the dynamics of stock, the size/age and sex structure, the fecundity, and the health status of the population. A comparative analysis of oxidative stress biomarkers (superoxide dismutase, catalase, glutathione-S-transferase activities and reduced glutathione, thiobarbituric acid reactive substance contents) showed significant differences between healthy and infected individuals. Another indirect effect of the disease, which probably leads to a decrease in the stock, was an increase in the proportion of immature females. Also, we observed some decrease in the infection rate along with the decline in the density of crayfish. However, stock reduction and some changes in the population may also be caused by a strong bloom of cyanobacteria.

Countries' vulnerability to food supply disruptions caused by the Russia-Ukraine war from a trade dependency perspective

Disruptions of key food and fertilizer exports from Russia and Ukraine have exposed many countries to challenges accessing some commodities since these countries' war began. We evaluated the short-term, external, and direct impacts of disruptions of six food commodities and three types of fertilizer supplies from Russia and Ukraine on food access for all trading partners of the two countries by applying a set of trade and socioeconomic indicators. We found that the external food supplies of 279 countries and territories were affected to varying degrees; 24 countries-especially Georgia, Armenia, Kazakhstan, Azerbaijan, and Mongolia-are extremely vulnerable because they depend almost entirely on a variety of food imports from Russia and Ukraine. Access to fertilizers was affected in 136 countries and territories, particularly Estonia (potassic fertilizer), Mongolia (nitrogenous fertilizers), Kazakhstan (mixed fertilizers), and Brazil, the United States, China, and India (all types of fertilizers). An integrated assessment of countries' import types, purchasing power parity per capita, and populations indicated that the Democratic Republic of the Congo, Ethiopia, Egypt, and Pakistan are most vulnerable to such supply disruptions. Development of research into diversification and decentralization strategies for food access is needed to guide stable food supply policies.

Evaluation of the effectiveness of foot-and-mouth disease vaccination of animals in the buffer zone of the Republic of Armenia in 2016-2020

BACKGROUND

Foot-and-mouth disease (FMD) is a high impact viral disease of livestock for which vaccines are extensively used for limiting the spread of infection. Armenia shares a border with both Turkey and Iran where FMD is endemic, making vaccination an important component of Armenia's control strategy. Additionally, Armenian veterinary services utilize both passive and active monitoring for prevention control.

METHODS

We sought to determine the immune status of animals vaccinated against FMD and to evaluate the effectiveness of our vaccination policy in Armenia. This was conducted in three regions including Shirak, Armavir, and Ararat Region which are located in the buffer zones that border Turkey and Iran. Through active monitoring in 2020, we studied blood serum samples from cattle and sheep using an enzyme immunoassay to determine the level of immune animals in these regions following the use of a polyvalent inactivated vaccine containing FMDV serotypes A, O, and Asia-1 that are relevant for this region. ELISA titers were assessed at 28, 90, and 180 days after vaccination in cattle of three age groups at the time of initial vaccination: 4-6 months, 6-18 months and ≥ 24 months of age with sheep of all ages.

RESULTS

The 3 age groups of cattle had similarly high levels of immunity with over 90% of the cattle showing a ≥ 50% protective titer 28 days after the first vaccination. By day 90, titers in cattle from the initial 4-18-month age groups dropped below 58% across the 3 serotypes and at or below 80% for the oldest cattle ≥ 24 months. Re-vaccination of cattle at 120 days did improve protective titers but never reached the level of immunity of the first vaccination. Sheep showed a similar rapid drop to less than 50% having a ≥ 50% protective titer at 90 days emphasizing the need for continual revaccination.

CONCLUSIONS

The results of this study have important implications for the current FMD vaccine policy in Armenia and improves our understanding of the rapid loss of protective titers over short periods. Since small ruminants are only vaccinated once per year and vaccination titers drop rapidly by 90 days suggests that they are vulnerable to FMD and that vaccination protocols need to be updated. Cattle should continue to be vaccinated every 3-6 months depending on their age to maintain a protective level of antibodies to protect them from FMD. More studies are needed to understand the possible role of small ruminants in the epidemiology of FMD and to evaluate revaccination at shorter intervals. These results show the concerns of rapid loss of protection to both cattle and small ruminants following 1 or more doses of commercial vaccines and that additional vaccines need to be evaluated in both groups to know how often they must be vaccinated to provide full protection. The addition of challenge studies should also be considered to better understand the level of protection as measured by serology and how it relates to protection from challenge. These results should be considered by anyone using these vaccines in cattle and sheep at longer than 3 month intervals.

Generation of three induced pluripotent stem cell lines (RAUi001-A, RAUi001-B and RAUi001-C) from peripheral blood mononuclear cells of a healthy Armenian individual

The study of pathological processes in cells carrying mutations should be carried out in comparison with a healthy control group. Familial Mediterranean fever (FMF), which is caused by a mutation in the MEFV gene, is predominantly found in people of Armenian nationality with the prevalence of 14-100 per 10000. We have obtained induced pluripotent stem cells (iPSCs) from Armenian healthy patient, which will be included as a control group in the study of this disease. iPSCs rapidly proliferate in colonies of cells with a typical pluripotent-like morphology, have a normal karyotype (46,XX). iPSCs express pluripotency markers (OCT4, SOX2, TRA-1-60, NANOG) and are able to give derivatives of three germ layers.

