Albanian Medical Journal

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Authors: Greg Evans

Substance abuse, particularly alcohol, is a major problem on college campuses. The United States National Institute on Alcohol Abuse and Alcoholism reports that approximately 60% of young American college students aged 18-22 years report drinking in the past month and 40% of students binge drink.

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Authors: Ahmet Kamberi

Despite criticisms of shortcomings, the World Health Organization s definition of health remains unamended since its adoption in 1948. Subsequent interpretations of the definition have sought to address some of the shortcomings. This paper argues about a new understanding of health. According to this understanding, health is perceived as the quality of being, emanating from satisfying the obligations and responsibilities toward self and others, in proportion with the shape, size and quality of a functioning life structure, as well as economic and social status, at a certain time and a given physical and social environment. Its source is cellular biologic potential energy, sufficiency and efficiency of which make us act, interact, cooperate or refrain, and adapt. Such an understanding has important implications. Individuals, communities and governments can improve their role in the assessment, preservation, protection, upholding, development, measurement and management of both individual and population health, which are fundamental to human wellbeing, progress and prosperity. Keywords: biological mechanisms, health definition, health measurement, life structure, potential biological energy.

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Authors: Dritan Todhe, Gjergji Çaushi, Eliziana Petrela

Aim: Our aim was to evaluate the surgical treatment of the tibial plateau fracture. The main objective was to offer statistical proofs whether the chosen treatment is the right one and to test if the use of medicaments in postoperative patients has improved their performance in Albanian patients. Methods: This study included a group of 126 patients operated at the Orthopedic and Trauma University Service in Tirana during 2005-2012. The average follow-up was four years. All patients were operated using screws or plate and screws as synthesis for the fracture. Patients were grouped according to the Schatzker classification and the surgical treatment technique in relation to the classification was investigated. The objective evaluation of the results was performed according to Iowa Knee Score, a clinical evaluation system. A questionnaire was conducted each year for the patients. The outcomes were compared for each patient during four years. Results: The chi-square test used to check the difference in treatment provided the following results: x2= 7.423, df =55, P=0.001. The use of hyaluronic acid improved the performance of the patients (r=0.887, P=0.003). Conclusions: Our findings indicate that improving the treatment of tibial plateau fractures through the right diagnosis, the surgical treatment technique and the postoperative period, followed by medical treatment and physiotherapy, is the key-point in getting the best results.

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Authors: Patricia Brownell

Legislative developments at the national level reflect the division among conceptual frameworks for abuse of older women: whether it is an older adult protective program, a form of elder mistreatment, or reflect intimate partner violence. Most, but not all, national legislation passed is bifurcated, addressing women as part of domestic violence laws, older adults as part of family violence legislation if at all, and older care dependent adults in need of protection residing in nursing homes and sometimes in the community as part of laws to protect the vulnerable in need of protection. Domestic violence legislation is generally not specifically inclusive of older women and vulnerable older adult legislation assumes some degree of care dependency on the part of the older adult victim; gender is not usually specified. There is a growing awareness of older women victims of family mistreatment both in terms of prevalence and in terms of commonalities and differences when compared to younger battered women. Both quantitative and qualitative research studies have begun to identify salient factors in cultural differences, age related needs, and service needs and gaps for older women victims. In addition, gender-based scholarship has begun to examine the application of frameworks for practicing effectively with older women who are victims of abuse. Gerontologists are beginning to focus more research attention on older women and abuse, and human rights experts are beginning to recognize the special vulnerabilities of older women who are care dependent and may lack the ability to protect themselves from undue harm without special protections that go beyond those needed by women of all ages who are not care dependent. Keywords: abuse, neglect, older women, violence.

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Authors: Sebastian Schee genannt Halfmann

Aim: The European region is facing major health challenges attributable to noncommunicable diseases. Non-communicable diseases are the leading cause of premature mortality in Europe. This paper aims to indicate how Disability-Adjusted Life Years (DALYs) attributable to tobacco smoking, alcohol use and diet have changed over the past 20 years in Albania and Greece. Moreover, the paper discusses the impact of policies and preventions to reduce the burden of diseases attributable to lifestyle. Methods: Review by using statistics of the Institute for Health Metrics and Evaluation (IHME). In order to compare the burden of disease (BoD) attributable to lifestyle, the health indicator DALY was used. Statistics were retrieved from the IHME database. Results: Greece and Albania differ in DALYs attributable to tobacco use, alcohol use and diet. Whereas DALYs related to all the three risk factors are decreasing in Greece, Albania experienced increasing DALYs until 2005. Since 2005, DALYs are slightly decreasing in Albania. The greatest gap in DALYs between the countries can be seen for nutritional deficiencies. DALYs attributable to nutritional deficiencies are almost 12 higher in Albania than in Greece. Conclusion: The countries differ in their policies and strategies on the prevention of lifestyle risk factors. Albania is facing changes in lifestyle behaviour since the opening to the West in 1990. The BoD increased in Albania due to lacking policies and health programs on lifestyle characteristics. The awareness about prevention is increasing, but policies are still lacking and are ineffective. Improvements of preventions and policies are needed to tackle the BoD, especially in Albania.

