Health status in selected post-communist European countries: a comparative study between Poland and Albania.

OBJECTIVES: The aim of this analysis was to compare selected health status indicators of the Albanian and Polish populations, pertinent to two former communist countries in Central and Eastern Europe (CEE). METHODS: This analysis was based on the estimates related to the Global Burden of Disease (GBD) 2019 study, reported by the Institute for Health Metrics and Evaluation (IHME). For Poland, IHME uses data mainly from the Central Statistical Office of Poland, whereas for Albania the information is based on the reports from the National Institute of Statistics. RESULTS: In 2019, life expectancy at birth was slightly higher in Albania compared to Poland (78.5 years vs. 78.1 years, respectively). Mortality rate from noncommunicable diseases was similar in both countries (about 520 deaths per 100,000 population). In 2019, the main risk factor for the overall mortality in both countries was the high systolic blood pressure. In Albania, high systolic blood pressure accounted for almost 32% of deaths from all causes, whereas in Poland it accounted for only 21% of all deaths. The second main risk factor in Albania concerned the dietary factors which were responsible for almost one in four deaths. In Poland, the second main risk factor for all-cause mortality concerned tobacco which was responsible for one in five deaths. The third leading risk factor in Albania was tobacco (responsible for one in five deaths), whereas in Poland it concerned the dietary risks (responsible for about 19% of the all-cause mortality). CONCLUSIONS: This analysis provides useful information about the current health status of two populations pertinent to the former Communist Bloc in CEE. While health indicators can provide important information about the differences in health status between populations, it is important to interpret these indicators in the context of the specific challenges and limitations facing each country.

Inducement of positive nutritional practices through health promotion campaigns among parents/caregivers in Albania.

Opting for homemade meals is the healthiest choice. We assessed the change in nutritional practices among parents/caregivers exposed to health promotion campaigns. Pre- and post-intervention surveys inquiring about nutritional practices were conducted respectively in March and June 2022 in a community-based sample of 583 parents/caregivers in Albania (62% females; age: 39.7 ± 7.1 years; response: 83%). The multi-component intervention consisted of community-based 'onsite' events (awareness raising campaigns) and 'online' interventions (knowledge portal and digital applications). After the intervention, the prevalence of home cooking and/or provision of home-made foods to children for eating at school increased by 11% (both P < 0.01). Engagement in healthy nutritional practices 'only after the intervention' increased especially among Roma/Egyptian parents/caregivers.

May Measurement Month 2019: an analysis of blood pressure screening results from Albania.

This article discusses the results of the May Measurement Month (MMM) 2019 campaign, which contributed to a third round of MMM hypertension screening campaigns carried out in Albania, a transitional country in the Western Balkans. The hypertension screening campaign in Albania was carried out during the period 1-31 May 2019 in 30 sites in many districts of the country. Overall, 19 154 participants aged ≥18 years were included (approximately 68% of these were women), with an overall mean age of 47.0 ± 15.3 years. Blood pressure (BP) was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on treatment for hypertension. Self-reported data consisted of height and weight, pre-existing conditions, including smoking status and alcohol consumption. Overall, the proportion of participants with hypertension was 38.6%. Less than two-thirds (64.7%) of hypertensive individuals were aware of their condition. Also, less than half (48.3%) of participants on antihypertensive medication had controlled BP (<140/90 mmHg). The most sizable correlations of high BP were with known hypertension status, use of antihypertensive medication, and obesity. The MMM campaign contributes to routine hypertension screening in Albania. Hence, health professionals and policymakers in Albania should act on the findings of MMM screening campaigns and continue its support as a valuable tool for early detection of hypertension in the general population.

Correlates of Lifetime Physical Abuse Among Schoolchildren Aged 15 Years in Post-communist Albania.

