Genc Burazeri

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 Observance and Acute Coronary Syndrome in Predominantly Muslim Albania: A Population-based Case-Control Study in Tirana

PURPOSE We aimed to assess the association of religious observance with acute coronary syndrome (ACS) in a predominantly Muslim population. METHODS A case-control study conducted in Tirana, Albania in 2003-2006 included 467 nonfatal consecutive ACS patients (370 men, 97 women; 88% response) and a population-based control group (469 men, 268 women; 69% response). Religious observance was assessed as a composite score based on mosque/church attendance, frequency of prayer and ritual fasting. The association of religiosity with ACS was assessed by multivariable-adjusted logistic regression. RESULTS Nonobservance was frequent in this population (67% among Muslim controls, 55% in Christian controls). Religious observance was inversely associated with ACS in both groups (multivariable-adjusted odds ratios for above median observance scores vs zero observance: 0.45 [95% confidence interval (CI) = 0.26-0.77] in Muslims, 0.58 [0.25-1.31] in Christians, and 0.48 [0.31-0.74] overall]. Associations with ACS were strongest for prayer and fasting. CONCLUSIONS In a country experiencing major socioeconomic transition from rigid communism, including extreme state-enforced secularism, we found an apparent protective effect associated with religious observance in both Muslims and Christians. This may be the first such study reported in a Muslim population.

Television viewing, leisure-time exercise and acute coronary syndrome in transitional Albania

OBJECTIVE To assess the association of leisure-time exercise and television (TV) viewing, a sedentary marker, with acute coronary syndrome (ACS) in Albania, a transitional country in Southeast Europe. METHODS A population-based case-control study was conducted among Tirana residents in 2003-2006. Information on leisure-time exercise (transformed into kilocalories of energy expenditure) and daily hours of TV viewing was obtained by interviewer-administered questionnaire. 460 non-fatal ACS patients (368 men, 92 women) and 628 coronary heart disease-free controls (413 men, 215 women) were studied. RESULTS Adjusted for socio-demographic characteristics, conventional coronary risk factors and leisure-time exercise, TV viewing was associated with ACS in women (OR=1.66, 95%CI=1.12-2.46 per hour/day viewing), but not in men (OR=0.93, 95%CI=0.81-1.07; P for sex-interaction=0.02). A low level of leisure-time exercise (adjusted also for TV viewing) was associated with ACS similarly in men and women (pooled sexes OR=2.03, 95%CI=1.29-3.22 for bottom vs top tertile of energy expenditure). CONCLUSIONS Leisure-time inactivity is confirmed as an important risk factor for ACS also in Southeastern Europe. TV viewing may be an informative coronary risk marker in transitional societies, especially in women.

Health literacy, self-perceived health and self-reported chronic morbidity among older people in Kosovo.

The aim was to describe health literacy among the older population of Kosovo, an Albanian speaking post-war country in the Western Balkans, in the context of self-perceived health status and self-reported chronic morbidity. A cross-sectional study was conducted in Kosovo in 2011 including 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. Sub-scale scores and an overall health literacy score were calculated for each participant. Information on self-perceived health status, presence and number of chronic diseases and socioeconomic characteristics was also collected. Mean values of the overall health literacy score and all sub-scale scores (access, understanding, appraisal and application) were lower among older people who reported a poorer health status or at least one chronic condition compared with individuals who perceived their health status as good or had no chronic conditions (p < 0.001 for all). Our findings provide valuable evidence on the independent and inverse association between health literacy levels and self-perceived health and chronic morbidity in this post-war European population. The putative link with chronic morbidity and lower adherence to health services is hard to establish through this cross-sectional study. Prospective population-based studies should be conducted in Kosovo and other transitional settings to replicate these findings and properly address the causal relationship between health literacy and health status.

