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Background: Seroprevalence studies have proven to be an important tool in tracking the progression of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to measure the seroprevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the general population of Kosovo by gender, age group and region and among asymptomatic people., Method: The Institute of Public Health of Kosovo conducted a cross-sectional population-based survey, aligned with the protocols of the WHO Unity Studies, from the beginning of May to the end of June 2021., Results: The survey covered a total of 2204 people with a response rate of 91.8% (41.9% [923] males and 51.2% [1281] females). In May to June 2021, the prevalence of antibodies in the overall population (IgG antibodies ≥ 1.1) was 37.0%. Seroprevalence was 34.4% in men and 38.9% in women (p < 0.05), with the highest percentage (48.7%) found in the 60-69 years' age group. The overall prevalence of acute IgM antibodies (IgM ≥ 1.1) was 1% (95% CI: 0.7%-1.5%), with no significant difference between genders and the highest prevalence among participants of 60-69 years of age (1.6%; 95% CI: 0.7%-3.6%)., Conclusion: A high prevalence of antibodies against SARS-CoV-2 was found in Kosovo before the start of the vaccination campaign. However, the results of the survey suggested that, by the end of June 2021, a desirable level of protection from the SARS-CoV-2 virus had not been reached., (© 2024 The Author(s). Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.)

Objectives: This study explores the mental health situation in Kosova and the impact of the COVID-19 pandemic., Methods: Marketed quantities of antidepressants (N06A) and anxiolytics (N05B) from 2017 to 2022 were analyzed using the Anatomical Therapeutic Chemical/Defined Daily Doses (ATC/DDD) methodology. Caution is advised as these quantities may not directly reflect patient usage and could include uses for conditions outside their primary indications., Results: Prior to the pandemic, antidepressant quantities remained relatively stable, but rose from 6.8 DDD/1000 inhabitants/day in 2019 to 9.7 in 2020 and 12.4 in 2021, before returning to pre-pandemic levels of 6.8 DDD in 2022. Over 80 % of these were selective serotonin reuptake inhibitors. Meanwhile, anxiolytic quantities initially decreased from 17.4 DDD in 2017 to 9.9 in 2019, then rebounded to 17.9 DDD in 2020. Notably, alprazolam usage surged from 2.9 in 2017 to 6.9 in 2021, subsequently dropping to 2.0 in 2022., Conclusions: The volatile trends in medication quantities during the pandemic suggest a fragile mental health landscape in Kosova-a developing, post-conflict country with a youthful population-underscoring the need for proactive interventions in similar contexts globally., Competing Interests: Declaration of competing interest The authors have no competing interests to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: In recent years, the global response to the HIV/AIDS pandemic has encountered significant challenges, impeding the collective aim of eliminating AIDS as a public health threat by 2030. A major concern undermining this goal is the delayed presentation (late presentation - LP) of individuals diagnosed with HIV/AIDS., Methodology: This study includes 85 HIV positive individuals with available CD4 count and viral load (VL) data at the time of HIV diagnosis, out of 169 registered people living with HIV in Kosovo. Employing descriptive and frequency statistics, Chi-square tests, non-parametric Mann-Whitney tests, and logistic regression analyses using SPSS Version 29, we generated statistical results with 95% confidence intervals., Results: The prevalence of LP in HIV positive individuals included in the study was 50.59%, with 30.59% classified as very late presenters (VLP). Determinants associated with LP included male gender, young adulthood, MSM mode of transmission, and a high viral load (log10 4.1-5.0 copies/mL). Comparative analysis with studies on this subject indicated similar patterns of LP in adults, males, and viral load, but different transmission mode patterns., Conclusion: This research illuminates the specific determinants of LP in Kosovo, offering valuable insights for tailoring interventions to enhance timely diagnosis and access to care for people living with HIV/AIDS.

Background: COVID-19 vaccines have proven effective against severe outcomes in many settings, yet vaccine effectiveness (VE) estimates remain lacking for Kosovo. We aimed to estimate VE against COVID-19 infections, hospitalisations, and deaths for one and two vaccine doses during the fourth pandemic wave in July-September 2021, the period when vaccination initially became widely available., Methods: We analysed routine surveillance data to define cases and vaccination status as partially (one dose) or completely (two doses) vaccinated. We used the screening method to calculate the proportion of cases with the outcomes vaccinated (PCV). The proportion of the population vaccinated (PPV) was based on numbers vaccinated and the Kosovo population estimate on 30/09/2021., Results: Between July-September 2021, 51,804 COVID-19 cases were reported in Kosovo with 9.3% of cases partially and 3.4% completely vaccinated. Estimated vaccine effectiveness for one dose was 93.1% (95%CI:92.9-93.2%) for infections, 90.3% (95%CI:88.8-91.7%) for hospitalisations, and 90.3% (95%CI:88.4-92.1%) for deaths. Estimated vaccine effectiveness for two doses was 97.8% (95%CI:97.6-97.9%) for infections, 94.5% (95%CI:93.3-95.6%) for hospitalisations, and 94.2% (95%CI: 93.7-96.5%) for deaths., Conclusions: This study provides real-world evidence for COVID-19 vaccine effectiveness in Kosovo using routine administrative data sources and the screening method. COVID-19 vaccine effectiveness against infections and severe outcomes in Kosovo was higher with two vaccine doses than one dose, which is in accordance with findings from other study designs and settings. Using the screening method in our study reflects an important initial methodology for estimating vaccine effectiveness with routine surveillance that may be particularly important for low- and middle-income settings with less robust surveillance systems or fewer opportunities to conduct more robust vaccine effectiveness study designs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rashiti-Bytyçi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019., Methods: The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured., Results: The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure., Conclusions: By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)

BACKGROUND Multiple sclerosis (MS) is treated with disease-modifying therapies (DMTs) that can increase susceptibility to viral infections. This retrospective study aimed to evaluate the presentation, management, and outcomes of patients with MS on DMTs admitted with symptoms of COVID-19 to a single center in Prishtina, Kosovo between March 2020 and April 2022. MATERIAL AND METHODS In this observational, single-center study, we included 282 patients with MS (mean age 37.8±11, 64.9% females), of whom 272 (96.4%) had confirmed COVID-19 infection, either through the presence of antibodies in the serum or a positive PCR test. RESULTS Most patients with COVID-19 infection were either asymptomatic or mildly symptomatic, while 11 patients were hospitalized due to moderate to severe symptoms. Among those with severe infection, 2 patients have died. Patients with moderate and severe COVID-19 had more advanced MS disease (P=0.001) and higher disability scales (P<0.001). In a logistic regression analysis, advanced MS remained significantly associated with worse symptoms, even after adjusting for other risk factors, with a relative risk (RR) of 2.8 (95% CI=1.1-6.6, P=0.018). MS patients on anti-CD20 DMTs more frequently experienced moderate and severe symptoms (RR=2.1, 95% CI=1.1-4.0, P=0.012). Anti-SARS-CoV-2 IgG was also lower in patients treated with anti-CD20. Notably, patients receiving vitamin D supplementation experienced a lower frequency of moderate to severe symptoms (P=0.007). CONCLUSIONS Patients with advanced MS exhibiting higher disability scales and those on anti-CD20 therapy faced an increased risk of experiencing more pronounced symptoms after COVID-19 infection. Patients on vitamin D supplementation had better clinical outcomes.

The prevalence of West Nile virus (WNV) is increasing across Europe, with cases emerging in previously unaffected countries. Kosovo is situated in a WNV-endemic region where the seroepidemiological data on WNV in humans remains absent. To address this issue, we have conducted a seroepidemiological investigation of 453 randomly selected sera from a hospital in Kosovo, revealing a 1.55% anti-WNV IgG seroprevalence. Comparative and phylogeographic analyses of the WNV genomes obtained by sequencing archived samples from patients with West Nile fever indicate at least two recent and distinct introductions of WNV lineage 2 into Kosovo from neighboring countries. These findings confirm the eco-epidemiological status of WNV in southeast Europe, where long- and short-range dispersion of lineage 2 strains contributes to a wider circulation via central Europe. Our results suggest an increasing risk for WNV spreading in Kosovo, underscoring the need for an integrated national surveillance program targeting vectors and avian populations for early epidemic detection, as well as the screening of blood donors to gauge the impact of virus circulation on the human population.

