Albanian Medical Journal

2

Authors: Suzanne Havala Hobbs

Our global health care systems face an enduring challenge: The urgent need for increased leadership capacity within the senior health services workforce. This call for leadership training is not new. It has been repeated for decades by diverse groups within the public health professional community as well as in the clinical health services.

5

Authors: Toni Yonkov Vekov

In healthcare, the value which a patient receives is usually defined as the result of the healthcare activities, achieved per a financial unit. Measuring this value should be the basis of the model for reimbursement of health products (therapeutic and diagnostic activities, medicines, prevention and prophylaxis and the like). When the reimbursement policy is bound to the value for the patient, then the medical providers are rewarded for their effectiveness in achieving good health results, while enabling to locate the responsibility for poor health results. The current health reforms in the economically developed EU countries are oriented precisely to such individualized long-term care policies. Keywords: approach, healthcare costs, management, reimbursement, value for patients.

6

Authors: Ramadan Halimi, Nazife Sylejmani-Hulaj, Hidajete Halimi, Sevdie Jashari-Ramadani

Aim: To assess the prevalence of Posttraumatic Stress Disorder (PTSD) and other comorbid disorders and also to assess the impact of demographic and social factors in deterioration of existing psychological problems in Kosovo War Veterans. Methods: Data were gathered from a representative sample of 215 Kosovo War Veterans. Subjects were assessed for the presence of lifetime and current DSM-IV TR psychiatric disorders with the following questionnaires: Harvard trauma questionnaire (HTQ), Beck's Depression Inventory and Mini International Neuropsychiatric Interview, Albanian version 5.0.0 (MINI 5.0). Results: All subjects under study were males (100%), with a mean age of 42.9±7.8. Criteria for PTSD were met by 113, or 52.6% of the subjects; criteria for PTSD in co-morbidity with Major Depressive Disorders were met by 70, or 32.6% of the subjects, and; criteria for Major Depressive Disorder were met by 77, or 35.8% of subjects. The study has confirmed a significant impact of education, unemployment and poverty in the deterioration of PTSD and other psychological disorders. Conclusion: Fourteen years after the war, our study has shown that psychological problems among War Veterans should still be considered as a very serious issue. Meanwhile, the demographic and social factors also have had a high impact in the deterioration of the PTSD symptomatology, in the symptomatology of Major Depressive Disorder and other Comorbid Disorders.

6

Authors: Veronika Duci, Juliana Ajdini

Aim: This study aims to explore the quality of life of cancer caregivers and the impact of socio-demographic factors. Methods: A quantitative approach was used to conduct the study. The sample selection was based on a quota strategy and resulted to a total number of N=377 cancer caregivers. The study took place in the Oncology Hospital, at the "Mother Teresa" University Hospital of Tirana. The research tool was a questionnaire starting with socio-demoghraphic questions for the caregivers followed by the Quality of Life Scale of Flanagan (1982). Data analysis was conducted using SPSS 16. Validity of the QoLS was satisfying (Cronbach alpha=0.882). Results: Findings indicated that the caregivers were mainly women, unenmployed, of different ages and different types of families. Most of them offered care for more than five hours per day. QoL of the participants were at most low to medium. Age had a negative correlation with QoL (rs = -0.362, P<0.001). Participants with secondary education reported lower levels of quality of life (U=3334.5, P<0.001, r = -0.33). The married participants had higher levels of QoL, compared to the widowed (U=1117, P<0.001, r = -0.23). The mean values were m=169.07 for the caregivers with children and m=244.20 for the ones without children. Conclusion: Quality of Life can be influenced by certain life stressors like having a family member with cancer and being a caregiver. Further research with a cancer caregiver focus is needed in the Albanian context.

7

Authors: Elia Krasimirova Georgieva, Peshka Angelova Pesheva, Lidia Mladenova Georgieva

Aim: To assess the prevalence of depression among medical students in Bulgaria. Gender and other associated factors were taken into account. Methods: A cross-sectional study was carried out in 2013 at Medical University-Sofia. A specially designed questionnaire was administered. The Beck Depression Inventory was used to study depression. The study was carried out at the Department of Social Medicine, Faculty of Public Health-Sofia. One hundred and fifty medical students in the second course and 128 students in the sixth course took part in the study. Descriptive analysis was performed. Relation between variables was assessed with chi-square test with a significance level P≤0.05. Results: Symptoms of depression were found in 54.7% of all medical students (mild depression in 41.7%, moderate in 11.5%, severe in 1.4%). There was no significant difference in depression rates for second and sixth course students (P=0.1613) and for males and females (P=0.85). The analysis showed that possible risk factors for developing depressive symptoms are not having a parent physician and the lack of an intimate partner. Conclusion: There was a high prevalence of depressive symptoms among medical students, with no significant difference by sex and course of education. It is important to identify students suffering from depression and to develop programs for addressing mental health problems.

