Chocolate intake is associated with a lower body mass index in adult men and women in transitional Albania

Aim: In light of the controversial evidence regarding health effects of chocolate intake, we aimed to assess its association with body mass index (BMI) among adult individuals in Albania, a transitional post-communist country in South Eastern Europe which has traditionally employed a Mediterranean dietary pattern.     Methods: A cross-sectional study was conducted in 2003-2006 involving a population-based sample of 737 Tirana residents aged 35-74 years (469 men, 268 women; overall response: 70%). Of these, 565 individuals (373 men and 192 women) provided data on chocolate intake and anthropometrics (77% of the sample). A 105-item food frequency questionnaire, including chocolate consumption, was administered to all individuals. Nine categories were used to assess the average frequency of intake of each food item in the past 12 months. In the analysis, chocolate intake was dichotomized into: consumption of <1/month vs. ≥1/month. A physical examination included measurement of weight and height. Furthermore, information on socio-demographic characteristics and classical risk factors was collected. Multivariable-adjusted general linear model was used to calculate the mean BMI values by chocolate intake groupings.   Results: Upon simultaneous adjustment for socio-demographic characteristics, classical risk factors and nutritional factors, there was an inverse association between BMI and chocolate intake in both sexes (sex-pooled mean BMI: 26.1 among participants who consumed chocolate <1/month vs. 27.0 in those with an intake of ≥1/month; P<0.001).   Conclusions: This study points to a beneficial effect of moderate chocolate intake on lowering BMI, which deserves further vigorous investigation and replication in prospective studies in Albania and other populations

Overview on health status of the Albanian population

The Albanian population is rapidly aging (in 2020, almost 15% of the population was ≥65 years) as a result of a steady increase in life expectancy (74.4 years in men and 78.7 years in women in in 2021), a gradual decrease in fertility rate (1.6 children per woman of childbearing age in 2020), and emigration of particularly young adults. This demographic transition experienced in the past three decades has inevitably led to a significant change in the epidemiological profile of the Albanian population, characterized by a remarkable shift towards non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD), cancer, chronic respiratory diseases, and diabetes. The main risk factors in the Albanian population consist of high blood pressure (top risk factor, accounting for about 34% of the overall mortality), nutritional-related risks (second, constituting about 25% of the overall mortality), and smoking (third risk factor, accounting for about 20% of the overall mortality). The national “Health Strategy, Albania 2021-2030” is a political document of the Albanian government that aims to define and achieve the objectives of the program for the protection and improvement of the health of the Albanian population. Following the national “Health Strategy, Albania 2021-2030”, two new action plans were recently developed: the “Action Plan on NCDs, Albania 2021-2030” and the “Action Plan on Health Promotion, Albania 2022-2030”

Chocolate intake is associated with a lower body mass index in adult men and women in transitional Albania

Aim: In light of the controversial evidence regarding health effects of chocolate intake, we aimed to assess its association with body mass index (BMI) among adult individuals in Albania, a transitional post-communist country in South Eastern Europe which has traditionally employed a Mediterranean dietary pattern.     Methods: A cross-sectional study was conducted in 2003-2006 involving a population-based sample of 737 Tirana residents aged 35-74 years (469 men, 268 women; overall response: 70%). Of these, 565 individuals (373 men and 192 women) provided data on chocolate intake and anthropometrics (77% of the sample). A 105-item food frequency questionnaire, including chocolate consumption, was administered to all individuals. Nine categories were used to assess the average frequency of intake of each food item in the past 12 months. In the analysis, chocolate intake was dichotomized into: consumption of <1/month vs. ≥1/month. A physical examination included measurement of weight and height. Furthermore, information on socio-demographic characteristics and classical risk factors was collected. Multivariable-adjusted general linear model was used to calculate the mean BMI values by chocolate intake groupings.   Results: Upon simultaneous adjustment for socio-demographic characteristics, classical risk factors and nutritional factors, there was an inverse association between BMI and chocolate intake in both sexes (sex-pooled mean BMI: 26.1 among participants who consumed chocolate <1/month vs. 27.0 in those with an intake of ≥1/month; P<0.001).   Conclusions: This study points to a beneficial effect of moderate chocolate intake on lowering BMI, which deserves further vigorous investigation and replication in prospective studies in Albania and other populations

