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PubMed2005

National haemophilia programme development in the Republic of Georgia.

After the dissolution of Soviet Union in 1991, haemophilia care in the Republic of Georgia was negatively affected because of the expense of treatment products, lack of clinical and diagnostic facilities, and the need for trained personnel throughout the country. In 2001, the Georgian Government, working through the Ministry of Health, in collaboration with Georgian Association of Haemophilia and Donors, the Institute of Haematology and Transfusion, and the World Federation of Haemophilia, initiated a National Haemophilia Programme. As part of this programme the first Georgian Haemophilia Treatment Centre (HTC) was established. In this paper, we will describe (i) our outreach efforts to identify patients with haemophilia (PWH), (ii) the diagnostic and clinical services provided to patients by the HTC, and (iii) the results of a patient survey designed to assess patient satisfaction with the care provided. Total of 216 PWH were diagnosed, mean age was 25 years (range 4 months to 75 years); 43% had severe, 33% had moderate and 24% had mild haemophilia A or B. Overall, 183 (85%) had haemophilia A and 33 (15%) had haemophilia B, giving a ratio of 5.6. During the 2-year period, 77% of the expected number of PWH was identified by our outreach programme. Vast majority had comprehensive evaluation including joint assessment and over 60% were tested for blood-borne infections within a year and half period. Our findings showed that haemophilia care was considerably improved since the beginning of the National Haemophilia Programme and the survey of PWH showed a high degree of satisfaction with services provided in the HTC. In conclusion, close collaboration of the government, non-government entities and medical professionals in a Georgian national haemophilia care model; resulted in the successful delivery of the much needed services and care to the people living in Georgia with haemophilia.

Adult↗
PubMed2006

Prevalence and degree of childhood and adolescent overweight in rural, urban, and suburban Georgia.

The prevalence and severity of child and adolescent overweight (OW) in the United States have been documented, but little is known regarding the prevalence of OW and "Extent of Overweight" (EOW) in individual states or specific regions within states. The aim of this study was to determine the prevalence of OW and EOW in school-aged youths from 4 regions of Georgia. A 2-stage cluster sampling procedure was performed in 2002, with participation of 4th-, 8th- and 11th-grade students (N = 3114). Measured height and weight were used to determine body mass index (BMI) for age percentiles and data were weighted to estimate population prevalence of OW. A logistic regression model determined predictors of OW. The overall estimate of OW prevalence was 20.2% and highest in males (22.0%), non-Hispanic blacks (21.8%), "other races" (32.4%), and students residing in rural growth (23.7%) and rural decline (23.0%) areas. Overweight prevalence was similar among grades. The overall estimated EOW was 4.3 and highest in males (4.7), other races (5.6), non-Hispanic blacks (5.2), and students from rural growth (5.4) and rural decline (5.0) areas. Sex, race, location, and economic tier were significant predictors (= 0.02) of OW. The prevalence and severity of OW was higher in youths residing in Georgia than nationally. School health professionals, community leaders, and parents should provide support for updated school policies aimed at providing BMI surveillance and a school environment that encourages physical activity and healthy nutrition practices.

Adolescent↗
PubMed1996

Georgia's harvesting healthy habits: a formative evaluation.

Occupational safety and health researchers seek to conduct effective cancer awareness campaigns to increase agricultural workers' skin cancer prevention and detection behaviors. Georgia undertook such a project using a social cognitive theory (Bandura, 1986) conceptual model, with its objectives focusing on personal determinants of and environmental influences on farmers' behavior. One underused strategy to increase the success of health campaigns, formative evaluation, was undertaken during year one of the demonstration project, with four goals. These included an assessment of: (1) the availability of societal resources to support farmers' practices, (2) the affordability for farmers to follow through with behaviors being promoted, (3) the social support for behaving in ways that reduce farmers' skin cancer risk, and (4) farmers' current knowledge, outcome expectations, and self-efficacy in this regard. Formative evaluation revealed an absence of information, products, services, and social support for farmers' skin cancer prevention and detection. As a result, the Georgia project's plan was refined to include specific activities aimed at increasing the environmental support for health promotion activities relating to farmers' skin cancer prevention and detection. These include a seminar for rural primary care physicians and public health nurses to increase knowledge and skills relating to conducting clinical skin exams; programs for agricultural extension agents, cotton scouts, and 4-H groups to provide opportunities to learn more about and practice sun safety; and a feed and seed store campaign.