Background: Very limited information is available on the prevalence and risk factors of asthma in adolescents in Kosovo, and no study has previously addressed the role of Human Development Index (HDI) on asthma in the region. The present study addresses these two issues., Methods: Following the Global Asthma Network (GAN) methodology, a cross-sectional survey, through standardised self-completed questionnaires, was conducted in the following six centres of Kosovo: Ferizaj, Gjakova, Gjilan, Peja, Prishtina and Prizren. Current asthma symptoms (CAS) and severe current asthma symptoms (sCAS) were defined according to the GAN standards. Environmental questionnaire inquired about gender, exercise, screening time, siblings, truck traffic, use of paracetamol, pet ownership, and smoking habits. Height and weight were also measured. Multivariate logistic regression analyses were performed in each centre along with meta-analyses to summarise the overall effects of each factor in the centres as a whole. Meta-regression of the prevalence rates was calculated using HDI as a moderator., Results: Participation rate was high (80.0-99.9%). Prevalence of CAS ranged from 4.6% to 11.3%, and sCAS from 1.7% to 4.5%. Factors associated with CAS were exercise, computer time, paracetamol use and dog ownership. sCAS was associated with paracetamol use and physical exercise. HDI explained 46% and 80% of prevalence variability of CAS and sCAS between centres, respectively., Conclusions: Prevalence of CAS and sCAS in Kosovo varies highly between centres. This variability is explained partly by HDI. Individual risk factors are common, with some determined in other studies conducted in other regions., Competing Interests: The authors declared no conflict of interest.

Canine leishmaniosis (CanL) is a neglected zoonotic disease caused by Leishmania spp. Leishmania infantum is the species responsible for the zoonotic form of the disease where dogs are reservoir hosts. This study aimed to determine the seroprevalence of CanL in asymptomatic dogs in Kosovo. Blood samples were collected from 285 dogs in all seven regions in Kosovo (35-50 samples per region) from summer 2021 to spring 2022. Sera were tested using enzyme-linked immunosorbent assay (ELISA), and the presence of anti-Leishmania IgG was confirmed by an indirect fluorescent antibody test (IFAT). The true overall seroprevalence of CanL of asymptomatic dogs in Kosovo with ELISA was 4.21% (95% CI: 2.42-7.21) while with IFAT was 3.51% (95% CI: 1.92-6.34). The highest rates were found in the Prishtina region to be 8.0% (4/50) by ELISA and 6.0% (3/50) by IFAT, and in the Mitrovica region, the prevalence was 0% (0/40). There were no significant differences among the different regions, gender, age, health status, and breed. These findings highlight the presence of CanL in most regions of Kosovo and underline the veterinary relevance of clinically asymptomatic dogs infected with Leishmania., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A pandemic may have a negative impact on healthcare workers' (HCW) mental health. In this cross-sectional study, we assess the self-reported prevalence of stress, anxiety, and depression and identify their predictive factors among HCW in Kosovo. The online questionnaire collected data on socio-demographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Descriptive statistics, t-test, and linear logistic regression were used to analyze the data. Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining were nurses, midwives, and other health professionals (22%). Prevalence rates for moderate to extremely high stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. The nurses reported significantly higher mean scores for depression and anxiety than the physicians ( p < 0.05). Being married, having poor health, not exercising, and reporting "burnout" from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers ( p < 0.05). Most HCWs (71.6%) reported a mild, moderate, or severe mental health burden, and certain factors predicted higher levels of such burden.

This study aimed to investigate the effects of particulate air pollution (PM2.5) on cardiovascular and respiratory diseases in Pristina, Kosovo, in a time-series analysis using daily primary healthcare visits to primary care institutions from 2019 to 2022. For the observation period, 6440 cardiovascular and 15,141 respiratory visits were reported, whereas the daily mean concentrations of PM2.5 ranged between 2.41 and 120.3 µg/m 3 . Single-lag models indicated a bi-phasic lag structure with increasing effect estimates some days after the air pollution event. In the distributed lag model with seven lags, the effect estimates for the cardiovascular cases indicated the adverse effect of air pollution. The cumulative effect estimate (summed over lag 0 to 6) for an increase of 10 µg/m 3 of PM2.5 was a relative risk of 1.010 (95% confidence interval: 1.001-1.019). For respiratory cases, a different lag model (lag 4 through 10) was additionally examined. In this model, significant increases in visits were observed on lags 7 and 8. Overall, no relevant increase in visits occurred during the seven days considered. Visits to general practitioners will often not occur immediately at disease onset because patients will wait, hoping that their health status improves spontaneously. Therefore, we expected some latency in the effects.

Background: In a cohort of primary health care users across Kosovo (KOSCO cohort), high rates and poor control  of diabetes and hypertension were observed. These conditions can be prevented and better controlled by adapting to a healthy lifestyle. Physical activity is an important target, as inactivity and related obesity were very prevalent in the KOSCO cohort. This qualitative study aims to identify individual and structural barriers to physical activity perceived by patients with diabetes and/or hypertension so as to inform health care providers and policy-makers in Kosovo on strategies for promoting physical activity., Methods: Interviews were conducted from July to October 2020 with 26 public primary health care users from five municipalities of Kosovo (Mitrovica, Vushtrri, Fushe Kosova, Gjakova, and Malisheva). The qualitative study was nested into the KOSCO cohort. KOSCO was implemented in 2019 and recruited consecutive patients visiting the public primary health care centres in these municipalities. Participants of this qualitative sub-study were selected if they had a doctor's diagnosis of diabetes and/or hypertension. The interview guide consisted of questions related to physical activity barriers these patients are facing, despite having received motivational counselling sessions in primary healthcare centres. Data were analysed using a framework methodology., Results: Three main themes moderating physical activity behaviour were identified: 1) neighbourhood built environment, 2) health-related problems, and 3) social support. The barriers to physical activity related to the first theme were structural features of the neighbourhoods such as: crowded sidewalks, lack of green spaces, lack of proper lighting in public spaces, as well as dense traffic. In regards to the second theme, the main health reasons for study participants to delay physical activity were related to: physical discomfort as well as stress, worry, and lack of energy. An additional barrier to exercise was lack of social support specifically from friends., Conclusion: The study identifies structural and individual targets for integrated and inter-sectoral physical activity promotion efforts., (© 2022. The Author(s).)

The migration of healthcare workers from developing countries to more economically developed countries is a long-standing and ongoing trend. Loss of qualified staff due to migration can negatively impact healthcare systems. Understanding factors that drive migration is essential to identifying and managing health system needs. Our study explored factors related to the migration intent of healthcare staff in Kosovo, particularly after the COVID-19 pandemic. We carried out a cross-sectional survey of healthcare workers from public and private institutions. The survey analysed the prevalence of willingness to migrate and whether willingness was affected by the pandemic, and calculated crude and adjusted odds ratios for variables which may influence migration willingness. 14.43% of healthcare workers reported aspiration to migrate, and 23.68% reported an increased chance of migrating after the pandemic. Dissatisfaction with wages and working conditions, higher education and private sector engagement were associated with increased odds of migration willingness. After the pandemic, factors related to interpersonal relationships and state response gave lower odds of migration intent. These findings point to potential factors associated with the migration of healthcare workers, which can help policymakers address gaps in national health system strategy.

