in Albania - Instituti i Shendetit Publik

AMJALBANIAN medical journal30 29 years of Albanian Medical Journal (Revista Mjekësore)ALBANIAN MEDICALJOURNALINTERNATIONAL PUBLIC HEALTH CONFERENCESUPPLEMENTTirana 6-7 May 2013INSTITUTE OF PUBLIC HEALTH

INSTITUTI I SHENDETIT PUBLIKALBANIAN MEDICALJOURNALSUPPLEMENTINTERNATIONAL PUBLIC HEALTH CONFERENCETirana 6-7 May 2013World HealthOrganizationREGIONAL OFFICE FOR Europe1

AMJALBANIAN medical journalALBANIAN medical journalSUPPLEMENTScientific Committee:Enver RoshiGenc BurazeriJera KrujaBajram HysaEduard KakarriqiAlban YlliSilva BinoArben LuzatiLlukan RrumbullakuSuela KëlliçiGazmend BejtjaEdmond PanaritiUlrich Laaser, GermanyHelmut Brand, The NetherlandsTheodhore Tulchinsky, IsraelCharles Hardy, USAIzet Masiè, Bosnia-HerzegovinaDoncho Donev, FYROMShaban Memeti, FYROMNaser Ramadani, KosovoOrganizing Committee:Gentiana QirjakoKlodian RjepajRoland BaniErka AmursiJolanda HyskaAlbana AhmetiSecretariat:Rudina ÇumashiRovena Daja

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAINTERNATIONAL PUBLIC HEALTH CONFERENCE INTIRANA, ALBANIADate and Conference themeThe International Public Health Conference organized in Tirana, Albaniaon May 6-7 2013, Publichealth challenges related tonon-communicablediseases .Conference aimThe International Public Health Conference aims to contribute to the improvement of publichealth in Albania by offering a means for exchanging information and a platform for debateto researchers, policymakers, and practitioners in the field of public health and health servicesresearch as well as public health training and education in Albania.Conference venue:Tirana International Hotel & Conference CentreSkanderbeg Square 8, Tirana, AlbaniaOrganizationThe International Public Health Conference is organized by the Institute of Public Health (IPH)under the auspices of the Albanian Ministry of Health. Funding for this Conference was providedby UNICEF, WHO, UNFPA, UNAIDS and IPH.The opinions expressed herein are those of the authors and do not necessarily reflect theviews of UNICEF, WHO, UNFPA and UNAIDS.Additional information about theInternational Public Health Conference organized in Tirana, Albania,on 6-7 May 2013 may be obtained from:THE INSTITUTE OF PUBLIC HEALTHStreet Address: "Aleksander Moisiu" 80, Tirana, AlbaniaTelephone: Tel. +355 42374756, Fax. +355 42370058,http:www.ishp.gov.alALBANIAN MEDICAL JOURNAL SUPPLEMENT1

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPLENARY SESSIONSModerators:Enver Roshi, Eduard Kakarriqi, Genc Burazeri,Arben LuzatiALBANIAN MEDICAL JOURNAL SUPPLEMENT7

ALBANIAN MEDICAL JOURNAL SUPPLEMENTWhy a conference on non-communicable diseasesin Albania?Enver Roshi 1,2 , Eduard Kakarriqi 1,2 , Genc Burazeri 1,2 , Bajram Hysa 31Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine,Tirana, Albania;3Faculty of Medicine, University of Medicine, Tirana, Albania.There is solid and consistent evidence that noncommunicablediseases (NCDs) have increased inAlbania in the past decade. In 2008, NCDsaccounted for about 89% of the overall mortalityin Albania (cardiovascular mortality accounted for59%, whereas cancer mortality accounted for about18%). In 2003, the share of NCDs comprised 76%of the overall mortality in Albania (cardiovasculardiseases accounted for 52% and cancer mortalityaccounted for 14% of the overall mortality).Overweight and obesity are major risk factors forNCDs. Findings from the Albanian Demographicand Health Survey (ADHS, 2008-09) indicate thatamong Albanians aged 15-49 years, 53% of menwere overweight (of whom, 9% were obese) and39% of women were overweight (of whom, 10%were obese). However, such a risk factor as obesity,takes effect since early childhood. The survey dataof the Institute of Public Health in Albania(PPKZH, 2008) indicated that 15.2% of childrenaged 9-10 years were overweight, of whom 3.8%were obese. Concerning the adolescents category(age-group: 15-19 years), according to ADHS 2008-09, the prevalence of overweight was higher amongboys (20.5%) than among girls (7.9%). Conversely,the percentage of obese boys and girls aged 15-19years was 1.3% and 1.4%, respectively.This international public health conference is animportant contribution to the currently availableinformation and facts on the public healthsignificance of NCDs in Albania and beyond.Presentations and other scientific materials from thisconference will help health professionals butparticularly policymakers to design and implementeffective and efficient intervention programs tocontrol and prevent NCDs in the adult populations.Keywords: A lbanian Demographicand Health Survey, morbidity, mortality, non-communicablediseases.8 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAAlbanian Medical Journal: A modest endeavor forstimulating research and a culture of scientificcommunication in the most isolated formercommunist country in EuropeGenc Burazeri 1-31Faculty of Public Heath, University of Medicine, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3Department of International Health, School for Public Health and Primary Care (CAPHRI),Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.In post-communist Albania, there is no sufficientresearch directed towards gaining a clearunderstanding of the health effects of transition andthe fluctuations in health outcomes. A generalcharacteristic which I have previously described inthe scientific literature (Burazeri et al. 2009) relatesto the problems faced by Albanian scientists forengaging in research work which basically includethe following features: lack of funds, lack of expertiseand, lack of good data .As a matter of fact, the current (international) publichealth conference in Tirana (May 6-7, 2013) is aperfect venue for dissemination and communicationof research findings pertinent to surveys and otherresearch work conducted in Albania and othercountries in the Western Balkans such as, e.g.,Demographic and Health Surveys which involvealso a detailed assessment of a wide array oflifestyle/behavioral characteristics and pre-existingchronic conditions in nationwide representativesamples of adult populations.There is an obvious case for action to change thestate of mind and the scientific paradigm ofmedical scientists and public health researchers inAlbania in terms of raising their awareness aboutthe pressing need to present their research findingsin international conferences and subsequently publishfull-length papers in scientific journals in the Englishlanguage. This is the only means for ensuring anadequate and prompt communication and exchangeof the scientific information with the peers, scientificgroups and research community at large.The only way for a small country such as Albaniato cope with the current publication scantiness is tointroduce and follow the best international scientificprinciples and quality criteria of research methods,and increase gradually the critical mass of competentresearchers.A lbanian Medical Journal aims to fill this void byproviding a modest yet important setting forpublication of research findings from studiesconducted not only in Albania, but also in othercountries of the Western Balkans and beyond.Keywords: A lbanian Medical Journal, medical literature, research, Western Balkans.ALBANIAN MEDICAL JOURNAL SUPPLEMENT9

ALBANIAN MEDICAL JOURNAL SUPPLEMENTMortality patterns in Albania: An overall picture overthe period 2001-2009Eduard Kakarriqi 1,2 , Bajram Dedja 1 , Bukurie Gega 1 , Alban Ylli 1,2 ,Ervin Toçi 1 , Alba Merdani 1 , Dorina Çanaku 1 , Sonela Xinxo 1 ,Kozeta Filipi 1 , Miranda Hajdini 11Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: This study aims at displaying an overall pictureof mortality rates MRs (deaths per 100,000population) in Albania over the period 2001-2009.The huge amount of our data makes quite impossibleto portray in detail such an important issue into thecontext of a conference presentation.Methods: Mortality data (based on death certificates)are obtained by the official annual publications of theInstitute of Statistics (INSTAT), whose content doesnot provide the desirable outputs on the matter. Theavailable data were analyzed in order to obtain crudeand standardized (world population as standardpopulation) general (=all causes), gender-specific MRs,crude and standardized gender-specific cause-specificMRs, and crude and standardized gender-specific, agespecificand cause-specific MRs, all of them atdistrict, regional (prefecture) and country level overthe period from 2001 to 2009 (the last annualINSTAT publication on mortality in Albania).Results: Main findings include the following: (i) thetrends over the period 2001-2009 of the crude andage-standardized gender-specific general (=allcauses) MRs at prefecture and country level; (ii) theproportion of crude gender-specific cause-specificMRs towards the crude general gender-specific MRsat country level; (iii) the trends over the period 2001-2009 of the crude gender-specific cause-specificMRs at country level.Conclusion: The access of the Institute of PublicHealth (IPH), namely its National EpidemiologicalObservatory, to the INSTAT database as regardsmortality data (=individual death certificates), is theonly solution towards the production by the IPHof the detailed mortality indicators according to therequirements of the WHO, Eurostat, and ECDC.Otherwise, following the current modus operandi onthe matter, we will continue to fail.Keywords: INSTA T, mortality patterns, mortality rate.10 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAStrategies for prevention of non-communicablediseasesDoncho Donev 11Institute of Social Medicine, Faculty of Medicine Ss Cyril and Methodius University in Skopje,Republic of Macedonia.Aim: To present two basic strategies for preventionof non-communicable diseases (NCDs) andtheir strengths and weaknesses.Methods: Starting from the WHO EuropeanStrategy and Action Plan for prevention and controlof NCDs in the period of 2011-2015, an analysisof the relevant literature on experiences in manycountries in prevention of NCDs was conducted.Results: There are two basic strategies forprevention of NCDs: population strategy andstrategy for high-risk individuals. Population strategyis aimed at reducing the level of risk factors in allindividuals in the general population through creatingconducive environment that enables the adoption ofhealthy lifestyles and appropriate legislation, taxationand financial incentives from the government.Although the effect is small at the individual level,the strategy has a large impact on population level,in particular it does not require behavioral changesand can give quick effects. Such strategies are oftenvery cost effective and can even generate profit. Itoffers achieving good for all. Strategy for high-riskindividuals is aimed at detection and treatment ofhigh-risk individuals through screening (e.g. for highblood pressure) and treatment before complicationsoccur. It offers achieving large effects in a fewpeople, but has little impact on population level. Itrequires behavioral changes at the individual level(cooperation). Often the costs are high (drugs foryears for many patients), and it is possible to achievegood for some.Conclusion: The population strategy has severaladvantages, but in practice it is necessary to use acombined approach for the detection and treatmentof high-risk individuals, too. It is necessary for theimplementation of the strategies to be followed byappropriate action plans for communication of theeffects to the overall population.Keywords: non-communicablediseases, high-risk individuals, populaiton strategy, prevention.ALBANIAN MEDICAL JOURNAL SUPPLEMENT11

ALBANIAN MEDICAL JOURNAL SUPPLEMENTThe burden of disease from non-communicablediseases in the Republic of Macedonia in 2011Azis Pollozhani 1 , Shaban Memeti 1 , Vladimir Rechica 11Institute of Public Health of the Republic of Macedonia.Aim: With the majority of the population living intoold age and so increasingly at risk of chronic diseaseand disability, the need for information on qualityas well as quantity of life in the Republic ofMacedonia has become more pressing. We analyzedcardiovascular diseases, malignant neoplasms,diabetes mellitus, respiratory and urinary diseases thatwere responsible for approximately >80% of maleand female mortality in 2000 and 2011.Methods: The Macedonia burden of disease study(BoD) is largely based on the methods developedfor the Global BoD Study. The method allows thequantification of all states of ill-health into acommon indicator that is disability-adjusted life years(DALY). The reference year for the analysis was2011 compared with 2000.Results: The increase of DALYs (per 1000population) in 2011 compared with 2000 was 10.4%for all cause mortality. In particular, we noticed anincrease of 10.8% for circulatorymortality, 4.3% formalignant neoplasm and diabetes, and 2.3% forurinary infections. According to our estimations, atotal of 18641 DALYs in the country will be savedunder the assumption that the selected risk factorswould decrease by 5% in a given time frame.Conclusion: The results coming from the BoDanalysis in the Republic of Macedonia are not onlyof relevance for the decision-makers in thegovernment, but also for all key institutions relatedto health. The DALYs measure is a promising toolto improve the capacity of public health professionalsto assess population health and establishevidence-based decision-making in public health.Keywords: burden of disease, disability-adjusted lifeyears, mortality, Republicof Macedonia.12 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAAssessment of risk factors for chronic diseasesin Kosova- STEPSwise approachSanije Gashi 1,2 , Naser Ramadani 1,2 ,Merita Berisha 1,2 , Silvije Vuletic 31National Institute of Public Health, Pristine, Kosovo;2Medical Faculty, University of Pristine, Pristine, Kosovo;3School of Medicine, University of Zagreb, Zagreb, Croatia.Aim: In 2005, the major chronic, noncommunicablediseases accounted for 60% of alldeaths and 47% of the global burden of disease.About 80% of chronic disease mortality is alreadyoccurring in low and middle income countries.The aim of this study was to carry out anepidemiological survey on risk factors forchronic diseases in Kosovo, according to theprotocol of WHO: STEPSwise approach to chronicdisease risk factor surveillance .Methods: According to the STEPSmethodology, 6117 people aged 15-64 yearswere included in this survey: 3028 (49.5%) malesand 3089 (50.5%) females. This survey wasconducted for the first time in Kosovo in 2010-2011.Results: Currently, 28.4% of responders smokecigarettes, males more often than females (37.4%vs. 19.7%, respectively). According to the surveyfindings, the prevalence of alcohol consumptionis not high in Kosovo. Lifetime abstainers ofalcohol constitute 75.5% among the males and93.1% among the females (overall prevalence:84.4%). In a typical week, more than half of theresponders (55.5%) declare that they eat fruitsevery day. The mean number of fruit servingsconsumed per day is 1.6, with no evidence for asex-difference. Only 11.5% of the respondersdeclare that they make vigorous physical activitiesand 19.2% of the population 15-64 years old isobese.Conclusion: Our findings indicate that the mainrisk factors for development of chronic diseasesin Kosovo are high prevalent at a population level.Such factors include smoking, physical inactivityand obesity. Conversely, alcohol intake is quitelow in the adult population of Kosovo.Keywords: chronic diseases, non-communicable diseases, Kosovo, risk factors, STEPS methodology.ALBANIAN MEDICAL JOURNAL SUPPLEMENT13

ALBANIAN MEDICAL JOURNAL SUPPLEMENTThe prevalence of adverse childhood experiencesand their relationship with behavioral factors in theAlbanian young populationGentiana Qirjako 1,2 , Genc Burazeri 1,2 , Bajram Hysa 3 , Erka Amursi 2 ,Alban Ylli 1,2 , Gazmend Bejtja 4 , Vasil Miho 5 , Dinesh Sethi 61Faculty of Public Health, University of Medicine, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3Faculty of Medicine, University of Medicine, Tirana, Albania;4Ministry of Health, Tirana, Albania;5WHO Country Office, Tirana, Albania;6WHO Regional Office for Europe, Copenhagen, Denmark.Aim: In the past decade, several international studieshave reported on the links between child maltreatment,risky behaviors and various chronic diseases.Our survey aimed to describe the magnitude ofAdverse Childhood Experiences (ACE) in theAlbanian young population and their associationswith risky behaviors.Methods: This survey was conducted in arepresentative sample of young adults (N=1437)selected from public universities [971 females (67.6%)and 466 males (32.4%); mean age: 21.2±2.3 years].The data collection consisted of an anonymous andself-administered structured questionnaire.Results: Results showed that the prevalence of childmaltreatment in this student population was high:sexual abuse 6%, physical abuse 42%, and emotionalabuse 51%. Overall, 14% of the students reportedat least four ACEs and almost half of themreported two or more ACEs. As for the lifestyle/behavioral factors, ACEs were positively associatedwith smoking, alcohol consumption, early lifetimesexual intercourse, number of sexual partners (>3)and unwanted pregnancies.Conclusion: Of particular importance, the findingsof this study conducted in Albania show that theodds of developing health risk behaviors such assmoking, alcohol abuse, illicit drug use, multiplesexual partners and suicide attempts increase withthe ACE score, implying a causal relationship.Appropriate strategies are needed for the preventionof child maltreatment in Albania.Keywords: adverse childhood experiences, alcohol abuse, behavioral factors, drug use, lifestyle factors, smoking.14 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPARALLEL SESSIONSSession 1: Chronic DiseasesModerator:Genc BurazeriALBANIAN MEDICAL JOURNAL SUPPLEMENT15

ALBANIAN MEDICAL JOURNAL SUPPLEMENTDepression and self reported mobility among olderpeople in five countries: IMIAS studyAlban Ylli 1,2 , Gentiana Qirjako 1,2 , Genc Burazeri 1,2 , Eduard Kakarriqi 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: The objective of this study was to assess theassociation of depression and self-reported mobilitycontrolling for socio-demographic characteristicsamong older people.Methods: The data for this presentation are basedon a pooled sample of 1993 older people fromBrazil (Natal), Canada (st. Hyacinte and Kingston),Columbia (Manizales) and Albania (Tirana). In allfive sites, all older people aged 65-74 years from aselected community were invited to participate. Astructured questionnaire and standard measurementswere used, including CES-D scale for depression,SPPB for physical performance, life spaceassessment instrument and Nagi s functionallimitation questionnaire.Results: overall, 27% of participants were classifiedas having a score of 16 or over in CES-D scale.There were significant variations between sites, withTirana exhibiting the highest proportion (39%) andKingston the lowest one (10%). Depression wassignificantly higher among females (33%), amongthose with lower education (31%) and among thepoor (37%). As it is documented elsewhere,depression was particularlyhigher with prevalencerates of over 70% among older people with poorphysical performance. Depression was significantlyhigher (42%) among people with lower mobility thatis difficulty walking 400 m or climbing stairs. Poormobility keeps predicting significantly well depressioneven after controlling for sex, education,income, study site and physical performance (OR2.2, 95%CI=1.7-2.9). Upon multivariable adjustment,only Tirana and st. Hyacinte display higherodds of depression compared to Kingston.Conclusion: People who feel difficulty in walkingor climbing stairs are likely to feel depressed,regardless of their measured physical performanceand socio-demographic characteristics.Keywords: aging, IMIA S study, mobility, older people.16 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAA primary health care based model for risk factorsof non-communicable diseases in AlbaniaJeta Lakrori 1 , Sonela Xinxo 1 , Alban Ylli 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Context: Currently, non-communicable diseasesNCDs (cardiovascular, cancers and chronicobstructive pulmonary disease) account for 89% ofdeaths in Albania. Risk factors such as tobacco andalcohol use and poor diet are widespread in bothurban and rural settings in Albania. Metabolicconditions such as hypertension and diabetes affectthe population, but people are often unaware oftheir condition which may also be poorly managed.Under these circumstances, the prevention and earlydetection of the NCD risk factors is considered acrucial intervention. Primary Health Care (PHC) inAlbania has a traditionally good coverage of thepopulation.Methods: The Albanian Institute of Public Healthhas started an NCD prevention model based on thestandardization of simple techniques to identifyhigher risk persons and training of PHC staff.Selection of risk factors screening methods is basedin the review of the best practices recommended byGRADE working group. Risk factors included in thestandard manual include smoking, sedentary life,alcohol abuse, obesity, high blood pressure, high totalcholesterol, poor diet, and poor stress management.In addition, standardized strategies for dealing withpositively classified cases are recommended.Results: A two-day course on screening for NCDrisk factors is already accredited and four courses areprovided in Tirana and Durres. This model ofprevention of NCD risk factors, applied in theprimary health care settings, is considered a low-costapproach for identifying the high risk groups fordeveloping NCDs.Conclusion: The continuous capacity building of theprimary health care providers, and the systematicmonitoring and supervision of the program will becrucial for the long-term success of this model inAlbania.Keywords: non-communicablediseases, prevention, primaryhealth care.ALBANIAN MEDICAL JOURNAL SUPPLEMENT17

ALBANIAN MEDICAL JOURNAL SUPPLEMENTHypertension as a major chronic condition in theadult population of KosovoValdet Hashani 1 , Enver Roshi 2,31Ministry of Health, Pristine, Kosovo;2Institute of Public Health, Tirana, Albania;3Faculty of Public Health, University of Medicine, Tirana, Albania.In the recent decade, hypertension has attracted evenmore attention from researchers and policy makers.Hypertension is considered as one of the mostwidespread medical conditions affecting peopleworldwide. The main concern is attributed to themorbidity and mortality rate associated withhypertension, a condition which nevertheless can becontrolled and prevented at a population level.Hypertension is also confirmed as an importantpredictor of coronary heart disease in the Kosovoadult population in both sexes. It is welldocumentedthat hypertension is an important riskfactor for ischemic heart disease and this has beenconfirmed by the Global Burden of Disease Studyupdate for 2004. The particularly rapid pace oftransition in Kosovo and its inherent association withhypertension, including also reduced energyexpenditure and resultant overweight and obesity,bear important implications for both the health careand health promotion sectors in post-war Kosovo.The prevalence of diabetes has also increased inKosovo since 1990 along with a steady increase inthe prevalence of hypertension. Therefore, aselsewhere, the increase in the prevalence rates ofdiabetes and hypertension, consequent to increasedobesity and reduced energy expenditure, is anotherissue of concern in Kosovo and bears importanthealth policy implications, similar to the situation inother populations undergoing rapid transition andsocial change.In conclusion, hypertension is ranked high in publichealth policy agenda in most of the countriesincluding developed/industrialized societies, as wellas developing/transitional countries such as Kosovo.Keywords: hypertension, high blood pressure, Kosovo, transitional countries.18 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAMortality from cerebrovascular diseases in Kosovofor the period 2006-2011Merita Berisha 1 , Valbona Zhjeqi 1 , Rina Hoxha 1 , Sanije Gashi 1 ,Valbona Govori 1 , Naser Ramadani 1 , Drita Zajmi 1 , Ilir Begolli 11Institute of Public Health, Pristine, Kosovo.Aim: Cardiovascular diseases (CVD) are the maincause of mortality globally; by 2030, almost 25million people will die from CVDs, mainly from heartdisease and stroke. Most CVDs can be prevented byaddressing the risk factors. Heart attacks and stroke areusually acute events. In Kosovo, CVDs are number onecauses of deaths too. The aim of this study was toanalyze the trend of deaths from cerebrovasculardisease (I60-I69) from 2006 to 2011, according toseveral modalities, as well as age group and gender.Methods: Retrospective data analyses was done, usingreports for Causesof death in Kosovafrom2006-2011 .Data were presented through tables and graphs;statistical parameters calculated such as relative numbers,trends, and assessed with chi-square test for thestatistical significance level set at p