Agriculture↗
PubMed2003

Transforming the delivery of rural health care in Georgia: state partnership strategy for developing rural health networks.

Since 1996, 19 networks covering 74 of the 117 rural counties in Georgia have emerged. This grassroots transformation of rural health care occurred through a series of partnerships launched by state government officials. These partnerships brought together national and state organizations to pool resources for investment in an evolving long-term strategy to develop rural health care networks. The strategy leveraged resources from partners, resulting in greater impact. Change was triggered and accelerated using an intensive, flexible technical assistance effort amplified by developmental grants to communities. These grants were made available for structural and organizational change in the community that would eventually lead to improved access and health status. Georgia's strategy for developing rural health networks consisted of 3 elements: a clear state vision and mission; investment partnerships; and proactive, flexible technical assistance. Retrospectively, it seems that the transformation occurred as a result of 5 phases of investment by state government and its partners. The first 2 phases involved data gathering as well as the provision of technical assistance to individual communities. The next 3 phases moved network development to a larger scale by working with multiple counties to create regional networks. The 5 phases represent increasing knowledge about and commitment to the vision of access to care and improved health status for rural populations.

Community Health Planning↗
PubMed2006

Urban-rural differences in the availability of hospital information technology applications: a survey of Georgia hospitals.

CONTEXT: Information technology (IT) has been identified as a potential tool for improving the safety of health care delivery. PURPOSE: To determine if there are significant differences between urban and rural community hospitals in the availability of selected IT functional applications and technological devices. METHODS: A mailed survey of community hospitals in Georgia assessing the current availability of IT applications (54.6% response rate). FINDINGS: Georgia hospitals reported having 63.6% of 56 possible functional applications computerized but only 52.9% of 41 technological devices. Compared to rural hospitals, urban hospitals had significantly more functional applications computerized (38.0 vs 31.8, P = .031) and technological devices available (23.9 vs 18.2, P = .016). Urban hospitals had significantly (P < .05) more IT applications available in 4 areas: emergency room services (7 of 10), surgical/operating room (8 of 12), laboratory (7 of 12), and radiology (5 of 11). Overall, the availability of IT applications was bimodal in rural hospitals: over 40% of rural hospitals had adopted over 70% of all applications, while approximately 26% of rural hospitals had adopted less than 30%. CONCLUSIONS: Some of the observed urban/rural differences in availability of IT applications may be due to differences in the scope of services provided by rural hospitals, in particular laboratories, radiology departments, emergency rooms, and surgery/operating rooms. Nevertheless, the bimodal distribution of IT applications adopted in rural hospitals raises concerns about the ability of selected rural hospitals to take advantage of regional data-sharing initiatives and maintain quality of patient care in the future.

Georgia↗
PubMed1975

Rape, race, and the death penalty in Georgia.

Following the 1972 Supreme Court decision on capital punishment, the Georgia legislature enacted a death penalty statute that attempts to avoid constitutional objections by establishing discretionary death sentencing for 361 rape cases in Georgia, comparing legal and nonlegal variables. Results indicate that blacks convicted of raping whites were disproportionately sentenced to death.

Black or African American↗
PubMed2006

Diversity of Bacillus anthracis strains in Georgia and of vaccine strains from the former Soviet Union.

Despite the increased number of anthrax outbreaks in Georgia and the other Caucasian republics of the former Soviet Union, no data are available on the diversity of the Bacillus anthracis strains involved. There is also little data available on strains from the former Soviet Union, including the strains previously used for vaccine preparation. In this study we used eight-locus variable-number tandem repeat analyses to genotype 18 strains isolated from infected animals and humans at different sites across Georgia, where anthrax outbreaks have occurred in the last 10 years, and 5 strains widely used for preparation of human and veterinary vaccines in the former Soviet Union. Three different genotypes affiliated with the A3.a cluster were detected for the Georgian isolates. Two genotypes were previously shown to include Turkish isolates, indicating that there is a regional strain pattern in the South Caucasian-Turkish region. Four of the vaccine strains were polymorphic, exhibiting three different patterns of the cluster A1.a genotype and the cluster A3.b genotype. The genotype of vaccine strain 71/12, which is considered an attenuated strain in spite of the presence of both of the virulence pXO plasmids, appeared to be a novel genotype in the A1.a cluster.

Animals↗
PubMed2006

Genetic background and antibiotic resistance of Staphylococcus aureus strains isolated in the Republic of Georgia.