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Authors: Ermira Muco, Arjan Harxhi, Loreta Kuneshka, Erjona Abazaj, Arsilda Gjataj, Mario Pipero, Dhimiter Kraja, Pellumb Pipero

Aim: Toxoplasmosis is a worldwide infectious disease, caused by a parasite most often found in cats and farm animals. Humans can get this disease from contacts with feces of infectious cats, eating raw or undercooked meat and contaminated vegetables or being born with it. Once a person is infected, the infection remains in the body for life. The aim of this study was to highlight selected epidemiological aspects of Lymphoglandulary Toxoplasmosis in immunocompetent adults in Albania. Methods: 291 patients admitted at the University Hospital Center Mother Teresa in Tirana over the years 1984-2012 and diagnosed with Lymphoglandulary Toxoplasmosis were included in this study (age range: 15 to 60 years). Socio-demographic data included sex, age group, place of residence (urban or rural area), educational level and profession. In addition, clinical information was collected including month of onset of illness, behavioral data characteristics such as contacts with cats, meat consumption and the quality of water consumed. Results: Male-female ratio was 1:1.8. The ages affected most included individuals 26-55 years old. Regarding the educational level, 17.2% of individuals had completed university studies, 32.3% the high school and the remaining 50.5% of participants had completed only the elementary school. Toxoplasmosis was present in 18 regions of the country, whereas contacts with cats were reported in 40.9% of the cases. Conclusions: Toxoplasmosis is a widespread disease in Albania and Lymphoglandulary Toxoplasmosis in immunocompetent adults is present as well. Incidence and prevalence of this disease is cross-linked with age, education level, season, personal hygiene, contact with cats and way of feeding. Education of the general population and continuous education of health professionals are important means for an effective control and prevention of this disease.

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Authors: Xhiliola Doci, Agim Sallaku, Sonela Xinxo, Ermira Vasili, Irena Savo, Helidon Nina

Aim: Non-melanoma skin cancers (NMSC) represent a burden to health services all over the world and their frequency is rising. The epidemiology of these tumors in Albania is poorly documented. The aim of this study was to describe selected epidemiological features of NMSC in Albania for the period 2005-2013. Methods: This was a cross-sectional study of non-melanoma skin cancer cases during 2005-2013. The information was retrieved from the Service of Statistics at the premises of the University Hospital Centre Mother Theresa during 2014 and consisted of the following variables: age at the moment of diagnosis, sex, residence, type of work environment, type of NMCS and anatomic localization of the lesion. Information about the number of the population was retrieved from the Institute of Statistics. SPSS, version 16 was used for data analysis. Results: 5289 patients were diagnosed with NMSC for the first time during 2005-2013, of whom 63.7% were males. Basal cell carcinoma was the most frequent tumor and the ratio with squamous cell carcinoma was 2.42 : 1.00. The mean age of NMSC patients was higher for males than females (67.57 years vs. 66.64 years, respectively, P<0.05). NCMS was more frequent among outdoor than indoor working individuals. The incidence has increased steadily over the years in Albania. Conclusion: The incidence of NMSC in Albania shows an increasing trend over the past decade, with males and individuals working outdoors being more often affected by such health conditions. These data should guide early detection and prevention strategies in order to lower the increasing burden on NMSC in Albania.

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Authors: Dorina Xhani, Fatlinda Tahiri

Aim: Sex selection is becoming of increasing concern not only in China, India, Pakistan and the Caucasus, but even in transitional Albania. In addition, the situations where abortion is restricted for sex-selection purposes, terminating a pregnancy for this reason is likely to involve an unsafe procedure carrying high risks. Our aim was to gain more understanding regarding this phenomenon, by explaining the situation in the context of women s mental health. Methods: We reviewed the latest documents concerning sex-selection based on the international literature and the databases of major organizations dealing with sex-selection. Social literature is used to analyze theoretical perspective in terms of the implications on mothers mental health after experiencing sex-selection. Results: The majority of the literature shows that in the case of sex-selection there are complex reasons and implications that occur in women s life. The findings indicate that a woman can experience a range of often contradictory emotions after having a sex-selective abortion. Conclusion: Our conclusion based on this literature review is that sex selective abortion represents a concerning issue. In some cultures, the failure of the wife to bear a male child leads to sex-selection, which has shown a negative influence on women s health. In theAlbanian context, further research is needed given the lack of information and data on this issue.

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Authors: Eno Gaçe, Herion Prifti, Rovena Dulli

Aim: The aim of this study was to determine the prevalence of malocclusion and dental anomalies in children with different disabilities attending different schools for disabled people in Albania. Methods: This study was carried out in nine special schools for children with disabilities in Albania. Participants were grouped according to disability type as follows: Autistic Spectrum Disorder, Down syndrome, Cerebral Palsy, Mental Retardation, Blind, Deaf-Mute. Malocclusion and dental anomalies were examined and assessed according to the World Health Organization 1997 criteria. Results: Overall, the prevalence of malocclusion for all groups of children was 51.2%. Of these, 21.9% of the children had slight malocclusion and 28.3% had severe malocclusion. Down syndrome had the highest value of malocclusion prevalence (69%), whereas cerebral palsy had the lowest (28.6%). Compared to boys, girls had slightly higher malocclusion prevalence (50.7%). Conclusions: Our findings indicate a high prevalence of malocclusions in Albanian children with disabilities. Health professionals and policymakers should be aware of the poor oral health conditions among vulnerable children in transitional Albania.