Sex-differences in socioeconomic status and health-seeking behaviour among tuberculosis patients in transitional Albania in 2012-2013

Aim: There is little scientific evidence about the main determinants of sex discrepancies in tuberculosis rates in Albania. The aim of this study was to assess the sex-differences in socioeconomic characteristics, knowledge and attitudes about tuberculosis and access to health care among tuberculosis patients in Albania, a transitional country in the Western Balkans. Methods: Our analysis involved all the new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; 69% males; overall mean age: 44±19 years). The recording and reporting system of tuberculosis cases was performed according to the WHO and EuroTB Surveillance guidelines. Information on socioeconomic characteristics of the patients, knowledge and attitudes about tuberculosis and access to health care was also collected. Logistic regression was used to assess the correlates of sex-differences among tuberculosis patients. Results: In multivariable-adjusted models, female sex was positively related to unemployment (OR=3.7, 95%CI=1.8-7.7), bad living conditions (OR=3.0, 95%CI=1.4-6.5), a longer distance to health care facility (OR=3.0, 95%CI=1.4-6.3), a lower level of knowledge about tuberculosis (OR=3.1, 95%CI=1.3-7.1) and a higher level of stigma against tuberculosis (OR=3.6, 95%CI=1.6-7.9). Conclusion: Our study informs about selected correlates of sex-differences in tuberculosis rates in post-communist Albania. Future studies should more vigorously explore determinants of sex-differences in tuberculosis rates in countries of the Western Balkans

Lung Surfactant Proteins A (SP-A) and D (SP-D) in Chronic Obstructive Pulmonary Disease (COPD)

Introduction:The biomarkers used in COPD are many, but studies of last decades are focused on the pulmonary surfactant, which plays a crucial role in normal lung function. Aim: Evaluation of the levels of SP-A, SP-D and other markers in patients with SPOK and their relation to inflammation and smoking. Material :We studied 118 patients with COPD . 10 cases were in stage B, 24 cases in stage C and 84 cases in stage D; 113 males and 5 females , mean age 69 ± 8 years and 70 ± 8 years respectively; Methodology: The SP-A and SP-D levels were measured on admission during acute exacerbation and in the day of discharge from hospital in remission of disease. We included a healthy control group. Results: In the healthy control group mean SP-A = 22.2 +/- 16.3 ng / ml and mean SP-D=90 +/- 36.8 ng / ml . In our study group ,on admission we found mean SP-A levels 46.8 + -35.2ng / ml and SP-D 175 +/- 99 ng / ml. In COPD Stage B mean SP-A was 33.78 +/- 19.7 ng / ml, Stage C 40.7 +/- 19.5ng / ml and stage D 50.2 +/- 39 ng / ml (p = 0.0001). Mean SP-D at Stage B was 168.3 +/- 121ng / ml, Stage C 160 +/- 78 ng / ml, and Stage D 181 +/- 102ng / ml (p = 0.0001).On the last day(remission) mean SP-A 38+ /23.5ng/ml and mean SP-D 147 +/- 91 ng / ml. In COPD Stage B mean SP-A was 42.7 +/- 26.2 ng / ml, Stage C 33 +/- 15.6ng / ml and stage D 38.5 +/- 25 ng / ml (p = 0.003). Mean SP-D at Stage B was 196 +/- 157ng / ml, Stage C 130 +/- 53 ng / ml, and Stage D 137 +/- 81ng / ml (p = 0.002). In exacerbation period smoking status has significant correlations with all biomarkers presented with the Spearman coefficient: SP-A( Rs = 0.249, p = 0.002); SP-D( Rs = 0.264 p = 0.001), IL6( Rs = 0.255, p = 0.002) and CRP ( Rs = 0.231, p = 0.004). In remission state smoking has significant positive correlation with SP-D (Rs = 0.282, p = 0.002) and SP-A (Rs = 0.273, p = 0.003) .In both evaluations the mean values of SP-A and SP-D were significantly higher in smokers compared to nonsmokers (p<0.05). Levels of IL6 measured in first day were significantly higher in smokers  p=0.025, mean CRP levels had no significant diffierencies between  two groups. Conclusion: SP-A and SP-D levels were higher in COPD patients compared to healthy control group. Their level were significantly higher AECOPD than in stable state of COPD and they correlated with the gravity of the disease. In remission state SP-A and SP-D levels ​​ reflects better the gravity of COPD. SP-A and SP-D levels are better related with smoking state and their levels are more increased in smokers . Keywords: COPD, acute exacerbation of COPD (AECOPD), SP-A and SP-