Maternal exposure to organochlorine pesticides and anthropometrics of newborns - a hospital-based cross-sectional study in rural and urban settings in Armenia

The study objective was to determine a possible association between maternal exposure to organochlorine pesticides (OCPs) and anthropometric measures at birth in group of postpartum women in urban and rural areas of Armenia. The anthropometric measures of infants were obtained from birth records and gamma-hexachlorocyclohexane (γ-HCH), dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene, and dichlorodiphenyldichloroethane were measured in breast milk. Gas-liquid chromatography with electron capture detection was used to identify OCPs. Total OCPs and DDTs were calculated, and the anthropometrics were analyzed for sex and areas, and group differences were compared (Student's t-test). Both individual OCPs and total OCPs and DDTs were significantly higher in rural samples than in urban ones (P < 0.01-0.000), with lower and upper quartiles differing by 2.6-fold and 3.1-fold, respectively (P < 0.000). There was no association between the anthropometrics and OCPs levels in rural or urban areas. However, this does not rule out the possibility of OCPs impact on health later in life. To our knowledge, this was the first study addressing these issues in Armenia. The results obtained will provide data on the current situation regarding birth outcomes in terms of prenatal exposure to OCPs in Armenia and will contribute to the available results from previous studies.

Unexpected mitotype diversity of Simplimorpha promissa (Lepidoptera: Nepticulidae) in Ukraine and Armenia revealing a possible cryptic taxon

In this paper, the results of a recent molecular study of theCotinus-feeding, leaf-miningSimplimorpha promissa(Staudinger) (Lepidoptera: Nepticulidae) are discussed for the first time on the basis of samples collected in Ukraine and Armenia. Newly obtained mtDNACO1-5'sequences from these countries were compared with previously known sequences from France, Italy, Croatia and Greece. A mitotype network and a Neighbor-Joining tree of twenty-two specimens ofS. promissaare provided.They show that the studied specimens from Ukraine and the rest of the European countries are genetically closer to each other than to the examined specimens from Armenia, thereby suggesting the Armenian specimens could represent a sister taxon to the EuropeanS. promissa. The study also revealed a significantly large genetic diversity ofS. promissain Ukraine.

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

AN INVESTIGATION OF PSYCHOLOGICAL AND PHYSIOLOGICAL FACTORS AFFECTING PERFORMANCE IN ADOLESCENT JUDOKAS

The purpose of this study was to investigate the psychological and physiological factors affecting performance levels in adolescent judokas. The research was performed in the "Sport EMI" scientific-research center of Armenian State Institute of Physical Culture and Sport. Participants' performance levels were assessed based on their kyu rankings, a hierarchical ranking system in judo. The psychological assessment involved the completion of the Well-being, Activity, and Mood (WAM) test. The physiological assessment focused on heart rate variability (HRV) measurements, which were obtained using the Varikard 2.51 complex equipment. A total of 23 male teenage judokas, aged between 10 and 16 years, were randomly selected from a judo club to participate in this study. Participants demonstrated high levels of well-being, activity, and positive mood, indicating positive psychosocial outcomes associated with judo practice. Analysis of heart rate variability (HRV) revealed deviations in certain variables, suggesting potential irregularities in autonomic nervous system regulation. Specifically, the Index of Activity of Regulatory Systems (IRSA), low-frequency power (LF), and total power (TP) exceeded normal ranges, indicating increased tension and overall activity in the regulatory systems. In addition, one-way analysis showed significant main effects of age, training duration, and high-frequency power (HF) on the participants' performance level (Kyu). The findings suggest that psychological and physiological factors play significant roles in the performance levels of adolescent judokas. Coaches and practitioners should consider both aspects in optimizing training strategies for young athletes.

Risk Characterization of the Armenian Population to Nickel: Application of Deterministic and Probabilistic Approaches to a Total Diet Study in Yerevan City

Nickel (Ni) is a widespread metal that occurs in food and drinking water from both natural and anthropogenic sources. Oral exposure to Ni can induce a variety of adverse effects; the European Food Safety Authority established a tolerable daily intake (TDI) of 13 μg/kg bw and a lowest-observed-adverse-effect level (LOAEL) of 4.3 μg/kg bw to assess the risk of allergic reactions upon acute exposure. This study, the first conducted in Armenia, aimed to assess the dietary exposure of the adult Yerevan population (1272 subjects of both sexes) to Ni in a total diet study (TDS). Detection of Ni was carried out using atomic absorption spectrometry. To determine food consumption values, a 24-h recall survey was used. Following the K-means clustering test, two clusters were determined for food product intake. For the risk characterization of acute oral exposure, the margin of exposure (MOE) was calculated using both deterministic and probabilistic (Monte Carlo method) approaches. The average total exposure was 4.396 μg/kg bw, with limited influence by age and gender. The main contributors were "fruits and vegetables" followed by "bread and flour-based products": the total intake would be 5.11 μg/kg bw for a woman with high consumption of fruits and vegetables. Hence, the estimated chronic dietary exposure was below the TDI, irrespective of age and gender groups, and including high consumers. However, acute oral exposure estimates led to MOE values of less than 30 for most food products, indicating potential health concerns for Ni-sensitized individuals. The Monte Carlo approach indicated that the probability of occurrence of MOE lower than 30 was very high in the case of beef/veal, pork and chicken meat, eggs, and fish, alongside vegetable sources such as buckwheat, tomato, watermelon/melon, and potatoes. The findings prompt an investigation of Ni sources in the target foods in the Caucasus area.

