Health literacy and body mass index: a population-based study in a South-Eastern European country.

BACKGROUND: The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date. OBJECTIVE: To assess the association between body mass index (BMI) and HL among Albanian adults. METHODS: A cross-sectional study was conducted in Tirana, Albania, in 2012-2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors. RESULTS: One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3-3.1) among inadequate HL individuals compared with excellent HL participants. CONCLUSION: Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics.

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.

May Measurement Month 2018: an analysis of blood pressure screening results from Albania.

This article reports on May Measurement Month (MMM) 2018, which consisted of the 2nd round of the hypertension screening campaign conducted in Albania, a former communist country in South Eastern Europe. The hypertension screening campaign in Albania was conducted during the period 13-31 May 2018. Overall, there were eight sites from seven districts of the country involving 7046 participants aged ≥18 years (61% women and 39% men; overall mean age 46.8 ± 15.7 years). Blood pressure was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg, or on treatment for hypertension. Self-reported information included height and weight, diabetes, smoking status, and alcohol intake. The proportion of participants with hypertension was 37.2% of whom only 52.1% exhibited awareness. Furthermore, only a quarter of hypertensive individuals were properly treated and controlled. Significant predictors of high SBP and/or high DBP included a previous diagnosis of hypertension, being on antihypertensive medication, frequent alcohol intake, and being overweight and obese. The MMM 2018 campaign in Albania had a unique value for early detection of hypertension, particularly among younger adults. Policymakers and decision-makers in Albania and elsewhere should also rely on the MMM screening campaigns which have a great potential for prevention and control of hypertension in the general population.

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.

Insulin resistance in early vs late nutrition and complications of sirs in neurosurgical intensive care unit (ICU).

BACKGROUND: Systemic Inflammatory Response Syndrome (SIRS) is a common complication in neurosurgical diseases in Intensive Care Unit (ICU). Because of associated insulin resistance (IR) the ICU is in dilemma in which stage to start the nutrition to patients and what is the amount of Insulin Unit to control the hyperglycemia. AIM: to define the IR and to compare IR and amount of insulin among ICU patients in "Mother Theresa" University Hospital Center (MTUHC) in Tirana Albania. METHODS: 154 patients with neurosurgical disease and SIRS complications were randomized in two groups: early nutrition 73 patients (47%) and late nutrition 81 (53%) and compared for a number of variables. RESULTS: There was no statistical age and gender difference between the two groups (P>0.05). The amount of insulin units to control the level of glycemia (80-110 mg/dc) was 12.8±7 unit per day in early nutrition and 23.8 ±12.9 units in late nutrition group (p<0.01). No patient in early nutrition group but six (7.4%) patients in late nutrition group developed insulin resistance (p=0.03). CONCLUSIONS: the IR due to the infection complications is higher among late than early nutrition group. Therefore, we suggest that in neurosurgical ICU it would be better to start the nutrition within 72 hours.

Distribution of Risk Factors in Male and Female Primary Health Care Patients with Osteoarthritis in Albania.

AIM: We aimed to describe the distribution of the main risk factors among primary health care users diagnosed with osteoarthritis in Albania, a post-communist country in South Eastern Europe. METHODS: Our study involved all individuals who were diagnosed with osteoarthritis over a two-year period (January 2013 - December 2014) in several primary health care centers in Tirana, the Albanian capital. On the whole, during this two-year period, 1179 adult individuals were diagnosed with osteoarthritis (521 men aged 60.1±10.6 years and 658 women aged 58.1±9.6 years). According to the criteria of the American College of Rheumatology, the diagnosis of osteoarthritis was based on the history of the disease, physical examination, laboratory findings and radiological findings. Binary logistic regression was used to assess the sex-differences regarding the major risk factors among individuals diagnosed with osteoarthritis. RESULTS: In multivariable-adjusted logistic regression models, female gender was inversely associated with smoking (OR=0.39, 95%CI=0.27-0.56), alcohol intake (OR=0.08, 95%CI=0.06-0.10), overweight but not obesity (OR=0.65, 95%CI=0.46-0.91 and OR=0.74, 95%CI=0.46-1.18, respectively), weight lifting (OR=0.38, 95%CI=0.22-0.66) and heavy physical exercise (OR=0.69, 95%CI=0.46-1.03). Conversely, female gender was positively related to genetic factors (OR=2.17, 95%CI=1.55-3.04) and preexisting inflammatory diseases (OR=1.53, 95%CI=0.93-2.53). CONCLUSION: This study offers useful evidence about the distribution of the main risk factors for osteoarthritis in adult individuals diagnosed with osteoarthritis in Albania. This information may support health professionals and decision-makers in Albania for evidence-based health planning and policy formulation in order to control the toll of osteoarthritis in this transitional society.

