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Brucellosis remains a public health problem in many Mediterranean countries. In this work are presenting data of human brucellosis clinics and treatment in a sample of hospitalized patients. Methods: All patient charts at regional hospital in Gjirokastra, Albania were systematically reviewed, during the period 2016-2021. All hospitalized patients with a laboratory confirmed diagnoses of brucellosis were included in the study. Variables of interest were clinical symptoms, clinical course and treatment provided. Sub-acute brucellosis was defined as clinical persistence of 3-12 months while cases with clinical symptoms persisting for ≥12 months were defined as chronic brucellosis. Results: 79% of the 86 patients were male and residing in rural areas. Fever, profuse sweating and arthralgia were the most common clinical signs. Around 70% of the brucellosis patients showed all these three symptoms. Despite a systematic tendency for more frequent presence of high fever, increased sweating and arthralgia on younger patients we could not find statistically significant differences among demographic categories. 18.6% of cases presented persistence of clinical signs after at least 3 months from the moment of the diagnoses. Almost 7% of the cases were classified as chronic cases. 75.6% of all patients were treated with a combination of doxycycline and ceftriaxone antibiotic regime. Conclusions: The massive use of a cephalosporin in treatment of brucellosis cannot be justified and may reflect a larger problem related to population awareness and health provider attitudes concerning antibiotic use in Albania. The results of this study may assist future interventions to improve brucellosis case management at hospitals or primary health care level as well as national measures at a larger scale for control of the disease.

Since winter 2020, excess deaths due to COVID-19 have been higher in Eastern Europe than most of Western Europe, partly because regulatory enforcement was poor.This paper analysed data from 50 countries in the WHO European Region, in addition to data from USA and Canada. Excess mMortality and vaccination data were retrieved from "Our World In Data" and regulation implementation was assessed using standard methods. Multiple linear regression was used to assess the association between mortality and each covariate.Excess mortality increased by 4.1 per 100 000 (P = 0.038) for every percentage decrease in vaccination rate and with 6/100 000 (p=0.011) for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index.Degree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19's deleterious health impacts.زيادة الوفيات الناجمة عن فيروس كوفيد-19 في بلدان أوروبا الشرقية التي تشهد ضعفًا في تنفيذ اللوائح وانخفاض التغطية بالتطعيم.ألبَن يلي، جينك بورازيري، يان يان وو، تين سينتيل.منذ شتاء عام 2020، كانت الزيادة في الوفيات الناجمة عن كوفيد 19-في أوروبا الشرقية أعلى من معظم أوروبا الغربية، ويُعزى ذلك جزئيًّا إلى ضعف تنفيذ اللوائح.هدفت هذه الدراسة الى تحليل بيانات من 50 بلدًا في الإقليم الأوروبي لمنظمة الصحة العالمية، بالإضافة إلى بيانات من الولايات المتحدة الأمريكية وكندا.جرى استخلاص بيانات التطعيم والزيادة في الوفيات من الموقع الإلكتروني "Our World In Data"، وقُيِّم تنفيذ اللوائح باستخدام طرق معيارية. واستُخدم الانكفاء الخطي المتعدد لتقييم الارتباط بين الوفيات الزائدة وكل متغير مشترك.ارتفع معدل الزيادة في الوفيات بنسبة 4.1 لكل 100000 (القيمة الاحتمالية = 0.038) لكل نسبة مئوية من انخفاض معدل التطعيم، وبنسبة 6 لكل 100000 (القيمة الاحتمالية = 0.011) لكل درجة انخفاض في تنفيذ اللوائح للبلد على مؤشر سيادة القانون.إن التمسك بإنفاذ اللوائح والحرص الشديد عليه، ومنها إنفاذ تدابير الصحة العامة، ربما يكون عاملًًا مهمًًّّا في التخفيف من الآثار الصحية السلبية لفيروس كوفيد 19-.Surmortalité due à la COVID-19 dans les pays d'Europe de l'Est en lien avec une mise en œuvre moins rigoureuse des réglementations et avec une couverture vaccinale plus faible.Depuis l'hiver 2020, la surmortalité due à la COVID-19 est plus élevée en Europe de l'Est que dans la plupart des pays d'Europe de l'Ouest, en partie du fait de la mise en œuvre insuffisante des réglementations.Le présent article analyse des données fournies par 50 pays de la Région OMS de l'Europe, ainsi que des données provenant des États-Unis et du Canada.Les données relatives à la surmortalité et à la vaccination ont été extraites du site Web « Our World In Data » et la mise en œuvre des réglementations a été évaluée à l'aide des méthodes standard. La régression linéaire multiple a été utilisée pour évaluer le lien entre la surmortalité et chaque covariable.La surmortalité a augmenté de 4,1 pour 100 000 (p = 0,038) pour chaque baisse en pourcentage du taux de vaccination et de 6 pour 100 000 (p = 0,011) pour chaque unité en moins dans le score de mise en œuvre des réglementations obtenu par un pays dans l'indice de l'état de droit.La rigueur de l'application des réglementations, y compris l'application des mesures de santé publique, peut être un facteur important pour atténuer les effets négatifs de la COVID-19 sur la santé.

