"Using behavioral insights to inform the COVID-19 vaccine response in Kosovo[1]: Population perceptions and interventions"

Objective

Understand population perceptions in Kosovo[1] regarding COVID-19 vaccination to inform the pandemic response.

Methods

Five rounds of a cross-sectional survey in representative samples of adults during 2020-2021. Analysis includes descriptive statistics, hierarchical cluster analysis, segmentation and logistic regressions.

Results

Self-reported intention to vaccinate increased after the introduction of COVID-19 vaccines in Kosovo.[1] In less than one year, vaccination intentions increased from 36% to 66% of those unvaccinated. Predictors for vaccine intentions included gender, age, trust in health authorities. Segmentation analysis identified population segments that had high vaccine nintentions but low uptake, informing messages and campaign initiatives designed to translate intentions into behavior.

Conclusion

Identifying people's perceptions and behavior is essential to support evidence-based policy making, especially during outbreak response.

Innovation

BI is an innovative focus of research in Kosovo [1] where little BI data had been collected prior, and provided a unique understanding of population views, attitudes and behaviors related to COVID-19. These findings were not only essential for an evidence-based pandemic response but also laid the foundation for future broad application of BI to inform interventions that seek to enable, support and promote health-related behaviurs in Kosovo[1].

Determinants of Knowledge, Attitudes, Perceptions and Behaviors Regarding Air Pollution in Schoolchildren in Pristina, Kosovo

Air pollution poses a significant public health challenge, and Kosovo, a low-middle-income country in the Balkan peninsula, suffers from particularly poor air quality, especially around the area of the capital Pristina. The availability of accurate and timely information is crucial in mitigating the adverse effects of air pollution. This study aimed at evaluating the knowledge, attitudes, behaviors, and perceptions (KAPB) related to poor air quality in Pristina's low-middle schools. Furthermore, the study explored the connections between these factors and socio-demographic and health attributes and provided valuable inputs for the development of future strategies and policies in air pollution mitigation. Regression analysis provided insights into how these various factors interacted with KAPB scores. The results revealed limited knowledge about air pollution sources and risks among pupils, with insufficient awareness of reliable information sources. While attitudes were generally positive, they declined with higher grade levels. Parental education significantly influenced knowledge and attitudes, and better health correlated with more positive attitudes. Perceptions of air pollution risks were influenced by grade, gender, and parental education, with better-educated parents associated with improved perceptions. Overall behavior scores increased with higher levels of parental education. Understanding the factors that shape pupils' responses to air pollution is critical for strategy and policy development. These findings can guide strategies to enhance environmental awareness and promote healthy behavior, helping address the pressing issue of air pollution in the country.

Particulate Air Pollution and Primary Care Visits in Kosovo: A Time-Series Approach

This study aimed to investigate the effects of particulate air pollution (PM2.5) on cardiovascular and respiratory diseases in Pristina, Kosovo, in a time-series analysis using daily primary healthcare visits to primary care institutions from 2019 to 2022. For the observation period, 6440 cardiovascular and 15,141 respiratory visits were reported, whereas the daily mean concentrations of PM2.5 ranged between 2.41 and 120.3 µg/m³. Single-lag models indicated a bi-phasic lag structure with increasing effect estimates some days after the air pollution event. In the distributed lag model with seven lags, the effect estimates for the cardiovascular cases indicated the adverse effect of air pollution. The cumulative effect estimate (summed over lag 0 to 6) for an increase of 10 µg/m³ of PM2.5 was a relative risk of 1.010 (95% confidence interval: 1.001-1.019). For respiratory cases, a different lag model (lag 4 through 10) was additionally examined. In this model, significant increases in visits were observed on lags 7 and 8. Overall, no relevant increase in visits occurred during the seven days considered. Visits to general practitioners will often not occur immediately at disease onset because patients will wait, hoping that their health status improves spontaneously. Therefore, we expected some latency in the effects.

Air Pollution in Kosovo: Short Term Effects on Hospital Visits of Children Due to Respiratory Health Diagnoses

The Republic of Kosovo is a small country in the Balkans. The capital city of Pristina hosts most of its population and is situated in a mountain basin with poor air exchange, especially during winter. Domestic heating, road transport, industry and coal-fired power plants contribute to high levels of air pollution. We performed a time-series analysis on effects of particulate air pollution (PM2.5) on respiratory health of children and adolescents, using hospital admission and ambulatory visit numbers from the pediatric university clinic. From 2018 until 2020, daily mean concentrations of PM2.5 ranged between 2.41 and 161.03 µg/m³. On average, there were 6.7 ambulatory visits per day with lower numbers on weekends and during the first COVID-19 wave in 2020. An increase in PM2.5 led to an immediate increase in visit numbers that lasted over several days. Averaged over a full week, this amounted to about a 1% increase per 10 µg/m³. There were, on average, 1.7 hospital admissions per day. Two and three days after a rise in air pollution, there was also a rise in admission numbers, followed by a decline during the consecutive days. This might indicate that the wards were overstressed because of high admission numbers and restricted additional admissions.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region

Background

The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region.