Aim: Our aim was to assess the prevalence and correlates of lifetime physical abuse among schoolchildren in Albania, a post-communist country in South Eastern Europe which is currently undergoing a rapid socioeconomic transition. Methods: The third wave of Health Behavior in School-Aged Children (HBSC) in Albania was conducted in 2017-18 including a nationwide representative sample of 1,708 schoolchildren aged 15 years (54% girls; response rate: 95%). Children were asked to report on lifetime physical abuse and a wide range of socio-demographic factors, lifestyle factors and health status characteristics. Binary logistic regression was used to assess the independent association of lifetime physical abuse with covariates. Results: Overall, the prevalence of lifetime physical abuse was about 32% (30% in boys vs. 32% in girls). In multivariable-adjusted logistic regression models, independent positive correlates of lifetime physical abuse among Albanian schoolchildren included lifetime smoking (OR = 1.5, 95% CI = 1.1-2.2), lifetime alcohol consumption (OR = 1.6, 95%CI = 1.2-2.1), irritability (OR[dailyvs.rarely/never] = 2.0, 95%CI = 1.3-3.0), and especially lifetime witnessed domestic violence (OR = 4.2, 95%CI = 2.2-7.9). Conversely, a higher score on life satisfaction was inversely related to lifetime physical abuse (P < 0.01). Conclusion: Our study provides novel evidence about the magnitude and selected independent correlates of lifetime physical abuse among schoolchildren in Albania, a country still embedded in an everlasting transition which is associated with tremendous changes in family structure, community links and societal norms and values. Irrespective of a wide range of sociodemographic factors and health characteristics, lifetime smoking, alcohol consumption, irritability, a lower score on life satisfaction and, particularly, witnessed domestic violence were strong and significant correlates of lifetime physical abuse among Albanian schoolchildren aged 15 years.

Extra-esophageal symptoms in individuals with and without erosive esophagitis: a case-control study in Albania.

INTRODUCTION: Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania. METHODS: A case-control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5 ± 16.3 years) and 273 controls (aged 46.4 ± 16.0 years; response rate: 70%) enrolled during the period January 2013-June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms. RESULTS: Patients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR = 3.2, 95% CI = 1.7-5.8), and even more so with laryngeal disorders (OR = 4.4, 95% CI = 2.6-7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR = 4.6, 95% CI = 2.9-7.3). CONCLUSION: Our findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.

Predictors of esophageal varices and first variceal bleeding in liver cirrhosis patients.

AIM: To assess "predictors" of esophageal varices (EV) and variceal bleeding using non-invasive markers in Albanian patients diagnosed with liver cirrhosis. METHODS: One hundred thirty-nine newly diagnosed cirrhotic patients without variceal bleeding were included in this analysis. Model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), platelet count to spleen diameter (PC/SD), fibrosis-4-index (FIB-4), fibrosis index (FI) and King's Score were measured for all participants. All patients underwent endoscopic assessment within two days of hospitalization. The major end point was the first esophageal variceal bleeding (EVB) event. The diagnostic performance of "predictors" for the presence of EV and EVB were assessed by sensitivity and specificity values obtained from the receiver operating characteristics procedure. RESULTS: FIB-4 was the only strong and significant "predictor" of esophageal varices (multivariable-adjusted OR = 1.57 for one unit increment; 95%CI: 1.15-2.14). Furthermore, a cut-off value of 3.23 for FIB-4 was a significant predictor of esophageal varices, with a sensitivity of 72%, a specificity of 58% and a proportion of area under the curve (AUC) of 66% (P = 0.01). During the follow-up (median: 31.5 mo; interquartile range: 11-59 mo), 34 patients (24%) experienced a first EVB. FIB-4 was a poor predictor of EVB (the AUC was only 51%) for a cut-off value of 5.02. Furthermore, the AUC of AST/ALT, APRI, PC/SD, FI, MELD and King's Score ranged from 45% to 55%. None of the non-invasive markers turned out to be a useful predictor of EVB. CONCLUSION: Despite the low diagnostic accuracy, FIB-4 appears the most efficient non-invasive liver fibrosis marker which can be used as an initial screening tool for cirrhotic patients.

Prevalence and correlates of inappropriate use of benzodiazepines in Kosovo.