AimThe objective of this analysis was to assess the association of excess COVID-19 mortality with regulation enforcement and vaccination rate in selected countries.MethodsThis analysis included 50 countries pertinent to the WHO European Region, in addition to USA and Canada. Excess mortality and vaccination data were retrieved from “Our World In Data” database, while regulation implementation was measured from a well-respected, standardized measure. Outpatient visits were also included in the analysis. Multiple linear regression was used to assess the independent association between excess mortality and each covariate.ResultsExcess mortality increased by 4.1/100 000 for every percent decrease in vaccination rate and with 6/100 000 for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index.ConclusionDegree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19’s deleterious health impacts.

This article discusses the results of the May Measurement Month (MMM) 2019 campaign, which contributed to a third round of MMM hypertension screening campaigns carried out in Albania, a transitional country in the Western Balkans. The hypertension screening campaign in Albania was carried out during the period 1–31 May 2019 in 30 sites in many districts of the country. Overall, 19 154 participants aged ≥18 years were included (approximately 68% of these were women), with an overall mean age of 47.0 ± 15.3 years. Blood pressure (BP) was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on treatment for hypertension. Self-reported data consisted of height and weight, pre-existing conditions, including smoking status and alcohol consumption. Overall, the proportion of participants with hypertension was 38.6%. Less than two-thirds (64.7%) of hypertensive individuals were aware of their condition. Also, less than half (48.3%) of participants on antihypertensive medication had controlled BP (

Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and exami...

Background Studies of the food security status of older adults are rare outside of the United States, especially in low- and middle-income settings. Food insecurity may contribute to disease and disability. Using a diverse sample of older adults, we examine the association of food insecurity with clinical and self-reported measures that are related to disease and impairment. Methods Cross sectional analysis of 1482 older adults from Kingston and St. Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). Outcome measures were Body Mass Index (BMI), waist circumference, and self-reported unintentional weight loss. Food insecurity was assessed with the 9-item Latin American and Caribbean Household Food Security Scale. Covariates were age, sex, study site, and education. Statistical analyses included Student's T-test, Chi-square test, and linear regression. Results 83% of participants were food secure; 12% experienced mild food insecurity and 5%, moderate/severe food insecurity. Among men, BMI and waist circumference varied significantly by food security status (p Conclusions Significant differences in clinical indicators of disease were observed by food security status in men. At the extreme, low BMI and waist circumference are linked to increased risk of malnutrition, compromised immune function, and respiratory and digestive diseases. Differences in these measures by food security status emphasize the need for gender and age specific food security interventions. Key messages Food insecure men experience clinical indicators of disease significantly more than food insecure women. Successful food security interventions may require sex specific focus across global settings. Little research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in sex specific research in this population across global settings.

Food insecurity prevalence is highest in low and middle-income countries, yet there is a dearth of research on the burden in older adults in these settings. Food insecurity has long-term consequences for the health of older persons. We examined cross-sectional food security data from 1,482 participants in the 2016 wave of the longitudinal International Mobility in Aging Study (IMIAS) conducted in Canada, Albania, Colombia, and Brazil. These are community samples between 68 and 79 years. Food security was assessed with the Latin American and Caribbean Household Food Security Scale and recoded to yes/no. Covariates of interest included sex, site, income, living arrangement, and education. Descriptive statistics, with tests of statistical significance, were used. Responses to scale items varied from 10% of participants reporting worry about running out of food and being unable to eat healthy foods to 2% reporting not eating for a whole day or having to beg for food. Food insecurity in the sample was 17%. Few Canadian respondents ( Key messages Food insecurity has severe health consequences for elderly and location, income, education, and living arrangement contributes to health inequalities in this population across diverse settings. Little to no research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in research in this population across global settings.

