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Agency: European Commission | Branch: H2020 | Program: RIA | Phase: SC1-PM-21-2016 | Award Amount: 4.26M | Year: 2017

Screening for vision and hearing disorders in children has shown to be highly effective. EU-directive 16620/11 invites EU-member states to give priority to such screening programmes. Early detection and treatment of a lazy eye (prevalence 3%) prevents lifelong visual impairment. Early detection and treatment of hearing impairment (prevalence 0.15%) prevents delayed speech and language development. Across Europe inequity exists in the provision of childhood vision and hearing screening programmes (VAHSPs). High-Income Countries (HICs) have VAHSPs, but they vary with regard to age and frequency of testing, tests used, uptake, screening professionals, referral pathway and funding. This makes it difficult for healthcare providers and policy makers to decide what VAHSP to implement in Low- to Middle-Income Countries (LMICs) and how. In this study, cost-optimised, evidence-based VAHSPs will be implemented in two LMICs, based on collated evidence from existing VAHSPs in Europe. Data on VAHSPs, demography, administration, general screening, screening professions, uptake and treatment availability will be gathered in an established network of professionals in 41 European countries and used in a disease/health system modelling framework to predict benefits and cost in the most optimal health system, taking regional diversity and organisational and resource requirements into account. Model-developed VAHSPs will be tested in the county of Cluj in Romania for vision, and in three counties in Albania for hearing screening. A generic strategy for implementation will be developed by detailed tracking, and from identified requirements, facilitators and barriers. The decision-analytic modelling framework and the strategy for implementation will be packed into a transferable TOOLKIT that will assist healthcare providers and policy makers worldwide in their decisions to introduce or modify VAHSPs, and increase effectiveness, efficiency and equity of child healthcare.


Bellis M.A.,Liverpool John Moores University | Hughes K.,Liverpool John Moores University | Leckenby N.,Liverpool John Moores University | Jones L.,Liverpool John Moores University | And 8 more authors.
Bulletin of the World Health Organization | Year: 2014

Objective To evaluate the association between adverse childhood experiences - e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration - and the health of young adults in eight eastern European countries. Methods Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10 696 respondents - 59.7% female - aged 18-25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide. Findings Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of health-harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval, CI: 1.32-2.15) - for physical inactivity - to 48.53 (95% CI: 31.98-76.65) - for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population. Conclusion Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in eastern European.


Vaso A.,University of Tirana | Adahan H.-M.,Pain Rehabilitation Unit | Gjika A.,University of Tirana | Zahaj S.,University of Tirana | And 3 more authors.
Pain | Year: 2014

Nearly all amputees continue to feel their missing limb as if it still existed, and many experience chronic phantom limb pain (PLP). What is the origin of these sensations? There is currently a broad consensus among investigators that PLP is a top-down phenomenon, triggered by loss of sensory input and caused by maladaptive cortical plasticity. We tested the alternative hypothesis that PLP is primarily a bottom-up process, due not to the loss of input but rather to exaggerated input, generated ectopically in axotomized primary afferent neurons in the dorsal root ganglia (DRGs) that used to innervate the limb. In 31 amputees, the local anesthetic lidocaine was applied intrathecally and/or to the DRG surface (intraforaminal epidural block). This rapidly and reversibly extinguished PLP and also nonpainful phantom limb sensation (npPLS). Control injections were ineffective. For intraforaminal block, the effect was topographically appropriate. The suppression of PLP and npPLS could also be demonstrated using dilute lidocaine concentrations that are sufficient to suppress DRG ectopia but not to block the propagation of impulses generated further distally in the nerve. PLP is driven primarily by activity generated within the DRG. We recommend the DRG as a target for treatment of PLP and perhaps also other types of regional neuropathic pain. ©2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


Sopjani M.,University of Prishtina | Rinnerthaler M.,University of Salzburg | Kruja J.,University of Medicine, Tirana | Dermaku-Sopjani M.,University of Prishtina
Current Molecular Medicine | Year: 2015