BACKGROUND: In post-war Kosovo, the magnitude of inappropriate use of benzodiazepines is unknown to date. OBJECTIVE: The aim of this study was to assess the prevalence and correlates of continuation of intake of benzodiazepines beyond prescription (referred to as "inappropriate use") in the adult population of Gjilan region in Kosovo. METHOD: A cross-sectional study was conducted in Gjilan region in 2015 including a representative sample of 780 individuals attending different pharmacies and reporting use of benzodiazepines (385 men and 395 women; age range 18-87 years; response rate: 90%). A structured questionnaire was administered to all participants inquiring about the use of benzodiazepines and socio-demographic characteristics. RESULTS: Overall, the prevalence of inappropriate use of benzodiazepines was 58%. In multivariable-adjusted models, inappropriate use of benzodiazepines was significantly associated with older age (OR 1.7, 95% CI 1.1-2.7), middle education (OR 1.8, 95% CI 1.2-2.7), daily use (OR 1.4, 95% CI 1.1-2.0) and addiction awareness (OR 2.7, 95% CI 2.0-3.8). Furthermore, there was evidence of a borderline relationship with rural residence (OR 1.2, 95% CI 0.9-1.7). CONCLUSION: Our study provides novel evidence about the prevalence and selected correlates of inappropriate use of benzodiazepines in Gjilan region of Kosovo. Health professionals and policymakers in Kosovo should be aware of the magnitude and determinants of drug misuse in this transitional society.

Self-reported Prevalence and Risk Factors of Non-communicable Diseases in the Albanian Adult Population.

AIM: There is growing evidence that non-communicable diseases (NCDs) are a major health problem in developing and transitional countries. The prevalence of NCDs and associated factors are under-researched in Albania. We aimed to assess the prevalence and socio-demographic and lifestyle correlates of NCDs in the Albanian adult population. METHODS: The study was carried out in the framework of Albania Living Standard Measurement Survey (LSMS), a national population-based cross-sectional study conducted in 2012 including 12,554 men and women aged ≥35 years. All participants reported on the presence of at least one chronic condition, which in the analysis was dichotomized into "yes" vs. "no". Information on socio-demographic characteristics (age, gender, education, employment status, residence) and lifestyle factors (smoking and alcohol consumption) was also collected. Logistic regression was used to assess socio-demographic and behavioral correlates of NCDs. RESULTS: Overall, the prevalence of chronic diseases in this population-based sample of Albanian adults was 2864/12554=22.8%. Upon multivariable adjustment for all covariates, positive correlates of chronic conditions were older age (OR=6.0, 95%CI=5.3-6.8), female gender (OR=1.2, 95%CI=1.1-1.4), residence in coastal areas of Albania (OR=2.0, 95%CI=1.7-2.5), unemployment (OR=1.8, 95%CI=1.6-2.0), low education (OR=1.6, OR=1.3-1.9) and current smoking (OR=1.2, 95%CI=1.1-1.5). Conversely, there was an inverse association with poverty (OR=0.8, 95%CI=0.7-1.0). CONCLUSIONS: This study provides evidence on self-reported NCDs and its determinants in transitional Albania. These baseline data may be useful for assessment of future NCD trends in Albania and cross-comparisons with the neighboring countries.

Breakfast Skipping Is an Independent Predictor of Obesity but not Overweight Among Children in a Southeastern European Population.

AIM: To assess the association of breakfast skipping with overweight and obesity among children in Albania, a post-communist country in the Western Balkans, which is undergoing a long and difficult political and socioeconomic transition towards a market-oriented economy. METHODS: A nationwide cross-sectional study was carried out in Albania in 2013 including a representative sample of 5810 children aged 7.0 - 9.9 years (49.5% girls aged 8.4 ± 0.6 years and 51.5% boys aged 8.5 ± 0.6 years; overall response rate: 97%). Children were measured for height and weight, and body mass index (BMI) calculated. Cut-off BMI values of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to define overweight and obesity in children. Demographic data were also collected. RESULTS: Upon adjustment for age, sex, and place of residence, breakfast skipping was positively related to obesity (WHO criteria: OR = 1.5, 95% CI = 1.3-1.9; IOTF criteria: OR = 1.9, 95% CI = 1.4-2.5), but not overweight (OR = 1.1, 95% CI = 0.9-1.3 and OR = 1.1, 95% CI = 0.9-1.4, respectively). Furthermore, breakfast skipping was associated with a higher BMI (multivariable-adjusted OR = 1.05, 95% CI = 1.02-1.07). CONCLUSIONS: Our findings point to a strong and consistent positive relationship between breakfast skipping and obesity, but not overweight, among children in this transitional southeastern European population. Future studies in Albania and other transitional settings should prospectively examine the causal role of breakfast skipping in the development of overweight and obesity.

Prevalence and demographic correlates of overweight and obesity among children in a transitional southeastern European population.

