Distinguishing host responses, extensive viral dissemination and long-term viral RNA persistence in domestic sheep experimentally infected with Crimean-Congo haemorrhagic fever virus Kosovo Hoti

Crimean-Congo haemorrhagic fever orthonairovirus (CCHFV) is a tick-borne, risk group 4 pathogen that often causes a severe haemorrhagic disease in humans (CCHF) with high case fatality rates. The virus is believed to be maintained in a tick-vertebrate-tick ecological cycle involving numerous wild and domestic animal species; however the biology of CCHFV infection in these animals remains poorly understood. Here, we experimentally infect domestic sheep with CCHFV Kosovo Hoti, a clinical isolate representing high pathogenicity to humans and increasingly utilized in current research. In the absence of prominent clinical signs, the infection leads to an acute viremia and coinciding viral shedding, fever and markers for potential impairment in liver and kidney functions. A number of host responses distinguish the subclinical infection in sheep versus fatal infection in humans. These include an early reduction of neutrophil recruitment and its chemoattractant, IL-8, in the blood stream of infected sheep, whereas neutrophil infiltration and elevated IL-8 are features of fatal CCHFV infections reported in immunodeficient mice and humans. Several inflammatory cytokines that correlate with poor disease outcomes in humans and have potential to cause vascular dysfunction, a primary hallmark of severe CCHF, are down-regulated or restricted from increasing in sheep. Of particular interest, the detection of CCHFV RNA (including full-length genome) in a variety of sheep tissues long after the acute phase of infection indicates a widespread viral dissemination in the host and suggests a potentially long-term persisting impact of CCHFV infection. These findings reveal previously unrecognized aspects of CCHFV biology in animals.

Contact tracing in Austria, Georgia, Kyrgyzstan, Ukraine, and Kosovo† during the COVID-19 pandemic: response review and good practices

BACKGROUND

During the COVID-19 pandemic, effective contact tracing was recognized as a crucial public health response to mitigate the spread of SARS-CoV-2 and reduce COVID-19-related morbidity and mortality, particularly before widespread vaccination. The World Health Organization (WHO) recommended implementing active surveillance strategies to trace and quarantine contacts of confirmed or suspected COVID-19 cases.

METHODS

A detailed review and analysis of the COVID-19 contact tracing responses was conducted in five European countries and territories, between March 2021 and August 2022. The countries and territories were selected to ensure geographical representation across the WHO European Region and applied a mixed-methods approach of in-depth interviews with various stakeholders across different administrative levels to identify good practices in COVID-19 contact tracing. The interviews covered 12 themes, including methods and procedures for COVID-19 contact tracing, information technology, quality assurance and key performance indicators.

RESULTS

The findings demonstrate that the policy approach, digitalization capabilities and implementation approach varied in the countries and territories and were dynamic throughout the pandemic. The analysis revealed that some practices were applicable across all countries and territories, while others were context-specific, catering to each country's and territory's unique needs. The study highlighted a need for all countries to institutionalize contact tracing as an essential function of existing health systems, to digitalize contact tracing practices and processes, and to build and retain contact tracing capacities for better pandemic preparedness.

CONCLUSION

The lessons related to COVID-19 contact tracing should be utilized to strengthen future outbreak response operations as part of epidemic and pandemic preparedness.

Mercury distribution and contamination in the soils of the Mitrovica region, Republic of Kosovo

The study was carried out to define the distribution of mercury in surface soils in the Mitrovica region, Republic of Kosovo and to assess the level and extent of contamination. A total of 156 soil samples were collected from a depth of 5 cm at each grid point of 1.4 × 1.4 km in an area of 301.5 km2. The mercury content was found to be between 0.02 mg/kg and 11.16 mg/kg. The average Hg content (0.49 mg/kg) exceeded the mean content in European (0.037 mg/kg) and world (0.06 mg/kg) soils by 13.2 and 8.2 times, respectively. From the calculated enrichment factors (EF) and the geo-accumulation index (I-geo), as well as from the distribution map of Hg content, it is evident that the soils of the study area are highly contaminated with mercury, with extremely high enrichment of Hg in the soils of Zone I, which was classified as the most contaminated zone with Hg and other potentially toxic elements in the study area as well as in the towns of Zveçan and Mitrovica. The higher Hg content is of anthropogenic origin, mainly due to lead and zinc mining and metallurgical activities in the study area. The mercury levels were also found to exceed the New Dutch List target value (0.3 mg/kg) in 90 km2 of the study area.

Breast Cancer Disparities and Innovations: A Focus on Kosovo

Due to the current limited capacity to provide digital mammography-based screening to all women, and the lack of modern surgical oncology methods, mastectomy is still the predominant form of surgical treatment in many parts of the world. As such there is little incentive to detect breast cancer earlier and significant fear of treatment and outcomes continues to contribute to late presentations. Neoadjuvant chemotherapy, pre-operative breast MRI and surgical mapping techniques can combine forces to allow for more women to be treated with breast conservation, decrease fear of treatment and improve outcomes.

Effectiveness of behavioural change interventions on physical activity, diet and body mass index of public primary healthcare users in Kosovo: the KOSCO cohort

BACKGROUND

Prevalent physical inactivity and poor nutrition contribute to high non-communicable disease (NCD) morbidity and mortality in Kosovo. To improve health services for patients with NCD the Accessible Quality Healthcare project developed behaviour change interventions following the principles of the WHO Package of Essential NCD (PEN) protocol. They were implemented into the public primary healthcare (PHC) system of five early-stage implementation municipalities (ESIM, 2018) and seven late-stage implementation municipalities (2020).

OBJECTIVE

To assess the effect of the behaviour change interventions; motivational stages of behaviour change for physical activity and nutrition; and body mass index (BMI).

DESIGN

Prospective cohort study.

DATA COLLECTION AND ANALYSIS

We included 891 public PHC users aged 40 years and above, who were enrolled in the KOSCO (Kosovo Non-Communicable Disease Cohort) cohort in 2019 and followed-up biannually until February 2021. The PHC users who consulted for themselves any health service were approached and recruited for cohort participation. Each participant contributed up to four self-reports of nutrition and physical activity, and up to three reports of motivation to change for a better lifestyle. These outcomes were modelled prospectively with robust mixed-effects Poisson regressions. The association between behaviour change interventions and BMI was quantified using linear regression.

RESULTS

There was a high rate of smokers 20.5% and obesity 53.1%, and high rates of self-reported diagnoses of diabetes: 57.1%; hypertension 62.6%. We found no effect of residing in an ESIM, but adherence to both guidelines was higher in ESIM at the latest follow-up time point. ESIM residence was also associated with a twofold increase in the probability of reporting a high motivation for a better lifestyle and with a statistically non-significant decrease in BMI of -0.14 kg/m2 (95% CI: -0.46 to 0.19) at the latest follow-up.

CONCLUSION

The longitudinal results extend evidence on the effect of WHO PEN protocol in promoting physical activity and nutritional behaviour in the Kosovo context.

Mental Health Information Reporting Assistant (MHIRA)-an open-source software facilitating evidence-based assessment for clinical services

Evidence-based assessment (EBA) in mental health is a critical aspect of improving patient outcomes and addressing the gaps in mental health care. EBA involves the use of psychometric instruments to gather data that can inform clinical decision-making, inform policymakers, and serve as a basis for research and quality management. Despite its potential, EBA is often hindered by barriers such as workload and cost, leading to its underutilization. Regarding low- and middle-income countries (LMIC), the implementation of EBA is recognized as a key strategy to address and close the prevalent mental health treatment gap.To simplify the application of EBA including in LMIC, an international team of researchers and practitioners from Tanzania, Kosovo, Chile, and Switzerland developed the Mental Health Information Reporting Assistant (MHIRA). MHIRA is an open-source electronic health record that streamlines EBA by digitising psychometric instruments and organising patient data in a user-friendly manner. It provides immediate and convenient reports to inform clinical decision-making.The current article provides a comprehensive overview of the features and technical details of MHIRA, as well as insights from four implementation scenarios. The experience gained during the implementations as well as the user-feedback suggests that MHIRA has the potential to be successfully implemented in a variety of clinical contexts and simplify the use of EBA. However, further research is necessary to establish its potential to sustainably transform healthcare services and impact patient outcomes.In conclusion, MHIRA represents an important step in promoting the widespread adoption of EBA in mental health. It offers a promising solution to the barriers that have limited the use of EBA in the past and holds the potential to improve patient outcomes and support the ongoing efforts to address gaps in mental health care.