Methods

Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use.

Results

In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour.

Conclusion

We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

Dental Health Evaluation of Children in Kosovo

Objectives: The aim of this study was to assess caries prevalence of preschool and school children in Kosovo. Methods: The assessment, which was carried out between 2002 and 2005, included measurements of early childhood caries, deft and DMFT. Results: In total, 1,237 preschool and 2,556 school children were examined. The mean deft of preschool children was 5.9, and the mean DMFT of school children aged 12 was 5.8. The caries prevalence for 2- to 6-year-old preschool children was 91.2%, and the prevalence for 7- to 14-yearold school children was 94.4%. The prevalence of early childhood caries was 17.6%, with a mean deft of 10.6. Conclusions: All data assessed showed the very poor oral health status of children in Kosovo. Interviews with children and teachers indicated poor knowledge regarding oral health. Significant measures must be taken to improve this situation. (Eur J Dent 2011;5:32-39)

Catastrophic expenditures and impoverishment due to out-of-pocket health payments in Kosovo

BACKGROUND

The current health system reforms in Kosovo aim to improve health status through universal health coverage. Risk pooling and ensuring access to necessary care without financial hardship are envisaged through compulsory health insurance. We measure the level of financial risk protection through two commonly applied concepts: catastrophic health expenditures and impoverishment.

METHODS

Data from the 2014 Kosovo Household Budget Survey were used to estimate catastrophic health expenditures as a percentage of household consumption expenditures at different thresholds. Poverty head counts and gaps were estimated before and after out-of-pocket (OOP) health payments.

RESULTS

Approximately 80% of the households in Kosovo incurred OOP health payments. Most of these expenditures were for medicine, pharmaceutical products and medical devices, followed by diagnostic and outpatient services. Hospital services and treatment abroad were less frequent but highly costly. Although households from the upper consumption groups spent more, households from the lower consumption groups spent a greater share of their consumption expenditures on healthcare. The catastrophic health expenditure head count showed an increase, while the impoverishment and poverty gap remained stable compared to 2011. Regression analysis showed that age of the household head, insurance coverage, household size, belonging to the lowest consumption expenditure quintiles, and having disabled and aged household members were significant predictors of the probability of experiencing catastrophic health expenditures.

CONCLUSIONS

Ongoing financing reforms should target the lower income quintiles and vulnerable groups, pharmaceutical policies should be revisited, and the internal referral system should be strengthened to overcome excessive spending for treatment abroad.

Impact of the National Population Register in Improving the Health Information System of Malignant Diseases in Kosova

Introduction

Malignant diseases are serious socio-medical problem, being that they cause grave problems in terms of health, social and economic perspective to an individual, in particular, and society in general. A proper reporting and monitoring system enables adequate calculation of indicators and evidence based decision making.

Aim

The study aims to examine the appearance of malignancies diagnosed and reported in Kosovo for a three years period: 2012, 2013, and 2014 by its modalities such as by the years of appearance, gender, age, and most frequent types of malignancies.

Material and methods

The study is a retrospective cohort research whereas source data we used are reports of malignant diseases from National Cancer Register (NCR) in the Health Information System (HIS) at the National Institute of Public Health of Kosova (NIPHK).

Results and discussions

In Kosova during years 2012, 2013 and 2014 a total of 7437 cases of malignant diseases were reported; in 2012 were 31%, in 2013 were 24.3%, and during 2014 higher number of cases were reported, 3320 or 44.6%. During the reporting period, the appearance of malignant diseases in both sexes is about equal, with a light predominance of male cases with 50.8% (or 3780 cases), while by age group were represented with the elderly, from ages 50 to 79 years with 5111 cases or 68.8% of total malignancies.

Conclusion

The highest number of malignant diseases was reported during year 2014 due to better reporting through HIS and NCR. Malignancies attacked both genders equally, whereas the most common types of malignancies were: melanoma and other malignant neoplasms of the skin, malignant diseases of the respiratory and intrathoracic organs, digestive tract, breast and female genital tract. The most affected the older ones.

