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In recent years there has been a considerable increase in understanding of changes in mortality in Russia and some other former Soviet republics. However, the situation in the republics of the Caucasus remains poorly understood. Information on Georgia is especially fragmentary as a fifth of the country remains outside government control, there has been large scale migration since 1991, and the introduction of fees for vital registration has compromised the quality of official statistics. The aim of the study is to produce plausible estimates for life expectancy in Georgia for the period 1990-1998 and thus to assess whether Georgia has undergone changes similar to other former Soviet republics in the post-independence period. Four models were used to construct life tables. Model 1 used officially published statistics on deaths and population. Model 2 applied new estimates of population derived from household surveys to the observed deaths. Model 3 adjusted model 2 for under-registration at extremes of life, with parameter estimates derived from a survey of infant mortality and comparison of observed rates with Coale-Demeny standard life tables. Model 4 arose following inspection of death rates by cause that revealed implausible discontinuities in cancer mortality rates and involved applying the estimates of under-registration that this finding implied to model 3. The four models produce quite different estimates of life expectancy, differing by 7.8 y for men and 6.8 y for women by 1998. In any of the models, however, Georgia does not appear to have experienced the marked deterioration in life expectancy seen in Russia following the transition to independence. Importantly, Georgia had also not experienced a marked improvement in life expectancy during the 1985 Soviet anti-alcohol campaign, again unlike other Soviet republics.Official statistics substantially over-estimate life expectancy at birth in Georgia. Despite undergoing a civil war, life expectancy in Georgia has been less affected by the transition than has Russia and the overall trends in mortality since the mid 1980s suggest that this may be because alcohol has played a smaller role in these changes than it did in Russia.
OBJECTIVE: Motor vehicle crashes remain the leading cause of death among US children 1 year of age and older. Although age-appropriate child passenger restraint use and back seating position are effective injury prevention strategies, many children 12 years of age and younger ride inappropriately restrained and seated in the front seat. In Georgia and in most states, surveillance of child passenger restraint use is less than optimal. Although child safety seat legislation is 1 of the most effective mechanisms for increasing correct restraint use and back seating position, Georgia's child occupant restraint law, like the laws in most states, falls short of practices recommended by government and child advocacy safety groups. The objective of this study was to document child passenger restraint use and seating position among children aged 0 to 12 years in Georgia and to use these study results to evaluate the efficacy of Georgia's child restraint surveillance and legislation. METHODS: In May and June 2001, police roadblocks were used to collect information about child passenger age, restraint use, and seating position. RESULTS: Data were collected on 1858 children who were riding in 1221 vehicles in 24 different Georgia counties. Results showed that 56% of children were inappropriately restrained and/or in the front seat. The most problematic age groups included infants who were in forward-facing child safety seats (28%) and/or in the front seat (22%); children who were 5 to 8 years of age in car seat belts alone (88%), rather than age- and size-appropriate child safety seats (6%); and children who were 9 to 12 years of age and riding in the front seat (39%). We compared our results with the existing Georgia passenger restraint surveillance system and found that it would have missed 77% of the children in our study who were inappropriately restrained and/or riding in the front seat. In a similar comparison, Georgia's restraint law did not cover over 74% of the children in our study who were riding at risk. CONCLUSION: The results of this study highlight 3 important areas for improving child passenger safety: targeted interventions to promote booster seat use and riding in the back seat, expanded child passenger restraint and seating position surveillance, and expanded legislation to mandate booster seat use and back seating position.