Our aim was to assess the prevalence and demographic correlates of overweight and obesity among children in Albania, a transitional country in Southeastern Europe. A nationwide survey was conducted in Albania in 2013 including a representative sample of 5,810 schoolchildren aged 7.0-9.9 years (51.5 % boys aged 8.5 ± 0.6 years and 49.5 % girls aged 8.4 ± 0.6 years; overall response: 97 %). All children were measured height and weight, based on which the body mass index (BMI) was calculated. The criteria of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to describe the distribution of BMI among children. Overall, mean value of BMI was 16.4 ± 2.4 (16.7 ± 2.5 in boys vs. 16.2 ± 2.4 in girls, P < 0.001). As per WHO criteria, 9.8 % of the boys were obese versus 5.5 % of the girls (P < 0.001). The prevalence of both overweight and obesity were remarkably higher among urban children compared with their rural counterparts (17.9 vs. 10.5 and 11.9 vs. 4.0 %, respectively, P < 0.001). As per IOTF criteria, 3.8 % of the boys were obese compared with 2.8 % of the girls (P < 0.001). The prevalence of overweight and obesity were similarly higher among urban children than in rural children (15.6 vs. 7.3 and 5.5 vs. 1.4 %, respectively, P < 0.001). Our findings indicate that Albania is in the middle of nutritional transition with a high prevalence of overweight and obesity among children aged 7.0-9.9 years. This is particularly evident in urban areas of the country. Conversely, our data do not indicate a double burden of malnutrition among children in Albania.

Serum procalcitonine levels as an early diagnostic indicator of sepsis.

INTRODUCTION: Prompt and accurate diagnosis of sepsis is of high importance for clinicians. Procalcitonine (PCT) and C-reactive protein (CRP) have been proposed as markers for this purpose. Our aim was to evaluate the levels of PCT and CRP in early sepsis and its correlation with severity of sepsis. METHODS: Levels of PCT and CRP were taken from 60 patients with sepsis criteria and 39 patients with SIRS symptoms from the University Hospital Center "Mother Teresa" in Tirana, Albania during 2010-2012. Sensitivity, specificity and predictive values for PCT and CRP were calculated. RESULTS: PCT and CRP levels increased in parallel with the severity of the clinical conditions of the patients. The mean PCT level in patients with sepsis was 11.28 ng/ml versus 0.272 ng/ml in patients with SIRS symptoms, with a sensitivity of 97.4% and a specificity of 96.6% for PCT >0.5ng/ml. The mean CRP level in septic patients was 146.58 mg/l vs. 34.4 mg/l in patients with SIRS, with a sensitivity of 98.6% for sepsis and a specificity of 75 % for CRP >11mg/l. CONCLUSION: PCT and CRP values are useful markers to determine early diagnosis and severity of an infection. In the present study, PCT was found to be a more accurate diagnostic parameter for differentiating SIRS from sepsis and may be helpful in the follow-up of critically ill patients.

Breast cancer screening in Albania during 2007-2008.

AIM: Our aim was to assess the prevalence of breast cancer among women who showed up and participated in the breast cancer screening program during October 2007-October 2008 in Tirana, the Albanian capital city. METHODS: A breast cancer prevention and treatment campaign was undertaken in Tirana, Albania, in 2007 which included also mammography examination for the early detection of breast cancer. All women residing in Tirana municipality were invited to undergo a mammography examination free of charge. RESULTS: A total number of 5224 women underwent mammography examination during October 2007 - October 2008 time period in Tirana. The highest number of mammography tests were performed in October 2008 (1284 tests), followed by June 2008 with 746 mammography examinations realized. In general, the prevalence of breast cancer positive mammography readings where higher among women older than 60 years, followed by the 51-60 and 41-50 years age-groups. CONCLUSION: Our findings indicate that, among 5224 examined women during a one-year period, 1.9% had a positive reading in mammography. This is one of the few reports large-scale breast cancer screening in Albania. The increasing of breast cancer rates necessitates implementation of multi-directional programs to prevent, early diagnose and control this condition in Albanian women.

Predictive Value of the Model of End-Stage Liver Disease in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis.