Introduction: Tularemia is a zoonotic disease that primarily affects adults and children in rural areas. Late diagnosis in children is often associated with treatment failure and accessory surgical procedures., Objective: To analyze the diagnostic and treatment options of pediatric tularemia during the last outbreak in Kosovo during years 2014 and 2015., Methodology: This retrospective study includes 36 children treated for Tularemia at pediatric department. The diagnosis was based on clinical, serological, and PCR testing., Results: Of the 230 patients treated for tularemia, 36 (16%) were children with a median age of 9.4 years old (range 2-15 years). Major clinical manifestations included fever (97%) and swelling of lymph glands (94%), and the duration of symptoms prior to hospitalization was two weeks (range 3-60 days). Leukocytosis (41%), along with an elevated erythrocyte sedimentation rate (97%) characterized the laboratory findings. Both serology and PCR were used to confirm tularemia in children in 100% of cases. Due to abscess formation, suppuration, and high prevalence of tuberculosis, surgical procedures were used as accessory therapy and for diagnosis in half of the patients (50%). Gentamycin was the first drug of choice (97%), while 3 patients experienced relapses. Since the majority of the patients (72%) used unsafe water from wells in rural regions, the outbreak was thought to be water-related., Conclusions: Every febrile child with swollen glands should be suspected of having tularemia. Gentamycin continues to be the preferred treatment for unilateral cervical glandular type. Successful therapy depends on early diagnosis and supplemental surgical procedures., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Izet Sadiku, Sadie Namani, Vera Ndrejaj Berisha, Albina Ponosheci Biçaku, Saranda Hyseni.)

The Republic of Kosovo is a small country in the Balkans. The capital city of Pristina hosts most of its population and is situated in a mountain basin with poor air exchange, especially during winter. Domestic heating, road transport, industry and coal-fired power plants contribute to high levels of air pollution. We performed a time-series analysis on effects of particulate air pollution (PM2.5) on respiratory health of children and adolescents, using hospital admission and ambulatory visit numbers from the pediatric university clinic. From 2018 until 2020, daily mean concentrations of PM2.5 ranged between 2.41 and 161.03 µg/m³. On average, there were 6.7 ambulatory visits per day with lower numbers on weekends and during the first COVID-19 wave in 2020. An increase in PM2.5 led to an immediate increase in visit numbers that lasted over several days. Averaged over a full week, this amounted to about a 1% increase per 10 µg/m³. There were, on average, 1.7 hospital admissions per day. Two and three days after a rise in air pollution, there was also a rise in admission numbers, followed by a decline during the consecutive days. This might indicate that the wards were overstressed because of high admission numbers and restricted additional admissions.

Introduction: Measles is among the most contagious and vaccine-preventable respiratory diseases. The aim of this research was to describe the socio-demographic profile, clinical manifestations and laboratory parameters of measles patients hospitalized at Kosovska Mitrovica Clinical Centre during the 2017-2019 outbreak., Methodology: The prospective study included all patients that had contracted measles (107) who were hospitalized at Kosovska Mitrovica Clinical Centre during the outbreak. All complications that led to hospitalization were analyzed and the frequencies of complications with respect to patient age and vaccination status were recorded., Results: More than half (51%) of the patients were unvaccinated. Patients' age varied statistically significantly with respect to vaccination status. Pneumonia was noted in 65% of the patients from the younger age group, compared to 32% of adults, and this difference was statistically significant. Hepatitis was a significantly more frequent complication in adults, affecting 36% of measles patients in this age group, compared to only 7% of those aged below 18 years. In the unvaccinated group, 71% pneumonia frequency was noted, compared to 11% and 35% in the vaccinated and unknown vaccination status groups, respectively. The differences in frequencies based on vaccination status were statistically significant., Conclusions: Most hospitalized patients were unvaccinated. Complications showed a significant difference with respect to the age and vaccination status of patients. Therefore, it is necessary to carry out continuous health promotion activities to raise awareness among the entire population of the importance and need for vaccination of children against measles, but also adults who have not been previously vaccinated., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Jelena Aritonovic Pribakovic, Natasa Katanic, Aleksandra Ilic, Mirjana Stojanovic Tasic, Nebojsa R Mitic, Momcilo Mirkovic, Danica Radomirovic, Milica Milentijevic, Milos Mirkovic, Radoslav Katanic.)

Background: Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. Their prevention is a priority to relieve the health system of from costly non-communicable disease treatments. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate change in the domains of smoking, diet, alcohol consumption and physical inactivity for at-risk patients. This study quantitatively assesses the uptake of motivational counselling and the distribution of health behaviours and stages of health behaviour change of the participants according to the intervention, as well as qualitatively describes experiences and perceived benefits of motivational counselling., Methods: Study participants (n = 907) were recruited consecutively in 2019 from patients visiting the Main Family Medical Centres in 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study as part of the Accessible Quality Healthcare project. For the quantitative study, we used baseline and first follow-up data on smoking status, physical inactivity, obesity, fruit and vegetable as well as alcohol consumption, uptake of counselling, and stages for behavioural change. For the qualitative study, in-depth interviews were conducted with a subset of 26 cohort participants who had undergone motivational counselling., Results: Motivational counselling was obtained by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours are high even in persons who underwent counselling (of whom 13% are smokers; 86% physically inactive; 93% with inadequate fruit and vegetable consumption; and 61% are obese); only the rate of smoking was lower in those who obtained counselling. Among smokers, over 80% were still in the pre-contemplation phase of behaviour change. More advanced stages of behaviour change were observed among the highly prevalent group of inactive persons and participants with poor dietary habits, among the 5 intervention municipalities. According to the qualitative study results, the participants who obtained motivational counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation., Conclusions: More tailored and additional primary health care approaches in accordance with patients' views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change., (© 2022. The Author(s).)

Objectives: Kosovo has the lowest life expectancy in the Balkans. Primary healthcare (PHC) plays an essential role in non-communicable disease (NCD) prevention. We described primary, secondary and tertiary prevention indicators in Kosovo and assessed their association with depressive symptoms., Methods: PHC users ( n = 977) from the Kosovo NCD cohort baseline study were included. Depressive symptoms were assessed using the Depressive Anxiety Stress Scale-21. Cross-sectional associations between depressive symptoms and prevention indicators were quantified with mixed logistic regression models., Results: Poor nutrition (85%), physical inactivity (70%), obesity (53%), and smoking (21%) were common NCD risk factors. Many cases of hypertension (19%), diabetes (16%) and Chronic Obstructive Pulmonary Disease (COPD) (45%) remained undetected by a PHC professional. Uncontrolled hypertension (28%), diabetes (79%), and COPD (76%) were also common. Depressive symptoms were positively associated with physical inactivity (OR 1.02; 95% CI 1.00-1.05 per 1-point increase in DASS-21) and undetected COPD (OR 1.07; 95% CI 1.00-1.15), but inversely with undetected diabetes (OR 0.95; 95% CI 0.91-1.00)., Conclusions: Continued attention and tailored modifications to primary, secondary and tertiary prevention in Kosovo are needed to narrow the Balkan health gap., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Obas, Bytyci-Katanolli, Kwiatkowski, Ramadani, Fota, Jerliu, Statovci, Gerold, Zahorka and Probst-Hensch.)

Territorial ownership claims are central to many interethnic conflicts and can constitute an obstacle to conflict resolution and reconciliation. However, people in conflict areas might also have a perception that the territory simultaneously belongs to one's ingroup and the rival outgroup. We expected such perceptions of shared ownership to be related to higher reconciliation intentions. We examined this expectation in relation to the territory of Kosovo among random national samples of Albanians and Serbs from Kosovo, and Serbs from Serbia (Study 1, total N = 995). In general, participants perceived low levels of shared ownership, however, shared ownership perceptions were positively related to reconciliation intentions in Kosovo. In Study 2 (total N = 375), we experimentally manipulated shared ownership (vs. ingroup ownership) and found that shared ownership elicited stronger reconciliation intentions. It is concluded that fostering a sense of shared ownership can be important for improving intergroup relations in post-conflict settings., (© 2021 The Authors. British Journal of Social Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

It has been demonstrated that pre-hospital emergency care reduces in-hospital mortality in patients admitted with acute coronary syndrome (ACS). The aim of this study was to analyze the relationship between pre-hospital emergency care and in-hospital mortality in ACS patients treated at the University Clinical Centre of Kosovo Emergency Department (UCCK ED). This observational clinical study included 1498 ACS patients treated at UCCK ED and followed-up by phone call for one year after discharge from the hospital. According to multivariate Cox regression analysis, age (HR=2.37, 95% CI 1.67-3.52), pre-hospital emergency care (HR=3.92, 95% CI 2.35-6.54), STEMI (HR=6.17, 95% CI 3.22-15.31), diabetes mellitus (HR=3.01, 95% CI 1.98-3.78), left ventricular ejection fraction <40% (HR=17.63, 95% CI 11.2-30.54) and ex-smoking (HR=2.34, 95% CI 1.57-3.85) were significant predictors of mortality in ACS patients. In-hospital mortality of patients admitted with ACS remains high in Kosovo as compared with developed countries. A better strategy for pre-hospital emergency care in Kosovo is recommended to save lives in these high-risk patients.