7

Authors: Erjola Piluri Ziu, Eris Mesonjesi, Maria Zoto, Blerina Bregu, Alfred Priftanji

The ALB-ISAAC 2011 study forms a part of a series of population surveys carried out in Tirana, using the internationally recognized procedures of the International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC initiative was designed to study the aetiology of asthma, allergic rhinoconjunctivitis, and atopic eczema in children in different populations using standardized methodology. In Albania, all of the three phases were carried out; Phase One (1995), Phase Two (1999-2000) and Phase Three (2001). ALB-ISAAC specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and atopic dermatitis in children living in Tirana, Albania in 2011-2012; 2) to estimate the risk factors of asthma, allergic rhinitis and atopic dermatitis and the correlation between this risk factors and the allergic diseases; 3) to estimate to what extent the variation in the prevalence and severity of asthma and allergies in children can be explained by differences in known or suspected risk factors or by differences in disease management; 4) to examine time trends in the prevalence of asthma, allergic rhino-conjunctivitis and atopic eczema in Tirana compared to 16 years earlier (ISAAC Phase One, 1995) and also the risk factors in developing asthma. The ALB-ISAAC 2011 repeated both the ISAAC Phase Two survey among 10-11-year-olds, and the ISAAC Phase One and Three surveys among 6-7-year-olds and 13-14-year-olds, during the school year 2011-2012. In combination with the earlier surveys, it offers both a current and a historical perspective on childhood asthma and allergy extending over 16 years. Keywords: allergic disorders, ISAAC, prevalence.

8

Authors: Vjollca Koko, Ana Ndrepepa, Skënder Skënderaj

Aim: We aimed to assess the severity of disease in patients with rheumatoid arthritis (RA) and to investigate the association of various risk factors for rheumatic diseases with the RA severity. Methods: This is an observational study that included 194 patients with RA living in the southern Albania during the years 1995-2011. The data collection was achieved in two phases: the retrospective phase (years 1995-2009) and the prospective phase (years 2010-2011). The main study endpoint was RA disability. Results: During 1995-2011, 194 patients with RA were identified. Eighty-nine patients were in RA stages III or IV and more than 1/3 of patients (n=69) had disabilities: three in stage II, 57 in stage III and nine in stage IV. Variables that showed a significant association with disability were age at the onset of disease, duration of disease, stages, male gender, occupation, smoking and alcohol consumption. Age at the onset of disease, disease duration, disability, alcohol and familial history showed a significant association with the RA stages. In the multivariate analysis, male gender, delay in diagnosis, occupation, age and RA stages were independently associated with disability, whereas alcohol consumption, age and age at the onset of disease were independently associated with the advanced RA stages. Conclusion: This study shows that nearly half of the patients with RA in the southern Albania are in the RA stages III and IV and 35.6% of them have disabilities. A series of predisposing factors for rheumatic diseases were independently associated with the RA severity.

9

Authors: Ditila Doracaj, Edi Grabocka, Elda Hallkaj

Aims: Infant and child feeding index (ICFI), which translates the multidimensional child feeding practices into one age-specific summary index, has proven to be a useful tool for examining the association between childcare and nutritional status. We examined this relationship in Diber, Albania using an adapted version of the ICFI developed by Ruel and Menon. Methods: A cross-sectional survey including 464 mothers of children aged 6-23 months was conducted in three districts of Diber during June-July 2012. The variables used for the ICFI were current breastfeeding, bottle feeding, use of complementary foods in the past 24 hours, frequency of use of food groups over the past week and feeding frequency. The index was calculated according to age distribution for children 6-8 months, 9-11 months and 12-23 months and was categorized into tertiles. The associations between ICFI and anthropometric indices including length-for-age (LAZ), weight-for-length (WLZ) and weight-for-age (WAZ) Z-scores were examined separately for each age group. Linear regression models were used to adjust for potential socio-demographic confounders. Results: The ICFI was positively associated with children's LAZ. Adjusted mean LAZ in low, medium and high tertiles of ICFI were, respectively, -1.34, 0.22, and 0.4 (P<0.01) among children aged 6-8 months; -1.01, 0.009, and 0.013 (P<0.01) among children aged 9-11 months; and -1.16, -0.69, and 0.51 (P<0.01) among children aged 12-23 months. Among the components of ICFI, dietary diversity, food-group frequency and frequency of feeding were positively associated with anthropometric indices. Conclusion: ICFI and its components could be used to assess the effect of complementary feeding practices in child growth.

9

Authors: Konstantinos H. Katsanos, Vasileios Grammeniatis, Nikoletta Karavasili, Dimitrios Christodoulou, Epameinondas V. Tsianos

Many of the varying manifestations of celiac disease can occur without the enteric involvement, thus medical specialties should be familiar with the ways of diagnosing and treating the disease. The resolution to the problem of celiac disease is the gluten free diet which restores the damage of the mucosa and relieves from symptoms. Celiac disease can appear with classical symptoms of malabsorption while it can arise with extraintestinal symptoms like fatigue, anorexia, arthralgy, osteoporosis, osteomalacia, short stature, gingival disorders, sidiropenic anemia, dermatitis herpetiformis and neurological disorders. During the last decade, sensitive and specific methods have been developed for the identification of specific antibodies at the serum of patients with celiac disease which had a tremendous impact on clinical expression, epidemiology and diagnostic approach of the disease. Nonetheless biopsy of small intestine remains the gold standard for the diagnosis of celiac disease. It is interesting to say that while once celiac disease was considered to be a rare disease, recent studies have shown that the prevalence reached 1/250 of the general population or 0.5% to 1.0% percent in Europe. Taken this into consideration, it is clear that celiac disease is a disease whose prevalence is continuously revised with a raising tendency. Keywords: celiac disease, epidemiologic features, Greece.

3

Authors: Tony Smith

Modern societies are afflicted with what has been described by broad range of health problems, including epidemics of over consumption and rising rates of mental distress and disorder diminishing levels of well-being and increasing health and social inequalities.

