Albanian Medical Journal

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Authors: Luka Kovačić, Ulrich Laaser, Genc Burazeri, Lijana Zaletel Kragelj

In order to develop the training and research capabilities for public health in South Eastern Europe a project funded by the German Stability Pact started in 2000. It was meant to support the reconstruction of postgraduate public health training programs through different activities, including the development of teaching modules. Originally planned to be on an Internet platform only, the Forum for Public Health in South Eastern Europe (FPH-SEE) and the MetaNET project together with Hans Jacobs Publishing Company decided to publish this training material also as hard copy volumes. The first book was published in 2004 and the sixth one in 2010, together comprising around 3500 pages. After successful and widespread use of the teaching modules of all six books between 2004 and 2011 (2), the project coordinators decided - again together with Hans Jacobs Publishing Company - to publish a 2nd fully revised edition of selected modules as e-book.

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Authors: Jonila Gabrani, Adriatik Gabrani

Crosswise Europe, the healthcare system is scarcely figuring out how to cover its costs. Not only are the fundraising methods not adequate, but, of even greater concern, the costs themselves are set to rise. As per World Bank figures, public expenditure on healthcare in the European Union (EU) could hop from 8% of GDP in 2000 to 14% in 2030 and it is foreseen that they will continue to grow afterwards. The major concern of Europe’s healthcare sector is to find ways and approaches in order to balance budgets and limit spending. Unless that is carried out, the funds to pay for healthcare will soon fall short of demand. The budgetary meltdown is continuously brought on by two interdependent trends: the ageing of the population and the parallel increase in the burden of chronic diseases.

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Authors: Mariana Dyakova, Aileen Clarke, Mark McCarthy

This brief communication presents a summary of the public health (PH) research system and policy in the United Kingdom (UK), from a research within the European project PHIRE (Public Health Innovation and Research in Europe). It draws also from two previous European Union projects: SPHERE (Strengthening Public Health Research in Europe) and STEPS (Strengthening Engagement in Public Health Research). The UK public health research system has a complex and multilevel structure with numerous funding, performing and collaborative organisations and programme-based commissioning. There is generally good communication and coordination among the four countries and the major PH funders and their strategies follow commonly identified vision and priorities. Some of the European PHIRE tracer projects were well-conducted and produced considerable impact nationally and locally. However, all of them had insufficient publicity and dissemination of results, not reaching any of the important PH stakeholders. Keywords: PHIRE, Public Health, SPHERE, STEPS.

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Authors: Kozeta Filipi, Anila Xhani

Aim: Atypical squamous cells of undetermined significance cells (ASCUS), occurring in organized cytological screening, may be either high-risk human papillomavirus (HPV) positive or negative. To refine the assessment of women with ASCUS, a high-risk HPV-DNA test is recommended as triage by NIH 1. Methods: A total of 53 consecutive women (mean age: 30 years; range 21-41 years) with a diagnosis of ASCUS from the primary screening were selected for triage in Tirana, the Albanian capital city, during September 2012 to April 2013. Their cervical smears were collected and evaluated by using conventional cytological examination in combination with a high-risk HPV-DNA test [(HPV) polymerase chain reaction (PCR) test).] The women were categorized into four groups: Group A, Cytology + /HPV +; Group B, Cytology–/HPV +; Group C, Cytology + /HPV–; and Group D, Cytology–/ HPV–. Women within Groups A-C were admitted for colposcopy and cervical biopsy. The women in Group D were considered as a low-risk group for tumor development, and were reexamined after three years. Results: In women in Group A (N=26), the prevalence of histological verified CIN 2-3 was 42%, in Group B (N=11) it was 63%, and in Group C (n=9) the prevalence was 66%. The prevalence of a high-risk HPV infection decreased with age in women with ASCUS. It was 71% in women <30 years, and 50% in women aged ≥40 years. Conclusions: In this sample of Albanian women, adding a high-risk HPV test in secondary screening increased the identification of women with CIN 2-3 lesions by 48% in comparison with repeated cytology. The clinical significance of the ASCUS diagnosis varied with age of the women.

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Authors: Anila Xhani, Kozeta Filipi

Aim: Cervical cancer is one of the most common female malignancies with high mortality rates in developing countries. Our purpose was to determine the prevalence of cervical cytological abnormalities in the population and the detection rate of epithelial abnormalities by cervical cytology (CC). Methods: A total of 5416 conventional pap-smear tests collected between January 2009 and January 2012 from Tirana University Hospital Obstetrics-Gynecology “Queen Geraldine” were retrospectively analyzed. Results: A total of 258 (4.8%) cases had epithelial abnormalities. The numbers and rates of epithelial abnormalities were as follows: Atypical squamous cell of undetermined significance (ASCUS; n=150 [2.76%]); atypical glandular cell of undetermined significance (AGUS; n=8 [0.14%]); low-grade squamous intraepithelial lesion (LSIL; n=87 [1.6%]); high-grade squamous intraepithelial lesion (HSIL; n=10 [0.18%]); and squamous cell carcinoma (SCC; n=3 [0.05%]). Conclusion: The prevalence of cervical cytological abnormality in our study was 4.8%. A larger community-based study may establish the exact prevalence of malignant and premalignant lesions, in order to plan for future screening.