Overview on health status of the Albanian population

The Albanian population is rapidly aging (in 2020, almost 15% of the population was ≥65 years) as a result of a steady increase in life expectancy (74.4 years in men and 78.7 years in women in in 2021), a gradual decrease in fertility rate (1.6 children per woman of childbearing age in 2020), and emigration of particularly young adults. This demographic transition experienced in the past three decades has inevitably led to a significant change in the epidemiological profile of the Albanian population, characterized by a remarkable shift towards non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD), cancer, chronic respiratory diseases, and diabetes. The main risk factors in the Albanian population consist of high blood pressure (top risk factor, accounting for about 34% of the overall mortality), nutritional-related risks (second, constituting about 25% of the overall mortality), and smoking (third risk factor, accounting for about 20% of the overall mortality). The national “Health Strategy, Albania 2021-2030” is a political document of the Albanian government that aims to define and achieve the objectives of the program for the protection and improvement of the health of the Albanian population. Following the national “Health Strategy, Albania 2021-2030”, two new action plans were recently developed: the “Action Plan on NCDs, Albania 2021-2030” and the “Action Plan on Health Promotion, Albania 2022-2030”

Necessary level of skills and abilities of family physicians from decision-makers’ perspective in transitional Kosovo

Objective: The aim of this study was to assess the necessary level of abilities and competencies of family physicians from the decision-makers’ perspective in Kosovo, a post-war country in the Western Balkans.Methods: Our study was conducted in May-July 2013 and included a nationwide representative sample of 100 decision-makers operating at different primary health care institutions or public health agencies in Kosovo (63 men aged 48.6±5.5 years, and 65 women aged 46.2±5.7 years). A structured self-administered questionnaire was employed aiming to assess the necessary level of skills, abilities and competencies of family physicians in Kosovo regarding  different domains of the quality of health care. The questionnaire included 37 items organized into six subscales/domains. Answers for each item of the tool ranged from 1 (“novice” physicians) to 5 (“expert” physicians). An overall summary score (range: 37-185) and a subscale summary score for each domain were calculated for each participant. Cronbach’s alpha was used to assess the internal consistency of the instrument, whereas Mann-Whitney’s U-test was employed to assess sex-differences in the mean values of the summary score of 37-item instrument and the summary scores of each of the six subscales.Results: The internal consistency of the whole scale (37 items) was Cronbach’s alpha=0.92. The summary score of the 37-item instrument was higher in men than in women (162.3±17.9 vs. 156.1±17.5, respectively, P=0.071). The subscale scores were all higher in men than in women, a finding which was borderline statistically significant for the “patient care and safety” domain only (33.4±4.4 vs. 32.0±4.0, respectively, P=0.057). There was a weak correlation between the overall summary score of the tool and the work experience of decision-makers (Spearman’s rho=0.234, P<0.001).Conclusion: In the context of Kosovo, this study provides important evidence on the expected skills and competencies of family physicians from the decision-makers’ viewpoint. Future studies in Kosovo should compare our findings related to the necessary skills and competencies vis-à-vis the actual self-perceived skills and competencies of family physicians

Predictive Value of the Model of End-Stage Liver Disease in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis

Objective. We aimed to assess the predictive value of the model of end-stage liver disease (MELD) in hospitalized cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and fatal outcome. Methods. A cross-sectional study included 256 consecutive patients (199 men and 57 women) diagnosed with cirrhosis and ascites who were hospitalized at the University Hospital Center in Tirana from January 2008 to December 2009. SBP was defined as a neutrophil count of ≥250 cells/mm3 in ascitic fluid. MELD score was based on laboratory parameters determined by UNOS Internet site MELD calculator. Results. In multivariable-adjusted logistic regression models controlling for age, sex, diabetes, and etiology, there was evidence of a positive association of SBP with MELD score: the odds ratio (OR) for SBP for one unit increment of MELD score was 1.06 (95% Cl = 1.02–1.09). MELD score was significantly higher in fatal cases than nonfatal patients (mean age-adjusted score was 32.7 versus 18.4 overall; 34.8 versus 18.0 in SBP patients, and 32.0 versus 18.5 in non-SBP patients; all P < 0.001). Conclusions. In this Albanian sample of hospitalized cirrhotic patients, MELD score was confirmed as a significant predictor of both SBP and fatal outcome

Necessary level of skills and abilities of family physicians from decision-makers’ perspective in transitional Kosovo