4

Authors: Drita Jaka, Enver Roshi

Aim: The objective of this study was to assess the association of anthropometric indices with the health status among adult prisoners in Albania. Methods: A cross-sectional study was conducted in 2013 including 401 prisoners in Albania: 290 (72%) males and 111 (28%) females. All participants were measured height and weight and waist and hip circumferences, based on which the anthropometric indices were calculated (body mass index [BMI] and waist-to-hip ratio [W/H]). In addition, an anonymous and structured questionnaire was administered including data on self-perceived health status, health-related problems, lifestyle factors (smoking, alcohol intake and drug use) and demographic and socioeconomic characteristics (age, sex, educational attainment and income level). Binary logistic regression was used to assess the association between self-reported health status and anthropometric indices. Results: Mean BMI was 27.84±3.91 among participants who reported a poor health vs. 26.16±3.62 in individuals who did not report a poor health status. Conversely, mean W/H was 0.92±0.07 and 0.89±0.06, respectively. In age-adjusted analysis, poor self-reported health status was positively related to the overall obesity (OR=1.59, 95%CI=1.14-2.18, P<0.01) and abdominal obesity (OR=1.72, 95%CI=1.23-2.34, P<0.01). Conclusion: Findings from this study point to a strong positive association between anthropometric indices and poor health status among Albanian adult prisoners. These findings should raise the awareness of policymakers and health care providers in Albania dealing with this marginalized segment of the population.

4

Authors: Sadet Gjata, Elizana Petrela, Altin Gjata

Aim: Similar to other regions of Albania, congenital malformations are leading causes of childhood mortality and chronic illness in Elbasan region, too. Nevertheless, to date, the evidence on the magnitude and determinants of congenital malformations for Elbasan region is scarce. The aim of this study was do describe the frequency of congenital malformations for the period 2007-2012, as recorded by the active screening procedures conducted in primary health care services in Elbasan region. Methods: An active screening for congenital malformations was undertaken by primary health care physicians in the region of Elbasan during 2007-2012. Hence, the information on congenital malformations was extracted from the health records pertinent to primary health care services in Elbasan region. On the other hand, the information about live births and infant deaths was collected from the Albanian Ministry of Health. Results: Overall, there was evidence of an increase in the rate of birth defects in Elbasan region from 18.4/1000 live births (in 2007) to 21.2/1000 live births (in 2012). However, the trend over time was inconsistent, with the highest peak noticed in 2010 (24.6/1000 live births). As a matter of fact, there was no evidence of a statistically significant linear trend in the increase of birth defects in Elbasan region for the period 2007-2012 (Cox-Stuart test for linear trend: P=0.25). On the other hand, there was evidence of a decreasing trend in infant mortality rate in the past few years in Elbasan region. Hence, infant mortality rate declined from 12.3/1000 live births in 2010 to 5.2/1000 live births in 2012. Conclusion: In Elbasan region, congenital malformations may have a negative health impact similar to the other regions of Albania. Health professionals and policymakers in Elbasan and other regions of Albania should be aware of the means of prevention and treatment of congenital malformations.

4

Authors: Altin Gjata, Teuta Backa, Sadet Gjata

Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density which can lead to an increased risk of fracture. Furthermore, osteoporosis is a recognized complication in several specific diseases and medical disorders. Risk factors for the fractures resulting from osteoporosis are categorized into non-modifiable and (potentially) modifiable risk factors. The presence of osteoporosis can be established by use of conventional radiography and by measuring the bone mineral density. Medication use is theoretically modifiable, although in many cases, the use of medication that increases osteoporosis risk may be unavoidable. The international literature recommends screening by bone densitometry for all women aged 65 years or older. In addition, it is recommended to provide screening for women with increased risk factors. On the other hand, in men, the harm versus benefit of screening for osteoporosis is unknown. The information about the magnitude and distribution of osteoporosis in population-based studies from Albania including Elbasan region is scarce. Therefore, there is a need to conduct epidemiological studies in order to assess the prevalence and distribution of osteoporosis in Elbasan region and other regions of Albania. Keywords: bone densitometry, Elbasan, fractures, osteoporosis, screening.

5

Authors: Elham Behzadi, Payam Behzadi, Reza Ranjbar

Aim: Klebsiella pneumoniae is an opportunistic pathogenic bacterium which may lead to colonization and infection of burn wounds. The objective of this survey wasto examine the triggering effect of UVB light for probable induction of programmed cell death (apoptosis) in irradiated colonies of Klebsiella pneumoniae. Methods: The samples were categorized into control and three irradiated groups. The well grown colonies of Klebsiella pneumoniae were irradiated by UVB beams during ten minutes at the wavelength of 302 nm. 10µl of purified total genomic DNA belonging to control and radiated colonies were extracted by DNP kit and were running on 1% agarose gel electrophoresis up to 30 minutes. Results: The pattern of DNA bands including both control and UV-irradiated colonies was completely normal. Neither deformity nor unusual patterns like laddering band nor smear was observed. Conclusion: There are different genetic and biophysical mechanisms which may inhibit the process of apoptosis in irradiated colonies of Klebsiella pneumoniae. That is why the current UV-irradiation protocol is not able to induce the apoptotic reaction in irradiated colonies.

