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PubMed2000

Epidemic investigation of diphtheria in the Republic of Armenia, 1990-1996.

While incidence rates of diphtheria steadily declined in Armenia after World War II, reemergence of the disease in 1990 brought about changes in public health practices and identified resource needs. The Armenian Ministry of Health (MOH) routinely collected diphtheria case reports, as a reportable health outcome. Diphtheria incidence rates increased from 0.02/100,000 in 1993 to 1/100,000 (36 cases) in 1994. The distribution of cases showed that the greatest number of illnesses and deaths occurred among persons 5-14 years old, yet incidence rates among persons 1-4 and 5-14 years old were similar (4. 4 cases/ and 4.3 cases/100,000, respectively). During 1990-1996, 9 (75%) of 12 cases who died and 18 (21%) of 84 cases who survived had not been vaccinated. The diphtheria epidemic in Armenia was an important, serious, and signal public health event. The Armenian MOH responded by revising immunization practices (1994), improving epidemic control measures (1995), and soliciting international resources (1992-1996).

Adolescent↗
PubMed2002

Risk factors for depression in the survivors of the 1988 earthquake in Armenia.

Most studies of psychopathology following disasters are concerned with posttraumatic stress disorder (PTSD). The present analyses sought to assess the rate and determinants of depression in adult survivors of the 1988 earthquake in Armenia. Unlike previous studies of earthquakes, the present analyses derive from a well-defined cohort of survivors who underwent diagnostic interviewing to characterize psychiatric morbidity. As part of a cohort study of 32,743 survivors of the 1988 earthquake in Armenia, a stratified population sample of 1,785 persons was interviewed about 2 years following the disaster using a special questionnaire based on the National Institute of Mental Health (NIMH) Disaster Interview Schedule/Disaster Supplement. 52% met the criteria for major depression. Of these, a total of 177 cases of depression with no other psychiatric diagnosis or comorbidity were compared with 583 controls from the same interviewed group who did not fulfill the criteria for any psychiatric disorder. Cases and controls were compared as to data obtained independently at the aftermath of the disaster on a number of exposures and characteristics related to the earthquake. More of the cases involved females (odds ratio [OR] for males 0.7 [95% confidence interval [CI] 0.5-0.9]) and from the city of Gumri, which had some of the worst destruction (OR for residents of Gumri 5.9 [95% CI 4.0-8.8]). Being with someone in the same building at the moment of the earthquake was protective for depression (OR for presence of other people 0.5 [95% CI 0.3-0.6]), and the risk of depression increased with the amount of loss that the family sustained as a result of the earthquake (OR for highest level of loss 2.5 [95% CI 1.3-4.8]). The use of alcohol was protective for depression (OR for those who drink 0.5 [95% CI 0.3-0.8]). In various models of multivariate adjustment and analysis, the increased risk of depression with loss, geographic location, and female gender was maintained. Also, being with someone during the disaster, receiving assistance and support after the earthquake, and alcohol use were protective for depression in these multivariate analyses. Depression is a common sequel to an earthquake. As with our previous study of PTSD, we were able to relate intensity of the disaster and loss to the risk of depression in a general population sample. The role of social support during and after the disaster as a protective mechanism against adverse psychological outcome was highlighted again. Whereas alcohol use in our previous study was not related to PTSD outcome, it is noteworthy that in the present analyses it emerged as a protective factor for depression.

Adolescent↗
PubMed1997

An epidemic of acute postinfectious glomerulonephritis in Armenia.