Metachronous Testicular Seminoma After Testicular Tumor

Testicular cancer represents approximately 1% of all cancers diagnosed in males. Testicular cancer is the most commonly diagnosed cancer in male adolescents and young adults between 15-35 years of age. Bilateral presentation is rare with a reported rate of 0.8% for every 1,000,000 men between the age 15-40 years from which 0.5% are synchronous and .2-3% are metachronous. We report a case of 42-year-old man with metachronous testicular seminoma within 8 years from the first testicular tumor. Patient was treated at the urology clinic with a left testicular mass causing painful swelling. He experienced discomfort in left side of testis before two weeks. He was on anti-inflammatory treatment by his GP doctor with recommendation to visit a urologist. It is the first time in our clinic of urology to treat a patient with metachronous testicle tumor. The follow-up of patients with testicular tumor is very important for early detection of metachronous testicular tumor. In routine, after surgery treatment the strict follow-up of patients continue in Oncologic Institute. In the first 5 years it is biannual, then yearly with tumor markers and images of thorax, abdomen and pelvis. In our case the patient continued the follow-up for two years until he stopped by himself.

Public Health Profile of Road Traffic Accidents in Kosovo 2010-2015

AIM

To determine the characteristics of the Socio-medical profile of road traffic accidents in Kosovo, between 2010 and 2015 year.

STUDY DESIGN

Retrospective study.

METHODS

A descriptive method based on the database of road traffic accidents from the National Police of Kosovo.

RESULTS

In Kosovo for the period 2010-2015, on average, the yearly number of road traffic accidents is 18437 with mortality rate 7.4 per 100000 and lethality of 1.5%. The highest number of fatal cases are drivers and above 19 years old with more than 80%. Among injured significantly highest percentage is among passengers for all years and above 19 years old. Road traffic accident with a vehicle occurs most frequently, with approximately over 70%, mostly on dry road 72.9% and clear weather 71.1%. The driver is the contributing factors of road traffic accidents on average 99.3% whereas climatic conditions only 0.5%, with over 50% of crashes occurring in urban road 56.2%, mostly during Monday 16.0% and in the afternoon rush hours between 14.00-18.00 with 31.0%.

CONCLUSIONS

There is a slight decrease in the mortality rate of 0.1‰ and lethality rate of 0.1% each year, whereas there is an increase of 21.5‰ for traumatism rate for each year.

Smoking Behaviors in Kosova: Results of Steps Survey

Introduction

Tobacco use continues to be the leading global cause of preventable death. Most of these deaths occur in low and middle-income countries, and this trend is expected to widen further over the next several decades. The overall objective of the study is to describe and analyse the smoking behaviours of adults in Kosova.

Methods

According to the STEPs methodology, 6,400 respondents, aged 15 - 64 years, are selected randomly within each sex and 10-year age-group. Out of 6,400 participants, 6,117 were selected, which is approximately 95.6%.

Results

The prevalence of smoking was higher among males (37.4%) compared with females (19.7%). In all age groups, the prevalence of smoking was higher among males compared with females. Regarding the age group of 15 - 24 years, the prevalence of smoking was 16.0%, but in the age group of 25 - 34 years, it nearly doubled to the rate of 31.9%. We have a smaller increase in the age group of 35 - 44 years, and after the age of 45, it falls gradually.

Conclusions

The prevalence of smoking in Kosova is high compared with other countries in Eastern Europe. In future decades, Kosova will face a high probability of an increased burden of smoking-related diseases.

Public knowledge, attitudes and practices regarding antibiotic use in Kosovo

Background:

Antimicrobial resistance is becoming a major public health challenge worldwide, caused primarily by the misuse of antibiotics. Antibiotic use is closely related to the knowledge, attitudes and behaviour of a population.

Objective:

The objective of this study was to assess the level of knowledge, attitudes and practices about antibiotic use among the general public in Kosovo.

Methods:

A cross-sectional face-to-face survey was carried out with a sample of 811 randomly selected Kosovo residents. The methodology used for this survey was based on the European Commission Eurobarometer survey on antimicrobial resistance.

Results:

More than half of respondents (58.7%) have used antibiotics during the past year. A quarter of respondents consumed antibiotics without a medical prescription. The most common reasons for usage were flu (23.8%), followed by sore throat (20.2%), cold (13%) and common cold (7.6%). 42.5% of respondents think that antibiotics are effective against viral infections. Almost half of respondents (46.7%) received information about the unnecessary use of antibiotics and 32.5% of them report having changed their views and behaviours after receiving this information. Health care workers were identified as the most trustworthy source of information on antibiotic use (67.2%).

Conclusion:

These results provide quantitative baseline data on Kosovar knowledge, attitudes and practice regarding the use of antibiotic. These findings have potential to empower educational campaigns to promote the prudent use of antibiotics in both community and health care settings.