5

Authors: Arben Haxhihyseni, Vangjel Tavo, Daniela Haxhihyseni, Migena Prifti

Aim: There are many studies to support the idea that hysteroscopic metroplastic procedure improves reproductive result in primary infertility in women with a history of obstetric problems. However, the role of uterine septum in patients with inexplicable infertility is still not clear because of lack of information. Our aim was to assess whether the hysteroscopic metroplastic procedure impacts the inexplicable infertility in women with uterine septum. Methods: In this study, 28 women with uterine septum and inexplicable infertility were included. All patients underwent hysteroscopic septal resection. The reproductive outcome in these patients was studied and analyzed within the first year of metroplastic procedure. Results: All cases (N=28) got pregnant within a year after the metroplastic procedure. Twenty-three of them had children at normal birth weight on the due date of delivery. Only two cases resulted in spontaneous abortion, losing their children; only three women had premature live birth. All women had pregnancies with one foetus. Eleven of them had cerclage. Conclusion: Hysteroscopic metroplastic procedure, in women with uterine septum, significantly improves the reproductive outcome.

6

Authors: Fitim Alidema, Majlinda Kryeziu-Alidema

Aim: Micronuclei analysis (MN) in exfoliative human cells presents an opportunity to study genomic changes in the target organs affected by cancer. The aim of this study was to analyze the extent of changes in the nuclei of epithelial exfoliated cells of oral buccal mucosa of patients with breast cancer treated with chemotherapy. Methods: This study lasted for four months and, during this time period, 22 patients became part of the study. The patients were diagnosed with breast cancer (22.7% male) with an average age of 48.7±11.0 years. Taking the epithelial cells from oral cavity of those 22 patients, we analyzed the degree of nuclei alteration in exfoliated cells of buccal mucosa. The statistical parameters were tested with the t-test. Results: The mean of degenerative changes in exfoliated epithelial cells of the buccal mucosa in patients with breast carcinoma increased significantly after chemotherapy (17.7±27.2 vs. 29.8±33.6, P<0.0001). The data indicates significant increase for all types of nuclei alterations. The frequency of various acute nuclei alterations and the total number of such alterations was similar in both genders. Conclusion: The results have shown that chemotherapy induced cell cytotoxicity, but it did not induce chromosomal changes and micronuclei formation.

7

Authors: Enriketa Kroi, Roland Hasa, Nikita Manoku

Aim: Shear-wave (SW) elastography is a new method of obtaining quantitative tissue elasticity data during breast ultrasound (US) examinations. The aim of this study was to correlate the maximum elasticity and standard deviation values of breast masses with histological findings, and to compare the validity of these procedures. Methods: This is a cross-sectional study among 76 consecutive patients conducted in the “Evangelism” medical center from January 2012 to April 2013. Patients underwent standard breast US supplemented by quantitative SW elastography using the Aixplorer® ultrasound system. SW elastographic evaluation (maximum elasticity of stiffest portion of mass and surrounding tissue and standard deviation [SD]) was calculated for each lesion. Elastography measurements were correlated with histology results. Maximum elasticity and standard deviation cut-off values of <60 kilopascals (kPa) and ≤10, respectively, were used for benign/malignant differentiation. Results: Mean age of participants was 51 years (range 25-65 years). In total, 79 lesions were noticed. Mean ultrasound mass diameter was 16.7 mm, while mean elastography mass diameter was 17.2 mm. Histologic results detected 36 benign lesions and 43 malignant ones. Maximum elasticity vs. SD sensitivity, specificity, positive predictive value, negative predictive value, misclassification rate and accuracy rate were respectively 95.3% vs. 83.8%; 86.1% vs. 88.9%; 89.1% vs. 90%; 93.9% vs 82.1%; 8.9% vs. 13.9% and 91.1% vs 86.1%. Conclusion: SW elastography yields useful quantitative information on breast masses. The performance of maximum elasticity is comparable with that of standard deviation.

8

Authors: Elia Krasimirova Georgieva, Lidia Mladenova Georgieva, Vili Slavchev Zahariev, Peshka A. Pesheva

Aim: To assess the stress levels and the sources of stress among medical students in Medical University-Sofia. Gender and other differences were taken into account. Methods: A cross-sectional study with a specially designed questionnaire was carried out. For studying the stressors, it was used an inventory called Medical Student Stressor Questionnaire. The study was carried out in 2013 at the Department of Social Medicine, Faculty of Public Health-Sofia. In the study took part 150 medical students in the second course and 128 students in the sixth course. Descriptive analysis was performed. Relation between variables was assessed with chi-square test with a significance level of P≤0.05. Results: Moderate to severe stress was experienced by 78.4% of the medical students. High and severe stress was declared by 20.1% of the students. High to severe stress was reported by 21.4% of the females and 18.2% of the males. Academic related stressors caused high to severe stress in 59.7% of the students. Conclusion: Academic related stressors were the main cause of stress both for the second and the sixth year students. A gender difference regarding stress levels was observed, where women reported higher levels of stress than men. There was no statistically significant difference in stress between second and sixth year students. We recommend more detailed future investigation of stress factors in Bulgarian medical students in order to introduce stress management programs.