Prison health in transitional Albania.

AIM: The information about prisoners' health in transitional countries including Albania is limited. The aim of our study was to assess the health status and its correlates among adult prisoners in Albania, a post-communist country in Southeast Europe. METHODS: This was a cross-sectional study conducted in 2013 including 401 prisoners in Albania [290 (72%) males and 111 (28%) females]. All participants were administered an anonymous and structured questionnaire including information 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 covariates. RESULTS: Overall, 173 (43.1%) of prisoners included in this study reported a poor health status, with a clear predominance of the female gender (P<0.01). Overall, 28.1% of prisoners reported the presence of at least one disease. The overall prevalence of smoking, excessive alcohol consumption and drug use were 59.1%, 34.9% and 10.2%, respectively. Upon multivariable-adjustment, poor self-perceived health status was positively associated with female gender (OR=2.01, 95%CI=1.41-2.96), smoking (OR=1.58, 95%CI=1.29-2.04), excessive alcohol consumption (OR=1.71, 95%CI=1.38-2.13) and the presence of diseases (OR=1.86, 95%CI=1.52-2.87). CONCLUSION: This study provides important information about the health status among Albanian prisoners. There is an urgent need for Albania to make a significant progress in health services provision for prisoners, which constitute a particularly vulnerable population subgroup.

Factors Affecting Elective and Non-elective Cesarean Sections: A Multinomial Regression Analysis Using Robson's Classification in a Southeast European Country.

BACKGROUND: Albania, a middle-income Southeast European country, is experiencing an increase in cesarean section rates. This study aims to analyze cesarean section practices in Albania using the Robson classification to identify patterns and provide insights into elective and non-elective cesarean trends. METHODS: This retrospective cohort study was conducted at the University Hospital of Obstetrics and Gynecology "Koco Gliozheni" in Albania, a leading tertiary hospital, from January to May 2023, involving 5,315 consecutive women who delivered during this period, including both live births and stillbirths, with a gestational age minimum of 28 weeks to align with standards of viability. We defined a function to systematically evaluate each case based on multiple criteria: parity, fetal presentation, onset of labor, previous deliveries, number of fetuses, and gestational age according to the Robson classification. Multinomial multiple regression was used to estimate the relationship between each of the above-mentioned variables and the likelihood of each type of cesarean delivery compared to normal births. RESULTS: The participants' mean age was 28.2 years (59.6% <30 years vs. 40.4% ≥30 years), while gestational age varied (12.1% before 37 weeks, the majority (72.3%) between 37 and 40 weeks, and 15.6% > 40 weeks). In elective cesarean sections, maternal age (odds ratio (OR) = 1.06) and gestational age (OR = 1.13) were associated with increased odds, with women with previous cesarean deliveries showing significantly higher odds (OR = 20.6), breech position (OR = 15.7), and multiple pregnancies elevating odds (OR = 7.3), whereas in non-elective cesarean sections, similar associations were observed with slightly different odds ratios which were maternal age (OR = 1.07), gestational age (OR = 1.16), previous cesarean delivery (OR = 6.3), breech position (OR = 8.5), and multiple pregnancies (OR = 5.1). Significant disparities in cesarean section rates were observed across various groups, with rates ranging from as low as 0.74% in Group 1 to as high as 89.24% in Group 5, and notable contributions from Group 2 with a rate of 69.95% and Group 6 with a rate of 81.29%. CONCLUSION: In conclusion, this study emphasizes the significance of factors such as maternal age, gestational age, previous cesarean deliveries, fetal presentation, number of fetuses, and multiple pregnancies in impacting the rates of elective, non-elective, and overall cesarean sections in Albania, highlighting the need for targeted strategies to improve maternal and fetal health outcomes.

Implementation of Newborn Hearing Screening in Albania.