Introduction: Infections with hepatitis C are on the rise. The statistics on the general population of Kosovo infected with hepatitis C is lacking. The study tends to detect sero-prevalence in the following risk groups: haemodialysis patients; patients of surgical units, internal medicine units, and mental health units; HIV-diagnosed patients, health professionals, and women in the prenatal period. A number of institutions, providers of medical care to these groups' patients, have been targeted., Methodology: A total of 378 samples were collected from various institutions, with 347 of them being tested for anti-HCV and 31 being tested for RT-PCR assays., Results: From the total of 387 samples, 72 samples (19.05%) resulted positive. The highest number was recorded in haemodialysis centres. In other groups, a low prevalence was recorded., Conclusions: The study can conclude that high prevalence of HCV infection still remains a major health problem, especially in haemodialysis centres. In the future, it is planned to expand the study in the future to include other risk categories or the entire population., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Albiona Rashiti-Bytyci, Naser Ramadani, Premtim Rashiti.)

Background: Anaesthesiology practitioners experience extraordinary pressure and stress in their daily work., Objective: The purpose of this research is to assess the occupational factors and burnout syndrome among anaesthesiologists and anaesthesiology technicians in Kosovo., Methods: This is a cross-sectional study carried out on a sample of 154 (out of 220) anaesthesiologists and anaesthesiology technicians in Kosovo. We collected the data using the Maslach Burnout Inventory and Occupational Role Stressors Scale., Results: The mean ± SD age of the study sample was 42.5 ± 8.7 years, and 57% of them were working more than 40 h per week. A high level of burnout in terms of depersonalization (DP) was found among 48 of anaesthesiologists and anaesthesiology technicians, 26 had high level of emotional exhaustion (EE). EE and DP showed significant positive correlation with work overload, managerial responsibility role, and overall occupational stress (p < 0.05). Female anaesthesiologists and anaesthesiology technicians showed higher score of personal achievement (PA) compared to males (p < 0.05)., Conclusion: Approximately one-third of Kosovar anaesthesiologists and anaesthesiology technicians showed high level of burnout and it is rising as work overload and the role of managerial responsibility increases. Increasing the number of employed anaesthesiologists and anaesthesiology technicians in health institutions in Kosovo will lead to a better workload distribution and lower burnout syndrome.

BACKGROUND In the Republic of Kosovo, full vaccination status in children under age 2 years includes: 1 dose of Bacillus Calmette-Guerin (BCG) hepatitis B virus (HBV) vaccine; 3 doses of diphtheria, tetanus, pertussis, hepatitis B, polio, and Haemophilus influenzae type b (DTaP-HB-IPV-Hib) vaccine; 3 doses of inactivated polio vaccine (IPV); and 1 dose of measles, mumps, and rubella (MMR) vaccine. Lot quality assurance sampling (LQAS) is a method used to assess the performance of health quality indicators. MATERIAL AND METHODS A national cross-sectional study with children aged between 12 and 24 months from Kosovo was performed between 2018 and 2020. The vaccination status of children was assessed with lot quality assurance sampling (LQAS) using randomized samples. RESULTS Among 430 children, more than 90% had completed the full immunization schedule. Delays in children's immunizations were observed. Most vaccinations showed short delays of less than 1 month, followed by delays of up to 3 months. The main reason for vaccination delay was the COVID-19 pandemic, following by child's illness at the scheduled time of vaccination or the parents were too busy to take the child to the vaccination site. Meanwhile, child age was the only parameter that showed difference among non-vaccinated and fully vaccinated (P<0.001). CONCLUSIONS LQAS analysis showed that between 2018 and 2020 lack of full immunization was due to delay caused by the parent not taking the child to the vaccination site, which may be prevented by improving information given to parents and the use of vaccination reminders.

The objective of this study is to evaluate the frequency of infections from central venous temporary catheters and the type of a microorganism caused, from January 2017 up to December 2019. This study was performed on patients who were on hemodialysis (HD) through the central temporary venous catheter, right and left femoral vein, right jugular vein, and right subclavian vein.The patients in the HD center in Pristina, Kosovo, were used as a clinical sample. In this study, 1902 patients with temporarily central venous catheters (CVCs) were involved, while the control group consisted of 642 patients. Both groups were matched for age and gender. In all patients and the subjects of the control group, following data were obtained: Anamnesis, medical examination, as well as biochemical and hematological laboratory tests, CVC swab and antibiogram and hemoculture. Data analysis was performed using the descriptive statistical methods and the Chi-square test comparing the laboratory results of a HD patients treated through the central temporary venous catheter. Based on the results of this research, higher incidence of infections occurred with femoral vein access, compared to other CVCs accesses. The most common microorganisms responsible were Staphylococus epidermidis, while the 2019 had the highest incidence of infection.

Prospective study, Level of evidence II. The aim of the study was to assess the prevalence of scoliosis among children aged 8-15 years old and to identify the impact of schoolbag weight in developing adolescent idiopathic scoliosis (AIS). AIS is a common disease whose prevalence varies between countries and gender, with an increased rate among females compared to males. Screening children in primary school settings for idiopathic scoliosis (IS) is an important public health issue and is crucial for early detection, prevention of further deformity, and healthy child growth. Our sample was composed of 1619 pupils from the municipality of Prishtina, surveyed from March to April 2019. Measurements were made with a scoliometer on the basis of the Adams test process. Three measurements were taken for each of the participants. Additionally, all the pupils were subjected to bare-foot height and weight measurements with and without school bags. The mean ± standard deviation age of pupils was 11.67 ± 2.00 years old and 49% were females. The prevalence of the angle of trunk rotation (ATR) ≥ 5 ° was 26.1%, females had 1.49 higher odds (95%CI 1.19-1.86) to develop an ATR of ≥ 5° compared to males. The highest rate of ATR of ≥ 5° was seen among the ninth-grade students (31.3%). 56.5% of 4th grade students carry a schoolbag weighing over 12.5% of body weight. Relatively high prevalence of idiopathic scoliosis was found in primary schools in Prishtina. The highest prevalence was found in students attending the ninth grade, while females gender dominated., (© 2021. The Author(s).)

Objectives: A number of instruments are used to identify potentially inappropriate medications (PIMs) in the elderly. In this study we identify PIMs in elderly patients and aim to compare three different instruments used to assess PIMs., Methods: In this prospective cohort study, we compared medications of elderly patients against three commonly used instruments: Beers' list, PRISCUS and STOPP/START, at the point of hospital admission and discharge in the nephrology clinic of Kosovo's largest hospital. Readmission risk was evaluated using the LACE Index and correlations with the number of PIMs and PIMs criteria were analysed., Results: Of 184 patients admitted to the nephrology clinic, 84 met study inclusion criteria. Patients had a median of three drugs at admission and four at discharge. Hospital readmission risk was high with median LACE Index being 11 (63% of patients). A higher number of PIMs was associated at the point of discharge compared with admission for all three tools (Beers' list: 29% vs 38 %, P=0.04; STOPP/STRART: 20% vs 23%, P<0.001; PRISCUS list: 12% vs 21%, P<0.001). The number of drugs at admission predicted the number of PIMs at discharge only when using Beers' criteria (P=0.006). At discharge, each increase in medication was associated with an increase in PIMs based on Beers' [0.134; (P=0.007)] and STOPP/START criteria [0.130; (P=0.005)]. Nitrofurantoin was the main PIM identified with Beers' and PRISCUS list in comparison to proton- pump-inhibitors being the most prevalent agents identified with STOPP/START criteria., Conclusions: There are differences when using Beers' criteria, STOPP/START criteria and PRISCUS list during identification of PIMs in elderly patients with high readmission risk. These differences should be considered when identifying PIMs in hospital settings., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Schmallenberg virus (SBV), a novel Orthobunyavirus, emerged in European domestic ruminants in 2011 causing abortions and malformations in newborns and none or mild clinical symptoms in adult animals. Here, a total of 364 bovine, ovine and caprine serum samples were collected in Kosovo and Albania between May 2014 and August 2016 and analyzed for the presence of anti‑SBV antibodies. Sera were tested using an enzyme‑linked immunosorbent assay (ELISA), and 48 ELISA‑positive samples were subsequently analyzed by serum neutralization test (SNT). The overall percentage of ELISA positive results was 17.9%; 23.1% (53/229) was the prevalence observed in Kosovo (cattle 45.5%, sheep 19.2% and goat 6.8%), while 8.9% (12/135) was that observed in Albania (cattle 11.1%, sheep 0% and goat 20.0%). SNT confirmed the presence of neutralizing antibodies against SBV in all samples tested. This is the first study reporting SBV circulation in domestic ruminants in Kosovo and Albania, with indication that this virus has been present in Kosovo and Albania at least since 2014 without being detected.