10

Authors: Ailsa Baker

Cervical cancer is a prominent public health problem in Europe. In 2012 it caused an estimated 12,977 deaths in the European Union (EU). Incidence and mortality from cervical cancer vary across Europe, with Romania having the highest estimated incidence and mortality rate in the EU in 2012. The significant health threat caused by this disease highlights the need for a comprehensive cervical cancer prevention programme to be fully developed and implemented throughout the EU. Collecting and analysing data on risk factors associated with cervical cancer is a crucial first step to developing a prevention programme. The following risk factors for cervical cancer are discussed in the literature: Human papillomavirus (HPV) infection; smoking; having human immunodeficiency virus (HIV) or another condition that makes it difficult to fight infection; using birth control pills for a long time (five or more years); giving birth to three or more children and having several sexual partners.The goal of this paper is to assess the availability of data in the form of indicators, on risk factors associated with cervical cancer. The first research question addressed is: “What indicators are available in international health databases?” Using Romania as an example, the second research question is: “Do the identified indicators provide data on Romania?” The European Health for All Database (HFA-DB), The Organisation for Economic Co-operation and Development (OECD) and Eurostat are three core international health databases that were used to address the research questions. The results showed indicators were available on smoking, having HIV and giving birth to three or more children. However, not every indicator that was available provided data on Romania. No indicators were available on HPV infection, contraceptive use or having several sexual partners. These results indicate a lack of available indicators related to risk factors associated with cervical cancer in HFA-DB, OECD and Eurostat. In addition, the identified gaps in the availability of data, with regards to Romania, could be detrimental to the development of a comprehensive national cancer prevention programme. Keywords: cervical cancer, data availability, health for all database, Romania.

2

Authors: Helmut Brand

What do we, here in Maastricht, know about the Balkans? What do we really know about this part in the centre of Europe? Do we understand what happened when former Yugoslavia broke up? Why could a war start in Europe again?

4

Authors: Manika Kreka, Eleni Nastas, Gentiana Qirjako, Bledi Kreka, Vjollca Hajro, Floreta Kurti, Anila Godo

Aim: Although the frequency of the painful sickle cell crisis, which is an important marker of sickle cell disease related complication, is considered a parameter of this disease’s severity, most patients do not frequently experience such crisis that can require always medical assistance. Methods: We studied 64 patients with sickle cell disease from December 2011 to December 2012 at the University Hospital Center, Tirana, Albania. About 63% of the patients were female. Pain rate was assessed by calculating the cumulative number of admissions for painful crisis (like articular, muscular, abdominal pain). The patients were categorized into three groups: 0, 1, or ≥1 crises per year. Painful crises that did not require medical assistance were excluded. Results: Sixteen patients did not have crisis, and 15 patients had more than one crisis per year. Avascular necrosis, acute chest syndrome, cholelithiasis and iron overload were significantly related to pain rate. Cholelithiasis was the prominent clinical manifestation amongst this group of patients. There was no significant change in laboratory findings. Pain was evaluated as an important marker and was present (one or more per year) in 15 patients with Sickle Cell Disease and Thalassaemia Sickle Cell Disease. Conclusion: The association between iron overload and the pain rate is probably the result of many blood transfusions used for treating painful crisis. Our data shows that several major diseases which are complications of sickle cell disease are not strictly related to pain rate and occur in a very significant number of patients that seem clinically well. Hence, we have to evaluate systematically these complications, even in patients which represent a mild-to-moderate clinical panorama of disease in order to prevent the severe complications.

5

Authors: Brunilda Hysaj (Vila), Lila Shundi, Mimoza Basho, Silva Bino, Eriona Abazaj, Tefta Rexha

Aim: To determine the prevalence and HCV genotype among high risk groups in Albania. Methods: In this study we analyzed 172 blood samples collected from various high risk groups for the presence and genotype of HCV virus with HCV-RNA (Cobas Amplicor HCV Test v2.0, Roche), HCV genotype (Line Probe Assay-LiPA, Bayer). The data analysis was done using SPSS, version 16.0. Results: A total of 172 blood samples were screened including thalasemic patients, dialysis patients, and injecting drug users (IDUs). Initial screening was done for anti-HCV using ELISA-test. Confirmation of active HCV infection was carried out with the help of Cobas Amplicor test V 2.0. Out of 172 samples, 121 (70.34%) were both HCV positive for anti-HCV and HCV RNA. Prevalence of active HCV-RNA infection in individual risk groups was: 20 (41.66%) for 48 thalasemics patients, 74 (88%) for 84 cases with dialysis and 27 (67.5%) for 40 cases in injection drug users, respectively. Four major genotypes (1, 2, 3, 4) and their subtypes (1a, 1b, 1a/b, 3a, 4a, 4e) were identified. The most frequent HCV genotypes were 1 and 3. There was no significant relationship between virus genotypes and sex, age and risk-group. Conclusions: The prevalence of HCV-RNA was higher in these population groups. Genotype 1, subtype 1b was the most prevalent in dialysis patients and genotype 3 was the most prevalent between the IDUs group, but more detailed studies with a larger number of patients are necessary to understand the HCV dynamics in this population subgroup of Albania.

6

Authors: Eralda Mariani, Polikron Pulluqi, Enver Roshi, Doriana Frashëri, Entela Buzali

Aim: Human brucellosis is a serious disease that can result in disabling complications. Brucellosis is still one of the most challenging issues of both health and economy. This study was designed to determine the epidemiological features of brucellosis in Korça prefecture, as this is one of the endemic areas in Albania. Methods: This is a retrospective descriptive study. Data on socioeconomic and occupational factors and history of exposure to animals and animal products over a 7-year period 2005–2012 were collected in Korça prefecture by using a structured questionnaire. Results: In total, 737 cases of brucellosis were reported. The incidence rate of brucellosis decreased from 95/100,000 in 2005 to 11/100,000 in 2012. The male-to-female ratio was 1.6 and the disease was most common in individuals aged 40-49 years. 62.8% of cases were from rural areas. Cases occurred throughout the year, with the highest incidence rate between May and August. Among the occupations identified, 37.3% were housewives, 22.6% farmers, 21.3% students, 6.1% shepherds and 12.7% of the patients had other occupations. Conclusions: Exposure and contact to home-owned animals and consumption of homemade milk and dairy products were identified as probable sources of human brucellosis infection in the districts included in this study conducted in Albania.