Resilience After Trauma in Kosovo and Southeastern Europe: A Scoping Review

Most people who experience trauma want to thrive and often find paths to well-being and healthy functioning. This scoping review explores the existing evidence on adversity and resilience in southeastern European countries, focusing on Kosovo. There is a lack of research on trauma and resilience in cultures outside the US and Western Europe. The paper provides a brief cultural and historical overview of this region and the collectivist cultures found there. We draw from a range of interdisciplinary literatures to identify key strengths that have the potential to improve health outcomes for trauma victims in this region. Overall, 42 papers from PsycInfo and PubMed were identified, using keywords such as "resilience" or "health" and "Kosovo," "Balkans," and "Southeastern Europe." Findings from this scoping review show that different cultural values, norms, and societal ecologies impact resilience within these societies. Some strengths, such as social support and sense of purpose, echoed similar research in the US and Western Europe. There was also evidence that factors such as dignity, family solidarity, social activism, and nationwide meaning-making are strengths associated with resilience for these collectivist societies of southeastern Europe. We also consider the implications of the results for other post-conflict societies. Finally, findings from this review call for culturally sensitive strength-based perspectives in promoting health and well-being after the high dosages of trauma common in this region.

Detection and Molecular Characterization of Blastocystis Species in Polish Soldiers Stationed in the Republic of Kosovo

Blastocystis species (sp.) is one of the less well-understood water- and foodborne protozoa of medical and veterinary importance linked to different gastrointestinal disorders. Soldiers participating in military missions are particularly vulnerable to infection with this protozoa. The present study used molecular methods to detect, identify, and subtype (ST) Blastocystis sp. in Polish soldiers stationed in the Republic of Kosovo. Fecal samples were collected from 192 soldiers on arrival and after four months of stay. After DNA extraction, the barcoding region of the small subunit ribosomal RNA (SSU-rRNA) gene was amplified and sequenced. The DNA of Blastocystis sp. was detected in six (3.13%) and thirty (15.16%) samples in the first and second batch, respectively. Sequencing analysis revealed infections with ST 2, 3, 4, and 7. There was no statistical association between Blastocystis sp. infection and the parasite's ST or the age or rank of soldiers. The results indicate that the visit to a new environment and prolonged stay in the area of military operation in Kosovo resulted in a significant increase in both Blastocystis sp. infections and ST diversity among surveyed soldiers. This shows the need to undertake appropriate countermeasures to reduce Blastocystis infections in the military environment abroad.

Stress induced by soil contamination with heavy metals and their effects on some biomarkers and DNA damage in maize plants at the vicinity of Ferronikel smelter in Drenas, Kosovo

The Ferronikel smelter in Drenas is one of the main industrial areas in the Kosovo and pollution by heavy metals causes serious threat for all living organisms on this area. The objective of this study was to determine the concentration of some heavy metals (Fe, Cu, Mn, Cr, Cd, Ni and Pb) in agricultural soils and in maize plants, and their potential toxic effects on this plant through some sensitive biochemical and molecular markers. Maize seedlings growth in nine soil samples from different locations of this area. The highest concentrations of heavy metals in soils and maize leaves were conducted close to the Ferronikel smelter, and in some locations, the nickel and chromium concertation in soils exceeded 800 mg kg-1. A significant effects of heavy metals induced toxicity resulted in the, build-up aminolevulinic acid and reduced activity of δ-aminolevulinic acid dehydratase, and chlorophyll content in the maize leaves. In general, maize seedlings growth in polluted locations showed an increase in nuclear DNA content and in G2M phase. We concluded that locations close to the smelter are affected by soil heavy metals pollution and these biochemical and molecular analysis would be a powerful ecotoxicological tool in biomonitoring of heavy metal pollution.

deneoformans) isolates from natural environment in Kosovo

A total of 300 tree-associated samples were collected from green areas in three towns in Kosovo, and cultured to isolate Cryptococcus species. One soil sample from Prizren tested positive, yielding three isolates identified as C. neoformans var. neoformans (C. deneoformans), molecular type VNIV, two MATα, and one MATa. Mating experiments revealed that they were fertile when crossed together, and multilocus sequence typing analysis showed unique sequence types not found in the global database. The study reports the presence of C. neoformans strains in the environment in Kosovo and highlights the importance of monitoring pathogen distribution and the potential impacts of climate change.

Key lessons learnt from COVID-19 intra-action reviews in the Republic of Moldova, Montenegro, Kosovo and North Macedonia 2020-2021: a qualitative study

OBJECTIVES

Our study described how the WHO intra-action review (IAR) methodology was operationalised and customised in three Western Balkan countries and territories and the Republic of Moldova and analysed the common key findings to inform analyses of the lessons learnt from the pandemic response.

DESIGN

We extracted data from the respective IAR reports and performed a qualitative thematic content analysis to identify common (between countries and territories) and cross-cutting (across the response pillars) themes on best practices, challenges and priority actions. The analysis involved three stages, namely: extraction of data, initial identification of emerging themes and review and definition of the themes.

SETTING

IARs were conducted in the Republic of Moldova, Montenegro, Kosovo and the Republic of North Macedonia between December 2020 and November 2021. The IARs were conducted at different time points relative to the respective pandemic trajectories (14-day incidence rate ranging from 23 to 495 per 100 000).

RESULTS

Case management was reviewed in all the IARs, while the infection prevention and control, surveillance and country-level coordination pillars were reviewed in three countries. The thematic content analysis identified four common and cross-cutting best practices, seven challenges and six priority recommendations. Recommendations included investing in sustainable human resources and technical capacities developed during the pandemic, providing continuous capacity-building and training (with regular simulation exercises), updating legislation, improving communication between healthcare providers at all levels of healthcare and enhancing digitalisation of health information systems.

CONCLUSIONS

The IARs provided an opportunity for continuous collective reflection and learning with multisectoral engagement. They also offered an opportunity to review public health emergency preparedness and response functions in general, thereby contributing to generic health systems strengthening and resilience beyond COVID-19. However, success in strengthening the response and preparedness requires leadership and resource allocation, prioritisation and commitment by the countries and territories themselves.

Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo

BACKGROUND

Several changes must be made to the services to ensure patient safety and enable delivering services in environments where the danger of infection of healthcare personnel and patients in primary care (PC) institutions is elevated, i.e., during the COVID-19 pandemic.

OBJECTIVE

This study aimed to examine patient safety and healthcare service management in PHC practices in Kosovo during the COVID-19 pandemic.

METHODS

In this cross-sectional study, data were collected using a self-reported questionnaire among 77 PHC practices.

RESULTS

Our main finding reveals a safer organization of PC practices and services since the COVID-19 pandemic compared to the previous period before the pandemic. The study also shows a collaboration between PC practices in the close neighborhood and more proper human resource management due to COVID-19 suspicion or infection. Over 80% of the participating PC practices felt the need to introduce changes to the structure of their practice. Regarding infection protection measures (IPC), our study found that health professionals' practices of wearing a ring or bracelet and wearing nail polish improved during the COVID-19 pandemic compared to the pre-pandemic period. During the COVID-19 pandemic, PC practice health professionals had less time to routinely review guidelines or medical literature. Despite this, implementing triage protocols over the phone has yet to be applied at the intended level by PC practices in Kosovo.