AIM: To evaluate the presentation and course of acute postinfectious glomerulonephritis (APGN), which has increased dramatically in Armenia after serious deterioration in the living conditions. STUDY DESIGN: Observational study, based on case notes, of a large homogeneous group of patients hospitalised for APGN at one centre over a five year period (1992-6). PATIENTS: 474 patients aged < 16 years with a diagnosis of APGN. RESULTS: The annual number of patients increased tenfold from 19 (average 1992/3) to 196 in 1995. Sixty two per cent were in the age group 4-9 years and 65% were boys. Upper respiratory infections, scarlet fever, and skin infections preceded APGN in 51%, 23%, and 13%, respectively. All patients had haematuria (93% gross), 84% had oedema, and 72% had hypertension. C3 was initially decreased in 95% of the patients examined. Renal function was impaired (serum creatinine > 100 mumol/l) in 29%. Four patients with renal failure had crescentic glomerulonephritis at biopsy; of these, three required temporary haemodialysis. Main extrarenal complications were heart failure (10%) and convulsions (3%). One patient died and five (3%) did not recover completely. CONCLUSIONS: APGN in children is associated with considerable initial morbidity, and long term outcome is not uniformly benign. Outbreaks of APGN may occur anytime in countries such as Armenia that are suffering from a sudden decline in socioeconomic conditions.

Acute Disease↗
PubMed1998

Contraception and induced abortion in Armenia: a critical need for family planning programs in eastern Europe.

OBJECTIVES: The purpose of this study was to determine the number of induced abortions per woman and the reasons for selecting induced abortion among parous Armenian women. METHODS: A consecutive series of 200 women attending an abortion clinic in Yerevan, Armenia, were queried by a physician about their reproductive histories. RESULTS: Women younger than 20 years of age reported a median of 1 and women older than 40 years reported a median of 8 induced abortions in their lifetimes (overall median = 3). Lack of contraceptive information was the major reason cited for not using contraception. CONCLUSIONS: Induced abortion is the major form of birth control among parous Armenian women. Concerted public health campaigns are needed to inform women and their physicians in Armenia and other Eastern European countries about alternative contraceptive methods.

Abortion, Induced↗
PubMed2001

Chromosome aberrations in lymphocytes of persons exposed to an earthquake in Armenia.

OBJECTIVE: This study attempted to determine the level of chromosome aberrations in lymphocytes of victims of the 1988 earthquake in Armenia. METHODS: Chromosome aberrations were measured in blood samples taken from 41 victims of the earthquake that hit Armenia in 1988 and in samples of 47 reference blood donors. The victims suffered from severe psychoemotional stress but were otherwise healthy. All the samples were taken 2 to 3 weeks after the earthquake. All the subjects were lifetime nonsmokers. The cells were scored blind as to the exposure status. RESULTS: The subjects exposed to the earthquake had a higher proportion of cells with chromosome aberrations [3.1 (SD 2.1)%] than the referents [1.7 (SD 1.3)%, P-value for the difference 0.0009]. The difference persisted when the values were adjusted for age and gender [relative risk (RR) 1.9, 95% confidence interval (95% CI) 1.4-2.5]. The difference was present for double breaks (RR 4.1, 95% CI 2.6-6.4), but not for single breaks (RR 1.1, 95% CI 0.8-1.7). The exposed subjects also had a lower percentage of cells with 46 chromosomes (P=0.03) than the referents. CONCLUSIONS: This study suggests an increase in chromosome aberrations in the lymphocytes of victims of a severe earthquake as compared with the levels of referents. If not due to bias or confounding, the difference may reflect the effect of either environmental exposures related to the earthquake or severe psychogenic stress. The levels of chromosome aberrations found among the earthquake victims in this study are comparable with those found in prospective studies of long-term cancer risk.

Adolescent↗
PubMedDate not supplied

Emergency medical services in the reconstruction phase following a major earthquake: a case study of the 1988 Armenia earthquake.

STUDY OBJECTIVE: To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical needs of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel. METHODS: The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS). RESULTS: Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem. CONCLUSION: In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.

Adult↗
PubMed1992

[Etiological structure of dysentery in the republic of Armenia].