The genetic composition and antibiotic sensitivities of 50 clinical isolates of Staphylococcus aureus obtained from various clinics in the Republic of Georgia were characterized. S. aureus strains ATCC 700699 and ATCC 29737 were included as reference standards in all analyses. All 52 strains had identical 16S rRNA profiles. In contrast, pulsed-field gel electrophoresis (PFGE) identified 20 distinct PFGE types among the 52 strains examined, which indicates that PFGE is more discriminating than is 16S rRNA sequence analysis for differentiating S. aureus strains. The results of our PFGE typing also suggest that multiple genetic subpopulations (related at the ca. 85% similarity level, based on their SmaI PFGE patterns) exist among the Georgian S. aureus strains. Twenty-two of the 50 Georgian strains were methicillin resistant and PCR positive for mecA, and 5 strains were methicillin sensitive even though they possessed mecA. None of the strains were vancomycin resistant or contained vanA. The nucleotide sequences of mecA fragments obtained from all mecA-containing strains were identical. Our data indicate that the population of S. aureus strains in Georgia is fairly homogeneous and that the prevalence of methicillin-resistant, mecA-positive strains is relatively high in that country.

Anti-Bacterial Agents↗
PubMed2004

Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia.

BACKGROUND AND PURPOSE: Despite Food and Drug Administration approval of tissue-type plasminogen activator (tPA) for stroke, obstacles in the US health care system prevent widespread use. The Remote Evaluation for Acute Ischemic Stroke (REACH) program was developed to address these obstacles in rural settings. We have previously shown the reliability of the REACH system in performing a valid National Institutes of Health Stroke Scale (NIHSS) evaluation at the Medical College of Georgia (MCG). We now report on the performance of the system since its deployment in 5 rural hospitals in east Georgia. METHODS: The rural emergency department (ED) staff can activate a Code REACH protocol 24 hours per day, 7 days per week by calling the Emergency Communications Center (ECC, an in-house dispatch center) at MCG, who pages the on-call consultant. The consultant calls back the ECC and is connected to the waiting ED. Simultaneously, using any broadband-connected workstation, the consultant logs in to the REACH system, allowing performance of an NIHSS evaluation, review of the computerized tomography (CT) images transmitted by the local radiology staff, and then the consultant can speak to the patient and family to verify time of onset. RESULTS: The REACH system has evaluated 75 patients from March 2003 to April 2004, and 12 have received tPA, all without intracranial hemorrhage complications. NIHSS scores ranged from 0 to 30, with a mean of 14.3 (SD=8.7, median 11.5). The mean onset to door time was 70.9 minutes (SD=70.8, median 50), the mean door to consult time was 45.1 minutes (SD=39.8, median 34), and the mean door to NIHSS completion was 62.9 minutes (SD=50.8, median 51). The mean onset to needle time was 135.33 minutes (SD=51.45, median 134.5). CONCLUSIONS: The REACH system enables remote stroke physicians to direct the local ED staff to administer tPA in rural settings where thrombolytics were not previously used. REACH may be used as a rapid consult tool to provide the same quality of stroke care to patients in rural hospitals as is given in tertiary stroke centers. This supports our endeavor to bring stroke expertise to rural community hospitals.

Emergency Service, Hospital↗
PubMed1979

Distribution of serotypes of the Mycobacterium avium-intracellulare-scrofulaceum complex in Georgia.

Cultures of the Mycobacterium avium-intracellulare-scrofulaceum (MAIS) complex, isolated from patients who lived throughout the state of Georgia, were studied using the serotyping scheme of Schaefer. One hundred four (77 per cent) of the 135 isolates tested could be classified into 16 serotypes. The rest were not typable. Fifty-eight per cent of all the typable strains were serotypes 1, 14, 16, and 42. Results of the serotyping were recorded, mapped, and analyzed by county of residence. Most frequent isolations of these mycobacteria were from patients who resided in the coastal plain of Georgia. This finding correlates with the mycobacterial skin test studies of Edwards and associates, who found that the largest percentage of reactors to PPD-Battey resided in the costal plain. The disparate distributions of certain serotypes suggest the possible importance of regional factors that may affect the serotypes of mycobacteria indigenous to an area. The data do not suggest that chicken or swine reservoirs are highly significant sources of human mycobacteria.