Background In 2019 Albania started a national screening program which uses as primary screening examination the high risk Human Papilloma Virus (hrHPV) testing. It targets women 40-50 years old providing systematic screening tests, as part of the routine examinations at primary health care centers. The evaluation study aimed to identify the performance of the program in its first year, barriers and satisfaction of women. Methodology A representative sample of 200 women, positive in screening test, was retrieved from the database of program information system. They were interviewed during the period October-November 2019, using a standardized questionnaire. Results Although the risk of being hrHPV-positive was higher in cities (OR = 1.52; 95%CI=1.29-1.81), the program was used more by women living in rural areas compared to those living in urban areas (OR = 1.81; 95%CI =1.74-1.89). 60.2% of women found the vaginal sampling procedure very simple and 72.4% not at all painful. 95.8% of women received the test results within two months. At the time of the survey, 90.4% of HPV-positive women had gone for follow up visit (71.7%) or were planning to go as soon as possible (18.7%). 35.2% of women who have performed colposcopy, have chosen private healthcare, with 7.8% going abroad. Higher education increased the odds to use a private facility or go abroad for the follow up visit. 87.2% of women reported substantial worries about the positive result. 89.8% of the sample rated the overall service as 'good' or 'very good'. Conclusions While results from the first evaluation show good acceptance from users, the program should address the proportion of women who chose private clinics for follow up examination. Key messages Results from the first evaluation of the cervical screening program in Albania show good acceptance from users. Program should address the proportion of women who chose private clinics for follow up examination.

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

Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant.To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania.A cross-sectional study was conducted in 2018-2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence.Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication.We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.الانتشار والارتباطات الاجتماعية السكانية للالتزام بتناول الدواء بين مستخدمي الرعاية الصحية الأولية في ألبانيا.دجانا روشي، جينك بورازيري، سالفاتوري إيطاليا، بيتر شرودر-بيك، ألبان إيلي، هيلموت براند.لا توجد أدلة تُذكر على حجم الالتزام بتناول الدواء ومحدداته بين المرضى وعموم السكان في جنوب شرق أوروبا.هدفت هذه الدراسة إلى تقييم مدى الانتشار والارتباطات الاجتماعية السكانية للالتزام بتناول الدواء بين مستخدمي الرعاية الصحية الأولية في ألبانيا.أُجريت دراسة مقطعية في عامي 2018-2019 على عينة مُثِّلة ضمت 1553 من مستخدمي الرعاية الصحية الأولية من البالغين (الاستجابة: 94٪) وقد اختيروا باحتمالية من 5 مناطق رئيسية في ألبانيا. واشتملت العينة على 849 امرأة (55٪) و 704 رجلً (45٪)، وبلغ متوسط أعمارهم 54.6 سنة (16.4). واستفسر استبيان منظم يديره محاور عن الالتزام بتناول الأدوية الموصوفة من أطباء الأسرة، والخصائص الاجتماعية السكانية لذلك. واستُخدم الانحدار اللوجستي الثنائي لتقييم الارتباطات الاجتماعية السكانية للالتزام بتناول الدواء.لم يتناول ثلاثمائة مشارك (19.8٪) الدواء الموصوف. وفي النموذج اللوجستي المُعدَّل متعدد المتغيرات، اشتملت الارتباطت المهمة لعدم تناول الدواء على الإقامة الريفية، وانخفاض المستوى التعليمي، والبطالة، وانخفاض المستوى الاقتصادي. ومن بين المشاركين البالغ عددهم 300 شخص، اعتبر 273 (91٪) ارتفاع تكلفة الأدوية سببًا لعدم تناولها.وجدنا ارتفاع معدل انتشار عدم تناول الأدوية التي يصفها أطباء الأسرة. وينبغي لصناع القرار وصناع السياسات في ألبانيا وفي أماكن أخرى أن ينظروا في توفير الأدوية الأساسية مجانًا أو بتكلفة منخفضة جدًا للفئات الاجتماعية الاقتصادية المنخفضة وغيرها من الفئات السكانية الضعيفة والمهمشة، لأن تكاليف عدم الامتثال ستكون أعلى في نهاية المطاف.Prévalence et corrélats sociodémographiques de l'observance thérapeutique chez les usagers des soins de santé primaires en Albanie.Les données sur l’ampleur et les déterminants de l’observance thérapeutique chez les patients et dans la population générale en Europe du Sud-Est sont rares.Évaluer la prévalence et les corrélats sociodémographiques de l'observance thérapeutique chez les usagers des soins de santé primaires adultes en Albanie.Une étude transversale a été menée en 2018-2019 auprès d'un échantillon représentatif de 1553 adultes usagers des soins de santé primaires (taux de réponse : 94 %) sélectionnés de manière aléatoire dans cinq grandes régions d'Albanie. Il s’agissait de 849 femmes (55 %) et 704 hommes (45 %), dont l’âge moyen était de 54,6 ans (16,4). Un questionnaire structuré administré par un enquêteur a permis de s'enquérir de l'observance thérapeutique pour les médicaments prescrits par les médecins de famille, et des caractéristiques sociodémographiques. La régression logistique binaire a été utilisée pour évaluer les corrélats sociodémographiques de l’observance thérapeutique.Trois cents participants (19,8 %) n'ont pas pris les médicaments prescrits. Dans le modèle logistique ajusté multivarié, les corrélats significatifs de la non-prise de médicaments comprenaient la résidence rurale, le faible niveau d'éducation, le chômage et le faible niveau économique. Parmi ces 300 participants, 273 (91 %) ont considéré le coût élevé des médicaments comme une raison de ne pas les prendre.Nous avons constaté une forte prévalence de la non-prise de médicaments prescrits par les médecins de famille. Les décideurs et les responsables de l’élaboration des politiques en Albanie et ailleurs devraient envisager la fourniture de médicaments essentiels gratuitement ou à un coût très bas pour les groupes à faible revenu et les autres catégories de population vulnérables et marginalisées, car le coût de la non-observance sera en fin de compte plus élevé.

Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults ({greater than or equal to}18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally three blood pressure readings were measured for each participant, and data on lifestyle factors and co-morbidities were collected. Hypertension was defined as a systolic BP {greater than or equal to} 140 mmHg, and/or a diastolic BP {greater than or equal to} 90 mmHg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1,508,130 screenees 482,273 (32.0%) had never had a blood pressure measurement before and 513,337 (34.0%) had hypertension, of whom 58.7% were aware and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to

Background: Determinants of hypertension diagnosis and/or awareness and control among older adults are understudied in Albania, a former communist country in South Eastern Europe, which is experiencing rapid demographic, socioeconomic and epidemiological transition. This paper examines the association of individual, interpersonal, organizational and community factors with hypertension awareness and control among older adults in Tirana, the Albanian capital. Methods: Using 2012 International Mobility in Aging Study data on older adults from Albania's capital city (n = 393) and the socioecological model as a conceptual framework, multinomial regression models identified factors associated with controlled, uncontrolled and undiagnosed hypertension. Results: For hypertension, 17.3% participants had none, 23.4% were controlled, 48.4% were uncontrolled and 10.9% were undiagnosed/unaware. Compared to those with controlled hypertension, in multivariable models, a high level of friend support was negatively associated with uncontrolled (OR: 0.4; 95% CI: 0.2-0.9) and undiagnosed (OR: 0.2; 95% CI: 0.1-0.6) hypertension. A high level of perceived neighbourhood safety was negatively associated with uncontrolled (OR: 0.6; 95% CI: 0.3-1.0) and undiagnosed (OR: 0.4; 95% CI: 0.2-1.0) hypertension. Compared to those with no hypertension, children's social support was positively associated with uncontrolled (OR: 2.2; 95% CI: 1.1-4.3) and undiagnosed (OR: 3.6; 95% CI: 1.3-9.6) hypertension. Conclusion: This study provides new insights about distinct risk factors for inadequate hypertension management in Albania. It highlights the importance of community-level factors (safety) and interpersonal factors (family and friend ties) to hypertension diagnosis/awareness and control, which may provide novel intervention opportunities for hypertension programs.

Objective:To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). Method: IMIAS data were analyzed ( N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt–Insult–Threaten–Scream (HITS) questionnaire requested information on domestic violence. Results: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston’s men to 25% in Tirana’s men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). Discussion: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not.

Albania is a small country on the Balkan Peninsula that recently implemented an innovative primary healthcare program called “Si Je?” (How are you?) which allowed all Albanians aged 40–65 years to receive a free, yearly basic health examination at their local health center. Access to basic primary care is a critical component of a nationwide culture of prevention particularly for the non-communicable diseases that comprise 89% of total deaths in the country. Yet, as in many middle-income countries, a culture of prevention in Albania is often secondary to ensuring basic health infrastructure and healthcare access for those critically in need. Using the social-ecological model as our conceptual framework, this paper provides new insights into the culture of prevention in Albania by analyzing the need for, and implementation of, the Si Je? program using (1) findings from a critical literature review, (2) quantitative data from the database created from this program, and (3) qualitative data from key informant interviews from 15 health center directors. Positive developments towards a culture of prevention include the fact that the Si Je? program has been expanded to those 35–70 years, strengthened links between community and primary care, and participation among rural communities who traditionally have limited primary care access. Challenges include continued urgent health infrastructure needs, politicization of the Si Je? effort, limited participation by some groups (particularly urban men), and regional variations. Despite challenges, Albania appears to be building new infrastructure for a sustainable culture of prevention, particularly around chronic disease.