Objective. We aimed to assess the predictive value of the model of end-stage liver disease (MELD) in hospitalized cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and fatal outcome. Methods. A cross-sectional study included 256 consecutive patients (199 men and 57 women) diagnosed with cirrhosis and ascites who were hospitalized at the University Hospital Center in Tirana from January 2008 to December 2009. SBP was defined as a neutrophil count of ≥250 cells/mm(3) in ascitic fluid. MELD score was based on laboratory parameters determined by UNOS Internet site MELD calculator. Results. In multivariable-adjusted logistic regression models controlling for age, sex, diabetes, and etiology, there was evidence of a positive association of SBP with MELD score: the odds ratio (OR) for SBP for one unit increment of MELD score was 1.06 (95% Cl = 1.02-1.09). MELD score was significantly higher in fatal cases than nonfatal patients (mean age-adjusted score was 32.7 versus 18.4 overall; 34.8 versus 18.0 in SBP patients, and 32.0 versus 18.5 in non-SBP patients; all P < 0.001). Conclusions. In this Albanian sample of hospitalized cirrhotic patients, MELD score was confirmed as a significant predictor of both SBP and fatal outcome.

Total fats, saturated Fatty acids, processed foods and acute coronary syndrome in transitional Albania.

BACKGROUND: We aimed was to assess the association of acute coronary syndrome (ACS) with selected food groups pertinent to non-Mediterranean prototype in Albania, a transitional post-communist country in Southeast Europe. METHODS: We conducted a case-control study in Tirana in 2003-2006 including 467 non-fatal consecutive ACS patients (370 men aged 59.1±8.7 years, 97 women aged 63.3±7.1 years; 88% response) and a population-based control group (469 men aged 53.1±10.4 years, 268 women aged 54.0±10.9 years; 69% response). A semi-quantitative food frequency questionnaire including 105 food items was administered to all participants based on which the daily calorie intake for selected food groups (meat products, overall oils and fats, sweets, and junk food) was calculated. General linear model was used to assess the association of food groups with ACS. RESULTS: Mean age-adjusted values of meat products, overall oils and fats, sweets and junk food were all considerably higher in cases than controls in both sexes. Cases had significantly higher mean "non-Mediterranean" diet scores (consisting of junk food, sweets, oils and fats except olive oil) than controls (10.3% vs. 5.9% in men and 15.2% vs. 8.3% in women, P<0.01 for both). CONCLUSIONS: In this Albanian population, intake of total fats, in particular saturated fatty acids was associated with a higher risk of ACS in both sexes. Furthermore, the consumption of processed foods was associated with considerable excess coronary risk which points to serious health implications for the Albanian adult population.

Role of intravenous omeprazole on non-variceal upper gastrointestinal bleeding after endoscopic treatment: a comparative study.

AIM: To evaluate and compare the clinical efficacy of intravenous omeprazole versus intravenous ranitidine therapy for the treatment of non-variceal upper gastrointestinal (UGI) bleeding after endoscopic therapy. METHODS: 108 patients (72 males and 36 females) admitted with non-variceal UGI bleeding in the Intensive Care Unit of the University Hospital of Durres, Albania, from 2004 to 2008, were included in the study. Patients with gastro-duodenal malignancy and those who were previously receiving anti-secretory drugs were excluded. All patients were treated endoscopically by injecting epinephrine (diluted 1:10.000) followed by ethanol and subsequently were randomized to receive either intravenous omeprazole (with an initial dose of 80 mg, followed by 8 mg/h infusion [n = 54]), or intravenous ranitidine (100 mg bolus, followed by 100 mg boluses every 6 hours for the next 72 hours [n = 54]). RESULTS: There-bleeding rate 72 hours after endoscopic treatment was lower in the omeprazole group than in the ranitidine group (6 vs. 14 patients, respectively; OR = 3.4; 95% CI = 1.1 -7.2; P < 0.01). Less volume of blood transfusion was needed for the omeprazole group than for the ranitidine one (1.1 +/- 1.8 units vs. 2.3 +/- 2.9 units, P = 0.03). The hospitalization period was shorter among patients treated with omeprazole than among those treated with ranitidine (5.4 +/- 2.6 days vs. 6.8 +/- 3.3 days, respectively; P = 0.04). The need for surgery and the mortality rate were not statistically different between the two groups. CONCLUSION: After endoscopic treatment of non-variceal UGI bleeding, intravenous omeprazole reduced the risk of recurrent bleeding, decreased the need for blood transfusion and shortened the period of hospitalization. Intravenous omeprazole should be used in patients with non-variceal UGI bleeding after effective endoscopic treatment.