Research Interests: Geography, Demography, Nutrition, Public Health, Urbanization, and 3 moreNature, Rural Area, and Residence
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Materials: Sample size: 9182 women between 20 and 40 years, residents in the States of Paraná, Santa Catarina and Rio Grande do Sul (Southern Region of Brazil). Methods: The determinants of physical activity was employed a logistic... more
Materials: Sample size: 9182 women between 20 and 40 years, residents in the States of Paraná, Santa Catarina and Rio Grande do Sul (Southern Region of Brazil). Methods: The determinants of physical activity was employed a logistic regression model. The variables used were: schooling, age, colour/race, travel time to work, participation in the labour market, family income per capita, State of health, mother of a child up to 5 years of age, number of children, self-assessment of health status and health plan ownership. The dependent variable a dichotomic variable for the possession of health plan and how health state, explanatory: household income per capita, labour market participation, age, colour/race. Sources of data: the data were obtained in the National Sample Survey of Households of 2008, a survey of home base, in which were interviewed 391,000 men and women of all Brazil. Results: On average, 28% of women interviewed practiced some physical activity, but as there is a positive relationship between income and practice of physical exercise, the percentage of practitioners varies from 11% to 72% depending on the per capita income for the family. For the duration of the practice of physical exercise, 91% of practitioners spent at least 30 minutes of physical activity. The practice of walking is associated with women with less education and income. The variables that determine women’s participation in sports activities are education and being a mother of a child up to 5 years, being that the first has positive impact and the second negative. The model for possession of health plan, the indicator variable practice sporting activity had positive signal and statistically significant showing women who have more practice health plan activities. Conclusions: The results are consistent with the theory of capital health and show women with more schooling and income health practice more physical activities, i.e. use part of your free time to produce health. In addition to engaging in sports activities, which cause the depreciation rate of health is lower, they acquire health plans more than sedentary women. The current policy of expansion of the number of kindergartens in Brazil can contribute to the increased participation of women with small children in sporting activities.
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of late toxicity was similar between the two groups. The complete response rate was 87.7% and 86.7% for groups I and II, respectively. Five-year overall and cancer-specific survival rates were, respectively, 49.7% and 61.1% in group I,... more
of late toxicity was similar between the two groups. The complete response rate was 87.7% and 86.7% for groups I and II, respectively. Five-year overall and cancer-specific survival rates were, respectively, 49.7% and 61.1% in group I, and 57.4% and 68.8% in group II, indicating no significant survival benefit with concurrent chemoradiotherapy. Performance status, comorbidity index and tumor size were significant prognostic factors for overall survival, whereas tumor size was the only significant prognostic factor for cancer-specific survival. Conclusions: This analysis showed no benefit of concurrent chemoradiotherapy with respect to overall and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population.
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Hypertension is a major preventable cause of death worldwide. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high blood pressure (BP) and identifying individuals with increased BP. A cross-sectional... more
Hypertension is a major preventable cause of death worldwide. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high blood pressure (BP) and identifying individuals with increased BP. A cross-sectional survey of volunteers aged ≥18 years old was carried out in May 2019 in Chile. Participating sites were distributed across the country, most of them from the Public Health System outpatient clinics. In addition, clinical research sites, universities, and private clinics participated. Blood pressure measurement protocol, hypertension categories, and statistical analysis followed the MMM protocol. Hypertension was diagnosed as mean systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg or receiving antihypertensive medication. Overall, 6876 individuals were screened. After multiple imputations, hypertension prevalence was 35.4%, of which 65.9% were aware of their condition. While 60.1% were on antihypertensive medication and 34.4% of the total number of hyperte...
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The improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the... more
The improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the maternal care financing in Georgia in terms of adequacy and effects. A qualitative design was used to explore the opinions of key stakeholders about the adequacy of maternal care financing and financial protection of pregnant women in Georgia. Women who had used maternal care during the past 4 years along with health care providers, policy makers, and representatives of international partner organizations and national professional body were the respondents in this study. Six focus group discussions to collect data from women and 15 face-to-face in-depth interviews to collect data from the other stakeholders were conducted. Each focus group discussion consisted of 7-8 women. Two focus group discussions were carried out at each of the target settings (i....