In this work materials on the etiological structure of Shigella infections at different territories of Armenia are presented. Four Shigella species have been found to circulate in Armenia. The dominating etiological agent is S. flexneri with S. sonnei also playing an important role. The serological picture of S. flexneri is characterized by the prevalence of subserovar 2a.

Armenia↗
PubMedDate not supplied

Population-based nutritional risk survey of pensioners in Yerevan, Armenia.

Armenia, a republic of the former Soviet Union, currently suffers from hyperinflation of its currency, a five-year country-wide blockade, and a war with Azerbaijan. Pensioners 60 years of age or older may be at high risk for significant nutritional deficits. We drew a stratified systematic sample (with a random starting point) of 456 pensioner names from all eight administrative regions in Yerevan, the capital of Armenia. We administered a questionnaire that gathered data including self-reported weight and height, demographic characteristics, living conditions, medical and dietary history, income, and aid received from various sources. The survey yielded 381 of 456 (84%) completed interviews. Ninety-one percent reported their diet had gotten worse during the past six months, including less variety (83%) and quantity (85%) of food. Seventy-six percent reported they did not have enough money to buy food, and 91% had cut the size of their meals or skipped meals. Forty-five percent reported a weight loss of > or = 5 kg in the previous year. After we adjusted for potential confounders, weight loss of > or = 5 kg was associated with illness affecting eating (adjusted odds ratio [OR] = 2.2, 95% confidence intervals [CI] = 1.4, 3.4), not having received aid (adjusted OR = 2.2, 95% CI = 1.1, 4.1), and cutting the size of or skipping meals (OR = 2.7, 95% CI = 1.1, 6.7).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Occupational blood lead survey--Armenia, 1991 and 1993.

The risk for lead exposure and lead poisoning is a persistent problem for some workers (1) and is an important issue in both industrialized and developing countries (2). In Armenia, where lead is used widely in industry (3), the Armenian Engineers and Scientists of America, Inc. (AESA), and the United Armenian Fund (UAF)* initiated a program in 1991 to use blood lead determinations to investigate lead exposures, identify industries and circumstances associated with lead hazards, and define specific jobs characterized by excessive exposures that increase the risk for lead poisoning of workers. In 1991, team investigators surveyed four factories that use lead; in 1993, one of the factories was resurveyed. Because the capacity of laboratories in Armenia to reliably determine blood lead levels (BLLs) is limited, blood specimens were transported to the United States for lead testing. This report presents the findings of both surveys and establishes the feasibility of sample collection at remote sites for transport to laboratories equipped and certified to process lead specimens.

Armenia↗
PubMed1998

Epidemic malaria transmission--Armenia, 1997.

The dissolution of the Former Soviet Union (FSU) has resulted in the disruption of the health infrastructure in many of the republics, as indicated in part by increases in infectious diseases that were previously controlled (e.g., diphtheria, typhoid, and hepatitis A). In 1994, the Ministry of Health (MOH) of Armenia (1995 population: 3.5 million) detected the first locally acquired case of malaria since the 1940s; the number of imported cases (15) was approximately twice the annual average during 1986-1989 (seven). In 1995, although no locally acquired cases were reported, the number of imported cases increased to 502. In 1996 and 1997, the total (locally acquired and imported) number of reported cases of malaria was 347 and 841, respectively. This report summarizes surveillance for malaria in Armenia during 1996-1997.

Armenia↗
PubMed2002

Giardiasis in children living in post-earthquake camps from Armenia (Colombia).