The aim of this study is to assess the factors associated with hypertension prevalence, awareness, treatment, and control, in the elderly populations of the International Mobility in Aging Study (IMIAS). Approximately 200 men and 200 women aged 65-74 years were recruited at each site (n=1995) during IMIAS' 2012 baseline survey at five cities: Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Blood pressure and anthropometric measurements were taken at participants' homes. Hypertension prevalence ranged from 53.4% in Saint-Hyacinthe to 83.5% in Tirana. Diabetes and obesity were identified as risk factors in all cities. More than two-thirds of hypertensive participants were aware of their condition (from 67.3% in Saint-Hyacinthe to 85.4% in Tirana); women were more aware than men. Awareness was positively associated with diabetes in Kingston, Manizales and Natal. Though most of those aware of their hypertensive condition were being treated pharmacologically, associations between awareness and physical activity and refraining from smoking were weak. Control among treated hypertensive participants was low, especially in Tirana and Natal. Diabetes and physical inactivity were associated with poor hypertension control. Hypertension is common in the older populations of IMIAS. Diabetes is strongly associated with hypertension prevalence, awareness and lack of control of hypertension. The fact that awareness is not strongly associated with healthy behaviours suggests that antihypertensive medication is not accompanied by non-pharmacological therapies. Improved health behaviours could strengthen hypertension control. Efforts should be made to increase men's awareness of hypertension. Hypertension control in diabetic patients is a challenge.

Micronutrient deficiencies are caused mainly by an inadequate intake of vitamins and minerals, as a consequence of an unbalanced diet composed mostly of carbohydrates in the conditions of poverty, the inability to take a variety of nutrients, the lack of knowledge on the most appropriate feeding practices and the relatively high incidence of infectious diseases. From a public health perspective, the importance of these deficiencies depends on the magnitude of their impact on health, especially among pregnant women, infants and children, given the consequences in the development of the fetus, in the growth of the child, the resistance to infections and the work performance later during the adult life. According the Albanian Demographic Health Survey (ADHS) 2008 to 2009, conducted jointly by the Albanian Institute of Public Health (IPH) and the National Institute of Statistics (INSTAT), the nutrition status of the Albanian population indicates amongst many other characteristic, that anemia prevalence is highest among children living in mountainous areas, coastal areas and rural areas, respectively. In addition, 19% of women have anemia with the highest prevalence in breastfeeding women and those living in rural areas. Therefore this study aims at evaluating the cost-effective analysis of interventions targeting malnutrition in Albania and how to improve them especially through flour fortification. Key words: Malnutrition, micronutrients, vitamins, minerals, deficiency, fortification, Albania.

Background fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility. Objective to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites. Methods in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space). Results the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24). Conclusion FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.

Objective: To compare diurnal cortisol profiles across samples of older adults from diverse populations and to examine if differences in circadian cortisol secretion are associated with poor physical performance (SPPB

Aims: Noroviruses (NoVs) represent the most important enteric viruses responsible for acute gastroenteritis world-wide. This study objective is to characterize the first outbreak of NoV that occurred in Ballsh, a small city in Albania. Methods and Results: Stool specimens were collected from people attending to the hospital. Samples were also collected from the aqueduct for bacteriological and virological tests. Overall 33 stools and five drinking water samples were collected, respectively, from the hospital in Ballsh and from the municipal aqueduct. No water samples were scored positive whereas ten stool samples (30·3%) were scored GGII NoV positive. All the GGII isolates were identified as GGII·4 genotype, and no GGI was identified. The alignment and protein analysis were performed using, respectively, ClustalV and the mega 4 software. Conclusions: This is the first report of NoV GGII·4 in Albania causing an outbreak. The genetic analysis showed several point mutations and amino acid substitutions with respect to the international strains. Significance and Impact of Study: Over the last decades, Albania has suffered from different outbreaks as cholera, poliomyelitis, hepatitis A and now, for the first time, it has been documented an outbreak of NoV.

The paper presents the data from a household survey in a representative sample of the population of individuals over 65 years old in three regions of Albania. The survey included a quantitative assessment of socioeconomic situation including poverty, social participation and social exclusion, as well as assessment of ill-health including limitations of daily living activities and chronic conditions. It was found that older people in urban areas are better covered with social security as compared to older residents in rural and informal areas. One third (32%) of participants reported not good or bad health and the majority (57%) of them were poor or very poor. Significant differences were found with individuals residing in informal areas around Tirana, reporting worse health conditions than elderly people living in urban areas. Approximately one fifth (18%) were totally or partially isolated from social networks. Prevalence of selected chronic conditions ranged from 9 percent to 58 percent. Almost the totality (93%) of the sample experienced some pain and 9 percent were bed-bound. More than one in four (27%) reported not receiving medical care when they needed it. Demographic trends mixed with a society in economic and political transition raise concerns about increasing needs for care and social inclusion of older people. Moreover, there is a low level of preparation of this society to cope with chronic diseases and long-term care. The findings suggest specific policies and actions to be considered by a number of stakeholders, including government and civic society.