Research Interests: Focus Groups, Health Care, Health, Health Administration, Maternal Health, and 15 moreGeorgia, Maternal Mortality, Health Care reform, Library and Information Studies, Humans, Female, Focus Group, Healthcare Financing, Health System, Financing, Health Expenditures, Coverage, Health Personnel, Democratic Republic of Georgia, and Administrative Personnel
Objectifs According to the latest evidences the depression and anxiety are seen as a risk-factor for cardiovascular diseases, as well as an obstacle in the behavior for the treatment of chronic diseases. The goal of survey: Identification... more
Objectifs According to the latest evidences the depression and anxiety are seen as a risk-factor for cardiovascular diseases, as well as an obstacle in the behavior for the treatment of chronic diseases. The goal of survey: Identification of symptoms of anxiety and depression in the women population and their association with defects of management of chronic diseases in particular, in the management of Arterial Hypertension (AH). Methodes The target population – university teachers. Sample size – 300; Sample frame – Women population in the Tbilisi State University. Survey tool – HADS-Anxiety and Depression Hospital Scale. Resultats • Response rate −48,9%; • age range – 30-39 years – 13%, 40-49 years – 29%, 50-59 years – 40%, 60-69 years – 18%; • Symptoms of anxiety and depression −65.5%; among them clinical form – 70%, subclinical form – 30%; The distrbution of the clinical forms in the age groups • 30-39 years – 37% clinical form; 40-49 years – 72% clinical form, 50-59 years – 64% clinical form, 60-69 years – 36% clinical form Conclusion Clinical symptoms of anxiety and depression are prevalent among women ages 40-59 year, and serves as one of the obstacles to medical treatment of AH – treatment breaks and frequent changes of antihypertensive drugs. Successful treatment of these clinical symptoms is a basis for improving the prediction of cardio-vascular diseases.
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When an institution is not easily accessible—for example, it is geographically far—it can be hard for institutional trust to develop. The institution is not only unavailable, but it can also be seen as inappropriate, non-affordable,... more
When an institution is not easily accessible—for example, it is geographically far—it can be hard for institutional trust to develop. The institution is not only unavailable, but it can also be seen as inappropriate, non-affordable, unapproachable, and unacceptable. In this paper, we examine whether reducing distance to medical facilities and professionals can improve trust in the maternal healthcare system. We do so by focusing on developments in Georgia. Since 2013, the government has aggressively closed the distance to service access not by building more facilities or hiring more staff per se, but by upgrading and funding existing facilities and professionals in a national network to better coordinate service provisions at the local levels. Employing an original survey, we match GPS coordinates to measure distance and use regression analysis to demonstrate how ensuring every woman has access to maternal healthcare at the right place at the right time has improved institutional tr...
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Background Children are becoming less physically active for a variety of interrelated reasons. The availability of opportunities for safe active playgrounds, recreational activities and active transport has decreased, while time spend on... more
Background Children are becoming less physically active for a variety of interrelated reasons. The availability of opportunities for safe active playgrounds, recreational activities and active transport has decreased, while time spend on sedentary screen-based activities has increased. This study aimed to evaluate physical activity (PA), sedentary and sleep behaviours of children aged 6-9 years in Europe using data from the WHO Childhood Obesity Surveillance Initiative (COSI). Methods The fourth COSI data collection round was conducted in 36 countries from 2015-2018 using a standardized protocol including a family form completed by parents with specific questions about diet and physical activity-related behaviours. Results Nationally representative data from the 24 countries, who filled in the non-mandatory family record form, were included. Information on PA, screen-time and sleep behaviours of 137,807 children were analysed. Pooled analysis showed that: one in two children walked ...
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Background Physical activity is key for preventing obesity and development of noncommunicable diseases later in life. Previous research suggests that socioeconomic factors, such as parental education or income, may influence a child’s... more
Background Physical activity is key for preventing obesity and development of noncommunicable diseases later in life. Previous research suggests that socioeconomic factors, such as parental education or income, may influence a child’s risk of obesity. However, previous research on this has provided heterogeneity in results. Our aim was to investigate the socioeconomic disparities between physical activity, sedentary behaviour and sleep patterns in school-aged children aged 6 to 9 years in 24 European countries, using a large nationally-representative sample of children from 24 countries (Albania, Bulgaria, Croatia, Czechia, Denmark, France, Georgia, Ireland, Italy, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Malta, Montenegro, Poland, Portugal, Romania, Russian Federation – only Moscow, San Marino Republic, Spain, Tajikistan, Türkiye and Turkmenistan). Methods COSI collected information on physical activity patterns of children, sedentary behaviour and sleep duration through a questi...