BACKGROUND: An earthquake in the coffee growing region of Colombia on January 25, 1999 destroyed 70% of the houses in Armenia city. Transitory housing camps still remained until two years after the disaster. Parasitological studies found that, in this population, giardiasis was the most frequent parasitic infection. This study was carried out in order to determine the epidemiological risk factors associated with this high prevalence. METHODS: Fecal samples were obtained from 217 children aged between 3 and 13 years. Stool samples were studied by direct wet examination and stained with ferric hematoxilin for microscopical examination. Epidemiological data were collected by questionnaire and analyzed by using the Epi-info software (CDC, Atlanta 2001). RESULTS: Giardia cysts were observed in 60.4% of the samples presented and trophozoites in 4.6%. The following epidemiological and laboratory factors were significantly associated with Giardia infection: 1. Use of communal toilet (vs. individual toilet) OR: 3.9, CI95%: 1.2-16; 2. water provision by municipal ducts (vs. water provision by individual tanks) OR: 3.5, CI95% 1.1-14, and 3. presence of mucus in stool OR: 2.3, IC95%: 0.9-6.7. CONCLUSIONS: A high prevalence of giardiasis was found in children living in temporary houses after the 1999 earthquake in Armenia (Colombia). Giardiasis is an emerging disease in post-disaster situations and adequate prevention measures should be implemented during these circumstances.

Adolescent↗
PubMed2004

Factors affecting the performance of maternal health care providers in Armenia.

BACKGROUND: Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. METHODS: Two hundred and eighty-five nurses and midwives were observed conducting real or simulated antenatal and postpartum/neonatal care services and interviewed about the presence or absence of the performance factors within their work environment. Results were analyzed to compare average performance with the existence or absence of the factors; then, multiple regression analysis was conducted with the merged datasets to obtain the best models of "predictors" of performance within each clinical service. RESULTS: Baseline results revealed that performance was sub-standard in several areas and several performance factors were deficient or nonexistent. The multivariate analysis showed that (a) training in the use of the clinic tools; and (b) receiving recognition from the employer or the client/community, are factors strongly associated with performance, followed by (c) receiving performance feedback in postpartum care. Other - extraneous - variables such as the facility type (antenatal care) and whether observation was on simulated vs. real patients (postpartum care) also had a role in observed performance. CONCLUSION: This study concludes that the antenatal and postpartum care performance of health providers in Armenia is strongly associated with having the practical knowledge and skills to use everyday tools of the trade and with receiving recognition for their work, as well as having performance feedback. The paper recognized several limitations and expects further studies will illuminate this important topic further.

Journal Article↗
PubMedDate not supplied

[Risk factors for Toxoplasma gondii infection in pregnant women in Armenia, Colombia].

OBJECTIVES: To determine the risk factors associated with acute toxoplasmosis during pregnancy in Armenia. METHODS: Case-control study; 14 cases and 34 controls (mean ages 23 +/- 5.5 and 23 +/- 5.1 respectively; p = 0.93). Cases were pregnant women with serological criteria for acute toxoplasmosis and controls were seronegative pregnant women for Toxoplasma IgG. RESULTS: The risk factors more strongly predictive of acute toxoplasmosis in pregnant women were: eating undercooked meat (OR: 13.2; 95% CI: 1.3-132; p = 0.01), drinking beverages prepared with un-boiled water (OR: 4.5; 95% CI: 1.1-17; p = 0.01), and contact with cats aged less than 6 months (OR: undefined, p = 0.01). Drinking of bottled water was a protective factor (OR: 0.24; 95% CI: 0.06-0.95; p = 0.02). CONCLUSIONS: 42% of Toxoplasma gondii infections in pregnant women Armenia were associated to contact with young cats and to consumption of undercooked meat. Drinking of bottled water to prevent toxoplasma infection during pregnancy is also recommended.

Adult↗
PubMed1999

Cancer incidence and mortality in a cohort of chloroprene workers from Armenia.

We evaluated the risk of cancer among 1897 men and 417 women exposed to chloroprene (2-chloro-1,3-butadiene, CP) at a production plant in Yerevan, Armenia, between 1940 and 1988. The cohort was followed up for cancer incidence for the years 1979-1990 and for cancer mortality for 1979-1988. In the cohort, incidence and mortality from all cancers were below expectation, but increased incidence (standardized incidence ratio 3.27, 95% confidence interval [CI] 1.47-7.27), and mortality (standardized mortality ratio 3.39, 95% CI 1.09-10.5) from liver cancer were noticed. A dose-response relationship was suggested between liver cancer and indices of CP exposure, such as duration of employment, duration of high CP exposure and cumulative exposure to CP. The risk of other neoplasms was not increased.