Knowledge, Attitudes and Practices of Mothers in Kosova About Complementary Feeding for Infant and Children 6-24 Months

AIM

This cross sectional study assessed knowledge, attitudes and practices regarding complementary feeding among mothers with children between 6-24 months at the national level.

METHODS

The sample of 492 mothers with children between 6-24 months, with a confidence level of 95%, the acceptable margin of 5%, the expected prevalence of 50% knowledge and effect of 1.3, were interviewed from all regions, in all Kosovo. Data were analyzed using SPSS version 17.0 and presented using descriptive and inferential statistics such as Chi-square with significance level set at 5%.

RESULTS

Overall, 88.4% of respondents had good knowledge of complementary feeding, while only 38.4% of mothers had good practices regarding time for starting complementary feeding. We found association between maternal knowledge and level of education for complementary feeding.

CONCLUSION

There is a need to further explore the factors responsible to improving practices for complementary feeding.

PATIENTS' SATISFACTION WITH HEALTH SERVICES AT THE NATIONAL INSTITUTE OF PUBLIC HEALTH OF KOSOVA

Aim:

Purpose of the research is to assess patient satisfaction with the quality of health services provided in National Institute of Public Health of Kosova.

Methods:

Study was observational and cross-sectional. Interviews were conducted with 625 clients of IPH. Inclusion criteria for enrollment in the study were patients above 18 years old, with verbally informed consent.

Results:

In our study, access to IPH, efficacy, patient-provider interpersonal communication, and explanations regarding procedures, readiness to answer to patients need and physical settings and appearance are valued satisfactorily whereas cleanliness was rated with minimal grades. Evaluated 12 quality components, were scored with average mark 3.6.

Conclusions:

SWOT analysis, and fishbone diagram should be used on regular bases and a new position for a manager for administrative issues, is opened, complaints box and list of rights and responsibilities of patients were dislocated in a more visible place, and internal staff turnover, is introduced.

Mothers' behaviours and knowledge related to caries experience of their children

PURPOSE

Insufficient attention paid by public institutions to primary oral health protection measures has contributed to a poor oral health status in Kosovo, especially in children. Because the oral health promotion activities identified the significant roles of mothers in primary prevention, the aim of this study was to determine the level of knowledge and the behaviour of mothers in connection with the caries experience of their children.

MATERIALS AND METHODS

664 of the mothers who accompanied their children to dental visits were interviewed and data on maternal knowledge and attitudes towards the oral health of preschool children were collected. The children underwent dental examination and the dmft index was recorded.

RESULTS

The mean dmft index in all children was 6.30 ± 3.23. A high prevalence of early childhood caries was recorded. The highest mean dmft was recorded for children whose mothers had finished primary and secondary school (6.41 ± 3.36 and 6.62 ± 2.87, respectively). The mothers displayed insufficient knowledge regarding dental visits, feeding, oral hygiene maintenance and the utilisation of fluoride/antimicrobial agents.

CONCLUSIONS

The results of this study show that the level of knowledge about oral health among interviewed mothers is very low to nonexistent. Mothers need to be educated and encouraged that they are a key factor in improving the oral health habits of their children. Since caries represents a serious public health problem in Kosovo, an overall preventive programme for oral health promotion is needed, including the oral health education of mothers.

Reforms and Challenges of Post-conflict Kosovo Health System

Before its collapse, Kosovo's healthcare system was an integrated part of the Former Yugoslav Republics System (known as relatively well advanced for its time). Standstill had begun in the last decade of the twentieth century as the result of political disintegration of the former state. The enthusiasm of the healthcare professionals and the people of Kosovo that at the end of the conflict healthcare services will consolidate did not prove just right. Although we can claim that reorganization of Kosovo healthcare was a serious push (especially in the first years after the conflict), the intensity of development begun to fall at the latter stages. Although the basic legislation for the operation of the Healthcare System today in Kosovo does exist, the largest cause for the reform stagnation is where the law is not implemented properly and measures are not set as to a meaningful system of accountability. Twelve years have passed by since the 1999 war-conflict and, although, Kosovo has made progress in many other spheres, it has not yet reached to consolidate a health system comparable to those of other European countries. Intending to get out of difficult situation, several healthcare strategic plans have been developed in the past decade in Kosovo, but attempts in this direction have not been particularly fruitful. This script describes the actual Healthcare complexity of a situation in Kosovo 12 years after the end of the 1999 war-conflict. Interconnection and historical background is also looked upon and is described in the flow of events. Finally, the description of transfer competencies from international administrators to the local authorities as well as the flow of strategic planning that took place since 1999 has also been analyzed.

Epidemiological characteristics of tularemia in kosova in the period 2006-2011

Introduction:

Tularemia is an important zoonosis in Kosovo. The first cases of tularemia in Kosovo were reported in 1999 among civil population in the west part of Kosovo. Tularemia has become an important problem in Kosova after 1999.