Fear of falling (FoF) is a common health problem among older adults. Although the relationship between FoF and limitation in daily activities has been reported, FoF's relationship to mobility disability, a transitional phase to end-stage disability, is not yet understood. We examined the relationship between FoF and mobility disability among community-dwelling older adults and explored the differences in this relationship among socio-culturally diverse sites.Cross-sectional study.Community.1875 participants (65-74 years) were recruited from five sites and included in the analysis (Kingston, Canada: 394; St-Hyacinthe, Canada: 397; Tirana, Albania: 359; Manizales, Colombia: 341; and Natal, Brazil: 384).FoF was quantified using the Falls Efficacy Scale-International (FES-I, range: 16-64). Mobility disability was defined as difficulty climbing a flight of stairs or walking 400m without assistance.Overall, 21.5% of participants reported high FoF (FES-I27). The average FoF scores were significantly different between the sites (p0.001) and higher in women (p0.001). In general, 36.2% of participants reported mobility disability. The distribution of mobility disability was significantly different at the five study sites (ranged from 19.8% at Kingston, Canada to 50.7% at Tirana, Albania, p0.001). After adjusting for covariates, those with high and moderate FoF had about 3 times (95% CI: 2.59-3.83) and 2.5 times (95% CI: 1.99-2.91) higher risk of mobility disability, respectively, compared to those with no/low FoF.FoF was significantly associated with risk of mobility disability across the sites. The strength of this relationship appears to be different between the five sites.

Objective The aim of this study was to explore the validity of self-rated health across different populations of older adults, when compared to the Short Physical Performance Battery. Design Cross-sectional analysis of the International Mobility in Aging Study. Setting Five locations: Saint-Hyacinthe and Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). Participants Older adults between 65 and 74 years old (n = 1,995). Methods The Short Physical Performance Battery (SPPB) was used to measure physical performance. Self-rated health was assessed with one single five-point question. Linear trends between SPPB scores and self-rated health were tested separately for men and women at each of the five international study sites. Poor physical performance (independent variable) (SPPB less than 8) was used in logistic regression models of self-rated health (dependent variable), adjusting for potential covariates. All analyses were stratified by gender and site of origin. Results A significant linear association was found between the mean scores of the Short Physical Performance Battery and ordinal categories of self-rated health across research sites and gender groups. After extensive control for objective physical and mental health indicators and socio-demographic variables, these graded associations became non-significant in some research sites. Conclusion These findings further confirm the validity of SRH as a measure of overall health status in older adults.

Background Elderly persons make greater use of psychotropic drugs, but there are few international studies on social differences in the use of these medications. The aim of this study is to examine social differences in the use of psychotropic drugs among persons aged 65–74 years in the International Mobility in Aging Study (IMIAS). Methods The sample consisted of 1,995 participants in the IMIAS 2012 baseline study in Saint-Hyacinthe (Canada), Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). During home visits, all medication taken by the participants in the previous 15 days was recorded. We then used the Anatomical Therapeutic Chemical classification system to code psychotropic drugs as anxiolytics, sedatives, hypnotics (ASH); antidepressants (ADP); or analgesics, antiepileptics, or antiparkinsonians (AEP). Prevalence ratios for psychotropic drug use according to sex, education, income, and occupation were estimated by fitting a Poisson regression and controlling for demographic and health covariates. Results Psychotropic drug use was higher among Canadian participants than among those living outside Canada. Prevalence of AEP drug use was higher for women than men in the Canadian and Latin American sites. In Tirana, antidepressant drugs were rarely used. Socioeconomic differences varied among sites. In the Canadian cities, low socioeconomic standing was associated with higher frequency of psychotropic drug use. In the Latin American cities, elderly people with high education and income levels showed a higher level of antidepressant drug use, while people with manual occupations had a higher use of AEP drugs. In Tirana, ASH drug use was higher among those with low income. Conclusion An inverse association was observed between socioeconomic standing and psychotropic drug use in Canada, while the opposite was true in Latin America. Albania was notable for an absence of antidepressant use and greater use of ASH drugs among low-income groups.

Background Albania, as with all Central and Eastern European countries whose health systems were highly centralized, has undertaken a number of reforms aiming to transform, among many items, the financing and delivery of primary health care services. Objective This study assesses the practice activities of general practitioners working in the region of Tirana, over a period of 12 months. Methods Production is measured by the number of monthly visits carried out by the practitioner, and practice profiles are determined by referral rates for specialist care and prescription rates per visit. Multi-level regression analyses, taking into account the hierarchical structure of the data, were performed to identify the factors associated with productivity and profiles of practice. Results Results show large urban-rural variations with respect to practice conditions, characteristics of practitioners, productivity, and profiles of practice. Productivity was weak in the city of Tirana (an average of 277 monthly visits), 18% of patients were referred to specialists, and 66% received prescriptions. In rural areas, productivity was weaker (an average of 179 monthly visits), referral rates were lower (11%), and the prescription rate was 74%. In urban and rural areas, productivity and profiles of practice were related to the characteristics of both the client and the health centre and to the type of practice. Conclusion There are only a few available epidemiological studies documenting the ongoing health transition and the concomitant increase in demand for primary health care services; therefore, we are unable to (causally) link the reported low productivity of general practitioners with population needs. Physician productivity and patient care is better for certain groups and in health care settings where a wide range of services and sophisticated medical technologies are available. The capacity to efficiently plan for medical manpower is limited - this may be attributed to deficiencies of the patient registration system on the lists of physicians who are paid on the basis of capitation. Additional studies examining utilization of health services, and satisfaction of patients and providers, is needed in order to provide sound recommendations for improving Albania's health care system.