CONCLUSIONS

Primary care practices in Kosovo responded to the COVID-19 pandemic crisis by modifying how they organize their work, implementing procedures for infection control, and enhancing patient safety.

Management of Non-Communicable Diseases in Kosovo: A Scoping Review

Background-Non-communicable diseases (NCDs) affect a growing share of the population in Kosovo. The country faces challenges with NCDs management, specifically detecting, screening, and treating people with NCDs. Objective-To assess the management of NCDs, including the inputs that influence the provision of NCDs and outcomes of NCD management. Eligibility criteria-Studies had to report NCD management in Kosovo. Sources of evidence-We systematically searched Google Scholar, PubMed, Scopus, and Web of Science. Charting methods-The data were charted by two researchers. We extracted data on general study details and design and information on the management and outcomes of NCDs in Kosovo. Synthesis of results-For the mix of studies that were included in the review, thematic narrative synthesis was used. We developed a conceptual framework based on health production core components to analyze the data. Results-Kosovo's health care system is available to provide basic care for patients with NCDs. However, there are serious limitations in the availability of key inputs providing care, i.e., funding, medicines, supplies, and medical staff. Additionally, in terms of the management of NCDs, there are areas for improvement, such as limited application of clinical pathways and guidelines and issues with referrals of patients among levels and sectors of care. Finally, it is worth noting that there is overall limited information on NCD management and outcomes. Conclusions-Kosovo provides only basic services and treatment of NCDs. The data reporting the existing situation on NCD management are limited. The inputs from this review are helpful for existing policy efforts by the government aimed to enhance NCD care in Kosovo. Funding-This study is part of the research done for a World Bank review of the state of NCDs in Kosovo and was funded through the Access Accelerated Trust Fund (P170638).

RADON IN DRINKING WATER FROM ALTERNATIVE SOURCES OF WATER SUPPLY IN THE NORTH OF KOSOVO

In this study, the results of research on radon activity concentrations in natural mineral waters, traditionally used for drinking but also for other needs, in rural and urban households in northern Kosovo are presented. Radon activity concentration in water was measured by the alpha spectrometric method with a RAD7 device. Radon activity concentrations in the 24 waters studied ranged from 1.6 ± 0.5 to 46.3 ± 6.3 Bq l-1, with an average activity concentration of 12.4 ± 2.0 Bq l-1, which was somewhat higher than the EPA recommended maximum activity concentration, but below the WHO recommended maximum. The contribution of radon activity concentrations in water was determined in relation to the total radon activity in air and enclosed space. The estimated annual effective doses of inhalation and ingestion radon from water were 109.4 ± 16.7 and 2.6 ± 0.4 μSv y-1, respectively.

Assessment of Potentially Toxic Element Concentrations in Soil And Vegetables and Impact on Human Health Through TF, EDI, and HRI Indicators: Case Study Anadrinia Region (Kosovo)

Vegetable cultivation areas in the Anadrinia region may have higher than background concentrations of potentially toxic elements (PTEs) from contaminated sources including anthropogenic activity and lithologic composition. The purpose of the present study was to assess PTEs concentrations in soil and vegetables and their impact on human health. In this study, 50 soils and 5 vegetables were sampled from the studied area. PTEs (As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, and Zn) were measured by inductively coupled plasma optical emission spectroscopy (ICP-OES) after digestion in microwave system. PTEs in soil and vegetables were assessed and compared to international data (Dutch List and WHO/FAO 2011), and their toxicological risk was estimated using transfer factor (TF), estimated daily intake (EDI), and hazard quotients (HQ). The average values of As, Cd, Co, Fe, and Mn in soil were 44.96, 0.324, 16.34, 13,172, and 765.1 mg/kg, and Cr, Ni, and Pb in vegetables were 21.02, 17.11, and 4.982 mg/kg. TF values were less than 1, suggesting low bioaccumulation. EDI values of Cu, Ni, Pb, and Zn were 6.29, 6.23, 2.09, and 16.6 mg/kg, higher than international guidelines. HQ values of Pb, Ni, and Cu were 6.22, 3.66, and 1.72, higher than maximum tolerable value 1 indicating significant health risk. Some of the analyzed elements in soil and vegetable exceeded permissible limits to Dutch List and WHO/FAO 2011, respectively. From a health point of view, this study revealed vegetable contamination, recommends periodic monitoring.

Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

BACKGROUND

Heart failure represents a life-threatening progressive condition. Early diagnosis and adherence to clinical guidelines are associated with improved outcomes for patients with heart failure. However, adherence to clinical guidelines remains limited in Kosovo.

OBJECTIVE

To assess the clinical decision-making related to heart failure diagnosis by evaluating clinicians' preferences for clinical attributes.

METHOD

Conjoint analysis with 33 clinical scenarios with physicians employed in public hospitals in Kosovo.

SETTING

Two public hospitals in Kosovo that benefited from quality improvement intervention.

PARTICIPANTS

14 physicians (internists and cardiologists) in two hospitals in Kosovo.

OUTCOME MEASURES

The primary outcome was the overall effect of clinical attributes on the decision for heart failure diagnosis.

RESULTS

When considering clinical signs, the likelihood of a heart failure diagnosis increased for ages between 60 to 69 years old (RRR, 1.88; CI 95%, 1.05-3.34) and a stable heart rate (RRR, 1.93; CI 95%, 1.05-3.55) and decreased for the presence of edema (RRR, 0.23; CI 95%, 0.15-0.36), orthopnea (RRR, 0.31; CI 95%, 0.20-0.48), and unusual fatigue (RRR, 0.61; CI 95%, 0.39-0.94). When considering clinical examination findings, the likelihood for heart failure diagnosis decreased for high jugular venous pressure (RRR, 0.49; CI 95%, 0.32-0.76), pleural effusion (RRR, 0.35; CI 95%, 0.23-0.54), hearing third heart sound, (RRR, 0.50; CI 95%, 0.33-0.77), heart murmur (RRR, 0.57; CI 95%, 0.37-0.88), troponin levels (RRR, 0.59; CI 95%, 0.38-0.91), and NTproBNP levels (RRR, 0.36; CI 95%, 0.24-0.56).

CONCLUSIONS

We often found odd and wide variations of clinical signs and examination results influencing the decision to diagnose a person with heart failure. It will be important to explore and understand these results better. The study findings are important for existing quality improvement support efforts and contribute to the standardization of clinical decision-making in the public hospitals in the country. This experience and this study can provide valuable impetus for further examination of these efforts and informing policy and development efforts in the standardization of care in the country.

Clinical Decision-Making for Appendectomy in Kosovo: A Conjoint Analysis

Objective: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for appendectomy. Method: A conjoint analysis with 17 clinical scenarios was executed with surgeons employed at public hospitals in Kosovo. Setting: The study was conducted at two public hospitals in Kosovo that have benefited from quality-improvement interventions. Participants: The participants included 22 surgeons. Outcome measures: The primary outcome was the overall effect of clinical attributes on the decision to perform appendectomy and make the preoperative preparations for appendectomy. Results: In the regression analyses, several attributes demonstrated statistically significant effects on the clinical decision to perform appendectomy and on the practice of preoperative preparation. Conclusions: We found that several factors influenced the decision to perform appendectomy and the practices for preoperative preparation. Nevertheless, the small sample size limited our efforts to interpret the results. These findings could assist Kosovo in the design and implementation of future similar studies and in fostering quality improvement measures that address clinical decision making and the lack of process standardization in the delivery of surgical care.