Socioeconomic conditions of elderly people in Kosovo: a cross-sectional study

BackgroundKosovo is the newest state in Europe facing a particularly difficult socioeconomic and political transition. The available evidence on socioeconomic conditions and quality of life of elderly people in Kosovo is scarce notwithstanding the ageing trend due to lowering of fertility rates and a higher life-expectancy. In this context, the aim of our study was to assess the socioeconomic conditions of elderly people in post-war Kosovo.MethodsA cross-sectional study was conducted in Kosovo in January-March 2011 including an age- sex-and residence (urban vs. rural)-stratified sample of 1,890 individuals (83.5% response) aged 65 years and over. A structured questionnaire included assessment of socio-demographic and socioeconomic characteristics including educational level and self-perceived poverty. Binary logistic regression was used to assess the association of self-perceived poverty with socio-demographic and socioeconomic factors.ResultsThe educational level in this representative sample of elderly people in Kosovo was quite low, particularly among women. About 47% of respondents perceived themselves as poor, or extremely poor (41% of men and 52% of women). In multivariable-adjusted models, self-perceived poverty was higher among older women, low educated individuals, urban residents, and elderly individuals living alone.ConclusionsFindings from this study indicate that the socioeconomic situation of the elderly population in Kosovo is rather challenging. Demographic trends coupled with the economic and political transition raise serious concerns about increasing needs for socioeconomic support of elderly people in Kosovo. Specific policies and actions should be considered by a number of stakeholders, including government and civil society in transitional Kosovo.

Prevalence and determinants of binge drinking in middle age in a transitional post-communist country: a population-based study in Tirana, Albania.

AIMS To assess the prevalence and determinants of binge drinking in the middle-age population of transitional post-communist Albania, for which data were previously unavailable. METHODS A population-based sample aged 35-74 years, interviewed and examined in Tirana in 2003-2006, included 450 men and 235 women for whom data on alcohol intake were collected (65.5% response). Multivariable-adjusted logistic regression was used to assess the association of drinking patterns with sociodemographic, socioeconomic and psychosocial characteristics and coronary risk factors. RESULTS Age-standardized to the 2005 census, 9.2% (95% confidence interval, CI = 6.5-11.9%) and 10.3% (95% CI = 7.4-13.1%) of men reported two to three or more annual episodes of drunkenness and hangovers, respectively. In women, the prevalence of both these markers of binging was 1.4% (95% CI = 0-3.1%). Among men, 8.9% (95% CI = 6.2-11.6%) reported drinking > or =60 g alcohol per session. In multivariable-adjusted models in men, binge drinking was related to low educational level (odds ratio, OR = 1.8, 95% CI = 1.0-3.3), financial loss in the pyramid collapse (OR = 1.6, 95% CI = 1.0-2.5) and religiosity (inversely) in both Muslims and Christians (OR = 0.2, 95% CI = 0.1-0.4). CONCLUSIONS Among men in this transitional Southeast European country, social disadvantage and financial stress appear to promote alcohol abuse (which is rare in women), and traditionalism may be protective.

Hostility and acute coronary syndrome in a transitional post-communist Muslim country: a population-based study in Tirana, Albania

BACKGROUND The study aims to assess: (i) the association of hostility with socio-demographic, psychosocial and coronary risk factors and (ii) the association of hostility with acute coronary syndrome (ACS) in post-communist secular though predominantly Muslim Albania. METHODS In a population-based case-control study conducted in Tirana in 2003-06, 464 non-fatal sequential ACS patients (368 men, 96 women, 87% response) and a population-sampled control group (n = 684; 449 men, 235 women, 65.5% response) provided data on Cynical Distrust, a measure of hostility. The correlates of hostility in the population sample were assessed using the general linear model and the association of hostility with ACS in the case-control comparison by multivariable-adjusted logistic regression. RESULTS In the population-based sample, hostility was related to age (inversely in men), social position, social mobility, relative income (all inverse in both sexes) and emigration of close family. In the case-control comparison, there was a strong graded relationship of hostility with ACS, independent of socio-demographic characteristics and conventional coronary risk factors, including lifestyle/behavioural factors [odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.18-1.34 in men, and OR = 1.17, 95% CI = 1.05-1.32 in women per unit score of hostility and OR = 5.3, 95% CI = 3.3-8.6 in men and OR = 3.1, 95% CI = 1.1-8.6 in women for upper versus lower tertiles]. CONCLUSION This may be the first report from post-communist countries of Eastern and Southeastern Europe or from a Muslim population on the hostility trait in a population-representative sample. Hostility was independently associated with ACS. This requires confirmation, in particular, to exclude the possibility of reverse causality. Hostility may represent an informative risk factor in transitional populations.