ALBANIAN MEDICAL JOURNAL SUPPLEMENTPrevention of cardiovascular diseases in theRepublic of MacedoniaElena Kosevska 1 , Doncho Donev 2 , Aziz Pollozhani 1 , Shaban Memeti 11Institute for Public Health, Skopje, Republic of Macedonia;2Institute for Social Medicine, Medical Faculty,University Ss. Cyril and Methodius ,Skopje, Republic of Macedonia.Aim: The aim of this study is to present the currentstatus of cardiovascular diseases (CVD) in theRepublic of Macedonia and preventive measuresthat are undertaken in order to reduce its relatedmorbidity and mortality.Methods: Statistical data for morbidity andmortality were analyzed. Furthermore, researchstudies and professional materials from domesticand foreign literature were scrutinized.Results: 57.9% (approximately, 11000 people) diedfrom CVD in the Republic of Macedonia. Thereis no trend of reducing deaths from these diseases(in 1990: 7113 deaths, or 48.6% of the overallnumber of deaths). One fifth of deaths were dueto ischemic heart diseases (IHD) and 90% of deathswere due to acute heart attack. The rate of hospitalmorbidity by CVD in the Republic of Macedoniais equal to approximately 172.2/ 10000, with anaverage of 35000 patients, mostly men. CVDaccounted for 14.3% of the total number of hospitaldiseases. The most common disease was CHD thatmostly occurs after 40 years of life and is morecommon in men.Conclusion: The Republic of Macedonia follows theWHO recommendations for a comprehensiveapproach for CVD prevention as a successful publichealth measure. Thus, in 2013, the Macedoniangovernment adopted a national program for CVDprevention, as it was proposed in the National Strategyfor NCD Prevention and Control. A holistic approachin implementation including health promotion andscreening is part of the program with more activeinvolvement of primary health care doctors. Mainstakeholders include the Ministry of Health, the Instituteof Public Health, ten Public Health Centres, and theUniversity Clinic for Cardiology.Keywords: cardiovascular disease, non-communicable diseases, prevention, Republic of Macedonia.20 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAAssociation of particulate air pollution with hospitaladmissions in pediatric clinics in Pristine, KosovoAntigona Ukëhaxhaj 1 , Naser Ramadani 1 , Dragan Gjorgjev 2 ,Selvete Krasniqi 1 , Tahire Maloku 1 , Drita Zogaj 1 , Sanije Gashi 1 ,Arbresha Loxha 11National Institute of Public Health, Pristine, Kosovo;2Medical Faculty, University of Skopje Kirij i Metodij , Skopje, FYROM.Aim: Air pollution is a critical environmentalproblem in urban areas in Kosovo. Ambient airquality is particularly poor in Pristine, the Obiliq area,and the Drenas area. The principal sources ofcontaminants are sulfur dioxide (SO2), nitrogenoxides NO and NO2 (NOx), ozone (O3), lead(Pb), carbon dioxide (CO2), particulate matter (PMor dust). The objective of this study was toinvestigate and define the current burden of acuteand chronic effects of particulate matters airpollution through specific mortality data andrespiratoryhospital admissions in UCCK Pristine,as well as to estimate potential benefits ofdecreasing of daily PM10 levels.Methods: The analytical research has predicted thepotential benefit of decreasing of daily average forconcentrations of O 3, Pm10 and PM2.5 and theimpact on human health in Pristine and Drenas forthe years 2010, 2011 and 2012. The study populationconsisted of all hospitalized patients in pediatricclinics for the period 2010-2012. Air pollutionmeasurements was used by KHMI data for theperiod 2010-2012 for the municipality of Pristinein the measurements point in: KHMI-MESP whichis equipped with automatic analyzer sulfur dioxide(SO 2), nitrogen oxides (NO x) carbon monoxide(CO), O 3, suspended particle analyzer PM10/PM2.5with air pointer Automatic Air Compact MonitoringSystem (Version 2.2) recordum MESSTECHNIKGmbH. Poisson regression models were used toassess the association of air pollutant concentrationswith hospitalization rates.Results: The air quality data from KHMI show thatPM, notably, exceeds the European Union limitvalue of an average annual concentration of 40 ìg/m 3 for PM10, both in the city center and in thesuburban area and often exceeds the one-day limitvalue (not to be exceeded more than 35 times a year)of 50 ìg/ m 3 . The overall number of deaths inchildren for the period 2010-2012 was 4880. Overallmorbidity in children was 2389: among childrenaged 0-4 years there were 1871 (78.3%) cases withrespiratory diseases, whereas in children aged 5-14years there were 518 (21.7%) cases with respiratorydiseases.Conclusion: This study has shown strong andconsistent associations between children hospitaladmissions from respiratory diseases and airpollution in Pristine, Obiliq and Drenas. Thesefindings provide evidence that air pollution continuesto have a significant adverse effect on populationhealth in Kosovo.Keywords: A ir pollution, airborneparticles, children respiratorydiseases, hospital admission, mortalityALBANIAN MEDICAL JOURNAL SUPPLEMENT21

ALBANIAN MEDICAL JOURNAL SUPPLEMENTHaemoglobinopathies in Albania: A public healthchallengeManika Kreka 1,2 , Gentiana Qirjako 3 , Eleni Nastas 2 , Anila Godo 2 ,Bledi Kreka 41Faculty of Technical Medical Sciences, University of Medicine, Tirana, Albania;2Service of Onco-Haematology Service, National Center of Haemoglobinopathies, University Hospital CenterMother Teresa , Tirana, Albania;3Faculty of Public Health, University of Medicine, Tirana, Albania;4Oncology Service, University Hospital Center Mother Teresa , Tirana, Albania.Haemoglobinoapathies are part of a considerablegroup of chronic genetic diseases, which are alwaysin focus of public health and are at a greaterimportance. About 7% of the world s populationis considered to be carrier of abnormal andpathological gene of hemoglobin.Our aim was to describe the register of haemoglobinopathicpatients data in the National Centerof Haemoglobinopathies in Albania.The mean age of individuals with haemoglobinopathiespatients studied was 17.3 years forfemales and 16.4 years for males. The mean age ofour patients is younger than in other countries. 65patients belong to the youngest age-group (1-10years old). About 97% of our patients were bornand live in the west area of Albania and only 3%live in North Albania (Fier: 68 patients; Tirana: 55patients; Kavaja: 40 patients; Vlora: 36 patients;Durrës: 23 patients; in cities of North Albania: 15patients).Patients diagnosed with Beta Thalassaeamia andIntermedia constitute 84.5% of the total, andpatients with Sickle Cell Disease constitute 15.5%.Patients over 18 years of age have a higher frequencyof thalassaemia compared to the Sickle Cell Disease.Haemoglobinoapathies are a great public healthproblem in Albania. Prevention policies related tobirth control of individuals with Haemoglobinopathiesis a serious challenge.Keywords: Haemoglobinoapathies, Sickle Cell Disease, thalasemia.22 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIASelf-reported health and type 2 diabetes mellitus in arepresentative sample of Albanian adults: a crosssectionalstudyArjan Bregu 1 , Ervin Toçi 2 , Afrim Pirraçi 3 , Jolanda Hyska 2 , Gentiana Qirjako 2 ,Irida Pano 4 , Llukan Rrumbullaku 51Ministry of Health, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3University Hospital Center Mother Teresa , Tirana, Albania;4Faculty of Technical Medical Sciences, University of Medicine, Tirana, Albania;5Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: Type 2 diabetes mellitus (DM) is an incurablechronic disease. Full collaboration and participationof individual patients is required to successfullymanage and control DM. This could affect patientsperception of their health status. In this context, ouraim was to assess the association of self-rated healthand DM.Methods: A cross-sectional survey was carried outin a representative sample of adults aged e 18 yearsold in Tirana, during April-November 2012. 845randomly selected individuals accepted to participate(response rate: 84.5%). Participants were askedwhether they had been ever told by a doctor thatthey had diabetes and to rate their own health status.Basic socio-demographic data were also collected.Results: Mean age of participants was 50.4 yearsold (51.3 years in men and 49.7% in women). Theoverall prevalence of diabetes in this sample ofadults was 11.5%. Approximately 7% ofparticipants rated their own health status as poor(7.0% of men and 7.4% of women). The overallprevalence of diabetes was 11.5%. DM prevalencewas significantly higher among those self-perceivingtheir health status as poor (35.2%) and average(23.0%) compared to 5.1% of diabetics withgood health status. In multivariable adjustedanalysis, self-perceived poor health was stronglyassociated with diabetes (OR=6.5, 95% CI=2.9-14.7).Conclusion: DM might be associated withsignificantly worse quality of life even aftercontrolling for a number of socio-demographicfactors. There is need for urgent patient educationinterventions in order to reduce the stress related toDM among Albanian patients.Keywords: adults, Albania, diabetes mellitus, self-perceived health.ALBANIAN MEDICAL JOURNAL SUPPLEMENT23

ALBANIAN MEDICAL JOURNAL SUPPLEMENTType 2 diabetes mellitus and the geneticcomponent: opportunities for early preventionHerion Muja 11Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: Type 2 diabetes mellitus (DM) is reported tohave a genetic component. Changes in life-stylecharacteristics of Albanian population point towardan increasing prevalence of DM in the future. Anypreventive option could help to alleviate DMburden. Our aim was to determine the associationof family history of diabetes with the presence ofDM among Albanian adults.Methods: During April-November 2012, 845randomly selected urban Tirana individuals agede 18 years old were interviewed. Participants wereasked to report if they had ever been diagnosedwith diabetes by a doctor or other medical staff andwhether they had any diabetic close relatives. Binarylogistic regression was used to assess the associationof family history with type 2 DM.Results: Mean age of participants was 50.4 yearsold (51.3 years in men and 49.7% in women). Theoverall prevalence of diabetes in this sample ofadults was 11.5% (no significant sex difference).Almost one third of respondents (32.4%) had atleast one close relative with diabetes. The likelihoodof having DM was 4.6 time higher among thosewith a positive family history for diabetes comparedto those having no diabetic relatives (OR=4.6, 95%CI:2.7-7.9) after multivariable adjustment analysis.Conclusion: Type 2 DM has a strong geneticcomponent among Albanian adult population.Educating the general population about this aspectcould raise the awareness of diabetic individualsclose relatives to regularly monitor their blood sugarlevels and avoid diabetes risk factors.Keywords: adults, diabetes mellitus, diabetes familyhistory.24 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAStress Reduction in the Secondary Prevention ofCardiovascular Disease Randomized, ControlledTrial of Transcendental Meditation and HealthEducation in Black individualsRobert H. Schneider 11Institute for Natural Medicine and Prevention, Maharishi University of Management, Fairfield, USA.Context: Blacks have disproportionately high ratesof cardiovascular disease. Psychosocial stress maycontribute to this disparity. Previous trials on stressreduction with the Transcendental Meditation (TM)program have reported improvements in cardiovasculardisease risk factors, surrogate end points,and mortality in blacks and other populations.Methods: This was a randomized, controlled trialof 201 black men and women with coronary heartdisease who were randomized to the TM programor health education. The primary end point was thecomposite of all-cause mortality, myocardialinfarction, or stroke. Secondary end points includedthe composite of cardiovascular mortality, revascularizations,and cardiovascular hospitalizations; bloodpressure; psychosocial stress factors; and lifestylebehaviors.Results: During an average follow-up of 5.4 years,there was a 48% risk reduction in the primary endpoint in the TM group (hazard ratio, 0.52; 95%confidence interval, 0.29 0.92; P=0.025). The TMgroup also showed a 24% risk reduction in thesecondary end point (hazard ratio, 0.76; 95%confidence interval, 0.51 0.1.13; P=0.17). Therewere reductions of 4.9 mm Hg in systolic bloodpressure (95% confidence interval -8.3 to 1.5 mmHg; P=0.01) and anger expression (P

ALBANIAN MEDICAL JOURNAL SUPPLEMENTDoes moderate alcohol use reduce the incidence ofcoronary heart disease?Sokol Myftiu 1 , Eliverta Majko 1 , Shpëtim Doksani 21Cardiology Service, University Hospital Center Mother Teresa , Tirana, Albania;2Clinic of Alcohol Addiction Treatment, University Hospital Center Mother Teresa , Tirana, Albania.Excessive alcohol intake has been associated with anelevated risk of liver disease, heart failure, cancer, andaccidental injury. Excessive alcohol consumption isa leading cause of death in industrializedcountries. However, research suggests that moderatealcohol intake is associated with some health benefitsincluding a decreased risk of cardiovascular disease.Public awareness of the French paradox in theearly 1990s stimulated an increased interest in thesubject of alcohol and heart disease. Given theepidemiological evidence that moderate drinkingreduces heart disease, it becomes important toexamine pathways from which alcohol might conferits cardiovascular benefits. Research suggests thatmoderate alcohol consumption improves cardiovascularhealth in a number of ways, including thefollowing:i. Alcohol improves blood lipid profile:a. It increases HDL cholesterol.b. It decreases LDL cholesterol.c. It improves cholesterol (both HDL andLDL) particle size.ii. Alcohol decreases thrombosis (bloodclotting):a. It reduces platelet aggregation.b. It reduces fibrinogen (a blood clotter).c. It increases fibrinolysis (the process bywhich clots dissolve).iii. Alcohol acts through additional ways:a. It reduces coronary artery spasm inresponse to stress.b. It increases coronary blood flow.c. It reduces blood pressure.d. It reduces blood insulin level.e. It increases estrogen levels.There is a lack of medical consensus about whethermoderate consumption of beer, wine, or distilledspirits has a stronger association with heart disease.Studies suggest that each drink is beneficial, withnone having a clear advantage. Most researchersnow believe that the most important ingredient isthe alcohol itself.The American Heart Association has recentlyreported that Morethan a dozen prospectivestudieshavedemonstrated a consistent, strong, dose-response relationbetween increasing alcohol consumption and decreasing incidenceof coronaryheart disease. Thedata aresimilar in men andwomen in a number of different geographic and ethnic groups.Consumption of one or two drinks per day is associated witha reduction in risk of approximately 30% to50%.Keywords: excessivealcohol intake, coronaryheart disease, moderatealcohol intake.26 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIACorrelation of uric renal stones with hypertensionand body mass indexValbona Bajrami 1 , Alma Idrizi 2 , Enver Roshi 3,4 , Yllka Themeli 11Diagnostic Center Ikeda;2Service of Nephrology, University Hospital Center Mother Teresa , Tirana, Albania;3Institute of Public Health, Tirana, Albania;4Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: The aim of the study was to assess theprevalence of hypertension in patients with uric acidstones and compare it with the hypertensivepopulation without renal stones. We also aimed toassess the correlations between renal stone diseasewith age and obesity.Methods: In this study, there were examined 40patients. Patients with uric acid stones were 25 versus15 patients with no renal stones.Results: The prevalence of hypertension was similarin both groups. The patients with renal stones,however, had a higher level of mean systolic anddiastolic blood pressure compared with patientswithout stones (155±12 mmHg vs. 145±8 mmHg,and 100± 0.9 mmHg vs. 100± 0.2 mmHg,respectively). Patients with renal stones were older(47±15 vs. 38±5 years), had a higher prevalence ofobesity (mean BMI: 28±0.4 vs. 25.7±0.6), had higherlevels of total cholesterol level (220±5mg/ dl vs.203± 4 mg/ dl) as well as triglyceride levels(160±9mg/dl vs. 126±4mg/dl), compared with norenal stone individuals.Conclusion: Patients with renal stones in our studyhad a higher mean level of systolic and diastolicblood pressure, BMI and cholesterol andtriglycerides levels compared with individualswithout renal stones. Future studies in Albania shouldinclude larger population-representative samples.Keywords: age, body mass index, hypertension, uric renal stones.ALBANIAN MEDICAL JOURNAL SUPPLEMENT27

ALBANIAN MEDICAL JOURNAL SUPPLEMENTChronic cholecystitis without gallstones in a sampleof Albanian patientsAfrim Pirraçi 1 , Arben Mitrushi 21University Hospital Center Mother Teresa , Tirana, Albania;2Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: Chronic cholecystitis without gallstones is aclinical condition characterized by gallbladdersymptoms in the absence of cholelythiasis. Our aimwas to describe chronic cholecystitis withoutgallstones among overweight patients in Albania, atransitional country in Southeast Europe.Methods: A study was conducted in Tirana, theAlbanian capital city, in 2012 including a sample of51 patients diagnosed with chronic cholecystitiswithout gallstones. All patients underwent a detailedand comprehensive ultrasound examination.Results: Overall, there were 31 (61%) male patientsand 20 (39%) female patients. Median age was 55years (interquartile range: 31 years; range: 21-83years). Overall, there were 43 (84%) obese(BMI>30) individuals, of whom 12 (28%) were veryobese (BMI>40). Three female participants werepregnant, two individuals had heart failure, onepatient had myocardial infarction, and one furtherparticipant had liver cirrhosis. In this sample ofAlbanian patients, the ultrasound characteristicsconsisted of gallbladder wall thickening, gallbladderenlargement, striated gallbladder wall, pericholecysticfluid, and coffee ground gallbladder.Conclusion: This is one of the few reportsdescribing the distribution of chronic cholecystitisin the absence of gallstones in Albanian patients.Currently, the diagnosis and treatment of chroniccholecystitis without gallstones is controversial.Recently, laparoscopic cholecystectomy has beenconsidered the most suitable intervention for thisclinical condition. Future studies in Albania shouldassess the main determinants of chronic cholecystitiswithout gallstones.Keywords: Albania, chronic cholecystitis without gallstones, gallbladder.28 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPolyethylene glycol conjugates with proteins:concept, design and therapeutical applications atthe University Hospital Center Mother Teresa inTiranaMirlinda Likmeta 1 , Artan Shkoza 2 , Ela Hoti 3 , Ledjan Malaj 31University Hospital Center (UHC) Mother Teresa , Tirana, Albania;2Department of Biomedical Sciences, Faculty of Medicine, University of Medicine, Tirana, Albania;3Faculty of Pharmacy, University of Medicine, Tirana, Albania.Aim: This study aims to describe the fundamentaltechnological and scientific principles of advanceddrug delivery/targeting and to analyze the applicationof polyethylene glycol (PEG) conjugates withproteins by the Clinics of University Hospital Center(UHC) Mother Teresa in Tirana, Albania.Methods: A broad overview (from the beginningof 2000s until now) of advanced drug delivery/targeting recent papers is collected and provided inorder to introduce the terminology and various keyconcepts pertinent to this subject and in particularemphasizing the PEG conjugates with proteins. Theclinical use over time by the clinics of UHCMother Teresa of these new products is analyzedand pharmaceutical, economical and therapeuticconsiderations are provided.Results: Recently, it has been proved that endfunctionalizedPEG can modify biologically activeproteins. This interaction can cause a reduction ofimmunogenicity, but also an alteration of pharmacokinetics.The modification of a protein by PEGis the so-called PEGylation . Therapeuticaladvantages of PEGylation are also an increasedretention time in the body and an increased stabilitytowards metabolic enzymes. In addition, PEGylationof proteins can also impart sustained clinicalresponse with minimal dosing, leading to improvedquality of life and reduced treatment cost. Despitetheir biopharmaceutical advantages the use ofconjugates is still limited in UHC Mother Teresa .The products in use are mainly PEG conjugates ofinterferon used in the treatment of chronic hepatitisB and C and PEG conjugates of erythropoietinused in the treatment of patients with anaemiaassociated with chronic kidney disease. The numberof the dosage forms units of Pegasys used is 1833per year and the price is 240 euro. The number ofthe dosage forms units of Pegintron used is 100 peryear and the price is 361 euro. The treatment perpatient is of one year with a frequency of oneapplication per week. The number of the dosageforms units of Mircera used is approximately 275and the price various on the dosage used. Theproper dosage is prescribed depending on thepatients Hb level and also, duration of the treatmentdepends on the patient s hemoglobin level.Conclusion: The use of biotechnological productsis in expansion and of great interest from thepharmaceutical and therapeutic point of view. Theuse of these products remains still limited in Albania.Advice is given on the benefits of use of theseproducts such as increased efficiency, convenienceand the potential market expansion.Keywords: biotechnological products, polyethylene glycol conjugates, proteinsALBANIAN MEDICAL JOURNAL SUPPLEMENT29

ALBANIAN MEDICAL JOURNAL SUPPLEMENTCorrelation between AAN, anti DNA, C3 and C4 withdisease activity in Systemic Lupus ErythematosusErgeta Ktona 1 , Myftar Barbullushi 2 , Teuta Backa 3 , Enver Roshi 4,5 ,Alma Idrizi 2 , Valbona Bajrami 11Ikeda DC, Tirana, Albania;2Nephrology Service, University Hospital Center Mother Teresa , Tirana, Albania;3Rheumatology Service, University Hospital Center Mother Teresa , Tirana, Albania;4Faculty of Public Health, University of Medicine, Tirana, Albania;5Institute of Public Health, Tirana, Albania.Aim: The aim of this study was to determine thecorrelations between antinucleosome antibodies(ANA) and anti-double-stranded (ds) DNAantibodies, complement (C) 3 and 4 levels, andclinical activities in Systemic Lupus Erythematosus(SLE) patients.Methods: Antinucleosome antibodies and antidsDNAantibodies were detected by enzyme-linkedimmunosorbent assays (ELISA). The levels of C3and C4 were measured by nephelometry. Clinicalactivities were determined by SLE clinical andlaboratory test in collaboration with Disease ActivityIndex.Results: Among 96 SLE patients, the prevalenceof AAN was 54.1% (n=52 patients), higher than38.5% (n=37 patients) [p

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIARetrospective study of cerebral infarction casesdiagnosed with carotid angio-CTAltina Xhaferi 1 , Medien Xhaferi 2 , Ilirjana Zekja 1 , Klodiana Poshi 1 ,Astrit Hoxhaj 31Faculty of Technical Medical Sciences, University of Medicine, Tirana, Albania;2University Trauma Hospital, Tirana, Albania;3Hygeia Hospital, Tirana, Albania.Aim: Carotid CTA is a useful examination for themanagement of ischemic stroke and atherosclerosislinked with vascular risk factors. Age and gender areindependent factors for stroke. Lacunar strokeseems to be attributed to chronic HTA, diabetesmellitus, while non-lacunar infarction to CAS andAF. Our aim was to describe cases of cerebralinfarction diagnosed with carotid angio-CT inAlbania.Methods: A retrospective case review study ofpatients that performed carotid CTA (527 cases) inTirana was conducted in 2012. The study samplewas retrieved from in-hospital admissions as wellas outpatients. Cerebral non-lacunar and lacunarinfarction patients who performed CT scanningand/or magnetic resonance imaging were examinedand compared with regard to CAS.Results: There was a significant associationbetween age and the grade of carotid artery stenosis(P=0.001). Furthermore, there was a statisticallysignificant male predominance (P=0.001). Also, therewas evidence of a significant correlation betweengrade of CAS and smoking (P=0.001), CAS andHTA (P=0.001), CAS and diabetes (P=0.001), CASand high cholesterol (P=0.001). Finally, there wasevidence of significant difference between CAatherosclerotic plaques in non-lacunar (54%) versuslacunar infarction (36%) [P

ALBANIAN MEDICAL JOURNAL SUPPLEMENTUrticaria in our clinic during a period from January2012-December 2012Antigona Begolli Gerqari 1 , Mybera Ferizi 1 , Sadije Halimi 1 , Afërdita Daka 1 ,Ilir Begolli 21Dermato-Venerology Clinic, University Clinical Center, Pristine, Kosovo;2National Institute of Public Health, Pristine, Kosovo.Aim: Urticaria affects about 15%-20% of thepopulation in Kosovo. The main cause of thiscondition is still unknown, although food proteinand several drugs are considered as putative riskfactors for urticaria. In some cases, urticaria may bea warning sign of selected autoimmune diseases ofthe thyroid gland, malignant diseases, and systemicdiseases. The aim of our study was to describe theprevalence of urticaria referred to our clinic fromJanuary to December 2012.Methods: This study presents results of aretrospective study of male patients referred to theClinic of Dermato-Venerology in Pristine sufferingfrom different forms of urticaria during 2012. Theage of the patients was 18 years and older. Dataon potential risk factors for urticaria (food and drugs)were included in this study.Results: We had 196 hospitalized male patients in ourclinic during 2012. Based on our records, urticaria waspresent in 33 cases (17%). Thirty patients had acute urticaria(90%), whereas 3 (11%) patients had urticaria recidivans.In 85% of the cases we identified the following riskfactors for urticaria: 60% were food-related, 25% weredrug-related, whereas for the remaining 25% of the casesthe cause of the disease was unknown.Conclusion: Acute urticaria was quite prevalent in thismale population in Pristina, the capital cityof Kosovo.Our findings indicate that the main cause of urticariainvolved food proteins (60%) followed by drug use(25%).Keywords: Dermato-Venerology, Pristine, urticaria.32 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIADermoid cyst in a patient with operated congenitalglaucoma-case reportArjeta Grezda 1 , Ermal Simaku 1 , Luljeta Jaupaj 11Eye Clinic, University Hospital Centre Mother Theresa , Tirana, Albania.Aim: Dermoid cyst is a pathological condition andit needs surgical treatment, while bleb is aconsequence of a surgical treatment for glaucoma.Our aim was to describe a case study distinguishingdermoid cyst from the bleb in a congenitalglaucoma.Methods: A female patient aged 18 years presentedcomplains of a whitish mass positioned in the uppernasal side of the right eye, growing since two years.The mass started to interfere with her vision and herappearance. She had glaucoma surgery when she wassix months old. Her eye exam showed the followingcharacteristics:· RE: BCVA 2/ 10, IOP 12mmHg, Conj. -diffuse bleb at 12-13 o clock. Cornea-Haab s striaepresent.· Whitish- dermoid like cyst-positionedsuperonasalyoccupying ¼ of the cornea, AC -quietand very deep, Pupil -round and reactive.· Lens-clear, Fo. 0.85c/ d· LE: Unremarkable, normal.The patient underwent surgery. We dissected the cystfrom the stromal cornea, limbus and conjunctiva,avoiding perforation of the cornea. Suture of theconjunctiva was performed trying to save the bleb.Results: We followed the patient for four weeks.The sutures were removed day days after the surgery.The cornea healed well and bleb had the samestructure as before surgery. BCVA and IOPremained both unchanged and the patient wassatisfied with her appearance.Conclusion: Dermoid cyst is not related tocongenital glaucoma but it can occur inglaucomatous patients as in any normal or othereye-diseased patient. This case study indicates thatophthalmologists should distinguish dermoid cystfrom blebs in order to surgically treat the cyst andpreserve the bleb from erroneous manipulations.Keywords: bleb, congenital glaucoma, dermoid cyst.ALBANIAN MEDICAL JOURNAL SUPPLEMENT33