Distribution and statistical analysis of major and trace elements in the bee pollen from the territory of Republic of Kosovo

The objective of this study was the determination of major and trace elements in the bee pollen samples from the whole territory of Republic of Kosovo. Pollen, as a natural plant product, is exposed to different contaminations absorbed by plants from the soil through the root system or with water intake, as well as to pollutants of different origins, including anthropogenic ones, deposited directly on pollen. In total 67 pollen samples were collected in 2019. The samples were analyzed for 27 macro and microelements by using ICP-AES and ICP-MS. The mean content of major elements in bee pollen was 4065, 3455, 1375 and 549 mg/kg for K, P, Ca and Mg, respectively. The range of the contents for some potentially toxic elements was 11.9-139.1, 1.9-16, 0.11-6.25, 0.01-0.329 and 0.001-0.38 mg/kg for Zn, Cu, Pb, Cd and As, respectively. Three groups of elements of mixed origin were identified through factor analysis: the first and the third Factors, are mostly of geogenic origin (Ag, Li, Al, Fe, Ca, Sr, K, Mg and P and Co, Ni, Cr, Cu and Mn) and the second Factor association is related to anthropogenic processes (Sb, As, Pb, Tl, Sn and Cd).

Volatile Constituents of Some Selected Plant Species Traditionally Used as Tea in the Sharri Mountains (Kosovo)

The study evaluates the chemical composition of the volatile constituents of ten plant species traditionally used as herbal tea in the Sharri Mountain regions (Kosovo and North Macedonia). Volatile constituents responsible for the flavour and fragrance of selected species (Crataegus monogyna, Cydonia oblonga, Malus sylvestris, Matricaria chamomilla, Morus alba, Morus nigra, Rosa canina, Sambucus nigra, Tilia cordata, and Vaccinium myrtillus) were separated and then identified using GC-MS, whereas GC-FID is employed for the quantitative analysis. Experimental data revealed different patterns of volatile constituents depending on plant species. Monoterpenes, sesquiterpenes, diterpenes, and norisoprenoids were the most abundant volatile constituents. Principal component analysis (PCA) was deployed for data analysis and resulted in grouping these ten species in four principal clusters. The combination of various volatile constituents present in specific plant species may play an important role in the specific aroma and taste sensation of these species used as recreational teas.

Statistical analysis of atmospheric deposition of heavy metals in Kosovo using the terrestrial mosses method

Heavy metals presence in the air in the territory of Kosovo was estimated using mosses as biomonitors. The periodic smog over the territory of Kosovo, particularly around industrial sites and cities, is a clear indication of air pollution which unavoidably will contain heavy metals, because of the nature of the industries in area. This work was carried out aming to assess the presence of heavy metals in the air, identify the most polluted sites, and the origins of pollution. Heavy metals such as Al, Cd, Cr, Cu, Fe, Ni, Pb, and Zn, were determined in 45 moss samples. Statistical analysis was performed to better explain the data. The most polluted sites appeared to be in Zveqan, Stanterg, Prapashticë, Siboc, and Lupç. The contamination factor (CF) showed that only Cu and Zn had no or almost no contamination levels over the range of moss samples with CF < 1, while Cd and Pb gave extremely high values, CF > 27. Pollution load index (PLI) also showed that only a few samples are moderately polluted 2 < PLI ≤ 3, while most of the samples appeared to be highly polluted 4 < PLI ≤ 5, and very highly polluted PLI > 5.

The Asian tiger mosquito Aedes albopictus (Skuse) in Kosovo: First record

The Asian tiger mosquito, Aedes albopictus, is an invasive mosquito species that is considered a potential vector of about 22 arboviruses, among which dengue, chikungunya and Zika. Here we report the first record of Aedes albopictus in the territory of the Republic of Kosovo. The first finding, in July 2020, was driven by a photo of an adult mosquito published by a citizen in social media. The subsequent field investigation in July 2020 confirmed the presence of adult mosquitoes by human landing catch and collection of eggs in ovitraps at the village Zhur. Monitoring was performed for 7 weeks with ovitraps and BG-Sentinel adult traps at 36 sampling stations from 7 localities, in the Southern part of Kosovo, on the border with Albania. Fifty-two out of 81 ovitrap samples resulted positive for the presence of Ae. albopictus. A total of 2,711 eggs are collected in 22 out 36 stations and a total of 78 adults from 4 out 4 stations with BG Sentinel trap and 15 adults with handled electric aspirator. Our finding shows that the tiger mosquito is expanding its geographical range in the Balkans, southeastern Europe.

An Exploratory Study of Gender Role Stress and Psychological Distress of Women in Kosovo

INTRODUCTION

Although investigations of changing gender roles have been performed globally, most studies have been conducted in high-income countries, and studies from emerging and developing countries are lacking. This study aims to examine the factor structure of the feminine gender role stress scale among women (FGRS) and explore its relationship with psychological distress (PD).

METHODS

A cross-sectional study was carried out with 656 women from Kosovo using a convenience sampling technique during October 2017 and March 2018. The data were collected through face-to-face interviews and analyzed using the Statistical Package for the Social Sciences version 21 and Mplus 7.3. Confirmatory factor analysis (CFA) and path analysis were used to understand the goodness-of-fit of the FGRS scale in the Kosovo context and explore the relationship between the FGRS scale and PD when treated as latent variables. Multivariance analysis of variance (ANOVA) was used to understand the differences between groups of women based on employment and FGRS. Multinomial logistic regression was used to assess the prediction of different domains of FGRS for PD separately for each category while controlling for age.

RESULTS

After demonstrating that the five-factor model of the FGRS showed a good fit to the data in this sample of Kosovo women, analyses revealed that the FGRS domains (fear of victimization and behaving with assertiveness) were positively associated with psychological distress.

CONCLUSION

The findings validate the usefulness of the FGRS scale in a sample of Kosovar women. The intersectionality perspective was used to interpret the importance of multiple layers of vulnerabilities and their coexistence, including education, socioeconomic status, and their implications for health inequalities.

Cancer incidence among the NATO peacekeeping forces in Bosnia and Kosovo: a systematic review and metanalysis

BACKGROUND

A few cohort studies of the NATO peacekeepers in the Bosnia and Kosovo war reported inconclusive results on cancer risk. A systematic review and metanalysis of such studies might help to resolve the interpretative limitations.

METHODS

Relevant publications were retrieved through a PubMed search and from the list of references of the selected reports. Five epidemiological studies, one each from Denmark, Italy, the Netherlands, Norway, and Sweden, satisfied the selection criteria. Random and fixed effect estimators were calculated. Heterogeneity across studies was formally tested for all cancer outcomes.

RESULTS

Incidence of all cancers was below the expectation, as was the case for lung cancer and cancer at most other organs. The incidence of Hodgkin's lymphoma exceeded expectation in the first years after deployment in the Italian cohort but not in the subsequent years of follow-up. The risk of colorectal cancer and bone cancer was increased in the Danish cohort, and so was the risk of leukaemia in the Swedish cohort. Bladder cancer cases were non significantly more than expected in the three Scandinavian studies. The Cochrane's Q-test was indicative of significant heterogeneity across studies for total cancer, colorectal cancer, melanoma, and leukaemia. The meta-estimate of risk of bladder cancer was increased two-fold (fixed effect summary [FES] = 2.16 (95% CI 1.35 - 2.97), based on three studies.

DISCUSSION

Exposure to depleted uranium, metals, and ultrafine particles has been claimed as responsible for the cancer cases observed among peacekeepers. None of these would account for the excess of bladder cancer. The hypothesis of viral epidemics around the deployment area of the Italian military as contributing to the temporary excess of Hodgkin's Lymphoma cases would be worth exploring.

Heavy Metal Contamination and Accumulation in Soil and Plant from Mining Area of Mitrovica, Kosovo

This study assesses the total concentration of eight toxic metals As, Cd, Co, Cr, Cu, Ni, Pb, and Zn in the soil and plant of Salix purpurea samples collected from Mitrovica mining region in Kosovo. The concentration, accumulation and transfer from soil to roots, stem and leaves were assessed using bioconcentration factor (BCF) and translocation factor (TF). The total metal content in the soil and plant was high following the trend of Zn > Pb > Ni > Cd > Cu > As > Co > Cr. The relevance between soil and accumulation of heavy metals in Salix purpurea was assessed using correlation matrix and principal components analysis. The results indicate that Salix Purpurea can be used in phytoremediation and stabilization of soil contaminated by heavy metals.