Exploring relationship of soil PTE geochemical and "VIS-NIR spectroscopy" patterns near Cu-Mo mine (Armenia)

PTE contamination of soils remains one of the global environmental concerns. The ways of detecting and monitoring PTE concentrations in soils varies including traditional field sampling accompanied by sample preparation and chemical analysis and state of the art visible and near-infrared (Vis-NIR) spectroscopic approaches. Among the different Machine Learning (ML) to extract soil information from spectra and to explore the relationship between spectral reflectance data and soil PTE content PLSR method is a well-established one to construct a soil PTE estimation model. This study aimed to explore the relationship of soil PTE geochemical and VIS-NIR spectroscopy characteristics in agricultural soils near Cu-Mo mine area in Armenia. PLSR method is applied to identify the links between the spectra and agricultural soil Ti, V, Cr, Mn, Fe, Co, Ba, Pb, Zn, Cu, Sr, Zr and Mo contents to reveal the potential of VIS-NIR spectroscopy in ex-situ monitoring of Kajaran soils. The results show that different portions of VIS-NIR spectra are responsible for Ti (1100-1200 nm, 2350-2500 nm), V (350-500 nm, 700-750 nm, 1000-1100 nm, 1400-2500 nm), Cr (1300-1400 nm, 1900-2100 nm) and Ba (450-500 nm, 600-800 nm, 1050-1700 nm, 2000-2100 nm, 2350-2400 nm) estimations through PLSR correspondingly. However, among the studied PTEs Ti and V, which shows significant negative correlations in VIS-NIR spectra registered at around 400-600 nm and 850-1150 nm regions, are remarkable and promising with the PLSR estimation results using VIS-NIR spectra Ti (R²_Test = 0.74), V (R²_Test = 0.71). This study shows that VIS-NIR spectroscopy has a high potential for the estimation of at least several PTE in soils and PLSR modelis reliable for deriving information from there.

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.

Synthetic surfactants in drinking and surface waters in Armenia and apparent non-association with some diseases

The main goal of this study is to compare the concentrations of anionic synthetic surfactants (ASS) in drinking and surface waters in Armenia and to explore possible relationship with diseases of the skin and digestive system. Surfactants are widely employed in numerous field of the economy, are in contact with the entire population throughout life and can be harmful to human health.The samples of drinking and surface waters (n = 144) were collected in Kotayk province to analyze ASS concentrations, physicochemical parameters and phytotoxic activity. The prevalence of diseases was analyzed for different population groups. ASS concentrations in surface waters were significantly higher in summer compared to spring (p = 0.006). In drinking water, concentrations were also higher in summer, but not significantly. In surface waters, ASS levels were 2.4-3 times higher compared to drinking (p = 0.03) and exceeded the permissible limit by 1.4-2.9 times in summer and fall. No phytotoxic activity and differences in both classes of diseases and age groups were revealed. The determination of ASS in both surface and drinking waters with the same trend showed their interrelation to a certain extent. This study provides important information for future research and action which will contribute to the sustainable development of local communities.

Sterols Content of Fruiting Bodies of Medicinal Artist's Bracket Mushroom Ganoderma applanatum (Agaricomycetes) Collected in Armenia

The qualitative analysis of hexane extracts obtained from different trama layers (WT, T1-T4) of dried fruiting bodies of medicinal bracket fungus Ganoderma applanatum collected in the Tavoush region of North-East Armenia was performed by GC-MS analysis. Three sterols [(7.22-ergostadienon, ergosterol and ergosta-14.22-diene-3-ol (3β, 5α, 22E)] have been identified. The results have shown that the content and ratio of sterols differ in analyzed trama samples. The highest amount of sterols was detected in middle parts of T2 and T3 layers, while content of sterols gradually decreased to the upper cortical (T4) and lower hymenial (T1) layers. The chromatographic profiles of identified compounds indicate that different sterols dominated in each layer: 7.22-ergostadienon in T4, ergosterol in T3, T2, and T1. The average weight loss of analyzed trama samples during six days of drying was about 40 wt.% (37.0-43.49 wt.%) of the total weight of basidiome, which decreased up to 5 wt.% in the next two days. The complete extraction of sterols lasted six days. Its further prolongation leads to stationary phase without an increase in the amount of extracted sterols.

