bluuebunny/crossref_metadata_2025 huggingface dataset:
Overview on epidemiological and clinical manifestation of COVID-19 in Albanian adults
Authors: Çomo Najada , Meta Esmeralda , Qato Migena , Gjermeni Nevila , Kolovani Entela , Pipero Pellumb , Harxhi Arjan , Kraja Dhimiter
Published: May 2023

On March 9, 2020 the first two cases of Sars-Cov-2 were identified and hospitalized in Albania. In this paper we present a retrospective analysis of 3000 consecutive COVID-19 confirmed cases in Albanian adults admitted at the Infectious Diseases Service which includes three tertiary care wards, part of Tirana University Hospital Center “Mother Teresa”. The period included in this analysis is from March 2020 – April 30, 2021.
The paper provides a general overview including demographic distribution, symptomatic diversity and clinical signs manifested among cases, as well as the association observed with underlying pathologies. The analysis included 1944 males and 1056 females. Overall, the age groups included range from 15 to 99 years (median 65 years; mean value 63.4±13.4 years).
There were no statistically significant age differences between males and females (mean ages were: 63.5±13.1 in females and 63.3±13.5 in males; median ages were: 64 years in females and 65 years in males; P=0.67).
There was evidence of a statistically significant difference between sexes regarding the presence of symptoms, which were more predominant in males (P<0.001). On the whole, we observed 19 cases with specific signs and symptoms, most of them (82.9%) among patients who reported the presence of such symptoms 5-14 days before hospitalization.
The comorbidities encountered were ranked according to systems and organs, classifying them in 22 categories, among which the most frequent were hypertension (52%) and diabetes mellitus (26.4%). Age was a strong risk factor for severe illness, complications, and death.
Analyzing symptom onset with total symptoms and comorbidities, it showed that some patients were affected for many days with few symptoms and few comorbidities. It seems they started as mild cases for many days unpredictably precipitating. There were also a few cases with many comorbidities, but a few symptoms upon hospital admission.
Epidemiological features of New-Onset Type 1 Diabetes Mellitus in children and adolescent during 2010-2014 in Albania - a unique experience.
Authors: Kollçaku Laurant
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
Syndromic surveillance in early detection of outbreaks of infectious diseases
Authors: Tomini Eugena , Simaku Artan , Kureta Elona , Vasili Adela , Bino Silva
Published: May 2023

Aim: Motivated by the threat of infectious diseases and bioterrorism, syndromic surveillance systems are being developed and implemented around the world. The aim of the study was to describe the early warning surveillance system in Albania.
 
Methods: Syndromic surveillance is a primary health care-facility- and emergency room (ER)-based syndromic surveillance system aiming at detecting outbreaks and undertaking public health actions. It is based on weekly notifications of nine syndromes by over 1,600 General Practitioners (GPs) in the 36 districts of Albania. Data is aggregated by district epidemiologists (DE) and centralized by the national Institute of Public Health.
Results: A syndrome is “a set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.”  In the context of syndromic surveillance, a syndrome is a set of non-specific pre-diagnosis medical and other information that may indicate the release of a bioterrorism agent or natural disease outbreak.
Since its inception, syndromic surveillance has mainly focused on early event detection: gathering and analysing data in advance of diagnostic case confirmation to give early warning of a possible outbreak.
Conclusion: The system is useful for detecting and responding to natural disease outbreaks such as seasonal and pandemic flu, and thus they have the potential to significantly advance and modernize the practice of public health surveillance.
Improving nutrition and health among Albanian schoolchildren
Authors: Hysk Jolanda
Published: May 2023

Nutrition is a critical part of health and development. Better nutrition is related to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non-communicable diseases and longevity.
Prevention of malnutrition among adolescents and improvement of the nutritional status of children are considered important targets in Albanian health system efforts to achieve benefits in the population’s health.
Key approaches for improving nutritional status and nutrition-related knowledge, attitude and practices among school-children in Albania (based on the main findings from the in-depth analysis of three nationwide surveys conducted in Albania between 2015 and 2018 on nutritional status and nutrition-related knowledge, attitudes and practices among school-children in Albania and other findings) consist ofprevention and promotion from an early age, focus on knowledge, attitudes and practices, limit exposure to less healthy foods and increase parental awareness and involvement.
These studies findings and respective recommendations can support the development of a National School Food and Nutrition Education programme in Albania. While there is evidence for the need to intervene at the national level, the stratified analysis at regional and district levels points to the need for the design and implementation of specific interventions at the local level. It is also very crucial to strengthen and improve anthropometric nutrition and surveillance systems for nutritional risk factors for children and adolescents, and use the data obtained by these systems effectively and appropriately.
 