Positive attitudes towards persons living with HIV in North Kosovo: The university students' perspective

HIV-related stigma could delay the identification and treatment of persons living with HIV (PLHIV), particularly in regions affected by ethnic conflicts. The aims of this study were to assess attitudes towards PLHIV and examine factors associated with stronger positive attitudes towards PLHIV among university students in the Serbian province of Kosovo. A cross-sectional study was conducted at the University of Pristina temporarily settled in Kosovska Mitrovica during the academic year 2013-2014. A total of 1,017 first- and fourth-year students completed an anonymous questionnaire about socio-demographic characteristics, PLHIV, high-risk groups for acquiring HIV and health behaviour. The main outcome measure was the Attitude Score (ATS), calculated as a sum of points awarded for all attitude-related items. The majority of students (84%) expressed positive attitudes towards PLHIV, while others were indecisive. Most students held negative opinions about persons who use drugs (64%), homosexual persons of both genders (50%) and sex workers (42%). Being female (odds ratio [OR] = 1.49, 95% confidence interval [CI] 1.05-2.09) and older (OR = 1.13, 95% CI 1.03-1.24), not doing paid work while studying (OR = 3.35, 95% CI = 1.63-6.84), studying health-related disciplines (β = -0.113, 95% CI = -0.085 to -2.747), having stronger positive attitudes towards homosexual persons of both genders (OR = 0.77, 95% CI = 0.64-0.94) and not using illicit drugs (β = 2.08, 95% CI = 1.03-4.20) were associated with stronger positive attitudes towards PLHIV. Social inclusion of PLHIV and individuals at high risk for acquiring HIV could help reduce the HIV-related stigma.

CRIMINAL ASPECT OF THE COVID-19 PANDEMIC IN BOSNIA AND HERZEGOVINA AND THE REGION

The COVID-19 pandemic (SARS-CoV-2) has caused multiple consequences globally, and all can be re-searched and addressed multidisciplinary, ie from a health (medical), legal, economic and security aspect. In this paper, the author focuses on the legal, ie criminal law aspect of this pandemic. After more than a year of the COVID-19 pandemic in the world, based on the measures taken in almost all countries, it can be concluded that the health and legal aspects are primary and complementary. This claim is supported by the fact that the protection of human health must be regulated by adequate legislation, which is, above all, the Law on the Protection of the Population from Infectious Diseases. However, in such an emergency situation without criminal protection, it is difficult to achieve effective health care for the population.Therefore, this article analyzes the criminal and medical aspects of crimes against human health that are similar or almost identical in all countries in the region, such as Bosnia and Herzegovina, Croatia, Slovenia, Serbia, Northern Macedonia and Kosovo.

First Data on Human Lyme Borreliosis in Kosovo: Prospective Evaluation of the Disease from a Tick Bite Perspective

Purpose: Lyme borreliosis (LB) occurs throughout Europe. No clinical and seroprevalence studies for LB in Kosovo have been publicly available thus far. Therefore, this study aimed to investigate LB from a tick bite perspective in the Pristina region, Kosovo. Methods: This single-center prospective observational study enrolled consecutive adult participants (≥18 years of age) with tick bite (embedded tick in the skin), who were examined at the Clinic of Infectious Diseases, Pristina, between January 2015 and August 2018. At the first visit related to the index tick bite, ticks (the complete ticks or parts of the ticks) were removed from the skin, blood samples were taken for serological tests, and antibiotic treatment was started when deemed necessary. The complete, undamaged ticks removed were proceeded for entomological identification. Participants were followed up at 2 months (serological tests were repeated) and 6 months after the index event for the development of clinical manifestations of LB and/or seroconversion against Borrelia burgdorferi. Results: A total of 380 subjects were included in the study. Most cases were seen in May and June in all study years. All 117 preserved ticks were identified as Ixodes ricinus. Immunoglobulin G seroprevalence among subjects during the first visit in the study was 28/380 (7.4%). Erythema migrans (EM) was clinically diagnosed in 74/380 patients (19.5%, 95% confidence interval 15.6-23.8). Only 15 clinically diagnosed EM (in seronegative patients) were serologically confirmed with seroconversion (2 months later), 3.9% of all subjects included in the study. There were three cases with clinical manifestation between the second and third visit: EM recidivans, multiple erythema, or several nonspecific systemic symptoms. Doxycycline and amoxicillin were mainly used for the treatment of borrelial skin lesions. Conclusion: This assessment can help indicate the need for disease awareness and reinforce the importance of primary prevention measures, early diagnosis, and appropriate treatment.

Occurrence and enrichment sources of cobalt, chromium, and nickel in soils of Mitrovica Region, Republic of Kosovo

The main purpose of this study is to determine the differences between anthropogenic sources and lithogenic sources of the content of certain potentially toxic elements in the region of Mitrovica, Republic of Kosovo. For that purpose, the results of a study on the spatial distribution and enrichment of cobalt, chromium and nickel in surface soil from Mitrovica and its environ, are reported. The average content of Co, Cr and Ni in soil amounts to 22 mg kg^-1, 60 mg kg^-1 and 96 mg kg^-1, respectively. Spatial distribution maps of Co, Cr and Ni shows their predominance in the area of Triassic serpentinites on the North-eastern and Western parts of study area. The lowest contents are found on the outcropping of Miocene latites, quartz-latites and pyroclastites. It has been established that the increased content of Co, Cr and Ni in soils from this area is of lithogenic origin. It is shown that content of Co, Cr and Ni exceeds the target Dutch value in 173 km², 82 km² and 256 km² (from 302 km² of the study area), respectively, while the content of Cr and Ni exceeds the action Dutch value in 17 km² and 63 km², respectively.

Comparison of Frontal Sinuses for Personal Identification in 3 Populations Using Cameriere's Code Number

ABSTRACT

The identification of unknown individuals is of crucial importance to society, especially in the context of mass disasters involving individuals of different nationalities. The comparison of frontal sinus patterns is an important tool for personal identification. In Cameriere's method, a new personal code number (codC) containing 8 digits was elaborated, based on the measurements of frontal sinus patterns. The present study is an update of this previous work. Digital radiographic images of the skulls of 299 individuals of different nationalities (100 Italians, 99 Kosovars, and 100 Turks) were analyzed, adopting the same maximum-weight dependence tree used in the original work. For comparisons between groups, Fisher exact test and the χ2 test were carried out. The method, applied to different population groups, significantly increases the likelihood of identifying a person by comparison of antemortem and postmortem frontal sinus radiographs. Results demonstrated that the model is more discriminative in identifying individuals of different nationalities.

Role of Calcium/Creatinine Ratio in Urine Compared with Proteinuria and Uric Acid in Predicting Preeclampsia: A Study from Kosovo

BACKGROUND Preeclampsia is a common complication of pregnancy and a major cause of morbidity and mortality of mothers and babies worldwide. This study aimed to explore what the role of calcium/creatinine ratio is in urine compared with proteinuria and uric acid in predicting preeclampsia. MATERIAL AND METHODS In this prospective case-control study, 200 pregnant women who participated in the study were consecutively divided into 3 groups: a group of 59 women with preeclampsia, 61 women with pregnancy-induced hypertension, and a control group of 80 normotensive pregnant women. A 24-h urine sample was collected for estimation of calcium/creatinine ratio and proteinuria and a blood sample for estimation of uric acid at a gestational age of 24-34 weeks of pregnancy. RESULTS The study found that the sensitivity of proteinuria as a predictor of preeclampsia was 96.6% (P=0.000) and specificity was 21.3%. The sensitivity of uric acid as a predictor was 96.6% (P=0.000) and the specificity was 48.8%; whereas for the 24-h urine calcium/creatinine ratio, the sensitivity was 87.9% (P=0.000) and the specificity 40.7%, which corresponds to a value of 0.105 (cutoff). Women with a calcium/creatinine ratio <0.105 have a higher risk of developing preeclampsia (87.9% confidence interval, P=0.000). CONCLUSIONS The role of the calcium/creatinine ratio in urine is inferior to proteinuria and uric acid in predicting preeclampsia.