Objective: The aim of this study was to assess the necessary level of abilities and competencies of family physicians from the decision-makers’ perspective in Kosovo, a post-war country in the Western Balkans.Methods: Our study was conducted in May-July 2013 and included a nationwide representative sample of 100 decision-makers operating at different primary health care institutions or public health agencies in Kosovo (63 men aged 48.6±5.5 years, and 65 women aged 46.2±5.7 years). A structured self-administered questionnaire was employed aiming to assess the necessary level of skills, abilities and competencies of family physicians in Kosovo regarding  different domains of the quality of health care. The questionnaire included 37 items organized into six subscales/domains. Answers for each item of the tool ranged from 1 (“novice” physicians) to 5 (“expert” physicians). An overall summary score (range: 37-185) and a subscale summary score for each domain were calculated for each participant. Cronbach’s alpha was used to assess the internal consistency of the instrument, whereas Mann-Whitney’s U-test was employed to assess sex-differences in the mean values of the summary score of 37-item instrument and the summary scores of each of the six subscales.Results: The internal consistency of the whole scale (37 items) was Cronbach’s alpha=0.92. The summary score of the 37-item instrument was higher in men than in women (162.3±17.9 vs. 156.1±17.5, respectively, P=0.071). The subscale scores were all higher in men than in women, a finding which was borderline statistically significant for the “patient care and safety” domain only (33.4±4.4 vs. 32.0±4.0, respectively, P=0.057). There was a weak correlation between the overall summary score of the tool and the work experience of decision-makers (Spearman’s rho=0.234, P&lt;0.001).Conclusion: In the context of Kosovo, this study provides important evidence on the expected skills and competencies of family physicians from the decision-makers’ viewpoint. Future studies in Kosovo should compare our findings related to the necessary skills and competencies vis-à-vis the actual self-perceived skills and competencies of family physicians

Assessment of knowledge, attitudes and practices about public health nutrition among students of the University of Medicine in Tirana, Albania

Aim: the aim of this survey was twofold: (i): to assess medical students’ knowledge, attitudes and practices regarding nutrition in general, in order to identify their level of competences in the field of nutrition which will be useful in their future role of providers/health care professionals, and; (ii) to assess the knowledge, attitudes and practices regarding the discipline of public health nutrition in order to identify the needs for improving the curriculum of this subject in all the branches of the University of Medicine in Tirana.Methods: A cross-sectional study was conducted in June-July 2013 including a representative sample of 347 students at the University of Medicine in Tirana, Albania (61% females and 39% males; overall mean age: 23±2 years; response rate: 87%). A nutritional questionnaire, adopted according to the models used in previous international studies, was used to assess the level of knowledge, attitudes and practices among the university students.Results: Overall, about one third of the students was not satisfied with the quality and quantity of nutritional education and demanded a more scientifically rigorous curriculum. In general, students’ knowledge about infant feeding practices was adequate. However, there were gaps in the students’ knowledge regarding the commencement of breastfeeding, or the duration of exclusive breast-feeding. Furthermore, there was evidence of an insufficient level of knowledge among students regarding diet and nutrition in general and their health impact, especially on development and prevention of chronic diseases.Conclusion: This survey identified significant gaps in the current curriculum of public health nutrition at the University of Medicine in Tirana. Our findings suggest the need for intervention programs to improve both the quantitative and the qualitative aspects of nutrition curricula in all the branches of the University of Medicine Tirana, in accordance with the professional expectations of this teaching institution, as well as the urge for a movement towards a more integrated curriculum and problem-based learning approach