Newborn hearing screening (NHS) was implemented in Albania in four maternity hospitals in 2018 and 2019. Implementation outcome, screening outcome, and screening quality measures were evaluated. Infants were first screened by midwives and nurses before discharge from the maternity hospital and returned for follow-up screening. Acceptability, appropriateness, feasibility, adoption, fidelity, coverage, attendance, and stepwise and final-referral rates were assessed by onsite observations, interviews, questionnaires, and a screening database. A post hoc analysis was performed to identify reasons for loss to follow up (LTFU) in a multivariate logistic regression. In total, 22,818 infants were born, of which 96.6% were screened. For the second screening step, 33.6% of infants were LTFU, 40.4% for the third, and 35.8% for diagnostic assessment. Twenty-two (0.1%) were diagnosed with hearing loss of ≥40 dB, six unilateral. NHS was appropriate and feasible: most infants are born in maternity hospitals, hence nurses and midwives could perform screening, and screening rooms and logistic support were supplied. Adoption among screeners was good. Referral rates decreased steadily, reflecting increasing skill. Occasionally, screening was repeated during a screening step, contrary to the protocol. NHS in Albania was implemented successfully, though LTFU was high. It is important to have effective data tracking and supervision throughout the screening.

Cross-cultural adaptation of an instrument measuring primary health care users' perceptions on competencies of their family physicians in Albania.

AIM: The objective of this study was to validate an international instrument addressing family physicians' competency level from the primary health care sers' perspective in Albania, a post-communist country in Southeast Europe. METHODS: This validation study, conducted in March-April 2012, included a sample of 114 primary health care users in Tirana municipality aged 18+ years (49 males and 65 females; mean age: 60 +/- 15 years). All participants were asked to self-assess the level of abilities, skills and competencies of their respective family physicians regarding different domains of quality of health care. Overall, the questionnaire included 37 items organized into 6 subscales/domains. Answers for each item of the tool ranged from 1 ("novice" physicians) to 5 ("expert" physicians). An overall summary score (including 37 items; range: 37-185) and a subscale summary score for each domain were calculated for male and female participants. Socioeconomic data were also collected. Cronbach's alpha was used to assess the internal consistency, and Mann-Whitney U test was used to compare mean scores for the overall scale and each subscale between men and women. RESULTS: Overall, internal consistency of the whole scale (37 items) was Cronbach's alpha = 0.89; it was higher in women than in men (0.91 vs. 0.82, respectively). The overall summary score for the 37 items of the instrument was 89.3 +/- 9.1; it was slightly higher in women than in men (89.7 +/- 10.6 vs. 88.8 +/- 6.7, respectively, P = 0.218). There were no statistically significant differences in the subscale summary scores between men and women. Overall, there was no correlation of the whole summary score or subscale scores with age. Conversely, there was evidence of a weak positive correlation with educational level. CONCLUSIONS: In the Albanian context, we provide evidence on the process of cross-cultural adaptation of a simple instrument measuring patients' self-perceived level of abilities and competencies of their family physicians regarding different domains of the quality of primary health care services.

Socioeconomic and lifestyle determinants of obesity in a transitional southeast European population.

OBJECTIVE: We aimed to assess the prevalence and socioeconomic and behavioral correlates of obesity in adult population of Albania, a transitional country in the western Balkans. METHODS: A cross-sectional study was conducted in 2007-2009 in the Albanian capital, including a sex-stratified random sample of 997 Tirana residents aged 25-65 years (83% response). A structured interview included data on demographic and socioeconomic characteristics and lifestyle factors. Physical examination included measurement of height, weight, and hips and waist circumferences. Binary logistic regression was used to assess the association of obesity with covariates. RESULTS: Half of participants were overweight, and about 30% were obese (36% women and 24% men). Obesity was positively associated with age, but inversely related to education and economic level. Almost every day drinkers were more likely to be obese compared to non-drinkers (OR = 2.2, 95% CI = 1.4-2.9). Fat and carbohydrate intake were both positively associated with obesity (for fat intake OR [low-moderate vs. high intake] = 3.1, 95% CI = 2.0-4.2) and for carbohydrate intake OR [low-moderate vs. high intake] = 2.8; 95% CI = 1.9-3.3). CONCLUSIONS: Our findings indicate that overweight and obesity pose serious public health concerns in this post-communist country. Health professionals and policy makers should focus particularly on the modifiable risk factors as an effective means of controlling the burden of obesity in Albania.

Determinants of witnessed parental physical violence among university students in transitional Albania.

