bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
Influence of a six-month strengthening programme on HbA1c, cholesterol and triglycerides in type II diabetics: A pilot study
Authors: Wenzel Helmut , Unger Edgar 
Published: May 2023

Aim: To assess the feasibility and effectiveness of resistance training on glycaemic control in adults with type 2 diabetes, the additional risk factors including low physical activity, measured by HbA1c, body weight, cholesterol and triglycerides.
Methods: We conducted a pilot study as a pre-and-post study with no control group. Participants had to meet the following inclusion criteria: type 2 diabetic person, 45-75 years old, duration of diabetes <10 years, no experience with resistance training within the last ten years, willingness to attend regularly the training sessions (two training units per week, with 45 mi­nutes of duration each). Furthermore, a certificate from the treating physician (diabetologist) was requested, testifying that there were no medical reasons against participation. Patients with severe accompanying diseases, high blood pressure, heart failure (NYHA III), or retinopathy were excluded. Eighteen persons (10 men, 8 women), aged 46-71 years could be included. Due to dropouts, the pre-post-evaluation was based on 13 individuals only. Mean age of this group (6 men, 7 women) was 63.6±5.5 years. Mean body mass index at the beginning was 29.8±4.9. Mean HbA1c was 7.5%±0.6%; the triglycerides were in the range between 134 mg/dl and 335 mg/dl with an average value of 195.8±50.9 mg/dl. Cholesterol level was between 149 mg/dl and 262 mg/dl, which corresponded to an average of 206.6±34.8 mg/dl. The training took place in a fitness centre under the supervision of a certified sports scientist between April 2010 and October 2010 for 28 weeks. During the training period, the patients were asked to report whether they changed their level of general physical activity during this period, as a potential confounder. Possible treatment adaptations had to be recorded.
Results: At the end of the study, the average HbA1c dropped from 7.5%±0.6% to 7.1%±0.8%. Mean cholesterol level dropped from 206.6±34.8 mg/dl to 191.3± 30.85 mg/dl. Mean triglycerides were lowered from 195.8±50.9 mg/dl to 144±30 mg/dl. These changes were all statistically significant (P<0.05). The dose-response curve was not significant, probably due to the small number of participants.
Conclusions: There is now suggestive evidence supporting the use of resistance training for improving glycaemic control and insulin sensitivity in type 2 diabetes. However, this has not been perceived clearly enough to date. It is also not in the focus of economic evaluations of diabetes preventing strategies. Activating diabetic patients to perform resistance training is an effective and efficient way to reduce the burden of diabetes and, even more, to prevent this disease.
Ten years onwards: Comparison of the South Eastern European regional public health strategy 2004 and the South Eastern European 2020 strategy
Authors: Wiskow Christiane , Ruseva Maria , Laaser Ulrich 
Published: May 2023

Aim: Regional collaboration has continuously contributed to the development of public health in the South Eastern Europe (SEE) region since 2000 when the Public Health Collaboration in SEE (PH-SEE) was initiated. This article looks into two frameworks for regional collaboration in the area of public health: a framework developed in 2004 by a network of public health professionals and academics, and another one developed by the SEE Health Network as integral part of the SEE 2020 strategy on Jobs and Prosperity in a European Perspective, adopted in 2013. It compares the commonalities and differences of the two frameworks; considers what is still valid and relevant after ten years and which new features have emerged in the new strategy.
Methods: A literature review was carried out and a qualitative analysis was applied for the comparison of the two frameworks.
Results: Notwithstanding the time gap of nearly ten years, the commonalities between the two regional health strategies are significant. Major consistent goals include: improving equity in health; strengthening human resources for health; improving intersectoral cooperation and governance. The differences between the two regional strategies, including issues around social participation and regional health information systems, are partially due to their different development context. Cross-border policies and quality management have emerged as new or more pronounced topics in the SEE 2020 strategy’s health dimension.
Conclusions: Many aspects addressed in the 2004 framework are pertinent with regard to the SEE 2020 health dimension and remain relevant in the current context. The integration of health as part of the economic SEE 2020 strategy reflects a significant paradigm shift and important step forward for public health
Performance of the public health care sector in the Republic of Macedonia
Authors: Mitevska Lolita , Stanculescu Manuela Sofia , Stikova Elisaveta 
Published: May 2023

