bluuebunny/crossref_metadata_2025 huggingface dataset:
Health behavior, stress and obesity among working age women in Myanmar
Authors: Htut Win Mya Mya , Sornlom Kittipong , Loahasiriwong Wongsa
Published: May 2023

Aim:  This study aimed to determine the prevalence of overweight and obesity and to investigate the association between socioeconomic factors, health behaviors, health literacy, knowledge, attitude, physical and mental health status, and overweight and obesity among working age women in Myanmar.
Methods: A cross-sectional study was conducted among 1,094 women aged 18 to 59 years old who were recruited by using multistage random sampling from 12 townships out of 6 districts among three states/regions. A structured questionnaire was developed and applied to assess the prevalence of overweight and obesity. Generalized Linear Mixed Model (GLMM) was performed to determine the association between dependent and independent variables after controlling the effects of covariates presenting adjusted OR and 95% confidence interval.
Results: More than half of the respondents were with overweight and obesity (51.28%; 95%CI: 48.31-54.23). The multivariable analysis indicated that factors significantly associated with overweight and obesity included; aged 31-59 years (Adjusted Odds Ratio (AOR) = 1.72, 95%CI:1.22-2.40), living without family (AOR= 2.07, 95%CI:1.20-3.57), average monthly income ≥200,000MMK (AOR= 1.38, 95%CI:1.05-1.82), parity≥1 (AOR= 1.61, 95%CI: 1.17- 2.23), high fat & protein consumption ≥5-days per week (AOR= 2.90, 95%CI:1.91-4.39), alcohol consumption (AOR= 2.53, 95%CI:1.91-3.36) and moderate-severe stress (AOR= 1.47, 95%CI:1.11-1.94).
Conclusion: More than half of working age women were with overweight and obesity. Socioeconomic status, health behavior and stress are the factors behind over nutrition. The findings provide relevant evidence to develop the appropriate policies and public health interventions in order to minimize the burden of overweight and obesity. Likewise, it is anticipated that this outcome would support the prevention of cardiovascular and other chronic diseases.
The InterAction Council
Authors: Nurse Joanna
Published: May 2023

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LEADING POLICY CHANGE IN PUBLIC HEALTH
Authors: PhD Genc Burazeri , Jacobs Dr. Hans , BA Kreshnik Petrela
Published: May 2023

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Policy Brief on Revising the TB Action Plan for the WHO European Region 2016-2020: What amendments are needed to reach the UN SDG3 to eliminate TB epidemics by 2030?
Authors: Serling Willa , Lotushko Volodymyr , Bocken Nick , Gietz Lisa , Paric Martina
Published: May 2023

Context:  The World Health Organization (WHO) European Region’s political attention shifted to the COVID-19 pandemic from the start of 2020 onwards. A consequence of this shift has been decreased political attention towards combating tuberculosis (TB) in the WHO European Region. As a result, decreasing TB data reporting, rising death rates, and increasing antimicrobial resistance (AMR) have prevented the WHO European Region from remaining on track to reach the United Nations Sustainable Development Goal 3 (SDG3) to eliminate TB epidemics by 2030. Furthermore, the WHO tuberculosis action plan for the WHO European Region 2016-2020 has missed opportunities to mitigate TB in this region, thus exacerbating the issue and preventing the achievement of SDG3. 
Policy Options: The WHO’s Roadmap to implement the tuberculosis action plan for the WHO European Region 2016-2020 provided guidance for TB management in the member states (MS), but did not sufficiently address AMR, lacking promotion of new TB vaccine rollout, nor describe national TB implementation strategies. The WHO 2016-2020 TB action plan is now overdue and WHO policymakers should consider the following recommendations when creating the new TB action plan.
Recommendations: This policy brief addresses the urgent need for a new WHO TB action plan to integrate a national level implementation commitment, AMR programming, and WHO support in creating a vaccine strategy with aims for the WHO European Region to achieve SDG3 and eliminate TB epidemics by 2030.
Autism and Inclusive Education: Recommendations for improvement during and after COVID-19
Authors: Reijnders Anne Petronella Maria , Eijnde Sanne Quérine van den , Janssen Ruben Renerus Martin , Kesse Robin van
Published: May 2023

Context: COVID-19 has disproportionately affected the autism community yet also provided an opportunity to improve education delivery. There are several policies to ensure education for autistic children, but there are still gaps that need to be filled. 
Policy Options: This policy brief analyses several interventions designed to create a more inclusive education environment for autistic children. The four policy options described and analyzed are: Teacher assistants focussing on children with special education needs, Peer Mentoring Interventions (PMI), Digitalization of Education, and Gamification.
Recommendations: The analysis concludes that PMI and Gamification would be the most feasible to implement. PMI can improve the dynamic between autistic children and their neurotypical peers. Gamification enables personalization to educational needs and fluid transition to at-home education. Subsequently, the European Union already invests in gamification, making the step smaller to invest in gamification for inclusive education.
Professionalize European Public Health Workforce: The need for a Minimum Dataset and Skills Passport
Authors: Kurtz Benedikt , Hennenberg Deirdre Norris , Supke Lea , Nguyen ThiYen Chi
Published: May 2023

