HLA-A, -C, -B, -DRB1, -DQA1, and -DQB1 Allele and Haplotype Repertoires in the Albanian Population from Kosovo.

To give new insight into the huge polymorphism of HLA system and supplement the existing data, an analysis of HLA alleles and HLA-A~C~B~DRB1~DQA1~DQB1 haplotype distribution in 124 Albanian individuals from Kosovo was performed. All samples were HLA-typed applying the polymerase chain reaction-sequence specific oligonucleotide probing (PCR-SSOP) method and all ambiguous HLA typing results were additionally confirmed by the standard PCR-Sequence Specific Primers (PCR-SSP) high-resolution protocol. Twenty-two HLA-A, 21 HLA-C, 37 HLA-B, 27 HLA-DRB1, 11 HLA-DQA1 and 14 HLA-DQB1 allele groups were detected. Sixteen out of 172 different six-locus estimated haplotypes were found at a frequency higher than 1.00% with a cumulative frequency of 28.82%. The most prevalent haplotype was found to be HLA-A*02:01~C*07:01~B*18:01~DRB1*11:04~DQA1*05:05~DQB1*03:0(5.2%).A total of 13 haplotypes were observed with higher frequency than in populations reported in HaploStats and The Allele Frequency Net Database. The proposed origin of the most frequent haplotypes reflects a basic Euro-Mediterranean background of Albanians in Kosovo. This is the first report of high-resolution HLA-A~C~B~DRB1~DQA1~DQB1 haplotype distribution among the Albanian population from Kosovo, which provides valuable anthropological data and confirms population-specific characteristics.

Can 'we' share the contested territory with 'them'? Shared territorial ownership perceptions and reconciliation intentions in Kosovo.

Territorial ownership claims are central to many interethnic conflicts and can constitute an obstacle to conflict resolution and reconciliation. However, people in conflict areas might also have a perception that the territory simultaneously belongs to one's ingroup and the rival outgroup. We expected such perceptions of shared ownership to be related to higher reconciliation intentions. We examined this expectation in relation to the territory of Kosovo among random national samples of Albanians and Serbs from Kosovo, and Serbs from Serbia (Study 1, total N = 995). In general, participants perceived low levels of shared ownership, however, shared ownership perceptions were positively related to reconciliation intentions in Kosovo. In Study 2 (total N = 375), we experimentally manipulated shared ownership (vs. ingroup ownership) and found that shared ownership elicited stronger reconciliation intentions. It is concluded that fostering a sense of shared ownership can be important for improving intergroup relations in post-conflict settings.

Persistent dermal lesions in a patient with previous history of visceral leishmaniasis.

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) that most frequently occurs after an episode of VL caused by Leishmania donovani. In this case report, we present a 21-year-old male patient with persistent skin lesions and recurrent visceral leishmaniasis (VL) due to Leishmania infantum. The patient did not respond to multiple lines of anti-leishmanial treatment (including Liposomal amphotericin B and miltefosine) and later died from cerebral lesions presumed to be secondary to persistent VL.

On Living And Moving With Zor: Exploring Racism, Embodiment, And Health In Albania.

Drawing on ethnographic research from Albania, I examine Romani and Balkan Egyptian women's health inequities. While it has been well documented that Romani people, who constitute Europe's largest socioracial minority group, experience racism and marginalization, how these forms of social exclusion shape health outcomes in the Balkans remains limited. I argue that racism is a root cause of social and health inequities, and that Romani and Egyptian women experience unique bodily fatigue marked by extreme zor ("difficulty," "constraint"). An examination of zor can potentially provide an understanding of how racism and marginalization are embodied over time.

Effect of Covid-19 pandemic on mental health among Albanian people residing in the country and abroad - Implications for mental care.