7

Authors: Nikolin Filipi, Kozeta Filipi, Blerim Saraçi

Aim: Cardiac surgery interventions can often be associated with complications. One of the most important of them is postoperative acute kidney injury (AKI) that can significantly contribute in a higher postoperative morbidity and mortality. The risk and prevention of acute kidney injury (AKI) following cardiac surgical interventions is less well understood and still remains a challenge. By conducting the study, we evaluated the factors that may predispose the appearance of AKI in terms of cardiac surgery. Methods: The study was based on the recorded clinical and demographic data of 72 adult patients (age ≥18 years) who underwent coronary artery bypass graft (CABG) surgery and valve surgery (with or without concomitant CABG) at the Hygeia Hospital Tirana, Albania, in cardiac surgery department during September 2011 – May 2012. According to RIFLE/AKIN classifications, risk factors such as patient’s condition, lowest mean arterial pressure during intervention, aortic clamp time, bypass time, intubation total time and hemorrhage and creatinine levels were studied during the first five postoperative days. Results: 72 patients were included in the study. Mean age was 61.3±9.7 years; 76.4% were men and 23.6% were women. About 78% were intervened of cardiopulmonary bypass, 11% underwent valvular replacement surgeries and 7% combined surgeries. Around 14% of patients developed signs of AKI within the fifth postoperative day. Pre, intra- and postoperative risk factors for acute renal failure were evaluated. By studying the variables’ correlation with AKI, we found a highly significant association (P<0.001) for values like total intubation time and ICU (intensive care unit) stay time as well as mean value of urea and creatinine within five days. A less significant association was found with lactate values taken 24 hours after cardiac interventions (P=0.05). Conclusion: In patients that undergo surgical procedures in cardiac surgery, the postoperative renal function tests, as well as intubated and ICU time, play a very important role in development of the postoperative AKI. Reducing these factors to their lowest limits, can directly help in minimizing the postoperative development of AKI and will surely reduce the treatment costs of the postoperative patient. Quality improvement strategies should be incorporated at all institutions in order to identify and track quality indicators relevant to the prevention of postoperative renal dysfunction during the index admission for cardiac surgery. Once identified, clinicians can implement preventative measures for high-risk patients.

8

Authors: Vjollca Shpata, Xhensila Prendushi, Alma Nurçe, Alketa Hoxha, Floreta Kurti, Ilir Ohri

Aim: Malnutrition is a frequent concomitant of surgical illness, especially in gastrointestinal surgery. The purpose of the studywas to evaluate the prevalence of malnutrition for intensive care unit (ICU) patients, who underwent gastrointestinal surgery and to determine the correlation with post-operative outcome. Methods: We prospectively studied 313 post-surgical patients 18 years that stayed 4 days at the Intensive Care Unit (ICU) of the UniversityHospital Center Mother Teresa in Tirana, Albania. Patients were divided into well-nourished (NRS 2002 <3) and malnourished groups (NRS 2002 3) according to their nutritional status. All patients were followed up clinically until discharge from ICU or death and their outcomes were recorded. Univariate and multivariate logistic regression analysis were used to identify the relationship between malnutrition and the clinical outcome. Results: The prevalence of pre-operative malnutrition was 61.7% and for gastrointestinal cancer patients it was 80.2%. Malnutrition, as analyzed by a multivariate logistic regression model, was an independent risk factor for higher complications, higher nosocomial infections, increased mortality, and longer stay in the ventilator and ICU. Conclusion: This study shows that malnutrition is a significant problem in surgical patients, especially in patients with gastrointestinal cancer, staying for more than four days in the intensive care unit. Malnutrition in gastro-intestinal surgery patients is an independent risk factor on increased post-operative morbidity and mortality.

8

Authors: Jeremy G. Guillory

Aim: The burden of disease among populations is not spread evenly across Europe. Some nations in Europe have the lowest disease burden in the world, while some lag far behind among industrialized nations. These differences make real-world impacts in the lives of the residents of Europe, and are thus important to investigate. The objective of this paper was, firstly, to examine the correlation between the geographic locations of nations in Europe and the amount of burden of disease accumulated by their populations. Looking further, to correlate the burden of disease with the amount spent on healthcare per capita in these nations. Finally, to investigate the question of how health system efficiency is affected by healthcare spending. Methods: Using data concerning burden of disease, healthcare spending and health system efficiency, correlations were made both visually and numerically in order to show the results. Results: There is a strong correlation between the high number of DALY’s accumulated by a population and living in Eastern Europe. This is related to low healthcare spending and lack of efficiency in the health systems of these nations. Conclusion: In order to reduce the burden of disease in Eastern Europe when compared to Western Europe, healthcare spending per capita must be increased to reach a minimum level where efficient practices can take place and DALY’s can be reduced.