Armenia↗
PubMedDate not supplied

Spinal cord injury rehabilitation in Armenia.

The International Federation of Red Cross and Red Crescent Societies has once again provided a new beginning for the victims of natural disaster and has initiated a change in cultural attitudes toward people with disabilities. My work in Armenia has also helped me to grow and experience a "world view" of my own.

Armenia↗
PubMed1996

Trauma system development in Armenia.

UNLABELLED: A medical partnership program between Boston University School of Medicine and the the Emergency Hospital, of Yerevan, Armenia, has been developed to improve the care of the injured in that city. The Emergency Hospital, a trauma center, was site-visited by experts from a Level I trauma center who evaluated prehospital and hospital-based emergency and trauma services and made system-wide recommendations. Recognizing local limitations, the hospital was found to have the leadership commitment, staff complement, and basic infrastructure to meet the American College of Surgeons' criteria for Level II trauma centers. The goal of integration of the academic, clinical, and research roles of a medical center consistent with Level I-type trauma centers was formulated. After 36 months, several issues raised in the assessment are being addressed notwithstanding political and economic turbulence. The Emergency Hospital has established an accredited residency program in emergency medicine; implemented programs for postgraduate medical education of its staff; begun to develop medical information systems; expanded the scope of its activities to other institutions; and restructured the emergency admissions area. Management systems remain largely undeveloped as the discipline lacks recognition as an analytic tool for institutional improvement. CONCLUSIONS: The use of existing published resources for assessment and improvement of health services in dissimilar health-care systems has been validated as a systematic approach. For system advances to be well-founded, a combination of education, management, and clinical approaches needs to be addressed. Of these, our experience is that management issues are the most resistant to change.

Armenia↗
PubMed2001

Pediatric urolithiasis in Armenia: a study of 198 patients observed from 1991 to 1999.

To study prospectively the risk factors and etiology of urolithiasis in all stone patients aged <15 years admitted from 1991 to 1999 to the Arabkir hospital in Yerevan. Stones were obtained by surgery (64%), extracorporeal shockwave lithotripsy (ESWL) (7%) or cystoscopic extraction (4%); 25% passed spontaneously. All were examined by infrared spectroscopy, and spot urines were analyzed chemically. 198 patients, 180 (68% males) with renal stones and 18 (83% males) with primary bladder stones, were studied. Calcium oxalate (CaOx) was the predominant constituent in 62% of the kidney stones, followed by struvite (17%), calcium phosphate (7%), uric acid (7%), ammonium acid urate (5%), and cystine (2%). Bladder stones contained CaOx in 72%, uric acid in 22% and ammonium acid urate in 6% of patients. Etiology was obviously metabolic in 5% and possibly metabolic in 26%. Twenty percent of stones were infectious, and 19% were endemic (9% bladder and 10% kidney stones); 4% were secondary to urinary stasis with malformation but no infection. Etiology in 26% remained unknown. Stone composition and metabolic etiology are similar to that in central Europe and North America. In contrast, infectious calculi and particularly endemic stones are still common, although becoming less so now. Urolithiasis in Armenia thus reflects the transition from a rural to an urban society.

Adolescent↗
PubMed2006

Feeding practices of babies and the development of atopic dermatitis in children after 12 months of age in Armenia: is there a signal?

We investigated the influence of feeding practices on development of atopic dermatitis (AD) in Armenian children (n = 240). In multivariate models early introduction to solids, family history of atopy, and breastfeeding by a mother with atopic condition were associated with the development of AD after 12 months post-term. A prospective study in Armenia is recommended to confirm our findings.

Armenia↗