BACKGROUND: Coronavirus disease caused by the novel coronavirus Covid-19 is a current worldwide outbreak. The use of quarantine and isolation proved effective in containing the spread of infection. OBJECTIVES: The purpose of this cross-sectional study was to assess the mental health of Albanian people residing in the country and abroad during the quarantine period for the Covid-19 pandemic. DESIGN: This study was carried out from 25th March - 20th April 2020 through a web survey shared on social networks. The goal was to reach at least the minimum sample size for cross-sectional studies. The Patient Health Questionnaire (PHQ-9) was used to assess mental health. Chi-square (χ2) and Fisher -Exact test were used to assess the statistical significance among variables. P values ≤0.05 were considered statistically significant. RESULTS: 715 participants were included in the final analyses (78.41% females and 21.53% males). Most were residents in Albania (80.41%) and the others resided mainly in Italy (6.89%), Greece (3.51%), Germany (2.43%), Kosovo (1.62%) and the UK (1.69%). Statistical association was found between gender, country of residency and measures taken. Summary score of PHQ-9 items was 6.4662. The total score of depression classification shows that 31.82% and 12.90% of participants have respectively mild and moderate depression. Female participants showed the highest score for some items of PHQ-9, p≤0.05. CONCLUSIONS: Findings suggest that health care professionals should recognize and address mental health problems associated with Covid-19 especially in vulnerable groups. Acting in a timely and proper manner is essential in preventing these problems from becoming chronic.

COVID-19 mortality among migrants living in Italy.

We aimed to compare COVID-19-specific and all-cause mortality rates among natives and migrants in Italy and to investigate the clinical characteristics of individuals dying with COVID-19 by native/migrant status. The mortality rates and detailed clinical characteristics of natives and migrants dying with COVID-19 were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2,687) between February 21st and April 29th, 2020. The migrant or native status was assigned based on the individual's country of birth. The expected all-cause mortality among natives and migrants living in Italy was derived by the last available (2018) dataset provided by the Italian National Institute of Statistics. Overall, 68 individuals with a migration background were identified. The proportions of natives and migrants among the COVID-19-related deaths (97.5% and 2.5%, respectively) were similar to the relative all-cause mortality rates estimated in Italy in 2018 (97.4% and 2.6%, respectively). The clinical phenotype of migrants dying with COVID-19 was similar to that of natives except for the younger age at death. International migrants living in Italy do not have a mortality advantage for COVID-19 and are exposed to the risk of poor outcomes as their native counterparts.

Healthcare Access, Quality, and Satisfaction Among Albanian Immigrants Using the Emergency Department in Northern Greece.

BACKGROUND: Greece constitutes a main point of entry for the EU but also a final destination for a large number of immigrants. The present research aims to illuminate the relationship of Albanian immigrants with the public health system in Greece. Cross sectional study of 167 Albanian immigrants who referred to the emergency department (ED) of a tertiary general hospital. The average age of the study population was 38.96 years (SD: ± 12.53), with 62.1% being familiar with health services. 54.9% referred to the ED for chronic problems. 41.9% were dissatisfied regarding the level of care provided; Albanian citizenship was thought to be the main reason (40%). Despite the majority of Albanian immigrants being familiar with health services in Northern Greece, there seems to be a misuse of the emergency department for chronic problems. A good proportion of immigrants believe their foreign citizenship prevents them from better healthcare.

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.

A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland.

Cultural variability regarding concepts of distress for common mental disorders (CMD) has been reported extensively in cultural clinical psychology across the globe. However, little is known about illness narratives in social communities from Southeast Europe. The purpose of this paper is to identify cultural concepts of distress (CCDs) among Albanian-speaking immigrants in Switzerland and to integrate the findings into literature from other parts of the world. Twenty semi-structured qualitative interviews were conducted using the Barts Explanatory Model Inventory (BEMI). A set of concepts was described through content analysis and semantic network analysis. The results show complex expressions of distress, which are mainly associated with post-migration living difficulties. Social problems and life-changing events mark the onset of the most common symptoms. Self-management and social support were described as the most important coping behaviors. Participants expressed trust in physical health care but little belief in psychotherapy. There is indication that mental illnesses are stigmatized in this population. It is therefore important to use non-stigmatizing terms in health communication. Moreover, individuals from this community consider suffering to be part of life, and they assume that this suffering must be endured with patience. It is vital to address these beliefs in psychological interventions.

Ethnic differences in body composition, sociodemographic characteristics and lifestyle in people with type 2 diabetes mellitus living in Italy.