Investigation of Concentration and Distribution of Elements in Three Environmental Compartments in the Region of Mitrovica, Kosovo: Soil, Honey and Bee Pollen

The abundances of selected elements in different environmental compartments, namely soil, honey, and bee pollen, was determined in this study. For that purpose, sixteen soil and honey samples, and nine pollen samples were taken in the region of Mitrovica, Kosovo. The concentration of elements was measured by ICP-AES and ICP-MS. Pollution level concentrations of Pb, Zn, As, and Cd were observed in soil. The level of soil pollution was estimated by calculating pollution indices. Pb was also observed at high concentrations in honey, as was Cd and Pb in pollen. Pearson’s correlation coefficients revealed mostly weak and moderate correlations of the concentrations of the eight selected elements among the soil, honey, and pollen samples. Several groups of elements with geogenic and anthropogenic origin were identified by hierarchical cluster analysis. The concentrations of selected heavy metals for soil and honey were compared to those in neighboring countries, and those for pollen with samples from Turkey, Serbia, and Jordan.

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.

Presence of veterinary antibiotics in livestock manure in two Southeastern Europe countries, Albania and Kosovo

Nowadays, veterinary drug application has become an integral practice in livestock farming. Veterinary antibiotics (VAs) are administered onto animals for therapeutic use; meanwhile, in some countries, they are used for growth promotion. To indicate the level of VAs use in livestock breeding in two countries, Albania and Kosovo, their presence was studied in the animal manure. In total, 38 manure samples, 22 from Kosovo and 16 samples from Albania, belonging to cattle, pig, and poultry, were collected and investigated for the presence of VAs. Seven VAs and 2 metabolites, from the groups of sulfonamides and tetracyclines, were identified by ultra-high pressure liquid chromatography coupled with tandem mass spectrometry (UHPLC-MS/MS). The detected antibiotics were sulfadiazine (SDZ), sulfathiazole (STZ), sulfamethazine (SMZ), oxytetracycline (OTC), tetracycline (TC), chlortetracycline (TC), and doxycycline (DOY). VAs were detected in 27% and 31.2% of the manure samples, from Kosovo and Albania, respectively, and the levels ranged from 0.04 to 10.1 mg kg^-1. VAs were widely detected (100%) in poultry manure from Kosovo, as well as poultry manure from Albania. The contamination rate ranged from pig manure (25%) to cow manure (66.6%). Sulfonamides were the most commonly detected VAs with maximum concentration of sulfadiazine (10.1 mg kg^-1) in poultry manure. Tetracyclines were most widely detected in poultry manure, as well as other animal manures. When it comes to the comparison between the two countries, VAs residues are more frequent per analyzed sample and higher in concentrations in the manure samples from Albania. Therefore, an environmental impact of VAs on both countries may be expected. These results indicate that VAs may enter the local ecosystem through manure application to agriculture and potentially may bring ecological risks.

Potential prognostic factors for hamstring muscle injury in elite male soccer players: A prospective study

Hamstring injuries remain the most common injury type across many professional sports. Despite a variety of intervention strategies, its incidence in soccer players playing in the UEFA Champions League has increased by 4% per year over the last decade. Test batteries trying to identify potential risk factors have produced inconclusive results. The purpose of the current study was to prospectively record hamstring injuries, to investigate the incidence and characteristics of the injuries, and to identify possible risk factors in elite male soccer players, playing in the Kosovo national premier league. A total of 143 soccer players from 11 teams in Kosovo were recruited. To identify possible prevalent musculoskeletal or medical conditions a widespread health and fitness assessment was performed including isokinetic strength testing, Nordic hamstring strength test, functional tests, and a comprehensive anamnesis surveying previous hamstring injuries. On average 27.9% of the players sustained at least one hamstring injury with three players suffering bilateral strains with the re-injury rate being 23%. Injured players were significantly older and heavier and had a higher body mass index compared to non-injured ones (p < 0.05). There was a lower passing rate in the Nordic hamstring strength test and a higher injury incidence among the previously injured players compared to non-injured ones (p < 0.05). Except for hamstring/quadriceps ratio and relative torque at 60°/sec (p < 0.05) for dominant and non-dominant leg, there were no other significant differences in isokinetic strength regardless of the angular velocity. No differences were observed for functional tests between cohorts. Regression analysis revealed that age, Nordic hamstring strength test, previous injury history, and isokinetic concentric torque at 240°/sec could determine hamstring injuries by 25.9%, with no other significant predicting risk factors. The battery of laboratory and field-based tests performed during preseason to determine performance related skills showed limited diagnostic conclusiveness, making it difficult to detect players at risk for future hamstring injuries.

Study protocol: a prospective cohort on non-communicable diseases among primary healthcare users living in Kosovo (KOSCO)

INTRODUCTION

With the lowest life expectancy in the Balkans, underlying causes of morbidity in Kosovo remain unclear due to limited epidemiological evidence. The goal of this cohort is to contribute epidemiological evidence for the prevention and control of non-communicable diseases such as depression, hypertension, diabetes and chronic respiratory disease in Kosovo as the basis for policy and decision-making, with a spotlight on the relationships between non-experimental primary healthcare (PHC) interventions and lifestyle changes as well as between depression and the course of blood pressure.

METHODS AND ANALYSIS

PHC users aged 40 years and above were recruited consecutively between March and October 2019 from 12 main family medicine centres across Kosovo. The data collected through interviews and health examinations included: sociodemographic characteristics, social and environmental factors, comorbidities, health system, lifestyle, psychological factors and clinical attributes (blood pressure, height, weight, waist/hip/neck circumferences, peak expiratory flow and HbA1c measurements). Cohort data were collected annually in two phases, approximately 6 months apart, with an expected total follow-up time of 5 years.

ETHICS AND DISSEMINATION

Ethical approvals were obtained from the Ethics Committee Northwest and Central Switzerland (Ref. 2018-00994) and the Kosovo Doctors Chamber (Ref. 11/2019). Cohort results will provide novel epidemiological evidence on non-communicable diseases in Kosovo, which will be published in scientific journals. The study will also examine the health needs of the people of Kosovo and provide evidence for health sector decision-makers to improve service responsiveness, which will be shared with stakeholders through reports and presentations.

Biochar effect on crop performance and Pb and Zn uptake of tomato (Solanum lycopersicum, L.) plants grown on heavy metals contaminated Kosovo soils

A greenhouse pot experiment was conducted to evaluate the effect of biochar on the growth and uptake of Pb and Zn by tomato plants (Solanum lycopersicum, L.) cultivated in two highly contaminated Kosovo soils, A and B. Plants were cultivated in the biochar amended and unamended soils. As expected, the biochar addition to the two polluted soils has contributed to significantly improve the crop yields, in terms of both fresh and dry weight. Further, results indicated that the effect of biochar on metal mobility is closely related, besides its properties, to soil's native characteristics. In fact, the addition of biochar to soil B had also beneficial effects on the uptake of both metals, halving in some cases the values of the biological accumulation and transfer coefficients, while it did not show the same efficacy on soil A.