ANGINA STREPTOCOCICĂ LA COPIII DE 5-15 ANI, ÎN ALBANIA. PREVALENŢA ȘI CORELAŢII SOCIO-ECONOMICE

BACKGROUND: The aim of this study was to assess the prevalence and socioeconomic correlates of Group A Beta hemolytic streptococcus (GABHS) tonsillopharyngitis in Vlora, which constitutes the biggest region in south Albania. METHODS: A cross-sectional study was conducted in Vlora district during December 2013 – February 2014. A  representative sample of 312 children aged 5-15 years was included (56% girls, 44% boys; overall response rate: 89%). Identification of GABHS was done through isolation of the microorganism by throat cultures. Binary logistic regression was employed to assess the association of positive cultures with demographic and socioeconomic characteristics of the children. RESULTS: Overall, the prevalence of GABHS in this study population was 20.2% (N=63). There was evidence of a positive association of GABHS with male gender (OR=1.66, 95%CI=0.95-2.90), a lower educational attainment of mothers of the children (OR=6.81, 95%CI=3.74-12.38), and unemployment of the fathers of the children (OR=2.91, 95%CI=1.62-5.23). CONCLUSION: Our study provides novel evidence about the prevalence and socio-demographic distribution of GABHS carriers in the general population of children aged 5-15 years in a major district of transitional Albania. Keywords: Albania, GABHS, incidence, streptococcus, Vlora.CONTEXT: Scopul acestui studiu a fost de a identifica nivelul prevalenței și corelațiile socio-economice ale anginei cu streptococ beta hemolitic de grup A, &icirc;n Vlora, cea mai mare regiune din sudul Albaniei. METODE: Un studiu transversal a fost desfășurat &icirc;n regiunea Vlora, &icirc;n perioada decembrie 2013-februarie 2014, pe un eșantion reprezentativ de 312 copii &icirc;n v&acirc;rstă de 5-15 ani (56% fete, 44% băieți; rată generală de răspuns de 89%. Identificarea streptococului beta hemolitic de grup A a fost făcută prin izolarea microorganismului &icirc;n culturile din exudatul faringian. Regresia logistică a stat la baza identificării asociației dintre culturile pozitive și caracteristicile socio-economice ale copiilor. REZULTATE: La nivelul populației analizate, prevalența streptococului beta hemolitic de grup A a fost de 20,2% (N=63). S-a identificat o asociere pozitivă a prezenței streptococului beta hemolitic de grup A cu sexul feminin (OR=1,66; 95%CI=1,95-2,90), cu nivelul scăzut de educație al mamei copilului (OR=6,81; 95%CI=3,74-12,38) și cu statutul de neangajat al tatălui copilului (OR=2,91, 95%CI=1,62-5,23). CONCLUZII: Studiul de față furnizează evidențe noi privind prevalența și distribuția socio-demografică a streptococului beta hemolitic de grup A &icirc;n populația generală de copii de 5-15 ani, la nivelul unei regiuni mari din Albania. Cuvinte cheie: Albania, streptococ beta hemolitic de grup A, prevalență, streptococcus, Vlora

ACIZII GRASI SI SINDROMUL CORONARIAN ACUT: UN STUDIU CAZ-CONTROL POPULATIONAL IN TIRANA, ALBANIA

BACKGROUND: Our aim was to assess the association of acute coronary syndrome (ACS) with selected macronutrients including fatty acids in Albania, a post-communist country in Southeast Europe undergoing nutritional transition in the past decades.METHODS: A case-control study conducted in Tirana in 2003-2006 included 467 non-fatal consecutive ACS patients (370 men aged 59.1±8.7 years, 97 women 63.3±7.1 years; 88% rate response) and a population-based control group (469 men aged 53.1±10.4 years, 268 women aged 54.0±10.9 years; 69% rate response). A semi-quantitative food frequency questionnaire was administered to all participants based on which the overall daily calorie intake and macronutrients were calculated. General linear model was used to assess the association of macronutrients with ACS. RESULTS: Intake of total fats as a percentage of total calories was significantly higher in cases than in controls in both sexes (39% vs. 35% in men and 42% vs. 39% in women; PSCOP: Scopul nostru a fost de a evalua asocierea sindromului coronarian acut (SCA) cu macronutrientii selectati, inclusiv acizi grasi, in Albania, o tara post-comunista din Sud-Estul Europei care a suferit, in ultimile decade, tranzitii nutritionale. METODE: Studiu caz-control efectuat in Tirana in 2003-2006, care include 467 pacienti care au suferit un SCA non-fatal (370 barbati cu varste de 59,1±8,7 ani, 97 femei 63,3±7,1 ani; rata raspuns 88%) si un grup control populational (469 barbati cu varste de 53,1±10,4 ani, 268 femei cu varste de 54,0±10,9 ani; rata raspuns 69%). S-a administrat tuturor participantilor un chestionar semi-cantitativ al frecventei alimentatiei, pe baza caruia s-au calculat totalutile  zilnice de calorii si macronutrienti. S-a folosit un model de regresie liniara simpla pentru a evalua asocierea macronutrientilor cu SCA.REZULTATE: Aportul total de grasimi, ca procent din totalul de calorii, a fost semnificativ mai mare in lotul de cazuri decat in lotul de control pentru ambele sexe (39% vs. 35% la barbati  si  42% vs. 39% la femei;