In 2001, two Albanian institutions, the Department of Public Health, Faculty of Medicine, University of Tirana and the National Institute of Public Health obtained membership to the Association of Schools of Public Health for the European Region (ASPHER). Since 2000, these two institutions have been members of the Public Health for South Eastern Europe (PH-SEE) network. Furthermore, in the fall of 2001, the Open Society Institute (OSI) and ASPHER launched a project that culminated in the establishment of a School of Public Health (SPH) and the commencement of the first Master of Public Health (MPH) programme in Tirana. The MPH programme began in December 2005 and enrolled 32 students from different backgrounds. A suitable start for the development of the MPH programme was the implementation of key modules developed by the European MPH programme. In addition, specific modules reflecting the needs of Albania were designed according to the preferences and the heterogeneous lecturing faculty involved in public health training. International guest lecturers delivered other modules, with ASPHER and the PH-SEE network offering an excellent solution for complementary modules in different public health disciplines. However, the newly established SPH in Albania should now strive for other postgraduate teaching programmes, undergraduate programmes, and especially service training and continuing education.

Vaccination coverage is one of the most important components which describe the immunization situation in a country. Now days more and more combined vaccines are being used which help the immunization programs to achieve high coverage for more than one antigen. Another reason for coverage improvement is the use of one or two-dose vials for the administration of DTP-HepB–Hib or MMR vaccine, enabling the vaccination of children at any time. In the last three years vaccination coverage with two doses of MMR and three doses of DTP containing vaccines is more than 95% or sometimes even 98% at national level. The coverage of Hepatitis B vaccine is also high due to its use on 5 in 1 combination. The use of one dose vials has played an important role on sustaining and increasing vaccination coverage. Another component affecting the immunization situation in the country is the influence of parental knowledge for vaccines and vaccination in Albania. Collected data through the use of a questionnaire showed that 6% of respondents have had fear and consequently refused vaccination of their children. While 92% of parents had the opinion that information about the health benefits or risks of vaccines would be absolutely useful and given to them prior to vaccination from health care workers. 72% of the subjects were concerned about the side-effects but this concern hasn’t stopped them to vaccinate their children. 35% of the interviewed mothers were still concerned that their child would contract a disease even though he/she had been already vaccinated.

After >10 years without detection of any cases of wild virus-associated poliomyelitis, a large outbreak of poliomyelitis occurred in Albania in 1996. A total of 138 paralytic cases occurred, of which 16 (12%) were fatal. The outbreak was due to wild poliovirus type 1, isolated from 69 cases. An attack rate of 10 per 100,000 population was observed among adults aged 19-25 years who were born during a time of declining wild poliovirus circulation and had been vaccinated with two doses of monovalent oral poliovirus vaccines (OPVs) that may have been exposed to ambient temperatures for prolonged periods. Control of the epidemic was achieved by two rounds of mass vaccination with trivalent oral poliovirus vaccine targeted to persons aged 0-50 years. This outbreak underscores the ongoing threat of importation of wild poliovirus into European countries, the importance of delivering potent vaccine through an adequate cold chain, and the effectiveness of national OPV mass vaccination campaigns for outbreak control.

This study evaluates the knowledge and attitudes of mothers regarding the immunization in a random sample of 100 children from Tirana, Durrës, Pogradec and Korçë, Albania. The questionnaire collected data on person answering the questionnaire, parent's educational and occupational status, parental knowledge on vaccines and vaccination and type of vaccine administration. The questions about attitudes on the utility of vaccinations were scored on a 5-point Likert scale with options ranging from ʺ1ʺ) to ʺ5ʺ). The behavior responses and the questions concerning mothers’ responsibility on taking decisions regarding vaccination were in ʺyes/noʺ format and only two questions were open ones. Almost all the children were vaccinated with all the three doses of DTP and hepatitis B. In the meantime, for the optional vaccines, such as Influenza, HPV, only 2% of respondents stated that their children had been vaccinated. The results showed that the attitudes toward the utility of vaccinations for preventing infectious diseases were favorable. Most of the respondents felt extremely confident in receiving honest and complete information about vaccination from doctors/ pediatricians but also from the experience of other parents. The objective of this study was to investigate the influence of parental knowledge of vaccines and vaccination in Albania.