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio <70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio <70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals.   Conflicts of interest: None declared

DISTRIBUȚIA CAZURILOR DE TUBERCULOZĂ ÎN ALBANIA, PERIOADA 2012-2013

CONTEXT: BACKGROUND: The information about current trends of tuberculosis in Albanian speaking countries is limited. Our aim was to describe the distribution of tuberculosis in Albania, a former communist country in Southeastern Europe. METHODS: This study included all new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; overall mean age: 43.8±19 years). The recording and reporting system was performed according to the WHO and EuroTB Surveillance guidelines. Socio-demographic characteristics included age, gender, residence, marital status, employment status, educational attainment and income level. In addition, data on selected risk factors were collected including smoking status, excessive alcohol consumption, presence of a separate kitchen in the house and distance to health care facility.    RESULTS: There were 136 (69%) male and 61 (31%) female cases. About 20% of the cases were 15-24 years old, whereas19% were ≥65 years old. About 45% of the patients were residing in urban areas. The unemployment rate was particularly high (43%) and only 29% had completed at least nine years of formal schooling. The overall prevalence of smoking was 21%. Only 27% of the patients reported a separate kitchen at their respective homes, whereas 23% had a distance >20 km from their health care facilities. CONCLUSION: Our study offers useful evidence which could inform health professionals, policymakers and decision-makers about the occurrence and distribution of tuberculosis cases in post-communist Albania, a country in the Western Balkans which is still struggling in its transition towards a market-oriented system.         Keywords: Albania, case detection rate, incidence, pulmonary tuberculosis.  CONTEXT: Informațiile cu privire la trendul actual al tuberculozei în rândul albanezilor sunt limitate. Scopul nostru a fost de a descrie distribuția tuberculozei în Albania, o țară fost comunistă din SE Europei. METODE: Acest studiu a inclus toate cazurile de tuberculoză pulmonară diagnosticate în Albania în perioada iunie 2012- iunie 2013 (N=197; media de vârstă: 43,8±19 ani). Sistemul de înregistrare și raportare a fost setat să performeze conform ghidurilor OMS și  a Rețelei Europene de Supraveghere a Tuberculozei. Caracteristicile socio-demografice au inclus vârsta, sexul, mediul de rezidență, statusul marital, angajarea, nivelul de educație, venit. Suplimentar, au fost colectate date despre factorii de risc incluzând fumatul, consumul în exces de alcool, prezența unei bucătării separate și distanța până la unitatea medicală. REZULTATE: Lotul de cazuri a cuprins 136 (69%) bărbați și 61 (31%) femei. Aproximativ 20% dintre cazuri au avut vârsta între 15-24 ani, iar 19% au avut 65 de ani și peste. Aproximativ 45% dintre pacienți locuiesc în mediul urban. Rata de șomaj a fost, în mod particular, înaltă (43%) și doar 29% au terminat 9 ani de școlarizare. Prevalența globală a fumatului a fost de 21%. Doar 27% dintre pacienți au raportat bucătărie separată în locul unde locuiau, iar 23% au raportat o distanță mai mare de 20km față de unitatea medicală. CONCLUZII: Studiul nostru oferă evidențe despre apariția și distribuția tuberculozei, utile pentru informarea profesioniștilor în sănătate, decidenți și politicieni implicați în procesul de luare a deciziilor în Albania, o țară post comunistă din V-Balcanilor, ce se străduiește să traverseze perioada de tranziție către un sistem orientat pe economia de piață.   Cuvinte cheie: Albania, rata de detectare a bolii, incidența, tbc pulmonary. &nbsp