Aim:

The aim of this study was to analyze the frequency and distribution of Tularemia in Kosovo in the period from 2006 to 2011, propose measures and activities for prevention and control of the disease.

Material and method:

In this descriptive, retrospective study, we used official reports on infectious diseases from National Institute of Public Health of Kosova (NIPHK), as well as epidemiological surveys. The data collected were analyzed and the corresponding statistical parameters were tested with SPSS for the level of significance for P<0.01 and P<0.05.

Results and Discussion:

The morbidity rate over the study period ranged from 0.38 (2011) to 11.26 (2010) per 100000 inhabitants. We found statistical significance between years for the level of P<0.00001. (X²-test=387.5; DF=5; P<0.0001). The majority of tularemia cases occurred in female (59%) with statistical significance for P<0.001 (X²-test=16.07; DF=1; P<0.001) The peak of cases in age group 20-40 years, with 242 cases or 48%, with statistical significance for the level of P<0.0001 (X²-test=253.14; DF=3; P<0.001) The main route of human infection is consumption of no safety water from wells (50%). The majority of tularemia cases occurred in female in Kosovo with 59% of observed cases while in a study in Central Anatolia region 54.7% were female.

Conclusion:

Kosova is an endemic zone of this disease since 1954 where the first cases were registered. Tularemia is a zoonosis, so in order to avoid human infections it is very important to implement measures well as perform public health education activities.

Effects of preparation techniques on root canal shaping assessed by micro-computed tomography

Background

Root canal shaping without any procedural error is of the utmost preference. Therefore, the purpose of this study was to use micro-computed tomography to evaluate and compare the root canal shaping efficacy of ProTaper rotary files and standard stainless steel K-files.

Material/Methods

Sixty extracted upper second premolars were selected and were divided into 2 groups of 30. Before preparation, all samples were scanned by micro-CT. Then, 30 teeth were prepared with stainless steel files and the remaining 30 with ProTaper rotary files. Canal transportation and centering ability before and after root canal shaping were assessed using micro-CT. The amount and direction of canal transportation and the centering ratio of each instrument were determined in the coronal, middle, and apical parts of the canal. The 2 groups were statistically compared using one-way ANOVA.

Results

ProTaper rotary files gave less transportation (p<0.001) and better centering ability (p<0.00001) compared with stainless steel files.

Conclusions

The manual technique for preparation of root canals with stainless steel files produces more canal transportation, whereas rotary files remain more centered in the canal.

Incidence, prevalence and clinical manifestations of systemic sclerosis in dukagjini plain

Introduction:

Progressive systemic sclerosis (PSS) is an inflammatory disease of connective tissue, with onset as edema that continues with fibrosis, induration, and skin atrophy, followed by attacks on the joints, internal organs, and secondary proliferation of connective tissue.

Purpose:

To research in which residence locations and among which group age is the most frequent incidence, prevalence and clinical manifestations of systemic sclerosis in Dukagjini Plain which is inhabited by 698450 resident citizens.

Material and methods:

51 patients with progressive systemic sclerosis were studied, out them 44 were females (86.3%) and 7 males (13.7%) respectively, during the period from 2005 to 2010. Their illness was active from 18 to 60 months in accordance with EUSTAR criteria. They are of different age, median age is 44.2 ±10.1. Their diagnose is determined based on revised ACR criteria. Prevalence of patients with PSS was 14.61/100.000, while the incidence was 2.8/100.000, whereas CI (Confidence interval) or limit of accuracy was 95%.

Results:

Largest number of patients per 100.000 citizens has Istog municipality which has the largest number of patients with PSS. It is followed by Mamusha and Rahovec municipalities. The largest examined group age is 35-44 year old, 41.2% respectively.

Conclusion:

Additional studies are necessary to carry out in order to find the reasons of asymmetrical distribution of patients with systemic sclerosis in the municipalities of Dukagjini Plain.

Problem of substance misuse and lack of national strategy in Kosovo

The aim of this project was to explore the problem of substance misuse among adolescent town dwellers in Kosovo, as a result of lack of a national strategy related to this problem.

DESIGN

261 students from 4 secondary schools took part in cross sectional survey performed in October 2005. The survey was carried out in Gjilan town in south-east of Kosovo.

MAIN RESULTS

From all questioned students, 36% smoked cigarettes every day, 12.6% consumed alcohol occasionally and 1.4% consumed all kind of drugs regularly. Girls consumed more cigarettes, whereas boys consumed more alcohol and other drugs. The prevalence of substance misuse was higher among students in their last year of high school attendance. Students in Gjilan continue to smoke, consume alcohol and drugs despite their knowledge about the adverse health consequences of substance misuse, but in the same time, most of them consider information and counselling the best way of substance misuse prevention.

