The role of Human Development Index in the epidemiology of asthma in adolescents in Kosovo: A cross-sectional multicentre Global Asthma Network (GAN) study.

BACKGROUND: Very limited information is available on the prevalence and risk factors of asthma in adolescents in Kosovo, and no study has previously addressed the role of Human Development Index (HDI) on asthma in the region. The present study addresses these two issues. METHODS: Following the Global Asthma Network (GAN) methodology, a cross-sectional survey, through standardised self-completed questionnaires, was conducted in the following six centres of Kosovo: Ferizaj, Gjakova, Gjilan, Peja, Prishtina and Prizren. Current asthma symptoms (CAS) and severe current asthma symptoms (sCAS) were defined according to the GAN standards. Environmental questionnaire inquired about gender, exercise, screening time, siblings, truck traffic, use of paracetamol, pet ownership, and smoking habits. Height and weight were also measured. Multivariate logistic regression analyses were performed in each centre along with meta-analyses to summarise the overall effects of each factor in the centres as a whole. Meta-regression of the prevalence rates was calculated using HDI as a moderator. RESULTS: Participation rate was high (80.0-99.9%). Prevalence of CAS ranged from 4.6% to 11.3%, and sCAS from 1.7% to 4.5%. Factors associated with CAS were exercise, computer time, paracetamol use and dog ownership. sCAS was associated with paracetamol use and physical exercise. HDI explained 46% and 80% of prevalence variability of CAS and sCAS between centres, respectively. CONCLUSIONS: Prevalence of CAS and sCAS in Kosovo varies highly between centres. This variability is explained partly by HDI. Individual risk factors are common, with some determined in other studies conducted in other regions.

Knowledge, Attitudes and Practices of Mothers in Kosova About Complementary Feeding for Infant and Children 6-24 Months.

AIM: This cross sectional study assessed knowledge, attitudes and practices regarding complementary feeding among mothers with children between 6-24 months at the national level. METHODS: The sample of 492 mothers with children between 6-24 months, with a confidence level of 95%, the acceptable margin of 5%, the expected prevalence of 50% knowledge and effect of 1.3, were interviewed from all regions, in all Kosovo. Data were analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square with significance level set at 5%. RESULTS: Overall, 88.4% of respondents had good knowledge of complementary feeding, while only 38.4% of mothers had good practices regarding time for starting complementary feeding. We found association between maternal knowledge and level of education for complementary feeding. CONCLUSION: There is a need to further explore the factors responsible to improving practices for complementary feeding.

Correlation between parents and child's version of the child health survey for asthma questionnaire.

Background: The American Academy of Pediatrics Children's Health Survey for Asthma (CHSA) is a widely used instrument to assess various aspects of health and well-being in relation to asthma. There is a parent and a child version of this questionnaire and little is known about the concordance between these versions. Method: In a cross-sectional study conducted in 13 facilities, hospitals and outpatient clinics covering all areas of Kosovo, children with asthma aged 7-16 years were enrolled. Information about asthma diagnosis was obtained from the treating physician. Children and parents answered the CHSA, parent or child version (CHSA-C) as well as a number of questions about environmental conditions, health insurance and socio-demographic characteristics. Results: The survey included 161 Kosovar children with asthma and their caregivers. Although there were significant differences between parents and child versions regarding physical health, child activity and emotional health, with parents rating physical and emotional health higher and child activity lower, there were significant correlations (R > 0.7) for physical and child activity scales but only a low one (R = 0.25) for emotional health. Inspection of concordance for single items revealed very high correlations (>0.9) for all disease events, but a significant underestimation of the number of wheezing episodes by parents. Good agreement was found for statements about disease severity. Conclusions: The high correlation between information about children's health obtained from parents and children underlines the usefulness of parents as source of information on child's asthma. Impact of the disease on emotional health is, however, underestimated by parents.

Evaluation of parents' attitudes and practices related to antibiotic use for their children in Kosovo: a cross-sectional survey.

BACKGROUND: Self-medication and lack of patient adherence contribute to antibiotic misuse. This article describes parents' attitudes and practices regarding use of antibiotics by their children in Kosovo. METHODS: A cross-sectional survey was conducted during data collection. We surveyed a total of 453 parents of children aged 0-15 years, who had experiences with using antibiotics for their children. Correlation tests and regression analysis were used to explore the relationship between variables. RESULTS: Our findings showed that 42.2% of parents strongly agreed or agreed with the use of antibiotics as a means to cure a cold or flu in their child more quickly. In addition, 29.8% were not aware of antibiotic side effects. Non-compliance with antibiotic treatment was 35.8%, and 28.9% of surveyed parents suggested that they had pressured their pediatricians to prescribe antibiotics for their children. A total of 10.15% of parents had no information on antibiotic resistance, and 34.38% of parents responded that they did not believe that self-medication with antibiotics could lead to resistance. Regression analysis results indicated that gender and age group have a significant influence on the parents' decision that an antibiotic should be used in children with high fever (p < 0.001). CONCLUSIONS: Our findings suggest that antibiotic management by parents in Kosovo is not satisfactory, and more attention should be given to their knowledge of the side effects of antibiotics, bacterial resistance and reduction in the self-medication. Health education, adequate measures and interventions are needed to overcome this situation and ensure rational use of antibiotics in Kosovo.