The authors investigate counter-urbanization and population change in Georgia between 1960 and 1980 by examining commuting patterns. "The immediate objective is to construct the entire set of commuting fields of both large metropolitan areas to metropolitan and nonmetropolitan employment centers. We then proceed to the relationship between commuting from nonmetropolitan areas to all levels of Georgia's urban hierarchy and population change in these nonmetropolitan settings. By matching population growth and decline areas with explicit employment ties...the nature of the population changes is much better understood." Data from the 1960, 1970, and 1980 censuses for 581 Census County Divisions (CCDs) in Georgia are analyzed. It is concluded that "most nonmetropolitan growth taking place in Georgia is associated with intensification of metropolitan commuting fields along with growth of nonmetropolitan centers and their influence along the very periphery of metropolitan spheres of employment influence. However, a significant share of Georgia's nonmetropolitan population revitalization is explained by growth independent of direct metropolitan influence. It would appear then that nonmetropolitan growth centers are an important part of the basis for population decentralization in Georgia. Metropolitan spill-over alone cannot account for counterurbanization on this portion of the American economic landscape."
Passage of Georgia's Distance Learning and Telemedicine Act of 1992 resulted in a windfall of $50 million from telephone company over-earnings. Rather than refund the money to consumers, legislators created a fund to finance telecommunications projects in medicine and education. When Governor Zell Miller signed the Act into law more than a year ago, he said, "[It] will immediately catapult Georgia to the forefront of this nation in the use of advanced telecommunications to improve the quality of life of its people." The law also set the state's cable television and telephone companies at odds. Nancy Horne, executive director of the Cable Television Association of Georgia, said that her industry's broadband fiber and coaxial infrastructure is in place to provide the state with telemedicine capabilities, and that transmission of full motion video or high resolution diagnostic images could take hours over standard telephone lines. Representatives of telephone companies argue that new high-speed cell relay switching technology provides instantaneous communications. An appointed Board of Governors holds tightly to the strings that secure a purse containing the $50 million. No grants have yet been awarded. In the middle of the debate stands Georgia's Department of Administrative Services, which moderates the competition between the two industries. And, the Medical College of Georgia created a demonstration project based on telephone technology. Representatives of both institutions gave Healthcare Informatics their views on developments of telemedicine in Georgia.
INTRODUCTION: Hypertension is a leading cause of stroke, coronary artery disease, heart attack, and heart and kidney failure in the United States, all of which contribute to the rising costs of health care. The Georgia Stroke and Heart Attack Prevention Program is an education and direct service program for low-income patients with hypertension. This project evaluated the cost-effectiveness of the program compared with the following two alternative scenarios: no treatment for high blood pressure and the typical hypertension treatment received in the private sector nationwide (usual care). METHODS: We estimated the preventive treatment costs and number of adverse health events averted (hemorrhagic and ischemic stroke, heart disease, and kidney failure) associated with the Georgia Stroke and Heart Attack Prevention Program in two Georgia health districts. We used program cost and service usage data obtained from the Georgia Department of Human Resources and probabilities and costs of expected adverse events published in peer-reviewed sources. We compared program costs and number of expected adverse health events averted with those expected from 1) no preventive care and 2) usual care for high blood pressure. RESULTS: The Georgia Stroke and Heart Attack Prevention Program was less costly and resulted in better health outcomes than either no preventive care or usual care. Compared with no preventive care in the two districts, the program was estimated to result in 54% fewer expected adverse events; compared with usual care, the program was estimated to result in 46% fewer expected adverse events. Combining the costs of preventive treatment with the costs of expected adverse events, the Georgia Stroke and Heart Attack Prevention Program cost an average of 486 dollars per patient annually, compared with average annual costs of 534 dollars for no care and 624 dollars for usual care. CONCLUSION: Maintaining a publicly financed stroke and heart attack prevention program is more cost-effective and results in greater health benefits than other plausible scenarios. Because the benefits of this program accrue to both the state and federal governments through reduced Medicaid and indigent care expenditures, both the state and federal governments have a financial incentive to support the program.