ALBANIAN MEDICAL JOURNAL SUPPLEMENTClinical blood use in patients undergoing coronaryartery bypass surgerySotiraq Lako 1 , Albana Daka 1 , Sabjan Memishaj 1 , Adela Vasili 2 ,Tatjana Nurka 31American Hospital, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3Faculty of Technical Medical Sciences, University of Medicine, Tirana, Albania.Aim: To assess the frequency of Red Blood Cells(RBC) transfusion and the impact of selected majorfactors on hemotransfusion rate, in patientsundergoing Coronary Artery Bypass Surgery(CABG) surgery over a period of two years inTirana, Albania.Methods: A prospective study of patients, in theCardiovascular Surgery Service of the AmericanHospital who underwent isolated CABG or incombination with other cardiac interventions. Theimpact of the CardioPulmonary Bypass Pump(CPB), gender, BMI d 25, age e 62.5 years, andpreoperative hematocrit 25 (P

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAObesity in the adult population of AlbaniaBujar Spahija 1 , Arjan Bregu 2 , Lulzim Çela 1 , Herion Muja 11Faculty of Public Health, University of Medicine, Tirana, Albania;2Ministry of Health, Tirana, Albania.Aim: The aim of this study was to assess theprevalence and distribution of overweight and obesityin the adult population of Albania, a transitionalcountry in Southeast Europe.Methods: A cross-sectional study was conducted in2007-2009 in Tirana, the Albanian capital city,including a sex-stratified random sample of 997Tirana residents aged 25-65 years (response rate: 83%).Physical examination included measurement of heightand weight (for calculation of the body mass index[BMI]), and hips and waist circumferences (forcalculation of the waist-to-hip ratio). In addition, astructured questionnaire was administered to allparticipants including information on demographicand socioeconomic characteristics and lifestyle/behavioral factors. Binary logistic regression was usedto assess the association of overweight (BMI>25) andobesity(BMIe 30) with covariates.Results: In this representative sample of Albanianadults, the prevalence of overweight was about 50%,whereas the prevalence of obesity was about 30%.Women were significantly more obese than men.Regardless of the gender, overweight and obesity wereboth positively and significantly associated with age, fatintake and carbohydrate intake.Conclusion: We obtained important evidence on theprevalence and distribution of overweight and obesityin transitional Albania. Our findings indicate thatoverweight and, particularly obesity, pose a seriouspublic health challenge for the Albanian health caresystem. Therefore, health care professionals and policymakers should focus particularly on the modifiable riskfactors such as unhealthy dietary patterns and lack ofphysical exercise as an effective means for controllingthe burden of obesity and its related morbidity andmortality in the Albanian adult population.Keywords: Albania, behavioral factors, lifestyle, obesity, overweight.ALBANIAN MEDICAL JOURNAL SUPPLEMENT35

ALBANIAN MEDICAL JOURNAL SUPPLEMENTthalassemia, a big public health problem in Vlora,AlbaniaVitori Hasani¹, Emirjona Kiçaj¹, Rudina Çerçizaj¹, Sonila Golemi²,Emiljana Coraj³, Dhurata Shena²¹Faculty of Public Health, University of Vlora, Vlora, Albania;²Regional Hospital of Vlora, Vlora, Albania;³Directorate of Public Health, Vlora, Albania.Aim: Thalassemia is a group of inherited diseases,which is characterized by a genetic defect ofhaemoglobin synthesis. The aim of this study wasto determine the number of patients withThalassemia receiving health care services in VloraRegional Hospital in order to define effectiveprevention programs for this disease with largeimpact.Methods: This was a descriptive study conductedin Vlora Hospital. The study population consistedof all patients with Thalassemia diagnosed andsuspected, presented in this hospital in the periodfrom 2010 to 2012. All data regarding sociodemographicprofile of individuals and the statusof Thalassemia were obtained from medical recordsof patients and registers of Vloras ThalassemiaCentre.Results: During the period 2010-2012, there were216 patients overall who were diagnosed withmajor Thalassemia in Vlora. Of these, 55.1%were females and 44.9% were males. About 45%of the patients resided in rural areas of Vlora and55% resided in the city of Vlora. About 56% ofthe patients were from 5 to 14 years of age,whereas only 1.3% (three patients) were 65 years orolder.Conclusion major Thalassaemia exhibited a highprevalence in Vlora Regional Hospital representinga serious public health challenge for this region ofAlbania. Prevention of Thalassemia can only berealized through a careful preliminary diagnosis ofadults who may be carriers of Thalassemia inorder to control birth events of sick children withThalassemia.Keywords: prevention, Thalassemia, Vlora.36 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPARALLEL SESSIONSSession 2: CancersModerator:Alban YlliALBANIAN MEDICAL JOURNAL SUPPLEMENT37

ALBANIAN MEDICAL JOURNAL SUPPLEMENTA new model of screening for breast cancer inAlbaniaAlban Ylli 1,2 , Kozeta Filipi 1 , Jeta Lakrori 1 , Eduard Kakarriqi 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.In Albania, an organized breast screening programdoes not yet exist. More than half of cancers arediagnosed in III/IV stage. Nevertheless, the level ofawareness among women about breast screeningand cervical screening is increasing during lastdecade; 80% of women had heard about mammogram.A team at Institute of Public Health (IPH) after twoyears analyses and assessments has proposed ascreening model based on Clinical Breast Examination(CBE) provided by PHC providers withreferral to the secondary care level for mammographywhen CBE abnormalities are detected. PHCproviders should also teach women to do BSE withall BSE abnormalities checked by CBE beforereferral to Mammography service. Abnormalitiesshould be followed-up by biopsy at the secondarycare level with referral to tertiary care when canceris suspected/ diagnosed. During 2012 IPH incollaboration with University Hospital Center (UHC)developed curricula and materials for in-countrytraining of general primary health care (PHC)practitioners on CBE, risk evaluation and referral formammogram and specialist. More than 180 doctorsare already trained, covering almost half of Albanianhealth centers with at least one trained practitioner.A complete practical guideline for GPs is plannedto be approved soon by Minister of Health.Trainings will continue through 2013 to completetrainings for GPs and start trainings for nurses.In addition to the continuation of these activities,during the next 2-3 years more efforts should bedirected to setting up an organized and sustainablemodel for comprehensive breast cancer control inAlbania, focusing first on three major regions ofcentral Albania (Tirana, Durres and Elbasan).Activities should be directed at establishment of aquality assurance system for breast imaging andimproving the responsiveness of the health systemin breast cancer care.Keywords: breast cancer, early detection, screening38 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAEpidemiology of breast cancer in AlbaniaElizana Petrela 1 , Ilir Akshija 2 , Ferdinand Jorgoni 2 , Agim Sallaku 31Faculty of Public Health, University of Medicine, Tirana, Albania;2University Hospital Centre Mother Teresa , Tirana, Albania;3Faculty of Medicine, University Hospital Centre Mother Teresa , Tirana, Albania.Context: Worldwide, it is estimated that more than1,38 milion women were diagnosed with breastcancer in 2008, and in Europe more than 332,000new cases of breast cancer were diagnosed at thesame time. Female breast cancer incidence rates varyconsiderably, with the highest rates in Europe andthe lowest rates in Africa and Asia. Breast cancerincidence rates generally increase with age,supporting a link with hormonal status. Theincidence of breast cancer has been increasing formany years in economically developed countries.Methods: We used the data of inter-hospital cancerregistry. University Hospital Center in Tirana is theonly national center which makes diagnosis andtreatment of cancer.Results: The breast cancer is the most frequentcancer in Albania, with a high mortality rate. Themean age at diagnosis for breast cancer is 51.3±10.4years old. The majority of the cases with breastcancer reside in urban areas (78%), especialy in Tiranacity, but there are cases of breast cancer all overAlbania.Conclusions: A lot of efforts have been made toestablish cancer screenning programs in Albania inthe past few years. Early detection is the key tosuccesful treatment of cancer. Albania shoulddefinitely build a national cancer register, which willprovide valid and reliable information about theincidence, survival, mortality rate, risk factors, andwill serve as a reference point for future screeningand treatment programs.Keywords: breast cancer, epidemiology, risk factors.ALBANIAN MEDICAL JOURNAL SUPPLEMENT39

ALBANIAN MEDICAL JOURNAL SUPPLEMENTPolicies and models adopted for breast and cervicalcancer screening in AlbaniaKozeta Filipi 1 , Alban Ylli 1,2 , Eduard Kakarriqi 1,2 , Philip Davis 31Department of Epidemiology and Health Systems, Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania;3European Cervical Cancer Association.In Albania, there is no organized breast and cervixscreening program. More than half of cancer casesare diagnosed in the third or the fourth stage of thedisease. During the past five years, there has been asharp increase in the availability of mammographycenters, but the utilization rates remains low. Lastyear, a detailed analyses (supported by UNFPA)which provided precise recommendations onscreening techniques and organizational modelsappropriate for Albania was followed byintroduction of clinical breast examination (CBE)among performance indicators of primary healthcare (PHC) providers by the Institute of HealthInsurance.The analyses and assessments have concluded in thefollowing screening algorithms to be adopted inAlbania in the short to medium terms:i. Breast screening will be undertaken usingCBE provided by PHC providers with referral tothe secondary care level for mammography whenCBE abnormalities are detected. Mammographyabnormalities should be followed-up by biopsy atthe secondary care level with referral to tertiary carewhen cancer is suspected/diagnosed.ii. Cervical screening will be developed byusing the conventional Pap-test with cervical samplescollected and prepared by PHC providers forsubsequent delivery to the cytology laboratory.When Pap abnormalities are detected, womenshould be referred to secondary health care forcolposcopy and biopsy. Women with confirmedCIN should be treated by LEEP, etc. at thesecondary care level while those with suspected/diagnosed invasive cancer should be referred totertiary care.Further international collaboration would consist inproviding training opportunities on different levelsof screening system. Supporting participation ofAlbanian cancer specialists in forums and networks,where best practices are shared, is vital.Keywords:screening, breast cancer, cervical cancer, A lbania40 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPsychosocial impact of oncologic palliative care inAlbaniaOrjola Pampuri 1 , Henrik Zotaj 21Institute of Public Health, Tirana, Albania;2Palliative Care Service Tirana, Albania.Treatment of individuals with cancer is a ratherchallenging endeavor in the Albanian context. Theinformation about palliative care is quite limited andcancer patients and their relatives are unfamiliar withthe necessary procedures and techniques of receivingpalliative care in Albania. The principles of servicedevelopment, methods and models of palliativecare are rapidly evolving in developed countries,though. Originally, palliative care was delivered inhospices where careful and ongoing efforts weremade to control pain at all time that patients weresuffering from various diseases, as well as controllingand stabilizing all the other symptoms, exhibited byindividuals.Currently, an important part of the treatment in thisregard pertains to the information with the latestdata on the number of patients and type of servicesoffered in oncology, palliative care specific centersin Tirana and, at the same time, the main goal is toprovide information about methods ofpsychotherapeutic treatment of patients receivingthese services, implementation and their effectiveness.The objectives of palliative care would be torecognize and inform the category of patientsreceiving medical treatment and psychotherapy, andevaluate the effectiveness of these services.Furthermore, the aim would be to inform andspecify the most effective psychotherapeutictreatments in oncology, palliative care as it affectspatients and their family members.For any kind of disease, no matter how advanced,regardless of treatment that can be given, there isalways something to obtain in terms ofimprovement of the quality of life of palliativepatients. The palliative care as a modern medicaldiscipline is relatively new, but it is one of the coredisciplines in the industrialized societies where agingissues are of paramount importance.Keywords: cancer, oncology, palliativecare,ALBANIAN MEDICAL JOURNAL SUPPLEMENT41

ALBANIAN MEDICAL JOURNAL SUPPLEMENTReducing the barriers on pain management inAlbania results from educational seminars withfamily doctorsRudina Rama 1,2 , Ali Xhixha 1 , Lukas Radbruch 31Sue Ryder Albania;2Department of Social Work and Social Policy, Tirana University, Tirana, Albania;3Center for Palliative Care, Malteser Hospital, Bonn, Germany.Aim: Palliative care (PC) is a very limited service inAlbania, provided mainly from non-for-profitsector (NGOs) covering about 30% of the overalldemands. There are very few doctors and nursesqualified on PC and Pain. Training and educationprograms on opioids are quite inexistent and thepatients cannot access opioids easily in Albania. Thisstudy evaluated the attitudes of family doctors onpain assessment, management and opioid usagebefore and after seminars on opioids painmanagement.Methods: The Barrier Questionnaire II was usedto evaluate attitudes towards pain management in227 family doctors (GP) working in the publicprimary health care system in both urban and ruralareas from six cities in Albania (response rate was83.3%). The data collection process was donebefore and after six seminars on opioids with familydoctors in different cities covering all regions of thecountry.Results: Barriers were high among the participatingphysicians with mean scores of 3 or above for 10of 27 items. The danger of addiction to painmedicines as well as the fear that many people withcancer get addicted to pain medicine received thehighest scores. At the end of the seminar, barrierswere significantly lower with the total mean scoresreduced from 2.4±0.6 to 1.6±0.7.Conclusion: High barriers on the use of opioidsamong family physicians in Albania were reducedsignificantly following one-day training course,demonstrating the effectiveness of this intervention.However, more research on the sustainability of thetraining effect is needed in order to draw appropriateconclusions.Keywords: Barrier Questionnaire, non-governmental organizations, palliativecare42 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPatient understanding of moles and skin cancer:factors influencing presentation in primary careMonika Fida 1 , Ermira Vasili 11Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: Cutaneous melanoma (CM) and nonmelanomaskin cancer (NMSC) incidence hasincreased rapidly in past two decades. CM andNMSC have a high chance for cure if detected inan early phase of development. Our aim was toexplore patient understanding of pigmented skinlesions (moles) and skin cancer and factors whichinfluence care-seeking behaviour. The ultimate goalwould be to introduce preventive measures andearly detection means for skin cancers.Method: Semi-structured interviews with all patientsundergoing skin examination and skin cancertreatment in Tirana, Albania in 2012.Results: Patient understanding and awareness wasinfluenced by family and friends experiences ofmoles, skin cancer and other cancers, knowledge ofrisk factors (that is poor) and the media. The reasonsand factors that influence the delay of the patientsfor seeking advice include lack of knowledge of thepatients; mentality regarding the changing moles,poor medical knowledge either by GPs regardingthe excision of the suspicion mole and correctexamination of the moles through thedermatoscopy. Deciding to seek help was oftenprompted by another person or triggered by rapidor multiple changes in a mole. Three of four peoplesubsequently diagnosed with melanoma did notseek help; instead, the dermatologist or rarely GPopportunistically noticed the lesion.Conclusion: Changing moles are often perceivedas non probable skin cancer lesions. Even when thecancer is evident on a clinical basis, the mentality ofthe people in Albania delays the treatment. Thispresentation will have a modest contribute tocurrent national strategies to improve medical andpatients awareness for earlier diagnosis of cancerby highlighting factors that can trigger or act asbarriers for care-seeking behaviors.Keywords: dermatoscopy, melanoma, skin cancer.ALBANIAN MEDICAL JOURNAL SUPPLEMENT43

ALBANIAN MEDICAL JOURNAL SUPPLEMENTEvaluation of cervical cytological abnormalities inthe Albanian populationKozeta Filipi 1 , Anila Xhani 21Institute of Public Health, Tirana, Albania;2Maternity Geraldina Queen , Tirana, Albania.Aim: Cervical cancer is one of the most commonfemale malignancies with high mortality rates indeveloping countries. Our purpose was todetermine the prevalence of cervical cytologicabnormalities in the Albanian population and thedetection rate of epithelial abnormalities by cervicalcytology (CC).Methods: A total of 5532 conventional pap-smeartests collected between January 2010 and January2013 from hospitals and private clinics wereretrospectively analyzed.Results: A total of 258 (4.8%) cases had epithelialabnormalities. The numbers and rates of epithelialabnormalities were as follows: atypical squamous cellof undetermined significance (ASCUS; n=159[61.6%]); atypical glandular cell of undeterminedsignificance (AGUS; n= 15 [5.8%]); low-gradesquamous intraepithelial lesion (LSIL; n=71 [27.5%]);high- grade squamous intraepithelial lesion (HSIL;n=10 [3.8%]); and squamous cell carcinoma (SCC;n=3 [1.1%]).Conclusion: The prevalence of cervical cytologicalabnormality in our study was 4.8%. Recently, someconflicting results from the same population werepublished. More prospective studies with largernumbers are needed in Albania.Keywords: cancer, cervical cancer, cytological abnormalities.44 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAThe treatment response in metastatic pancreaticcancer patientsBledi Kreka 1 , Dhurata Tarifa 1 , Manika Kreka 2 , Floreta Kurti 2 ,Gentiana Qirjako 3,41Oncology Service, University Hospital Center Mother Teresa , Tirana, Albania;2Faculty of Technical Medical Sciences, University of Medicine, Tirana, Albania;3Faculty of Public Health, University of Medicine, Tirana, Albania;4Institute of Public Health, Tirana, Albania.Aim: Treatment of pancreatic cancer remains ahuge challenge in Oncology. Chemotherapy is themain and the only treatment in many cases, butespecially in the metastatic cancer of pancreas. Theaim of our study was to assess the role of patientperformance status (PS) in the understanding thesuccess of treatment of progressed pancreaticcancer disease.Methods: There were 50 patients treated during a3-year period (2010-1012) at the ChemotherapyUnit, Service of Oncology, at the public hospitalin Tirana. All the patients were diagnosed withmetastatic cancer since initiation or they had relapseafter surgery. We did an evaluation for theperformance status according to ECOG. Thepatients were divided into two groups (each with25 patients): one group for interval PS: 0-1 and thesecond group for the PS interval: 2-3). The treatmentwas based on use of 5 Fu, every 21-28 days. Theevaluation was done after the first three cycles. Therewere excluded patients with very low performancestatus (those who could not use treatment); patientswith organ dysfunction; or patients above 70 years ofage.Results: In the first group, the patients had 90 cyclesof treatment, whereas in the second group there were130 cycles of treatment. In the first group, the partialresponse was achieved in 8 patients, whereas in thesecond group it was achieved in one patient only(P=0.03).Conclusion:The evaluation of performance status isan important parameter in the decision for treatmentof veryprogressed metastatic cancer. Our findings arecompatible with previous reports on this matter.Keywords: cancer patients, pancreatic cancer, performance status.ALBANIAN MEDICAL JOURNAL SUPPLEMENT45

ALBANIAN MEDICAL JOURNAL SUPPLEMENTVincristine-induced neurotoxicity in childhoodcancers in AlbaniaArtan Shkoza 1 , Mirlinda Likmeta 21Department of Biomedical and Experimental Studies, University of Medicine, Tirana, Albania;2Department of Pharmacy, University Hospital Centre (UHC) Mother Teresa , Tirana, Albania.Aim: Neurotoxicity is a known adverse effect ofseveral chemotherapeutic drugs such as vincristine,cisplatin, oxaliplatin, docetaxel, paclitaxel, andbortezomib. Of these, vincristine is commonlyusedin pediatric cancer patients. Vincristine causes axonaldegeneration due to microtubular disruption, andthe consequent decreased axonal transport. In thisarticle, we intend to discuss the neurological courseof these patients, along with a brief review of theliterature on the subject.Methods: We studied the clinical records of allpediatric cancer patients who received vincristineduring their treatment at our hospital during theperiod January 2009 to December 2012. Weconducted a retrospective review of patient s age,sex, weight, clinical diagnosis, appearance ofneurotoxic symptoms, number of doses and totaldose of vincristine received, interventionsperformed, progression of neurological symptoms,and time to recovery of neurotoxic symptoms.Children with acute lymphoblastic leukemia, andlymphoblastic non-hodgkin s lymphoma were puton AIEOP protocol and those with Hodgkin sdisease were started on monthly cycles of ABVD(adriamycin, bleomycin, vinblastine, dacarbazine)alternated with COPP (cyclophosphamide,vincristine, prednisolone, procarbazine).Results: Most of the children treated with the usualdoses of vincristine for various types of childhoodcancers developed neurotoxicity during treatment.Peripheral neurotoxicity was seen in the form ofweakness of lower limbs, areflexia, neuropathicpain, or sensory loss. Autonomic neuropathies weremanifested as constipation and urinary retention. Inchildren with severe neuropathy, vincristineadministration was withheld/ dose reduced untilclinical improvement started, which took about 2-3 weeks time. We found a relatively higher incidenceof vincristine-induced neuropathy in Albanianchildren, which was probably due to the coexistenceof malnutrition among them.Conclusion: Our results show a surprising higherincidence of vincristine-induced neurotoxicity,compared to earlier estimates by a few authors,which range between 3 and 13%. This may be partlyexplained by the fact that all of our patients whodeveloped neurotoxicity were severely malnourishedwith the weight for age as well as body mass indicesbeing below the 3 rd percentile for age for allchildren, using standards recommended by theWorld Health Organization.Keywords: children, childhood cancers, vincristine-induced neurotoxicity.46 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIACraniopharyngioma surgical treatment: Results fromAlbaniaArtur Xhumari 1 , Mentor Petrela 11Service of Neurosurgery, University Hospital Center Mother Teresa , Tirana, Albania.Aim: Surgical treatment of craniopharyngiomas hasbeen historically challenging and, despiteadvancements in microsurgical and skull basetechniques, it continues to pose a significant challengeto modern day surgeons. The aim of our study wasto analyze the characteristics of the patients operatedfor craniopharyngioma between 2002 and 2007 inthe Service of Neurosurgery, University HospitalCentre (UHC) Mother Theresa , Tirana, and toevaluate the surgical results and long follow-upoutcomes.Methods: In this retrospective study were includedall new cases operated in the Service ofNeurosurgery, UHC Mother Theresa , Tirana,from January 2002 to December 2007.Results: There were 38 patients operated for acraniopharyngioma, of whom 12 were children.50% of tumors were 4-6 cm in diameter. In 42%of the cases it was achieved a total removal. Tumordiameter, composition, calcification andhydrocephalus, all influenced the removal quality.During follow-up, 36.8% of the patients exhibiteda recurrence. The removal quality was the onlyvariable influencing the recurrence. The results ofrecurrence surgery were worse than those of primarysurgery. At the last follow-up visit, 76.3% of thepatients were independent in their daily activities.Conclusion: Our study provides useful evidenceabout the surgical results of the craniopharyngiomasurgery in the Service of Neurosurgery, UHCMother Theresa , Tirana. Our surgical strategyattempting complete removal, but refraining fromdamaging for the sake of total removal, yields goodimmediate and long-term results.Keywords: craniopharyngioma, functional outcome, surgery.ALBANIAN MEDICAL JOURNAL SUPPLEMENT47

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INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPARALLEL SESSIONSSession 3: Health InformationModerator:Enver RoshiALBANIAN MEDICAL JOURNAL SUPPLEMENT49

ALBANIAN MEDICAL JOURNAL SUPPLEMENTInfant mortality in Albania: A detailed picture over theperiod 2001-2011Eduard Kakarriqi 1,2 , Bukurie Gega 1 , Bajram Dedja 1 , Alba Merdani 1 ,Dorina Çanaku 1 , Miranda Hajdini 1 , Gazmend Bejtja 31Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania;3Ministry of Health, Tirana, Albania.Aim: The study aims at displaying a detailed pictureof infant mortality in Albania, giving the properanswers to the respective issues such as place (infantmortality rates IMRs according to prefecture andcountry level), time (respective IMRs trends overthe period 2001-2011), age-groups (early neonatal,late neonatal and post-neonatal mortality rates), andcausality as well.Methods: Two are the main data sources, namelythe IMR data obtained by the Institute of StatisticsINSTAT (based on death certificates), and IMRoperative data obtained by the Ministry of HealthMoH (data based on timely respective deathnotification by health centres all over the country).As regards the causality, the study was based on ascrutinized analysis of death certificates (availablefrom INSTAT) of all infant deaths in 2001 and2003.Results: (i) there is a significant difference betweenIMRs provided by INSTAT data and IMRSprovided by the MoH operative data, the formerbeing always (far) lowest than the latter; (ii) there isa significant exponential decreasing trend of IMRsat both prefecture and country level over the period2001-2011 in Albania: from a country rate of 17.5/1000 at 2001 to country rates of 9.7/1000 and 8.7/1000 in 2010 and 2011, respectively; (iii)nevertheless, there exist (large) differences of IMRsbetween country prefectures (regions): thoughannual oscillations, regions with the highest IMRs andthose with the lowest ones over years might bepointed out; (iv) the burden of early neonatalmortality rate on the total IMR is increasing overtime; (v) the death causality patterns of the three agegroupsof the first year of age are different: whilethe main death causes in early neonatal period includeNeonatal Diseases and Congenital Malformations,in the late neonatal period and post-neonatal periodthe mortality patterns attempt to be the same withthose of infant mortality (0-1 year) in total, with theAcute Respiratory Infections as the main cause ofdeath; (vi) there are no significant gender-specific(male-female) differences in IMRs; (vii) there are nosignificant differences over time (2001-2011) in theIMRs according to place of residence (urban vs.rural areas).Conclusion: The afore-mentioned results pave theway to draw the respective study conclusions.Keywords: infant mortality, INSTA T, trends over time.50 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAUnder-5 mortality in Albania: A detailed picture forthe period 2001-2009Eduard Kakarriqi 1,2 , Bajram Dedja 1 , Bukurie Gega 11Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: This study aims at displaying a detailed pictureof under-5 (=child, =1-4 years) mortality in Albania,giving the proper answers to the respective issuessuch as place (under-5 mortality rates U-5MRsaccording to prefecture and country level), time(respective IMRs trends over the period 2001-2009),and causality as well.Methods: The data (based on death certificates) areobtained by the official annual publications of theInstitute of Statistics (INSTAT), whose content doesnot provide all required outputs on the matter. Theavailable data were analyzed in order to obtain theU-5 MRs at both regional (prefecture) and countrylevel over the period from 2001 to 2009 (the lastannual INSTAT publication on mortality in Albania).Results: Salient findings consist of the following:(i) there is a significant exponential decreasing trendof U-5 MRs at both prefecture and country levelover the period 2001-2009 in Albania: from acountry rates of 6.9/ 1000 6.7/ 1000 in 2001-2002to country rates of 2.5/ 1000 2.7/ 1000 in 2007-2009; (ii) nevertheless, there exist (large) differencesof U-5 MRs between country prefectures (regions)though annual oscillations; (iii) the causality patternspresent a significant descending burden rankingbeing portrayed by circulatory system diseases,followed by injuries/accidents and respiratory systemdiseases; (iv) there are no significant differencesbetween gender-specific (male-female) U-5 MRs; (v)there is no significant difference over time (2001-2009) in the U-5 MRs according to place ofresidence (urban vs. rural areas).Conclusion: The afore-mentioned results pave theway to draw the respective study conclusions, whichare important for policy formulation in Albania.Keywords: child mortality, INSTAT, under-5 mortality.ALBANIAN MEDICAL JOURNAL SUPPLEMENT51