This study aimed to compare immigrants and Italian natives with type 2 diabetes mellitus (DM2) in terms of anthropometric parameters and lifestyle-related characteristics and to investigate the relationship between ethnicity and glycemic control in men and women with DM2 living in Italy. The sample included 100 immigrants (55 Albanians and 45 Africans) and 100 Italians, followed by the Public Health Clinics of Rimini. The association of ethnicity with sex, socioeconomic status, anthropometric and hematological characteristics, and lifestyle were examined. In addition, differences among groups in glycemic control were evaluated. Among males, African participants presented significantly lower values than other groups in adiposity parameters and triglycerides. The highest percentage of obesity and of normal weight was found in Italians and in Africans, respectively. Among females, there were scanty differences, but Italians presented higher WHR values than the other groups. No statistical differences appeared in hematological parameters among groups. There were no significant differences in glycemic control among groups and sexes. Also considering the differences between subjects with optimal (L) or nonoptimal (H) glycemic control, the differences in lifestyle, anthropometric, and hematological variables remained scarce. Among all groups, significantly higher values of glucose were detected in H than in L. A similar condition appeared for triglycerides in males. Immigrant and native Italian diabetics did not present any difference in their clinical characteristics, but Italians generally presented worst lifestyle habits. The percentage of subjects with poor metabolic control of diabetes was not low, but similar in immigrants and natives.

HLA profile of the Macedonian, Albanian and Macedonian Muslim donors in the Macedonian Bone Marrow Donor Registry.

The aim of this study was to determine the HLA allele and haplotype frequencies of the volunteer donors from the Macedonian Bone Marrow Donor Registry (MBMDR). We analyzed 1541 donors, from different nationalities and presented the HLA allele and haplotype frequencies for Macedonian, Albanian and Macedonian Muslims, most numerous nationalities in MBMDR. Difference between the three groups was observed for allele frequencies in HLA-C and HLA-DRB1 loci. The most common haplotype in Macedonian was HLA-A*01-B*08-C*07-DRB1*03, while in Albanian and Macedonian Muslims HLA-A*02-B*18-C*07-DRB1*11. This study confirmed the close relationship between the populations that live in the Balkan Peninsula.

Y-chromosome haplogroup architecture confers susceptibility to azoospermia factor c microrearrangements: a retrospective study.

AIM: To assess the association between azoospermia factor c microrearrangements and semen quality, and between Y-chromosome background with distinct azoospermia factor c microrearrangements and semen quality impairment. METHODS: This retrospective study, carried out in the Research Center for Genetic Engineering and Biotechnology "Georgi D. Efremov," involved 486 men from different ethnic backgrounds referred for couple infertility from 2002-2017: 338 were azoospermic/oligozoospermic and 148 were normozoospermic. The azoospermia factor c microrearrangements were analyzed with sequence tagged site and sequence family variant markers, quantitative fluorescent polymerase chain reaction, and multiplex ligation probe amplification analysis. The Y-haplogroups of all participants were determined with direct single nucleotide polymorphism typing and indirect prediction with short tandem repeat markers. RESULTS: Our participants had two types of microdeletions: gr/gr and b2/b3; three microduplications: b2/b4, gr/gr, and b2/b3; and one complex rearrangement gr/gr deletion + b2/b4 duplication. Impaired semen quality was not associated with microrearrangements, but b2/b4 and gr/gr duplications were significantly associated with haplogroup R1a (P<0.001 and P=0.003, respectively) and b2/b3 deletions with haplogroup E (P=0.005). There were significantly more b2/b4 duplication carriers in Albanians than in Macedonians with haplogroup R1a (P=0.031). CONCLUSION: Even though azoospermia factor c partial deletions/duplications and Y-haplogroups were not associated with impaired semen quality, specific deletions/duplications were significantly associated with distinct haplogroups, implying that the Y chromosome background may confer susceptibility to azoospermia factor c microrearrangements.

The Relationship Between Quality of Life, Psychological Wellbeing, Satisfaction with Life and Acculturation of Immigrants in Greece.