Ticks and blood samples were collected from wild birds mist-netted on St. Catherine's Island, Georgia, and at the Wedge Plantation in coastal South Carolina in 1994 and 1995. Immature stages of 5 species of ixodid ticks were recovered from 10 of 148 (7%) birds belonging to 6 species in Georgia, whereas 6 ixodid species were recovered from 45 of 259 (17%) birds representing 10 avian species in South Carolina. Borrelia burgdorferi sensu lato was isolated from 27 of 120 (23%) screened ticks (Ixodes scapularis and Ixodes minor) recovered from South Carolina birds, but from none of 16 screened ticks removed from Georgia birds. This spirochete was also isolated from 1 of 97 (1%) birds in South Carolina. In 1995, neither eastern equine encephalitis (EEE) virus nor St. Louis encephalitis (SLE) virus was isolated from any of 218 bird sera screened, but serum neutralizing antibodies were found to EEE virus in 4 of 121 (3%) sera and to SLE virus in 2 of 121 (2%) sera from South Carolina. No antibody to either virus was detected in 51 avian sera screened from Georgia. Trypanosomes (probably Trypanosoma avium) were isolated from 1 of 51 (2%) birds from Georgia and from 13 of 97 (13%) birds from South Carolina. Our data suggest that some wild birds may be reservoir hosts for the Lyme disease spirochete and for encephalitis viruses in coastal Georgia and South Carolina and that migrating birds can disperse immature ticks infected with B. burgdorferi.
BACKGROUND: Asthma is a common chronic condition with significant impact on those who have it. Information about children with asthma was sought to guide state program planning. METHODS: A random-digit-dial telephone survey of 1503 households with 2700 children was conducted in Georgia. Primary caretakers were interviewed. Results for households, children, and caretakers were weighted by number of telephone lines; results for children were also weighted to the Georgia 1998 estimated population. Data were collected and analyzed in 2000. RESULTS: Asthma prevalence among children in Georgia aged 0 to 17 years was 10.5% (95% confidence interval [CI]=9.2%-11.9%). Among children with asthma, 64.8% (95% CI= 58.5-71.1) had an attack and 30.0% (95% CI=24.2-35.8) visited an emergency department in the last year. In the past year, 53.9% (95% CI=46.8-61.0) of school-aged children with asthma and 29.7% (95% CI=23.7-35.7) of adults in households of children with asthma missed school or work because of the child's asthma. Among children with asthma, 56.1% (95% CI=48.6-63.6) lived in a household where neither caretaker nor child has taken a course or been taught about managing asthma, and 28.6% (95% CI=22.1-35.1) lived in a household where adults smoked inside the house. CONCLUSIONS: Asthma has a substantial effect on the lives of children in Georgia, including medical events and missed school, and on adult caretakers in terms of missed work due to the child's asthma. To reduce the burden of asthma in Georgia, exposure of people with asthma to tobacco smoke in the home should be eliminated and training in asthma management should be more widely available.
This article is on the mental health of the population of Georgia describing context and mental health needs, extrinsic and intrinsic influences on mental health in the country, and health and social services for people with mental health problems and mental illnesses. The mental health profile of Georgia has been compiled with the help of an instrument developed by the International Consortium on Mental Health. Georgia is one of the former republics of the USSR with a population of about 4.5 million people. Political, social and economic changes have led to wide scale social stress in Georgia in recent years and to related psychosocial and behavioural problems. Difficult economic conditions and internal displacement are thought to be key contributory factors to the three-fold increase in suicide experienced during the decade following independence. Georgia has produced a written mental health policy. However, its implementation is hampered by the lack of resources, training and community awareness. The Government has passed a Mental Health Act, but this is also ineffective at present due to a lack of staff, financing and appropriate facilities.
All states are now required by federal law to measure immunization coverage in each public clinic in their jurisdiction once a year. This law is based on data suggesting a twofold increase of immunization coverage in public clinics in Georgia during a seven-year period when the state developed a system for measuring clinic coverage and using these data to stimulate immunization performance. Review of the history of the development of the Georgia system suggests that measurement alone is not sufficient to raise coverage, however. In Georgia, measurement was coupled with a vigorous program of feedback of coverage data, provision of incentives for good performance, and exchange of information among clinics. The Centers for Disease Control and Prevention (CDC) has summarized the Georgia system with the acronym AFIX--Assessment, Feedback, Incentives, eXchange of information--and recommends that all state immunization program managers test and adapt this methodology. The article comments on the development of the Georgia system and describes why CDC believes other states should adopt it.