The Klotho protein deficiency is known to participate in premature aging. As an aging suppressor, Klotho is an important molecule in aging processes and its overexpression results in longevity. Due to many reasons, the insulin/insulin-like growth factor-1 (IGF-1) has been considered as a key pathway in aging research. The Klotho gene is closely related to this pathway. The Klotho gene encodes a transmembrane protein that after cleavage is also found as a secreted protein. Importantly, its overexpression suppresses insulin/IGF-1 signaling and thus extends the lifespan. In addition, Klotho participates in the regulation of several other intracellular signaling pathways, including regulation of FGF23 signaling, cAMP, PKC, transforming growth factor-β (TGF-β), p53/p21, and Wnt signaling. The aim of this review is to summarize current literature that shows the involvement of Klotho in the regulation of several intracellular pathways. The results of our review clearly indicate that Klotho participates in several intracellular signaling pathways, and by regulating them, Klotho is involved in aging and longevity. © 2015 Bentham Science Publishers.


Background: The basis for qualitative changes concerning everyday clinical practice are created from epidemiological studies, which not only generalize situations but at the same time provide specific details of the country's features; especially during periods of social transition. The aim of this study was to present demographic and epidemiological features of severe burns treated in the Service of Burns in UHC (University Hospital Center) in Albania and to analyze burn mortality as an important outcome measure. Method: The data used was obtained by the analysis of the medical records of 2337 patients hospitalized in Burns Service ICU near in Tirana, Albania during 1998-2008. Statistical analysis is done with SPSS 15 software. Descriptive analyses, inferential statistics and Chi-square test and Kendall's tau-b are calculated. Logistic regression is used for the prediction of death probability by two risk variables, BSA burned and age. Results: The severe burn incidence was 7 patients per 100,000 persons/year. The overall mean estimated BSA (%) is 22.8 ± 14.7. The main causes of the burn were found to be the scalds in 61.8% of the cases followed by flame (23%), chemicals (10.7%) and electrical injury in 4.5% of the cases. The mean hospital period is 11.6 ± 10. The overall mortality is 10.5%. Based on probability of death, we noticed that older age and larger burn size were associated with a higher likelihood of mortality. Conclusions: The long-term studies and the comparison of our results with the ones of other burn centers has allowed us to determine the actual level of care and as well as to build up contemporary protocols in order to improve the treatment with the objection of decreasing the mortality. © 2011 Elsevier Ltd and ISBI. All rights reserved.


Vyshka G.,University of Medicine, Tirana | Kruja J.,University of Tirana
International Medical Case Reports Journal | Year: 2013

A 44-year-old Albanian male was consulted and diagnosed with dementia. His magnetic resonance imaging suggested diffuse white matter changes. The suspicion of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) was raised, and a genetic analysis confrmed such a suspicion through uncovering a pathogenic mutation at the level of exon 4 (c.475C>T) of chromosome 19. The patient came from a large family of 13 children, all of whom underwent clinical, genetic, and imaging examination. The pathogenic mutation was found present only in his eldest sister (50 years old), and she presented also very suggestive signs of CADASIL in her respective imaging study, but without any clinically signifcant counterpart. All other siblings were free from clinical and radiological signs of the disorder. Our opinion was that we were dealing with a mutation showing a very low level of penetrance, with only two siblings affected in a large Albanian family with 13 children. © 2013 Vyshka and Kruja.


Korita I.,University of Medicine, Tirana | Bulo A.,University of Medicine, Tirana | Langlois M.,Catholic University of Leuven | Blaton V.,Catholic University of Leuven
Journal of Medical Biochemistry | Year: 2013