ALBANIAN MEDICAL JOURNAL SUPPLEMENTThe structure of under-5 mortality rate over theperiod 2008-2012 in Albania on the basis of theoperative data of the Ministry of HealthBajram Dedja 1 , Bukurie Gega 1 , Eduard Kakarriqi 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Context: The primary causes of childhood mortalitychange as children grow. A large component of earlyinfant mortality consists on congenital diseases andother biological factors related to conditions in earlyinfancy. As under-five mortality declines over time, itis often observed that child mortality declines to agreater degree than infant mortality.Methods: The data are obtained by the database ofthe Ministry of Health, consisting on operative dataas regards U-5 MRs at both district and country levelover the period from 2008 to 2012, whose contentdoes provide all but required outputs on the matter.Results: For the most recent five years, the level ofunder-five mortality is less than 4-5 deaths per 1,000live births. Such data do not equalize with thoseobtained by the Institute of Statistics (based on deathcertificates), implying a more precise and accuratenature of operative data of the Ministry of Health.Conclusion: The findings suggest that under-fivemortality has decreased over the period 2008-2012in Albania. This phenomenon is mainly due toimprovements in childrens environments broughtabout by public health interventions orimprovements in living conditions.Keywords: childhood mortality, mortality, obstetrical activity, under-five.52 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAMorbidity in the districts of Saranda and Delvina forthe period 2003-2010Dhimitraq Dhame 11Directorate of Public Health, Saranda, Albania.The study is based on the data gathered from 39,175clinical files of Petro Nako Saranda Hospital forthe period 2003-2010. The data on population aredrawn by Vlora County Council: Population01.01.2010. Hospital morbidity data are gatheredand assorted in accordance with the requirementsand the new international standards classifications ofWHO and the International Classification ofDiseases (ICD-9).Based on Final Diagnosis and the ICD-9classification, 36618 hospitalization cases wereregistered in the population of Saranda and Delvinadistricts for the period 2003-2010, for which casesare presented with epidemiological characteristicssuch as: geography, period, prevalence, sex, and age.This study provides a quantitative view of the healthsituation for the population of Saranda and Delvinadistricts, notwithstanding a major limitation asSaranda and Delvina districts are characterized byhigher rates of intensive emigration a factor thatshould be considered for any further analysis.Nevertheless, this study provides reliable statisticaldata, which are also comparable to the national data.Morbidity survey results are important to those whoare willing to understand the current situation, toadopt policies and plan to intervene in order toimprove health care services at population level.This study is important since the obtainedinformation is valuable to many actors for planningpurposes, especially governmental actors, nongovernmentalorganizations, donors andinternational organizations.Analysis and interpretation of these data is a crucialpoint for the design and implementation of suitablepolicies and interventions in order to improvepopulations health indicators.Keywords: Delvina, epidemiology, prevalence, population, Saranda.ALBANIAN MEDICAL JOURNAL SUPPLEMENT53

ALBANIAN MEDICAL JOURNAL SUPPLEMENTWould policies and strategies for targetedpopulation-groups impact the access to healthservices in Albania?Bujana Hoti 1 , Roland Bani 21UNDP Office, Tirana, Albania;2Institute of Public Health, Tirana, Albania.Aim: This study engages on the importance ofknowing the difference, if evident, amonggeographical areas and population groups, buildingup ad-hoc and limited special interventions, but nottransferring the difference among populationsgroups at the strategy and policy level. The researchhighlights the question if the access to health servicesdiffers among Roma and the general population.The research seeks to explore determinants of healthand the qualitative dimensions of availability,accessibility and quality of health care services usedby them.Methods: A qualitative approach was chosen forthis study due to the exploratory nature of the topic.Qualitative research helps to better understandattitudes, behaviours, culture or lifestyle by offeringan opportunity to discuss topics in depth. Theresults of a qualitative approach are compared withquantitative findings of DHS 2008-2009, BIO-BSS2009 and 2011, UNDP and UNICEF study onneed assessment among Roma.Results: The findings of the qualitative study amongRoma population regarding the determinants ofaccess to health care services do no show adifference with similar quintiles of the population.Issues like late access, or preventive services areequally lacking among poor Albanians, or peopleliving in rural or peri-urban areas. Lack of resources,lack of trust and the realization of the need forpreventive services are the main causes of poorhealth among the Albanian population.Conclusion: There are no data showing thatdifferentiating policies and strategies at the highestlevel will solve the health issue of the targetedpopulation. There is a recognition that thecommunity needs to improve its educational levelin order to improve the physical, mental and socialwell-being of its members for both, the generalpopulation, or the Roma community.Keywords:access tohealth services, Roma population, vulnerablegroups.54 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIACurrent challenges of the health care system inAlbaniaQamil Dika 1 , Genc Burazeri 2,31Health Insurance Institute, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania;3Institute of Public Health, Tirana, Albania.There have been several efforts to reconstruct theAlbanian health sector along with economic recoveryin the past decade. Thus, a National Strategy forSocioeconomic Development came into force in2002 as the frame for sustainable development.Subsequently, it was changed in 2005 to the NationalStrategy for Development and Integration andaligned with the European Union (EU) agenda andthe Millennium Development Goals.A Long-Term Strategy on the Development of theHealth System was approved and endorsed in 2004and is focused on the core functions of the healthsystem. In the past few years, health legislation isbeing thoroughly revised with focus on the lawsrelated to financing of health services. The HealthInsurance Fund established in 1995 is growingrapidly in terms of service packages provided.However, the Albanian Ministry of Heath recognizesthe need to reorganize health services on a costefficiencybasis.Furthermore, there are several challenges for theAlbanian health care system which should be takeninto consideration: (i) poor health infrastructure andscarce resources caused by several major crises in thepast couple of decades; (ii) fragmented subsidizationof the health needs of the population (funds aredivided between the Ministry of Health, the HealthInsurance Fund and the Ministry of Labor); (iii)outdated, weak and inefficient public health services,which are still unable to meet the challenges of the(double) burden of diseases related to socioeconomic,lifestyle and environmental determinants and risks.Keywords: A lbania, health reform, health system, ministryof health.ALBANIAN MEDICAL JOURNAL SUPPLEMENT55

ALBANIAN MEDICAL JOURNAL SUPPLEMENTA new ethos: Clinical psychology in the context ofthe Albanian Public HealthSuela Ndoja 11Italian Albanian Association.For the last two years, I have been involved inefforts to develop and evaluate information-basedand value-based systems of social care for childrenand young people with serious mental and healthchallenges. Having received my scientific studies inclinical psychology in 2010, this effort to work withthese persons introduced me with theimplementation of an effective system of social andhealth care as an important part of a multidisciplinaryeffort to enhance the social andemotional well-being of children and youngindividuals. This approach has really attracted me toexpand on the competencies and knowledge that Ihave gained through my studies. Thus, I do mind acall for a new ethos not to diminish the contributionthat clinical psychology has made. It is to indicatethat the contribution of clinical psychology shouldaddress social needs in the context of Public Health.Therefore, the aim would be to suggest a valuebasedsystem of care to Mental Health Services asan important movement for clinical psychology inthe context of the Albanian Public Health addressingthe society needs including non-communicablediseases, too. This, I suggest to be one of the mostsuitable keys to clinical psychologists understandingthe clinical practice in the core definition of theprofessions competencies. On the other hand, thiswould increase the number of persons who will behelped by psychological interventions investigatingtheir inner world.Keywords: clinical psychology, ethos, publichealth.56 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAReforms and challenges of post-conflict Kosovohealth systemMustafa Mybera 11Institute of Public Health, Pristine, Kosovo.Before its collapse, Kosovos healthcare system wasan integrated part of the Former YugoslavRepublics System (known for its relatively welladvancedsystem for at that time). Standstill hadbegun in the last decade of the twentieth Centuryas a result of political disintegration of the formerstate. The enthusiasm of the healthcare professionalsand people of Kosovo that at the end of the conflicthealthcare services would consolidate did not provejust right. Although one can claim that reorganizationof Kosovo healthcare was a serious push (especiallyin the first years after the conflict), the intensity ofdevelopment begun to fall at the latter stages. Whilethe basic legislation for the operation of the currenthealthcare system in Kosovo does exist, the mainreason for the reform stagnation is the lack of properimplementation of the laws and measures are not setas to a meaningful system of accountability.Twelve years have passed by since the 1999 warconflictand, although Kosovo has made progressin many areas, it has not yet consolidated a healthsystem comparable to those of other Europeancountries. Intending to get out of difficult situation,several healthcare strategic plans have beendeveloped in the past decade in Kosovo, butattempts in this direction have not been particularlyfruitful.This paper describes the actual healthcare complexityof a situation in Kosovo, 12 years after the end ofthe 1999 war-conflict. Interconnection and historicalbackground is also looked upon and is describedin the flow of events. Finally, the description oftransfer competencies from internationaladministrators to the local authorities as well as theflow of strategic planning that took place since 1999is also critically analyzed.Keywords: challenges, conflict, Kosovo, reform, reorganization, results.ALBANIAN MEDICAL JOURNAL SUPPLEMENT57

ALBANIAN MEDICAL JOURNAL SUPPLEMENTPsychosocial determinants of health in KosovoMusa Qazimi 1,2 , Bujar Spahija 2 , Herion Muja 2 , Irida Pano 2 , Lulzim Çela 2 ,Zejdush Tahiri 21Principal Family Medicine Center, Gjilan, Kosovo;2Faculty of Public Health, University of Medicine, Tirana, Albania.In industrialized countries, psychosocial factors havebeen linked to non-communicable diseases and theirrelated mortality, particularly for cardiovasculardiseases. Many psychosocial traits have beenreported as predisposing factors for coronary heartdisease and diabetes. From this point of view, manystudies conducted especially in developed countrieshave reported that psychosocial factors are associatedwith increased risk of cardiovascular outcomes andall-cause mortality.The evidence from Albania and Kosovo is scarce,notwithstanding recent reports from Burazeri et al.which have convincingly linked psychosocial factorswith an increased risk for acute coronary syndrome.The psychosocial factors which were explored in apopulation-based case-control study conducted inTirana by Burazeri et al. included hostility (aliascynical distrust scale), the attitudes towards thesocioeconomic and political transition, angerexpression, degree of religiosity and degree oftraditionalism. All these important psychosocialfactors were linked to poor coronary health in thisstudy conducted in Albania. Overall stress, anadditionally important psychosocial variable, hasbeen also arguably and consistently linked tounfavourable health outcomes in western countries,but available evidence about this psychosocial factoris scarce for Albania and Kosovo.There is an obvious need to conduct similar studiesin Kosovo in order to asses the deleterious effectof psychosocial factors on health status of thepopulation at large, which is also coupled with thedifficult socioeconomic and political circumstancesof transitional Kosovo. In conclusion, therelationship of health status with psychosocialfactors should be explored in detail in populationrepresentativesamples of adult individuals inKosovo.Keywords: health, hostility, Kosovo, psychosocial factors, stress.58 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIACompetencies of family physicians frompractitioners and policymakers perspective intransitional KosovoFitim Skeraj 1,2 , Katarzyna Czabanowska 3 , Gazmend Bojaj 2 ,Elizana Petrela 2 , Genc Burazeri 2,31Principal Family Medicine Center, Prizren, Kosovo;2Faculty of Medicine, Tirana University, Tirana, Albania;3Department of International Health, School for Public Health and Primary Care (CAPHRI),Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.We have already reported on the design anddevelopment of a questionnaire on self-assessmentlevel of skills, abilities and competencies of familyphysicians which has been aligned with the QualityImprovement Competency Framework (QICF). Asdiscussed earlier, the QICF was developed in thecourse of a systematic and vigorous research workinvolving well-known European primary careexperts dealing with issues pertinent to qualityimprovement.On the face of it, the international tool validated inKosovo, exhibited a good internal consistency forboth the test and the retest procedures in arepresentative sample of policymakers and in arepresentative sample of primary care physicians inKosovo. Particularly for the policymakers, we havereported a remarkably high internal consistency inboth rounds of application of the questionnaire.In general, the instrument behaved adequatelyshowing a reasonable stability over time, as indicatedby the test-retest reliability coefficients calculated inthe sample of policymakers and primary carephysicians.The overall internal consistency of the instrument inthis Kosovo sample of family physicians wascomparable with a prior report from Albania, whichprovided a similar cross-cultural adaptation processof the same instrument in a representative sampleof family physicians operating in primary health careservices in Tirana. Therefore, our work in Kosovoexpands further the evidence of validation of thisinternational instrument in Albanian speakingcountries.Currently, we are trying to validate this very sameinstrument in Albanian speaking regions of theRepublic of Macedonia. At the same time, thisinstrument is currently being administered to a largenationally representative sample of family physiciansand to a representative sample of policymakers inKosovo.Keywords: competencies, cross-cultural adaptation, familyphysician, general practitioner, Kosovo, policymakers, primaryhealth care, validation.ALBANIAN MEDICAL JOURNAL SUPPLEMENT59

ALBANIAN MEDICAL JOURNAL SUPPLEMENTEvaluation of the immunization program throughMeasles, Tetanus and Hepatitis B vaccinationErida Nelaj 1 , Iria Preza 1 , Mirela Lika 2 , Silva Bino 11Department of Epidemiology and Control of Infectious Disease, Institute of Public Health, Tirana, Albania;2Department of Biology, Faculty of Natural Sciences, Tirana University, Tirana, Albania.Aim: Vaccines are the most cost-effective publichealth intervention. Albania has a very wellestablished immunization program nationwide.Vaccination coverage is very high for all antigensincluded in the national immunization schedule.Vaccination rates are frequently considered asurrogate measure of protection. Serum levels ofprotective antibody are a more objective measure.The aim of this study was to evaluate theImmunization Program with Measles, Tetanus andHepatitis B vaccinations in order to prove programefficacy, increase public confidence in immunizationsand advocate for sustainable immunizationprograms.Methods: There were three main components usedin the methodology of this study, such asimmunization coverage surveys, serologic surveysand surveillance for acute cases of Measles, Tetanusand Hepatitis B.Results: This study showed that vaccinationcoverage is really high, more than 95% and in thebasal vaccination doses it reaches more than 98%.Drop-out rates between doses and vaccines resultedless than 10% which indicates that children whostarted the vaccination schedule continued to receivethe following doses without interruption. Antibodieslevel for each antigen showed to be higher inimmunized children than in the unimmunized ones.Antibodies for viral antigens, such as Measles andHepatitis B, remain for the whole life, instead theones responsible for Tetanus protection decreaseover the years. Incidences of these vaccinepreventablediseases are really low and they arereduced every year in Albania.Conclusion: These findings indicate that vaccinationwith Measles, Tetanus and Hepatitis B are the mostfruitful strategies for the long-term control of suchdiseases in Albania.Keywords: Hepatitis B, immunization, Measles, Tetanus, vaccination.60 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAVaccination of hard-to-reach population in TiranadistrictIria Preza 1 , Erida Nelaj 1 , Silva Bino 11Institute of Public Health, Tirana, Albania.Aim: During the last decades, the migration withinthe country has become a common phenomenonin Albania. Tirana, the major district in Albania, hasthe highest percentage of new comers from otherregions of the countryand, consequently, the highestnumber of children aged 0-14 years. Identificationof these children, keeping track and continuation ofthe vaccination schedule, is considered one of thechallenges of the health sector, especially for thehealth workers dealing with vaccination in thisdistrict. The main aim of this study was to identify,register and vaccinate children belonging to thehard-to-reach population subgroup.Methods: Screening door-to-door and analysis ofall immunization activities related to hard-to-reachpopulation.Results: Through the door-to-door screeningprocess, it was possible to identify and check around589 children 0-14 years old, of whom 219 (37%)were not registered. From a close monitoring andsupervision of the screening process, it was foundthat 169 (76%) of these unregistered children didnot have a regular vaccination schedule.Conclusion: A well-planned strategy based onstandardized procedures of transferring thevaccination data, demographic and social conditionsas well as local needs is the key to the success. It isimportant to define the capacity of the vaccinationhealth workers, borders and the monitoring processthroughout the study. Door-to-door screeningcombined with follow-up and with interactivecommunication and collaboration between healthworkers and parents can help to identify, register andvaccinate more new children as well as keeping trackof the registered ones.Keywords: hard-to-reach population, Tirana, vaccination.ALBANIAN MEDICAL JOURNAL SUPPLEMENT61

ALBANIAN MEDICAL JOURNAL SUPPLEMENTQuality improvement efforts at the National Instituteof Public Health of KosovoValbona Zhjeqi 1 , Naser Ramadani 1 , Rina Hoxha 1 , Sanije Gashi 1 , Ilir Begolli 1 ,Drita Salihu 1 , Merita Berisha 11National Institute of Public Health, Pristine, Kosovo.Aim: The aim of this research work was to assessusers satisfaction with the quality of health servicesprovided at the National Institute of Public Health(NIPH) and the Regional Institutes of Public Health(RIPH) in Kosovo.Methods: This was a cross-sectional survey. Studypopulation consisted of clients/users of the IPHsat both regional and national level. An anonymousquestionnaire (ten items organized in three domains)was administered to all participants.Results: The study involved 397 individuals: 217(55%) women and 180 (45%) men. Mean age ofthe respondents was 38.3 years. Access to the IPHwas not identified as a problem since only 28 (7.1%)individuals reported not so easy access . Aproblem which was identified, concerns the fact thatusers do not know where to do a complaint againstthe IPH. Of the 397 users, only 45.8% consideredpositively the overall quality of services provided atthe IPHs. Clients in Pristine remain the most criticalusers: 91% of them stated that they do not knowwhere to complain, followed by the RPH in Ferizaj(64%). Among quality components, 12 of themwere evaluated and scored with an average markof 3.7. Comparing average marks of the RIPH,Ferizaj RIPH was graded with the lowest mark (3.2),whereas Gjilan RIPH was rated with the highestgrade (4.3).Conclusion: Patients were generally satisfied withaccess to IPH. A problem, however, was the factthat patients did not know where to submit acomplaint, mostly in Pristine and Ferizaj. Patientsevaluated the quality of health services with anaverage mark (3.7). Conversely, the courtesy of thestaff was rated with the highest grade (4.5) whereashygiene with the lowest grade (3.3).Keywords: evaluation, instituteof publichealth, Kosovo, quality, satisfaction.62 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIALeadership communication styles: A descriptiveanalysis of health care professionals leading inAlbanian healthcare settingsAdriatik Gabrani 1 , Jonila Gabrani (Cyco) 2 , Elizana Petrela 1,31Department of Health Management, Faculty of Public Health, University of Medicine, Tirana, Albania;2Finance and Banking Department, Albanian University, Tirana, Albania;3Statistics Service, University Hospital Center Mother Teresa , Tirana, Albania.Context: The study of leadership in health care iscaptivating for many reasons. Health care leaders willinevitably have an impact on the lives of manypeople, as individuals rely on physicians and nursesduring some of the most critical moments in theirlives. Furthermore, cost constraints and innovationswithin organizational structure impose a greaterattention to leaders. A new leadership style is neededin which leaders engage staff, patients and partnerorganizations to improve patient care and healthsystem outcomes. There is a growing trend forleaders to break the old autocratic model ofleadership to newer models using the concepts ofshared and participatory leadership. Yet, sparseliterature exists on leadership traits orcommunication styles in Albanian healthcare settings.Objective: To investigate and assess the leadershipstyles of leaders in health care settings in Albania.Methods: Research is reported on open-endedquestionnaire from a large sample of leaders andmanagers (n=612) from a range of public healthcareorganizations. A style score was calculated and thenrelated to data on respondents biographical ageand gender. In order to compare the results, the samequestionnaire was administered to the staff of thesetting to evaluate their leaders communication style.Preliminary Results: Interesting findings onleadership styles: according to self-evaluation, leadersperception on their communication style resulted asdemocratic , compared to workers perceptions ontheir leaders as autocratic .Added value/Originality: The relevant literatureshows that health workforce leadership is an underresearchedarea particularly in the public sectorinstitutions within health sector settings. Thus, thecurrent investigation has contributed to improve theunderstanding of leaders trait on this significantissue. Furthermore, the study findings are discussedin perspective of practical implications of healthmanagement system regarding workforce issues,contra party perspectives. Overall, this studyprovides new support to previous internationalresearch (especially to eastern European countries)about leadership s communication style as a crucialdriver for organizational effectiveness andperformance.Keywords: communication, health care, leadership, organizational structure.ALBANIAN MEDICAL JOURNAL SUPPLEMENT63

ALBANIAN MEDICAL JOURNAL SUPPLEMENTCross-cultural adaptation of a questionnaire aboutcompetencies of family physicians in Kosovo frompractitioners and policymakers perspectiveGazmend Bojaj 1,2 , Katarzyna Czabanowska 3 , Fitim Skeraj 2 , Zejdush Tahiri 2 ,Genc Burazeri 2,31Principal Family Medicine Center, Kline, Kosovo;2Faculty of Public Health, University of Medicine, Tirana, Albania;3Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health,Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.Competencies in quality improvement are importantfor family physicians in order to foster patient care.In Kosovo, we validated an instrument developedwith the support of the EC Lifelong LearningProgram addressing family physicians competencylevel from the primaryhealth care users perspective.The instrument was administered to a representativesample of primary health care users in Kosovo agede 18 years in December 2012. All individualsincluded in this validation exercise were asked toassess, from their perspective, the level ofcompetency of their respective family physicians, orgeneral practitioners regarding several key domainsof primary health care services including: patientcare and safety (8 questions), effectiveness andefficiency (7 questions), equity and ethical practice (8questions), methods and tools (5 questions),leadership and management (4 questions), andcontinuing professional development (5 questions).Answers for each question of the instrument rangedfrom 1 ( novice =physicians have little or noknowledge/ ability, or no previous experience of thecompetency described and need close supervisionor instruction) to 5 ( expert =physicians are theprimary sources of knowledge and information inthe medical field). An overall summary score(including 37 questions; range: 37-185) and a subscalesummary score for each domain were calculated forall participants. Socioeconomic data were alsocollected (age, sex, educational level, employmentstatus and income level).Thus, we validated an international instrument in theKosovo context which aims to capture primaryhealth care users self-perceived level of competencyof their family physicians regarding differentdomains of health care services. Currently, thisquestionnaire is being administered on a nationwidescale including a large representative sample ofprimary health care users in different regions ofKosovo.Keywords: competencies, cross-cultural adaptation, family physician, general practitioner, Kosovo, primary health care,validation.64 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAExploring possibilities to implement distancelearning in AlbaniaSuela Këlliçi 1 , Xheladin Draçini 1 , Bajram Hysa 11Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: Distance learning, or distance education, is analternative way to deliver education and instructionto students who are not physically present in atraditional setting such as the classroom. Distancelearning could be a good possibility to providecontinuous education to health professionals. Thecontinuous education is alreadya must for all healthprofessionals in Albania and the Faculty of Medicinetends to be deeply involved in this process.Methods: The Faculty of Medicine tried to exploreall possibilities to provide the best educationstrategies to the health professionals in collaborationwith the other involved partners (Ministry of Health,and professional organizations).Results: After a review of the existing educationdelivering systems and the international experience,we explored deeply into the distance educationsystem, as it appeared suitable for the Albaniancontext. For this purpose, many of our staffmembers went on study tours and received trainingin countries where this system is developed in orderto better understand the functioning of this systemand to get instructions on how the distance coursescould be prepared and delivered in Albania.Conclusion: Distance learning could be a promisingpossibility to provide continuous education forhealth professionals in Albania and the Faculty ofMedicine can play a crucial role in this process.Further efforts are required from the Faculty ofMedicine and from other interested institutions toestablish and implement such a system in Albania.Keywords: distancelearning, education, facultyof medicine.ALBANIAN MEDICAL JOURNAL SUPPLEMENT65