Agglutination Tests↗
PubMedDate not supplied

The scope of practice of diabetes educators in the state of Georgia.

PURPOSE: The purpose of this study was to identify and describe the scope of practice trends of diabetes educators in the state of Georgia. METHODS: The Diabetes Educator Responsibilities Questionnaire (DERQ) was sent to 221 members of the American Association of Diabetes Educators listed in the 1995 membership directory in Georgia. Of the 221 members, 97 returned completed questionnaires. This population of healthcare professionals comprised the sample population. RESULTS: In assessing the primary responsibilities of the sample, more than 50% of the respondents performed six of the nine educator roles. Less than 50% of the respondents indicated that they "Always" or "Frequently" used behavior modification strategies in teaching people with diabetes. CONCLUSIONS: The questionnaire used in this study should be expanded to elicit more detailed information regarding decisions to use or not use behavior modification techniques in diabetes education.

Behavior Therapy↗
PubMed2006

Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia.

BACKGROUND: A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1) to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2) to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention. METHODS: A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH) offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff. RESULTS: The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response. CONCLUSION: To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and response. Linking the intervention to broader health sector reforms in management processes and organizational culture will be critical to ensure that efforts designed to promote evidence-based decision-making are successful, especially as they are scaled up to the national level.

Focus Groups↗
PubMed2006

Business and public health collaboration for emergency preparedness in Georgia: a case study.

BACKGROUND: Governments may be overwhelmed by a large-scale public health emergency, such as a massive bioterrorist attack or natural disaster, requiring collaboration with businesses and other community partners to respond effectively. In Georgia, public health officials and members of the Business Executives for National Security have successfully collaborated to develop and test procedures for dispensing medications from the Strategic National Stockpile. Lessons learned from this collaboration should be useful to other public health and business leaders interested in developing similar partnerships. METHODS: The authors conducted a case study based on interviews with 26 government, business, and academic participants in this collaboration. RESULTS: The partnership is based on shared objectives to protect public health and assure community cohesion in the wake of a large-scale disaster, on the recognition that acting alone neither public health agencies nor businesses are likely to manage such a response successfully, and on the realization that business and community continuity are intertwined. The partnership has required participants to acknowledge and address multiple challenges, including differences in business and government cultures and operational constraints, such as concerns about the confidentiality of shared information, liability, and the limits of volunteerism. The partnership has been facilitated by a business model based on defining shared objectives, identifying mutual needs and vulnerabilities, developing carefully-defined projects, and evaluating proposed project methods through exercise testing. Through collaborative engagement in progressively more complex projects, increasing trust and understanding have enabled the partners to make significant progress in addressing these challenges. CONCLUSION: As a result of this partnership, essential relationships have been established, substantial private resources and capabilities have been engaged in government preparedness programs, and a model for collaborative, emergency mass dispensing of pharmaceuticals has been developed, tested, and slated for expansion. The lessons learned from this collaboration in Georgia should be considered by other government and business leaders seeking to develop similar partnerships.

Bioterrorism↗
PubMed1996

A study of physician reactions to the Medicare cost containment pilot program in the State of Georgia.

Having reduced the unit cost of physician fees during the 1980s, the federal government set up a Medicare pilot study in the state of Georgia in 1989 to test the impact of its cost containment strategies aimed at reducing volume of services. This research has attempted not only to clarify the nature of physician reaction to the Medicare pilot study and to quantify the level of the dissatisfaction, but also to provide a richer understanding of the dynamic meaning of the dissatisfaction that Georgia physicians feel.

Aged↗
PubMedDate not supplied

Individual and structural influences shaping pharmacists' decisions to sell syringes to injection drug users in Atlanta, Georgia.

OBJECTIVE: To better understand the individual (e.g., attitudes and beliefs) and structural (e.g., laws and regulations) factors that influence and shape pharmacists' decisions about selling syringes to injection drug users (IDUs). DESIGN: Qualitative research. SETTING: Metropolitan Atlanta. PARICIPANTS: 20 practicing pharmacists who work in or near areas of high drug use in Atlanta, and nine pharmacists who are considered leaders in their profession in Georgia. INTERVENTIONS: Semistructured, in-depth interviews. MAIN OUTCOME MEASURES: Individual and structural factors that influence pharmacists' decisions about selling syringes to IDUs. RESULTS: Pharmacists reported that they use their professional discretion in making syringe sale decisions and that these decisions are influenced by individuals factors such as their personal attitudes and beliefs about the nature and causes of drug use, and by structural factors such as the Georgia Board of Pharmacy regulation stating that syringes cannot be sold if they will be used for an "unlawful purpose." CONCLUSIONS: IDUs' access to sterile syringes from pharmacies in Atlanta, would likely be increased by (1) providing practicing pharmacists with professional education programs that describe the broad professional support for IDU access to sterile syringes and why blood-borne infection prevention is a legitimate medical purpose for selling syringes and (2) removing or modifying the restrictive Board of Pharmacy regulation governing syringe sales.