CONCLUSIONS

The prevalence and trends of substance misuse among students in our survey indicates that it is time to start acting. It is assumed that results of survey may be a very useful source of information for policy-makers, government and ministry of health in developing and implementing national strategy that would address the most important issues in connection with addiction among adolescents.

Low back pain predict sickness absence among power plant workers

Background:

Low back pain (LBP) remains the predominant occupational health problem in most industrialized countries and low-income countries. Both work characteristics and individual factors have been identified as risk factors. More knowledge about the predictors of sickness absence from LBP in the industry will be valuable in determining strategies for prevention.

Objectives:

The aim of this longitudinal study was to investigate whether individual, work-related physical risk factors were involved in the occurrence of LBP sickness absence.

Methods:

A follow-up study was conducted among 489 workers, aged 18–65 years, at Kosovo Energetic Corporation in Kosovo. This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of LBP sickness absence. Logistic regression models were used to determine associations between risk factors and the occurrence of sickness absence due to LBP.

Results:

Individual factors did not influence sickness absence, whereas work-related physical factors showed strong associations with sickness absence. The main risk factors for sickness absence due to LBP among production workers were extreme trunk flexion (OR = 1.71, 95% CI = 1.05–2.78) as well as very extreme trunk flexion (OR = 6.04, 95% CI = 1.12–32.49) and exposure to whole-body vibration (OR = 1.75, 95% CI = 1.04–2.95).

Conclusion:

Reducing sickness absence from LBP among power plant workers requires focusing on the working conditions of blue-collar workers and risk factors for LBP. Increasing social support in the work environment may have effects in reducing sickness absence from LBP.

Toxoplasmosis in Kosovo pregnant women

This study presents the initial results of a collaborative project aimed at the evaluation of Toxoplasma seroprevalence in a population of Kosovar pregnant women. The serum samples of 334 pregnant women were tested to detect IgG, IgM, IgG avidity for toxoplasmosis. Data regarding age, occupation, area of origin and education were also obtained for the pregnant women examined; 97/334 (29.4%) resulted positive for IgG antibodies, four of whom (4.1%) were also positive for IgM, (1.2% of the total population examined). All four IgM-positive pregnant women also demonstrated low avidity tests. The rate of IgG seroprevalence found in our study was lower than that observed in various European countries, especially those of western Europe. Conversely, the percentage of recent infections was higher than expected. The higher rate of infections could be the result of a recent toxoplasmosis epidemic in Kosovo, most likely due to the altered hygienic conditions caused by the forced transfer of the ethnic-Albanian population from an area of low (Serbia) to high (Kosovo) toxoplasmosis prevalence.

Congenital nephrotic syndrome

The aim of this case is to present a case of a two month old female with congenital nephritic syndrome, which is very rare. On admission, the baby showed marked edema and distended abdomen. She was diagnosed and treated with daily albumin infusions, antibiotics, diuretic, gamma globulin replacement, ACEI and NSAIDs. Parents were informed about the nature of the disease, prognosis, and advised for further medical care in a more advanced kidney transplantation centre. This was the first treatment of this condition in the Pediatric Clinic in Kosovo and it presented a challenge for us.

Dental health evaluation of children in kosovo

OBJECTIVES

The aim of this study was to assess caries prevalence of preschool and school children in Kosovo.

METHODS

The assessment, which was carried out between 2002 and 2005, included measurements of early childhood caries, deft and DMFT.

RESULTS

In total, 1,237 preschool and 2,556 school children were examined. The mean deft of preschool children was 5.9, and the mean DMFT of school children aged 12 was 5.8. The caries prevalence for 2- to 6-year-old preschool children was 91.2%, and the prevalence for 7- to 14-year-old school children was 94.4%. The prevalence of early childhood caries was 17.6%, with a mean deft of 10.6.

CONCLUSIONS

All data assessed showed the very poor oral health status of children in Kosovo. Interviews with children and teachers indicated poor knowledge regarding oral health. Significant measures must be taken to improve this situation.

Early childhood caries in preschool children of Kosovo - a serious public health problem

Background

Even though it has been widely studied, early childhood caries (ECC) remains a serious public health problem, especially in countries where there is no national program of oral health assessment and no genuine primary oral health care, such as in Kosovo. The purpose of this study was to assess the prevalence of ECC and analyze caries risk factors.

Methods

The subjects were 1,008 preschool children, selected by stratified random cluster sampling, in the municipality of Prishtina, capital of Kosovo. Data were collected through clinical examination and interviews. Dmft data were recorded according to WHO criteria. Bacterial examination (CRT bacteria test) and plaque test of Greene-Vermillion were used.