Blood lead level (BLL), δ-aminolevulinic acid dehydratase activity (ALAD), hemoglobin (Hb) and hematocrit (hct) in primary school-children and adult residents living in smelter rural areas in Kosovo

The objective of this study was to investigate the effects of chronic environmental lead (Pb) exposure in blood lead level (BLL), δ-aminolevulinic acid dehydratase (ALAD) activity, hemoglobin (Hb) amount and hematocrit (Hct) value in primary schoolchildren and adults. Blood was obtained for BLL, ALAD, Hb and Hct measurements in 23 primary schoolchildren (girls and boys) and 117 adult residents (women and men) living in three villages (Kelmend, Boletin and Zhazhë) defined by concentric circles 2, 3 and 5 km in radius drawn around from the smelter-refinery complex "Trepça"in Zveçan and in Koliq village 40 km away. As expected, BLLs were substantially higher in the schoolchildren from smelter area compared with control (11 ± 4.2 µg/L and 6.9 ± 1.6 µg/L respectively) and in adult residents from Kelmend, Boletin and Zhazhë (24 ± 11.8, 12 ± 4.5, 11 ± 5.4 and 8.0 ± 2.8 µg/L respectively). Blood ALAD activity of children in Zhazhë is 16% inhibited compared to control and blood ALAD activity in adults in villages from smelter area is 32, 3%, 48, 4% and 17, 8% inhibited compared to control. There is no difference of Hb and Hct values in schoolchildren from Zhazhë and in adult residents from Kelmend and Zhazhë compared with control. Results of this study provide evidence of moderate inverse correlation between BLL and ALAD activity in both examined cohorts from smelter area. The inhibition of ALAD activity in primary schoolchildren and adults occurred at blood lead levels < 24 µg/L; consequently it can cause an increase of δ- Aminolevulinic acid.

Provision of community pharmacy services during COVID-19 pandemic: a cross sectional study of community pharmacists' experiences with preventative measures and sources of information

Background An infectious disease caused by a novel coronavirus (later called COVID-19) reached pandemic levels in 2020 and community pharmacists were involved in responding to this pandemic, also in Kosovo. Objectives To explore the experiences of community pharmacists in relation to provision of community pharmacy services during COVID-19 pandemic. Setting Community pharmacists in Kosovo. Methods This was a cross-sectional study where data was collected via a self-administered online questionnaire, from 264 pharmacists actively practicing in Kosovo during the pandemic. The questionnaire consisted of a combination of closed and open-ended questions, optional statements and statements on a five-point Likert scale, derived at least in part from the Transtheoretical Model. One-way analysis of variance was used to analyze differences in responses to Likert-type items whereas categorical variables were analyzed using Chi square testing. Main outcome measures Community pharmacists’ perceptions on COVID-19 related preventative measures. Results A response rate of 40.6% was achieved. Sufficient and adequate COVID-19-related preventative measures were being implemented by a majority of pharmacies (n = 232; 87.9%), and over two-thirds of respondents agreed/strongly agreed that their pharmacies were sufficiently prepared with protective equipment for their personnel. Implementation of preventative measures was associated with respondents’ perception that pharmacists and the pharmacy profession were valued more by patients during the pandemic and to a lesser degree, by other health professionals. Most commonly stated pros dealt with employee and patient safety, while key cons dealt with increased costs and running out of the necessary protective equipment. Key barriers to pharmacy activities were price increases by wholesalers, and patients’ panic and excessive buying, whereas drivers dealt with professional obligation to assist and opportunity to prove inseparable to other health professionals. The most popular means of accessing COVID-19 related information by pharmacists was via mobile devices and information from professional organizations was considered most useful by pharmacists. Conclusions Community pharmacies actively implemented various measures as precautions to mitigate the spread of COVID-19. Our findings highlight the value of continuous provision of information by professional organizations and use of mobile devices as key means to access information by pharmacists.

The use of macroinvertebrate based biotic indices and diversity indices to evaluate the water quality of Lepenci river basin in Kosovo

Benthic macroinvertebrates are used to evaluate water quality in 8 sampling stations in Lepenci river basin in Kosovo. Sampling was performed in spring, summer and fall 2017. Following biotic indices are used: EPT taxa richness, Biological Monitoring Working Party (BMWP), Average Score per Taxon (ASPT), Stroud Water Research Center index (SWRC), Family biotic index (FBI), as well as diversity indices: Shannon-Weaver index (H), Simpsons index (D), Hill's index (Hi), Mergalef index (D_Me) and Menhicnik's index (D_Ma). Our results show the presence of 34 macroinvertebrate taxa in Lepenci river which belong to Insecta, Crustaceans and Annelidae. The water quality along the river show variation from high and good class upstream, to moderate, poor and bad, downstream. The Pearson's bivariate correlation used to analyze the relationship between physicochemical parameters with biotic and diversity indices showed a significant correlation (p < 0.01) of EC, TSS, O₂, COD, BOD, NH_4, and PO₄^3- with biotic indices EPT, BMWP, ASPT, SWRC, FBI. We can conclude that the values of biotic and diversity indices have shown differences in water quality between polluted and unpolluted sites and reflect the ecological status of the river, therefore we can consider them as valuable tools for water quality assessment in rivers in Kosovo.

Lead contamination of the mining and smelting district in Mitrovica, Kosovo

Lead contamination in topsoil of the mining and smelting area of Mitrovica, Kosovo, was investigated for total concentrations and chemical fractions by sequential extraction analysis, mineralogical fractions by X-ray diffraction (XRD) and scanning electron microscopy with energy-dispersive X-ray spectrometer (SEM-EDX). The study revealed that all samples contained Pb exceeding USEPA standard of 400 mg kg^-1. The highest total concentration of Pb (125,000 mg kg^-1) was the soil from the former smelter. Sequential extraction results showed that the predominant form of Pb was associated with Fe-Mn oxide-bound fraction which ranged from 45.37 to 71.61% of total concentrations, while carbonate and silicate Pb-binding fractions were dominant when physical measurements (XRD and SEM-EDX) were applied. Application of Pb isotope ratios (²⁰⁶Pb^/207Pb and ²⁰⁸Pb^/206Pb), measured by inductively coupled plasma mass spectrometry, identified that Pb contamination is originated from similar anthropogenic source. The results reflected that the Pb contamination in the soil of this area is serious. In order to provide proper approaches on remediation and prevention of health impacts to the people in this area, a continuous monitoring and health risk assessment are recommended.

Risk assessment of heavy metal toxicity by sensitive biomarker δ-aminolevulinic acid dehydratase (ALA-D) for onion plants cultivated in polluted areas in Kosovo

Biomarkers allow an integrated risk assessment of heavy metal pollution effects in living organisms. In this study, the biochemical effects of Cd, Cr, Ni, Pb and Zn pollution in agricultural soil and their accumulation in Alium cepa L. (onion) were evaluated with ALA-D enzyme response as a biomarker, along with δ-aminolevulinic acid (ALA) and total chlorophyll contents in leaves of this plant. Soil samples were randomly selected from agricultural areas in two regions, Mitrovica and Obiliqi, which are considered the most industrially polluted regions in Kosovo. Results show that Pb and Zn concentrations in soil samples from Mitrovica (1953-2576 mg kg ^-1) and Obiliqi regions (138-179 mg kg ^-1) and their bioaccumulation levels in onion were significantly higher in comparison with the control group. There was an adverse negative correlation between Pb or Zn concentration and ALA-D activity and total chlorophyll content, and a positive correlation with ALA content. This study indicates that ALA-D activity can be used as a very sensitive biomarker for evaluation of heavy metal pollution. The bioaccumulation of heavy metals from soil polluted areas poses a threat for food contamination and public health.

Mental Health System Reform in Contexts of Humanitarian Emergencies: Toward a Theory of "Practice-Based Evidence"

Humanitarian emergencies such as armed conflicts are increasingly perceived as opportunities to improve mental health systems in fragile states. Research has been conducted into what building blocks are required to reform mental health systems in states emerging from wars and into the barriers to reform. What is less well known is what work and activities are actually performed when mental health systems in war-affected resource-poor countries are reformed. Questions that remain unanswered are: What is it that international humanitarian aid workers and local experts do on the ground? What are the actual activities they perform in order to enable and sustain system reform? This article begins to answer these questions through ethnographic case studies of mental health system reform in Kosovo and Palestine. Based on the findings, a theory of "practice-based evidence" is developed. Practice-based evidence assumes that knowledge is derived from practice, rather than the other way around where practice is believed to be informed by systematic evidence. It is argued that a focus on practice rather than evidence can improving system reform processes as well as the provision of mental health care in a way that is sensitive to local contexts, structural realities, culture, and history.