Objective: To evaluate nutritional status of children and adolescents living in three Serbian enclaves in Kosovo and Metohija., Methods: We conducted an observational cross-sectional, population-based study, enrolling children and adolescents who underwent a pediatric screening performed in the three Serbian enclaves of Gračanica, Gornje Kusce and Velika Hoča in Kosovo and Metohija. Children and adolescents (5-19 years) of all ethnic groups were evaluated in one of the three free outpatient medical facilities in rural villages in Kosovo. Body weight and height were measured, height-for-age z- scores (HAZ) and BMI-for-age z-scores (BAZ) indicators were analyzed. The anthropometric indicators HAZ and BAZ distributions were compared between sex and ages using Fisher's exact test. A two-sample Z-test for proportions was used to detect differences in individual categories of height- and BMI-for-age categories across sexes and age classes., Results: Three hundred twenty-eight children and adolescents (184 females, 56.1% and 144 males, 43.9%) aged between 5 and 19 years were enrolled in the study. 241/328 participants showed a normal linear growth; with significantly more girls (78.3%) than boys (67.4%) being in the normal category. Similarly, a significant difference in BAZ distribution between sexes was noted, with more females being in the normal BMI category compared to males (63.0% vs 50.0%, respectively). Underweight and severe underweight subjects showed a prevalence of 1.5 and 0.6%, respectively. Overweight and obesity prevalence was 19.5 and 9.1%, respectively, which was comparable to World Health Organization overweight and obesity prevalence data for Serbia., Conclusions: Prevalence of undernutrition and severe undernutrition in children and adolescents living in three Serbian enclaves in Kosovo and Metohija is small. By contrast, a tendency to an increase in overweight and obesity, especially in the male population, was noted.

Background: SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19., Objective: The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully., Methods: Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19-related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R., Results: COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight., Conclusions: The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia., (©Lori Ann Post, Elana T Benishay, Charles B Moss, Robert Leo Murphy, Chad J Achenbach, Michael G Ison, Danielle Resnick, Lauren Nadya Singh, Janine White, Azraa S Chaudhury, Michael J Boctor, Sarah B Welch, James Francis Oehmke. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 03.02.2021.)

This study was conducted to assess the presence of West Nile virus (WNV) in Kosovo by serological testing of apparently healthy local horses and free-range chicken, and it attempted to detect viral nucleic acid in birds and mosquitoes. Between January 2018 and June 2019, 260 equine serum samples were collected, additionally 580 adult mosquitoes (53 pools) were grouped in for genera, including Culex spp. (226 individuals; 26 pools), Aedes spp. (136 individuals; 16 pools), Anopheles spp. (184 individuals; 7 pools), and Culiseta spp. (34 individuals; 4 pools). Fifty domestic birds and 51 wild birds were collected from different regions of Kosovo. Equine and domestic bird serum samples were tested by flavivirus IgG enzyme-linked immunosorbent assay (ELISA), while mosquitoes and bird viscera were tested for WNV RNA by RT-qPCR. All ELISA-positive results were confirmed by plaque reduction neutralization test (PRNT) and eight by virus neutralization test. WNV antibodies were present in 27 out of 260 equine sera (10.38%) and one out of 50 samples in domestic birds by ELISA and PRNT. Eight of 27 positive equine serum samples with high titer neutralized WNV, but not Usutu virus. No WNV RNA was detected in birds or mosquitoes. The occurrence of WNV antibodies in local equines from all regions of Kosovo indicates that the virus is circulating within the country. Public health authorities should therefore plan a risk assessment and disease control program.

Introduction: Postpartum depression affects 10 up to 15 % of women of childbearing age in industrialized countries and presents significant public health problem which leads to short and long-term consequences for mother, child and her family. However, social determinants, including poverty, gender stereotypes, domestic violence, gender discrimination and cultural differences make this medical issue more problematic in less developed countries. The aim of this study was to examine the prevalence and risk factors of postpartum depression at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo (a tertiary referral center)., Material and Methods: A prospective observational cohort study was conducted from June 2019 to October 2019 at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo. A total of 247 delivery women were screened for postpartum depression at 6 weeks following delivery using the Edinburg Postnatal Depression Scale (EPDS). Socio-demographic, obstetric and psychologic factors were tested as predictors of PPD using bivariate or multivariate logistic regression analysis (Logit model). Odds ratio (OR) with 95 % confidence intervals were calculated for each risk factor. The p values < 0.05 were considered statistically significant., Results: The prevalence of PPD at the Clinic for Obstetrics and Gynecology in Kosovo teaching hospital was 21 % at 6 weeks following childbirth. The bivariate and multivariate logistic regression analysis identified four predictor variables for postpartum depression: pregnancy complications (OR 1.057; 95 % CI; 1.002-1.114 and P = 0.040); fear of childbirth (OR 1.121; 95 % CI; 1.057-1.190 and P = 0.00016); prenatal depression or anxiety (OR 1.088; 95 % CI; 1.032-1.147 and P = 0.0018); poor marital relation (OR 1.085, 95 % CI; 1.002-1.174 and P = 0.044). No statistically significant association was found between the postpartum depression (PPD) and maternal age, education, employment, family type, smoking, previous abortion, parity, household income, social support, child gender, birthweight, and breast feeding., Conclusions: The high prevalence of postpartum depression in our setting and its known adverse effects on woman, infant and her family implies an urgent need for evidence-based interventions. Such interventions are needed to promote knowledge of perinatal mental illness and improve maternal mental health in particular in less developed countries. Future efforts should address early identification of high-risk women, assessment of risk factor during the antenatal period, early postpartum depression screening and timely therapeutic approaches, to improve social and psychological functioning of the woman., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Although studies on HIV knowledge have previously been conducted in central Serbia and southern Kosovo, none has included the Serbian population residing in the northern part of the Kosovo province. The aim of this study was to assess HIV-related knowledge and to estimate factors contributing to a higher HIV-related knowledge level among Serbian university students in the Kosovo province. A cross-sectional study including 1017 first- and fourth-year students enrolled at the University of Pristina temporarily seated in Kosovska Mitrovica was carried out during the academic year 2013-2014. The students completed a 31-item questionnaire comprising demographic data, HIV transmission knowledge and attitude towards HIV testing. Data were statistically analysed. Students demonstrated good knowledge of HIV (average 32.8 ± 3.3 out of a maximum 42). Only 5% of the students reported having been tested for HIV. Factors associated with being more knowledgeable about HIV were studying health-related disciplines (β = -0.09; 95% confidence interval [CI] -0.13, 0.00), using the internet as a source of information about HIV (β = -1.09; 95% CI -1.65, -0.52), having a positive attitude towards HIV testing (β = -0.43; 95% CI -0.59, -0.26), having a low self-perceived risk for HIV infection (β = 0.41; 95% CI 0.23, 0.56) and the position that one would keep the same level of contact with an HIV-positive person after learning their HIV status (β = 0.38; 95% CI 0.21, 0.55). Setting up specialized classes on this topic at high schools and universities could help to increase the awareness of HIV infection and promote HIV testing and a positive attitude towards HIV-positive persons.