Few studies have examined the quality of life of immigrants in Greece and its relations to acculturation. This study explored the quality of life, psychological wellbeing and satisfaction with life among Albanian immigrants, Pontic Greeks in comparison to native Greeks. Furthermore, the relationship between quality of life, psychological wellbeing, satisfaction with life and acculturation of Albanian immigrants and Pontic Greeks was investigated. The study was based on 520 participants from broader area of Athens, 58.3% (303 people: 150 men and 153 women) native Greeks, 21.9% (114 people: 57 men and 57 women) Albanian immigrants and 19.8% (103 people: 50 men and 53 women) Pontic Greeks. Quality of life was measured by WHOQOL BREF-while wellbeing was measured with Satisfaction With Life Scale and The Affect Balance Scale. An adapted a version of Vancouver Index of Acculturation was used to assess acculturation of immigrants. The findings indicated three important factors contributed to quality of life and wellbeing of immigrants: ethnicity, heritage dimension of acculturation and gender. Albanian immigrants and Pontic Greeks scored lower on quality of life and satisfaction with life than native Greek.

Ethnic differences in body image perception in patients with type 2 diabetes.

BACKGROUND: The present study compared the prevalence of obesity, fat distribution, body image perception and lifestyle among diabetic African and Albanian immigrants living in Italy, as well as diabetic Italians, aiming to identify health risks and their possible causes. METHODS: The study sample consisted of 200 diabetic subjects living in Italy. A questionnaire regarding socio-demographic and lifestyle information was administered to participants, and anthropometric measurements and body image perception were assessed. Proper perception of weight status and the degree of dissatisfaction in body image perception were valued. RESULTS: Italians showed a higher health risk, both with regard to anthropometric characteristics and lifestyle, whereas African immigrants showed a lower one. All of the male groups underestimated their weight and Albanians were the most dissatisfied. Women perceived their current body image as heavier than their desired body image, showing a dissatisfaction toward their weight. Subjects of both sexes belonging to the overweight and obese categories generally underestimated themselves; this was particularly true in obese Africans. People with a higher body mass index were more likely to be dissatisfied than those with a lower one. Body image dissatisfaction increased when people estimated themselves as being overweight. Among lifestyle habits, being an ex-smoker increased body image dissatisfaction. CONCLUSIONS: The underestimation of weight detected in the present study requires attention. Nevertheless, the high percentage of overweight/obese people, coupled with the higher frequency of people dissatisfied with their high weight, suggests an awareness of the problem that could be more effective for weight loss.

Health inequalities and health equity challenges for victims of modern slavery.

BACKGROUND: Modern slavery is a serious organized crime, with severe consequences for the physical and mental health of victims, and so has public health implications. Anecdotally many victims of sex slavery experience difficulties accessing healthcare. Public Health England recently articulated the importance of health engagement to address modern slavery but little is known about the experiences of the survivors. METHODS: We conducted in depth interviews with Albanian female survivors of sex slavery who all displayed significant and complex health needs. Interviews were conducted between July 2017 and January 2018. Thematic analysis identified four primary themes: (i) barriers to access, (ii) negotiating access, (iii) health needs and care received and (iv) overall experience of primary care. RESULTS: Survivors experienced repeated challenges accessing healthcare, for themselves and their children, and initially could not access GP services. When accompanied by an advocate they reported qualitatively and quantitatively improved experiences resulting in improved permeability. Confusion surrounding eligibility criteria and a lack of understanding of modern slavery emerged as the primary barriers, fueling biased adjudications. CONCLUSIONS: The importance of advocates, enabling rights-based approaches, improving understanding about access to health services for vulnerable groups, and a need for education across health service settings are discussed.

Oral Health Practices, Beliefs and Dental Service Utilization of Albanian Immigrants in Milwaukee, Wisconsin: A Pilot Study.

