New terminology of medication adherence enabling and supporting activities: ENABLE terminology

Introduction: Medication non-adherence negatively affects the effectiveness of evidence-based therapies and sustainability of healthcare systems. Lack of agreed terminology of medication adherence enabling and supporting activities leads to underuse of the available tools. The ENABLE COST Action was aimed at proposing a new terminology for these activities in order to help both scientific research and its clinical application. Methods: Initial discussions within the ENABLE Working Groups allowed for the conceptualization of four interlinked terms related to adherence, i.e., "medication adherence technology", "medication adherence enhancing intervention", "best practice" and "reimbursement". The iterative process of internal discussion was structured around two dedicated international workshops. Moreover, extensive stakeholder consultations have been organised, including an interactive online survey used to assess the level of agreement with, and the clarity of relevant terms and definitions proposed. Results: Detailed analysis of the results of this process allowed for fine-tuning of the items, and finally, for proposing the final set of definitions. Across all the three phases of this process, the definitions were substantially modified to better reflect the concepts, simplify the language, and assure completeness and cohesiveness of terminology. Feedback obtained from the stakeholders helped this process and confirmed that the final terms and definitions were well received by the experts active in the field of medication adherence. Discussion: Covering the gap in the existing terminology, this work proposes a cohesive set of terms and definitions applicable to medication adherence enabling and supporting activities. Promoting evidence-based approach to this field, this terminology may help research, clinical practice and policy.

Assessment of the Albanian University female students' knowledge, attitudes, and practices on cervical cancer

INTRODUCTION

Cervical cancer is highly preventable and if diagnosed and treated early, highly curable. Yet it remains the fourth most common cancer in women worldwide. In Albania, cervical cancer is the second most frequent cancer among women 15 - 44 years. A national cervical cancer screening program has been established, which offers HPV tests as part of routine examinations in primary health care centres.

AIM

To assess knowledge, attitude, and practices (KAP) as well as associated factors regarding cervical cancer, among Albanian University female students, and provide useful information for the development of evidence-based preventive strategies for the future.

METHODOLOGY

A cross-sectional KAP study was conducted among Albanian University female students during March to May 2022. A total of 503 female students participated in the study (response rate of 82%). A Google questionnaire based on WHO guidance and similar KAP surveys was used to collect the study data. Descriptive analysis was used to analyze the knowledge, attitude, and practices of Albanian female students regarding cervical cancer.

RESULTS

Overall, most students in the study (71.2%) had little knowledge about cervical cancer. Only a fifth of them (20.7%) knew about HPV as a risk factor for the disease with a smaller proportion (18.9%) recognized HPV vaccine as a preventive method. In terms of risky behaviors: 45.9% of respondents showed a positive attitude towards condom use; with 17.7% of students reporting several sexual partners. Only 6.8% of respondents had ever done an HPV test and a total of 7.5% were HPV vaccinated.

CONCLUSIONS

The study showed that respondents had a low level of knowledge and unfavorable attitudes about cervical cancer including risk factors, screening, and preventive procedures. The findings could serve as baseline information for further research in this area and highlight the need for more effective information-education-communication strategies to stimulate and support a shift towards positive behaviors of this target group.

Association of Cardiovascular Disease Risk and Health-Related Behaviors in Stroke Patients

Brain stroke continues to be a leading cause of mortality and disability in both developed and developing countries, with higher healthcare costs due to the long-term care and rehabilitation that it incurs. The purpose of the current study was to assess the association between brain stroke patients' health-related behaviors and their risk for cardiovascular disease.

METHODS

A cross-sectional study was carried out from March to August 2022 in the Vlora district regional hospital in Albania. The study included 150 out of 170 participants who met the necessary criteria, achieving an 88% response rate. Measurement tools included the Framingham Cardiovascular Risk Scale (FRS) and the Lifestyle Health Promotion Profile II (HPLP II).

RESULTS

The patients' average age was 65.9 ± 9.04 years. Over 65% of the stroke patients suffer from diabetes, and 47% from hypertension. About 31% of them have a high risk of hyperlipidemia (mean TC = 179 ± 28.5). About 32% of the brain stroke patients manifested unhealthy behaviors, while 84% of them had a high risk of cardiovascular disease (FRS = 19.5 ± 0.53). Cardiovascular disease (CVD) risk was statistically associated with stress management behaviors (p = 0.008; OR = 0.20; CI = 95%). This risk was highest in the over-70 age group as well as in men.