Diverse dietary practices across the Early Bronze Age 'Kura-Araxes culture' in the South Caucasus

The Kura-Araxes (KA) cultural phenomenon (dated to the Early Bronze Age, c. 3500/3350-2500 BCE) is primarily characterised by the emergence of a homogeneous pottery style and a uniform 'material culture package' in settlements across the South Caucasus, as well as territories extending to the Ancient Near East and the Levant. It has been argued that KA societies practised pastoralism, despite a lack of direct examination of dietary and culinary practices in this region. Here, we report the first analyses of absorbed lipid residues from KA pottery to both determine the organic products produced and consumed and to reconstruct subsistence practices. Our results provide compelling evidence for a diversified diet across KA settlements in Armenia, comprising a mixed economy of meat and plant processing, aquatic fats and dairying. The preservation of diagnostic plant lipid biomarkers, notably long-chain fatty acids (C20 to C28) and n-alkanes (C23 to C33) has enabled the identification of the earliest processing of plants in pottery of the region. These findings suggest that KA settlements were agropastoral exploiting local resources. Results demonstrate the significance of applying biomolecular methods for examining dietary inferences in the South Caucasus region.

The dynamics of phytoplankton seasonal development and its horizontal distribution in Lake Sevan (Armenia)

High-altitude freshwater lakes are experiencing ever-increasing risk of harmful algal blooms (HABs) on the face of climate change and a growing demand on agricultural production. The biggest alpine lake of the Caucasus, Lake Sevan, has "blooming" recently almost every year. Thus, the study of phytoplankton community' development patterns in Lake Sevan is gaining urgency. The aim of the work has been the study of the seasonal dynamics of quantitative and qualitative characteristics of phytoplankton in Lake Sevan. Also, we have tried to determine the features of horizontal distribution of phytoplankton within different seasons with the focus on Cyanobacteria distribution to identify current spatial-temporal features of HABs in Lake Sevan. Seasonal ground data collected from the photic zone of 178 stations in 2016-2018 was analysed and spatially interpolated. The results of analysis of seasonal dynamics of phytoplankton groups abundance have revealed the increased role of Cyanobacteria in the algal "blooms". Particularly, HABs were led by the dominant species of the genus Dolichospermum/Anabaena that are potentially toxic. Univariate analysis of variance with the post hoc Tukey test has proved the significance of changes in the quantitative parameters of phytoplankton development within years with the peak in 2018. Some antagonistic relations between the groups of phytoplankton under the HAB events were also shown through factorial and correlation analysis. Spatial interpolations revealed very limited extents of HABs compared with "blooms" led by Bacillariophyta species. HABs were mainly occurring in the littoral zone in a close proximity to the estuaries of Lake Sevan major tributaries.

PSYCHOPHYSIOLOGICAL CORRELATES OF STUDENTS' WELL-BEING IN ARMENIA

This article focuses on develop the model of psychophysiological bases of well-being, for what Psychophysiological features of well-being of Armenian' student was investigated. For diagnosis of well-being was used the WHOQOL-1. The indicators of functional state were registered the indicators of heart rate variability. All student participated in anonymous research. The purpose of our study is to identify the relationship of students Psychological Wellbeing with physiological indicators as an indicator of physical health. The sample consisted of 140 voluntary respondents from different HEI (High Education Institute) from Armenia (45% female), aged 18-25 years (median age 22, 4), who participated in anonymous research. In the first stage, the students answered WHOQOL2. After the questions of the questionnaire Measuring Quality of Life, the functional indicators were registered in the laboratory "Sport Cab" of Armenian State Institute of Physical Culture and Sport. To identify the relationship between the indicators of functional state (physiological indicators) and the components of well-being of the students in the RA, a Pearson correlation analysis was performed. Psychological well-being was positively correlated with tension indicators and High Frequencies indicators. Negative correlations were found between almost all other indicators and psychological components of well-being. More interesting are those facts that no reliable links have been found between the "physiological indicators" of well-being and social relations. The obtained correlations between the studied indicators of psychological well-being and physiological indicators allow us to consider the indicators of the cardiovascular system not only as factors of physical health, but also as components of psychological well-being.

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.

Potentially toxic elements contents and the associated potential ecological risk in the bottom sediments of Hrazdan river under the impact of Yerevan city (Armenia)

This research aims to assess the ecological status of the Hrazdan river (Armenia) section that flows through Yerevan. The distribution of potentially toxic elements (PTE) (Cr, V, As, Zn, Cu, Ni, Co, Mn, Pb, Ti, Mo, Fe, and Ba), the bottom sediments pollution level, and the ecological risk were assessed employing the single pollution index (SPI), the enrichment factor (EF), the geo-accumulation index (I_geo), and the potential ecological risk index (RI). On sampling sites, water quality parameters (turbidity, DO, electrical conductivity (EC), salinity, TDS, pH, temperature °C) were measured as well. The correlation analysis revealed a significant correlation between Zn-Cu, Pb; Cu-Pb, Mo; Co-Fe, Ti pointing out similar sources and origination of these elements. The results indicated that the content of the studied elements in the Hrazdan bottom sediments exceeded the background content in urban soils, which was due to a set of geological and anthropogenic factors. High contents of elements were determined on the sampling sites spatially confined to the residential and industrial areas. According to EF and I_geo data, the priority bottom sediment contaminants are As, Pb, Mo, Zn, V, and Cu. The RI value varies from 196 to 316 with the mean of 246 which corresponds to the moderate-level ecological risk. On the whole, a moderate (77.8%) and a considerable (22.2%) ecological risk was revealed. The major source of Pb, Cu, Zn, and Mo contents was identified as the surface runoffs in the urban environment. This was verified by the cluster analysis results.