9

Authors: Shpëtim Doksani, Anila Kristo, Sokol Myftiu, Fatime Elezi

Aim: There has been an increase in the levels of alcohol intake in Albania, particularly among men. In recent years, the use of pharmacotherapy together with psychosocial interventions has enhanced the percentage of success in maintaining alcoholic patients in remission. The aim of this study was to describe an alcohol treatment program in Albania, as well as to assess the response to psychotherapeutic and pharmacologic treatment of alcohol-addicted patients in Albania. Methods: This is a prospective study including 51 consecutive subjects admitted to the Clinic for the Treatment of Alcohol Addiction at the University Hospital Center “Mother Teresa” in Tirana, Albania, over the period September 2010 – September 2011. After the three week period of hospitalization all patients were followed up for one year after discharge. Results: Mean age of the patients was 47.3± 9.8 years (range 31-60 years). About 96% of the patients were males. The most frequent disorders among patients were psychiatric disorders in 41 (80%) patients, followed by internal disorders in 36 (70%) patients and neurological disorders in 15 (30%) patients. Patients with high dependence were 3.2 times more likely to manifest anxiety and general depressive disorders than patients with low dependence without a significant difference between them (OR= 3.2, 95%CI=0.6-19.28, P=0.1). About 45% of the patients achieved one year abstinence (95%CI=33.2-58.6). About 55% (95%CI=41.3-67.7) of the patients relapsed to alcohol use. Divorced patients were 8.7 times more likely to relapse compared to the married counterparts (OR=8.7, 95%CI=1.7-66.4). Around 67% of married patients who relapsed manifested family/spouse relationship difficulties (P<0.01). Conclusion: The high rates of associated psychiatric disorders in patients with alcohol-use disorders require that alcoholic patients undergo careful psychiatric evaluation. Similarly, the treatment of alcohol-dependent patients with comorbid disorders is complex. The pharmacotherapy should not be considered as the only form of treatment, but as an integrated part of a multimodal approach including psychological and social support.

2

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.

3

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.

5

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.

6

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.

6

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.

7

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.

8

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.

9

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.

1

Authors: Vesna Bjegović-Mikanović

The forthcoming South Eastern European Journal of Public Health (SEEJPH) is an open-access, international peer-reviewed journal involving all areas of health sciences. The main focus of the journal, however, is on public health. In addition, this journal encourages submissions from scientists and researcher pertinent particularly to Eastern European countries. From this perspective, the aim of SEEJPH is to offer a means for publication to researchers from the transitional former communist countries of Europe in order promote their scientific work and increase their scientific visibility in Europe and beyond.

4

Authors: Katarzyna Czabanowska, Ken Rethmeier, Tony Smith

Skills to work across disciplines and especially trans-disciplinary education are essential for leadership in public health. Further, effective leadership skills are required to affect constructive change in health care settings and practices. Several influential professional development programs such as Health Care Management (HCM) program developed and delivered by Project Hope. The project Developing European Leadership Through Action-learning in Healthcare (DELTAH) aimed to improve the performance of participating healthcare organisations through fostering the level of leadership skills amongst healthcare managers. However, few programmes have been developed to equip public health professionals with leadership competencies which specifically reflect public health discipline. “Leaders for European Public Health” (LEPHIE) Project funded by the European Commission Lifelong Learning Programme was designed to develop a curriculum for European Public Health Leaders. The public health leadership content is aimed to be applicable to the performance in diverse European Public Health practices and contexts and reflects the priorities and objectives of the European Health Program. The programme is competence based. A competency framework has been developed to support the curriculum and facilitate self-assessment. The Module uses innovative training methods, such as problem-based and blended learning formats. We believe that the integration of modern technology with a collaborative approach to learning by professionals, supported by interdisciplinary competency-based educational design, will result in a transformative learning experience. Keywords: competencies, educational innovation, leadership, public health.

5

Authors: Dorina Roko, Anila Babameto-Laku, Vage Mokini, Maksim Cikuli

Aim: The objectives of this study were to evaluate the effects of treatment with Gleevec (Imatinib mesylate) in the chronic stage of chronic myeloid leukemia (CML), to follow up the hematological and cytological remissions in patients treated in this way and to observe the significance of Sokal score in these patients. Methods: Evaluation study of Imatinib mesylate responses in chronic phase of chronic myeloid leukemia and the significance of Sokal score was performed at the Haematological and Genetic Service in University Hospital Center ¨Mother Theresa’’ in Tirana, Albania on a sample of 70 CML patient’s with an average age of 48 years old (range, 18-72 years old) at the time of diagnosis. This study was conducted from April 2011 to April 2013. Hematologic and cytogenetic responses were assessed according to defined criteria. At the end of the study, responses were overall analyzed according to Sokal score. Results: Complete hematologic responses were seen in 91% of patients while complete and major cytogenetic responses were observed in 59% and 78% of cases respectively. Responses were found to be higher in patients who had low Sokal score at the time of presentation. Conclusions: Imatinib mesylate has a substantial activity in the chronic phase of CML. A low Sokal score predicts a higher hematologic as well as cytogenetic response in patients during chronic phase.

6

Authors: Doncho Donev

During the International Public Health (PH) Conference in Tirana, 6-7 May, 2013, I was invited by the editors-in-chief to write an editorial for the next issue of the Albanian Medical Journal (AMJ). As a member of the AMJ Editorial Board and a member of the Forum for PH cooperation in South Eastern Europe (FPH-SEE) Network and an active contributor to the most of activities of the Stability Pact PH-SEE Project from November 2000, when the project officially started, I accepted the invitation with pleasure and honor.