In the past decade, leishmaniasis seems to be re-emerging in Balkan countries. There are serious implications that Kosovo is a visceral leishmaniasis endemic region with autochthonous transmission; nevertheless, surveillance of vectors, reservoirs or the disease is not yet established. Gaining knowledge about sandfly vector species is a prerequisite for the development of a monitoring and control plan in the future. After a long gap in research of over 70 years, sandfly studies in Kosovo were resumed in 2014. During this presence/absence study, nine sandfly species were detected: Phlebotomus papatasi, Ph. perfiliewi, Ph. tobbi, Ph. neglectus, Ph. simici, Ph. balcanicus, Ph. alexandri, Ph. mascittii and Sergentomyia minuta. Three species are new with regard to the fauna of Kosovo - Ph. alexandri, Ph. balcanicus and Ph. mascittii. Besides increased diversity, changes in the number of collected specimens and distribution range of species were recorded, with Ph. neglectus being the most dominant species with the widest distribution. Testing of randomly chosen females for Leishmania spp. DNA resulted the in detection of L. tropica in a specimen of Ph. neglectus. The presence of numerous vector species in the sandfly fauna of Kosovo pose a threat for the re-emergence of vector-borne diseases. Therefore, continuous surveillance is recommended with regular updates on vector distribution and abundance., (© 2020 The Royal Entomological Society.)

Canine vector-borne pathogens are a group of widespread microorganisms and nematodes transmitted by arthropods that do not only impact dog health but may also pose a health risk to humans as many of them are zoonotic. As no data exist on the presence of canine vector-borne pathogens in Kosovo, we here present a first study on the seroprevalence of selected vector-borne pathogens, the dog heartworm Dirofilaria immitis and the bacteria Anaplasma spp., Ehrlichia spp. and Borrelia burgdorferi sensu lato. The study was carried out from July to October 2019 in all regions of Kosovo and included 149 clinically healthy dogs (84 owned, 40 sheltered and 25 free-ranging). Blood samples collected from each individual were tested using a commercially available rapid multiplex enzyme-linked immunosorbent assay. In total, 37.6% of the examined dogs were seropositive for one or more of the target pathogens. Most frequently, antibodies were found against Anaplasma spp. (24.8% of the dogs tested), followed by antigen detection of D. immitis (14.8%) and antibodies of B. burgdorferi s.l. (1.3%). The lowest antibody prevalence (0.7%) showed E. canis where only one dog was found positive. This preliminary study demonstrates the circulation of several zoonotic vector-borne pathogens in natural cycles involving dogs in Kosovo. It should trigger studies on infection prevalences in humans and initiate vector surveillance programmes in order to manage and control transmission and the diseases associated with the pathogens.

Background: Tuberculosis (TB) remains a significant worldwide social and life-threatening epidemiological problem. Because this disease requires multiple drug treatment and prolonged therapy for several months, followed by a high probability of adverse effects (AEs), we assessed AE monitoring for anti-TB drugs in the Health Care System of Kosova., Methods: This survey was a cross-sectional analysis performed at the primary, secondary and tertiary health care levels in Kosova. We included 930 registered tuberculosis patients within three levels of this health system in our study. Furthermore, we interviewed 62 physicians and 71 nurses at TB health facilities. Data were collected from official TB registers and personal contact with patients for 12 months., Results: The representative age group was 19 to 29 years (30.49%), followed by a group of patients aged >60 years (23.23%). Among 930 patients treated with TB drugs, the total incidence of adverse AEs was 29.03%. Female TB patients had a higher rate of AEs than did male patients (33.56% vs 28.84%, respectively). The highest incidence of registered AEs was recorded in the gastrointestinal system (270, 80.83%), followed by the central nervous system (CNS, 7.50%) and was lower in other organ systems. The reporting of anti-TB drug effects by medical staff (TB medical doctor and TB medical nurse) at different levels of TB medical settings occurred among 62.90% of medical doctors and 81.69% of nurses. Only 53.23% of medical doctors and 46.48% of nurses completed pharmacovigilance training., Conclusion: The pharmacovigilance approach in Health System of Kosova is not comprehensible and not systematic. The relatively low incidence of AEs among TB patients is due under reporting of these by medical staff. The knowledge, attitudes, and adherence of medical staff reveal low awareness for pharmacovigilance activities, and this concern should be addressed to reinforce this important issue for the safe treatment of TB patients., (© 2020 John Wiley & Sons Ltd.)

The European Union supported programmes for rabies control in Kosovo between 2010 and 2015, including spring and autumn biannual oral vaccination campaigns targeting foxes. Throughout the programmes foxes were obtained to provide samples for monitoring the campaigns. This paper explores the seasonal pattern of bait uptake and seropositivity in the fox population. Bait uptake varied by season and by the phase of the project supporting the programme (the main differences between phases being the number of baits distributed and flight line separation). Seropositivity varied by season and by titre of the vaccine used in the preceding campaign. The analyses also suggested a negative effect of higher daytime temperature on bait uptake, and possible association between geographic location of sampling and concordance between bait uptake and seropositivity, but the dataset was too unbalanced to support robust conclusions on these detailed aspects. Descriptive summaries of the data and the multilevel analyses showed that the proportion of sampled foxes that were positive for bait uptake and the proportion seropositive were both high through winter, following the autumn campaigns, and declined through spring and summer, with a low point in samples collected during the time when juvenile foxes are typically dispersing from their birth dens. The percentage of foxes positive for bait uptake was below 30 % (first project phase) and 40 % (second project phase) from mid-July to mid-October following a spring campaign, compared with around 70 % (first project phase) and 80 % (second project phase) in the periods between autumn and the following spring campaigns. As could be expected, the percent of samples that were seropositive followed a similar seasonal pattern, with some additional variation associated with the titre of vaccine used. This seasonal pattern is likely because the population sampled in the late summer months includes increasing numbers of young foxes that could not have been effectively exposed to the spring vaccination campaign, and would have lost any possible maternal immunity by late summer. The main finding of high levels of bait uptake and seroprevalence through winter, following the autumn campaigns, declining through summer despite the implementation of spring campaigns, supports advice that countries lacking financial resources to support biannual campaigns should focus resources on once per year vaccination in late autumn or early winter. This pattern also indicates that a fox population may rapidly become naïve after cessation of vaccination programmes, therefore strongly coordinated regional programmes and good surveillance will be needed., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: During the Kosovo War (1998-99) approximately 31,000 rounds with Depleted Uranium (DU) were fired on 85 targets in Kosovo. The number of haematological malignancies (HM) increased after the war and the concern was the use of DU during the war. The aim of this study was to analyse the incidence rates of HM in Kosovo throughout a 20-year that includes pre- and post- war period (1995-2015); and to examine if there is any association between the use of DU rounds and incidence rates of HM in different regions of Kosovo., Methods: In this retrospective register-based study, 1,798 new patients diagnosed with leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and Multiple myeloma were analysed over a 20 year period. Incidence rates were calculated focusing on specific time periods, regions and age-groups. In addition, the correlation between the use of DU in different regions and their incidence of HM was analysed., Results: The average annual crude rate of all HM in Kosovo was 5.02 cases per 100,000 persons. Incidence rates of HM in first post-war period (2000-2003) increased by 0.37 cases/100,000 persons (9.51%) compared to the pre-war period (1995-1998) whereas in the last post-war period (2012-2015), incidence of HM increased by 3.19/100,000 persons (82%). Gjakova and Peja, the first and third most exposed regions to DU ordnance ranked first and second in difference in HM. Prishtina, Gjilan and Ferizaj, regions with the least number of rounds/km2, were characterized by a decline of incidence rates., Conclusions: After the war, the increase in incidence rate of HM was higher in two regions with most DU rounds/km2 expended Despite these findings, this study warrants further investigation and does not lead us to a conclusive finding on the existence of a causal relationship between the use of DU during the war and the rise in incidence of HM in Kosovo., Competing Interests: The authors have declared that no competing interests exist.