Conflicts of interest: None declared.
 
Acknowledgment: This document is based on the In-depth analysis of three nationwide surveys conducted recently in Albania regarding ‘Nutritional Status and Nutrition-Related Knowledge, Attitude and Practices Among School-Children in Albania”carried out by Ass. Prof Jolanda Hyska in the framework of the Project "Improving the nutritional status of children in schools in Albania", a project developed by the Albanian Center for Economic Research (ACER), funded by UNICEF Albania. The views and opinions expressed in this publication are those of the author and do not necessarily represent the official opinion of ACER nor of UNICEF.
Modern Health Systems Developments In the United Arab Emirates
Authors: Aburayya Dr. Ahmad
Published: May 2023

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Factors Affecting Medical Students’ Acceptance of the Metaverse System in Medical Training in the United Arab Emirates
Authors: Alawadhi Maryam , Alhumaid Khadija , Almarzooqi Sameeha , Aljasmi Shaima , Aburayya Ahmad , Salloum Said A. , Almesmari Waleid
Published: May 2023

Aim: Medical training activities have been disrupted in many regions following the outbreak and rapid spread of the coronavirus disease 2019 (COVID-19) across the globe. The most affected areas include organizations’ process of leveraging high-tech medical equipment from abroad to facilitate a practical approach to learning. Also, as countries implemented COVID-19 safety regulations, it became difficult for organizations to conduct face-to-face training. Consequently, non-face-to-face learning methods have been introduced in the medical field to enable instructors to remotely engage with learners. The current research investigated the students' perceptions of the use of metaverse systems in medical training within the medical community of the United Arab Emirates (UAE).
Methods: A conceptual model comprising the adoption properties of personal innovativeness, perceived enjoyment, and Technology Acceptance Model concepts was utilised. The current research targeted students in UAE medical universities. Data was obtained by conducting online surveys that were implemented in the winter semester of 2021/2022 between 15th February and 15th May 2022. 500 questionnaires were issued to students following their voluntary participation and 435 questionnaire responses were obtained i.e. an 87% response rate. The research team tested the measurement model employing Structural Equation Modeling using Smart Partial Least Squares Version (3.2.7).
Results: Statistically significant associations were confirmed to exist between Personal Innovativeness (PI) influenced by both the Perceived Ease of Use (PEOU), and Perceived Usefulness (PU) (β= 0.456) and (β= 0.563) at P<0.001. The statistically significant associations involving Perceived Enjoyment (EJ) and PEOU and PU (β= 0.554, P<0.05), (β= 0.571, P<0.05) were further confirmed. Additionally, PEOU had a relationship with PU (β= 0.863, P<0.001). Eventually, PEOU and PU significantly influenced the participants’ inclination to use the metaverse technology with (β= 0.745, P<0.001) and (β= 0.416, P<0.001), respectively.
Utilising ‘new’ power strategies for public health education in addiction and dependency: learning from social media influencers
Authors: Scott Lisa O’Rourke
Published: May 2023

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The Potential of Men’s Sheds as a Resource for Men Coping with Mental Health Challenges and Addiction
Authors: Heinz Melinda
Published: May 2023

Men’s Sheds are defined as grassroots community-based organizations comprised of men coping with mental health challenges and addiction. Men in need experience the benefits of receiving support from other men and feel that their levels of loneliness and depression declined after they joined the Men’s Shed. Men’s Sheds could serve as a mental health refuge for a variety of men with diverse needs. It may be worthwhile to pilot a program investigating the efficacy of using Men’s Sheds to support individuals recovering from addictions.
Researching Gambling: Have we learned nothing from Big Tobacco’s overt manipulation of science?
Authors: Houghton Frank
Published: May 2023

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Connecting the Person by Removing the Stigma: Why Ireland Should Follow the Portuguese Model of Drug Decriminalisation
Authors: Finucane Aisling , Stritch Jennifer Moran
Published: May 2023

The decriminalisation of drugs and how it can impact addiction, crime and mental health is a subject that inspires global interest and debate.  Much has been written about the positive outcomes of decriminalisation from a public health perspective, including the elimination of aggressive policing and community oversight and the shift to offering treatment and social supports for those affected by addiction.  Ireland has yet to move to a model of decriminalisation, although a system similar to the one employed in Portugal has been suggested.  This article briefly outlines reasons why a paradigm shift is vital if progress is to be made in reducing addiction in contemporary Ireland. The potential benefits could include a reduction in the pervasive social stigma connected with substance abuse, leading to less social exclusion within the Irish population.
The first comprehensive Health Sector Review and future Operational Plan of Liberia after the EBOLA crisis: Review Report 2016
Authors: Liberia Republic of , Health Ministry of
Published: May 2023