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Letter to Editors: Misunderstanding should be avoided by precise formulation: Comment on Jerliu et al. “Public Health in Kosovo after five difficult years of independence”
Authors: Bjegovic-Mikanovic Vesna , Marinkovic-Eric Jelena
Published: May 2023

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Technical efficiency of Kosovo public hospitals
Authors: KarmaPhD Emiljan , Gashi Dr. Silvana
Published: May 2023

Aim: The goal of this paper is to evaluate the technical efficiency of Kosovo public hospitals and to propose ways to improve the situation.
Methods: An input-oriented Data Envelopment Analysis model with a constant return to scale was applied for a 3-year period from 2018 to 2020. Input variables of number of beds, number of specialists and how they are used to produce outputs of inpatient discharges and surgical operations, are examined.
Results: The analysis highlights the marked hospital technical inefficiencies. This study clearly points out the greater attention of public healthcare institutions toward production efficiency. Results illustrate that at least half of Kosovo Public Hospitals operate inefficiently compared to their counterparts. Inefficient, compared to efficient hospitals, on average utilize at least (depending on scenarios analysed) 30% more beds and specialists.
Conclusions: The resources available for public health services in Kosovo are the lowest in Europe and the challenge remains to secure financial resources and use them effectively. The study illustrates that most of Kosovo Public Hospitals run inefficiently. Productivity is low, efficiency needs to be improved, especially in terms of introducing modern treatment methods such as daycare. Based on this research, it seems advisable to decrease the number of beds while rationalizing the number of specialized physicians with respect to the special requirements of therapeutic and diagnostic processes in the individual hospitals.
Nonoperative management for major blunt hepatic trauma in a 3-year-old child
Authors: Cela Dritan , Abilaliaj Valmira , Shpuza Aldo
Published: May 2023

Introduction: Based on hemodynamic stability, non-operative management of low- and high-grade liver injury is the first treatment choice over surgical treatment. Small clinics are still preferring primary operative approach instead of nonoperative one.
Presentation of the case: We are presenting a case (3-year-old male child) of nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) with massive hemoperitoneum. The patient was put into a conservative treatment with antibiotics, fluids and ½ unit of blood. The results of Computed Tomography showed significant amounts of perihepatic and periileal fluid between the bowels and in the Douglas pouch, which persisted for five days. Laboratory alterations ​​of Serum Glutamic Pyruvic Transaminase, Serum Glutamic-Oxaloacetic Transaminase, and Total Bilirubin reached their maximum values on third day, persisting in decline until fifth day and returned to normal after tenth day. The hospital stay was 11 days, the length of time necessary for the complete conservatory treatment and full recovery of the trauma.
Discussion: More than 80%-90% of liver injuries are managed with nonoperative intervention. Early and late complication can be managed by interventional radiology procedures when it is possible. Success rate of conservative treatment is over 80%.
Conclusion: If no other abdominal injuries are evident and patient is hemodynamically stable nonoperative management for major blunt hepatic trauma in children is the best choice of treatment
Editorial comment on the editorial policy of SEEJPH with reference to the comments by Bjegovic-Mikanovic & Marinkovic, and by Jankovic
Authors: Laaser Ulrich
Published: May 2023

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An empirical study into factors that influence e-learning adoption by medical students in UAE
Authors: Alsharafi Afrah
Published: May 2023

Aim: The global higher education sector has shown an inclination towards the adoption of technology-based learning for introducing innovation in teaching and learning activities. However, this e-learning environment can only be effective if students have positive perceptions of e-learning. Hence, educational personnel is required to consider how students perceive this concept. This research intends to serve this purpose by identifying factors affecting students' acceptance of e-learning as well as their intention toward the use of e-learning for their learning activities.
Methods: The Technology Acceptance Model (TAM) was used in this re-search to formulate a theoretical framework. This research will employ online questionnaires as a data collection tool while the international students enrolled at United Arab Emirates universities will serve as study participants.
Results: The research outcomes indicated the most crucial role played by the predictors of “Accessibility" “Perceived Enjoyment", “Social Influence”, “Perceived Usefulness”, and "Perceived Ease of Use" in shaping students’ intention to resort to e-learning platforms for learning purposes.
Conclusion: The research indicated that the extended TAM model is applicable in the UAE educational context. The research outcomes also showed the possibility for policymakers in the educational sector to make effective use of e-learning platforms both as a technological solution and as an e-learning platform to support distance learning. The research also highlights the practical implications for the concerned educational developers in the educational sector to help them develop and apply a competent e-learning system.
Predicting the intention to use social media among medical students in the United Arab Emirates: A machine learning approach
Authors: Alomari Khaled Mohammad
Published: May 2023