Celiac Disease in Kosovar Albanian Children: Evaluation of Clinical Features and Diagnosis.

BACKGROUND: Celiac disease is an immune-mediated disorder characterized by variable clinical manifestations, specific antibodies, HLA-DQ2/DQ8 haplotypes, and enteropathy. OBJECTIVES: The aim of this study was to present the clinical spectrum and patterns of celiac disease in Kosovar Albanian children. METHODS: A cross-sectional retrospective study was performed with Albanian children aged 0-18 years, treated for celiac disease in the Pediatric Clinic, University Clinical Center of Kosovo from 2005 to 2016. RESULTS: During the study period, 63 children were treated for celiac disease. The mean age at diagnosis was 5.5 years (SD ± 3.31). The mean age at celiac disease onset was 3.3 years (SD ± 2.02), while the mean delay from the first symptoms indicative of celiac disease to diagnosis was 2.2 years (SD ± 2.09). More than 70% of the patients were diagnosed in the first 7 years of life, mainly presented with gastrointestinal symptoms, while primary school children and adolescents mostly showed atypical symptoms (p<0.001). The classical form of celiac disease occurred in 78% of the cases. Sixty (95%) patients carried HLA-DQ2.5, DQ2.2 and/or HLA-DQ8 heterodimers, and only three of them tested negative. CONCLUSION: Kosovo, as the majority of developing countries, is still facing the classical form of celiac disease as the dominant mode of presentation; as a result, most children with other forms of the celiac disease remain undiagnosed. Physicians should be aware of the wide range of clinical presentations and utilize low testing thresholds in order to prevent potential long-term problems associated with untreated celiac disease.

Functional Pattern of Increasing Concentrations of Brain-Derived Neurotrophic Factor in Spiral Ganglion: Implications for Research on Cochlear Implants.

BACKGROUND: As previously various studies have suggested application of brain-derived neurotrophic factor (BDNF) may be considered as a promising future therapy for hearing deficits, in particular for the improvement of cochlear neurone loss during cochlear implantation. AIM: The present study's aim was to establish the upper threshold of the concentration of BDNF in Naval Medical Research Institute (NMRI) mice spiral ganglion outgrowth. METHODS: Spiral ganglion explants were prepared from post-natal day 4 (p4) (NMRI) mice of both sexes under the approval and guidelines of the regional council of Hearing Research Institute Tubingen. RESULTS: Spiral ganglion explants were cultured at postnatal days 4 in the presence of different concentrations of BDNF as described under methods. We chose an age of postnatal day (P4) and concentrations of BDNF 0; 6; 12.5; 25 and 50 ƞg/ml. Averaged neurite outgrowth is measured in 4 different cultures that were treated with different concentrations. Results show that with increasing concentrations of BDNF, the neurite density increases. CONCLUSION: The present finding show evidence that BDNF has a clear incremental effect on the number of neurites of spiral ganglia in the prehearing organ, but less on the neurite length. The upper threshold of exogenous BNDF concentration on spiral ganglion explant is 25 ƞg/ml. This means that concentration beyond this level has no further incremental impact. Therefore our suggestion for hydrogel concentration in NMRA mice in future research should be 25 ƞg/ml.

Influence of Gender and Age on Average Dimensions of Arteries Forming the Circle of Willis Study by Magnetic Resonance Angiography on Kosovo's Population.

BACKGROUND: Circulus arteriosus cerebri is the main source of blood supply to the brain; it connects the left and right hemispheres with anterior and posterior parts. Located at the interpenducular fossa at the base of the brain the circle of Willis is the most important source of collateral circulation in the presence of the disease in the carotid or vertebral artery. AIM: The purpose of the research is to study the diameter and length of arteries and provide an important source of reference on Kosovo's population. METHODS: This is an observative descriptive study performed at the University Clinical Center of Kosovo. A randomised sample of 133 angiographic examinations in adult patients of both sexes who were instructed to exploration is included. RESULTS: The diameters and lengths measured in our study were comparable with other brain-cadaver studies especially those performed by MRA. All dimensions of the arteries are larger in male than female, except the diameter of PCoA that is larger in female (p < 0.05) and length of the ACoA (p < 0.05). Significant differences were found in diameters of arteries between the younger and the older age groups. CONCLUSION: Knowing the dimensions of the arteries of the circle of Willis has a great importance in interventional radiology as well as during anatomy lessons.