BACKGROUND: Albania, as with all Central and Eastern European countries whose health systems were highly centralized, has undertaken a number of reforms aiming to transform, among many items, the financing and delivery of primary health care services. OBJECTIVE: This study assesses the practice activities of general practitioners working in the region of Tirana, over a period of 12 months. METHODS: Production is measured by the number of monthly visits carried out by the practitioner, and practice profiles are determined by referral rates for specialist care and prescription rates per visit. Multi-level regression analyses, taking into account the hierarchical structure of the data, were performed to identify the factors associated with productivity and profiles of practice. RESULTS: Results show large urban-rural variations with respect to practice conditions, characteristics of practitioners, productivity, and profiles of practice. Productivity was weak in the city of Tirana (an average of 277 monthly visits), 18% of patients were referred to specialists, and 66% received prescriptions. In rural areas, productivity was weaker (an average of 179 monthly visits), referral rates were lower (11%), and the prescription rate was 74%. In urban and rural areas, productivity and profiles of practice were related to the characteristics of both the client and the health centre and to the type of practice. CONCLUSION: There are only a few available epidemiological studies documenting the ongoing health transition and the concomitant increase in demand for primary health care services; therefore, we are unable to (causally) link the reported low productivity of general practitioners with population needs. Physician productivity and patient care is better for certain groups and in health care settings where a wide range of services and sophisticated medical technologies are available. The capacity to efficiently plan for medical manpower is limited–this may be attributed to deficiencies of the patient registration system on the lists of physicians who are paid on the basis of capitation. Additional studies examining utilization of health services, and satisfaction of patients and providers, is needed in order to provide sound recommendations for improving Albania’s health care system.

Objectives.This paper presents the results of an ongoing community-based surveillance program of cardiovascular risk factors in Geneva, Switzerland, using percentiles with their associated 95% confidence intervals and compares the Genevan results with published data from international surveys reporting percentiles. Methods.A random survey of adults ages 35 to 74 years was conducted from 1993 to 1994. Confidence intervals for percentiles based on parametric and nonparametric methods are given. Results.The distribution of total cholesterol was shifted upward with increasing age. The median reached a maximum at 55–64 years among men (5.7 mmol/L) and at 65–74 years among women (5.9 mmol/L), and remained relatively stable thereafter. In both genders, systolic and, less so, diastolic blood pressure increased progressively with advancing age. The median daily energy intake among men declined from 2,390 kcal at age 35–44 years to 2,169 kcal at age 65–74 years, while among women it remained stable at about 1,900 kcal. In both males and females, the relative intake of saturated fat was stable throughout life (14 to 13%). The median body mass index (BMI) was about 25 kg/m2across all age groups among men, but increased with age among women, with a peak of 23.6 kg/m2occurring at ages 65–74 years. Compared with U.S. and western European surveys, Genevan men and women had lower total plasma cholesterol and Genevan women tended to have lower BMIs. Conclusions.Percentiles with their associated precision appear particularly well suited for international comparison of surveillance data. They could be used in the future to monitor shifts in distributions resulting from mass prevention strategies.

Adolescent health is a major global priority. Yet, as recently described by the World Health Organization (WHO), increased recognition of the importance of adolescent health rarely transforms into action. One challenge is lack of data, particularly on adolescent fertility. Adolescent pregnancy and childbirth are widespread and affect lifetime health and social outcomes of women, men, and families. Other important components of adolescent fertility include abortion, miscarriage, and stillbirth. Access to reliable, consistently-collected data to understand the scope and complexity of adolescent fertility is critical for designing strong research, developing meaningful policies, building effective programs, and evaluating success in these domains. Vital surveillance data can be challenging to obtain in general, and particularly in low- and middle-income countries and other under-resourced settings (including rural and indigenous communities in high-income countries). Definitions also vary, making comparisons over time and across locations challenging. Informed by the Adolescence and Motherhood Research project in Brazil and considering relevance to the Southern Eastern European (SEE) context, this article focuses on challenges in surveillance data for adolescent fertility for middle-income countries. Specifically, we review the literature to: (1) discuss the importance of understanding adolescent fertility generally, and (2) highlight relevant challenges and complexity in collecting adolescent fertility data, then we (3) consider implications of data gaps on this topic for selected middle-income countries in Latin America and SEE, and (4) propose next steps to improve adolescent fertility data for evidence-based health promotion in the middle-income country context. Conflicts of interest: None., South Eastern European Journal of Public Health (SEEJPH), Volume XI, 2019