Aim: The volume of research being conducted on the acceptance of social media platforms is rising. But the factors influencing the acceptance for academic reasons are still not properly identified. This study's goal is two-fold. Initially, by including Technology Acceptance Model (TAM) and external variables, analyze the students' intention to use social media networks. Secondly, to employ Machine Learning (ML) algorithms and Partial Least Squares-Structural Equation Modeling (PLS-SEM) to verify the proposed theoretical model.
Methods: The focus of this research is to create a conceptual model by supplementing TAM with a subjective norm to assess students' adoption of social media in the classroom. Students currently at one private university in the United Arab Emirates (UAE) provided a sum of 627 acceptable questionnaire surveys out of 700 distributed corresponding to 89.6%. The collected data were evaluated using ML and PLS-SEM.
Results: According to the research findings, students' intention to utilize social media networks for learning is significantly predicted by “subjective norms, perceived usefulness, and perceived ease of use”. These findings illustrated how crucial it is for students to feel capable and secure using social networks in their academic work. For validation using machine learning classifiers, the results showed that J48 (a decision tree) typically outperformed other classifiers.
Conclusion: According to the empirical findings, "subjective norm," "perceived usefulness and ease of use" all significantly increase students' intention to use social networks for learning. These results were in line with earlier research on social network acceptability. Lawmakers and managers of social media platforms in education must therefore concentrate on those factors that are crucial to promoting education and enhancing students' capacity for developing and implementing successful social media applications.
Efficacy of an IgM preparation in the treatment of patients with sepsis: a double-blind randomized clinical trial in a pediatric intensive care unit
Authors: Kola Ermira , Çelaj Ermela , Bakalli Iliriana , Lluka Robert , Kuli-Lito Gjeorgjina , Sallabanda Sashenka
Published: May 2023

Aim: Additional treatments for sepsis to be administered alongside the standard therapy recommended by the Surviving Sepsis Campaign have recently undergone evaluation. Due to its anti-bacterial, anti-inflammatory and immunomodulatory properties, intravenous polyvalent immunoglobulin M (IgM)–enriched immunoglobulins (IgM preparation) has been investigated as one of these potentially valid adjunctive therapies. The aim of this trial was to assess the efficacy of an IgM preparation as adjuvant therapy in the treatment of pediatric patients with sepsis.
Methods: In our study, 78 septic patients admitted to a pediatric intensive care unit (PICU) at the University Hospital Center “Mother Teresa” in Tirana, Albania, were randomized into two groups (intervention and control). All patients were treated according to standard PICU sepsis guidelines. Additionally, patients in the intervention group received the IgM preparation Pentaglobin® while patients in the control group received standard sepsis therapy, but no immunoglobulin  administration.
Results: The survival rate was higher in the intervention group (87%, N=34) than in the control group (64%, N=25), and this difference was statistically significant  (P=0.03). Length of stay (LOS) was also significantly shorter in the intervention group.
Conclusion: In this study conducted in Albania, use of an IgM preparation, in addition to standard sepsis therapy, led to a significant increase in the survival rate as well as a significant reduction in LOS compared with placebo, when administered in PICU patients with sepsis.
The Impact of COVID-19 Lockdowns on Air Quality: A Systematic Review Study
Authors: Dahu Butros M. , Aburayya Ahmad , Shameem Beenish , Shwedeh Fanar , Alawadhi Maryam , Aljasmi Shaima , Salloum Said A. , Aburayya Hamza , Aburayya Ihssan
Published: May 2023

Background:
The purpose of this article was to review the published literature and evaluate the association between air quality/air pollution and the lockdown/stay-at-home orders during COVID-19 pandemic. Our goal is to identify the various environmental factors, such as urban and rural air quality, which were affected by the lockdown during the coronavirus disease (COVID-19) pandemic.
Methods:
We searched PubMed (2000–2021) for eligible articles using the following: (1) Aerosol[Title/Abstract], AND (2) air quality[Title/Abstract] OR air pollution[Title/Abstract] AND (3) COVID-19[Title/Abstract]. A total of 39 articles were identified through the search conducted in PubMed. We first screened the title and the abstract of those 39 articles for eligibility. A total of 24 articles did not meet the eligibility criteria and were excluded based on the title and the abstract review. The 15 remaining articles were assessed in full text for eligibility and data extraction. After a full-text review, 3 articles were excluded. Finally, a total of 12 selected articles were confirmed for data extraction.
Results:
Among the 12 studies, 5 articles focused on the effect of the air pollution, fine particulate matter, and air pollutants of COVID-19 pandemic’s lockdown, while 1 article targeted the relationship between the weather/air quality and COVID-19 death rate during lockdown. In addition, 5 papers focused on the association between the environmental factors, air pollution and air quality and COVID-19 mortality rate. Finally, 1 research study paper aimed to study the COVID-19 positivity rate and the effect of air quality during the stay-at-home order or the lockdown which was occurred in March 2020. It is important to note that it has been found that an increase in the average PM2.5 concentration was correlated with a relative increase in the COVID-19 test positivity rate. This explains the increase in the number of COVID cases during the period of the wildfire smoke from August to October 2020 (1).
Conclusion:
The findings indicate that the COVID-19 lockdown has significant impact on the air quality across the world. The lockdown significantly reduces the air pollutants such as NO2, CO, O3 and Particulate Matter PM2.5 and PM10. This reduction led to a much healthier and safer outdoor air and hence improved the air quality during the lockdown/stay-at-home orders. More research is needed to validate that the air pollutants (NO2, CO, O3, PM2.5 and PM10) have a significant impact on the COVID-19 mortality and fatality rates.
Addiction & Dependency
Authors: Houghton Dr. Frank , Scott Dr. Lisa O’Rourke
Published: May 2023