CONCLUSION

Brain stroke patients had a high probability of developing CVD. For better health among stroke patients, new evidence-based behavior change approaches must be introduced into preventative and management programs.

Albanian university students' knowledge, attitudes, and practices regarding COVID-19 infection and vaccine: A cross-sectional study

INTRODUCTION

COVID-19 pandemic remains a public health concern worldwide. Given that, students represent a subgroup of the population with an impact on the pandemic.

AIM

The aim of this study is to evaluate the knowledge, attitudes, and practices of Albanian students about COVID-19, and to provide a database to plan and implement preventive evidence-based interventions.

METHODOLOGY

An online survey was conducted among Albanian university students during April-May 2022, to collect information on their knowledge, attitudes, and practices related to COVID-19, through a structured questionnaire.

RESULTS

A total of 906 students, 72.8% females, were included in it. 93.4% of participants knew the ways of transmission of COVID-19; 92.5% had information about preventive measures, but only 30% knew about quarantine and 37.0% knew vaccination as a preventive measure. Regarding attitudes, 54.8% of participants believed that COVID-19 infection is very dangerous. 46.5% have a negative attitude toward covid vaccines. Almost all respondents (93.7%) apply regular hand washing as a preventive measure; 82.8% cover their mouth when coughing or sneezing; but only 28.2% always use a mask indoors.

CONCLUSIONS

Albanian university students had good knowledge, positive attitudes, and appropriate preventive practices against COVID-19, but the study found that some limitations in terms of information and misconceptions still exist. Raising awareness and providing adequate information, education, and more effective communication programs will have a positive impact on increasing knowledge, improving attitudes, and supporting the required student behavior change.

Impact of COVID-19 Outbreak in Healthcare of People with Type 2 Diabetes: Evidence from a Cross-Sectional Study

Objective The aim was to assess the impact of the COVID-19 outbreak on the health care of type 2 diabetes patients and identify the correlated factors. Research Design and Methods A cross-sectional study was carried out from November 2020 to February 2021. The study enrolled 400 adults with type 2 diabetes aged 40–65 with at least one other chronic illness receiving health services in primary care in Vlore, Albania. A short questionnaire based on literature, taking into account the situation of the COVID-19 pandemic, was used for the data collection. The administration of the questionnaire was done by trained nurses. All participants gave their written informed consent before administering the questionnaire. Two-tailed Pearson correlation and linear regression were used to test the correlations.  Results                                                                                Among 400 patients with type 2 diabetes in the study, 53.0% were female and 47.0% were men. Most of the participants were married (n = 303) with a high level of education (54.3%). Treatment was mainly with oral medications (58.0%). Based on body mass index, 63.0% of participants were overweight. Employment status (p = 003), the type of treatment, oral medication vs insulin (p = 001), body mass index (p = 001), and living alone (p = 008) were the more correlated factors.  Conclusions Care of type 2 diabetic patients due to the COVID-19 pandemic is closely associated with social determinants of health and the resources of healthcare settings. The need to address innovative approaches to care including self-care, social support, and e-health is recommended.    

European Network to Advance Best Practices and Technology on Medication Adherence: Mission Statement

Medication non-adherence is associated with almost 200,000 deaths annually and €80-125 billion in the European Union. Novel technological advances (smart pill bottles, digital inhalers and spacers, electronic pill blisters, e-injection pens, e-Health applications, big data) could help managing non-adherence. Healthcare professionals seem however inadequately informed about non-adherence, availability of technological solutions in daily practice is limited, and collaborative efforts to push forward their implementation are scarce. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) aims to 1) raise awareness of adherence enhancing solutions, 2) foster knowledge on medication adherence, 3) accelerate clinical application of novel technologies and 4) work collaboratively towards economically viable policy, and implementation of adherence enhancing technology across healthcare systems.