Aim: Healthcare authorities constantly search for new approaches of assessing the performance of the health sector. Comparative studies help for improvements in healthcare by learning from each-other. Our aim was to assess the performance of the public healthcare system in the Republic of Macedonia, through the analysis of preparedness of institutions to fulfill the population’s healthcare needs and expectations.
Methods: This study had a regional character. The national research team interviewed 175 randomly selected participants from Macedonia. The research was performed in the period March 2012 – March 2013. For the research purposes there were used especially designed questionnaires for cancer, stroke, myocardial infarction, diabetes mellitus and injuries. For assessment of the performances, the appropriate techniques were developed.
Results: Macedonians consider public healthcare system as being medium-good in all aspects: accessibility, availability, quality of health care services and population’s confidence. The knowledgeable observers (N=125) believe that state-of-the-art treatment exist all over the country (“yes”: 33.6% and “rather yes”: 44.8%). They believe that the services are accessible to everybody, free of major charges (“yes”: 31.2% and “rather yes”: 45.6%). The individual witnesses (N=50) argued toward lack of pharmacies and proper medicines in rural areas, with a gap between the availability and quality of services in rural vs. urban areas.
Conclusion: The future goals for Macedonia include better public healthcare financing, cost definition of health packages, improved disease prevention and effective human resources.
Trends and demographic characteristics of hemorrhagic stroke in Albania during the period 2004-2015
Authors: Gjorgji Petrit , Kruja Jera 
Published: May 2023

Aim: Our aim was to describe the trend over time and the demographic distribution of hemorrhagic stroke in Albania in the past decade.
Methods: This study included all patients diagnosed with hemorrhagic stroke and admitted during the period 2004-2015 at the University Hospital Center “Mother Teresa” in Tirana (988 cases overall; 34% women; overall mean age: 57.8±19.3 years). Information about selected demographic characteristics was also collected for all study participants.
Results: The proportion of older patients (≥70 years) was slightly, but not significantly, higher in women than in men (32% vs. 27%, respectively; P=0.163). Furthermore, the proportion of Tirana residents was similar in both sexes (47% in men vs. 45% in women). Overall, there was evidence of a significant linear trend over time (Mann-Kendall test: P<0.01), indicating a gradual increase in the number of hemorrhagic stroke cases in Albania for the period 2004-2015.
Conclusion: This study provides useful information about the increasing trend of hemorrhagic stroke in Albania, a transitional country in Southeastern Europe which is characterized by rapid changes including unhealthy dietary habits.
Correlates of rheumatoid arthritis among women in Albania
Authors: Kollcaku Julia , Kollcaku Artur 
Published: May 2023

Aim: Our aim was to assess the association of rheumatoid arthritis with socio-demographic characteristics and lifestyle factors among women in transitional Albania.
Methods: A cross-sectional study was carried out in 2012-2013 including a sample of 2198 women aged 30 years and above who attended the Rheumatology services at primary health care clinics in Tirana municipality (mean age: 60.2±9.7 years; overall response rate: 95%). The diagnosis of rheumatoid arthritis was based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria. In addition, a structured questionnaire was administered to all study participants including information on demographic and socioeconomic characteristics and behavioral factors. Binary logistic regression was used to assess the association of rheumatoid arthritis with covariates.
Results: Overall, 437 (19.9%) women were diagnosed with rheumatoid arthritis (both incident and prevalent cases). In multivariable-adjusted models, rheumatoid arthritis was positively and significantly related to older age (OR=1.8, 95%CI=1.3-2.6), a lower educational attainment (OR=1.4, 95%CI=1.1-1.9), smoking (OR=1.5, 95%CI=1.1-2.0), alcohol intake (OR=1.9, 95%CI=1.2-3.1) and overweight and obesity (OR=1.5, 95%CI=1.2-2.0 and OR=1.6, 95%CI=1.2-2.0, respectively).
Conclusion: This study provides useful evidence about selected correlates of rheumatoid arthritis among women attending specialized primary health care services in Albania. Health professionals and policymakers in Albania should be aware of the magnitude and consequences of this chronic condition in the adult population.
Launch of the ‘One Health Global Think-Tank for Sustainable Health & Well-being’ – 2030 (GHW-2030)
Authors: Laaser Ulrich , Lueddeke Dr George , Nurse Dr Joanna 
Published: May 2023