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Public Health Teaching Books (Open Access)
Authors: Laaser Ulrich
Published: May 2023

European Stability Pact for South Eastern Europe
Funded by Germany 2001-2010
PUBLIC HEALTH TEACHING BOOKS (1st edition) PUBLISHED OPEN ACCESS
Health Systems and Their Evidence Based Development (578 pages)
Management in Health Care Practice (672 pages)
Health Promotion and Disease Prevention (806 pages)
Health Determinants in the Scope of New Public Health (633 pages)
Public Health Strategies: A Tool for Regional Development (647 pages)
Methods and Tools in Public Health (1014 pages)
Review of Costing Tools Health System in Liberia
Authors: Popovic Natasa
Published: May 2023

Review of Costing Tools Health System in Liberia
Book Review: Politics and health updated
Authors: Danzon Marc , Charpak Yves
Published: May 2023

Book Review: Politics and health updated
Modern Teaching – Distance Learning
Authors: ASPHER
Published: May 2023

Modern Teaching – Distance Learning
Taking up from COP26 going forward: contribution of the Book “Survival: One Health, One Planet, One Future by George R. Lueddeke”
Authors: Eliudi Saria Eliakimu  , Linda Mans
Published: May 2023

Since its publication in 2019, the book "Survival: One Health, One Planet, One Future", written by George R. Lueddeke, has proven to be timely and useful in these uncertain and tense ("rattling" – Lueddeke’s word) times we are experiencing. Indeed, we have had (and still are experiencing) the COVID-19 pandemic and the war between Russia and Ukraine that was started early 2022. In this article, we recall the urgency of climate action, the goals of COP26 (that took place from 31st October to 12th November 2021) and provide suggestions for topics that might deserve a place in a possible update of the book. These topics include (i) a critical analysis of the effects of Russia and Ukraine War and lessons from the perspective of One Health and Wellbeing; (ii) progress in various countries in using the One Health approach to address issues that affect the health and wellbeing of population (equity), the environment and ecosystems in general (including global trends in non-communicable diseases and antimicrobial resistance); and (iii) look at the current global governance systems in relation to how they can better function proactively to prevent future wars (interconnected challenges).
Determinants of low birth weight in the health district of Bounkiling in Senegal
Authors: Martial Coly Bop  , Cheikh Tacko Diop  , Bou Diarra  , Boubacar Gueye  , Ousseynou Ka
Published: May 2023

Aim: Low birth weight (LBW), 9.1 million deaths per year, is a global health issue. The proportion of LBW in Senegal is estimated at 12% (in 2017) and is at 11.7% (in 2017) in the region of Sedhiou. In this regard, rigorous management is required to address this issue, especially in rural areas. The objective of the study was to identify the determinants of LBW.Methodology: This is a case-control study which has been conducted in the district of Bounkiling. Socio-demographic characteristics of the mothers, their obstetrical and medical history, and information on the health status of the newborn in the case group were compared with that of the controls. Bivariate and multivariate analyses are performed using Epi info 7 software to identify the determinants.Results: Low-weights accounted for 97.05% of LBW. The sex ratio was 0.87 in favor of girls. The Apgar score at birth was not good for 31.4% of newborns. Teenage mothers accounted for 17.08%. The multivariate analysis showed that the determinants of LBW (p < 0.05) were the female sex of the newborn, the Apgar score at birth, the maternal age <=19 years, the household income < 83.96 USD, maternal history of low birth weight and physical labor during pregnancy.
Conclusion: Strengthening communication on early marriages and pregnancies, empowering women and improving pregnancy monitoring would be levers to counter the determinants of low birth weight.
Epidemiological features of New-Onset Type 1 Diabetes Mellitus in children and adolescent during 2010-2014 in Albania - a unique experience.
Authors: Laurant Kollçaku
Published: May 2023