The first comprehensive Health Sector Review and future Operational Plan of Liberia after the EBOLA crisis: Review Report 2016
The first comprehensive Health Sector Review and future Operational Plan of Liberia after the EBOLA crisis: Consolidated Operational Plan 2016-2017
Authors: Liberia Republic of , Health Ministry of
Published: May 2023

The first comprehensive Health Sector Review and future Operational Plan of Liberia after the EBOLA crisis: Consolidated Operational Plan 2016-2017
Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales
Authors: Wales Public Health
Published: May 2023

Making a Difference: Investing in Sustainable Health and Well-being for the People of Wales
Global Population Health and Well-Being in the 21st Century: Toward New Paradigms, Policy and Practice
Authors: Behbod Behrooz , George Lueddeke R
Published: May 2023

Global Population Health and Well-Being in the 21st Century: Toward New Paradigms, Policy and Practice
Biographical Lexicon of Public Health
Authors: Masic Izet
Published: May 2023

Biographical Lexicon of Public Health
Health: Systems – Lifestyle – Policies ; Forum for Public Health in Southeastern Europe Vol I
Authors: Burazeri Genc , Kragelj Lijana Zaletel
Published: May 2023

Health: Systems – Lifestyle – Policies ; Forum for Public Health in Southeastern Europe Vol I
A study on risk perception, cognitive awareness and emotional responses to identify unmet training needs of frontline health care workers for COVID-19 containment in India
Authors: Madhumita Dobe  , Monalisha Sahu  , Chandrashekhar Taklikar  , Shibani Dutta
Published: May 2023

Aim: Frontline Health Care Workers (FLHCWs) are the key workforce in the fight against ongoing COVID-19 pandemic. They hail from the community and are responsible for supporting the health system in generating awareness, implementing preventive strategies, contact tracing and isolating potential cases. In their job responsibilities, FLHCWs thus may perceive heightened risk of exposure to the virus, leading to overwhelming emotional response and psychological distress. The objective of this study was to investigate risk perception, cognitive awareness and emotional responses among FLHCWs trained to deal with Covid 19, to identify unmet needs of this training in India.Methods: A cross-sectional study was conducted in a total of 131 frontline workers selected by a multistage sampling process from two states (Odisha and Himachal Pradesh) of India. The FLHCWs were interviewed personally (when feasible) with the help of a predesigned pretested semi-structured questionnaire.Results: The findings suggested that majority (90%) of the FLHCWs perceived that they are susceptible to nCoV-19 infection and 77.1% of FLHCWs felt high probability of them getting infected with the nCoV-19. Almost 90% of them responded that it is something they think about all the time and 41% of FLHCWs admitted that they feel helpless in the situation. About 63% of FLHCWs perceived that the nCoV-19 infection was a severe illness and 35% perceived it to be very severe and life threatening. Although most of them had received some unstructured and non-uniform training on preventive measures against COVID-19, yet only 38% felt that the knowledge was adequate to protect themselves from the nCoV-19 infection. The training sessions lacked psychological component for capacitating them with coping skills to address their emotional and psychological responses.
Conclusion: The FLHCWs experienced heightened risk perception and symptoms of emotional distress in significant numbers even after trainings. A more inclusive public health policy dialogue to address the emotional and psychological coping skills is needed for capacitation of these frontline workers to address the challenges of Pandemic response now and in future.
Level of satisfaction among primary health care workers in Kosovo
Authors: Haxhi Kamberi  , Vanesa Tanushi  , Muhamet Kadrija
Published: May 2023