The central mission of the GHW-2030 multi-sectoral think tank is to contribute to the implementation of the UN Sustainable Development Goals (SDGs) by working toward achieving the education and health goals in cooperation with the Commonwealth Secretariat using an international interdisciplinary/multidisciplinary/transdisciplinary global One Health approach. A major focus of the think tank will be on the health and well-being – physical, emotional, aspirational – of children and young people particularly as these relate to their personal security, physical and emotional well-being, education and employment and the sustainability of life on the planet.
Trajectories of life satisfaction during one-year period among university students: Relations with measures of achievement strategies and perception of criteria for adulthood
Authors: Piumatti Giovanni 
Published: May 2023

Aim: The aim of this study was to examine how university students’ achievement strategies in an academic context and perceptions of criteria for adulthood relate to life satisfaction trajectories across one year.
Methods: A convenience sample of 143 young adults 18-28 years (mean age: 20.9±2.7 years; 109 females and 34 males) attending the University of Turin in northwest Italy completed questionnaires at three points with a six-month interval between each measurement. Latent Growth Curve Modelling and Latent Class Growth Analysis were used to assess longitudinal changes in life satisfaction and the related heterogeneity within the current sample.
Results: Three trajectories of life satisfaction emerged: high stable (37%), moderate decreasing (57%), and low stable (6%). At every time point high success expectations were related to a high stable life satisfaction trajectory. In turn, those adopting achievement avoidance strategies were more likely to have low-stable or moderately decreasing life satisfaction trajectories. The perception of the criteria deemed important to be defined as adults did not change across time points or across life satisfaction trajectories’ groups.
Conclusion: These findings suggest that self-reported measures of achievement strategies among university students relate longitudinally to life satisfaction levels. Positive and optimistic dimensions of personal striving may be protective factors against the risk of decrease of life satisfaction among university students.
Investigations on Rare Earth Elements in Sediments from South Vellar Estuary along Bay of Bengal and Palk Strait, Tamil Nadu, India
Authors: Mookkan Velmurugan Puliyakurichi , Vijayaprabhakaran Krishnan , Thangappan Devika Periyathambi , Suhail Meer Mohammad 
Published: May 2023

The rare earth elements (REEs) in the sediments of the South Vellar estuary on the eastern coast of India were measured using thermal ionization mass spectrometry (TIMS). Lanthanides (La-Lu) and a number of other elements (Cr, Ni, Zn, Pb, Ag, Co, Cd, and V) were studied in bed sediment samples. The estuary’s total REE content (REE) ranges from 73.30 to 360.50 g/g. Continental weathering has a substantial impact on the distribution of REEs. Using factor analysis on the elemental data, two important groups of elements were identified: (a) LREEs, HREEs, Pb, Ag, and Cd, revealing an association with river detritals; and (b) Co, Ni, Zn, Cr, and V, indicating complex estuary processes. Because of the silicate weathering of crustal materials and the resultant increase in LREEs in detritals, LREEs are more enriched than HREEs. We get to the conclusion that 30% of HREE flux and 70% of LREE flux to the Bay of Bengal are provided by the estuarine system.
Manual para la aplicación de la norma IATF 16949-2016 en departamentos de producción y mantenimiento
Authors: Franco Baltazar Angel Adad , Becerra Rodríguez María Blanca , Hernández Hernández Arturo , López Navarro Isabel Ernestina , Zea Pérez José Marcos 
Published: May 2023

El propósito de este manual fue implementar la norma IATF16949-2016, en los departamentos de producción y mantenimiento en una empresa de botas de hule, con el fin de realizar una mejora continua y sistemática en la calidad del área de producción y de mantenimiento, además de aumentar la eficiencia en el proceso productivo; disminuyendo los desperdicios y defectos. Para llevar a cabo esto, se requiere la constante capacitación de las herramientas de CORE TOOLS, cuyo propósito es exigir la mayor calidad dentro del proceso para evitar rechazos por parte de los clientes. Algunos resultados obtenidos en las áreas de producción y mantenimiento fueron la diversidad de artículos como cámaras de llantas y tapetes para automóviles, en el área de mantenimiento se logró mantener los equipos en óptimas condiciones de funcionamiento. Como conclusión con este manual de la norma IATF 16949-2016 la empresa consiguió ingresar al sector del mercado automotriz