Every contact leaves a trace: Documenting contamination in lithic residue studies at the Middle Palaeolithic sites of Lusakert Cave 1 (Armenia) and Crvena Stijena (Montenegro)

Investigations of organic lithic micro-residues have, over the last decade, shifted from entirely morphological observations using visible-light microscopy to compositional ones using scanning electron microscopy and Fourier-transform infrared microspectroscopy, providing a seemingly objective chemical basis for residue identifications. Contamination, though, remains a problem that can affect these results. Modern contaminants, accumulated during the post-excavation lives of artifacts, are pervasive, subtle, and even “invisible” (unlisted ingredients in common lab products). Ancient contamination is a second issue. The aim of residue analysis is to recognize residues related to use, but other types of residues can also accumulate on artifacts. Caves are subject to various taphonomic forces and organic inputs, and use-related residues can degrade into secondary compounds. This organic “background noise” must be taken into consideration. Here we show that residue contamination is more pervasive than is often appreciated, as revealed by our studies of Middle Palaeolithic artifacts from two sites: Lusakert Cave 1 in Armenia and Crvena Stijena in Montenegro. First, we explain how artifacts from Lusakert Cave 1, despite being handled following specialized protocols, were tainted by a modern-day contaminant from an unanticipated source: a release agent used inside the zip-top bags that are ubiquitous in the field and lab. Second, we document that, when non-artifact “controls” are studied alongside artifacts from Crvena Stijena, comparisons reveal that organic residues are adhered to both, indicating that they are prevalent throughout the sediments and not necessarily related to use. We provide suggestions for reducing contamination and increasing the reliability of residue studies. Ultimately, we propose that archaeologists working in the field of residue studies must start with the null hypothesis that miniscule organic residues reflect contamination, either ancient or modern, and systematically proceed to rule out all possible contaminants before interpreting them as evidence of an artifact’s use in the distant past.

The awareness, practical approaches and attitude of health care professionals to drug hypersensitivity reactions in Armenia

BACKGROUND

Drug hypersensitivity reactions (DHRs) is commonly encountered in clinical practice. This condition requires sufficient knowledge of health care professionals (HCPs) carrying for these patients.

OBJECTIVE

To assess the awareness, practices and attitudes to DHRs among HCPs in Armenia and to identify main problems and take appropriate measures.

MATERIALS AND METHODS

The 23-item questionnaire covering 3 domains - knowledge, practice and attitude - was developed and applied in an anonymous survey. Data were analyzed according to specialty, experience, type of medical facility and regions using Pearson's χ2 and Fisher's exact tests.

RESULTS

A total of 381 respondents with response rate of 63.5  % took part in the survey. The gaps in knowledge/awareness about DHRs diagnosis and management, as well as in practical approaches were identified. The differences depending on specialty, duration of HCPs experience, working place both by geographical region and medical facility type were revealed. According to attitude rates the importance of creating a national registry of patients with severe DHRs (>95.0 %) and the need to introduce a clear algorithm for managing these patients (99.5 %) are highlighted.

CONCLUSIONS

Targeted educational programs are needed for better understanding of DHRs. The implementation of the national guidelines needs improvement. The approach used can be recommended for study of the problems in other areas of healthcare (Tab. 4, Fig. 2, Ref. 15).

EVALUATION OF BODY COMPOSITION INFLUENCE ON STRESS RESISTANCE, ENDOTHELIAL FUNCTION AND WELLNESS INDICATORS ACCORDING TO PHYSICAL ACTIVITY LEVEL AND GENDER IN YEREVAN, REPUBLIC OF ARMENIA

Determining the influence of body composition on stress resistance, endothelial function and wellness and as a function of daily physical activity level and gender is of great medical-preventive importance․ The aim of this study was to analyse the influence of body composition on the stress resistance, endothelial function and wellness in different physical activity groups. A cross-sectional study was conducted with 2000 participants (829 men and 1171 women) aged 10-90 years. The Multiscan BS_OXI instrument was applied to measure the integral indicators․ For the study, statistical analysis was performed using Primer of Biostatistics version 4.03 by Stanton A. Glantz. Data analysis showed: (i) in the high physical activity group there was a significantly weak correlation between body composition and stress resistance in male (Rxy=0.24, p=0.000) and female (Rxy=0.28, p=0.0000) groups. In the case of low physical activity, a reliable weak correlation was registered only in the male group (ii) in the low physical activity group, there was a significant correlation between the body composition index and the change in the endothelium in the male (Rxy=0.4, p=0.000) and female group (Rxy=0.3, p=0.000) and in the group of participants with moderate physical activity, there was a significant correlation only in female group. (iii) In the high physical activity participant group, the correlation between body composition and wellness index was directly proportional in the male group (Rxy=0.33, p=0.000); in moderate and low physical activity, the correlation was directly proportional in the male and female groups. Thus, our study showed that the association of body composition with stress resistance, endothelial function and well-being depends on the level of physical activity and gender. However, further research is recommended to determine the influence of body composition ranges on various health indicators and to make recommendations and implement appropriate health and fitness programmes for the Armenian population, which should also focus on disease prevention.