Aim: The objective of this study was to assess the extent and selected corelates of work satisfaction among primary healthcare professionals in Kosovo.Methods: A cross-sectional study was conducted in selected regions of Kosovo during the period May-June 2022 including a representative sample of 500 primary healthcare workers (209 men and 291 women; overall mean age: 42.0±12.3 years). A structured 9-item questionnaire was administered to all participants aiming at assessing the level of satisfaction among primary healthcare workers (each item ranging from 1 [high] to 5 [low]). A summary score was calculated for all 9 items related to satisfaction level ranging from 9 (the highest satisfaction level) to 45 (the lowest satisfaction level). Binary logistic regression was used to assess the association of satisfaction level (dichotomized into “satisfied” vs. “unsatisfied”, based on median value of the summary score) with selected demographic factors and work characteristics of primary healthcare workers.Results: Mean summary score of the 9 items related to the satisfaction level of primary healthcare workers was about 23±5; median score was 23 (interquartile range: 20-26). In multivariable-adjusted logistic regression models, the level of satisfaction was not significantly related to any demographic factor, but positively associated with the years of working experience of primary healthcare workers [OR(for 1 year increment in the work experience)=1.03, 95%CI=1.00-1.05]
Conclusion: The evidence from this study conducted in Kosovo indicates no significant relationships of the level of satisfaction with demographic factors of primary healthcare workers, but a strong association with their working experience. Policymakers in Kosovo and in other countries should be aware of the importance of working conditions and working environment in order to gradually increase the level of satisfaction of the staff, which is a basic prerequisite for quality improvement of service delivery at primary healthcare level.
Complete Issue
Authors: Burazeri Genc , Laaser Ulrich , Martin-Moreno Jose , Schröder-Bäck Peter
Published: May 2023

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Syndromic surveillance in early detection of outbreaks of infectious diseases
Authors: Eugena Tomini  , Artan Simaku  , Elona Kureta  , Adela Vasili  , Silva Bino
Published: May 2023

Aim: Motivated by the threat of infectious diseases and bioterrorism, syndromic surveillance systems are being developed and implemented around the world. The aim of the study was to describe the early warning surveillance system in Albania.Methods: Syndromic surveillance is a primary health care-facility- and emergency room (ER)-based syndromic surveillance system aiming at detecting outbreaks and undertaking public health actions. It is based on weekly notifications of nine syndromes by over 1,600 General Practitioners (GPs) in the 36 districts of Albania. Data is aggregated by district epidemiologists (DE) and centralized by the national Institute of Public Health.Results: A syndrome is “a set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.” In the context of syndromic surveillance, a syndrome is a set of non-specific pre-diagnosis medical and other information that may indicate the release of a bioterrorism agent or natural disease outbreak.Since its inception, syndromic surveillance has mainly focused on early event detection: gathering and analysing data in advance of diagnostic case confirmation to give early warning of a possible outbreak.Conclusion: The system is useful for detecting and responding to natural disease outbreaks such as seasonal and pandemic flu, and thus they have the potential to significantly advance and modernize the practice of public health surveillance.
The Ethics effect
Authors: Schröder-Bäck Peter , Maeckelberghe Els , Bordonada Miguel Ángel Royo
Published: May 2023

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Disentangling the relationship between falls, fear of falling, physical function and walking by applying a socioecological framework to the International Mobility in Aging Study
Authors: Phoebe W. Hwang  , Mohammad Auais  , Afshin Vafaei  , Nicole T.A. Rosendaal  , Yan Yan Wu  , Catherine M. Pirkle
Published: May 2023

Introduction:The relationships between falls, fear of falling, poor mobility, and PA avoidance occur in a cyclic, multi-directional fashion. Aim: This study investigates the concomitant associations of fall history, fear of falling, and physical performance (SPPB) on physical activity using a cross-national sample of community-dwelling older adults from middle and high-income countries.Methods:Linear mixed-effects models looking at the influence of individual and environmental factors were used and participants were nested within each study site.Results:Estimated walking minutes was 52% lower for those with low SPPB compared to high SPPB, 20% lower for those with medium level fear of falling compared to low levels, and 50% lower for those with high level fear of falling compared to low levels.Conclusion:An individual’s fear of falling and physical performance may be important to consider when making PA recommendations to older adults regardless of sex, age, and environment.
Reducing the Burden of HIV and HCV among Sex Workers Who Use Drugs in France
Authors: Konstantinos Angoumis  , Amanda Langston  , Kristin Mosler  , Clémentine Rialland  , Mathilde Veys  , Jessica Neicun
Published: May 2023