Tuberculosis Treatment Adherence of Patients in Kosovo.

SETTING: The poor patient adherence in tuberculosis (TB) treatment is considered to be one of the most serious challenges which reflect the decrease of treatment success and emerging of the Multidrug Resistance-TB (MDR-TB). To our knowledge, the data about patients' adherence to anti-TB treatment in our country are missing. OBJECTIVE: This study was aimed to investigate the anti-TB treatment adherence rate and to identify factors related to eventual nonadherence among Kosovo TB patients. DESIGN: This study was conducted during 12 months, and the survey was a descriptive study using the standardized questionnaires with total 324 patients. RESULTS: The overall nonadherence for TB patient cohort was 14.5%, 95% CI (0.109-0.188). Age and place of residence are shown to have an effect on treatment adherence. Moreover, the knowledge of the treatment prognosis, daily dosage, side effects, and length of treatment also play a role. This was also reflected in knowledge regarding compliance with regular administration of TB drugs, satisfaction with the treatment, interruption of TB therapy, and the professional monitoring in the administration of TB drugs. CONCLUSION: The level of nonadherence TB treatment in Kosovar patients is not satisfying, and more health care worker's commitments need to be addressed for improvement.

Public Health Profile of Road Traffic Accidents in Kosovo 2010-2015.

AIM: To determine the characteristics of the Socio-medical profile of road traffic accidents in Kosovo, between 2010 and 2015 year. STUDY DESIGN: Retrospective study. METHODS: A descriptive method based on the database of road traffic accidents from the National Police of Kosovo. RESULTS: In Kosovo for the period 2010-2015, on average, the yearly number of road traffic accidents is 18437 with mortality rate 7.4 per 100000 and lethality of 1.5%. The highest number of fatal cases are drivers and above 19 years old with more than 80%. Among injured significantly highest percentage is among passengers for all years and above 19 years old. Road traffic accident with a vehicle occurs most frequently, with approximately over 70%, mostly on dry road 72.9% and clear weather 71.1%. The driver is the contributing factors of road traffic accidents on average 99.3% whereas climatic conditions only 0.5%, with over 50% of crashes occurring in urban road 56.2%, mostly during Monday 16.0% and in the afternoon rush hours between 14.00-18.00 with 31.0%. CONCLUSIONS: There is a slight decrease in the mortality rate of 0.1‰ and lethality rate of 0.1% each year, whereas there is an increase of 21.5‰ for traumatism rate for each year.

PATIENTS' SATISFACTION WITH HEALTH SERVICES AT THE NATIONAL INSTITUTE OF PUBLIC HEALTH OF KOSOVA.

AIM: Purpose of the research is to assess patient satisfaction with the quality of health services provided in National Institute of Public Health of Kosova. METHODS: Study was observational and cross-sectional. Interviews were conducted with 625 clients of IPH. Inclusion criteria for enrollment in the study were patients above 18 years old, with verbally informed consent. RESULTS: In our study, access to IPH, efficacy, patient-provider interpersonal communication, and explanations regarding procedures, readiness to answer to patients need and physical settings and appearance are valued satisfactorily whereas cleanliness was rated with minimal grades. Evaluated 12 quality components, were scored with average mark 3.6. CONCLUSIONS: SWOT analysis, and fishbone diagram should be used on regular bases and a new position for a manager for administrative issues, is opened, complaints box and list of rights and responsibilities of patients were dislocated in a more visible place, and internal staff turnover, is introduced.

Tuberculous meningoencephalitis.

Tuberculous meningitis is an infection of the the membranes covering the brain and spinal cord (meninges). Tuberculous meningitis is a major global health problem and is the most severe form of extrapulmonary tuberculosis, with high rate mortality. Last years in Kosovo incidence of TB was decreased in less than 1000 cases per year and 10-20 cases per year of TB meningoencephalitis. Still Kosovo has limited numbers of TB. TBM is diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) studies, and radiological findings. Clinical picture, neurological status, anamnestic data, suspect (but not specific) lab tests, and imaging new methods, together can give very valuable help to clinicians for early adequate and successful treatment.

Suicide prevalence in Kosova for the period 2007-2008.