CLINICAL, ENDOSCOPIC, AND HISTOLOGICAL CHARACTERISTICS OF HELICOBACTER PYLORI POSITIVE AND NEGATIVE ARMENIAN CHILDREN WITH RECURRENT ABDOMINAL PAIN AND/OR DYSPEPSIA

Recurrent abdominal pain (RAP) and dyspepsia are common complaints in children. These symptoms are often associated with Helicobacter pylori (Hp) infection. The aim of the present study was to prospectively analyze clinical, endoscopic, and histological characteristics of Hp+ and Hp- children with RAP and/or dyspepsia. Patients aged 2-18 years with RAP and/or dyspepsia, referred for an upper endoscopy to Arabkir Medical Center - Institute of Child and Adolescent Health (Arabkir MC-ICAH) from November 2015 to December 2017, were involved in the study. Histology was assessed according to the updated Sydney system. Gastric and duodenal specimens were stained by modified Giemsa staining for Hp infection. One antral biopsy was cultured in Hp selective media. 150 patients were included into the study: 70.7% Hp+, 29.3% Hp-. Nausea and vomiting were significantly more common in Hp+ patients (p<0.05). Gastric nodularity (p=0.02), erosions in the stomach (p=0.056), and duodenal erosions (p=0.019) were more common in Hp+. Chronic active (p=0.027) and non-active gastritis (p=0.002), cumulative findings of metaplasia/dysplasia/atrophy in the stomach (p=0.014) and chronic non-active duodenitis (p=0.016), were significantly more common in Hp+ patients. Hp infection prevalence is high in Armenian children with dyspepsia and/or RAP. Clinical symptoms, endoscopic findings, and histopathological findings were significantly different in Hp+ patients as compared to Hp- patients.

HLA-C*04:01 Affects HLA Class I Heterozygosity and Predicted Affinity to SARS-CoV-2 Peptides, and in Combination With Age and Sex of Armenian Patients Contributes to COVID-19 Severity

The novel SARS-CoV-2 coronavirus infection has become a global health concern, causing the COVID-19 pandemic. The disease symptoms and outcomes depend on the host immunity, in which the human leukocyte antigen (HLA) molecules play a distinct role. The HLA alleles have an inter-population variability, and understanding their link to the COVID-19 in an ethnically distinct population may contribute to personalized medicine. The present study aimed at detecting associations between common HLA alleles and COVID-19 susceptibility and severity in Armenians. In 299 COVID-19 patients (75 asymptomatic, 102 mild/moderate, 122 severe), the association between disease severity and classic HLA-I and II loci was examined. We found that the advanced age, male sex of patients, and sex and age interaction significantly contributed to the severity of the disease. We observed that an age-dependent effect of HLA-B*51:01 carriage [odds ratio (OR)=0.48 (0.28-0.80), Pbonf <0.036] is protective against severe COVID-19. Contrary, the HLA-C*04:01 allele, in a dose-dependent manner, was associated with a significant increase in the disease severity [OR (95% CI) =1.73 (1.20-2.49), Pbonf <0.021] and an advancing age (P<0.013). The link between HLA-C*04:01 and age was secondary to a stronger association between HLA-C*04:01 and disease severity. However, HLA-C*04:01 exerted a sex-dependent differential distribution between clinical subgroups [females: P<0.0012; males: P=0.48]. The comparison of HLA-C*04:01 frequency between subgroups and 2,781 Armenian controls revealed a significant incidence of HLA-C*04:01 deficiency in asymptomatic COVID-19. HLA-C*04:01 homozygous genotype in patients blueprinted a decrease in heterozygosity of HLA-B and HLA class-I loci. In HLA-C*04:01 carriers, these changes translated to the SARS-CoV-2 peptide presentation predicted inefficacy by HLA-C and HLA class-I molecules, simultaneously enhancing the appropriate HLA-B potency. In patients with clinical manifestation, due to the high prevalence of HLA-C*04:01, these effects provided a decrease of the HLA class-I heterozygosity and an ability to recognize SARS-CoV-2 peptides. Based on our observations, we developed a prediction model involving demographic variables and HLA-C*04:01 allele for the identification of potential cases with the risk of hospitalization (the area under the curve (AUC) = 86.2%) or severe COVID-19 (AUC =71%).

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.

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.

Eutrophication leads to the formation of a sulfide-rich deep-water layer in Lake Sevan, Armenia

Lake Sevan is a meso-eutrophic water body, which was severely impacted by anthropogenic level decrease, pollution and eutrophication during the last century. Starting in the 1970s, these processes resulted in the formation of an oxygen-depleted hypolimnion during summer-autumn stratification of the lake. In this work, we demonstrate for the first time that eutrophication of the lake leads not only to the full depletion of oxygen and nitrate in the hypolimnion but as well to the presence of sulfate-reducing microorganisms and toxic hydrogen sulfide. Concentrations of hydrogen sulfide in the hypolimnion of Major and Minor Sevan in October were as high as 9 and 39 μM, respectively. In October 2019, 66 % of lake's bottom was covered by sulfidic waters, while the fraction of sulfidic water volume reached 19 %. Values of δ³⁴S for hypolimnetic sulfide are lower by only 7-12 ‰ compared to epilimnetic sulfate, while δ³³S values of sulfide are similar to the δ³³S values of sulfate. These isotopic fingerprints are not consistent with microbial sulfate reduction as the sole source of hydrogen sulfide in the hypolimnion. We attribute the formation of a sulfidic deep-water layer to a combination of microbial sulfate reduction in the water column and diffusion of hydrogen sulfide from the sediments.