Aim: Diabetes mellitus is a major public health problem worldwide. Type 1 diabetes mellitus (T1DM) is the most common metabolic chronic disease in genetically susceptible children and adolescents, due to an autoimmune process characterized by a selective destruction of insulin producing β-cells. The aim is to assess the epidemiological features of new-onset T1DM in children and adolescent at the national level during the period 2010-2014 in Department of Pediatrics, Endocrine Unit, University Hospital Center 'Mother Teresa', Tirana, as the unique center for pediatric endocrinology and diabetology in Albania.Methods: The clinical and laboratory characteristics of 152 patients aged <15 years newly diagnosed with T1D from 1 January 2010 to 31 December 2014 were studied. T1D was diagnosed according to WHO 2006 criteria and DKA was diagnosed based on ISPAD 2014 criteria. Patients were classified into 3 sub-groups (I: 0-4 years, II: 5-9 years, and III; 10-14 years). Statistical analysis was performed using SPSS 26.
Results: The incidence of new-onset of T1DM was 5.012/100.000/year. The mean age of children at diagnosis was 8.3 ± 3.6 years. The patients were mostly diagnosed at ages 5-9 years (40.1%), and 10-14 years (39.5%), followed by the 0-4 years age group (20.4%). Mean duration of symptoms was 23.35 ± 17.16 days; longer in the subgroup 5-9 years (P= 0. 0.013). Three quarters (75%) of children with T1DM live in urban areas. Viral infections or other circumstance triggers were in 41.9% of children aged 0-4 years compared to other subgroups (P=0.002). Most of the children were born in the spring−summer months (53.23%) compared to the autumn−winter months (46.77%). Approximately 1/4 of the children were born and diagnosed with type 1 diabetes in each of the seasons of the year and 52.63% of the patients studied were first born. Family history for DMT1 and DMT2 is observed in 15.8% and 17.8% of the children, respectively. Polyuria (99.3%), polydipsia (99.6%) and weight loss (98.1%) were the most common symptoms and 67.8% of patients presented with diabetic ketoacidosis (DKA). Misdiagnosis was in 21 (13.8%) patients. Mean glycosylated hemoglobin A1c (HbA1c) was 11.63%; 11.9 ± 2.0 in DKA positive children and 11.1 ± 2.4 in DKA negative children (p= 0.195).At diagnosis and during follow up of T1DM 25% (38/152) developed associated autoimmune diseases; 68.42% at diagnosis of T1DM and 65.79% (25/38) of patients were female. During follow up children with T1DM developed associated CD and SAT, 2.54, and 2.19 years, respectively.Conclusion: Diabetes mellitus is one of the major public health problems worldwide. Albania is a country with middle incidence of T1DM and the age at onset is decreasing. The symptoms lasted significantly longer and mean HbA1c levels were significantly higher in older children. The incidence of DKA in children with newly diagnosed T1DM is high.
Sexual health knowledge, attitude and risk perception among in-school and out-of-school female adolescents in Onitsha, Anambra State, Nigeria
Authors: Adogu Prosper , Udigwe Ifeoma , Nwabueze Achunam , Adinma Echendu , Udigwe Gerald , Onwasigwe Chika
Published: May 2023

Aim: Young people need protective information and skills in order to reduce the riskassociated with unsafe sex. This study assessed and compared the sexual health knowledge, attitude and risk perception of in-school and out-of-school female unmarried adolescents in Onitsha North Local Government Area, Anambra State, Nigeria.
Methods: A comparative cross-sectional design was used in which 391 in-school female adolescents (mean age: 15.9±1.4 years ) were selected from 25 private and 17 public schools in Onitsha North Local Government Area, Anambra State, Nigeria using multistage sampling method. A comparison group of 392 out-of school female adolescents (mean age: 15.5±2.5 years) was also selected from a major market in the same Local Government Area using cluster sampling technique. Data was collected from the respondents with pre-tested, interviewer-administered questionnaires on reproductive and sexual health knowledge, risk perception and attitude, sexual behaviour, contraceptive knowledge and sources of sexual health information.
Results: In-school girls demonstrated better knowledge of sexual and reproductive health compared to their out-of-school counterparts. The awareness of fertile period, contraception methods, STI and HIV transmission and prevention were all significantly better among the in-school adolescents compared to their out-of-school counterparts (P<0.05). They also had markedly higher risk perception of getting pregnant (P<0.05) or acquiring HIV infection (P<0.05) compared to their out-of-school counterparts.
Conclusion: About 21% of adolescents in this study area were involved in risky sexualbehaviour and this was higher among the out-of-school adolescents than their in-school counterparts. All stakeholders in the state and the Local Government Area should come together and develop interventions that would improve the sexual health knowledge and sexual risk perception of the adolescents.
Policy Recommendations to Improve Mental Health in Polish Prisons
Authors: Juan Roman Mora Barrios  , Anne van den Broek  , Riccardo Buttarelli  , Han Reuvers  , Wiktoria Sobotka  , Martina Paric
Published: May 2023