6

Authors: Albana Adhami, Dritan Çela, Llukan Rrumbullaku, Enver Rroshi

Aim: The aim of this study was to describe the distribution of primary health care (PHC) physicians in urban and rural areas of Albania in the past decade. Methods: We reviewed the number of PHC physicians (per 10,000 population) in each of the 36 districts of Albania separately for urban areas and rural areas for the period 2000-2012. The information on the number of PHC physicians and the population size in each district for the period under study was collected from the files of the Health Insurance Fund. Mann-Kendall test was used to test for linear trend in the variation of the number of PHC physicians in both urban and rural areas of Albania. Results: In urban areas, there was evidence of an overall decrease in the number of PHC physicians (per 10,000 population) from 4.4 (in 2000) to 3.9 (in 2012) [linear trend: P=0.02]. Conversely, in rural areas, there was evidence of a slight increase from 3.5 (in 2000) to 3.7 (in 2012), with no evidence of a significant linear trend (P>0.05). In 2000, the excess number of PHC physicians in urban areas compared with the rural areas was 9 per 100,000 population, whereas in 2012 this difference was only 2 per 100,000 population. Conclusion: Regarding the distribution of PHC physicians in Albania, the current analysis indicates a significant decrease in urban areas, but only a slight non-significant increase in rural areas of the country. It would be interesting to assess in future analyses the link between the distribution of PHC personnel and health outcomes in urban areas compared to rural areas of transitional Albania.

6

Authors: Valdet Hashani, Jolanda Hyska, Gentiana Qirjako, Enver Roshi

Aim: We have previously reported on the prevalence and socioeconomic predictors of hypertension in the adult population of transitional Kosovo. The aim of this study was to assess the association of hypertension with lifestyle/behavioral factors in the adult men and women in 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. Data on lifestyle factors (including smoking, alcohol intake, physical exercise and dietary fat intake), demographic factors and socioeconomic characteristics were also collected. Binary logistic regression was used to assess the association of hypertension with lifestyle/behavioral factors. Results: The prevalence of hypertension was 38.9% in men and 28.8% in women. In crude logistic regression models, hypertension was positively related to smoking (OR=1.78, 95%CI=1.39-2.30), excessive alcohol consumption (OR=2.53, 95%CI=1.78-3.66), physical inactivity (OR=2.71, 95%CI=1.67-3.86) and excessive dietary fat intake (OR=2.21, 95%CI=1.53-3.09). Upon simultaneous adjustment for socioeconomic characteristics and lifestyle factors, significant “determinants” of hypertension were smoking (OR=1.64, 95%CI=1.24-2.07) and physical inactivity (OR=2.13, 95%CI=1.42-2.94). Conclusion: Our findings point to a deleterious effect on coronary health of behavioral factors in this representative sample of the adult population in Kosovo. There is an obvious need for policymakers and health promotion specialists in Kosovo to implement effective programs and activities in order to control and prevent the negative health outcomes related to hypertension.

7

Authors: Adrian Hoxha, Genci Dervishi, Edjona Bici, Alvi Naum, Jonida Seferi, Klejda Risilia, Eni Tresa.

Aim: Assessment of nutritional status and dietary patterns of Roma population should be documented because they may reflect the extent of marginalization and associated health risks. This study assessed the nutritional status and dietary patterns among Roma community in Albania. Methods: A representative sample of 400 Roma individuals living in five districts of the country was included in this study. A food frequency questionnaire was administered, body weights and heights were measured and socio-demographic and health information was collected through interviews. Factor analysis was used to identify dietary patterns of the Roman community. Results: The results of this study revealed that, in Roma population living in Albania, 49% of individuals had a normal body weight, 43.8% were overweight and/or obese (especially the age group >25 years) and 7.2% were underweight. Two dietary patterns were identified: one pattern with a higher consumption of dairy products, vegetables, and milk and another pattern included fat, bread and alcohol. The increase in BMI is due to disproportionate distribution of food items and calories derived rather than a balanced diet. Conclusion: Majority of the Roma population in this study sample from Albania consumed a high-calorie diet resultant mainly from cooking oil, bread and alcohol, which may predispose these vulnerable individuals to overweight and obesity.

11

Authors: Sanjin Musa, Šeila Cilović-Lagarija

Aim: Federation of Bosnia and Herzegovina has a low prevalence of HIV, less than 1% of the total population. Until November 2011, Federation of Bosnia and Herzegovina had registered 117 persons living with HIV, of which 71 developed AIDS. The aims of this study were to assess training of health workers in HIV/AIDS; prevention measures in the workplace, knowledge, attitudes and practices about HIV with an emphasis on HIV stigma and discrimination. Methods: This study involved 1118 health professionals in public and private health sector in the Federation of Bosnia and Herzegovina. An anonymous survey with a structured questionnaire was conducted for the purposes of research applied to the stratified cluster sampling in 4 levels. Results: Results of the survey show that 47.8% (533/1115) of health care professionals appeared to be providing health care to persons living with HIV. Health care workers are certain that HIV is transmitted through blood, sperm and other body fluids containing blood, but not so through other body fluids (saliva, sweat and tears). Only 40.4% of health workers knew that all pregnant women who are HIV-infected will not give birth to babies with AIDS. In the past 12 months of working with patients, 29.3% of health workers had needle-stick injury. Conclusion: This survey has shown that the health workers’ knowledge on the ways of HIV transmission and general issues pertaining to HIV, as well as knowledge and application of safety measures is not satisfactory. These results are reflected in attitudes toward persons living with HIV.