Background: The clinical value and the interrelationship of HDL and the metabolic syndrome were studied using plasma levels of TNF-a, IL 6, IL 10, IL 8, IL 1beta, IL 2R in patients with cardiovascular stenosis. Methods: On the basis of exclusion criteria, we recruited 198 male and female patients aged 45 to 75 years with CVD and 43 patients with MS. Patients were subdivided into %stenosis according to the CASS guidelines. Lipids were measured on an Olympus AU640 analyzer. Ox-LDL was measured by the immunosorbent assay and MDA by HPLC. Cytokines were analysed with DPC Immulite 1000. Statistical tests were performed using SPSS for Windows, 14.0 & Medcalc. Results: Ox-LDL and apoB were significantly higher in the MS(+) patient group (88.7 U/L) compared to the MS(-) group (77.5 U/L). Ox-LDL showed a positive correlation (P=0.001) with LDL-C, apoB and MDA. There was a higher concentration of HDL in the patient group MS(-), which was confirmed by a non-significant (P=0.849) change of apoA(I) from 1.267 g/L in the MS(+) to 1.275 g/L in the MS(-) group. A light significant increase of IL 10 (P=0.05) in MS(+) patients was observed, and the other analysed inflammation markers were mostly unchanged. MS has no direct association with the cytokine production. Conclusion: Ox-LDL and apoB were significantly higher in the MS(+) patient group. In a multiple regression analysis for ox-LDL, apoB (P=0.003) emerged as a strong predictor of the ox-LDL concentration, independent of age, gender, BMI and smoking.


Gjata M.,University of Medicine, Tirana
Medicinski arhiv | Year: 2011

The study's aim was to evaluate the relations between pulse pressure (PP), hypertension and anemia with left ventricular hypertrophy (LVH). The risk factors and prevalence of LHV were evaluated in 111 patients with CRF. LVH was diagnosed in 81.9% of all patients. The prevalence of hypertension was 72.6%. Anemia was present in all patients. Of the variables tested lower levels of hemoglobin, systolic blood pressure (SBP) and PP predicted the occurrence of LVH. This study has shown a strong association between chronic kidney disease (CKD) and LVH in pre dialysis patients. Pulse pressure, SBP and anemia play an important role in the development of left ventricular hypertrophy in CKD patients.


Sulcebe G.,University of Medicine, Tirana | Shyti E.,University of Medicine, Tirana
Human Immunology | Year: 2016

This paper reports the HLA-A, -B, -C, -DRB1 and -DQB1 allele and haplotype polymorphism in a population of 432 healthy individuals from Albania. First-field HLA genotyping was performed by polymerase chain reaction sequence-specific priming and/or oligonucleotide methods. The data were analyzed statistically using gene counting and Arlequin software packages. No deviation from Hardy Weinberg Equilibrium was detected at any of the loci studied. The HLA genotypic data of the population sample reported here are available publicly in the Allele Frequencies Net Database and they can serve as a reference database for further HLA-based population genetics studies including the Albanian population. © 2016.


Hoxha I.,University of Medicine, Tirana | Malaj A.,University of Medicine, Tirana | Malaj L.,University of Medicine, Tirana
Journal of Infection in Developing Countries | Year: 2015

Conclusions: This study enables policymakers to further analyze the quality of antibiotic prescriptions and draw comparisons to other countries. The analyzed data suggest there are different factors influencing out-of-pocket use of antibiotics and wrongly prescribed antibiotics. Further studies are necessary to evaluate these factors.Methodology: Data from 2011 and 2012 on antibiotic use from ambulatory and hospital sector were examined. Antibiotics were divided based on anatomic therapeutic chemical classification. Defined daily dose (DDD) for each drug was assigned, and DDD per 1,000 inhabitants per day (DID) was used as a measurement unit. In cases of antibiotic combinations for which DDD were not available, unit doses were assigned.Introduction: Health institutions in Albania have recently reported an increase in antibiotic misuse and microbial resistance. Until now, there have been no comprehensive studies that analyzed the overall use of antibiotics in Albania. The aim of this study was to analyze the overall antibiotic use in Albania between 2011 and 2012, using standardized methodology of measurement, based on World Health Organization guidelines.Results: In 2011–2012, total antibiotic use decreased from 24.25 to 20.66 DID. Penicillin’s were the most used antibiotic class, with 10.62 DID (2011) and 10.51 DID (2012). Tetracycline use decreased from 5.45 DID (2011) to 0.98 DID (2012). Macrolides increased from 1.36 to 1.88 DID, quinolones from 1.72 to 2.51 DID. The overall antibiotic use was significantly higher than the reimbursed antibiotic use – 3.17 DID (2011) and 2.79 DID (2012) – based on the official data for the same period. © 2015 Karim et al.

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