Black or African American↗
PubMed1989

Public images of alcoholism: data from a Georgia survey.

Attitudes toward alcoholism among a representative sample of 524 adults in Georgia indicate acceptance of the disease concept remains incomplete. Despite expected regional differences, results from bivariate analyses are consistent with previous research conducted in other areas of the U.S. The Georgia data indicate similar levels of acceptance of the disease concept of alcoholism, similar demographic correlates with that acceptance and similar treatment recommendations for alcoholism. Attitudes toward alcoholism are found to be significantly correlated with views concerning cocaine dependence, but the acceptance of the disease concept of alcoholism is significantly greater. The multivariate discriminant analysis reveals that education and income are the most significant discriminators between the medical and moral/medical images of alcoholism, followed by religion, age and race.

Adolescent↗
PubMed1998

Trends and predictors of infant sleep positions in Georgia, 1990 to 1995.

BACKGROUND: In recent years, the prone sleeping position has emerged as the strongest modifiable risk factor for sudden infant death syndrome, the leading cause of infant mortality between 1 month and 1 year of age in the United States. Since April 1992, sudden infant death syndrome risk-reduction strategies have included the promotion of the back or side sleeping position (nonprone) for healthy infants younger than 1 year of age. Most recently, the back position has been advocated as the best sleeping position and the side position as an alternative. METHODS: To evaluate trends in prevalence of the prone position from 1990 to 1995, we used data available from the Georgia Women's Health Survey, a random digit-dialed telephone survey of 3130 women 15 to 44 years of age. We examined the position in which women put their infant to sleep in the first 2 months of life for their most recent live birth (N = 868) and determined independent predictors of prone sleep position among women who consistently used the prone or the back/side position (n = 636) using multiple logistic regression. RESULTS: The prevalence of mothers who put their infant to sleep in the prone position significantly decreased, from 49% in 1990 to 15% in 1995. This decrease is primarily attributable to a major shift to the side position rather than to the back. Using multiple logistic regression, we found the prone sleeping position to be significantly higher among women who entered prenatal care after the first trimester (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4-9.2), were black (OR, 2.1; 95% CI, 1.4-3.1), had less than a high school education (OR, 2.2; 95% CI, 1.4-3.4), and were living in rural Georgia (OR, 1.9; 95% CI, 1.3-2.7). For the period after April 1992, women who had previous children were 2.6 (OR, 95% CI, 1.7-4.1) times more likely to use the prone sleep position than were first-time mothers. CONCLUSIONS: The prevalence of the use of the prone sleep position for infants decreased significantly over the study period. This decrease coincided with national efforts to promote the back or side sleeping position. Increased efforts should target groups who are more likely to use the prone position to attain the national goal of </=10% of prone position prevalence by the year 2000, with emphasis on placing the infant on the back.

Adolescent↗
PubMed2002

Ticks parasitizing dogs in northwestern Georgia.

From January 1998 through September 1999, 324 dogs in three northwestern Georgia counties were examined for ticks. Six species of ticks were recovered. The three most commonly collected ticks were the American dog tick, Dermacentor variabilis (Say) (310 male male, 352 female female; prevalence, 97%; mean intensity 2.1); the brown dog tick, Rhipicephalus sanguineus (Latreille) (118 male male, 119 female female, 38 nymphs; prevalence, 22%; mean intensity, 3.8); and the lone star tick, Amblyomma americanum (L.) (8 male male 26 female female, 2 nymphs; prevalence, 5%; mean intensity, 2.4). Other ticks recovered were Ixodes cookei Packard (3 female female); the Gulf Coast tick, Amblyomma maculatum Koch (2 female female); and the blacklegged tick, Ixodes scapularis Say (1 female). Another adult female specimen of I scapularis was recovered from a cat, further reinforcing that this medically important tick is present in northwestern Georgia.

Animals↗