Albanian Medical Journal

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Authors: Fatjona Kraja, Indrid Këlliçi, Luljeta Çakërri

Perceived health status reflects people’s overall perception of their health, including both physical and psychological dimensions. It is a relative measure and the evidence suggests that people assess their health in relation to their circumstances and expectations, and their peers. To ensure healthy ageing of the population, the later part of the life span of an individual should be free from chronic diseases and impairments. Besides these objective measures of health, the self-perceived health (also referred to as self-reported health) has received considerable attention in the recent literature. This is due to its strong association with life expectancy on the one hand, and with the future state of health on the other. Individuals’ self-assessment of their health status may include some aspects that are difficult to capture clinically, such as incipient disease, disease severity, physiological and psychological reserves and social function. When people rate their health, they think not only of their current situation, but also of declines and improvements.

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Authors: Afrim Pirraçi, Arben Mitrushi, Drita Totozani

Aim: In surgical settings, it is important to understand the anatomy and different types of variations of the gallbladder and the biliary tract, because these structures are in close connection with the adjoining organs and may show various anomalies and anatomic variations. Our aim was to assess the level of morphological variations of gallbladder in the Albanian population. Methods: A sample of 9481 primary health care users aged ≤80 years was examined in Tirana, the Albanian capital city, during 2011-2012 (response rate: 95%). All participants underwent an ultrasound examination of the gallbladder. Results: Overall, the length of gallbladders ranged from 5 cm to 12 cm. However, in 81% of study participants, the length of gallbladders ranged from 7 cm to 10 cm. Conversely, the width of gallbladders ranged from 2.5 cm to 5.0 cm (mean value: 3.89±0.75 cm). There was evidence of a moderate positive correlation between length and width of gallbladders (r=0.34, P=0.008). Overall, there were 74 (0.78%) cases with gallstones 95%CI=0.61%-0.98%). About 85% of study participants had a pear-type gallbladder. Conclusion: Our study provides novel evidence on the morphological variations of gallbladder in the Albanian population. Our findings pertinent to the prevalence of gallstones and anatomical variation of the gallbladder are generally compatible with similar reports from other countries.

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Authors: Nereida Spahia-Zeneli, Merita Rroji, Saimir Seferi, Ilirjana Zekja, Myftar Barbullushi, Nestor Thereska

Aim: Cardiovascular disease is the leading cause of morbidity and mortality in patients in dialysis treatment. Atherosclerosis is accelerated in long-term maintenance haemodialysis. Several reports have investigated carotid artery intima-media thickness (CIMT) and the presence of carotid artery plaque (CAP), as surrogate markers of carotid atherosclerosis in ESRD patients. The aim of this study was to assess the prevalence of atherosclerotic carotid artery changes in dialysis patients and determine the potential link with classic and non-classic risk factors contributing to its development. Methods: 72 dialysis patients who agreed to participate (40 males) were included in this study: 39 patients on peritoneal dialysis (PD) and 33 patients on haemodialysis (HD). Mean age was 53.8±12.1 years old. Mean time on dialysis was 40.0±35.6 months. CIMT and presence of CAP were obtained by B-mode ultrasonography. CRP, fibrinogen, calcium, phosphate, PTH, alkaline phosphatase, uric acid, serum albumin, and lipid profile were examined. In addition, anthropometric indices were measured. We analyzed the differences of these parametres in groups with and without atherosclerosis and their link to atherosclerosis. Results: Atherosclerosis was found in 50 (69.4 %) patients, in 44 (62 %) men, in 25 (75.7%) HD patients and in 25 (64%) PD patients. Old age, diabetic nephropathy (DN), high phosphate (P), high pulse pressure (PP) and high BMI were found to be significantly linked with atherosclerosis. High CaxP product and fibrinogen were marginally significantly linked to atherosclerosis. Conclusion: Atherosclerosis was highly prevalent in dialysis patients in this Albanian study. In our study, the older, the obese, the more inflamed and the high phosphoremic patients were more prone to atherosclerosis.

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Authors: Valdet Hashani, Jolanda Hyska, Enver Roshi

Aim: Hypertension is an important risk factor for cardiovascular disease including the transitional countries of the Western Balkans. Our aim was to assess the prevalence and socioeconomic determinants of hypertension in the adult population of post-war Kosovo. Methods: A cross-sectional study was conducted in Pristina in 2012-2013 including a representative sample of 1793 consecutive primary health care users aged ≥35 years (mean age: 51.2±6.7 years; 52.5% women; overall response rate: 95%). All participants were measured their systolic and diastolic blood pressure. Information on demographic factors and socioeconomic characteristics was also collected. Binary logistic regression was used to assess the association of hypertension with demographic and socioeconomic characteristics. Results: Overall, the prevalence of hypertension was 33.6% (38.9% in men vs. 28.8% in women). In unadjusted logistic models, there was evidence of a positive and significant association of hypertension with male gender, urban residence, unmarried civil status, unemployment and retirement, and a lower income level. Upon multivariable-adjustment, significant “predictors” of hypertension were male gender, unemployment, and a lower income level. Conclusions: Our findings indicate a relatively high prevalence of hypertension in the adult population of post-war Kosovo, especially among men and the most disadvantaged socioeconomic groups. Health care professionals and policymakers in Kosovo should be aware of the high burden of morbidity and mortality-related outcomes associated with hypertension.