There is limited information on the oral health of Albanian immigrant population residing in the U.S. This creates a hinderance to developing and implementing appropriate dental care programs for the population. This study investigated oral health practices, beliefs, dental visits and associated factors of Albanian adults living in Milwaukee, Wisconsin. Purposive and snowball sampling methods were employed. Self-administered questionnaires were used to collect data on oral health practices, beliefs, dental visits and socio-demographic information. Descriptive and multivariable logistics regression were conducted. Overall, 266 adults were recruited, 54% male, 56% have lived 10 or more years in the U.S., 95% rated their oral health as excellent/good and 87% reported having a dental visit in the last year. Age, ability to speak English, having a usual source of dental care, and reporting excellent/good oral health were associated with having a dental visit in the last year. A substantial number of Albanians adult reported a dental visit in the last year and those that did not write or read in English had lower odds of reporting a dental visit.

Their view: difficulties and challenges of patients and physicians in cross-cultural encounters and a medical ethics perspective.

BACKGROUND: In todays' super-diverse societies, communication and interaction in clinical encounters are increasingly shaped by linguistic, cultural, social and ethnic complexities. It is crucial to better understand the difficulties patients with migration background and healthcare professionals experience in their shared clinical encounters and to explore ethical aspects involved. METHODS: We accompanied 32 migrant patients (16 of Albanian and Turkish origin each) during their medical encounters at two outpatient clinics using an ethnographic approach (participant observation and semi-structured interviews with patients and healthcare professionals). Overall, data of 34 interviews with patients and physicians on how they perceived their encounter and which difficulties they experienced are presented. We contrasted the perspectives on the difficult aspects and explore ethical questions surrounding the involved issues. RESULTS: Patients and physicians describe similar problem areas, but they have diverging perspectives on them. Two main themes were identified by both patients and physicians: >patients' behaviour in relation to doctors' advice< and > relationship issues<. CONCLUSIONS: A deeper understanding of the difficulties and challenges that can arise in cross-cultural settings could be provided by bringing together healthcare professionals' and patients' perspectives on how a cross- cultural clinical encounter is perceived. Ethical aspects surrounding some of the difficulties could be highlighted and should get more attention in clinical practice and research.

Unilateral pulmonary hypoplasia in an adult patient.

Pulmonary hypoplasia (PH) is a developmental anomaly of the lung parenchyma, characterized by a decrease in the number and size of airways, alveoli and vessels. We present a case of a 31-year-old patient with a history of chronic productive cough and frequent respiratory infections, who was referred for investigation of abnormal chest x-ray. The combination of chest computed tomography (CT) and bronchoscopy set the diagnosis of left pulmonary hypoplasia and the patient was treated surgically with a left pneumonectomy. PH is usually diagnosed immediately after birth, causing severe respiratory failure with high mortality. The less severe, unilateral forms can possibly survive by causing compensatory hyperinflation of the other lung and remain undiagnosed until adulthood, presenting either asymptomatic or with symptoms of chronic bronchitis and recurrent respiratory infections. Chest CT is considered the imaging technique of choice for the diagnosis and for the differential diagnosis from other congenital or acquired conditions. The treatment is usually conservative, although surgical resection is indicated in cases of severe cystic changes and intense symptomatology.

Oral Health Beliefs, Attitudes, and Practices of Albanian Immigrants in the United States.

Research indicates a high prevalence of oral disease among Albanians. There is a lack of evidence regarding oral health beliefs and practices among Albanian immigrants in the United States and abroad. This research seeks to better understand the oral health beliefs, attitudes, and practices among Albanian immigrants living in the United States. A descriptive study was employed with a purposive sample (n = 211) of Albanian adult immigrants. A cross-sectional validated questionnaire was provided in both English and Albanian, with a response rate of 66 %. Results revealed a high use of dental services among respondents, with 68 % reported as having a dental visit and cleaning within the past year. Although 25 % of participants stated their parents and grandparents have used folk remedies, 88 % of them stated that use of folk remedies did not influence their decision to seek professional dental care. Increasing age was inversely associated with the belief in the importance of retaining natural teeth, as older respondents were less likely to agree with the prior statement; older respondents were more likely to agree with the statement "bleeding gums are normal." Low oral health care access and utilization was not a factor among the majority of the Albanian immigrants studied. Focusing on providing age appropriate oral health education and behavioral strategies could increase oral health knowledge and potentially improve poor oral health status among this population.