South Eastern European Journal of Public Health

7

Authors: Petrit Gjorgji, Jera Kruja

Aim: Our aim was to describe the trend over time and the demographic distribution of hemorrhagic stroke in Albania in the past decade. Methods: This study included all patients diagnosed with hemorrhagic stroke and admitted during the period 2004-2015 at the University Hospital Center “Mother Teresa” in Tirana (988 cases overall; 34% women; overall mean age: 57.8±19.3 years). Information about selected demographic characteristics was also collected for all study participants. Results: The proportion of older patients (≥70 years) was slightly, but not significantly, higher in women than in men (32% vs. 27%, respectively; P=0.163). Furthermore, the proportion of Tirana residents was similar in both sexes (47% in men vs. 45% in women). Overall, there was evidence of a significant linear trend over time (Mann-Kendall test: P<0.01), indicating a gradual increase in the number of hemorrhagic stroke cases in Albania for the period 2004-2015. Conclusion: This study provides useful information about the increasing trend of hemorrhagic stroke in Albania, a transitional country in Southeastern Europe which is characterized by rapid changes including unhealthy dietary habits.

9

Authors: Julia Kollcaku, Artur Kollcaku

Aim: Our aim was to assess the association of rheumatoid arthritis with socio-demographic characteristics and lifestyle factors among women in transitional Albania. Methods: A cross-sectional study was carried out in 2012-2013 including a sample of 2198 women aged 30 years and above who attended the Rheumatology services at primary health care clinics in Tirana municipality (mean age: 60.2±9.7 years; overall response rate: 95%). The diagnosis of rheumatoid arthritis was based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria. In addition, a structured questionnaire was administered to all study participants including information on demographic and socioeconomic characteristics and behavioral factors. Binary logistic regression was used to assess the association of rheumatoid arthritis with covariates. Results: Overall, 437 (19.9%) women were diagnosed with rheumatoid arthritis (both incident and prevalent cases). In multivariable-adjusted models, rheumatoid arthritis was positively and significantly related to older age (OR=1.8, 95%CI=1.3-2.6), a lower educational attainment (OR=1.4, 95%CI=1.1-1.9), smoking (OR=1.5, 95%CI=1.1-2.0), alcohol intake (OR=1.9, 95%CI=1.2-3.1) and overweight and obesity (OR=1.5, 95%CI=1.2-2.0 and OR=1.6, 95%CI=1.2-2.0, respectively). Conclusion: This study provides useful evidence about selected correlates of rheumatoid arthritis among women attending specialized primary health care services in Albania. Health professionals and policymakers in Albania should be aware of the magnitude and consequences of this chronic condition in the adult population.

14

Authors: Luz Arenas-Monreal, Lilian E Pacheco-Magana, Celina Rueda-Neria, Josue Carrillo-Estrada, Margarita Marquez-Serrano, Laura Magana-Valladares, Marta Rivera-Pasquel

Aim: To present the results of a community initiative focused on strengthening physical activity and the consumption of fruits, vegetables and natural water while discouraging the use of highly energetic food and sugary drinks in public schools of Morelos. Methods: A quasi-experimental study with an educational initiative focused on the school community of two primary schools and two junior high schools. Pre- and-post initiative measurements were made. The study took place in the municipality of Yautepec, Morelos, Mexico, in a rural area and an urban area, from August 2010 to July 2011. Results: Water consumption among school-aged children increased from 15.1% to 20.1% and soda consumption decreased from 21.4% to 13.2%. A slight increase in the consumption of fruits and vegetables was also measured (oranges, jicamas, bananas, tomatoes, prickly pear pads, lettuces), that are accessible in the region. It was found that the supply of fresh food is limited and that high energy density foods have an oversupply in both study areas. Physical activity increased with actions such as football and dancing, in accordance with the baseline measurement. No changes were observed in the nutritional condition of school-aged children (n=150; 13.3% with overweight and 7.3% with emaciation), or in adults who presented a body mass index higher than normal, 60.2% to 88.4%. Conclusion: In addition to educational activities, schools need to implement strategies to improve the access and availability of fresh foods while limiting the access of high energy-density foods.

18

Authors: Kristina Selli, Kasia Czabanowska, Lina Danusevičienė, Rūta Butkevičienė, Ramunė Jurkuvienė, Judy Overall

Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015). Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results: This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i) the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii) the lack of information for complaining and the fear of consequences of complaining; iii) the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv) the high level of burden of proof in court cases and lack of good practices; v) the lack of a patient (human) rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions: This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care; encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the rights of patients and compensation for the damage to their health’, clearly stating where to complain in case of discrimination; create a webpage and brochures with readable and understandable information for elderly persons and their families and caregivers; establish legal consultation and mediation cabinets in health care facilities; establish an older persons’ rights protection service under the Ministry of Social Security and Labour in close cooperation with the Ministry of Health; promote sustainable results by incorporating a human rights-based approach regarding elderly persons in all policies.

5

Authors: Ulrich Laaser, Peter Schröder-Bäck

Is the group of public health professionals consistent of other professions such as physicians, nurses, social workers and the like, or should public health professionals define themselves as a distinct profession in their own rights? As of today, in Europe, public health professionals do not build an own profession.

13

Authors: Maha Nubani-Husseini, Elliot Berry, Ziad Abdeen, Milka Donchin

Aim: This study aims to assess the Palestinian girls’ dietary habits and physical activity patterns as a baseline for intervention. Methods: A cross-sectional study of grade 4 and 5 pupils (mean age: 11 years) in 14 all-girl schools in East Jerusalem, of four different types of school ownership (overall N=897), was conducted, using self-administered questionnaires and height and weight measurements. Logistic regressions were conducted to determine predictors of healthy behaviours. Results: Only 36.6% of the pupils reported eating breakfast daily, with UNRWA schools having the highest rate of daily breakfast consumption (42.6%). About 28% reported eating the recommended daily quantity of five portions of fruits and vegetables. Only 15% of the pupils reported being active at least five days a week and more than one third of the schoolchildren viewed TV for ≥4 hours a day. The prevalence of overweight and obesity was 22.2% and 7.6%, respectively, with private schools having the highest rates, 29.6% and 12.8% respectively (P=0.001). Additional predictors of overweight and obesity were: being the first child in the family, watching TV for more than four hours a day, always eating while watching TV and being physically active less than five days a week. Conclusions: Most Palestinian pupils miss breakfast, eat less fruits and vegetables than recommended and have sedentary behaviours. These findings raise serious concerns and point to the urgent need for tailored interventions.

25

Authors: Vesna Bjegovic-Mikanovic

In order to promote awareness of factors that affect social services, their quality, effectiveness and coverage, the term “governance” is frequently used. However, there is no agreement on definitions, frameworks and how it relates to the health sector. In this overview, two interrelated processes in Serbia will be analyzed: governance and management at the macro-, meso-, and micro level. Key messages are as follows: i) Continue decentralization and support to an effective national decision-making body (Health Council of Serbia) with all relevant stakeholders; ii) Reduce the well-known implementation gap and agree on a binding time frame for reforms, and; iii) Establish obligatory schemes for education and training of managers and support sustainability of state institutional capacity to teach, train and advise on a scientific basis. Keywords: governance, health sector, management, Serbia.