BACKGROUND: We aimed to assess the extent and the socioeconomic correlates of witnessed parental physical violence among university students in Albania, a country in transition from rigidly structured socialism to a market-oriented system. METHODS: 2797 students (93% of all students) at the Medical Faculty, Tirana, filled out an anonymous structured questionnaire in April-June 2009. Information on witnessed father-to-mother physical violence during childhood and/or adolescence and sociodemographic and socioeconomic data were collected. The association of witnessed parental violence with socioeconomic factors was assessed with multivariable-adjusted logistic regression. RESULTS: 736 (26.7%) of students witnessed father-to-mother physical violence, and 36 (1.3%) reported 'very often' witnessing episodes. In multivariable-adjusted models, independent predictors of witnessed violence were: low family income [odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.7-3.2], rural origin (OR = 1.9, 95% CI = 1.5-2.5), father's lower education and unemployment (OR = 5.4, 95% CI = 4.1-7.1 and OR = 2.5, 95% CI = 1.9-3.2, respectively) and mother's educational and employment advantage compared with the spouse (OR = 2.7, 95% CI = 1.9-3.8 and OR = 2.2, 95% CI = 1.6-2.8, respectively). CONCLUSION: Father's socioeconomic disadvantage and mother's socioeconomic empowerment were each independently related to increased risk for witnessed father-to-mother physical violence among university students in this transitional patriarchal society. Health professionals in post-communist Albania should be aware of the ways in which witnessed domestic violence influences physical and psychological health of young adults.

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.

Mothers' perceptions of universal newborn hearing screening in transitional Albania.

The universal newborn hearing screening (UNHS) component of the multi-center EUSCREEN project is being piloted in Albania since January 1st 2018. The aim of this study was to explore mothers' perceptions about various elements of UNHS in Albania. A cross-sectional study was carried out in the three sites of UNHS in Albania, namely in Tirana, Kukës and Pogradec during May-June 2019. During this period 512 consecutively approached mothers giving birth to included maternity hospitals were interviewed face-to-face about different aspects of UNHS. Basic socio-demographic and socioeconomic information was also collected. Mean age of participating mothers was 28.6 years ± 5.5 years. The overwhelming majority (93%) of mothers knew what their baby was being tested for, 33% were aware that hearing screening was offered in maternity hospital, 94% were very satisfied/satisfied with UNHS and about 62% were very stressed/stressed waiting for screening results, with significant sociodemographic and socioeconomic differences. The main information source about UNHS was screening staff in the maternity hospitals where mothers gave birth, reported in 67% of cases. All mothers (100%) agreed on the importance of early detection of newborn hearing problems, all mothers were willing to be informed early if their newborn baby had a hearing problem and all mothers were willing to contribute financially for testing the hearing of their newborn baby. These findings should guide information and education campaigns about UNHS in Albania. The public willingness to financially support neonatal hearing testing should be considered as an opportunity to achieve universal newborn hearing screening in the country.

Implementation of a neonatal hearing screening programme in three provinces in Albania.

OBJECTIVES: The EUSCREEN study compares the cost-effectiveness of paediatric hearing screening programmes and aims to develop a cost-effectiveness model for this purpose. Alongside and informed by the development of the model, neonatal hearing screening (NHS) is implemented in Albania. We report on the first year. METHODS: An implementation plan was made addressing objectives, target population, screening protocol, screener training, screening devices, care pathways and follow up. NHS started January 1st, 2018 in four maternity hospitals: two in Tirana, one in Pogradec and one in Kukës, representing both urban and rural areas. OAE-OAE-aABR was used to screen well infants in maternity hospitals, whereas aABR-aABR was used in neonatal intensive care units and in mountainous Kukës for all infants. Screeners' uptake and attitudes towards screening and quality of screening were assessed by distributing questionnaires and visiting the maternity hospitals. The result of screening, diagnostics, follow up and entry into early intervention were registered in a database and monitored. RESULTS: Screeners were keen to improve their skills in screening and considered NHS valuable for Albanian health care. The number of "fail" outcomes after the first screen was high initially but decreased to less than 10% after eight months. In 2018, 11,507 infants were born in the four participating maternity hospitals, 10,925 (94.9%) of whom were screened in the first step. For 486 infants the result of screening was not registered. For the first screen, ten parents declined, eight infants died and one infant was discharged before screening could be performed. In 1115 (10.2%) infants the test either could not be performed or the threshold was not reached; 361 (32,4%) of these did not attend the second screen. For the third screen 31 (34.4%) out of 90 did not attend. Reasons given were: parents declined (124), lived too far from screening location (95), their infant died (11), had other health issues (7), or was screened in private clinic (17), no reason given (138). CONCLUSIONS: Implementation of NHS in Albania is feasible despite continuing challenges. Acceptance was high for the first screen. However, 32.4% of 1115 infants did not attend the second screen, after a "fail" outcome for the first test.