Genotoxicity risk assessment in fish (Rutilus rutilus) from two contaminated rivers in the Kosovo

Being exposed to untreated urban and industrial water, the rivers Drenica and Sitnica are considered to be the most polluted ones in the Kosovo. Our previous investigations on the cyto- and genotoxic potential of water samples from these rivers evaluated with primary rat hepatocyte cultures indicated a risk for the health of aquatic organisms. In order to assess the genotoxic risk to aquatic organisms, we therefore performed a two year study (2016-2017) on roach (Rutilus rutilus) from these rivers. Specimens were collected at three locations along the Drenica river and two locations along the Sitnica river, and the genotoxicity was evaluated by the micronucleus as well as the Comet assay (DNA damage) in erythrocytes. The frequencies of micronucleated cells were determined for samples collected in four seasons, whereas the Comet assay was employed on samples collected in five seasons during the two-year period. The data obtained revealed an increase of the frequency of micronucleated erythrocytes from Rutilus rutilus collected at most sampling locations and from both rivers at all seasons investigated. Significant differences to the control (lake Badovc) were found in summer 2016 and spring 2017 samples. When comparing the seasons, the summer 2016 samples were most genotoxic, followed by spring 2017 and autumn 2016. With regard to the Comet assay data, a similar but more prominent "response" was observed. Another important observation is that micronucleus rates as well as DNA damage levels were significantly higher in samples collected in 2016 compared to the respective seasons in 2017. Altogether, the "response" obtained with both markers confirmed a genotoxic risk for fish due the pollution of these rivers. Since there were, however, seasonal and annual variations of the genotoxicity levels further in depth studies have to be carried out addressing the nature of these changes.

Mortality experience of US veterans following service as international peacekeepers in Bosnia/Kosovo theater, 1996-2002

BACKGROUND

Beginning in 1996 US military personnel served as peacekeeping forces in Bosnia/Kosovo. No studies have assessed the long-term post-deployment health of this US cohort. Based on the health concerns raised in studies of military personnel from other countries, this study focused on mortality due to Leukemia, respiratory disease, respiratory cancer, and heart disease.

METHODS

This study compared the post-war cause-specific mortality of 53,320 veterans who deployed to Bosnia/Kosovo between 1996-2002 to that of 117,267 veterans who also served in the military between 1996-2002, but were not deployed to Bosnia/Kosovo. Expressed as standardized mortality ratios (SMR)s the cause-specific mortality for both deployed and non-deployed were compared separately to that of the US general population. Cause-specific mortality risks among Bosnia/Kosovo veterans relative to that of non-deployed veterans were assessed using Hazard Ratios (HR)s generated by Cox proportional-hazards models.

RESULTS

The overall mortality of both deployed and non-deployed veterans was almost half that of the US population, SMR = 0.59, 95%, C.I., 0.55-0.62 and SMR = 0.66, 95%, C.I., 0.64-0.68, respectively. Neither group of veterans had any excess of disease related mortality compared to that of the US population. Compared to non-deployed, deployed veterans did not experience any increased risks for any of the diseases of a priori interest.

CONCLUSION

It does not appear that US military deployed to Bosnia/Kosovo have any increased risks of disease related mortality. However, this study would not have been able to detect increased risk of cancers with latency periods that exceeded the 18 years of follow-up available in this study.

The Role of TaqI DRD2 (rs1800497) and DRD4 VNTR Polymorphisms in Posttraumatic Stress Disorder (PTSD)

BACKGROUND

Posttraumatic stress disorder (PTSD) is a complex stress related disorder, that follows a severe traumatic experience, characterized with an intense sense of terror, fear, and helplessness. The aim of this study is to identify associations of genetic variations within candidate genes DRD2 and DRD4 with various PTSD related phenotypes. PTSD lifetime and PTSD current subjects were analyzed separately, each of them were analyzed in a Case/Control design, as well as regarding BSI and CAPS within cases only.

SUBJECTS AND METHODS

719 (487 male, 232 female) participants who had experienced war-related trauma between 1991 and 1999 in Bosnia and Hercegovina, Kosovo and Croatia were included in the study. Sociodemographic questionnaire, Clinician Administered PTSD Scale (CAPS) and the Brief Symptom Inventory (BSI) were used to collect clinical data.

RESULTS

The DRD2 rs1800497 variant and a variable number tandem repeat (VNTR) located in exon three of DRD4 were investigated for association with PTSD. In case control analyses we did not identify any significant associations. Within the PTSD current patients, we identified an association of DRD2 rs1800497 with BSI in the genotypic and the recessive model with the T allele as the risk allele.

CONCLUSION

Our findings suggest that rs1800497 of DRD2 gene is involved in pathogenesis of PTSD.

The composition, diversity, and distribution of mosquito fauna (Diptera: Culicidae) in Kosovo

The aim of this study is to identify the mosquito species that currently exist and their distributions in Kosovo in order to determine current potential endemic zones and areas at a higher risk for future epidemics. These scientific data will be shared with public health authorities for implementing mosquito control programs. During a two-year period of monitoring in 48 localities in 23 provinces in Kosovo, a total of 1,604 mosquitoes representing 13 species and six genera were collected and morphologically identified. Members of species complexes were also classified to species using DNA barcoding. In total, 13 species were identified with Culex pipiens s.l., the predominant species with an abundance rate of 39%. The remaining 12 species identified were grouped into five genera: Anopheles, Aedes, Coquillettidia, Culiseta, Uranotaenia, including species that are vectors of arboviruses in other parts of the world.

Atrophoderma of Pasini and Pierini in a young adult: a case report

Atrophoderma of Pasini and Pierini is a skin atrophy presenting as single or multiple sharply demarcated, hyperpigmented, non-indurated patches, with a slight depression of the skin, that can converge and form a confluent area with atrophy as a consequence. The condition was first described by Pasini in 1923 and subsequently by Pierini in 1936. They distinguished this form of atrophy from other diseases and conditions in which the atrophy is morphologically and clinically different. The disease was initially associated with Borrelia burgdorferi infection; however, at present, various theories have emerged for the appearance of the disease, linked to genetic, neurogenetic, and immunological factors. Here we present a patient that was admitted to the hospital due to disseminated lesions on the skin of the lower limbs, with slightly pigmented and atrophic skin along with irregular borders varying in size, from several mm to a few cm, clearly demarcated from the healthy skin, with no history of a tick bite or a family history of similar skin disorders.

Trace Metal Content of Coal Exacerbates Air-Pollution-Related Health Risks: The Case of Lignite Coal in Kosovo

More than 6600 coal-fired power plants serve an estimated five billion people globally and contribute 46% of annual CO₂ emissions. Gases and particulate matter from coal combustion are harmful to humans and often contain toxic trace metals. The decades-old Kosovo power stations, Europe's largest point source of air pollution, generate 98% of Kosovo's electricity and are due for replacement. Kosovo will rely on investment from external donors to replace these plants. Here, we examine non-CO₂ emissions and health impacts by using inductively coupled plasma mass spectrometry (ICP-MS) to analyze trace metal content in lignite coal from Obilic, Kosovo. We find significant trace metal content normalized per kWh of final electricity delivered (As (22.3 ± 1.7), Cr (44.1 ± 3.5), Hg (0.08 ± 0.010), and Ni (19.7 ± 1.7) mg/kWh_e). These metals pose health hazards that persist even with improved grid efficiency. We explore the air-pollution-related risk associated with several alternative energy development pathways. Our analysis estimates that Kosovo could avoid 2300 premature deaths by 2030 with investments in energy efficiency and solar PV backed up by natural gas. Energy policy decisions should account for all associated health risks, as should multilateral development banks before guaranteeing loans on new electricity projects.