Results

The mean dmft of preschool children was found to be 5.8. The prevalence of ECC was 17.36%, with a mean dmft of 11 ± 3.6. Streptococcus mutans prevalence in ECC children was 98%. A significant correlation between dmft and S mutans counts (≥10⁵ CFU/mL saliva) was demonstrated. A correlation was also found between daily sweets consumption and dmft in children with ECC (P < 0.001). Comparing the dmft of ECC children and duration of bottle feeding showed a statistical correlation (P < 0.001). The mean plaque test was 1.52. None of the examined children had ever used fluoride.

Conclusion

The prevalence of ECC was high among preschool children in the municipality of Kosovo. We recommend increasing parents' knowledge of proper feeding habits and oral health practices, and increasing preschool children's accessibility to dental services.

Suicide prevalence in Kosova for the period 2007-2008

Kosovo as a newer state, characterized with political, economical and cultural transition is touched by suicide phenomenon. Aim of this survey is to analyze prevalence of suicide in Kosova for period 2000-2008 and in particular for 2007-2008.

METHODOLOGY

Survey is retrospective one and data were taken from Statistical Office of Kosova and Kosovar Police Service report. Cases are analysed due to demographic characteristics as sex, age group, years, dwelling place, months, week days and methods of suicides.

RESULTS

After the war there is an increase of suicides as it is presented with basic index. For year 2000, there is an increase of 122% compared with cases on 1983, then the highest increase is for 2001 with 711.1%. After 2005 there is a slight decrease of suicides with trend of y = 58-8X. Due to sex, suicides are significantly higher at males than females for both years, with 78.9% for 2007 and 74.5% for 2008. The highest number of suicides is found at age groups 21-30 and 31-40 years with 21.1% for 2007 and 21-30 and 41-50 years with 25.5% for 2008. Average age for suicide victims is 42 years for 2007 and 44 years for 2008. Suicides are more frequent at rural places but not significantly. Greatest percentage of suicides was on July with 21.1% for 2007 and June and October with 15.7% for 2008. On 2007 the highest percentage of suicides was on Wednesdays with 21.1% and on 2008 was on Tuesdays with 19.6%. Due to the time of day, the most frequent time for suicides was 16-18.00 for 2007 and for 2008 the greatest percentage of suicide is on unknown time with 27.5%. The most frequent method of suicide was hanging for both years, with 64.9% for 2007, and 52.9% for 2008, fire arm with 14% for 2007 and 21.6% for 2008 and poisoning with 5.3% for 2007 and 11.8% for 2008. Suicides are most frequent at rural places but not significantly.

CONCLUSION

Suicides due to sex are significantly higher in males than females in all age groups. Average age of suicide victims is rising from 42 years for 2007 to 44 years for 2008. Suicides are more frequent at rural places and the greatest percentage of suicides due to months was on July for 2007 and June and October for 2008, on Wednesdays for 2007 and Tuesdays for 2008. PROPOSED MEASURES: Suicides are consequence of socioeconomic, psychological and political problems as unemployment and poverty. For challenging suicide phenomenon there is a need for multi-sectoral approach involving health and non health sector as politics, labor, education and media.

Cases of poisoning with organophosphates treated at the University Clinical Centre of Kosova

Everywhere today, poisonings present a significant and continuous increase of incidence in illness. Poisonings with organophosphates are more and more often. We do not have accurate statistics for this problem. The aim of this work was to present the clinical characteristics of poisoning with organophosphates, treated in University Clinical Centre in Prishtina. With the retrospective method, 23 patients were analyzed, 18 female and 5 male. Out of these, to (43.5%) have had tentative suicide, while 13 (56%) were accidentally exposed to poison. Poisoning with organophosphates was present in 3.8% of the overall number of poisonings. Organophosphate that was found in the analyzed poisoned patients was malathion (known here as Etiol). Average hospitalization time was 8.8 days (1 - 50 days range), average age of the patients was 27.1 years. Mortality scale was 52.1%. All these patients were treated with atropine. Atropine was given in intravenous way during 4.2 +/- 3.5 days and the average total dose was 82 +/- 61.5 mg. Pralidoxime antidote was not given to any of the patients. In adults, the poisoning was done mainly with the aim of suicide. Poisoned children with Etiol are in larger numbers from rural areas.