Trend and Correlates of Leadership Competencies Among Female Health Professionals in Albania.

Aim: Our aim was to assess the trends and correlates of the leadership competency level of female health professionals in Albania, a transitional country in the Western Balkans, based on a standardized international instrument. Methods: Two nationwide cross-sectional studies were conducted in Albania in 2014 (first wave; n = 105 women) and subsequently in 2018 (second wave; n = 121 women). A structured questionnaire was administered to all female participants aiming at self-assessing the current level of leadership competencies and the required (desirable) level of leadership competencies for their current job position. The questionnaire consisted of 52 items pertinent to eight domains. Answers for each item of the instrument ranged from 1 ("minimal competency level") to 5 ("maximal competency level"). Overall summary scores (range: 52-260) were calculated for both the current and the required leadership competency levels in both survey rounds, based on which the gap in leadership competency level was also computed (required minus current competency level). Binary logistic regression was used to assess the correlates of the gap in leadership competency level among study participants. Results: In multivariable-adjusted logistic regression models, there was evidence of a positive association between the gap in leadership competency level and: workplace in urban areas (OR = 3.2, 95%CI = 1.6-6.6); work experience (OR[for 1 year increment] = 1.1, 95%CI = 1.0-1.2); first round of the survey conducted in 2014 (OR = 2.1, 95%CI = 1.0-4.3); and, particularly, a high managerial job position/level (OR = 3.8, 95%CI = 1.6-9.3). Conversely, there was an inverse relationship with the age of women (OR[for 1 year increment] = 0.9, 95%CI = 0.8-1.0). Conclusion: Our study provides useful evidence about trends over time and selected correlates of the gap in leadership competencies among female health professionals in Albania. Policymakers and decision-makers in Albania and other countries should be aware of the unmet need for leadership training of female health professionals at all levels.

Religious affiliation and acute coronary syndrome: a population-based case-control study in Tirana, Albania.

BACKGROUND: Our aim was to assess the association of religious affiliation (Muslim versus Christian) with acute coronary syndrome (ACS) in Albania, a predominantly Muslim country in Southeast Europe. METHODS: A population-based case-control study was conducted in Tirana, the Albanian capital, in 2003-2006. Of non-fatal consecutive ACS patients, 467 were recruited (370 men aged 59.1 +/- 8.7 years and 97 women 63.3 +/- 7.1 years, 88% response). The coronary heart disease-free control group comprised 469 men (53.1 +/- 10.4 years) and 268 women (54.0 +/- 10.9 years) (69% response), 452 and 237 of whom were fully examined. Information collected included sociodemographic, psychosocial and behavioural characteristics by structured interview and anthropometric measurements. Furthermore, data on religious affiliation was available for all but 20 of the non-respondents. Multivariable-adjusted logistic regression was used to assess the association of religious affiliation (Muslim versus Christian) with ACS. RESULTS: Of ACS patients, 77.1% were Muslims compared with 65.8% of the entire control group. Muslims in both sexes were at higher risk of ACS than Christians (age- and sex-adjusted OR = 1.8, 95% CI = 1.4-2.3, P < 0.01). The association persisted (OR = 1.6, 95%CI = 1.1-2.3, P = 0.02) upon further adjustment for marital status, family size, education, income, employment status, social position, emigration of close relatives, financial loss and coronary risk factors. CONCLUSIONS: In this transitional country, we found a higher risk of ACS in Muslims than Christians, independent of the socioeconomic circumstances and conventional coronary risk factors assessed. This finding requires replication and the determinants of the excess risk sought.

Factors associated with fatal traffic accidents in Tirana, Albania: cross-sectional study.