Context:The far-reaching effects of the Covid-19 pandemic exacerbated the adverse working and living conditions of Sex Workers (SWs) in France. These consequences, coupled with illicit drug use, and reduced access to prevention measures raise concerns for the transmission of the Human Immunodeficiency virus (HIV) and Hepatitis C virus (HCV) among Sex Workers Who Use Drugs (SWWUD), creating an urgent call for targeted interventions. There is an acute need for accessible, ongoing care for SWWUD to prevent HIV and HCV infections and mitigate adverse health effects. Current French health services such as harm reduction and HIV/HCV prevention services often operate separately and seldom address SWs and People Who Use Drugs (PWUD) simultaneously. Given the compounding set of challenges that SWWUD face, a holistic approach to policy interventions must be considered.Policy Options:Firstly, integrated services are particularly effective in promoting harm reduction and improving the health of their users. When these services include substance use care and HIV services, uptake of these interventions and primary care utilisation increases due to enhanced accessibility. Secondly, pre-exposure prophylaxis (PrEP) and needle and syringe programs (NSP) are clinically effective prevention methods that, when coupled with point-of-care-testing (POCT), can reduce the prevalence of HIV and HCV and improve the monitoring of these viruses. Finally, willingness to engage with health services is impacted by the attitudes of healthcare staff. Sensitisation training can promote trauma-informed care, a non-judgemental approach in health workers, encouraging SWWUD to seek care and achieve better health outcomes.
Recommendations:A three-pronged approach to implementing integrated services is recommended. First, facilitating access to care can be attained through the linkage of patients to treatment, primary care, sexual and reproductive health, and social services. Existing service providers can be supported with interdisciplinary teams and telemedicine to reduce care fragmentation. Additionally, prevention and testing measures can be enhanced through the coordinated provision of needle and syringe programs, point-of-care testing, PrEP, and harm reduction supplies. These services should be linked to established integrated service centres to ensure a continuum of care. Finally, peer leaders may deliver sensitisation training for service providers to reduce stigma and improve understanding of the unique health needs of SWWUD. Integrated service providers should further employ peer leaders as peer navigators to promote the vision of community empowerment and inclusion.
Stemming the Tide of Disinformation in Public Health
Authors: Marie Derstroff  , Victoria E. Härtling  , Wilhelmiina Hölttä  , Mike H. Traub  , Linda A.P.J. van der Linden  , James C. Thomas
Published: May 2023

Context: Disinformation, or incorrect information that is intended to mislead, was pronounced during the COVID pandemic. Disinformation that steers away from life-saving practices or toward life-threatening practices can be fatal. The European Union has in place policies and offices to combat disinformation. However, they lack the full mandate and clarity of systems to meet the needs for quick and effective responses.Policy Options:Means to enhance the effectiveness of existing policies include [1] clarifying a rapid response framework, [2] enhancing media literacy in the public, [3] inoculating the public against anticipated disinformation, and [4] engendering public trust through coordinated and consistent communication.
Recommendations:Among these four, options 2 and 3 were deemed the best opportunities for quick action, early successes, and the fewest institutional or political hurdles. We recommend [a] that the EU Commission establishes an EU Media Agency with a solid governance structure to support innovative media literacy undertakings and successful implementation; [b] that the existing Media Literacy Expert Group create a media literacy program implementation framework; and [c] that existing EU initiatives on disinformation debunking, media literacy, and inoculation strategies be merged into a single Misinformation Community within the European Institute of Innovation and Technology [EIT].
Advancing policies for public health benefit: A collection of policy briefs developed by the Maastricht University students
Authors: John Middleton  , Katarzyna Czabanowska
Published: May 2023

Where there is no vision, the people perish’ has never been truer than today. We need new models of how to train the future public health leaders in the 21st century to improve and protect people and planet”. The Maastricht University Public Health Leadership course has been described previously (1). The course aims to create leaders with vision, who can see a future different to the status quo, who can influence and drive change, who are able to communicate their vision and win others to embrace and implement it.
Smoking prevalence among the adult population of Kosovo: Results of STEPS survey 2019
Authors: Sanije Hoxha-Gashi  , Musli Gashi  , Naser Ramadani  , Sefedin Muçaj  , Myvedete Tërshnjaku
Published: May 2023

Aim: Tobacco use remains the leading preventable cause of death worldwide. The vast majority of these deaths occur in low – and middle-income countries, and the gap is expected to widen further in the coming decades. This study aimed to evaluate the prevalence of smoking among Kosovo adults by gender, age group and type of smoking.Methods: A population-based survey was conducted among people aged 18-69 years from April 2018 to June 2019 using the WHO STEPs instrument. 2800 randomly selected households were approached using multistage cluster sampling, and 2695 agreed to participate in the survey (response rate 96.2%).Results: According to the findings of our study, 25.7% of the population aged 18-69 years was a current smoker (men 35.3% vs. women 15.9%) and 90.1% of them smoked tobacco products on a daily basis (Men 91.5% current smokers on daily basis vs. Women 87.1% on daily basis). Smokers started smoking at an average age of 19.3 years. Women started smoking significantly later than men, at the age of 20.9 years, compared to 18.6 years for men, and the younger age group started smoking earlier. The average smoking duration is 19.3 years, with no gender differences (Men 19.5 years vs. Women 19.0 years average smoking duration). On average, 97.4% of daily smokers smoke manufactured cigarettes.Conclusion: Smoking prevalence was high among Kosovo adults, especially men and the majority of them smoke on daily basis.
Methods Of Physical Exercise As A Way To Optimize The Physical Condition Of Football Players: A Systematic Review
Authors: Pomo warih Adi  , Singgih Hendarto  , Sapta Kunta Purnama  , Rumi Iqbal Doewes  , Sugiyanto  , Muchsin Doewes
Published: May 2023