Context: Mental health is a central aspect of public health and social development, as such it corresponds to target 3.4 of the Sustainable Development Goals. This target aims to promote mental health and well-being, making it especially necessary to address this matter in environments such as prisons where exposure to risk factors is high. Incarceration itself is a cause of mental illness. Central and Eastern European countries hold some of the highest prison populations in the region and Poland numbers in this regard are 50% higher than the average in the European Union (EU) (about 179 inmates per 100,000 inhabitants). In Polish prisons, the chance of receiving adequate psychiatric and psychological care is limited due to a shortage of trained personnel and scarce infrastructure. However, data on mental health in Polish prisons is not routinely reported from official sources. Article 150 of the Polish Penal Code attempts to protect the mental health of inmates; yet, in reality, there is no legal enforcement to apply these measures, a feature shared with most of its neighbouring countries. The aim of this policy brief is to offer recommendations to lower recidivism rates, up-scale prison staff and create spill-over effects on (mental) healthcare and security in Polish prisons.Policy Options: The World Health Organization (WHO) European Framework for Action on Mental Health 2021-2025 should be adapted to the Polish Prison System. Best practices focus on a collaborative approach centred on healthcare services, labour policies, well-being and rehabilitation. Ideally, incarceration provides inmates with the possibility to be included and active, to see their relatives, to vote, to be engaged and maintain contact with the outside society. These best practices statistically reduce mental illnesses, lower recidivism and promote inclusion and rehabilitation.
Recommendations: To tackle mental health challenges that prisoners in Poland experience, it is recommended to adapt a new approach with the following components: improving methodological quality of data collection as well as routine reporting to enable good governance structures, promoting collaborative efforts among stakeholders, and strengthening existing resources through capacity building which has been convincingly demonstrated as the most cost-effective type of interventions.
Self-perceived level of competencies of family physicians in transitional Kosovo
Authors: Skeraj Fitim , Czabanowska Katarzyna , Bojaj Gazmend , Burazeri Genc
Published: May 2023

Aim: Family physicians and general practitioners are currently facing increasing demands to meet patients’ expectations and rapid technological and scientific developments. The aim of this study was to determine the self-perceived level of competencies of primary health care physicians in Kosovo, a post-war country in the Western Balkans.
Methods: A cross-sectional study was conducted in Kosovo in 2013 including arepresentative sample of 597 primary health care physicians (295 men and 302 women; mean age: 46.0±9.4 years; response rate: 90%). A structured self-administered questionnaire was used in order to determine physicians’ competencies 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. General linear model was used to assess the association of physicians’ self-perceived level of competencies with covariates.
Results: The internal consistency of the whole scale (37 items) was Cronbach’s alpha=0.98. Mean summary score of the 37-item instrument and subscale summary scores were all higher in men than in women. In multivariable-adjusted models, mean level of self-perceived competencies was higher among older physicians, in men, those with >10 years of working experience, physicians serving >2500 people, specialized physicians and those involved in training activities.
Conclusion: Our study provides useful evidence on the self-assessed level of competencies of primary health care physicians in post-war Kosovo. Future studies in Kosovo and other transitional settings should identify the main determinants of possible gaps in self-perceived levels of physicians’ competencies vis-à-vis the level of physicians’ competencies from patients’ perspective.
On Urgently Tackling the Mosquito-Borne Diseases in the European Union
Authors: Zuwaira Paula Hashim  , Jeny Aguilera-Cruz  , Addiena Luke-Currier  , Karolina Airapetian  , Loredana Andreea Silaghi  , Issam Alsamara
Published: May 2023

Context: According to a recent Lancet report the world is dangerously close to reaching climate-driven points of no return. Climate change, together with other drivers, contributed to a large diffusion of mosquito-borne diseases (MBDs) in the last decades. The intensity of such a phenomenon led various mosquito species to migrate to new areas, outside their historical habitats. Europe is among the affected territories. Moreover, the problem is projected to rise and expand within the continent, including populations who have never been exposed to MBDs and impacting the whole society, especially the most vulnerable groups. As Europe is a relatively new area for the diffusion of MBDs, no strong and unified measures have been put into practice yet. Meanwhile, MBDs surveillance experiences implemented across Europe report gaps, such as the absence of entomological research and legal support, the capacity limitation for surveillance, and variability in entomological and epidemiological surveillance systems. Hence, it could be necessary to use the experiences from Latin America, Asia and Africa. Given the aforementioned overview, this policy brief aims to provide policy options in order for the European Union to address MBDs, with a particular emphasis on strengthening surveillance across the Member. States given recent attention drawn to this issue by the ECDC’s 2021 report on vector control and surveillance.
Policy Options and recommendations: This advisory group conducted a non-systematic literature review to determine three policy options, with a specific focus on surveillance, to address the issue of MBDs. 1. Surveillance systems for mosquitoes and MBDs should be implemented in all member states, and case definitions for these MBDs should be harmonised to enable coordination and consistency of MBDs surveillance across the European Union (EU). 2. Create an EU-level networks umbrella for financial and organisational coordination of Member States (MS)’ multi-sectoral collaboration on MBDs surveillance. 3. Developing the competencies for surveillance and research professionals for mosquitoes and MBDs surveillance.
Sustainable Reform of European Union (EU): Common Fisheries Policy
Authors: Chungwan Lo  , Selin Deniz  , Jakob Hardt  , Rosario Pérez López  , Jule Pleyer  , Suzanne M. Babich
Published: May 2023