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Authors: Anila Kristo, Jonila Çela, Erisela Dino, Eriseldi Rapi, Elona Lamja, Qemajl Aliu, Niko Leka, Jovan Basho

Aim: A number of factors influence response to therapy among chronic hepatitis C patients treated with Peginterferon alfa-2a and Ribavirine. Predictors of treatment success in routine clinical practice remain to be established. The aim of this study was to assess the effects of host and viral related factors during treatment of chronic hepatitis C. Methods: A total of 80 patients, diagnosed with CHC, were included in this prospective study during the period 2008-2012. All the patients were treated with Peginterferon alfa-2a (180 μg s.c/week) and Ribavirine 800-1200 mg/day (according to body weight and genotype). The duration of treatment varied from 24-48 weeks according to the virological response. The primary end point was SVR defined as undetectable HCVRNA level 24 weeks after the end of treatment. We assessed the impact on SVR of age (<40, 40-55 and >55 years), sex (males vs. females), BMI (<27 vs. >27), genotype (1+4 vs. 2+3) and baseline viral load (HCVRNA>800000 UI/ml vs. HCVRNA<800000 UI/ml). Data were analyzed statistically by use of T-test. Results: Regardless the genotype, 47(58.75%) patients had SVR and 33 (41.25%) had non-SVR. 55.3% of females and 44.7% of males achieved SVR, without significant differences between them. The rates of SVR in groups of patients <40, 40-55 and >55years were 53%, 59% and 73.3%, respectively, with significant differences between group 1 and group 3 (P= 0.03). Conversely, the prevalence of genotype 1b in group 1 was higher than in group 3 (79% vs. 34%, P<0.001). The group of patients with BMI<27 had a SVR rate higher than those with BMI>27 (72% vs. 50 %, P<0.05). The patients with genotypes 2 and 3 had higher SVR rates than those with genotypes 1 and 4 (83% vs. 48%, P<0.01). Patients with baseline HCVRNA<800000UI/ml had higher SVR rates than those with HCVRNA>800000 (P<0.01). Conclusion: BMI<27, genotype 2 and 3, and low viral load at baseline (<800000UI/ml) should be considered as positive predictive factors in CHC treatment response, whereas there is no significant difference between males and females regarding the SVR rate. Importantly, age <40 years does not seem to be a positive predictive factor in our country, which may be explained by the high prevalence of genotype 1b in this group of patients.

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Authors: Leonard Deda, Laerta Kakariqi, Irsida Mehmeti

Surveillance programs provide invaluable information regarding pathogen incidence and antimicrobial resistance. Health care professionals and policy makers depend on this information for developing responsible and effective treatment strategies that limit the emergence and spread of antimicrobial resistance. Continuous surveillance also reveals trends in pathogen susceptibility to currently and previously prescribed antimicrobial agents. Routine surveillance of antimicrobial use reveals trends in dosing and allows comparisons of antimicrobial use data with antimicrobial resistance data that can provide important insights into the influence of particular agents. They are also internationally applicable. Both of these tools provide their maximal benefits when used jointly and in coordination. Keywords: antibiotic consumption, antimicrobial resistance, surveillance.

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Authors: Wesley Jongen, Peter Schröder-Bäck

Of the three potential EU candidate countries—Albania, Bosnia and Herzegovina, and Kosovo—only Albania has already formally applied for EU membership. At the same time, considering key health and healthcare indicators, Albania appears to score worst of all South-Eastern European (SEE) acceding, candidate and potential candidate countries. Therefore, this article intends to assess to what extent Albanian public health could benefit from its country’s process towards EU accession. The EU accession process might best be understood through the notion of conditionality, implying that (potential) accession countries have to meet the EU’s accession requirements—as set out in the so-called acquis communautaire—in order to become official candidate and eventually member. For public health, these requirements relate to general health conditions in the country, financing of the health system, and efficiency of healthcare delivery. It can be argued then that Albanian public health is most likely to benefit from the EU accession process by being encouraged to meet these acquis requirements. So far, however, only moderate progress can be witnessed. Some progress has been made with regard to communicable disease control, while main areas of concern remain tobacco use control, health inequalities and the financing of the Albanian health system. On the other hand, progress does look promising, certainly when taking into account that Albania had the worst starting position in terms of public health of all the SEE acceding, candidate and potential candidate countries. The aftermath of the 2013 Albanian parliamentary elections will be a crucial test for granting the official EU candidate status to Albania, a development that could spur progress in Albanian public health even further. Keywords: Albanian public health, European Union, potential EU membership candidacy.