Enver Roshi

Factors associated with spousal physical violence in Albania: cross sectional study.

Abstract Objective To describe the prevalence of intimate partner violence and associated factors among married women in Albania. Design Cross sectional study. Setting Tirana, the capital city of Albania. Participants A representative sample of 1039 married women aged 25-65 living in Tirana and recorded in the 2001 census. Methods Questionnaire on intimate partner violence and social and demographic characteristics of the women and their husbands. Main outcome measure Womens experience within the past year of being hit, slapped, kicked, or otherwise physically hurt by the husband. Results More than a third (37%, 384/1039) of women had experienced violence. Risk was greatest among women aged 25-34 (odds ratio 1.47, 95% CI 1.04 to 2.09), women with tertiary education (3.70, 2.04 to 6.67), women in white collar jobs (4.0, 1.59 to 10.0), women with least educated husbands (5.01, 2.91 to 8.64), and women married to men raised in rural areas (3.31, 2.29 to 4.80). Women were at higher risk if they were more educated than their husbands (4.76, 2.56 to 9.09). Conclusions In transitional Albania, the risk of spousal violence is high, and more empowered women are at greater risk.

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.

Evaluation of Thrombocytopenia in Systemic Lupus Erythematosus and Correlation with Different Organs Damages

Introduction: Thrombocytopenia is highly prevalent among patients with Systemic Lupus Erythematous(SLE) and at the same time it has been reported that a correlation exists between Thrombocytopenia and organ damage. The aim of this study is to highlight the correlation between Thrombocytopenia and the clinical manifestations of SLE. Objectives: The objective is to show the clinical manifestations and organ damage of Systemic Lupus Erythematous (SLE) patients who have been found to have Thrombocytopenia. Methods: A retrospective study was conducted examining all patient charts diagnosed and treated for SLE at the Rheumatology Service of Mother Teresa Hospital Centre. All the data were collected from discharged patient charts. The data included were Anti DNA,AAN,C3 , thrombocytopenia, leucopenia, and organ damage. Data were taken from 2009 to 2013. The classification criteria of the American College of Rheumatology was used for all patients regarding the diagnosis. Results: Out of 330 patients, 12 (3.64%) are men and 318 (96.3%) women. 73 of all patients have thrombocytopenia as cases and 257 patients had SLE without thrombocytopenia, which was considered as the control group. AAN 68(93.1%), Anti DNA 50 (64.3%) , low value of C3 46 (63%), and leucopenia were higher in thrombocytopenic patients compared with control group (p<0.05) 48 (65.7%) of thrombocytopenic patients develop lupus nephritis, 10 (13.6%) were with pulmonary involvement, and 42 (57.5%) had leukopenia. Conclusion: Thrombocytopenia is not directly associated with any disease activity, organ damage and mortality, but it should be considered as a prognostic factor which may help identifying a category of patients whose disease course can be aggravated.

Public Health Aspects of the Family Medicine Concepts in South Eastern Europe

Introduction: Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the individuals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union. Aim: The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was conducted as well as the Ministries of Health. Results: Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward family medicine and primary prevention interventions. The population is not enough educated for complicated enforcement for and prevention of diseases that have a heavy burden on the budget. Health insurance and payment of health services is often a problem, because the patients must be treated regardless of their insurance coverage and financial situation. The decrease in production and economic growth, as well as low gross national income in the countries with economic crisis, lead to the inability of treatment for a large number of the population. Such situation a system leads to additional debts and loans to healthcare system. Measures implemented for provision of acute curative care largely did not lead to improvements in the health status of the population. Educational and preventive measures, as well as higher standards for quality and accessibility of health care services for entire population in each country, especially those struggling are bound to joining the European Union and their implementation must start. The most A large number of medical institutions are is inefficient in health education and health promotion and must work to educate patients and families and increase the quality of preventive health services. Modernization of health care delivery and joining the European Union by increasing overall economic stability of countries is one of the primary goals of all countries in Southeast Europe.

Health Literacy and Socioeconomic Characteristics among Older People in Transitional Kosovo.

Aims: Health literacy among older people has received little attention in transitional countries of Southeast Europe. Our aim was to assess the level and socioeconomic correlates of health literacy among older people in Kosovo, a post-war country in the Western Balkans. Study Design: Cross-sectional study. Place and Duration of Study: Kosovo, between January-March 2011. Methods: This nationwide survey, conducted in Kosovo in 2011, included 1753 individuals aged ≥65 years (886 men, 867 women; mean age 73.4±6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access , understanding , appraisal , and application of health information. Subscale scores and an overall health literacy score were calculated for each participant. Information on socioeconomic characteristics was also collected. Results: Subscale scores of health literacy were strongly correlated with each-other

Cross-cultural Adaptation of a Questionnaire on Self-perceived Level of Skills, Abilities and Competencies of Family Physicians in Albania

Objective: Our aim was to validate an international instrument measuring self-perceived competency level of family physicians in Albania. Methods: A representative sample of 57 family physicians operating in primary health care services was interviewed twice in March-April 2012 in Tirana (26 men and 31 women; median age: 46 years, inter-quartile range: 38-56 years). A structured questionnaire was administered [and subsequently re-administered after two weeks (test-retest)] to all family physicians aiming to self-assess physicians’ level of abilities, skills and competencies regarding different domains of quality of health care. 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 (range: 37-185) and a subscale summary score for each domain were calculated for the test and retest procedures. Cronbach’s alpha was used to assess the internal consistency for both the test and the retest procedures, whereas Spearman’s rho was employed to assess the stability over time (test-retest reliability) of the instrument. Results: Cronbach’s alpha was 0.87 for the test and 0.86 for the retest procedure. Overall, Spearman’s rho was 0.84 (P<0.001). The overall summary score for the 37 items of the instrument was 96.3±10.0 for the test and 97.3±10.1 for the retest. All the subscale summary scores were very similar for the test and the retest procedure. Conclusion: This study provides evidence on cross-cultural adaptation of an international instrument taping self-perceived level of competencies of family physicians in Albania. The questionnaire displayed a satisfactory internal consistency for both test and retest procedures in this sample of family physicians in Albania. Furthermore, the high test-retest reliability (stability over time) of the instrument suggests a good potential for wide scale application to nationally representative samples of family physicians in Albanian populations.

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.

Prevalence and Factors Associated with Congenital Malformations in Tirana, Albania, During 2011-2013

Aim: Congenital Malformations (CMs) represent a challenge especially for developing countries. Data about CMs in Albania are rather scarce. In this context, our aim was to assess the prevalence and factors associated with CMs in Tirana, the capital of Albania. Methods: Information on all CMs at birth during 2011-2013 was retrieved from the National CM Surveillance System. For each CM case, three controls (babies born without CM) were retrieved as well. Overall, 831 cases and 2522 controls were included in this study. The prevalence was calculated using the total number of live births in Tirana during the same period. Binary logistic regression was used to determine the factors associated with CMs adjusting for a number of covariates. Results: The three-year prevalence of CMs was 23.41 per 1,000 live births. The most affected body systems were the musculoskeletal, cardiovascular and genital systems. CMs were more prevalent among male babies. Advanced mothers’ age, lower education, unemployment status and lower gestational age were all positively associated with increased likelihood of CMs. Conclusions: Socio-demographic factors of mothers are linked to CMs in Albania. Future surveys are needed in Albania in order to establish determinants of CMs at a national level.

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.

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.