ALBANIAN MEDICAL JOURNAL SUPPLEMENTThe situation of children with autism in Shkodra cityZamira Shabani 1 , Arben Hoxha 2 , Fatmir Vadahi 1 , Kujtim Pelinku 1 ,Rina Gera 11University Luigj Gurakuqi , Shkodër, Albania;2Development Center, Shkodër, Albania.Aim: Autism is a group of developmental braindisorders, collectively called autism spectrumdisorder (ASD). The term spectrum refers to thewide range of symptoms, skills, and levels ofimpairment or disability that children with ASD mayexhibit. We conducted a review of the autism casesin Shkodra city. We aimed to describe thedistribution of this condition according to gender,area of residence, and age-groups of these childrenin two institutions in Shkodra city.Methods: A survey was conducted including allchildren in two institutions that provide services forchildren with autism. More specifically, theinformation was collected from the following twoinstitutions: Development Center of Children andthe Special School in Shkodra city. A descriptivemethod was used and the data was analyzed inMicrosoft Excel 2007.Results: There were 49 cases in total diagnosedwith autism that attend studies in these twoinstitutions (34 of the children attend theDevelopment Center of Children , whereas theremaining 15 children attend the Special School ).This study has evidenced that males are moreaffected than females (79% male and 21% female).The vast majority of the diagnosed cases were fromurban areas of Shkodra (86%).Conclusion: Even though autism is not well-studiedin Albania, our findings indicate that this conditionhas serious implications for the children who areaffected and for their respective families. Socialservices and health care system in Albania should beprepared to tackle autism in terms of earlydiagnosisand provision of appropriate social services andhealth care services for the affected children.Keywords: autism, children, mental health, Shkodra.66 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAHealth risks from water and new challenges for thefutureArben Luzati 1 , Valbona Bara 1 , Oltiana Petri 1 , Anilda Kokali 1 , Anjeza Çoku 1 ,Mimoza Luzati 11Institute of Public Health, Tirana, Albania.Water is a very important element for the humanexistence, as a necessity for the economy, industryand agriculture. Water sources occupy 71% of theland surface and only 1% of this amount, locatedunderground, consists of drinking water, while therest is salt water. The main water reserves arerepresented by: i) surface waters including waters ofthe oceans, seas, rivers, lakes and pools; ii)groundwater including natural groundwaterresources, hydro-geological, individual or collectivewater wells, and; iii) free water, which is constantlypresent in the air (water vapour).Albania is one of the first countries in Europe forpossession of abundant water resources, which varyfrom 5-1500 L/ sec. Although the quantities aresufficient to meet current needs, water quality is oftenproblematic due to pollution, especially in lowlandareas, where most of the Albanian population residescurrently. Also, in these areas take place most of theurban and agricultural industrial activities. Waterpollution implies the presence of microorganisms andchemical substances, toxic and radioactive substancesthat are classified as harmful for humans.Water pollution may be bacteriological, physicalchemical,toxic and radioactive. Bacteriologicalpollution of water is caused by bacteria, viruses,parasites eggs, which cause serious diseases such astyphoid, cholera, hepatitis A, salmonella, etc.Chemical pollution is caused by waste waterchlorides, nitrates, nitrites, ammonia, sulphates andphosphates. Toxic pollution is due to the presenceof heavy metals such as nickel, lead, cadmium,mercury, arsenic, zinc, and the presence of polycyclicaromatic hydrocarbons, artificial chemical fertilizers,pesticides, or oil products with high sulphurconcentration. The main means of radioactivepollution consist of nuclear explosions resulting inradioactive precipitations, which may contaminatenatural water sources. The radiation causes anionizing action to living cells, leading to differentchanges in the molecular structure that are associatedwith subsequently somatic and genetic consequences.The monitoring of drinking water still remains anirreplaceable activity in providing information onwater quality. Monitoring activities can also beenriched with innovative tools, such as genotypingand bio-molecular methods, particularly usefulduring incident and outbreak investigations inattributing sources and establishing correctinterventions.In most of the developed countries, but also intransitional countries such as Albania, there are nosurveillance systems on water-borne diseasesprobably reflecting the belief that these diseasesbelong to the past.A fairly recent argument of public concern is dueto the awareness of the possible simultaneousoccurrence in water of a wide variety of substancessuch as pharmaceuticals, pesticides in non-agriculturalareas, chemical substances that interact with theendocrine system, personal care products, surfactants,etc. New challenges are also posed from theexpansion of potentially harmful microalgae andciuanobacteria in new ecosystems as a consequenceof intensification of intercontinental trafficand climate change.Keywords: drinking water, pollution, risk assessment, water.ALBANIAN MEDICAL JOURNAL SUPPLEMENT67

ALBANIAN MEDICAL JOURNAL SUPPLEMENTThe microbiological quality of the drinking water inrural areas of Kamëz and VoraTone Sokoli-Imeraj 1 , Mhill Gecaj 1 , Lulzime Gecaj 2 , Enriketa Çela 11Directorate of Public Health, Tirana, Albania;2Directorate of Health Insurance, Tirana, Albania.Aim: Access to safe drinking water is an importantissue of health and development at national, regionaland local levels. The aim of this study was to assessthe bacteriological quality of the drinking water inrural areas of Kamëz and Vora (peri-urban areasof Tirana).Methods: In total, there were tested 385 samples(points of control) in rural areas of Kamëz andVora (from January to December 2012). Thebacterial load of the examined samples wasestimated by use of the multiple pipes method.Estimation of the microbiological pollution wasbased on the Albanian Legislation, the decision Nr.145, date 26.02.1998 for drinking water quality. Thedata analysis was done in SPSS, version 16.0.Results: The examined samples define the bacterialpollution indicators: Total Coliform, FaecalColiform, Faecal Streptococci. The results of themicrobiologic tests indicated that: 27.6% of theexamined samples were higher than the normal valuein Kamëz, and 32% of the examined samples werehigher than the normal values in Vora. Our dataindicated a relationship between the pollution leveland the residual level of chlorine (P

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAMicrobial contamination and identification of newstrains in the surgery clinics during September2012 March 2013 in AlbaniaZahide Sulejmani 1 , Gjergj Koja 1 , Entela Erindi 11Institute of Public Health, Tirana, Albania.Aim: Hospital environment plays an important rolein being a reservoir for pathogenic microbe resistantmicroorganisms and a suitable environment for thetransmission and spread of infections to the healthpersonnel and the community of visitors. The aimof this study was to evaluate and highlight microbialcontamination and new strains in surgicalenvironments, and to identify reservoirs ofmicrobes that may play a role in the emergence ofnosocomial infectious episodes.Methods: This study was conducted during theperiod September 2012 - March 2013 and includedseveral surgical clinics of the University HospitalCenter in Tirana (General Surgery Clinic, Pediatrics,Oncology, Ophthalmology, Maxillofacial Surgery,and Otolaryngology), as well as Surgical Clinics inKukes and Shkodra districts (north Albania). Airpollution examinations were performed withstandard methods recommended by WHO withRCS (Reuter centrifugal sampler) Rodak plate instage blood agar, Sabouraud, with values 500-1000microbe/ 1m 3 air. Surface contaminationexaminations were performed by the standardmethod Rodak dishes TSA terrain (trypticase soyagar) and Bujon plain with values 1000-2500microbe/100cm 2 .Results: From the total of 225 tested samples, therewere identified and isolated 41 microbial strains, or18.2% nosocomial episodes. Microbes which werepathogens had the following distribution : 41.4%E. Coli, 39.1% Staphylococcus Aurous, 7.3%Pseudomonas, 2.4% Clebsiella, 4.8% Aspergylus,2.4% fungi Penicillium, and 2.4% Pantoea (a classstrain of Enterobacteries which is linked to thetransmission of hospital infections).Conclusion: Application and rigorousimplementation of all elements of the clinicalprotocols for the control and prevention of hospitalinfections should be a top-priority for the Albanianhealth sector.Keywords: microbes, nosocomial contamination, pathogens, strains.ALBANIAN MEDICAL JOURNAL SUPPLEMENT69

ALBANIAN MEDICAL JOURNAL SUPPLEMENTSolar energy and public healthZaira Poga 11Department of Health Promotion, Institute of Public Health, Tirana, Albania.With climate change and global warming at theforehead of environmental concerns, the demandfor alternative energy sources is stronger than ever.One of the most alternative power sources is solarenergy. Solar energy can be used to provide heatand electricity to homes, schools or other buildings.The conditions of Albania are favorable fordevelopment of solar energy due to its climate andthe high intensity of solar radiation.The solar radiation of Albania is calculated at morethan 1,500 kWh/ m 2 / yr. The average daily solarradiation is about 4.1kWh/m 2 , reaching more than4.6kWh/m 2 in the south-western part of Albania.Albania has on average about 2,400 hours ofsunshine per year, 2500 hours in the western partand a record of about 2,850 hours in certainlocations. Solar energy is being increasingly used forheating purposes. Based on a survey of NationalAgencyof Energy, the number of the installed solarheating panels in 2003 has increased with 35%compared to 2002.Solar energy benefits the environment and publichealth in terms of resource conservation, reducedpollution and greenhouse gas emissions and energyconservation. According to some studies, the use ofsolar power in residential settings can reduce energyconsumption by up to 50%. Solar energy producesno air pollution or greenhouse gas emissions. Thereare advantages and disadvantages of solar energyuse, but advantages appear to outnumber thedisadvantages and, therefore, solar energy is deemedan important tool for conservation of theenvironment and public health improvement.Keywords: environment, publichealth, solar energy.70 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAIncidence of Group-A Beta Hemolytic Streptococcal(GABHS) Carriers in ENT PracticeSonil Mone 1 , Iris Mone 21Regional hospital, Vlora, Albania;2Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: To evaluate the role of GABHS in acute andchronic throat infections in children from 5 to 15years old, and to identify a way for the eradicationof the infection.Methods: We have collected data from patientsvisited in our ENT department from 2009 to 2013.Several groups of patients have been selected forthis study:Patients without any symptoms ofpharyngitis, who are routinely examined at our clinicfor other problems (Group I, Number of patientsn=60);Patients diagnosed with Tonsillopharingitiswithout any current treatment (Group II, n= 85);Patients who had completed a full antibiotictreatment for GABHS throat infection (Group III,n=70);Patients who had been removed tonsilswith or without adenoidectomy (Group IV, n=60).Throat swabs for bacterial isolation were culturedin a private laboratory. This approach wasconsidered as the best means for determining thepresence of GABHS in the throat.Results: The incidence of GABHS carriers amongthe first group of children was 1.5%. Patientsdiagnosed with tonsilopharyngitis regardless of theetiology(viral or bacterial) of the second group hadan incidence of 6%. In patients who had received10 days of oral cephalosporin for acute GABHSinfection, the culture was positive in 20% of them.Only two patients (3.3%) in the fourth group werestill carriers of GABHS.Conclusion: The role of GABHS in acute throatinfection in children is often overrated, and theimmediate use of antibiotics without any furtherinvestigation in not justifiable. The best approach foreradication of the streptococcal throat infectionremains tonsillectomy. It would be interesting forfurther studies to determine if the positive effect ofsurgery is not limited over time.Keywords: carrier, ENT, Group-A Beta HemolyticStreptococcal (GA BHS).ALBANIAN MEDICAL JOURNAL SUPPLEMENT71

ALBANIAN MEDICAL JOURNAL SUPPLEMENTSafety in schools pertinent to the hygienic-sanitaryaspectNexhat Dula 11Institute of Public Health, Gjakova, Kosovo.Context: Recently, there exists a common opinionthat safety in schools is a problematic matter whichis being heatedly debated every day, thus challengingthe education system to deal more seriously with thisproblem. When tackling safety in schools, usually oneconsiders different forms of violence betweenstudents, as well as teacher-student relations.However, safety in schools should also consider thehygienic-sanitary conditions because of the possibilityof serious endanger threatening students and thepersonnel. The research conducted in the schools ofGjakova Municipality shows and proves areasonable concern coming from students, parentsand the school personnel.Methods: The data extracted from the inspectionconducted in the schools of Gjakova Municipality.This research study employed the descriptivemethod.Results: The analysis of hygienic-sanitary conditionin schools found that, in this region, the majority ofthe schools do not reflect genuine safety in thehygienic-sanitary aspect for students and teachers.Conclusion: Lack of necessary hygienic-sanitaryconditions in schools, jeopardizes safety of studentsand the personnel in schools. Besides that, the actualhygienic-sanitary conditions in schools have anegative impact on the epidemiologic situation whichat the same time endangers the students safety aswell. A higher persistence of the regional and centralIPHs is needed towards local and central relevantauthorities for fulfilling optimal hygienic-sanitaryconditions in schools in Kosovo.Keywords: hygiene, safety, sanitary, schools.72 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIABlood cultures in the Prizren area in 2011Violeta Kryeziu 1 , Afërdita Kurti 1 , Nurishahe Hulaj 1 , Violeta Emini 1 ,Nazif Ahmeti 1 , Lebibe Hashani 1 , Myrvete Rexhepi 11National Institute of Public Health of Kosova, Branch in Prizren, Kosovo.Aim: Blood cultures allow the isolation of a largenumber of different microorganisms that arepresent in the blood. We analyzed microbiologicalcharacteristics of all blood cultures delivered at themicrobiological laboratory of the National Instituteof Public Health of Kosova in the Branch ofPrizren.Methods: All blood cultures there were receivedand analyzed in 2011 at the microbiologicallaboratory in Prizren were included in this study.Results: Overall, there were 558 blood culturesanalyzed in 2011 in the Prizren microbiologicallaboratory. Of these, 223 (39.96%) resulted inpositive growth, while 335 (60.04%) were negative.The largest number of isolates consisted ofStaphyloccocus aureus and gram-negative bacteriaisolates of Klebsiella pneumonia.Conclusion: Based on our results, we can concludethat the most frequent causes of bacteremia are suchmicroorganisms as Staphyloccocus, Klebsiellapneumoniae and Escherichia coli. Despite limitingfactors (such as duration, time of incubation, andcontamination), blood cultures remain the onlymethod of identification of the causes ofbacteremia and sepsis.Keywords: bacteremia, blood cultures, microorganisms, sepsis.ALBANIAN MEDICAL JOURNAL SUPPLEMENT73

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INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPARALLEL SESSIONSSession 4: Lifestyle factorsModerator:Gentiana QirjakoALBANIAN MEDICAL JOURNAL SUPPLEMENT75

ALBANIAN MEDICAL JOURNAL SUPPLEMENTHealth Behaviour in School-Aged Children Survey inAlbaniaEngjëll Mihali 1 , Gentiana Qirjako 1,2 , Erka Amursi 1 , Genc Burazeri 1,2 ,Albana Ahmeti 1 , Gazmend Bejtja 3 , Ehadu Mersini 4 , Mariana Bukli 5 ,Enver Roshi 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania;3Ministry of Health, Tirana, Albania;4WHO - Tirana Office, Tirana, Albania;5UNICEF - Tirana Office, Tirana, Albania.Context: The Health Behavior in School-AgedChildren (HBSC) is a cross-national research studyof the health behavior and health of adolescentsacross a large number of countries in Europe andNorth America. It aims to gain new insight into, andincrease understanding of adolescent health behavior,health and lifestyle in their social context. The studyis conducted every four years in all countries thatare members of HBSC network.Albania is part this network since 2009. This year,HBSC Study in Albania is proposed to be carriedout as part of the activities of the National ActionPlan for Food and Nutrition, 2013-2020, and willbe supported by the WHO and UNICEF.Methods: HBSC is a school-based survey with datacollected through self-completion questionnairesadministered in the classroom. The internationalstandard questionnaire enables the collection ofcommon data across participating countries and thusenables the quantification of patterns of key healthbehaviors, health indicators and contextual variables.These data allow cross-national comparisons to bemade and, with successive surveys, trend data analysisis also possible. The study will be conducted intwelve districts (prefectures) of Albania, which willcover all geographical areas of the country. The focuswill be on children 11 years, 13 years and 15 years.The field work will be carried out during April 2013.Relevance: Findings from the HBSC survey willhelp policymakers, health sector professionals andespecially health promotion specialists to improvetheir work towards specific topics that influence thehealth of the Albanian children.Keywords: cross-sectional study, Health Behavior in School-A geChildren (HBSC), school-based survey.76 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIASubstance use among 15-16 year old adolescents inTirana Findings from the 2011 ESPAD studyErvin Toçi 1 , Eduard Kakarriqi 1,2 , Alban Ylli 1,2 , Roland Bani 1 ,Genc Burazeri 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: During the last two decades, Albania hasexperienced vast population displacements andTirana, the capital, welcomed a good proportion ofthe newcomers. In this context of demographictransition and economic instability, our aim was toassess substance use prevalence among Tiranaadolescents living with the uncontrolled urbanizationprocess.Methods: In 2011, the European School SurveyProject on Alcohol and Other Drugs (ESPAD) wascarried out for the first time in Albania using astandardized methodology. We used a two-stagestratified sample of 9 th and 10 th graders in Albania.The detailed questionnaire enquired about alcohol,tobacco and illicit drug use.Results: Life-time, last year, last month and lastweek prevalence of alcohol, tobacco and other illicitdrug use were higher among Tirana adolescentscompared with the rest of the country. Higherproportions of Tirana pupils engage in morefrequent, higher quantity and more dangerous useof psychoactive substances. Furthermore, higherproportions of Tirana school adolescents considerit easy or very easy to find alcohol, tobacco or illicitdrugs compared with their counterparts livingelsewhere.Conclusion: The prevalence of substance use ishigher among Tirana adolescents than in otherdistricts of Albania. Future studies are needed inorder to understand the mechanisms and risk factorsof substance use among Albanian adolescents.Keywords: adolescents, ESPAD, substance use, Tirana.ALBANIAN MEDICAL JOURNAL SUPPLEMENT77

ALBANIAN MEDICAL JOURNAL SUPPLEMENTSmoking prevalence and its association with sociodemographicfactors among students of theUniversity of Tirana and the Polytechnic UniversityLoreta Kuneshka 1 , Marsida Duli 2 , Numila Maliqari 31Faculty of Public Health, University of Medicine, Tirana, Albania;2Department of Medical Sciences, Faculty of Medical Sciences, Kristal University, Tirana, Albania;3Department of Pediatrics, Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: The aim of this study was to assess theprevalence of smoking and its association withsocio-demographic factors among students of theUniversityof Tirana and the Polytechnic University.Methods: A cross-sectional study was conductedin January-October 2012 inclduing a sample of 665students (55% females) at the University of Tiranaand 798 students at the Polytechnic University (40%females). All participants completed an anonymousquestionnaire on smoking habits aiming to assessstudents level of knowledge about the damages thatsmoking causes, the organs and systems that aremostly affected and the sources of informationabout smoking (written media, electronic media,school, or other sources). The questionnaire alsoincluded socio-demographic data. Logisticregression was used to assess the associationbetween smoking and socio-demographiccharacteristics. Chi-square test was used to comparethe group of students of the University of Tiranawith the students of the Polytechnic University.Results: Boys had a higher smoking prevalence thangirls (39% vs. 24%, P

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAKnowledge, attitudes and practices on drug useamong students in Prizren, Kosovo, in 2013Nurishahe Hulaj 1 , Naser Ramadani 1 , Ilir Begolli 1 , Lebibe Hashani 1 ,Violeta Kryeziu 1 , Nazif Ahmeti 1 , Fadil Kryeziu 1 , Myrvete Rexhepi 1 ,Agron Hoxha 11National Institute of Public Health of Kosova, Prizren Branch.Aim: To assess the level of knowledge, attitudes andpractices regarding drug use among students inPrizren, Kosovo.Method: This was a cross-sectional research study.An anonymous self-administered questionnaireconsisting of 20 items was used in this survey. Thesurvey was conducted during March 2013.Approval for research was obtained from theMunicipal Education Directorate of Prizren. In theresearch participated 465 students from grades X,XI, XII and XIII (age range: 15-19 years).Results: Mean age of the students was 17.0 years.There were 51% males and 49% females. Studentsfrom urban areas were 57.4%. About 65% of thestudents reported that they read sufficiently aboutdrugs, whereas 28% of the students felt that theschool taught them quite little about drug-relatedissues. However, students reported that the keysource of information about drug-relatedinformation was television advertising. About 86.3of the students have never taken part in activitiesdiscussing about drug effects.Conclusion: The level of knowledge about drugrelatedissues is not satisfactory among students inthis region of Kosovo. The main source ofinformation appears to be television viewing. Multisectoralactions and effective measures should beundertaken in Prizren in order to control and preventthe drug use among students.Keywords: drugs, public health, schools, student knowledge.ALBANIAN MEDICAL JOURNAL SUPPLEMENT79

ALBANIAN MEDICAL JOURNAL SUPPLEMENTGlobal Youth Tobacco Survey (GYTS) in AlbaniaRoland Shuperka 1 , Ledina Hoxha 2 , Krist Kocani 3 , Redona Shuperka 21Institute of Public Health, Tirana, Albania;2The Association of Health Professionals Against Tobacco and Alcohol;3For Tobacco Free Albania.Aim: The purpose of this study was to collect dataon young peoples smoking prevalence, knowledgeand attitudes related to tobacco use, exposure tomedia messages on smoking and to environmentaltobacco smoke, and the inclusion of healtheducation about tobacco use in school curricula inAlbania.Methods: Target group were pupils fromelementary schools attending the seventh, the eighthand and the ninth grades in Albania. Overall, 59representative schools were included in the survey,with 4771 pupils in the age of 13-15 years.Results: According to the survey findings, 11.5 %of schoolchildren were current smokers (17.6%boys and 6.3% girls). More than three out of tenever smokers initiated smoking before the age of10 years. Four out of ten pupils lived at homeswhere other people smoked. A large proportion ofpupils had experimented with tobacco, more thenfive out of ten of pupils in the overall sample. About65% of schoolchildren reported exposure tosecond-hand smoke in places outside their homes.About 83% of schoolchildren were not refusedwhen buying tobacco products despite their youngage.Conclusion: Awareness campaigns on the dangersof cigarette smoking need to be intensified inAlbania. Our data suggest a decreasing age ofinitiation of cigarette use among Albanianadolescents. Therefore, measures on tobacco controland prevention should be implemented and includethe following elements: schools-based programs onsmoking cessation and prevention, restriction ofexposure to second-hand smoke, media campaigns,and prohibition of availability of tobacco productsto minors.Keywords: global youth tobaccosurvey, pupils, smoking.80 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAGlobal Health Professional Student Survey (GHPSS)among Albanian medical studentsMeriglena Rusta 1 , Artenida Duraku 2 , Ledina Hoxha 2 , Redona Shuperka 21Tirana Regional Health Authority, Tirana, Albania;2Tobacco Free Albania, NGO.Aim: To determine the tobacco use and cessationcounseling among health-professional students.Methods: The GHPSS was a school-based surveywith a focus on third-year medical students.Results: The prevalence of ever-smoked cigarettesfor medical students was 65.0%. About 23% ofthe students currently smoked cigarettes, but 52 %of them wanted to quit smoking. ETS exposurewas over 5 in 10 students live in homes where otherssmoke in their presence and over 8 in 10 wereexposed to smoke in enclosed public places in thepast week. The data showed that 88.7% of medicalstudents recognized that they are role models insociety. Over 97.2% of medical students consideredthey should receive training on counseling andtreating patients to quit using tobacco. However,21.1% of medical students have received formaltraining.Conclusion: The GHPSS has shown significantneeds for cessation assistance among healthprofession students as well as gaps in professionaltraining to provide similar effective assistance to theirfuture patients. The GHPSS is helpful in evaluatingthe behavior and attitudes regarding tobacco amonghealth professional students, but additional researchis necessary to improve the evidence base foreffective tobacco-related curricula, especiallymaterials that are appropriate for a range of culturaland economic circumstances pretinenent to Albania.Keywords: Global Health Professional Student Survey, smoking, students, tobacco.ALBANIAN MEDICAL JOURNAL SUPPLEMENT81