Context:Oceans are encountering great loss of biodiversity. Global overfishing and overconsumption of aquatic foods prompted the European Union to create the Common Fishery Policy (CFP) with the intention of supporting sustainability of the environment, economy, and society, and to protect the long-term supply of aquatic foods. The Mediterranean Sea is a vulnerable European region due to fishing at unsustainable levels. Factors exacerbating the situation in this region include socio-economic conditions, weakregulatory power of the EU, poor communication and low levels of consensus among stakeholders.Policy Options:Three policy options are highlighted: 1) Fish-restricted areas (FRA) in eight Mediterranean regions to maintain or reverse fish collapse, as a means to recover fish stocks in regions with higher exploitation rates: 2) Supporting and improving small-scale fisheries (SSF) to reduce the impact on marine wildlife and increase selectivity, including standard gear and size restrictions,as well asstrict seasonal closures; 3) Integration of Participatory Action Research (PAR) to improve stakeholder compliance with the landing obligation.Recommendations:Policy options were assessed by four evaluation criteria (economic feasibility, effectiveness, political feasibility, and equity). Integrating the PAR into the CFP was deemed to be the best option of those examined. A positive impact on the economy, political feasibility, and equity for stakeholders would be expected outcomes of implementation of this alternative. Regular evaluation and continuous improvement would increase the likelihood of policy success.
Towards an integrative post-2015 sustainable development goal framework: Focusing on global justice – peace, security and basic human rights
Authors: R.Lueddeke George
Published: May 2023

Following the Millennium Summit of the United Nations in 2000, the adoption of the United Nations (UN) Millennium Declaration by 189 nations, including the eight Millennium Development Goals (MDGs), has been hailed as a unique achievement in international development. Although the MDGs have raised the profile of global health, particularly in low- and middle-income countries, underpinned by the urgent need to address poverty worldwide, progress has been uneven both between and within countries. With over one billion people, Africa is a case in point. Aside from children completing a full course in primary school and achieving gender equality in primary school, none of the twelve main targets set for SS Africa has been met. A key reason suggested for this lack of progress is that the MDGs fall far short in terms of addressing the broader concept of development encapsulated in the Millennium Declaration, which includes human rights, equity, democracy, and governance.To strengthen the likelihood of realizing the post-2015 Sustainable Development Goals (SDGs), particularly with regard to “planet and population” health and well-being , UN and other decision-makers are urged to consider the adoption of an integrated SDG framework that is based on (i) a vision of global justice - underpinned by peace, security and basic human rights; (ii) the development of interdependent and interconnected strategies for each of the eleven thematic indicators identified in the UN document The World We Want; and (iii) the application of guiding principles to measure the impact of SDG strategies in terms of holism, equity, sustainability, ownership, and global obligation. While current discussions on the SDGs are making progress in a number of areas, the need for integration of these around a common global vision and purpose seems especially crucial to avoid MDG shortcomings.
Population aging from 1950 to 2010 in seventeen transitional countries in the wider region of South Eastern Europe
Authors: Jakovljevic Mihajlo , Laaser Ulrich
Published: May 2023

Aim: Population aging has profoundly reshaped demographic landscapes in all South Eastern European (SEE) countries. The aim of this study was to provide a thorough comparative inter-country assessment on the speed of population aging in the entire SEE region for the period 1950-2010.
Methods: Descriptive observational analysis of long-term trends on core primary and composite indicators of population aging across seventeen countries of the wider SEE region, with panel data sets at a national level.
Results: During the past six decades, the entire SEE region has experienced a rapid increase in the median age (from 25.2 years in 1950 to 37.9 years in 2010), with a simultaneous fall of fertility rates for two children per woman (from 3.55 children per each childbearing woman in 1950 to 1.49 in 2010), coupled with significant rise in the population of elderly citizens. The speed of population aging has vastly accelerated (with a 2.5 fold increase) over the past three decades. The percentage of individuals over 65 years has doubled from 7% in 1950 to 14% in 2010.
Conclusion: Complex national strategies are needed to cope with the shrinking labour force coupled with the growing proportion of the older population. With all likelihood, population aging will further accelerate in the near future. This profound long-term demographic transition will threaten financial sustainability of current health systems in all SEE countries.
Public health leadership competency level among health professionals in a South Eastern European country
Authors: Pampuri Orjola , Czabanowska Katarzyna , Hysa Bajram , Roshi Enver , Burazeri Genc
Published: May 2023