Navigating the nationalist landscape of exclusion: Armenian citizens of Turkey and the politics of naming

This article examines how Armenian citizens of Turkey employ names and naming strategies in their everyday life in order to navigate a nationalist social landscape. Studies of nationalist politics in everyday life have been particularly successful in demonstrating how nationalism is experienced and reproduced through the consumption of national symbols and rituals. What remains relatively glossed over in these accounts are the individuals' constant and dynamic engagements with nationalist politics not only through national symbols and rituals but also through everyday social practices with fellow citizens. The present study seeks to capture and analyze this latter, relatively understudied, aspect. In doing so, the discussion reveals how individuals use different name strategies in order to fend off shame and humiliation as well as inhibit threats to status advancement. Overall, the following narrative moves beyond a demonstration of the functionality of nationalism as a source of unity and solidarity. Instead, it reveals the ways in which nationalist politics and minorities' responses align, diverge and/or conflict on the ground.

Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

OBJECTIVE

To describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.

SETTING

Primary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.

DESIGN AND PARTICIPANTS

Before (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.

OUTCOME MEASURES

Consultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.

RESULTS

Care for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).

CONCLUSIONS

Despite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

Geomorphological evolution along international riverine borders: The flow of the Aras River through Iran, Azerbaijan, and Armenia

International rivers are one of the most politicized natural resources. Their dynamism, whether driven by the influence of natural processes or artificial drivers, can generate political issues between countries where de river is the common boundary. The present study has tried to discern the role of international riverine borders as a limiting factor of their dynamics from a geomorphological point of view. In this context, the main objective of this research is to assess how land cover in the floodplain has been affected by river dynamics along a border by analysing a 160-km-long reach of the Aras River, which is the natural frontier between Iran, Azerbaijan, and Armenia, over the last 35 years (i.e., 1984-2019). Landsat images from 1984 to 2019 have been used to assess land cover changes in a floodplain buffer using Support Vector Machine algorithms and geomorphological changes through indexes such as the River Network Change Index, Channel Mobility Index, Sinuosity index, and Bank retreat index. The results show that active channel has mainly experienced a narrowing process during the study period, with a narrowing rate of 2.05 m/year. In addition, the average value of the River Network Channel Index (-2.45 m/year) reveals that lateral deposition and narrowing were the main processes occurring within the study reach. Channel displacement toward the non-Iranian part was more prominent, being around 27 m on average along the whole study reach which may cause new problems and conflicts that conditions the border situation. In the whole study period, the succession category showed a higher rate of increase in comparison with rejuvenation. Stabilization of surfaces prevailed, with most of the area maintaining the same type during the study period. Regarding land cover types, artificialization appears to be the most prominent transition that express the Aras River, and specifically the floodplain buffer zone, has been strongly affected by human pressure, with farmland activities, urbanization, and damming being the most important types. The key to this habitat degradation comes from the management with irrigation purposes of large reservoirs that directly or indirectly would cause most of the changes detected.

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.

Phylogenetics of Bacillus anthracis isolates from Russia and bordering countries

Anthrax is a concern for public health and veterinary medicine in Russia. The available phylogenetic data on isolates from Russia and neighboring CIS countries are clearly not enough to gain a better understanding of their position in the global phylogenetic population structure of this pathogen. In this study, we analyzed the genomes of 66 Bacillus anthracis strains, which were isolated between 1935 and 2019 from different sources in Russia, as well as in Ukraine, Azerbaijan, Georgia, Armenia and Moldova. Whole genome SNP analysis of genomes of 66 strains obtained in this study along with 222 B. anthracis genomes available in the GenBank database revealed 7242 SNPs used to construct a phylogenetic reconstruction with the method of Maximum Likelihood. Studied strains belong to 6 different genetic groups: A.Br.008(A.Br.008/009), A.Br.081(Ames), A.Br.014(A.Br.Aust94), A.Br.082(A.Br.001/002), A.Br.034(A.Br.005/006, Ancient A) and B.Br.002 (B.Br.001/002). Within the group A.Br.014(A.Br.Aust94) a subcluster A.Br.029 of strains isolated in Georgia, Armenia, Azerbaijan, Russia (Republic of Dagestan) and Turkey, named Caucasus-East Anatolia (CEA), was identified. In the subgroup A.Br.105(Tsiankovskii) the cluster A.Br.117 of strains from Russia, Ukraine and Slovakia are assigned, in the subgroup A.Br118 (STI) - cluster A.Br.123 with strains from Russia and Georgia and cluster A.Br.125 with strains from Republic of Dagestan. New subclusters B.Br.017("EUROPE") were identified in the B.Br.002(B.Br.001/002) cluster, represented by strains from the European part of Russia, as well as from South Korea and Finland. For 8 clusters and subclusters, the SNP markers were identified. The study confirmed a significant genetic diversity of the strains isolated in Russia and border countries and clarified their position in the phylogenetic structure of the global B. anthracis population. New genetic clusters A.Br.029 (CEA), A.Br.117, A.Br.123, A.Br.125, and B.Br.017 («EUROPE») were defined. 96 marker SNPs specific for these clusters were identified.