ALBANIAN MEDICAL JOURNAL SUPPLEMENTHIV Risk Behaviors Among Injecting Drug Users inAlbaniaRoland Bani 1 , Arian Boci 2 , Gentiana Rjepaj 3 , Elda Hallkaj 21Department of Infectious Disease Control, Institute of Public Health, Tirana, Albania;2"STOP AIDS Association;3Obstetrical Hospital Koço Glozheni .Aim: To explore the sexual risk behaviors amonginjecting drug users. (IDUs) in order to inform thedevelopment of sexual risk reduction interventionsfor IDUs.Methods: A cross-sectional study was conductedamong a sample of 200 IDUs in capital city, Tirana.The Respondent Driven Sampling (RDS)methodology was used and the sample isrepresentative of Tirana city. The study collectedinformation on demographics; drug use history;sexual risk behavior; HIV/ AIDS knowledge,attitudes, and other psychosocial variables; and HIVand HCV seroprevalence.Results: Population estimates reveal that about 32% of IDU are younger than 25 years old. Themedian age at first injection is 21 years, with about18.5% of IDU estimated to have injected beforethe age of 19. 43.5 % of the population injecteddrugs multiple times daily. The most commonlyused injectable and non-injectable drugs in the pastmonth were heroin (93.2%), diazepam (33.4%),marijuana (48%), and cocaine (30%). Populationestimates show that half of IDU clean their needlesor syringes every time (20.6%) or almost every time(30.7%). The cleaning agents are predominantly coldor hot water (56.5% and 7.1%, respectively), with alow percentage of IDU using alcohol or boilingwater, and none of the IDU participants in thestudy reported using bleach. Only one of the IDUrespondents tested positive for HIV, and the RDSsoftware was unable to estimate the proportion ofthe Tirana IDU network that may be living withHIV. 29.8 % are estimated to be infected withhepatitis C, an infection that is transmitted the sameway as HIV.Conclusion: Sexual risk behavioral, unsafe injectingpractices, coupled with high rates of hepatitis C,illustrate the vulnerabilityof IDU to HIV. While HIVprevalence is low, IDU injection and sexualbehavioral risks warrant immediate attention.Keywords: HIV, Knowledge, Prevention, Risk behavior, Roma82 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAHIV- Related Risk Behaviors Among RomaPopulation: Results of a Bio-Behavioral SurveyRoland Bani 1 , Marjeta Dervishi 1 , Shpëtim Qyra 1 , Mimoza Basho 1 ,Silva Bino 11Department of Infectious Disease Control, Institute of Public Health, Tirana, Albania.Aim: To provide updated measurements of keybehavioral and biological indicators, includingcorrelations between risk behaviors and exposure tospecific STIs, among Roma population, and enhancecapacities to maintain surveillance as part of theNational AIDS Monitoring Plan.Methods: A cross-sectional study was conductedamong a sample of 620 individuals (aged 18-49) incapital city, Tirana. Standard household clustersampling techniques were used and the sample isrepresentative of urban Tirana. The study exploredHIV-related knowledge and risky sexual behaviors,health-seeking behaviors, and seroprevalence ofHIV, and syphilis among Roma.Results: The weighted Roma study sample wasyoung, with thirty percent of participants being lessthan 24 years of age, and a median age of 30. Interms of education, 38.5 % had received noeducation, a very low percentage given the factthat primary education is compulsory in Albania.94% of the Roma reported ever having had sexualintercourse (defined as vaginal or anal intercourse).The median age at first sex was 16 years of age.The vast majority of Roma (about 84%) had sexbefore the age of 18, with 23.5 % having first sexualintercourse between the ages of 10 and 14 years.This early age of sexual initiation is more commonamong females, almost twice than males. Biologicalprevalence rates of disease were low, none of theRoma, sample tested positive for the HIV. H whilesyphilis rates were 0.3%.Conclusion: The current prevalence of HIV andsyphilis among Roma population is low; however,the high prevalence of reported risky behaviorssuggests that Roma are at high risk of contractingsexually transmitted infections.Keywords: HIV, Knowledge, Prevention, Risk behavior, RomaALBANIAN MEDICAL JOURNAL SUPPLEMENT83

ALBANIAN MEDICAL JOURNAL SUPPLEMENTNutritional status in a representative sample ofschool-children living in rural and urban areas ofAlbaniaJolanda Hyska 1,2 , Entela Bushi 2 , Enkeleda Kadiu 21Faculty of Public Health, University of Medicine, Tirana, Albania;2Department of Environment and Health, Institute of Public Health, Tirana, Albania.Aim: To assess the prevalence of overweight andobesity in Albanian children living in rural and urbanareas, and to analyze determinants and indicators ofrisk of overweight with the specific scopemodification of the wrong eating habits andbehaviors.Methods: A cross-sectional study including arepresentative sample of children attending thefourth grade of elementary schools were the targetgroup (1000 children aged 9-10 years were enrolledin this study from three districts of Albania: Tirana,Shkodra and Vlora). This study was designed forevaluation of the anthropometric parameters, basedon the body mass index (BMI) and assessment ofchildrens dietary preferences and habits.Results: The prevalence of overweight among thechildren in rural areas was 9.7%, of whom 0.3 %of them were obese. The number of the overweightchildren in urban areas was twice higher than in ruralareas (19%). For each obese child in villages there weremore than 10 obese children in the cities. Theoverweight children engaged in an average of 2 h ofactive motor exercise and as much as 4 h of sedentaryactivity (watching television, playing video games, orreading). Most of the overweight children had loweducatedparents (63% in rural areas and 88% in urbanareas).Conclusion: The childhood overweight and obesityis a big problem for public health in Albania, especiallyin urban areas. Unhealthy behaviors are a major riskfactor for childhood overweight. These data, coupledwith the analysis of the dietary preferences and foodhabits, will allow the introduction of specific measuresaimed at preventing childhood obesity.Keywords: obesity, overweight, school children.84 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAObesity creates problems with individualperformanceJonida Haxhiu 11Institute of Public Health, Tirana, Albania.Background: Obesity under many circumstancescauses a number of problems in a persons life,which may include health problems, socialproblems, and psychological problems. In mostcases, obese persons face prejudices and in somecases discrimination, which may stumble theirfunctionality.Methods: This study is designed in the form of aqualitative survey. For the purpose of this study, therewere conducted 16 in-depth interviews with obesepersons. Also, there were conducted two focusgroupdiscussions, and inspection of personal files.There have been several meetings for an interview.Results: The study found that obese persons haveproblems with performance in school, at work, andsocial integration all because of prejudices towardsthem. Thus, obese people find it difficult to get ajob, keeping a job they already have, to be active insocial activities, as well as in other social roles.Conclusion: Being obese affects the individualperformance, which deteriorates in most cases. Onthe other hand, these performance problems cancreate stress, which in itself may be an incentive toeat, causing many times a vicious circle: eating,prejudices, stress, eating.Keywords: health problems, obesity, psychological problems, work.ALBANIAN MEDICAL JOURNAL SUPPLEMENT85

ALBANIAN MEDICAL JOURNAL SUPPLEMENTIodine status among school-children in AlbaniaJolanda Hyska 1,2 , Iris Mone 31Faculty of Public Health, University of Medicine, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3Faculty of Medicine, University of Medicine, Tirana, Albania.Aim: Iodine deficiency disorders (IDDs) arecurrently one of the major worldwide public healthproblems. IDDs remain a public health concern inAlbania too. This survey was undertaken todetermine median urinary iodine concentrationamong school children, and assess the level of iodinein salt samples at the household level, after theintroduction of the use of iodized salt at nationallevel in Albania.Methods: A cross-sectional study was conductedincluding a representative sample of school-children(N=1060) aged 6-13 years. Urine and salt sampleswere examined for iodine concentration levels.Results: Overall, median urinary iodineconcentration was 100.4 mg/l, indicating non iodinedeficiency;also, 49.6% of the urine samples examinedshowed iodine insufficiency (2.4% severe IDD, 13.4%moderate IDD and 33.7% mild IDD, respectively).Iodine content was found to be adequate in 62.1%of the salt samples. The median iodine concentrationof salt samples was 18.5 mg/ l.Conclusion: Compared to the results of previoussurveys, the IDDs rates have declined in the last fewyears in Albania. However, IDDs continue to be animportant public health problem in Albania. Thesefindings call for identification of factors to strengthenthe National IDD Control Program: the need to banproduction, trading and use of the non-iodized saltin Albania, and the need for repeated surveys tomonitor the progress in eliminating IDDs in Albania.Keywords: iodine, iodine deficiency disorders, school-children.86 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIASocial determinants of poor nutrition outcomesamong children 0-59 months in AlbaniaMariana Bukli 1 , Enver Roshi 2,31UNICEF Tirana Office, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: This paper analyses the associations betweensocioeconomic characteristics and various measuresof malnutrition among children 0-59 months of agein Albania in order to improve the targeting ofinterventions and to monitor and evaluateachievements towards attaining the MDGs.Methods: The anthropometric indicators, heightfor-age,weight-for-height, and weight-for-age, arecombined with variables measuring micronutrientdeficiencies through biomarkers for anaemia status.The analysis uses data from the AlbanianDemographic and Health Survey 2008-2009, basedon cross-sectional data collected from a sample of1,616 children aged 0-59 months. For stunting,anaemia and underweight, binary logistic regressionwas used and for wasting and overweight,multinomial logistic regression was employed tomeasure the relative risk of all confounding factors.Results: Age of the child, age of the mother,educational level of the mother, household wealthindex, region and place of residence were allsignificantly related to anaemia (all p

ALBANIAN MEDICAL JOURNAL SUPPLEMENTDietary patterns in the Albanian adult populationIris Mone 1 , Anyla Bulo 11Clinical and Biochemistry Laboratory Service, Faculty of Medicine, University of Medicine, Tirana, Albania.Context: Albania has preserved the use oftraditional foods and dishes similar to othercountries of the Mediterranean region and thus maybenefit from a healthy diet which is not high insaturated fats and salt typical for processed foodsof the non-Mediterranean prototype.Methods: A desk review of the available evidencefrom Albania for the period 1990-2011 wasconducted in order to assess the dietary patterns andcalorie intake including macronutrients pertinent tothe Albanian adult population.Results: Many Albanians eat the internationallyrecommended minimum intake of over 400 g. offruits and vegetables (in addition to potatoes) perday, which prevent deficiencies of micronutrientsand help to prevent non-communicable diseases. But,most Albanians do not reach the recommended 600g. per day threshold. In the past decade vegetableproduction has not improved as much as livestockoutput, partly because only about half of thegreenhouses built during the communist period arein use.Conclusion: Several components of traditionalMediterranean diet in Albania are being replaced byprocessed, western foods which are higher in saltand saturated fats. However, no individually-basednutritional surveys have been conducted to estimatethe quantity and quality of food intake in the adultpopulation in Albania. Consequently, valid andaccurate information on macronutrients andmicronutrients for the Albanian adult populationremains scant.Keywords: macronutrients, Mediterranean diet, micronutrients, processed foods, saturated fats, traditional diet,western foods.88 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIALevels and distribution of physical activity in theadult population of Tirana, AlbaniaLulzim Çela 1 , Bujar Spahija 1 , Arjan Bregu 2 , Herion Muja 11Faculty of Public Health, University of Medicine, Tirana, Albania;2Ministry of Health, Tirana, Albania.Aim: In developed/ industrialized countries, theprotective association of leisure-time physical exercisewith coronary heart disease (CHD) is well-established.However, population-based data on physical exercisein transitional countries of the Western Balkans arescarce, especially for Albania. In this context, our aimwas to assess the levels of physical exercise in the adultpopulation of Tirana, Albania, a country undergoingsignificant changes in behavioral characteristicsincluding physical activity.Methods: In 2012, we conducted a cross-sectionalsurvey in Tirana including a representative sample of850 adults aged e 18 years (500 women, mean age:49.7±18.8 years; 345 men, mean age: 51.3±18.4years). A semi-structured questionnaire was administeredto all participants inquiring about levels ofinvolvement in physical activities (which wascategorized in the analysis into: low, moderate, andhigh). Information about demographic characteristicsand socioeconomic factors was also collected.Results: Overall, about 22% of survey participantsreported high levels of physical activity, whereas 18%of individuals reported low levels of physicalexercise. There were no sex-differences in the levelsof physical activity. Regardless of the gender, highlevels of physical exercise were positively associatedwith younger age, a lower body mass index, and alower abdominal obesity index.Conclusion: Our findings inform about the levelsand distribution of physical activity in a representativesample of the adult population in Albania.We conclude that the levels of physical activity inthis sample of Albanian adults were low and thisfact should raise serious concerns to public healthprofessionals and particularly policymakers. There isan obvious need for health campaigns in order topromote physical activity in the adult population ofAlbania.Keywords: energyexpenditure, physical activity, physical exercise, physical inactivity.ALBANIAN MEDICAL JOURNAL SUPPLEMENT89

ALBANIAN MEDICAL JOURNAL SUPPLEMENTParticipation of adolescents in physical activity inAlbania in 2009Rudina Çumashi 1 , Rovena Daja 11Institute of Public Health, Tirana, Albania.Aim: of the Youth Risk Behavior SurveillanceSystem among adolescents was to monitor six(priority) categories of health risk behaviors amongyouth in Albania. One of these categories was theparticipation of adolescents in physical activity.Methods: This was a quantitative study withparticipation of high school students, aged 16-18years. The sample size was 3200 students, drawn ona multistage cluster sampling technique withprobability proportional to size (for the 12 districtsof Albania). The instrument of the study was astandardized questionnaire adapted from the Centerfor Disease Control and Prevention, USA. The dataanalysis was conducted in SPSS.Results: About 40% of the students did notperform any physical activity during a week, while37% reported to have had physical activities with aduration of 30 minutes without sweating or havingdifficulties in breathing 1-2 days per week. 23% ofstudents have performed a physical activity of 20minutes which had made them sweating in 3 ormore days per week (37.5% male and 12.9% femalestudents). About 70% of students participated in anhour of physical education and 8% of them in twoor more hours. 37% of the students had watchedTV for 3-4 hours per day.Conclusion: Participation of the adolescents inphysical activities has decreased over the years inAlbania. There is an urgent need for activepromotion of physical activity, efficient healtheducation, and greater focus on health education inschool curricula, as well as involvement of healthprofessionals in promotional campaigns related toyouth participation in different physical activities.Keywords: adolescent, sedentarylifestyle, physical activity.90 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAMental Health CounselingRedona Dudushi 1 , Roland Bani 1 , Marjeta Dervishi 1 , Elina Mukaj 1 ,Flora Balla 1 , Blerta Xhani 11Institute of Public Health, Tirana, Albania.Mental health is a integral part of our overall life.Mental Health Counseling has to do with manyaspects of our lives including: how we feel aboutourselves, how we feel about others, how we areable to meet the demands of life. Mental healthcounseling has been in practice for a considerabletime in various forms, and has often been a functionof religious or other community organizations intenton supporting the overall health and prosperity ofcitizens.The mental health counseling has the goal ofestablishment individuals balance between all aspectsof life (social, physical, spiritual and emotional).Counseling helps to bring change and clarity inthought, emotion, and in behavior. The counselingin itself has different goals as facilitating behavioralchange, enhancing ones coping skills, promotingdecision making, and improving relationships. Themental health counseling has important role intreatment of persons living with HIV/ AIDS.The Counseling process is becoming a core elementin a holistic model of health care, in whichpsychological issues are recognized as integral topatient management. HIV counseling has two majorobjectives: the prevention of HIV transmission andthe support of those affected directly and indirectlyby HIV/AIDS. It is important that HIV counselingshould have these dual aims because the spread ofHIV can be prevented by changes in behavior. Thecounseling has a particular contribution in that itenables frank discussion of sensitive aspects of aindividuals life. Also, when patients know that theyhave HIV infection they may suffer greatpsychosocial and psychological stresses through afear of rejection, social stigma, disease progression,and the uncertainties associated with futuremanagement of HIV. Good clinical managementrequires that such issues be managed with consistencyand professionalism, and counseling can bothminimize morbidity and reduce its occurrence. Avery important indicator to gauge the specific soundHIV/AIDS remains a number of voluntary testingfor HIV.Functioning of voluntary counseling and testingcenters in each prefecture currently allows Albaniato perform testing in these prefectures. Around2137 voluntary tests are carried out on voluntarycounseling and testing centers in Tirana and in allregions of the country, a figure that has undergonea slight increase compared to last year, when the1677 voluntary tests were conducted. Empoweringthese centers should be an ongoing process.Keywords: counseling, HIV / A IDS, mental health.ALBANIAN MEDICAL JOURNAL SUPPLEMENT91

ALBANIAN MEDICAL JOURNAL SUPPLEMENTMental health promotion in the curricula of the 9 thgrade and the higher education system in AlbaniaErka Amursi 11Institute of Public Health.Aim: Mental well-being is one of the mostimportant components of health. Mental healthproblems have a high prevalence in Albania, as wellas anywhere in the world, with an increasingincidence. For these reasons, the increasing ofpeoples knowledge and skills in order to controltheir mental health is a priority. This study aims toanalyze the extent of involvement of the aspects ofmental health promotion in the current curricula ofthe 9 th grade and the higher education system inAlbania.Methods: In this qualitative study the currentcurricula of the 9 th grade and higher educationsystem were reviewed regarding the issues relatedto mental health promotion.Results: Mental health problems are addressed inthe 9 th grade in the subject Biology and HealthEducation , in a chapter about stress. Also, life skillsissues, which have an indirect impact in mental healthpromotion, are covered in the 10 th grade, in thesubject Life skills . In the 11 th grade, in the subjectof Psychology, these issues are addressed in moredetail. But, it is an elective discipline, which is notattended by all students.Conclusion: Although mental health issues areactually addressed in the current 9 th grade and highereducation system curricula, the extent of theknowledge and skills acquired by the students areinsufficient compared to the magnitude and impactof these problems in the general population.Therefore, a more extensive coverage of theseissues in the school curricula is needed for Albania.Keywords: curricula, mental health, health promotion.92 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAThe impact of television violence among youngpeopleAulona Zotaj 11Institute of Public Health.Nowadays, the power of media is growinggradually. Such a problem is accompanied byanother disturbing phenomenon: the explosion ofviolent crime. Modern society is exposed to amassive dose of violence that occurs daily in themedia. Meanwhile, a large number of studies onviolence in the media have been undertaken in thepast forty years using different research methods.This paper aims to show the factors affecting theappearance of aggressive behavior in young people,what effect (if any) creates violence exposure onyouth and what measures can be taken to reducethis phenomenon.Different studies, conducted mainly in the field ofcommunication and psychology are introduced.These studies have found out that television (TV)violence has multiple effects on childrens behaviorof all ages. These effects include: imitation ofviolence and crimes watched on TV, reduction ofsusceptibility to aggressive behavior, explosion ofimpulsive acts of aggression, replacing of socializationactivities with peers as well as the reductionof interaction with adults.Youth exposure to TV violence is associated withemotional effects on young people, who maybecome desensitized to violence in real life and seethe world as a scary place, where people use violentmethods to resolve conflicts. Scientific evidencesfrom a group of studies on media-relatedaggression are summarized in literature reviews andhave come to the conclusion that watching violentmovies increases aggression.Theories and data suggest that social factors maymoderate the effect of media violence on aggressionif they change the chances for a child to beidentified with aggressive characters, previously seenviolence.These factors may be cultural, social including family,or environmental. For example, cultural environments,with strong sanctions against violence in thegroup reduce the expression of aggressive behaviorlearned through media. Parents, as social key factorshave the potential to become moderators of theeffects of media violence on children. Children andteenagers form their attitudes, beliefs and act as aresult of exposure to media content, but they candiscuss what they can see with others - especiallywith parents and friends. When parents take an activerole in mediating - including regular and criticalcomments -children are less likely to be adverselyaffected by media content.Researchers of communication sciences suggest thatany interference made by parents can reduce theimportance given to the television violence bychildren and can also reduce children s aggressiveattitudes. Apparently, young people need thepresence of adults to create a more realistic idea ofthe world in which they live, and this cannot belimited within the events of the TV screen.Keywords: media, television, violence, youth.ALBANIAN MEDICAL JOURNAL SUPPLEMENT93

ALBANIAN MEDICAL JOURNAL SUPPLEMENTCommunication for behavior change for improvedhealth and nutrition outcomes of children in AlbaniaDaniela Nika 1 , Mariana Bukli 2 , Jeta Lakrori 1 , Gentiana Qirjako 1,31Institute of Public Health, Tirana, Albania;2UNICEF Tirana Office, Tirana, Albania;3Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: Design and implementation of a communicationcampaign to promote sustainable change inthe behavior of families and communities forimproved care and feeding practices for mothersand children.Methods: Communication Strategy to ReduceMalnutrition in Children in Albania was prepared in2011 as one of the main components of NutritionJoint Program. It was developed collaboratively bya Group of National Experts, and an internationalcommunication consultant, supported by UNICEFoffice in Albania. This Strategy was developed usinga systematic Audience-Centered CommunicationPlanning Process. It was based on Diffusion ofInnovations, and the change model was based in the7 Steps of Change: awareness, knowledge, attitudesfavoring the new behavior, decision to try, trial,confirmation and advocacy. Development ofcommunication products was based on formativeresearch and pretesting.Results: An exciting, colorful campaign, targetingwomen, new and future mothers and mothers-inlawwas developed, promoting and modeling acoherent package of infant and young child feedingpractices. This campaign uses a variety of massmedia and interpersonal channels, and is unified bycentral character, a logo, a tagline and a musicaltheme. This is a behavior change campaign, makingeffective use of information, evidence, attitude andimage change messages, and modeling to promotechange. Health professionals were also targeted toimprove their communication and nutritioncounseling skills.Conclusion: Communication for behavior changeis a new culture for Albania, and requires adequatebudget allocations and experts trained in social andbehavior change communication for health andnutrition. Spreading information does not necessarilybring changes in attitudes and behaviors. It isimportant to find the right balance between massmedia communication and interpersonalcommunication activities especially in view of budgetrestrictions and limited social responsibility frommedia.Keywords:communication strategy, healthynutrition social and behavioral change.94 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPotentially inappropriate prescribing among olderpeopleDriton Shabani 1,2 , Zejdush Tahiri 2 , Besnik Jucja 21Department of Pharmacy, Faculty of Medicine, University of Pristine, Kosovo;2University of Medicine, Tirana, Albania.Older people often experience multiple diseases and,therefore, this is inevitably associated with multipledrug use. This phenomenon, being referred to aspolypharmacy, is related to the concurrent use of atleast five different medications. It has beenconvincingly demonstrated that multiple usage ofmedications may lead to inappropriate prescribingand a decrease in the therapeutic response. Accordingto the vast international literature on this matter,potentially inappropriate prescribing in older peopleare considered those drugs which do not haveevidence-based indications for use, those which beara high risk for side effects in older people comparedwith younger adults, or those drugs which have notbeen shown to be cost-effective in clinical settings,but particularly in epidemiological (populationbased)studies.From this perspective, inappropriate prescribing inolder people is a common and serious healthcareproblem in most of the countries worldwide, butespeciallyso in transitional countries of the WesternBalkans including Kosovo and Albania where thereare no clear and strict regulations related toprescriptions of medications. Therefore, similar toother countries, the polypharmacy phenomenon issupposedly linked to an increased risk of adversedrug reactions and inappropriate prescribing inKosovo and Albania too.Although inappropriate prescribing is a vastphenomenon in many countries, this condition isalmost fully preventable and, thus, there have beendeveloped specific screening instruments forinappropriate prescriptions including Beers Criteriaand the Inappropriate Prescribing in the Elderly Tool(IPET).In the international literature, Beers Criteria consistof the most frequently reported screening instrumentfor inappropriate prescribing notwithstandingsome major criticism which has been evoked mostlydue to the fact that several drugs are rarely prescribedcurrently, there exists a lack of structure in thepresentation of the criteria and omission of severalimportant and common inappropriate prescribinginstances.These internationally validated instruments arecurrently being cross-culturally adapted andsubsequently will be administered to a nationwiderepresentative sample of older people in Kosovo.Keywords: Beers Criteria, inappropriateprescribing, InappropriatePrescribingin theElderlyTool (IPET), older people,polypharmacy.ALBANIAN MEDICAL JOURNAL SUPPLEMENT95