Objective: Investigating the training methods used to optimize the physical condition of football players and describing the results of each study.Methods: This is a systematic review of published research. Articles published between 2015 and 2021 describing training methods to improve the physical condition of football players were reviewed. Electronic searches were conducted via Google Scholar, Web of Science, Scopus, and PubMed. All articles presenting methods of physical exercise to improve physical condition performance were included.Results: There were 41 articles that used training methods to improve the physical condition of football players. From these articles, they are grouped according to the physical condition that is assessed and which is improved. Some of the training methods that can be used include neuromuscular, unilateral and bilateral, ballistic, plyometric, combined weight & plyometric, mixed training with optimum load, complex COD & plyometric, strength, combined strength, eccentric, repeated-sprint, resisted/unresisted sprint, resistance, elastic band, core, combine core & small-sided games, aerobic interval training, blood flow restriction aerobic interval training, intermittent, anaerobic speed endurance, high-intensity interval training, high-intensity interval training & small-sided games, tabata sprint, very-heavy sled, pilates, and functional.Conclusion: After a systematic review, several training programs were found to improve the physical condition of football players such as strength, aerobic and anaerobic endurance, muscle power, speed and acceleration, flexibility, agility, and balance.
Health-related behaviour among managers of Slovenian hospitals and institutes of public health
Authors: Farkas Jerneja , Lainscak Mitja , Kukec Andreja , Kosnik Mitja
Published: May 2023

Aim: Behavioural risk factors have a significant impact on health. We aimed to assess health-related behaviour, health status, and use of healthcare services among managers of Slovenian hospitals and institutes of public health.
Methods: This was a cross-sectional study which included management (directors, scientific directors, directors’ deputies) of Slovenian hospitals and institutes of public health (63 respondents; 57% women; overall mean age: 51±7 years; response rate: 74%). Data were obtained using an anonymous self-administered questionnaire.
Results: About 35% of respondents were directors. More than half of the respondents were overweight or obese (52%), the majority were not sufficiently physically active (59%) and overloaded with stress (87%). Hypercholesterolemia (36%), spinal disease (17%), and arterial hypertension (16%) were most common chronic diseases. Whilst only few participants visited their general practitioner due their health complaints, blood pressure (76%), cholesterol (51%), and glucose (54%) were measured within last year in most of the respondents.
Conclusion: Our findings point to a high prevalence of overweight and obesity as well as workplace-related stress among Slovenian public health managers. Therefore, effective preventive strategies should be focused on stress management along with promotion of healthy behavioural patterns.
Sex-differences in socioeconomic status and health-seeking behaviour among tuberculosis patients in transitional Albania in 2012-2013
Authors: Kurti Vera , Hafizi Hasan , Kurt Bardhyl , Marku Fitim , Mema Donika , Burazeri Genc
Published: May 2023

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.
What we need to improve the Public Health Workforce in Europe?
Authors: Bjegovic-Mikanovic Vesna , Czabanowska Katarzyna , Flahault Antoine , Otok Robert , M. Shortell5 Stephen , Wisbaum Wendy , Laaser Ulrich
Published: May 2023

With the growth and complexity of current challenges such as globalization, health threats, and ageing society, financial constraints, and social and health inequalities, amultidisciplinary public health workforce is needed, supported by new skills and expertise. It has been demonstrated that public health education needs to include a wider range of health related professionals including: managers, health promotion specialists, health economists, lawyers and pharmacists. In the future, public health professionals will increasingly require enhanced communication and leadership skills, as well as a broad, interdisciplinary focus, if they are to truly impact upon the health of the population and compete successfully in today‘s job market. New developments comprise flexible academic programmes, lifelong learning, employability, and accreditation. In Europe‘s current climate of extreme funding constraints, the need for upgrading public health training and education is more important than ever. The broad supportive environment and context for change are in place. By focusing on assessment and evaluation of the current context, coordination and joint efforts to promote competency-based education, and support and growth of new developments, a stronger, more versatile and much needed workforce will be developed.
Shaping and authorising a public health profession
Authors: Czabanowska Katarzyna , Laaser Ulrich , Stjernberg Louise
Published: May 2023