Canine Leishmaniasis caused by Leishmania infantum is endemic in Mediterranean countries. The disease represents an important public health issue in Kosovo in which the autochthonous cases by humans were reported in the last years. The objective of this study was to survey the serological and clinical data of Canine Leishmaniasis in dogs in southwestern region of Kosovo. The blood samples were collected from stray dogs in four municipalities, respectively Prizren, Gjakova, Rahovec and Deçan. The total 125 samples were collected between April/September 2016. Antibodies of Leishmania infantum were detected by competitive enzyme-linked immunosorbent assay (ELISA IgG). Out of total 125 serum samples, 23 dogs (18.4%) were positive for Leishmania infantum. In three of 23 infected dogs (13%) were shown the clinical signs of Canine Leishmaniasis as skin and ocular lesions, decreased appetite, lameness, diarrhea, lethargy and progressive weight loss. The highest infection rate was detected in Prizren municipality (21.6%), followed by Gjakova (17.6%), Rahovec (17.1%) and Deçan (7.8%). The present study confirmed that the Leishmaniasis is endemic in southwestern part of Kosovo and emphasized the need to establish the surveillance and control of this disease.

This study compared pedestrian behaviors in five countries (Estonia, Greece, Kosovo, Russia, and Turkey) and investigated the relationships between these behaviors and values in each country. The study participants were 131 pedestrians for Estonia, 249 for Greece, 112 for Kosovo, 176 for Russia, and 145 for Turkey. The principal component analyses revealed that the four-factor structure of the Pedestrian Behavior Scale (PBS) was highly consistent across the five countries. ANCOVA results revealed significant differences between countries on the PBS items and scale scores. Specifically, Greek and Turkish participants reported transgressive pedestrian behaviors more frequently than Estonian, Kosovar, and Russian pedestrians while Kosovar participants reported transgressive pedestrian behaviors less frequently than Estonian pedestrians. In addition, Turkish and Russian pedestrians reported lapses and aggressive behaviors more frequently than Estonian, Greek, and Kosovar pedestrians. Finally, Turkish and Estonian pedestrians reported positive behaviors more frequently than Kosovar pedestrians. Unexpectedly, the regression analyses showed that values have varying effects on pedestrian behavior in the five countries. That is, context or country may determine the effect of values on pedestrian behaviors. The results are discussed in relation to the previous literature., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Intimate partner violence (IPV) among university students is a prevalent problem in many countries; however, it is not currently recognized in Kosovo as a social issue in terms of research, prevention, and intervention. The aim of this article was to examine the relationship between violence socialization experiences, approval of violence, and IPV perpetration/victimization among university students in Kosovo. The questionnaires were administrated to a convenience sample of 700 students of University of Prishtina who were in relationship for 1 month or longer. The Revised Conflict Tactics Scale (CTS-2) was used for measuring physical, psychological, and sexual violence, whereas for measuring violence socialization and violence approval, scales from Personal and Relationships Profile (PRP) were used. Findings from this study show that there were statistically significant gender differences in terms of socialization and approval of violence among university students. Similarly, perpetrators and victims of IPV (physical, psychological, and sexual violence) showed higher rates of socialization of violence and tolerance toward IPV. Besides, findings indicate that approval of violence mediates the relationship between socialization of violence and IPV perpetration and victimization, for both genders. The implications of the current findings within a cultural context are also discussed.

Introduction: Asthma is a chronic inflammatory airway disease characterized by episodes of airway narrowing leading to manifestations of symptoms such as wheeze, shortness of breath, chest tightness and cough, that may resolve spontaneously or following treatment., Aim: The aim of this paper was to present the collected data related to the prevalence of self-reported respiratory symptoms, asthma, and use of asthma medication among school children aged 13-14 years from the city of Gjilan, a municipality located in southeast Kosovo., Methods: This was a cross-sectional study realized during the year 2018 as a part of the Project of Global Asthma Network (GAN) Phase I. The study elaborated randomly selected sample of 1200 school children from the city of Gjilan, in the southeast of Kosovo. The mean age was 13.4±0.51 with median IQR=13 (13-14). About 618 (51.5%) were male and 582 (48.5%) were female with the relation between the genders of 1:1.1. The percentage difference between the genders was not statistically significant (Difference test: Difference 3% [(-0.99-6.99) CI 95%]; Chi-square=2.159; df=1 p=0.1417). The prevalence of wheezing/ whistling in the chest EVER and the last 12 months was 12.7% vs. 6.4% respectively with no significant association between gender and symptoms (p>0.05) (Table 1). About 1132 (94.3%) had no attacks of wheezing in the last 12 MONTHS, 59 (4.9%) had 1-3 attacks, 7 (0.6%) had 4-12 attacks and 2 (0.2%) had>12 attacks. The analysis did not indicate a significant association between gender and the frequency of wheezing attacks (none / 1-3 / ≥ 4) for Pearson Chi-square: 2.5501; df=2; p=0.2801., Conclusion: This study has found moderately low asthma prevalence among adolescents in the southeast region of Kosovo, with no significant association between genders. Although, should be considered as an urgent need the proper examination, because asthma seems to be under-diagnosed and also untreated. It's possible that doctors in our country hesitate to diagnose asthma or the parents themselves and the children deny it., Competing Interests: None declared., (© 2020 Valbona Gashi, Luljeta Ahmetaj.)

Background: Celiac disease is an immune-mediated disorder characterized by variable clinical manifestations, specific antibodies, HLA-DQ2/DQ8 haplotypes, and enteropathy., Objectives: The aim of this study was to present the clinical spectrum and patterns of celiac disease in Kosovar Albanian children., Methods: A cross-sectional retrospective study was performed with Albanian children aged 0-18 years, treated for celiac disease in the Pediatric Clinic, University Clinical Center of Kosovo from 2005 to 2016., Results: During the study period, 63 children were treated for celiac disease. The mean age at diagnosis was 5.5 years (SD ± 3.31). The mean age at celiac disease onset was 3.3 years (SD ± 2.02), while the mean delay from the first symptoms indicative of celiac disease to diagnosis was 2.2 years (SD ± 2.09). More than 70% of the patients were diagnosed in the first 7 years of life, mainly presented with gastrointestinal symptoms, while primary school children and adolescents mostly showed atypical symptoms (p<0.001). The classical form of celiac disease occurred in 78% of the cases. Sixty (95%) patients carried HLA-DQ2.5, DQ2.2 and/or HLA-DQ8 heterodimers, and only three of them tested negative., Conclusion: Kosovo, as the majority of developing countries, is still facing the classical form of celiac disease as the dominant mode of presentation; as a result, most children with other forms of the celiac disease remain undiagnosed. Physicians should be aware of the wide range of clinical presentations and utilize low testing thresholds in order to prevent potential long-term problems associated with untreated celiac disease., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and Objectives: Identification of the manifestations, assessment and follow up of children with hypertrophic cardiomyopathy (HCM) by transthoracic echocardiography may be important for clinical management and our understanding of pathogenesis., Methods: We present a comprehensive analysis of 43 children seen in Kosovo, 23 were male, aged between 4 months and 9 years at first presentation (median of 2 years and 3 months)., Results: Cardiac failure, seen in almost half of them, was the most common presenting feature. At admission, the chest x-ray revealed an increased cardiothoracic ratio, to a mean of 72% in 6 infants and to 65% in 37 older children. Measured by transthoracic echocardiography, 28 children had asymmetric hypertrophy of left ventricle while 15 had concentric hypertrophy. Left ventricular ejection fraction was depressed in 21 children. Patients with cardiac failure received various combinations of diuretics, B-blockers, ACE inhibitors and anticoagulant therapy (aspirin). Death occurred in 8 children, in 4 of them shortly after admission, the other 4 left Kosovo and continued examination and treatment abroad Kosovo; their death has been confirmed by family members. The remaining 32 were followed- up for a mean 42 months, with a range from 5 to 115 months. Surgical intervention was not performed to any of them, despite the clinical and echocardiography indications due to a limitation of resources. Recovery was noted in 14 children but still requiring anti-heart failure medications. Slightly over two-fifths died. Of those with asymmetric form, 45% died, half of those presenting in infancy, and 89% of those who presented at admission with signs of cardiac failure., Conclusion: The results of our study show that similar to many centers, the etiology of HCM is often uncertain. In the absence of etiology, treatment aimed at the cause is either impossible or, at best, empirical.