Echocardiographic assessment of left atrial size in patients with end-stage renal disease

BACKGROUND

Cardiac disease is the most common cause of death in patients with end-stage renal disease. It is assumed that the high rate of cardiovascular mortality is related to accelerated atherosclerosis. Patients with chronic renal insufficiency have an increased prevalence of coronary artery disease, silent myocardial ischaemia, complex ventricular arrhythmias, atrial fibrillation, left ventricular hypertrophy, annular mitral and aortic valve calcification, and enlargement of the left atrium, than patients with normal renal function. It is also well known that haemodialysis is associated with cardiovascular structural changes and rapid fluctuations in electrolyte levels. In this study, we sought to estimate left atrial size by means of echocardiography and to determine any correlations between different echocardiographic measurements in patients with end-stage renal disease.

METHODS

We analysed data from 123 patients who were on regular haemodialysis, by means of traditional transthoracic echocardiographic examination. The usual statistical parameters, correlations and the Student's t-test were performed, with levels of significance of p < 0.01 and p < 0.05.

RESULTS

The most presented age group was 60 to 69 years old, with a predomination of females (56.1%). We found dilated left atrium in 26.02% of the study patients and a high statistical correlation between different methods of measurement and calculated volumes of the left atrium.

CONCLUSION

Evaluation of left atrial size should be determined by several different measurements, and left atrial enlargement should be seen as a risk factor for advancing disease.

Tobacco use among Kosovar schoolchildren: a cross-sectional study

One out of ten deaths worldwide among adults is attributable to tobacco use. Most people begin using tobacco before the age of 18. The European Region of WHO faces nearly one third of the worldwide burden of tobacco-related diseases. We aimed to study the prevalence of tobacco use among Kosovar schoolchildren, knowledge and behaviors related to tobacco use and its health impact. A cross-sectional study was performed, using anonymous self-administered questionnaire carried out among 7088 students in 110 schools. The target population group were students aged between 13 and 15 years were enrolled in all the targeted grade levels. The questionnaire consists of two main parts developed especially for the European region. Statistical analysis and the complex sampling design were done by EPI Info 2000 statistical software package. Around one-third (2622=37%) of all students, reported to have smoked cigarettes. One-fifth (20.9%) of ever smokers initiated smoking before the age often. Significantly more boys than girls ever smoked cigarettes (43.5% and 30.4% respectively). Over one-third (37.0%) had ever smoked cigarettes, as compared to over one-half (53.9%) of secondary students. There is a high probability of an increased burden of disease from tobacco in the future decades in Kosova. Special attention should be paid to the cessation needs of current smokers, school-based programs on environmental tobacco smoke, and the health risk of exposure due to smoking by siblings and friends.

Level of knowledge regarding tuberculosis and stigma among patients suffering from tuberculosis

The goal of this study was to determine the degree of the tuberculosis awareness concerning medical aspects of tuberculosis and stigma toward the illness. The main focus was on the supervision of the health educative program effects on the tuberculosis throughout the identification of health needs; to determine demographical aspects associated with the level of knowledge (age, gender, living conditions, level of education etc.); to improve health education program efficacy through identification of health priorities. In the survey 155 tuberculosis patients aged 12-87 years old from different regions of Kosovo (89 females and 66 males) were included; 53.5% of patients were from rural region. Educational background: 11.6% illiterate patients; 39.4% of patients have completed primary and secondary education; 9.7% of patients were highly educated. The special questionnaire was composed and patients were interviewed. The questionnaire consisted of 19 questions. For statistical processing Hi square-test, t-test and linear correlation were used. The investigation showed that level of knowledge regarding tuberculosis was satisfactory. The meaning of direct observational therapy was known to only 51% of patients. In general patients have been informed by the health staff. Stigma was obviously present in Kosovo. More vulnerable were patients without education background and from villages. Key need in global control of tuberculosis remains the adoption of DOTS (directly observed treatment, short course). Health education must be designed depending on target population for achievement of success in fighting and preventing tuberculosis.

Drug abuse in Prishtina region

Currently the drug abuse has become one of the most serious problems in many countries. The drugs abuse is also widespread in less developed societies. This problem is present in Kosova too with the tendency of rising. The of this research was to show the number of drug abusers in Prishtina region, the type of drugs used, the way of drug administration, then survey of the age, sex, marital status, residence of the drug abusers including their social status (employment, profession and economical status). During the surveyed period the number of hospitalized drug abusers in Neuropsychiatry clinic was 39. 25.5% of them were hospitalized more than ones, with 367 stay days with average treatment period of 7.5 days. Average age of those hospitalized for the first time was 27.9 years of age. 64.1% of them were 25-34 years old. 97.4% of the hospitalized were male. 32 (82.1%) patient were from Prishtina, 5 from Ferizaj and 1 from F. Kosova and Kacanik. During the surveyed period there was no patient hospitalized from other cities of Prishtina Region (Besiana, Drenas, Kastriot, Lipjan, Shtime and Shterpc).