The aim of this short report is to stimulate a discussion on the state of a public healthprofession in Europe and actions which need to be taken to authorise public healthprofessionals based on their competencies. While regulated professions such as medicaldoctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these influential (elite) professions. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself; secondly, we explain who public health professionals are and what usually is required for shaping the public health profession; and thirdly, we attempt to sketch the road to the authorisation or licensing of public health professionals. Finally, we propose some recommendations.
Control of public expenditure on drug products in Bulgaria – Policies and outcomes
Authors: Vekov Toni Yonkov
Published: May 2023

Aim: The aim of this study was to assess the economic performance of the application of the policy for negotiating discounts on drug products and agreements on the controlled access of patients in Bulgaria.
Methods: The methodology involves comparison of the amounts of public spending on medicines in two periods – during the course of the analyzed drug policies (January 2007 – June 2009), and the period in which negotiations on the price of medicines and programs for the controlled access of the patients was discontinued (July 2009 – December 2012).
Results: In Bulgaria, the government did not apply methods for controlling publicexpenditure on medicines bargaining price concessions from manufacturers andimplementing agreements on controlled access of patients after June 2009. This led to an annual increase in the expenditures on drug products for home treatment (on average, 17% for the period 2009-2012).
Conclusion: This trend in Bulgaria will continue in the future since expenditure control only through price control by means of a reference system and the positive list of medicines is ineffective. There is a need for implementation of combined drug policies in Bulgaria in the form of negotiations on rebates with manufacturers and agreements on controlled access of patients and reference pricing.
Geophagia: A cultural-nutrition health-seeking behaviour with no redeeming psycho-social qualities
Authors: D. Norman Ishmael , N. Binka Fred , H. Godi Anthony
Published: May 2023

Aim: We investigated if Geophagia is restricted to only pregnant and lactating women in Ghana. We also investigated if the key driver of Geophagia is poverty and other socio-cultural factors.
Methods: This analysis was part of a broader national study of resilience among thepopulation of Ghana (N=2,000). Regional comparisons were made possible due to the stratified and random selection of representations that were similar in characteristics such as being urban or rural, ethnicity, religion and gender.
Results: It was found that Geophagia was present among both females and males and was not restricted to pregnant and lactating women. Geophagia was not driven by poverty or the lack of formal education or the presence of gainful employment. Geophagia was practiced by both urban and rural residents irrespective of religious proclivities and devotion. The assertion that Geophagia was an instinctive primordial response to gastro-intestinal disturbances was not sustained by the data in this study, although the literature review suggested such in calves and lambs.
Conclusion: In order to address the potential health threats posed by Geophagia, the key cultural drivers need to be studied and understood. We also need to appreciate the shocks and stresses that create such desires. It is not a case of mental illness and it cannot be concluded that Geophagia is driven by a psychiatric disorder. This paper would be disseminated to inform policy in Ghana and beyond.
Health seeking behaviour among caregivers of under-five children in Edo State, Nigeria
Authors: Q.Aigbokhaode Adesuwa , C.Isah Essy , R.Isara Alphonsus
Published: May 2023

Aim: Timely and appropriate healthcare seeking behaviours if practiced by caregivers of under-five children can have a significant impact on child survival. This study assessed the knowledge of, and general health seeking practices among mothers of under-five children in Nigeria.
Methods: This descriptive cross-sectional study was carried out among caregivers of under-five children in Edo State, Nigeria, in 2013. A multi-staged sampling technique was used to recruit respondents. Data collection was done by means of a structured interviewer-administered questionnaire adapted from UNICEF/IMCI household baseline survey questionnaire.
Results: A total of 370 caregivers (mean age: 31.1±5.9 years) participated in the study. Almost all of them were females 368 (99.5%), 234 (63.2%) had secondary education and 283 (76.5%) were in the unskilled social class. Over 70%, 76%, 72%, 76% and 82% of participants did not know that being unable to eat/drink, fast breathing, blood in stool and convulsion, respectively, were symptoms of a child not feeling well. The place of primary care of children by caregivers was at home 142 (38.4%), chemist shop 91 (24.6%) and health facility 80 (21.6%). Cost and long waiting time were major reasons for not seeking care in health facilities.
Conclusion: This study showed poor health seeking practices among caregivers of under-five children in Edo State, Nigeria. There should be continuous education of  caregivers on recognition of danger signs in children and the need to seek appropriate medical care in health facilities.
The history of European public health education accreditation in perspective
Authors: D. Goodman Julien
Published: May 2023