Introduction: It has recently been demonstrated that there is a very high prevalence of hepatitis C virus (HCV) infection among hemodialysis patients in Kosovo with HCV subtype 1 being the most prevalent subtype. In this study, we further detail the molecular epidemiology of HCV outbreaks occurring in seven dialysis centers in Kosovo., Methodology: In total, 273 samples obtained from HCV RNA positive patients undergoing hemodialysis at one of the seven centers in Kosovo were selected for this study: 171 subtype 1a samples, 91 subtype 4d samples, and 11 subtype 1b samples. A partial HCV NS5B region was amplified and sequenced. Subtype-specific phylogenetic analyses were performed with the inclusion of control sequences and transmission clusters were identified., Results: NS5B sequences were successfully obtained in 257/273 (94.1%) of samples; 162 subtype 1a, 84 subtype 4d, and 11 subtype 1b sequences. Phylogenetic analyses showed a high degree of phylogenetic clustering of HCV sequences subtyped 1a (99.4%), 1b (63.6%), and 4d (76.2%). Distinct phylogenetic clusters of sequences obtained from hemodialysis patients were observed for all three subtypes studied. In addition, several smaller clusters within the large clusters were identified, mainly from a single dialysis center., Conclusions: Phylogenetic analyses confirmed nosocomial transmission during dialysis as a major factor in the spread of HCV at the seven dialysis centers in Kosovo., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2019 Xhevat Jakupi, Jana Mlakar, Maja Lunar, Ibrahim Rudhani, Lul Raka, Norma Tavakoli, Mario Poljak".)

Purpose: The purpose of this paper is to explore the association between the quality of prison life and mental health among prisoners and the occurrence of violence., Design/methodology/approach: In total, 203 prisoners from Dubrava Correctional Center in Kosovo participated. Data on background characteristics of the prisoners, quality of prison life, mental health symptoms and exposure to physical, psychological and sexual violence were collected through interviewer-administered questionnaires. Data were analyzed using general linear models (GLM) and manual backwards model search with step-wise exclusion., Findings: The GLM analysis showed a significant negative association between anxiety symptom load (-1.4), physical violence (-1.5) and psychological violence (-1.9), and quality of prison life. Furthermore, it appeared that prisoners rating of quality of life (QoL) increased with time among prisoners not exposed to violence, while this was not seen among prisoners exposed to violence. Finally, there was an inverse association between the dimensions of respect, fairness, humanity and good staff/prisoner relations, and the proportion of prisoners exposed to violence., Originality/value: An environment with higher levels of respect, fairness, humanity and good relations between staff and prisoners was associated with lower levels of violence. Hence, a prison that focuses on promoting QoL and good mental health among prisoners will show lower levels of violence, thereby making the prison a more tolerable place for the prisoners and a better working environment for prison staff.

Background: Surgical site infections (SSI) are a common complication after a cesarean section (C-section) and mainly responsible for increased maternal mortality and morbidity, dissatisfaction of patients, longer hospital stays as well as higher treatment costs. The aim of this study is to determine the incidence rate and risk factors of surgical site infections in women undergoing caesarean section at the University Clinical Center of Kosovo (UCCK), in the Clinic for Obstetrics and Gynecology., Methods: We conducted a prospective observational cohort study involving 325 women who underwent labor and scheduled C-sections from January, 2018 to September, 2018 at the University Clinical Center of Kosovo, Clinic for Obstetrics and Gynecology. Each woman was followed for 30-postoperative days. Data analysis included descriptive statistics, univariate and multivariate logistic regression analysis. Culture-based microbiological methods were used to identify causal agents in postoperative wounds., Results: Overall the SSI rate was 9.85% and the median time to SSI was the 7th postoperative day. The mean age of the patients was 31.3 ± 5.5 years (range from 17 to 46 years). The average length of stay was 4.2 ± 3.4 days. Several factors reduced the risk of SSI. These included: age less than 35 years (RR 0.25; 95% CI; 0.199-0.906 and P = 0.027) preoperative use of antibiotics (RR 0.232; 95% CI; 0.107-0.502 and P = 0.000) and duration of the operation less than 1 h (RR 0.135; 95% CI; 0.054-0.338 and P = 0.000). Previous cesarean section and one or more co-morbidity were associated with 7.4 fold and 8 fold increased risk of SSI, respectively. We found a statistically significant association between SSI and co-morbidity, preoperative antibiotic use, duration of operation, age and history of previous cesarean section (P = 0.000; 0.000; 0.0001; 0.023; 0.000; respectively using chi-square test). Multivariable logistic regression analysis confirmed that one or more co-morbidity, previous C-section, preoperative antibiotics and duration of the surgery < 1 h are predictors of SSI., Conclusion: The high incidence rate of SSIs after C-sections in this study highlight the need for prioritizing SSI control and surveillance. Patient demographics, procedures utilized and surgical factors must be incorporated in programs to reduce the infection rate. Additionally, an effort must be given to decrease number of the C-sections performed for the first time through assuring optimal care for the mother and child. The National Committee for Prevention and Control of Nosocomial infection in Kosovo should provide updated guidelines for control and prevention of the nosocomial infections.

Teachers' stress is a dynamic combination of the individual teacher's characteristics and characteristics of the classroom and school environment. To date, there are limited studies on teachers' stress in the context of lower-middle-income countries (LMICs), where working conditions as well as general political and economic circumstances might pose a considerable threat for teachers' well-being. This study explores whether certain combinations of individual and environmental experiences of teachers in LMICs may result in stress, assessed as patterns of diurnal cortisol rhythm. Participants were kindergarten teachers in Kosovo and Ukraine, two LMICs in Europe. Latent Profile Analysis identified three subgroups of teachers that significantly differed on teachers' education and experience. Preliminary results of Latent Growth Modeling suggested differences between profiles in baseline waking cortisol and patterns of diurnal decline. Teachers in the profile that was characterized by the longest experience working in the field but the lowest level of education showed blunted cortisol in the morning and a flatter slope; a pattern that could indicate a maladaptive cortisol response. Future directions for studying stress processes among teachers in LMICs and implications for policy and practice on how to support teacher well-being in low-resource contexts are discussed., (© 2019 Society for Community Research and Action.)

Objective: To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo., Design: Cross-sectional survey., Setting: Five largest public hospitals in Kosovo., Participants: 859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo., Outcome Measures: The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital., Results: Women with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90)., Conclusions: We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

EpiNATO-2 is the only interoperable health surveillance system that is defined in North Atlantic Treaty Organization (NATO) doctrine. It was first implemented in the Kosovo Force and European Union Training Mission Mali in 2013. EpiNATO-2 is mandated for use during all NATO operations. Its coverage has steadily increased and now includes all NATO Joint and Component Command Operations and several non-NATO operations. The system monitors morbidity predominately for Role 1 sites by using weekly reports from the medics and other medical providers. The reports for all sites in theater are sent to the Combined Joint Medical (CJMED), which consolidates and submits them to NATO Deployment Health Surveillance Capability (DHSC), the satellite branch of NATO Centre of Excellence for Military Medicine (MILMED COE), for analysis and feedback. Although EpiNATO-2 will likely have a number of overlaps with most nations' disease and nonbattle injury trackers, a distinguishing characteristic is that it has specific categories for classifying more clinical activity. Sustaining the quality of data collection is paramount and achieved through contemporaneous analysis and feedback that are disseminated via CJMED to all providers. This enhances situational awareness about evolving trends in health issues across the deployed force and is intended to provide information for action and medical decision-making and force health protection assurance at the local and theater levels. The awareness imparted by this article can add to the Special Operations Forces (SOF) medics' tool kit to ensure success for the SOF medic and SOF community while deployed or collaborating with NATO and NATO partner nation militaries at any level in theater., (2019.)