Identification of radionuclides' altitudinal distribution In soil and mosses In highlands of Armenia

The present study was conducted in mountain regions of Armenia with the aim to assess the activity concentrations of natural K-40 and artificial Cs-137 in soil and mosses and reveal the distribution similarities and differences. Most widespread moss species and surface soils were sampled concurrently from eight mountain ridges and massifs by different altitudinal belts. Statistical analysis revealed significant differences and opposite characteristics for K-40 and Cs-137. In case of K-40 the activity concentrations decreased in mosses by altitude but with no significant correlation. The mean activity concentrations of K-40 in the soils of different altitudinal belts are close, nevertheless, the higher activity concentrations are common for soils derived from ingenious rocks. For Cs-137 in mosses, the correlation with altitude is statistically insignificant, but the altitudinal dependence is noticeable within separate ridges and massifs. A significant correlation was identified between Cs-137 in soil, altitude and precipitation rate. Studying natural K-40 and artificial Cs-137 radionuclides together yielded interesting contrasting results confirming the dissimilar behaviour of radionuclides with different origins in the environment.

The Implementation of the WHO Mental Health Gap Intervention Guide (mhGAP-IG) in Ukraine, Armenia, Georgia and Kyrgyz Republic

Despite the increasing burden of mental disorders, a lot of people worldwide suffer a gap in receiving necessary care in these countries. To close this gap, the WHO has developed mhGAP training modules aimed at scaling up mental health and substance use disorders services, especially in low- and middle-income countries. This article presents the experience of implementing the Mental Health Gap Action Programme (mhGAP) in Ukraine, Armenia, Georgia, and Kyrgyz Republic. Data were gathered from an electronic questionnaire administered to representatives from higher educational institutions where the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) was implemented in existing curricula for medical students, interns, and residents in family medicine and neurology, practicing physicians, and master's program in mental health students. More than 700 students went through the programs that provided the feedback. Evaluations of program effectiveness mainly involved standard discipline tests or pre- and post-tests proposed in the mhGAP trainer manual. This finding suggested that mhGAP-IG can be successfully adapted and implemented both on undergraduate and on postgraduate education levels and among medical and nonmedical specialists. Future evaluations need to more definitively assess the clinical effectiveness of mhGAP-IG implementation.

The identification of phytoextraction potential of Melilotus officinalis and Amaranthus retroflexus growing on copper- and molybdenum-polluted soils

The contamination of soils by heavy metals from the mining industry nowadays is one of the greatest threats to environment and human health. The cleaning of polluted soils using cost-effective and eco-friendly methods such as phytoextraction has wide public recognition. Considering the above-mentioned ones, the objectives of the present study were the identification of Cu and Mo accumulation capability and the phytoextraction potential of Melilotus officinalis and Amaranthus retroflexus as well as the determination of the influence of ammonium nitrate and EDTA on phytoextraction effectiveness. The contaminated soil samples for phytoremediation experiments under ex situ conditions were collected from the surroundings of the Zangezur Copper and Molybdenum Combine, Armenia. During the studies, it was found out that M. officinalis and A. retroflexus are capable of growing in polluted soils. M. officinalis grown in polluted soil had greater ability to accumulate heavy metals in roots, while the ability to transport the copper to aboveground parts was more pronounced in A. retroflexus. During the growing of these plant species for phytoextraction of soils contaminated by copper, it is necessary to use chelates, in particular the EDTA, for the enhancement of the effectiveness of phytoextraction process. EDTA due to chelating influence increased the availability of copper for plants and its mobility in them that lead to greater accumulation of this metal in shoots. The application of chelates did not have a significant impact on molybdenum accumulation intensity in plants; therefore, in case of this metal, it is unreasonable to use additional chelating compounds.

Principles to develop a simplified multimetric index for the assessment of the ecological status of Armenian rivers on example of the Arpa River system

The Government of the Republic of Armenia (RA) strives to ensure the measures to achieve good ecological status for Armenian surface water bodies. However, the main goal remains unaccomplished, as the hydro-biological monitoring tools are not properly developed. Thus, the current work aims at contributing to the establishment of principles and a relevant and cost-effective biological monitoring tool for the RA aquatic ecosystems, through the development of a simplified multimetric index (MMI). Since the adoption of the decree N° 927-N from 11 Jun 2011, the baseline studies have been initiated in the six river basin management areas established in the RA. The current work is summing up the results for the Arpa River system in order to test the methodology. In particular, it is testing the possibility to develop MMI based on the use of Rapid Biological Assessment protocol accepted in our monitoring system. Also, the work represents the approach of bottom-up biotic validation of reference sites established in the recent hydro-biologic monitoring system. Due to the proposed validation procedure, further use of one of the established reference sites in the case study object has been rejected. Considering well-established approaches for MMI development in EU member states, four variations of MMI were developed for a particular river system, and the combination of N_taxa-%EPT-Abundance(ind/m²)-BMWP-ASPT-FBI-N_family metrics has been proposed as the main one. However, further development of a river typology and the establishment of joint reference conditions in the Caucasus region have concluded as a priority.