Aim: The aim of this paper is to investigate the history of accreditation of academic public health education and understand why there is a 65 year gap between the first system in America and the uptake of accreditation in Europe. The paper intends to search for parallels and dissimilarities between the development in America and Europe and then consider if any parallels could be used for determining the future role of accreditation in Europe.
Methods: The paper draws heavily upon a literature review and analysis and the examination and interpretation of primary and secondary sources. Firstly there is an exploration of the American development which is complemented by an evaluation of the developments in Europe.
Results: The paper demonstrates that there are two key features required for the development of accreditation: interstate collaboration and a liberalisation or opening up of the education market.
Conclusions: Since the Second World War, Europe has embraced interstate collaboration which has led to a liberalisation of certain economic markets. The future for sector based accreditation of public health education will be determined by the extent Europe pursues liberalisation and whether a competitive environment will bring into question the transparency and trust in state sponsored accreditation agencies.
The Maastricht Treaty 1992: Taking stock of the past and looking at future perspectives
Authors: Stein Hans
Published: May 2023

Aim: The article contains a personal view of the history as well as the future of the European Union‟s (EU) health policy. Describing and evaluating the developments on the road from the Treaty of Maastricht to a new Europe it asks and tries to answer the question if weespecially the EU Member States – really know where we want to go to and how to get there.
Method: Based on personal experiences, countless EU documents, as well as scientific publications the paper shows the impact EU Health policy has had in the Member States in the past.
Historical development: Considering that the legal basis for health has been and remains to be very weak limiting EU action to support, coordinate, and supplement actions of Member States – which, as a rule, still consider health to be first and foremost a national responsibility and therefore do not want interference from international institutions – the amount and content of EU health activities in the past years has been quite remarkable. Health policy may not be an EU priority and as a crosscutting policy sector it is dominated by many other EUpolicies. However, especially the “hard law” regulations and directives of the Internal Market give EU the power and competence to achieve health objectives. The size of this growing influence is shown by direct interventions, made possible by the legal acts to improve economic policy coordination. Health and health care in this context are considered as a key policy area for economic growth and EU macroeconomic policy. On the other hand, there isrisk that such regulations affecting health policy  and population health may be dominated too much by economic institutions and their interests, whereas health authorities play onlyminor role to date.
Conclusion: For the future of EU health policy it is essential that its position is considerably strengthened, in order to assure that health interests of the EU population are sufficiently safeguarded.
Complete Issue
Authors: Burazer Genc , Laaser Ulrich , Martin-Moreno Jose , Schröder-Bäck Peter
Published: May 2023

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E-health and m-health: Great potentials for health and wellbeing, but also for harmonization and European integration in health
Authors: Bozikov Jadranka
Published: May 2023

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Estimating health impacts and economic costs of air pollution in the Republic of Macedonia
Authors: Meisner Craig , Gjorgjev Dragan , Tozija Fimka
Published: May 2023

Aim: This paper assesses the magnitude of health impacts and economic costs of fine particulate matter (PM) air pollution in the Republic of Macedonia.
Methods: Ambient PM10 and PM2.5 monitoring data were combined with population characteristics and exposure-response functions to calculate the incidence of several health end-points known to be highly influenced by air pollution. Health impacts were converted to Disability-Adjusted Life Years (DALYs) and then translated into economic terms using three valuation approaches to form lower and higher bounds: the (adjusted) Human Capital Approach (HCA), Value of a Statistical Life (VSL) and the COI (cost of illness).
Results: Fine particulate matter frequently exceeds daily and annual limit values andinfluences a person‟s day-to-day health and their ability to work. Converting lost years of life and disabilities into DALYs - these health effects represent an annual economic cost of approximately €253 million or 3.2% of GDP (midpoint estimate). Premature death accounts for over 90% of the total health burden since this represents a loss of total life-long income. A reduction of even 1μg/m3 in ambient PM10 or PM 2.5 would imply 195 fewer deaths and represent an economic savings of €34 million per year in reduced health costs.
Conclusion: Interventions that reduce ambient PM10 or PM2.5 have significant economic savings in both the short and long run. Currently, these benefits (costs) are „hidden‟ due to the lack of information linking air quality and health outcomes and translating this into economic terms. Policymakers seeking ways to improve the public‟s health and lessen the burden on the health system could focus on a narrow set of air pollution sources to achieve these goals