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Authors: Marjeta Dervishi, Silva Bino, Roland Bani, Shpëtim Qyrra, Redona Dudushi, Florinda Balla

Aim: The aim of this study was to evaluate the medical, social and psychological treatment of children living with HIV/AIDS and identify the rate of discrimination they are facing, as well as the role and problems of the Convention on Children Rights and Albanian legislation in this regard in order to shed light into the situation of children living with HIV and their families in Albania. Methods: We used a semi-structured questionnaire, which included open-ended questions as well, to assess the needs of 19 children living with HIV. Also, focus groups with family members, community, local authorities and health services’ members were organized. The information obtained was analized in a qualitative manner. Results:26% of the children included in this study were stigmatized and discriminated because of their disease, whereas the rest had not made public their HIV status in order to avoid potential stigma and discrimination. 16% and 32% of HIV children had lost their mother or father, respectively, making them more vulnerable and seriously aggravating their socio-economic status. Late diagnosis has not only affected children’s health, but it has also had a high financial cost for families seeking medical help for many years. Conclusions: Children affected by HIV and their families face medical treatment related problems, lack of other supporting services and a number of barriers to ensure normal living conditions on a daily basis. There is a serious call for urgent actions in order to address the specific needs of this vulnerable subgroup in Albania.

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Authors: Naim Jerliu, Ervin Toçi, Genc Burazeri, Naser Ramadani, Ian Philp, Helmut Brand

Aim: The objective of this study was to validate the EASY-Care tool, an international instrument addressing older people’s health needs and current priorities in Albanian settings. Methods: This validation study, conducted in August-September 2010, included a sample of 38 older people who were users of primary health care services in Pristina (N=20) and in Tirana (N=18). All participants were administered the finalized version of EASY-Care Standard 2010 which was agreed by the EASY-Care International Research Network and already validated in many countries worldwide. The EASY-Care assessment instrument consists of two sections: i) basic information (personal data, biography, medical history), and; ii) assessment of needs and current priorities (visibility, hearing and communication, self-care, movements, security, accommodation and financial circumstances, physical health, mental health and well-being). Results: Overall, there were 18 men (47.4%) and 20 women (52.6%) included in this validation sample. Median age was 68.5 years (interquartile range: 65.0-76.0 years). Overall, 71% of participants could use telephone without help; 89% could look after their personal appearance; 87% could dress on their own; 92% were able to use toilet and shower; 66% could do household tasks; 79% could cook their own meals; 97% could feed themselves, and; 87% could use medicines on their own. Overall, 79% of older people had not had falls in the last 12 months; 42% of individuals perceived their health status as good; 60% had suffered any body pain in the last month; 58% had been worried by the feeling of desperation, depression or hopelessness in the last month; 74% had been worried due to lack of interest or pleasure to do something in the last month, and; 63% of study participants were worried in relation to los of their memory. Conclusions: In Albanian settings, we provide evidence on the process of cross-cultural adaptation of a useful instrument employed internationally assessing older people’s health and social needs and their current priorities.

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Authors: Christin Krajewski, Genc Burazeri, Helmut Brand

Aim: Little is known about the degree to which the diverse sublevels of self-stigma are experienced by people with a mental illness from different countries. This study aims to describe and compare the sublevels and intensity of self-stigma across six European countries. Methods: A cross-sectional study was conducted including 1223 persons with a psychiatric disorder who were members of a national mental health non-governmental organisation in the following countries: Croatia (N=101), Israel (N=125), Lithuania (N=200), Malta (N=115), Romania (N=104) and Sweden (N=151). The “Internalized Stigma of Mental Illness Scale” was chosen to measure internalized stigma. Results: Moderate-to-high levels of internalised stigma ranged from 15.2% in Sweden to 57.4% in Croatia. Mean of perceived discrimination and devaluation was predominantly above the midpoint, and hence showed a high level of perceived discrimination and devaluation across the countries. Nevertheless, there was evidence of a huge amount of variation from 27.2% of the Israeli participants to 88.7% of the Swedish individuals reporting a moderate-to-high level. General Linear Models with self-stigma as the dependent variable showed very divergent results with no, positive, and negative significant relationships between internalised stigma and the psychometric measures as covariates. Concerning socio-demographic characteristics, only in Lithuania two variables were to a certain degree related to self-stigma, the highest level of education and the number of social contacts. Conclusion: These findings suggest that in of the six countries a certain amount of people with a psychiatric disease suffer both self-stigma and perceived discrimination and devaluation. However, between-country variations in self-stigma and perceived discrimination and empowerment exist. It seems that the “one size fits all” approach does not apply to interventions against self-stigma.

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Authors: Kristine Sørensen, Barbara Schuh, Greg Stapleton, Peter Schröder-Bäck

Aim: Health literacy is named as one prerequisite of promoting patient education and enabling citizens to take informed choices concerning their own health, as well as for the health of their families and communities. Underlying ethical questions become apparent when the problems of limited health literacy are addressed. This paper intends to provide an overview of ethical aspects of health literacy in public health policy and research. Methods: The basis for this ethical analysis is a framework of seven biomedical and public health ethical principles: Beneficence, non-maleficence, respect for autonomy, efficiency, health maximisation, social justice and proportionality. A systematic literature search was conducted for articles on ethical issues of health literacy. Results: Only 11 articles dealing explicitly with health literacy and ethical issues were identified. The topics most widely discussed relate to the principles of respect for autonomy and social justice. Conclusions: Awareness of the ethical scope of health literacy is not sufficiently developed yet in health policy and public health research. The study emphasises that change is required and should be induced in order to secure basic rights, transparency and autonomy and to overcome barriers of health literacy. Following ethical practices to improve health literacy will secure just health care, in both prevention and promotion, and eventually better health for all.