A Cross-Sectional Survey on Medication Management Practices for Noncommunicable Diseases in Europe During the Second Wave of the COVID-19 Pandemic

Maintaining healthcare for noncommunicable diseases (NCDs) is particularly important during the COVID-19 pandemic; however, diversion of resources to acute care, and physical distancing restrictions markedly affected management of NCDs. We aimed to assess the medication management practices in place for NCDs during the second wave of the COVID-19 pandemic across European countries. In December 2020, the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) conducted a cross-sectional, web-based survey in 38 European and one non-European countries. Besides descriptive statistics of responses, nonparametric tests and generalized linear models were used to evaluate the impact on available NCD services of the number of COVID-19 cases and deaths per 100,000 inhabitants, and gross domestic product (GDP) per capita. Fifty-three collaborators from 39 countries completed the survey. In 35 (90%) countries face-to-face primary-care, and out-patient consultations were reduced during the COVID-19 pandemic. The mean ± SD number of available forms of teleconsultation services in the public healthcare system was 3 ± 1.3. Electronic prescriptions were available in 36 (92%) countries. Online ordering and home delivery of prescription medication (avoiding pharmacy visits) were available in 18 (46%) and 26 (67%) countries, respectively. In 20 (51%) countries our respondents were unaware of any national guidelines regarding maintaining medication availability for NCDs, nor advice for patients on how to ensure access to medication and adherence during the pandemic. Our results point to an urgent need for a paradigm shift in NCD-related healthcare services to assure the maintenance of chronic pharmacological treatments during COVID-19 outbreaks, as well as possible future disasters.

Is the mental health of young students and their family members affected during the quarantine period? Evidence from the COVID-19 pandemic in Albania

WHAT IS KNOWN ON THE SUBJECT?: Mental health is deteriorated during the quarantine period. Mental health status is affected by the quarantine even after the end of it and for an extended period. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Depression levels among nursing/midwifery students during the quarantine period are high. Depression levels among students' family members during the quarantine period are high. Those who are not satisfied with COVID-19 prevention measures and those who believe that COVID-19 and quarantine can cause problems on health, have elevated levels of depression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Provision of mental health services during the quarantine period should be a priority for the healthcare system. Offering mental health first aid training and support can improve the mental health status of students and their family members. ABSTRACT: Introduction The use of quarantine method has a significant impact on mental health status. Aim This study aimed to assess the levels of depression among bachelor and master university students (nurses/midwives) and their family members' during the quarantine period of COVID-19 pandemic. Method A cross-sectional study was conducted in Vlora University, Albania. Patient Health Questionnaire (PHQ-9) was used. Institutional e-mails of all active students were used for their recruitment. Results In total, 863 students and 249 family members participated in the study. The mean PHQ-9 score was 6.220 (SD = 5.803) and 6.280 (SD = 5.857) for students and family members, respectively. Being unsatisfied with COVID-19 prevention measures, beliefs that COVID-19 infection and quarantine process can cause problems on their health status were the key factors for students to be screened positive for mental problems in multiple regression analysis. For parents, the last two factors were found to contribute significantly. Discussion Our findings indicate that quarantine measures have a significant impact on the levels of depression among both university students and their family members. Broader population studies are necessary to safeguard these results. Implications for Practice Provision of mental health services during the quarantine period is of paramount significance. Mental health first aid training and support could benefit both students and their parents significantly. Additionally, follow-up services after the end of quarantine are recommended.

How healthcare workers are coping with mental health challenges during COVID-19 pandemic? - A cross-sectional multi-countries study

Background

The coronavirus pandemic (COVID-19) has a social and psychological impact among healthcare workers worldwide and appropriate coping strategies are essential to avoid the negative mental health effects. This study aimed to investigate the coping strategies among the healthcare workers from different countries and their attitude towards teamwork during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted by using an online, web-based questionnaire, which was distributed to healthcare workers from 32 countries during April and May 2020. The respondents were recruited by the non-random convenience sampling method.

Results

A total of 2166 respondents responded to the survey and the majority were working in low- and middle-income countries. Among them, 36% were doctors, 24% were nurses and 40% worked in other healthcare sectors. More than 70% of the respondents answered that “getting family support” and “positive thinking” were coping methods for them during the COVID-19 pandemic. Approximately half of the respondents worshiped according to their belief and conducted prayers (58.4%) and had adequate sleep and food intake (48.2%). The significant associations were observed between attitude score towards interprofessional teamwork and gender (p = 0.009), age (31–45 years) (p < 0.001), marital status (p < 0.001), occupation (p < 0.001), working experience (2–5 years) (p = 0.005), current workplace (clinics) (p = 0.002).

Conclusion

The local healthcare authorities should promote coping methods and develop an innovative way to encourage practicing among healthcare workers. Digital mental health support interventions or workplace mental health support teams should be accessible to protect mental wellbeing among healthcare workers.