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Boxes with participant quotes. This file contains the full list of study participant quotes in accordance to the five access-related themes. (DOCX 22 kb)
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Key question included in the in-depth interviews. This file contains a list of questions used during in-depth interviews with healthcare professionals and decision makers. (DOCX 15 kb)
Key question included in the focus group discussions. This file contains a list of questions used during focus group discussions with mothers. (DOCX 15 kb)
Guide for Focus group discussions. The Guide for Focus group discussions was used to study stakeholders' views on the strengths and weaknesses of maternal care financing and its reform in Georgia. (DOC 100 kb)
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Guide for In-depth Interview. The Guide for In-depth Interviews was used to study stakeholders' views on the strengths and weaknesses of maternal care financing and its reforms in Georgia. (DOC 88 kb)
May Measurement Month (MMM) is aimed at raising public awareness about arterial hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at 200 sites on a national scale. More than 500... more
May Measurement Month (MMM) is aimed at raising public awareness about arterial hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at 200 sites on a national scale. More than 500 volunteers, including doctors (80%) and medical students (20%) participated in the screening. To familiarize them with the research tools and standard blood pressure (BP) measurement method, their training was conducted by the Georgian Society of Hypertension in Tbilisi and other large cities. Social and mass media, medical societies, and other stakeholders were actively involved in the recruitment process. A total of 10 756 people were screened. The mean age of participants was 53.1 years (SD 16.1). Males—67.9%, females—32.1%. One hundred percent were White. After multiple imputation, the number of hypertensive patients was 6.037 (56.1%) and out of them 4950 were aware and 4701 (77.9%) were on medication, 1336 (22.1%) were not taking a medication. Of ...
May Measurement Month is a global campaign aimed at raising public awareness of hypertension and to improve the management of hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at... more
May Measurement Month is a global campaign aimed at raising public awareness of hypertension and to improve the management of hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at 400 sites on a national scale. More than 500 volunteers, including physicians (80%) and students of medical universities (20%) participated in the screening. To familiarize them with the research tools and standard blood pressure (BP) measurement method, they were trained by the members of the Georgian Society of Hypertension and the National Center for Disease Control and Public Health’s staff. Medical societies, health-care professionals, public health workers, social mass media, and other stakeholders were actively involved in the recruitment process. A total of 13 267 (38.5% males and 61.5% females) individuals were screened. The mean age of participants was 54.7 years (SD 15.9). All participants were Caucasian. After imputation of missing BP read...
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Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this... more
Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classificatio...
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In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban-rural differences in frequency of fruit, vegetable, and soft drink consumption in... more
In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban-rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6-9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30-80% and 30-90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1-2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.
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BACKGROUND Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The... more
BACKGROUND Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits. METHODS The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status. RESULTS Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet. CONCLUSION Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.
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Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies... more
Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.
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Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure... more
Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6–9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015–2017, using a standardized protocol that included a family form completed by parents with specific questions about their children’s PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a ...
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May Measurement Month (MMM) is aimed at raising public awareness about arterial hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at 200 sites on a national scale. More than 500... more
May Measurement Month (MMM) is aimed at raising public awareness about arterial hypertension—the main risk factor for cardiovascular diseases in the population. Screening was carried out at 200 sites on a national scale. More than 500 volunteers, including doctors (80%) and medical students (20%) participated in the screening. To familiarize them with the research tools and standard blood pressure (BP) measurement method, their training was conducted by the Georgian Society of Hypertension in Tbilisi and other large cities. Social and mass media, medical societies, and other stakeholders were actively involved in the recruitment process. A total of 10 756 people were screened. The mean age of participants was 53.1 years (SD 16.1). Males—67.9%, females—32.1%. One hundred percent were White. After multiple imputation, the number of hypertensive patients was 6.037 (56.1%) and out of them 4950 were aware and 4701 (77.9%) were on medication, 1336 (22.1%) were not taking a medication. Of ...
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in... more
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory ...
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Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in... more
Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children’s parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks “every day”, “most days (four to six days per week)”, “some days (one to three days per week)”, or “never or less than once a week”. We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consume...
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Since 1991, the health system of the Republic of Georgia has passed through several phases of reform. Privatization and marketization of the healthcare system are among the major reforms. The aim of this study was to analyze the changes... more
Since 1991, the health system of the Republic of Georgia has passed through several phases of reform. Privatization and marketization of the healthcare system are among the major reforms. The aim of this study was to analyze the changes in the utilization of, and access to maternal care services during the period 1999–2010. Secondary analysis was done using data from three national reproductive health surveys (RHS). From three RHSs we selected 7,684 women who experienced childbirth/s during 5-years prior to each survey. We analyzed data on pregnancy outcome, type of childbirth, access and utilization of prenatal, natal and immediate postnatal care, and looked at associations with maternal age, ethnicity, educational level, employment status, residence, religion, and economic status. Binary and multinomial regressions were the main statistical models used along with descriptive statistics. We found that the overall utilization of prenatal care services was quite high; in the first wa...
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It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight... more
It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and we...