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Our aim was to assess the prevalence and demographic correlates of overweight and obesity among children in Albania, a transitional country in Southeastern Europe. A nationwide survey was conducted in Albania in 2013 including a representative sample of 5,810 schoolchildren aged 7.0-9.9 years (51.5 % boys aged 8.5 ± 0.6 years and 49.5 % girls aged 8.4 ± 0.6 years; overall response: 97 %). All children were measured height and weight, based on which the body mass index (BMI) was calculated. The criteria of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to describe the distribution of BMI among children. Overall, mean value of BMI was 16.4 ± 2.4 (16.7 ± 2.5 in boys vs. 16.2 ± 2.4 in girls, P < 0.001). As per WHO criteria, 9.8 % of the boys were obese versus 5.5 % of the girls ( P < 0.001). The prevalence of both overweight and obesity were remarkably higher among urban children compared with their rural counterparts (17.9 vs. 10.5 and 11.9 vs. 4.0 %, respectively, P < 0.001). As per IOTF criteria, 3.8 % of the boys were obese compared with 2.8 % of the girls ( P < 0.001). The prevalence of overweight and obesity were similarly higher among urban children than in rural children (15.6 vs. 7.3 and 5.5 vs. 1.4 %, respectively, P < 0.001). Our findings indicate that Albania is in the middle of nutritional transition with a high prevalence of overweight and obesity among children aged 7.0-9.9 years. This is particularly evident in urban areas of the country. Conversely, our data do not indicate a double burden of malnutrition among children in Albania. [ABSTRACT FROM AUTHOR]

AIMS -- Our aim was to assess the demographic and social factors associated with lifetime use of tobacco, alcohol and cannabis among school students aged 15-16 in Albania in order to make information and knowledge available for health promotion specialists working on substance use prevention. DESIGN -- This cross-sectional study was conducted in March-May 2011 in the framework of the European School Survey Project on Alcohol and Other Drugs (ESPAD). In total. 3189 students born in 1995 participated in the survey. The standardised ESPAD questionnaire was used to collect data about substance use. RESULTS -- Our multivariable adjustment analysis showed that being a male and having easy access to cigarettes were the only universal factors significantly increasing the likelihood of ever using tobacco, alcohol or cannabis. Own smoking was strongly and significantly associated with alcohol and cannabis use. The associations of own substance use with peer substance consumption were weak to moderate. CONCLUSIONS -- Own smoking seems to be the most important single independent risk factor which strongly and significantly predicted alcohol and cannabis use among Albanian school students. Policy makers need to strengthen the rule of law whereas health promotion professionals should firmly address smoking in adolescence through target interventions. [ABSTRACT FROM AUTHOR]

Background: A number of studies proved that social networks and social participation have beneficial health effects in Western countries. However, the evidence from Southeast European region is scant. We aimed to assess the extent of social networks and social participation and their relationship with self-perceived health status among older people in post-war Kosovo. Methods: A nationwide cross-sectional study was conducted in Kosovo in 2011 including a representative sample of 1890 individuals aged ≥65 years (949 men, mean age 73 ± 6 years; 941 women, mean age 74 ± 7 years; response rate: 83%). Social networks were assessed by means of number of friends and family members that participants had contacts with, whereas social participation by involvement in social groupings/organizations. Information on self-perceived health status and demographic and socioeconomic characteristics was also collected. Results: Overall, 93% of study participants reported that they had at least weekly contacts with more than one family member, and 97% reported daily contacts with their respective friends. Conversely, only 14% of participants reported engagement with social groupings. Generally, individuals who had contacts with friends and/or engaged with social organizations reported a better health status. Conclusion: Our findings point to strong family ties in this patriarchal society. Conversely, levels of social participation were considerably lower in Kosovo compared with the Western European countries. The low participation levels in social groupings and their putative deleterious health effects should raise the awareness of policymakers to improve the conditions and increase the degree of social participation among older people in transitional Kosovo. [ABSTRACT FROM AUTHOR]

Abstract: A cross-sectional study including 796 individuals with a psychiatric disorder was conducted in Croatia, Israel, Lithuania, Malta, Romania and Sweden in 2010 aiming to assess correlates of self-stigma. The Internalized Stigma of Mental Illness (ISMI) was used to measure self-stigma, whereas the Boston University Empowerment Scale was used to measure the self-efficacy/self-esteem (SESE) and sense of power/powerlessness (PP). Perceived discrimination and devaluation was measured with the Perceived Devaluation and Discrimination (PDD) Scale. Thirty three percent of participants had moderate-to-high ISMI scores. In multivariable-adjusted analysis, significant ‘predictors’ of high ISMI scores were: age-group of 50–59 years, current employment, lower social contacts, and minimal-to-low SESE and PP scores. Remarkably, no significant association between ISMI and PDD was evident. Furthermore, there was evidence of a significant interaction between SESE and country. Study participants might not be representative to all individuals with mental disorders in countries included in this survey. Our findings indicate that people with psychiatric diseases suffer both self-stigma and perceived discrimination and devaluation. This is one of the very few reports highlighting country differences and diagnosis disparities of self-stigma among individuals with mental illnesses. Between-country differences should be considered and carefully addressed in the process of policy formulation and interventional programs against stigma. [Copyright &y& Elsevier]