As part of a new vision for public health in Georgia, the role of the public health nurse (PHN) is shifting from a predominantly individual and clinic-based care model to a population health practice model. Based on focus groups conducted with management and frontline PHNs in 2001, nurses in Georgia were unprepared for this transition and lacked a strong understanding of population health concepts and competencies. To prepare nurses for their new and expanded responsibilities, an online population health course was developed specifically for currently employed PHNs. The Quad Council PHN Competencies (2003) provided the roadmap in identifying the population health online course and continuing education training program priority competencies for PHNs in Georgia. Along with incorporating the competencies into case studies and didactic learning, the required projects served as evidence of competency application. The population health online course was offered from fall 2000 to spring 2005 in collaboration with Georgia schools of nursing and has enabled a cohort of nurses to lead the way as Georgia transitions into a new public health model. Nurses who completed the course reported greater experience with and an understanding of population health competencies.
This study analyzes the 4-year phase-in of Medicaid Primary Care Case Management (PCCM) in Georgia and Alabama. The effect of PCCM implementation on children's primary and preventive care, independent of changes in Medicaid participating providers, was measured by race. Accounting for provider supply, PCCM was associated with lower use of primary care for all children except white non-Hispanics in urban Georgia. In urban Alabama, PCCM reduced preventive care for white and black non-Hispanic children. This held only for blacks in urban Georgia, while PCCM was associated with increased preventive care among all children in rural Georgia. The negative effect of PCCM was further compounded by negative effects of reduced provider availability. Reductions in office-based Medicaid providers affected Alabama children more often, while reductions in hospital-based physicians had a negative effect for Georgia children. Implementation of PCCM without fee increases may have had unexpected negative effects that differentially affected minority children.
The aim of the study was to describe the clinical and epidemiological features of children and adolescents with visceral leishmaniasis in Georgia. We performed a retrospective analysis of demographic, clinical and laboratory data from children and adolescents under age of 18 (n=200) with visceral leishmaniasis admitted to the referral center -- Tbilisi S. Virsaladze Institute of Parasitology between 2000 and 2005. Diagnosis was based on detection of amastigotes in the bone marrow punctate. Age ranged from 4 months to 15.9 years, the average age was 2.79+/-0.17 years. There were 84 girls and 116 boys. 190 cases came from Eastern Georgia (123 from the capital), 10 cases -- from Western Georgia. The period between manifestation of first clinical signs of the disease and admission to the referral center varied from 1 week to 1 year (6.8+/-0,6 weeks in average). Main clinical and laboratory presentations were splenomegaly and hepatomagaly, anemia, pancytopenia (84.5%). Among associated diseases, the most frequent were bronchitis and pneumonia (7.0%) and jaundice (3.5%). In all patients glucantime was used for treatment. One patient died. Visceral leishmaniasis can be considered as an important etiological agent of the fever of unknown origin in Georgia, particularly in Eastern Georgia and in children under six. Health care workers should be trained for the early recognition and appropriate management of visceral leishmaniasis and its complications.