AIM: To assess the prevalence of fatal road traffic accidents in Tirana, Albania, and describe their determinants. METHODS: This cross-sectional study included all road traffic accidents recorded by the Traffic Police Department of Tirana district for the period 2000-2005. A structured questionnaire included information about the type of traffic accident (fatal vs non-fatal event), year of event, age and sex of the responsible party, reason of accident, location and time of event, and the type of vehicle involved. Multivariable-adjusted binary logistic regression analysis was used to assess the predictors of fatal road traffic accidents. RESULTS: Overall, there were 1578 recorded road traffic accidents in Tirana district during 2000-2005. Of these, 272 (17%) were fatal. Multivariable-adjusted models showed that younger age (OR, 3.97; 95% CI, 2.28-6.91), high speed (OR, 2.54; 95% CI, 1.62-3.98), and especially alcohol consumption (OR, 6.15; 95% CI, 3.54-10.66) were strong and significant predictors of fatal accidents. Fatal accidents were more prevalent on intercity roads (OR, 4.25; 95% CI, 3.11-5.82) and involved especially vans and trucks (OR, 4.12; 95% CI, 2.34-7.24). CONCLUSION: Young age, high speed, and alcohol are predictors of fatal road traffic accidents in Tirana district. These findings can serve as a basis for health care professionals and policymakers to create preventive measures for traffic accidents.

Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition: population-based case-control study in Tirana, Albania.

AIM: To assess the association between conventional risk factors and acute coronary syndrome in Albania, a transitional country in Southeast Europe. METHODS: A population-based case-control study was conducted in Tirana in 2003-2006. A total of 467 consecutive patients with nonfatal acute coronary syndrome were recruited. There were 370 men with mean+/-standard deviation (SD) age of 59.1+/-8.7 years and 97 women with mean+/-SD age of 63.3+/-7.1 years. The control group comprised a population-representative sample of Tirana residents. In the control group, there were 469 men with mean+/-SD age of 53.1+/-10.4 years and 268 women aged 54.0+/-10.9 years. A structured questionnaire on demographic, socioeconomic, psychosocial factors, and health behaviors was administered. Physical measurements included anthropometrics and blood pressure. Venous blood and adipose tissue aspirations from the gluteal region were frozen-stored for future analysis. Multivariable-adjusted logistic regression was used to assess the independent associations of conventional risk factors with acute coronary syndrome. RESULTS: Upon adjustment for covariates, family history of coronary heart disease was found to be a strong predictor of acute coronary syndrome in both men (odds ratio [OR], 3.70; 95% confidence interval [CI], 2.58-5.30) and women (OR, 4.53; 2.40-8.57). Waist-to-hip ratio in men (OR, 4.03; 2.83-5.73) and obesity in women (OR, 3.31; 1.54-7.14) were strongly associated with acute coronary syndrome. In men, but not in women, there was a significant association with hypertension and current smoking (P=0.011 and P<0.001, respectively). Diabetes was not significantly independently associated in either sex. CONCLUSION: Classical risk factors predicted coronary heart disease in Albania, similarly as in the rest of the world, although associations with family history and anthropometric indices were stronger. These findings are resulting largely from the heterogeneous adoption of lifestyles conducive to increased coronary risk in transitional countries, and they point to the urgent need for targeted public health interventions.

Association between Nephrolithiasis, Hypertension and Obesity in Polycystic Kidney Disease.

AIM: We aim to define the correlations between nephrolithiasis, hypertension, age and obesity in patients with autosomal dominant polycystic kidney disease (ADPKD) in Albania. MATERIAL AND METHODS: We included 100 patients with autosomal dominant polycystic kidney from 2011 to 2014. The patients underwent X-ray and renal ultrasonography. We performed the metabolic evaluation of blood and urine. RESULTS: The patients with renal stones had a higher level of mean systolic and diastolic blood pressure compared with patients without stones (155 ± 12 mmHg vs. 145 ± 8 mmHg, and 105 ± 0.9 mmHg vs. 92 ± 1.28 mmHg, respectively). Patients with renal stones were older (47 ± 15 vs. 38 ± 5 years), had a higher prevalence of obesity [body mass index (BMI): 28 ± 2.4 vs. 25.7 ± 0.6], had higher levels of total cholesterol level (220 ± 5 mg/dl vs. 203 ± 4 mg/dl) as well as triglyceride levels (160 ± 9 mg/dl vs. 126 ± 4 mg/dl), compared with no renal stone individuals. CONCLUSION: ADPKD patients with renal stones in our study had a higher mean level of systolic and diastolic blood pressure, BMI and cholesterol and triglycerides levels compared with individuals without renal stones.