Background There is little evidence on benzodiazepine misuse and associated factorsin transitional countries of the Western Balkans. Objective The aim of this study was to assess the level and socioeconomic correlates of misuse of benzodiazepine drugs in the Albanian adult population. Method We conducted a cross-sectional study including a representative sample of 422 individuals (158 men and 264 women) who were benzodiazepines users. A structured questionnaire included data on age, gender, type of drug used, and awareness of possibility to develop dependence and continuation of therapy after prescription. Results 289 individuals reported treatment continuation compared with 89 participants who reported no continuation of benzodiazepine drugs. There were no significant age group ( P = 0.351), sex ( P = 0.454), or educational differences ( P = 0.117) in treatment continuation. Age was inversely related to the awareness of becoming dependent with the prolonged use of benzodiazepines (78.4 % of the persons aged ≤40 years were aware of the dependence versus 51.9 % in the age group >40 years; P = 0.002). Conclusion Our study provides pioneering evidence on the use and misuse of benzodiazepines in Albania. Findings from this study may influence the reforms and policy formulation related to drug misuse in Albania. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the association of alcohol drinking frequency and quantity with acute coronary syndrome (ACS) in a predominantly Muslim southeast European population, where heavy drinkers drink consistently. Methods: A population-based, case-control study conducted in 2003 through 2006 in Tirana, Albania, included 465 nonfatal sequential ACS patients aged 35 to 74 years (369 men, 96 women; 88% response) and a population-based control group (450 men and 235 women aged 35–74 years; 65.5% response). A structured interview included sociodemographic, psychosocial, and behavioral characteristics. Anthropometric measurements were performed. Statistical analysis employed multivariable-adjusted logistic regression. Results: Women abstained or were light drinkers. Among men, there was a protective association of ACS with both frequency of intake [multivariable-adjusted odds ratio (OR; almost daily versus occasional drinkers), 0.3; 95% confidence interval (CI), 0.2–0.5] and “moderate” drinking quantities [OR (100–299 versus <10 g/wk), 0.4; 95% CI, 0.2–0.6]. Heavy drinking (≥300 g/wk; ≈10% of men) was regular rather than episodic, and was associated with loss of protection. Conclusions: Among the men in this transitional Mediterranean population, we found a strong protective effect associated with both moderate frequency and quantity of intake. The unique context of our study reinforces the case for causality in the relationship between moderate alcohol intake and coronary health. [ABSTRACT FROM AUTHOR]

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

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

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

Our aim was to describe the prevalence and associated factors of intimate partner violence in postcommunist countries of South East Europe (SEE). Review of recent reports regarding intimate partner violence in SEE countries as documented in the official Web sites of the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), Minnesota Advocates for Human Rights, Centers for Disease Control, and Medline. In Belgrade, Serbia and Montenegro, the prevalence of physical violence against women has been reported as 69.8%. In a reproductive health survey conducted in 1997 in Moldova, 22% of the women interviewed reported they had been abused by a partner or former partner at some time in their lives. More than 31% of female university students in Macedonia have reported that they had been victims of physical or psychological violence. Data from Albania indicate that spousal physical violence is one of the highest reported internationally. In Tirana, the Albanian capital city, the prevalence of past-year physical intimate partner violence was reported by 37% of women interviewed. The most empowered Albanian women were most likely to experience physical abuse and the least powerful men and those of rural origin were most likely to perpetrate spousal violence. Notwithstanding the lack of well-documented data and the questionability of extent to which the reported results are comparable among different SEE countries, the evidence suggests that intimate partner violence is an important public health problem in transitional countries of SEE. Information on intimate partner abuse can provide valuable clues to primary care and community care practitioners about the health status of female populations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

The Faculty of Medicine in Tirana, the only institution providing medical training in Albania, has currently developed three separate branches of study, General Medicine, Dentistry, and Pharmacy. Since the early 1990s, following the collapse of the communist regime, many faculty members have been trained abroad in different areas of medical sciences. Yet, little emphasis is placed on research work and teaching of evidence-based medicine in both undergraduate and postgraduate studies. Medical students are not exposed to sources of evidence, searching techniques, and important medical databases, such as PubMed and Cochrane Library. Exposing medical students and young physicians to probabilistic thinking, the importance of communication, and levels of evidence in medical practice is what the academic medicine in Albania should strive for. To address this challenge, the Faculty of Medicine in Tirana needs to strengthen the mobility of its students and their training in Western schools. These young and well-trained faculty members will provide the critical mass of future academicians required to develop a modern medical school in Tirana. [ABSTRACT FROM AUTHOR]