UNLABELLED: Kosovo as a newer state, characterized with political, economical and cultural transition is touched by suicide phenomenon. Aim of this survey is to analyze prevalence of suicide in Kosova for period 2000-2008 and in particular for 2007-2008. METHODOLOGY: Survey is retrospective one and data were taken from Statistical Office of Kosova and Kosovar Police Service report. Cases are analysed due to demographic characteristics as sex, age group, years, dwelling place, months, week days and methods of suicides. RESULTS: After the war there is an increase of suicides as it is presented with basic index. For year 2000, there is an increase of 122% compared with cases on 1983, then the highest increase is for 2001 with 711.1%. After 2005 there is a slight decrease of suicides with trend of y = 58-8X. Due to sex, suicides are significantly higher at males than females for both years, with 78.9% for 2007 and 74.5% for 2008. The highest number of suicides is found at age groups 21-30 and 31-40 years with 21.1% for 2007 and 21-30 and 41-50 years with 25.5% for 2008. Average age for suicide victims is 42 years for 2007 and 44 years for 2008. Suicides are more frequent at rural places but not significantly. Greatest percentage of suicides was on July with 21.1% for 2007 and June and October with 15.7% for 2008. On 2007 the highest percentage of suicides was on Wednesdays with 21.1% and on 2008 was on Tuesdays with 19.6%. Due to the time of day, the most frequent time for suicides was 16-18.00 for 2007 and for 2008 the greatest percentage of suicide is on unknown time with 27.5%. The most frequent method of suicide was hanging for both years, with 64.9% for 2007, and 52.9% for 2008, fire arm with 14% for 2007 and 21.6% for 2008 and poisoning with 5.3% for 2007 and 11.8% for 2008. Suicides are most frequent at rural places but not significantly. CONCLUSION: Suicides due to sex are significantly higher in males than females in all age groups. Average age of suicide victims is rising from 42 years for 2007 to 44 years for 2008. Suicides are more frequent at rural places and the greatest percentage of suicides due to months was on July for 2007 and June and October for 2008, on Wednesdays for 2007 and Tuesdays for 2008. PROPOSED MEASURES: Suicides are consequence of socioeconomic, psychological and political problems as unemployment and poverty. For challenging suicide phenomenon there is a need for multi-sectoral approach involving health and non health sector as politics, labor, education and media.

Drug abuse in Prishtina region.

Currently the drug abuse has become one of the most serious problems in many countries. The drugs abuse is also widespread in less developed societies. This problem is present in Kosova too with the tendency of rising. The of this research was to show the number of drug abusers in Prishtina region, the type of drugs used, the way of drug administration, then survey of the age, sex, marital status, residence of the drug abusers including their social status (employment, profession and economical status). During the surveyed period the number of hospitalized drug abusers in Neuropsychiatry clinic was 39. 25.5% of them were hospitalized more than ones, with 367 stay days with average treatment period of 7.5 days. Average age of those hospitalized for the first time was 27.9 years of age. 64.1% of them were 25-34 years old. 97.4% of the hospitalized were male. 32 (82.1%) patient were from Prishtina, 5 from Ferizaj and 1 from F. Kosova and Kacanik. During the surveyed period there was no patient hospitalized from other cities of Prishtina Region (Besiana, Drenas, Kastriot, Lipjan, Shtime and Shterpc).

Etiological factors in cerebral palsy in Prishtina region.

OBJECTIVE: To analyze the possible etiological factors, socio-economical characteristics, pregnancy and birth characteristics for Cerebral Palsy in region of Prishtina. DESIGN: Retrospective study. SETTING: National Institute of Public Health in Kosova. METHOD: Study was based in the data collected from two different questioners. Questioner for disabled persons and their families, (81), questioner with 150 women who have children with no disabilities. RESULTS: As possible etiological factors, we can name health problems before pregnancy 7.4%, complications during pregnancy 19.8% and during deliverance 37%. Although none genetically disorder was found to be more frequent in families that had similar disorders. According to the analysis of the socio-economical characteristics, considerable differences were found among mothers with children with cerebral palsy and those with healthy babies. These characteristics can be causing factors of cerebral palsy, especially low level of education of parents, high number of family members and children, bad living conditions and low family living standards. According to analysis of pregnancy and birth characteristics considerable differences were found among mothers of children suffering with cerebral palsy and those with healthy children and these factors can be causing factors, especially pregnancy and birth complications, rare visits to consulting institutions, deliverance without professional help, low weight of the newborn (premature birth and deliverance of older mothers). CONCLUSION: Possible etiological factors are: complicated birth and health related problems during and before the pregnancy. Other possible factors can be: poor education of parents, large number of family members and bad living conditions, low birth weight, birth in late ages, and very rare visits to the counseling services for pregnancy.