ALBANIAN MEDICAL JOURNAL SUPPLEMENTDemographic and socioeconomic factorsassociated with inadequate functional health literacyamong primary health care users in KosovoHaxhi Kamberi 1 , Ervin Toçi 2 , Afrim Pirraçi 3 , Naim Jerliu 4 , Herion Muja 21Regional Hospital Isa Grezda , Gjakovë, Kosovo;2Institute of Public Health, Tirana, Albania;3University Hospital Center Mother Teresa , Tirana, Albania;4Institute of Public Health, Pristine, Kosovo.Aim: Functional health literacy (FHL), whichencompasses comprehensive reading and numericalskills, is a prerequisite for taking sound healthdecisions. Thus, inadequate FHL may pose a seriousbarrier towards achieving optimal health. Our aimwas to determine the factors associated withinadequate FHL among adult primary care patientsin Kosovo.Methods: During November 2012 February2013, 1035 primary health care patients aged e 18years old were interviewed in the premises of thePrincipal Family Medicine Centers of Pristine,Gjakova and Prizren municipalities in Kosovo(response rate: 86.3%). FHL was assessed using thevalidated Albanian version of the TOFHLA testwhich measures reading comprehension andnumerical skills. TOFHLA scores range between 0-100 with higher scores implying better functionalhealth literacy. Chi-square test was used to determinethe factors associated with inadequate FHL in thisstudy sample.Results: Mean age of participants was 44.3 years± 17.3 years. Almost two thirds (60.2%) ofparticipants were females. Inadequate FHL wassignificantly higher among individuals aged >50 yearsold compared to their youngest counterparts (64.9%vs. 20.2%, respectively), those with low educationcompared to highly educated participants (79.7% vs.8.1%, respectively), rural compared to urbanresidents (48.2% vs. 40.4%, respectively) and amongindividuals with poor economic status compared tothose with high economic status (72.9% vs. 37.3%,respectively).Conclusion: Inadequate FHL varies significantlyaccording to selected demographic and socioeconomicfactors of Kosovo primary health careusers. Interventions targeting high-risk groups couldhelp strengthen FHL and subsequently improveindividual health decision making.Keywords: functional health literacy, Kosovo, primarycareusers, socioeconomicstatus.96 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAMenopause and quality of life in womenMiranda Hajdini 11Institute of Public Health, Tirana, Albania.The importance of female sexual fulfillment isincreasingly recognized in todays society. Womenssexual lives continue well into the menopausal yearsand beyond; however, the impact of menopause onthe quality of the sexual life has not been comprehensivelystudied in the medical literature. Thisreview attempts to clarify the impact of thephysiological, psychological and psychosocialchanges occurring at midlife that may affectwomens quality of sexual life. Pharmaceutical andpsychological interventions that may assist inimproving the quality of sexual life of menopausalwomen are discussed.Female sexuality is complex and not fully understoodand, consequently, controversy frequentlyarises in the discussion of female sexual problemsand their treatment. A future perspective on howthe impact of menopause on the quality of sexuallife may be more cohesively investigated.Menopause is defined as the permanent cessation ofmenstruation resultingfromlossof ovarian follicularactivity .In the majority of women, menopause is a naturalevent occurring, on average, at the age of 51.3years. An earlier menopause may be inducedsurgically by oophrectomy, often accompanied withhysterectomy, or as a consequence of prematureovarian failure. The time at which natural menopauseis said to have occurred for an individual is aretrospective clinical diagnosis based on 12 monthsof amenorrhea from the woman s last menstrualperiod. Natural menopause is not a singular eventbut a transition lasting on average 3.8 years. Thetransition begins with the peri-menopause and thisperiod, often referred to as the climacteric,commences at a mean age of 47.5 years. Themenopause transition can be divided into earlytransition and late transition (also known as early andlate peri-menopause); early postmenopause and latepostmenopause, with each stage marked by changesin hormonal status producing patterns ofmenopausal symptoms.Keywords: menopause, peri-menopause, postmenopause.ALBANIAN MEDICAL JOURNAL SUPPLEMENT97

ALBANIAN MEDICAL JOURNAL SUPPLEMENTPsychosocial intervention in combination withpharmacotherapy and treatment response amongpatients with alcohol addiction in Tirana, AlbaniaShpëtim Doksani 1 , Sokol Myftiu 2 , Artan Simaku 3 , Rabushe Kollcaku 11Clinic of Alcohol Addiction Treatment, University Hospital Center Mother Teresa , Tirana, Albania;2Faculty of Medicine, University of Medicine, Tirana, Albania;3Institute of Public Health, Tirana, Albania.Aim: Alcohol abuse and alcoholism represent aworld-wide problem, both from a medical and asocial point of view. Psychiatric disorders occurmore often among alcoholics than among thegeneral population. The aim of this study was toinvestigate the treatment response and the patternof psychiatric, neurologic and internal co-morbiditieswhich may affect the organization of thetreatment.Methods: This study included 51 patients, whostarted psychosocial treatment at alcohol treatmentinpatient clinic over the period September 2010September 2011. Socio-demographic and socioeconomiccharacteristics included marital status,educational level, employment status, and incomelevel. Treatment stages followed the HUDOLINscheme.Results: Mean age of the patients was 47.3± 9.8years (range: 31-72 years). There were 49 (96%)males and only 2 (3.9%) females. The most frequentdisorders in this group of patients were thepsychiatric disorders (n=41, 80%), followed byinternal disorders (n=36, 70%) and neurologicaldisorders (n= 15, 30%). A significant positiveassociation was found between psychiatric disorders(generalized anxiety, or mayor depressive disorders)with the civil status divorced (P= 0.006);unemployment (P

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIASafety and health in the waters of the swimmingpoolsDrita Mema 1 , Donika Boçari 1 , Arben Luzati 1 , Valentina Pashaj 1 , Olta Petri 1 ,Besim Agolli 11Department of Health and Environment, Institute of Public Health, Tirana, Albania.Aim: The increase in the number of swimmingpools as recreational places has brought the necessityof their sanitary evaluation. This study is based onthe WHO recommendations for safe and healthypools.Methods: This study included several outdoor poolsin Tirana. These pools have different structuralcharacteristics (surface, volume) and disinfectionmeans. The study was conducted within a periodof three years. Sampling was conducted in variousdays over the weekend. Analytical methods inaccordance with the Albanian standards ISO, ENwere employed. Quality control of the analysis wascarried out through the participation in laboratorytest, IPA 2011. The main physical and chemicalindicators used to assess the quality of pool watersincluded the following: free chlorine, suspendedmatter, pH, and ammonia. Conversely, microbiologicalindicators included total coliform, faecalcoliform, faecal, sptreptococus, and pseudomonasaeruginosa. Maintenance indicators included the areaavailable per each sunbather, the usage of annexesas public environments, and sanitation services.Results: This study demonstrated that severalindicators in the swimming pools of Tirana arequite poor. Free chlorine in 49.6% of the analyzedsamples was below the recommended values.Furthermore, ammonia in 50.6 % of the analyzedsamples was above the recommended values. Totalcoliform number in 70% of the analyzed sampleswas above the recommended values. The report ofthe area per each sunbather in all pools was notmanaged by their keepers.Conclusion: In Tirana, the factors which influencethe safety of the swimming pools include themicrobiological (fecal) indicators, the chemical (byproductof the chlorination: chloramines) indices andcontamination by the users of the pools (ammonia).Proper management of the microbiological,chemical and maintenance indicators are a basicprerequisite for healthy and safe swimming poolsin Albania.Keywords: free chlorine, recreational places, swimming pool, water safety.ALBANIAN MEDICAL JOURNAL SUPPLEMENT99

ALBANIAN MEDICAL JOURNAL SUPPLEMENTLevel of hand hygiene in health care services inVloraAgron Bashllari 1 , Marinela Zejno 2 , Elona Agalliu 11Epidemiology Service, Public Health Directorate, Vlora, Albania;2Vlora Regional Hospital.Aim: Hand hygiene is an important element of thequality of health care services. Our aim was todescribe the level of hand hygiene in Vlora RegionalHospital.Methods: This was a descriptive study undertakenbetween December 2012 and January 2013 includinga representative sample of the personnel (n=200).A standardized WHO-recommended questionnairewas administered to all participants. Epi-Info wasused for data analysis.Results:· 97% (95%CI=94.6%-99.3%) of participantsreported there is non-stop running (safe) water inthe hospital.· Conversely, 93.5% (95%CI=90.0%-96.8%) ofindividuals reported that there were no papernapkins of single usage.· 69.3% (95%CI=63.0%-75.6%) of intervieweesreported that the institution has no real plan forimproving the infrastructure for hand hygiene.· 90% (95%CI=85.0%-94.0%) of individualsreported that there is no monitoring mechanism ofthe compliance of hand hygiene within the hospital.· Only 6% (95% CI 3.3% -9.9%) of the interviewedpersonnel reported washing always theirhands before visiting/treating patients.· The hand hygiene compliance rate for the item:before visiting/ treating the patient was 3%.Conclusions: Our findings point to the urgent needfor implementation of the program for handhygiene, according to WHO guidelines. Furthermore,there is a need for prioritization of possibleinterventions concerning: infrastructure; continuoustraining of personnel; promotional campaigns;evaluation and feedback of information on handhygiene; establishment of a positive institutionalclimate about the issue of hand hygiene by engagingthe leading staff of the hospital.Keywords: hand hygiene, health careservices, V lora.100 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPARALLEL SESSIONSSession 5: Reproductive HealthModerator:Eduard KakarriqiALBANIAN MEDICAL JOURNAL SUPPLEMENT101

ALBANIAN MEDICAL JOURNAL SUPPLEMENTNational Contraceptive Security Strategy in Albania,2012-2016Miranda Hajdini 1 , Dorina Çanaku 1 , Fjedor Kallajxhi 11Institute of Public Health, Tirana, Albania.Albania has made significant progress in the area offamily planning in the last 10 years. The Ministryof Health (MoH) of Albania has taken the lead instrengthening contraceptive security (CS) to ensurea lifetime supply of contraceptives for all Albanianswho need them. By 2010, Albania has beencompletely self-reliant and independent of outsidedonor support for contraceptives by providing100% financial coverage for the public sector. In2008-2009 a Demographic and Health Survey wasconducted (ADHS 2008-2009), where the moderncontraceptive prevalence rate was reported at only11%, and total fertility rate 1.6.The two key principles of the Albanian NationalContraceptive Security Strategy are contraceptivesecurity and contraceptive independence. Contraceptivesecurity involves guaranteed, reliable, longtermsupply of quality contraceptives for everyAlbanian who wants them. Contraceptive independenceis defined as complete self-reliance inmaintaining contraceptive security, with no need forexternal donors to fund contraceptives or relatedlogistics technical assistanceThe overarching goal of the Albanian NationalContraceptive Security Strategy 2012-2016 (ANCSS2012-2016) is to ensure that Albanian men and womencan choose, obtain, and use high-quality family planningservices and contraceptives, whenever they want them,for planning their families.The Albanian National Contraceptive Security Strategy2012-2016 has two phases:· First phase (2012-2013): This phase will becharacterized by maintaining the 2011 policy ofproviding contraceptives free-of-charge for all thepopulation in-need. Also, a study to identify the costsof providing family planning services in the publicsector will be conducted during the first phase, allowingquantification of all service and program costs relatedto provision of familyplanning bythe public sector.This phase will be used also to improve the nationallogistical information system on contraceptives byattempting to include information from the privatesector (pharmacies and other selling points forcondoms), social marketing and NGO sectors.· Second phase (2014-2016): During this phase, freeof-chargecontraceptives provided by the public sectorwill be targeted to most vulnerable populationsubgroups.Keywords: contraceptives, health education, security strategy.102 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAAbortion indicators in Albania for the period 2009 -2011Alba Merdani 1 , Dorina Çanaku 1 , Eduard Kakarriqi 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Context: In Albania, before the legalization ofabortion (1994), the mortality rate was rankedamong the highest in the European region: almost50% of all pregnancies resulted in miscarriage, mostof them self-induced or not performed in safeconditions. Despite uncertainty about the actualnumber of abortions before 1990 in Albania, afterthe legalization of abortion the trend has beentowards fewer abortions.Since 2007, the Institute of Public Health hasestablished abortion surveillance in order todocument the number and characteristics of thewomen obtaining abortions.Methods: Abortion surveillance is the main sourceof data, because it is based on the abortion formscoming from all the maternity wards as well as theprivate clinics licensed to perform abortions inAlbania. For the purpose of trend analysis, data areevaluated from 48 areas that provide data every yearregarding the period 2009-2011. Abortion ratios(abortion per 1,000 live births) are calculated usingnativity data from the Ministry of Health.Results: The national abortion ratio declinedgradually from 270.2 per 1,000 live births in 2009to 242.2 per 1,000 live births in 2011. Women aged20-34 years were accounted for the majority ofabortions during the entire period of the analysis(around 65.5%). Abortions performed in publicsector in 2011 constituted 88.8% of the totalnumber of abortions, with an increase on the privatesector, which constituted 11.2% of abortions,compared to 8.4% in 2009.Conclusions: Ongoing abortion system isimportant in order to evaluate the programs aimedat preventing unintended pregnancies and fosteraccess to family planning.Keywords: abortion, indicators, surveillance.ALBANIAN MEDICAL JOURNAL SUPPLEMENT103

ALBANIAN MEDICAL JOURNAL SUPPLEMENTDo the socio demographic characteristics ofmothers affect the preterm birth in Tirana?Sonela Xinxo 1 , Eduard Kakarriqi 11Institute of Public Health, Tirana, Albania.Aim: Preterm delivery is associated with increasedrisk for infant mortality and morbidity, as well aslong-term morbidity (in particular, chronic disease)and high economic costs for both families and thesociety. The aim of this study was to describe theeffect of different social and demographiccharacteristics of mothers on preterm birth (less than37 weeks of gestation).Methods: This case-control study examined sociodemographic risk factors for preterm birth, atUniversity Obstetric Hospitals of Tirana duringMarch-December 2012. A total of 140 preterminfants mothers and 280 in term infants motherswere included in the study. The odds ratio (OR)calculated by logistic regression analysis was used asa measure of association between the preterm birthand the socio demographic variables such as age(below vs. above 35 years), residence, education,employment, and marital status.Results: The highest significant ORs of pretermwere found in mothers living in rural areas (OR=2.1,95%=1.2-4.7), low-educated mothers (OR=1.4,95%CI=1.1-2.6) and mothers who worked duringtheir pregnancy (OR=4.2, 95%CI=1.2-7.3). TheORs of preterm birth were found non-significantregarding the marital status and age of the mothers.Conclusion: Women residing in rural areas, thosewith a low educational level and those workingduring their pregnancy are more likely to have apreterm birth. Our findings indicate that pretermbirth should be considered as a pregnancy outcomewhich is affected by the socio-demographiccharacteristics of mothers.Keywords: mothers, preterm birth, socio-demographic factors.104 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAThe prevalence of congenital malformations inTirana, during 2010 and 2011Dorina Çanaku 1 , Alba Merdani 1 , Ervin Toçi 1 , Eduard Kakarriqi 1,2 ,Enver Roshi 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Background: Congenital malformations (CM) andpreterm births are important causes of childhooddeath, chronic illness, and disability in manycountries. Congenital malformations may have agenetic, infectious or environmental origin; yet, inmost of the cases it is difficult identify their cause.Congenital malformations can be defined asstructural or functional anomalies, which are presentat the time of birth.Methods: This is a cross-sectional study. Congenitalmalformations data are extracted from thecongenital malformations surveillance system inAlbania and the data about live births are collectedfrom the Ministry of Health.Results: Congenital malformations affect approximately14 in 1000 infants in Albania. Approximately1 in 100,000 inhabitants in Albania die everyyear from congenital malformations. The mostcommon major congenital malformations in Tiranaare heart defects, gastro-intestinal defects, musculoskeletaland neural tube defects. Approximately 80%of CM cases identified in Tirana are residents ofthis district. Approximately 70% of CM cases areof rural residence and around 60% of them aremales. About 60% of their mothers are unemployed.17% of CM cases are born preterm (before37 completed weeks of pregnancy). The annualprevalence of congenital malformations in Tiranain 2010 and 2011 was approximately 24 per 1000live births.Conclusion: Congenital malformations may resultin long-term disability, which may have significantimpacts on individuals, families, health-care systemsand societies. Many congenital malformations can beprevented and treated. An adequate intake of folicacid, iodine, vaccination, and adequate antenatal careare key preventive tools.Keywords: congenital malformations, epidemiology, surveillance, Tirana.ALBANIAN MEDICAL JOURNAL SUPPLEMENT105

ALBANIAN MEDICAL JOURNAL SUPPLEMENTFeeding and care practices of children in targetinterventions areas of the Nutrition Program inAlbaniaMariana Bukli 1 , Elizana Petrela 2 , Daniela Nika 31UNICEF Tirana Office, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania;3Institute of Public Health Tirana, Albania.Aim: To generate baseline information onknowledge, attitudes and practices about infant andyoung child feeding and care practices in order toplan nutrition interventions and help prepare thenew Food and Nutrition Action Plan for Albania.Methods: The survey was designed to provideinformation on a representative sample ofhouseholds in the target intervention areas of theNutrition Program (Kukes and Shkodra prefecturesand two peri-urban municipalities of Tirana: Kamëzand Paskuqan). A stratified two-stage cluster samplewas designed selecting 1,584 households withwomen between the ages of 15-49 years, schoolchildrenaged 5-14 years, and children under 5 years.The data were collected through personal, face toface interviews.Results: Forty two percent of infants under 6months were exclusive breastfed. Among children6-23 months, only 38% of were fed with theminimum acceptable diet that includes combinationof food groups and adequate number of meals perday. Using the dietarydiversityscore, 51% of infantswere not fed with the minimum acceptable numberof food groups in a day. 88% of children 5-15years had a diet that meets the minimum acceptablelevel of dietary diversity. Only 50% of mothers feltthey have enough information about adequate childfeeding.Conclusion: The 1000 days from pregnancy to theend of the second year of child s life represent aperiod of vulnerability but also a window ofopportunity for effective interventions. Interventionsshould be implemented early in child s life in orderto yield the highest returns in terms of reduced childmortality, improved child health, physical growthand mental development and prevention of noncommunicablediseases later in life.Keywords: children, feeding and care practices, nutritional program.106 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAIodine status among pregnant women in AlbaniaEnkeleda Kadiu 1 , Jolanda Hyska 1,2 , Entela Bushi 11Department of Environment and Health, Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: Adequate iodine intake is required for thesynthesis of thyroid hormones that are importantfor normal fetal and infant neurodevelopment.IDDs remain a public health problem in Albania.In the recent past, Albania had severe iodinedeficiency disorders, as shown by severe data. Thisstudy aims to describe urinary iodine excretionduring pregnancy in women living in of the Central- South East area of Albania that resulted withmiddle and severe IDD prevalence, and low levelof iodine content in salt (National IDD survey2006).Methods: This was a cross-sectional study includinga representative sample of 137 pregnant womenfrom first to second trimesters, attending motherand child health care centers. Urinary iodine excretionand the iodine in salt in household level weremeasured in all participating women.Results: The median urinary iodine concentrationwas 159.4 µg/l indicating non-iodine deficiency. Yet,48.5 % of the urine samples examined showediodine insufficiency, 29.4% sufficient iodine and22.0% excessive iodine. Iodine content was foundto be adequate in 73.7 per cent of salt samples. Themedian iodine concentration of salt samples was29.6 mg/l.Conclusion: The data showed a good progress, butAlbanian pregnant women are still iodine insufficient.Findings of this study call for further attention toiodine intake during pregnancy. The currentlyrecommended intake of iodine through universal saltiodization may not be adequate for pregnant andlactating women, and supplementation duringpregnancy and lactation should be further consideredin light of the latest recommendations.Keywords: iodine, iodine deficiency disorders, pregnant women.ALBANIAN MEDICAL JOURNAL SUPPLEMENT107

ALBANIAN MEDICAL JOURNAL SUPPLEMENTAssessment of iron status in Albanian children andwomen through biochemical iron indicatorsEhadu Mersini 1 , Genc Burazeri 2,31World Health Organization, Tirana Office, Tirana, Albania;2Institute of Public Health, Tirana, Albania;3Faculty of Public Health, University of Medicine, Tirana, Albania.Aim: To assess the iron status among Albanianchildren aged 6 months to 14 years and women 15-49 years in a cross-sectional study conducted in theprefectures of Shkodër, Kukës and periurban areasof Tirana.Methods: A total of 443 children 6-59 months, 530children 5-14 years, and 418 women 15-49 yearswere included in this study. Iron status was definedutilizing biochemical indicators. Iron depletion wasdefined as low serum ferritin (SF28 nmol/l) plus irondepletion. Iron deficiency anemia (IDA) was definedas ID with hemoglobin (Hb) below the WHOcutoff value for age and sex: 11.0 g/dl for children6-59 months, 11.5 gr/dl for children 5-11 years old,12.0g/ dl for children 12-14 years old and(nonpregnant) women 15-49 years old. Individualswith indication of inflammation (CRP>10mg/ l)were excluded from the analyses.Results: The prevalence of iron depletion amongchildren 6-59 months, children 5-14 years andwomen 15-49 years were 28.4%, 10.9% and 23.6%,respectively. The overall prevalence of ID and IDAamong children 6-59 months was: 9.1% and 7.5%,respectively; among children 5-14 years: 6.1% and3.4%, respectively; and among women 15-49 years:8.1% and 7.1%, respectively.Conclusion: Findings of this study indicate thatspecific attention should be given in Albania to ensurethat the dietary intake of iron is adequate forchildren, adolescent girls and women throughimplementation of integrated strategies that includeimprovement of dietary intake through education,food fortification and use of iron supplements.Keywords: anemia, deficiency, dietaryintake, irondepletion.108 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIASignificance of HPV tests in women with cervicalsmears exhibiting squamous cells of uncertainsignificance (ASCUS)Anila Xhani 1 , Kozeta Filipi 21Maternity Geraldina Queen , Tirana, Albania;2Institute of Public Health, Tirana, Albania.Aim: In Albania, cervical cancer cases are diagnosedin advanced stages. The aim of our study was toassess the relationship between the humanpapillomavirus (HPV) tests and the cytologicalfindings.Methods: Overall, 1321 women participating in theopportunistic cytological screening in the Maternityof Tirana, Albania and 52 showing atypicalsquamous cells of uncertain significance (ASCUS)in their cervical smears were identified during theyear 2012. All women were invited for a repeatedexamination about three months later. At thatoccasion, a smear sample was collected and usedfor cytological examination and a concomitant HPVtest. HPV detection and typing were carried out bypolymerase chain reaction and HPVdeoxyribonucleoside acid (DNA) sequence analysis.Results: Women with an ASCUS diagnosis showeda normal cytology and a negative HPV test in 13.5%of the cases, abnormal cytologyand a positive HPVtest in 48% of the cases; in 21% of the women,the HPV test was positive, whereas cytology wasnormal; and in 17% of the women, the HPV testwas negative, whereas cytology was abnormal(ASCUS or more). HPV test was positive in 70%of ASCUS cases. HPV high-risk was detected in28% of HPV test positive and in 100% of casesdiagnosed in CIN 3. Oncogenic types detected were33, 16, 18, 52, 68, 51, 31, and 56.Conclusion: Our findings indicate that HPV testsidentify a larger group of women at risk to developcervical cancer in comparison with cytologicalexamination. As the HPV tests have a highersensitivity than the cytological screening, it issuggested that a HPV test in conjunction with adiagnosis of ASCUS can be employed moreefficiently to selected women for whom furtherfollow-up is recommended.Keywords: cervical cancer, HPV , smear.ALBANIAN MEDICAL JOURNAL SUPPLEMENT109