Alcohol intake and its correlates in a transitional predominantly Muslim population in southeastern Europe.

OBJECTIVE Our aim was to assess alcohol consumption and its correlates in Albania, a predominantly Muslim though largely secular Southeast European republic in transition from rigidly structured socialism to a market-oriented system. METHODS A population-based sample of Tirana residents aged 35-74 years was interviewed and examined in 2003-2006 (450 men and 235 women with data on alcohol intake, 65.5% response). Multivariable-adjusted logistic regression was used to assess the association of drinking frequency, quantity and type of drink with socioeconomic, psychosocial and coronary risk characteristics. RESULTS 30.6% (95%CI=26.3%-34.9%) of men, age-standardized to the 2005 census, and 5.6% (95%CI=2.6%-8.6%) of women reported almost daily intake of alcohol, whereas 17.0% (95%CI=13.4%-20.5%) of men and 46.6% (95%CI=40.2%-53.1%) of women abstained. In men, frequent drinking was positively associated with age and not receiving financial support from close family emigrants, and was strongly inversely related to religious observance in both Muslims and Christians. In women it was associated with smoking and upward social mobility. Alcohol intake was not associated with religious affiliation in either sex. In men, intake of spirits (predominantly raki) and beer were associated with lower socioeconomic indices, smoking and obesity (beer only), whereas wine intake was associated with financial security, being secular, and not smoking. Among men, 11.3% (95%CI=8.3%-14.3%) reported high intakes (> or =210 g of pure alcohol/week) and 6.0% (95%CI=3.8%-8.3%) very high intakes (> or = 420 g/week). High intakes were associated with frequent, rather than episodic, drinking. CONCLUSIONS Our study may be the first to provide information on alcohol intake and its characteristics in an Albanian population sample, one of the few predominantly Muslim countries in Europe. Alcohol consumption in women was extremely low. However, consistent very heavy intake of alcohol appears to be more frequent among Albanian men than in many former communist countries in Europe, and is cause for concern.

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.

Concurrent validation of two key health literacy instruments in a South Eastern European population.

BACKGROUND Public health practice has come to increasing recognition of health promotion and the central role of knowledge, attitude, beliefs and practices in achieving health promotion. Health literacy (HL) is an under-explored topic in South Eastern European countries. There are no HL reports from Albania to date. The aim of this study was to assess the concurrent validity of the European Health Literacy Survey Questionnaire (HLS-EU-Q) and the Test of Functional Health Literacy in Adults (TOFHLA) in a population-based sample of adults in Albania. METHODS A cross-sectional study was conducted in 2013 in Tirana, Albania, including 239 individuals aged ≥ 18 years (61% women; 87% response). A structured interviewer-administered questionnaire was applied twice (test and retest procedure after 2 weeks) including HLS-EU-Q and TOFHLA instruments. RESULTS The internal consistency was high for both instruments (Cronbachs alpha for the test procedure was 0.92 for TOFHLA and 0.98 for HLS-EU-Q). Both tools exhibited a high stability over time (Spearmans rho: 0.88 for TOFHLA and 0.87 for HLS-EU). Mean values of both instruments were similar in men and women (mean score for TOFHLA: 76.0 vs. 76.5, P = 0.83; mean score for HLS-EU-Q: 32.2 vs. 32.6, P = 0.63). For both instruments, higher HL scores were significantly associated with younger age, higher educational and economic level and lower body mass index. CONCLUSIONS Our study provides valuable novel evidence on concurrent validation of two major HL instruments in a South Eastern European population-based sample. Future studies should be conducted in order to confirm and expand our findings.