Aim: The aim of this study was to describe the current and the required leadershipcompetency level of health professionals in Albania, employing a recently establishedinternational instrument.
Methods: A nationwide cross-sectional study was conducted in Albania in July-December 2014 including a representative sample of 267 health professionals (162 men and 105 women; mean age: 44.7±10.3 years; overall response rate: 89%). A structured questionnaire was administered to all health professionals aiming at self-assessing the current level of leadership competencies and the required (desirable) level of leadership competencies for their current job position. The questionnaire included 52 items grouped into eight subscales/domains. Answers for each item of the tool ranged from 1 (“minimal competency level”) to 5 (“maximal competency level”). An overall summary score (range: 52-260) and a subscale summary score for each domain were calculated for both the current and the required leadership competency levels. Wilcoxon signed ranks test was employed to comparethe overall scores and the subscale scores of the current and the required level of leadership competencies among health professionals.
Results: Mean value of the overall summary score for the 52 items of the instrument was significantly lower for the current leadership competency level compared with the required leadership competency level (138.4±11.2 vs. 159.7±25.3, respectively; P<0.001). Most of the subscales’ scores were significantly higher for the required than for the current leadership competency level.
Conclusion: Our study provides useful evidence about the current and the required level of leadership competencies among health professionals in transitional Albania. Findings of this study may help policymakers in Albania to identify the gap between the required and the current level of leadership competencies among health  professionals. Furthermore, findings of this study should be expanded in the neighbouring countries of the South Eastern European region and beyond.
Anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania
Authors: Harizi Edlira , Rroji Arben , Cekaj Elton , Gabrani Sazan
Published: May 2023

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage.
Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis.
Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001).
Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms.
The South Eastern Europe Health Network: A model for regional collaboration in public health
Authors: Ruseva Maria , Chichevalieva Snezhana , Harris Meggan , Kostova Neda Milevska , Jakubowsk Elke , Kluge Hans , M. Martin-Moreno Jose
Published: May 2023

Inter-country alliances, articulated through regional approaches, have increasingly been used to drive economic development and social progress in the past several decades. The South Eastern Europe Health Network (SEEHN) stands out among these types of initiatives for the tangible improvements it has achieved in regional governance for health, with several important lessons for public health leaders worldwide. This review paper, written by several key participants in SEEHN operation, follows the main milestones in network development, including its foundation under the Stability Pact’s Initiative for Social Cohesion and the three ministerial forums that have shaped its evolution, in order to show how it can constitute a model for regional collaboration in public health. Herewith we summarise the main accomplishments of the network and highlight the keys to its success, drawing lessons that both international bodies and other regions may use in their own design of collaborative initiatives in health and in other areas of public policy.
Adverse effects of maternal age, weight and smoking during pregnancy in Pleven, Bulgaria
Authors: Hristova Petkana Angelova , Georgieva Stela Ludmilova , Khan Azhar , Kamburova Mariela Stefanova
Published: May 2023

Aim: This paper aims to study the relationship between mothers’ age, body mass index (BMI), gestational weight gain (GWG) and smoking and the risk for premature birth in Pleven, Bulgaria.
Methods: A case-control study was conducted in Pleven in 2007. The study was comprehensive for all premature children (N=58) and representative for full-term infants (N=192, or 10.4% of all of the 1827 full-term children) born in 2007 at the University Hospital of Pleven and resident in the city of Pleven. Retrospective data on determinants under study were collected from all the mothers included in this study (N=250).
Results: Mothers of premature children were more likely to be above 35 years old (27.6%), with a BMI ≥25 kg/m2 (23.1%), GWG below the recommended value (38.5%) and to smoke during pregnancy (37.9%). The odds of being a smoker during pregnancy were five times higher among mothers with low birth weight (LBW) newborns compared with their counterparts with normal birth weight newborns (OR=5.1, 95%CI=2.4-10.6). There was a positive association between BMI and LBW in infants whose mothers were overweight (OR=2.1, 95%CI=1.0-4.0). The risk of LBW increased when GWG was less than recommended (OR=1.8, 95%CI=1.0-3.1).
Conclusion: Our results indicate that pre-pregnancy BMI ≥25 kg/m2, less than recommended GWG and smoking during pregnancy are risk factors for premature birth in Pleven region. Findings from this study suggest the need for active health and educational actions by health professionals in order to avoid premature births in Bulgaria.
Obituary Professor Luka Kovacic, MD, PhD
Authors: Bozikov Jadranka
Published: May 2023

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Complete Issue
Authors: Burazeri Genc
Published: May 2023

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