ALBANIAN MEDICAL JOURNAL SUPPLEMENTLogistic Management of Information Systems forContraceptive DistributionMiranda Hajdini 11Institute of Public Health, Tirana, Albania.Context: In Albania, family planning services areoffered in all 36 districts and in 427 public sectorfamily planning clinics, or service delivery points.National Logistic Management of InformationSystems for Contraceptive Distribution (LMIS) hasbeen set up in order to ensure the supply for eachproduct, the necessary quantity, and monitoring &evaluation of family planning services.Methods: Reviewed data reported every trimesterfrom LMIS focal points in 36 District Public Healthdirectorates. This system collects service statisticsfirst visit, revisits, counseling visits, total visits, andCouple Years of Protection (CYP).Results: LMIS figures from 2006-2012 indicate astable consumption of contraceptives, but a decreaseof 5% in the number of new visits and a slightreduction in the number of injections and IUDsprovided. Total CYP/GMR was estimated at 5.2%and 4.3% in 2006 and 2012, respectively. CYP wasestimated at 20729 in 2006, combined oralcontraceptives, and IUD accounting respectively for27%, 41% and 16% condom and injections of thetotal CYP. CYP was estimated at 18433 and 17060in 2010 and 2012 respectively, combined oralcontraceptives, and IUD accounting respectively for27%-26%, 33-31% and injections and condoms20%-22% of the total CYP.Conclusion: In Albania, family planning services atprimary health care are now part of the packageof services provided in the health centers. LMISshould be a continuous supply of types of moderncontraceptives that are offered free of charge. Thefact that contraceptive prevalence rate is increasingslowly, points to the need for more contraceptiveeducation and health promotion campaigns inAlbania.Keywords: Albania, Logistic Management of Information Systems for Contraceptive Distribution (LMIS).110 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAAssessment of knowledge level about sexuallytransmitted infections among university students inAlbaniaLumturi Mërkuri 1 , Gentiana Qirjako 1,2 , Ervin Toçi 1 , Pëllumb Pipero 31Institute of Public Health, Tirana Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania;3University Hospital Centre Mother Theresa , Tirana, Albania.Aim: Sexually Transmitted Infections (STIs) amongyoung people are becoming a public health problemand one of the major determinants of humandevelopment. They cause physical, psychological,social and economic problems, as well as otherconsequences. Therefore, STIs among young peopledeserve a special attention. Our aim was to assessthe current level of knowledge at Albanian universitystudents on STIs in order to design appropriatehealth Information-Education-Communicationprograms and to create a database for theirmonitoring and evaluation.Methods: A descriptive quantitative study wasconducted at national level during the period March-May 2013, collecting information from a sample of2000 students, selected randomly and proportionalto size from the overall number of the universitystudents (sampling frame). Data collection instrumentconsisted of a self-administered, structured andanonymous questionnaire, which was previously pretestedin a small group of students. Data analysis wasdone in SPSS, version16.0.Result: The results showed good levels of studentsknowledge concerning STIs in general, HIV/AIDS(97.6%), hepatitis B (85.2%), and syphilis (64.7%).However, students were not informed about somespecific STIs and had several misconceptions aboutthese infections. Almost all students were aware ofthe major transmission routes, but their knowledgeof signs and means of prevention was notsatisfactory. A significant association was foundbetween students level of knowledge and theirresidence, parental education and income level.Conclusion: Our findings indicate that students inAlbania have not sufficient knowledge about STIsand considerable misconceptions about theseinfections. Residence, parental education and incomelevel are associated with students level of knowledgeand may have a significant impact on the healthinformation-education-communication programs.Keywords: knowledge, sexually transmitted infections, young people.ALBANIAN MEDICAL JOURNAL SUPPLEMENT111

ALBANIAN MEDICAL JOURNAL SUPPLEMENTSexual disclosure and HIV-related risky behaviorsamong young men who have sex with men inAlbaniaElda Hallkaj 1 , Roland Bani 11Institute of Public Health, Tirana, Albania.Aim: Using data of Bio-BSS 2011, it is exploredthe link among the coming-out process, specificallyits dimension of self-disclosure of sexual identity toothers, with HIV-related risky behaviorsunprotected sexual behavior, multiple partners,injecting drug use among sexuallyactive young age(18-24 years old) men who have sex with men(MSM) in Albania.Methods: This quantitative study consisted ofrespondent driven sampling (RDS) for recruitmentof MSMs. Data were entered in SPSS, version 19.0.Double entry was performed for quality control.RDS Analysis Tool, version 6.0.1 was used for dataanalysis.Results: Participants under 24 years were dividedregarding self-disclosure component into: category1 MSM disclosed to MSM community only(71.8%); category 2 - MSM disclosed to family and/or friends (28.2%):· 80% of MSM who reported two or more partnersin the last six months, belonged to category 1.· 76.9% of MSM who had never used condombelonged to category 1, and all who had not usedcondom in the last sexual intercourse belonged againto category 1.· 87.5% of MSMs reporting to have injected drugsin the last month belonged to category 1.Conclusion: The MSM community in Tirana is aclosed group. This fact, based on the study results,has a negative impact on their involvement in HIVriskybehaviors. HIV preventive approaches in thecountry targeting MSMs need to include psychologicaland social components.Keywords: Bio-BSS, HIV , riskybehaviors, sexual disclosure.112 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIARelationship of childhood abuse and householddysfunction with the leading causes of death inadultsRovena Daja 1 , Gentiana Qirjako 1,21Institute of Public Health, Tirana, Albania;2Faculty of Public Health, University of Medicine, Tirana, Albania.The relationship of risky behaviors and diseases inadulthood to the breadth of exposure to childhoodemotional, physical, or sexual abuse, and householddysfunction during childhood has not beenpreviously described in Albania.The current evidence pertains mainly to industrializedsocieties, USA in particular. Although studies ofclinical samples in USA have identified links betweenchildhood abuse, especially sexual abuse, and adultrisky behaviors, the generalizability of these findingsto the overall population and the relative importanceof different types of abuse in men and women arenot known. A questionnaire about adversechildhood experiences was mailed to 13,494 adultsby the Department of Preventive Medicine,Southern California (1998), who had completed astandardized medical evaluation at a large HMO;overall, 9,508 (70.5%) individuals responded. Sevencategories of adverse childhood experiences werestudied: psychological, physical, or sexual abuse;violence against mother; or living with householdmembers who were substance abusers, mentally illor suicidal, or ever imprisoned. The number ofcategories of these adverse childhood experienceswas then compared to measures of adult riskbehavior, health status, and disease. Logisticregression was used to adjust for effects ofdemographic factors on the association between thecumulative number of categories of childhoodexposures (range: 0-7) and risk factors for theKeywords: abuse, adverse childhood experiences, violence.leading causes of death in adult life.More than half of respondents reported at leastone, and one-fourth reported e 2 categories ofchildhood exposures. This study reported a gradedrelationship between the number of categories ofchildhood exposure and each of the adult healthrisk behaviors and diseases that were studied(P

ALBANIAN MEDICAL JOURNAL SUPPLEMENTHome visits to promote health and development ofRoma children in Tirana and DurrësGentiana Qirjako 1 , Genc Burazeri 1 , Erka Amursi 1 , Marina Ndrio 2 ,Donika Naqi 3 , Silva Bino 1 , Gazmend Bejtja 4 , Mirlinda Bushati 51Institute of Public Health, Tirana, Albania;2Faculty of Social Sciences, University of Tirana, Tirana, Albania;3Community Centre of Health and Wellbeing, Tirana, Albania;4Ministry of Health, Tirana, Albania;5UNICEF - Country Office, Tirana, Albania.Context: The psychosocial development ofchildren 0-6 years old can be considered as aneglected part of growth and development of thehealth system in Albania. Little emphasis on this issuehas been made from the health staff. Nurses andother specialists have received only limited trainingon this topic while the development milestones andtool for their assessment are lacking in the well-babyclinics. The situation is even worse for Romachildren. The aim of the project was to providepsychosocial support and at home health care formothers and children of Roma community inDurrës and Tirana while setting up a practice forthe health sector to provide support to thepsychosocial development of children.Methods: Based on the findings from a rapidassessment, two documents for home visits weredeveloped: a manual for parents regarding thegrowth and development aspects for children aged0-6 years; and practical how to guidelines fornurses and social workers involved in home visits.The manual for parents includes all the basicinformation necessary for an appropriate developmentof the children (development milestonesaccording to age, nutrition, hygiene, safety, positiveparenting, etc), which can be used from all parentsin the population, including Roma community asbeing developed based on the needs of the mostvulnerable groups. Check lists for the psychosocialdevelopment of the children, checklists for theevaluation of the security at home environment andchecklists for evaluation of the parent-childcommunication as well as for the mental wellbeingof the parents were produced to be used from thehome visits specialists. The home visits were carriedout by the working groups each consisting of twospecialists (psychologists/social workers and healthprofessionals pediatricians) and one Romacommunity leader, who facilitated the process.Results: A more comprehensive approach to earlylife of children was developed, building on existingchild survival programmes and extending interventionsin early life to include social/emotional andlanguage/cognitive development. The home visitsinterventions have showcased of how the universalmodel of home visits can be upgraded for targetingvulnerable communities. A modeling and practice ofbehaviors have been created (there were visited 240families and 295 children, a series of assessments andhow to guides developed) and is being sharedamong well baby clinics. In 93% of the cases, thehome visits have involved parents (mainly mothers)who have acquired better skills on healthy nutritionalhabits, development of their children, immunization,effective health care-seeking behavior, psychosocialand social problems, and prevention of domesticviolence.Conclusion: Interventions for holistic developmentof the early age and targeting vulnerable groups aremost effective when they are conducted by aspecialized multidisciplinary team including bothhealth professionals and social workers.Keywords: children growth and development, homevisits, multidisciplinaryteam, Roma children.114 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAThe cost of illness and administrative dataset as anessential source A case study of diarrhoea inAlbanian childrenAlbana Ahmeti 1 , Silva Bino 1 , Artan Simaku 1 , Iria Preza 11Institute of Public Health, Tirana, Albania.Aim: Estimation of Cost-of-Illness (CoI) is anessential indicator for measuring the economicburden of disease and enables in-depth studies ofcost-effectiveness, cost-utility, or cost benefit. CoIstudies can estimate in monetary terms the cost ofthe disease from health services prospective as wellas the economic consequences of illness in terms oflost productivity to society. There are very fewstudies related the CoI for various diseases inAlbania. Here we aim to describe the mostimportant cost components of CoI for diarrhea inchildren, using the administrative data as one of theessential sources.Methods: We mined and used the administrativerecords of Ministry of Health, Health InsuranceInstitute and the main health service providers. Also,data from the National Institute of Statistics wereincorporated within the study.Results: After analyzing diarrhoea data we foundout that the mean inpatient cost per case of severediarrhea is estimated at US$ 233.39. The meanoutpatient cost per case is estimated at $7.37(95%CI=$2.37-$14.87) while the mean cost per casein emergency room was $15.97 (95%CI=$11.4-$29.33). The mean indirect cost per case of diarrheacases, as social productivity loss, was estimated at$46 (95%CI=$30-$121).Conclusion: The estimation of CoI for diarrhoeacases in children and especially the type of costs canhelp to make further economic analysis about costeffectivenessof an intervention and better estimatesof the intervention strategies. The advantage ofusing the administrative data is the low cost and thequick follow-up of patient records, but there areseveral limitations such as enrolment not based ondiagnoses or disease protocols.Keywords: cost-benefit analysis, cost-effectiveness analysis, cost of illness, economic analysis, cost-utility analysis.ALBANIAN MEDICAL JOURNAL SUPPLEMENT115

ALBANIAN MEDICAL JOURNAL SUPPLEMENTQuality of vaccination program in VloraAgron Bashllari 1 , Marsela Fejzo 1 , Elona Agalliu 1 , Ana Duka 11Epidemiology Service, Public Health Directorate, Vlora, Albania.Aim: This study aimed to assess the quality of thevaccination program in primary health care (PHC)services in Vlora city.Methods: This was a descriptive study carried outfrom December 2012 to February 2013. All PHCcenters of Vlora city (n=19) were targeted with anoverall nursing personnel of 42 individuals. Astructured questionnaire was administered to allparticipants, which was developed by the experts ofthe Institute of Public Health in Tirana. EPI-INFOwas used for the statistical analysis.Results:· In Vlora city, the ratio for one vaccination nurseis 415 children of 0-14 years of age.· The average period of time for the first visitof a newborn child in pediatric consolatory clinicis 28.6 days (95%CI=24.5-32.7 days).· 94% (95%CI=86.8%-100%) of the personnelhas received training only for the introduction ofthe new vaccines of the national vaccinationprogram.· 92% (95%CI=84.6%-100%) of participants knewthe vaccines that must be stored at +4 0 C to +8 0 C.· 62% (95%CI=47.4%-76.6%) of the personnelwere not familiar with the sensitive vaccines againstfreezing.· 81% (95%CI=69.2%-92.8%) of individualswere able to recognize VVM.· 14.5% (95%CI=3.9%-25.0%) of individualsperformed recap of the needle after injection.· 80.5% (95%CI=68.5%-92.4%) of the personnelused alcohol 70 0 for disinfection.· In 17% (95%CI=5.7%-28.3%) of the cases,there were found disposed syringes/needles in anunsecured container.· 73.2% (95%CI=59.8%-86.5%) of the hospitalwaste of PHC is disposed in urban waste containers.Conclusions: There is an obvious need to improvethe knowledge of the population with the packageof services provided byprimaryhealth care services,in particular concerning vaccination issues. Furthermore,continuous training of the personnel aboutall elements of the vaccination program is required.Cold chain is one of the components of thevaccination program which functions quite well. Yet,vaccination personnel must strictly apply all theelements of work safety.Keywords: primary health care, vaccination, V lora.116 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAQuality of health services for women in Vlora regionGëzime Balilaj 1 , Agron Bashllari 1 , Leonard Sinani 11Directorate of Public Health, Vlora, Albania.Aim: The aim of this study was to assess the leveland quality of health services for women in thedistrict of Vlora during the period 2000-2010 anddrawing conclusions for planning and reviewingprograms and policies which aim at reducing healthproblems of women in this region of Albania.Methods: This was a descriptive study covering theperiod 2001-2010. The study population consistedof the overall inhabitants of Vlora region. Sourceof data was the District s Health Service. Dataanalysis was undertaken in Excel.Results: Gynecologist coverage for the periodunder study was 1/ 5500 women. The number ofwomens clinics was four for the city of Vlora and95 for the overall villages. Anemia was thepredominant pathology during pregnancy in 2010(151.2/1000 live births). The number of births withC-section has increased over the years, reaching 385in 2010. There was evidence of a decrease in thenumber of abortions from 681.5 (in 2001) to 424(in 2010). The specific weight of spontaneousabortion has increased in the recent years, reaching46.3% in 2010. Use of KOC in family planning hasincreased up to 12.3% (15-49 years). Infant mortalityhas fallen from 9.7 (in 2001) to 6.2 (in 2010). Finally,the level of Pap-testing has increased.Conclusions: In Vlora region, family planningservices and mother and child care services shouldestablish priorities for the entire community, as wellas for the high-risk groups. Regarding the morbidityduring pregnancy, anemia exhibited the highest sharebearing the risk of miscarriage. Our findings indicatethat the number of cytological examinations and theuse of family planning methods are graduallyincreasing in Vlora region.Keywords: mother and child, quality of health care, Vlora, women.ALBANIAN MEDICAL JOURNAL SUPPLEMENT117

ALBANIAN MEDICAL JOURNAL SUPPLEMENTEarly detection of hearing impairment in newbornsand infantsEdlira Beqiri 11University Hospital Centre Mother Teresa , Tirana, Albania.Globally, it is reported that 1-2 out of 1000newborns have markedly impaired hearing. Thecurrent scientific evidence suggests the need foruniversal neonatal hearing screening (UNHS) for theearlydetection of hearing impairment. UNHSis bestperformed in two stages: first measurement ofotoacoustic emissions and then automated assessmentof the brainstem auditory evoked response.To be effective, UNHS programs must have a highcoverage rate, high sensitivity and specificity, andproper tracking with a low rate of loss to followup.Children with positive screening tests for hearingimpairment should undergo confirmatory testing assoon as possible and then receive the appropriatetreatment. Early intervention is particularly critical forspeech acquisition. The early detection and treatmentof hearing impairment in newborns and infants hasa beneficial effect on language acquisition.Keywords: hearingimpairment, infant, newborn.118 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAThe results of a three-year project on neonatalhearing screening in AlbaniaDaniela Nika 1 , Elisabetta Genovese 21Institute of Public Health, Tirana, Albania;2University of Modena e Reggio Emilia, Italy.Aim: Deafness is the most common anomalyamong newborns. Hearing impairment in childrenconstitutes a serious obstacle to their optimaldevelopment and education including languageacquisition. Early detection and intervention canprevent its consequences. Neonatal HearingScreening (NHS) in Albania started in 2009 in fourmaternity centers (two in Tirana, one in Shkodra,and one in Fier).Methods: NHS is carried out in two phases: Phase1 - TEOAE testing of all newborns within the firstmonth. Stage 2 - ABR testing of FAIL and REFERcases, and children with risk factors.Results: Total number of newborns tested duringthe three-year program was 44341. The prevalenceof ipoacustic babies was 2,5 newborns per 1,000live births, which is two times higher than indeveloped countries. Main risk factors amongdiagnosed infants included preterm births, cranialfacialanomalies, syndromes, asphyxia at birth, orfamilyhistoryof deafness.Conclusion: Based on the number of births and theobserved prevalence, each year we would expectapproximately 80-90 newborns with significant hearingimpairment in Albania. Universal NHS is widelyrecommended by WHO as a new strategy forprevention and, in most developed countries, thisapproach is mandatory. There is a need for in-depthanalysis of the causes and extension of this strategyacross Albania as a public health tool that enables theearly diagnosis and minimizes the magnitude of thisnegative condition in the Albanian population.Keywords: deafness, neonatal hearingscreening, prevalence.ALBANIAN MEDICAL JOURNAL SUPPLEMENT119

ALBANIAN MEDICAL JOURNAL SUPPLEMENTPatient-centered approach, we need it can weafford it? The example of Diabetes mellitusProf. Dr. med. Ulrich Laaser DTM&H, MPHFaculty of Health SciencesUniversity of BielefeldPOB 10 01 31D-33501 Bielefeld, Germanyulrich.laaser@uni-bielefeld.dePerson-oriented medicine requires a supportiveenvironment which has to be created as personorientedhealth care through a competent health caremanagement. The group of diabetic patients posesspecific problems because of its size, lifelongperspective, and costs.The management system has to permanentlyconsider total quality improvement by ContinuingMedical Education, updated clinical guidelines,regulated referral based on gate-keeping, healthliteracy and self management including main riskfactors, and cost-effectiveness. In order to reach fullcoverage of the patient population adequate ITprovision, free of charge access (incl. under the tablepayments), elimination of waiting lists, accreditationand certification are essential elements of success.However, nothing can replace our empathy with thepatient.120 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIALIST OF AUTHORSAAgalliu Elona 100, 116Agolli Besim 99Ahmeti Albana 76, 115Ahmeti Nazif 73, 79Akshija Ilir 39Amursi Erka 14, 76, 92,114BBacka Teuta 30Bajrami Valbona 27, 30Balilaj Gëzime 117Balla Flora 91Bani Roland 54, 77, 82, 83, 91, 112Bara Valbona 67Barbullushi Myftar 30Bashllari Agron 100, 116, 117Basho Mimoza 83Begolli Ilir 19,32,62,79Bejtja Gazmend 14, 50, 76, 114Beqiri Edlira 118Berisha Merita 13, 19, 62Bino Silva 60, 61, 83, 114, 115Boçari Donika 99Boci Arian 82Bojaj Gazmend 59, 64Bregu Arjan 23, 35, 89Bukli Mariana 76, 87, 94, 106Bulo Anyla 88Burazeri Genc 8, 9, 14, 16, 55, 59, 64, 76, 77, 108, 114Bushati Mirlinda 114Bushi Entela 84, 107CCoraj Emiljana 36Czabanowska Katarzyna 59, 64ÇÇanaku Dorina 10, 50, 102, 103, 105Çela Lulzim 35, 58, 89Çela Enriketa 68Çerçizaj Rudina 36Çoku Anjeza 67Çumashi Rudina 90DDaja Rovena 90, 113Daka Afërdita 32Daka Albana 34Davis Philip 40Dedja Bajram 10, 50, 51, 52Dervishi Marjeta 83, 91Dika Qamil 55Doksani Shpëtim 26, 98Donev Doncho 11, 20Draçini Xheladin 65Dudushi Redona 91Duka Ana 116Dula Nexhat 72Duli Marsida 78Duraku Artenida 81DHDhame Dhimitraq 53EEmini Violeta 73Erindi Entela 69FFejzo Marsela 116Ferizi Mybera 32Fida Monika 43Filipi Kozeta 10, 38, 40, 44, 109GGabrani Jonila 63Gabrani Adriatik 63Gashi Sanije 13, 19, 21, 62Gecaj Lulzime 68Gecaj Mhill 68Gega Bukurie 10, 50, 51, 52Genovese Elisabetta 119Gera Rina 66Gerqari Antigona 32Grezda Arjeta 33Godo Anila 22Golemi Sonila 36Govori Valbona 19ALBANIAN MEDICAL JOURNAL SUPPLEMENT121

ALBANIAN MEDICAL JOURNAL SUPPLEMENTGJGjorgjev Dragan 21HHajdini Miranda 10, 50, 97, 102, 110Halimi Sadije 32Hallkaj Elda 82, 112Hasani Vitori 35, 36Hashani Lebibe 73, 79Hashani Valdet 18Haxhiu Jonida 23, 85Hoti Ela 29Hoti Bujana 54Hoxha Rina 19, 62Hoxha Agron 79Hoxha Ledina 80, 81Hoxha Arben 66Hoxhaj Astrit 31Hulaj Nurishahe 73, 79Hysa Bajram 8, 14, 65Hyska Jolanda 23, 84, 86, 107IIdrizi Alma 27, 30JJaupaj Luljeta 33Jerliu Naim 96Jorgoni Ferdinand 39Jucja Besnik 95KKadiu Enkeleda 84, 107Kakarriqi Eduard 8, 10, 16, 38, 40, 50, 51, 52, 77, 103, 104, 105Kallajxhi Fjedor 102Kamberi Haxhi 96Këlliçi Suela 65Kiçaj Emirjona 36Koja Gjergj 69Kokali Anilda 67Kollcaku Rabushe 98Kosevska Elena 20Krasniqi Selvete 21Kreka Bledi 22, 45Kreka Manika 22, 45Kocani Krist 80Kryeziu Violeta 73, 79Kryeziu Fadil 79Ktona Ergeta 30Kuneshka Loreta 78Kurti Afërdita 73Kurti Floreta 45LLaaser Ulrich 120Lako Sotiraq 34Lakrori Jeta 17, 38, 94Lika Mirela 60Likmeta Mirlinda 29, 46Loxha Arbresha 21Luzati Arben 67, 99Luzati Mimoza 67MMajko Eliverta 26Malaj Ledjan 29Maliqari Numila 78Maloku Tahire 21Mema Drita 99Memeti Shaban 12, 20Memishaj Sabjan 34Merdani Alba 10, 50, 103, 105Mërkuri Lumturi 111Mersini Ehadu 76, 108Mihali Engjëll 76Miho Vasil 14Mitrushi Arben 28Mone Iris 71, 86, 88Mone Sonil 71Muja Herion 24, 35, 58, 89, 96Mukaj Elina 91Mybera Mustafa 57Myftiu Sokol 26, 98NNaqi Donika 114Nastas Eleni 22Ndoja Suela 56Ndrio Marina 114Nelaj Erida 60, 61Nika Daniela 94, 106, 119Nurka Tatjana 34PPampuri Orjola 41Pano Irida 23, 58Pashaj Valentina 99122 ALBANIAN MEDICAL JOURNAL SUPPLEMENT

INTERNATIONAL PUBLIC HEALTH CONFERENCE IN TIRANA, ALBANIAPelinku Kujtim 66Petrela Elizana 39, 59, 63, 106Petrela Mentor 47Petri Olta 67, 99Pipero Pëllumb 111Pirraçi Afrim 23, 28, 96Poga Zaira 70Pollozhani Azis 12, 20Poshi Klodiana 31Preza Iria 60, 61, 115QQazimi Musa 58Qirjako Gentiana 14, 16, 22, 23, 45, 76, 94, 111, 113,114Qyra Shpëtim 83RRadbruch Lukas 42Rama Rudina 42Ramadani Naser 13, 19, 21, 62, 79Rechica Vladimir 12Rexhepi Myrvete 73, 79Rjepaj Gentiana 82Roshi Enver 8, 18, 27, 30, 76, 87, 105Rusta Meriglena 81RrRrumbullaku Llukan 23SSalihu Drita 62Sallaku Agim 39Schneider Robert H. 25Sethi Dinesh 14Simaku Artan 98, 115Simaku Ermal 33Sinani Leonard 117Skeraj Fitim 59, 64Spahija Bujar 35, 58, 89Sokoli Tone 68Sulejmani Zahide 69SHShabani Driton 95Shabani Zamira 66Shena Dhurata 36Shkoza Artan 29, 46Shuperka Roland 80Shuperka Redona 80, 81TTahiri Zejdush 58, 64, 95Tarifa Dhurata 45Toçi Ervin 10, 23, 77, 96, 105, 111THThemeli Yllka 27UUkëhaxhaj Antigona 21VVadahi Fatmir 66Vasili Adela 34Vasili Ermira 43Vuletic Silvije 13XXinxo Sonela 10, 17, 104XHXhaferi Altina 31Xhaferi Medien 31Xhani Anila 44, 109Xhani Blerta 91Xhixha Ali 42Xhumari Artur 47YYlli Alban 10, 14, 16, 17, 38, 40, 77ZZajmi Drita 19Zejno Marinela 100Zogaj Drita 21Zotaj Henrik 41Zotaj Aulona 93Zekja Ilirjana 31ZHZhjeqi Valbona 19, 62ALBANIAN MEDICAL JOURNAL SUPPLEMENT123 121