Despite conventional wisdom that southern states have neither the money nor popular support for such a program, a Georgia group has outlined a universal, comprehensive, single-payer proposal called "Georgia SecureCare." The group's telephone survey in 2003 found that a majority of households was concerned about losing health insurance or access. Economic analyses demonstrated that SecureCare would reduce statewide health care spending by dollar 0.72 billion (approximately 2%) in the first year while providing all Georgia residents with a generous benefit package. Despite initial increased healthcare utilization costing about dollar 3.84 billion, notable savings were attributable to lower annual administrative costs (dollar 3.82 billion) and bulk purchasing (dollar 0.74 billion saved for prescription drugs and durable medical equipment). For most families and for large employers, annual expenditures for health would decline. Georgia respondents to the telephone survey initially expressed approximately 72% support for SecureCare. After furnishing them with common objections to the plan, their support dropped to approximately 62%. A universal, state-sponsored plan would likely save money for Georgia, and it could easily win broad-based popular support.
The perceived imbalance between the supply of and demand for practicing dental hygienists has encouraged organized dentistry to pressure legislators for revisions in state practice acts. Georgia's recent experience with this type of legislation has required dental hygiene educators to develop, implement, and evaluate strategies that would increase the pool of available dental hygienists. The purpose of this paper is to present a review of strategies that were developed by Georgia dental hygiene educators to meet the recommendations spurred by proposed legislation in the General Assembly of Georgia. Dental hygiene program directors were charged by the chancellor of the University System of Georgia to improve student recruitment and retention, to explore the feasibility of new programs in areas of need, and to examine innovative ways to improve access to dental hygiene education. Dental hygiene faculties united with their professional association to activate alumni and registered hygienists, to improve public awareness by accentuating positive aspects of dental hygiene careers, and to organize a communication network whereby legislative information could be disseminated rapidly. Student recruitment was strengthened through individual and joint programs organized by dentists and dental hygienists. In response to these efforts, program enrollments were increased substantially, and a new program was established in an area of need. Nationally, dental hygienists are facing many challenges and problems that threaten to weaken or eliminate their status as educated and competent health professionals. Recently, dental and dental hygiene educators' attention was drawn to legislative activity in Georgia.
Physician supply in Georgia must be considered an urgent issue. Several important points must be recognized and addressed. The lowest physicians rates are in the more rural county population groupings. The only county population grouping with a surplus of physicians is in the over 150,000 population. The majority of physicians are concentrated in the metropolitan counties. Sixteen percent of all physicians practice in the 134 counties having less than 50,000 population. The majority of physicians are in primary care specialties. Family practice is the most dominant specialty in rural areas. By the year 2000, Georgia can expect to add 5,600 physicians due to growth. By the year 2000, Georgia can expect to lose 2,600 physicians due to retirement. Family practitioners are the most uniformly distributed of the specialties examined. They are also the specialty most needed. The average age of Georgia physicians is 46. General surgeons are in the oldest average age group (50), whereas internists are in the youngest (44). Older physicians are concentrated in the more rural areas. A significant number of all physicians are over age 55. The majority of these will be retired by the year 2000. Physicians over age 65 represent 9.2% of all physicians from the survey. In Georgia, 13.6% of all physicians were Foreign Medical School Graduates. They tend to locate their practices in medically underserved areas. The specialty choices most frequently favored by FMGs are: pediatrics, internal medicine, family practice, and obstetrics/gynecology. A total of 71.2% of all physicians accept Medicare patients; 83.8% accept Medicare patients. Ninety-two percent of all obstetricians accept obstetric patients, but this participation is threatened by problems with malpractice insurance.
The provision of health care to the growing number of persons uninsured against medical expenses affects Georgia doctors, hospitals, and state and local government at all levels. While much is known nationally about the uninsured, there are no good data about this group in Georgia. This study uses U.S. Census Bureau data to provide a demographic profile of Georgians who lack health insurance and to identify groups at particular risk for being uninsured. Approximately 950,000 (17.7%) of non-elderly Georgia residents are uninsured, compared to 37 million (17.6%) in the U.S. as a whole. As is true generally in the U.S., those in Georgia who are poor, young, non-white, and in families with a female head are at greatest risk. Of particular note are the poor in Georgia with incomes from 50% to 100% of the federal poverty level (55.2% uninsured). This population deserves the special attention of all involved in finding a solution to this problem.