Effect of Covid-19 pandemic on mental health among Albanian people residing in the country and abroad - Implications for mental care

BACKGROUND

Coronavirus disease caused by the novel coronavirus Covid-19 is a current worldwide outbreak. The use of quarantine and isolation proved effective in containing the spread of infection.

OBJECTIVES

The purpose of this cross-sectional study was to assess the mental health of Albanian people residing in the country and abroad during the quarantine period for the Covid-19 pandemic.

DESIGN

This study was carried out from 25th March - 20th April 2020 through a web survey shared on social networks. The goal was to reach at least the minimum sample size for cross-sectional studies. The Patient Health Questionnaire (PHQ-9) was used to assess mental health. Chi-square (χ2) and Fisher -Exact test were used to assess the statistical significance among variables. P values ≤0.05 were considered statistically significant.

RESULTS

715 participants were included in the final analyses (78.41% females and 21.53% males). Most were residents in Albania (80.41%) and the others resided mainly in Italy (6.89%), Greece (3.51%), Germany (2.43%), Kosovo (1.62%) and the UK (1.69%). Statistical association was found between gender, country of residency and measures taken. Summary score of PHQ-9 items was 6.4662. The total score of depression classification shows that 31.82% and 12.90% of participants have respectively mild and moderate depression. Female participants showed the highest score for some items of PHQ-9, p≤0.05.

CONCLUSIONS

Findings suggest that health care professionals should recognize and address mental health problems associated with Covid-19 especially in vulnerable groups. Acting in a timely and proper manner is essential in preventing these problems from becoming chronic.

Knowledge and Health Beliefs of Nursing Students Toward Human Papilloma Virus and Vaccine Use

Objective: Human Papilloma Virus (HPV) infection is the most common sexually transmitted among young people of both sexes. It is also the main cause of cervical cancer. This study aimed at assessing students’ knowledge and health beliefs about HPV infection and the use of the vaccine.Methods: The sample of the cross-sectional study was 120 randomly selected nursing students from the Faculty of Public Health, University of Vlore “Ismail Qemali” Albania. Anonymous, self-administered questionnaire based on the literature and Health Belief Model, was used for data collection in May 2017. The questionnaire included assessment questions for students’ knowledge and health beliefs about HPV and vaccine use. Also, questions about socio-demographic characteristics were included. Data analysis included the calculation of averages, frequencies, and confidence intervals. P values ≤0.05 were accepted as statistically significant.Result: Mean age 20.3±2.2 years, 92.44 % of students were female. 65.83% of students know that HPV is a sexually transmitted infection and a vaccine is available to prevent it. Ambiguities and uncertainties exist in regard to screening with Pap test after vaccination. Perceived benefits are high for 50.83% of students. Perceived severity appeared low as only 25% of students agree that they may be affected by HPV. Statistical association, p =0.0347 was found between perceived risk and the year of study. The parents’ role in vaccination against HPV have a strong statistical association, p=0.0058 with the year of study as only 8.33 % of students in the third year agree with the fact that that parents do not allow them to be vaccinated against HPV. Conclusion: The study noted the student’s ambiguity and misconceptions about HPV infection. Low severity and lack of knowledge about the vaccine emphasizes that identifying their current level of knowledge and the main source of information are essential to provide comprehensive and appropriate health education.

Nurses, Healthy Women and Preventive Gynecological Examinations--Vlora City Scenario, Albania

BACKGROUND

Nurses play an important role in preventive medicine because they represent the largest sector of health professionals. This role is very crucial in developing countries, which are going through rapid societal and economic changes, associated with a rising burden of cancers due to different risk factors. The current study aimed to compare health awareness between nurses and healthy women regarding preventive gynecological examinations and to answer the question - can nurses make a difference in women's health?

MATERIALS AND METHODS

This cross sectional research included a total of 150 women, 70 nurses and 80 healthy women, randomly selected. Data were collected in 2014 in Vlora city through a self-administered questionnaire that assessed different variables about preventive gynecological examinations.

RESULTS

Cervical screening rates were 20.3% and 41.8%, respectively, for nurses and healthy women, despite the former having a statistical significant greater knowledge of risk factors and symptoms.

CONCLUSIONS

Even if the health awareness of nurse participants can be considered good, they need themselves to increase participation rates in cervical screening if they are to provide role models for health education/promotion addressing misconceptions and barriers.