In Albanian, “Si je?” means “How are you?” Public health researchers at the University of Hawaiʻi at Mānoa asked exactly that question of an innovative new health program in Albania. Their analysis shows how one country is making progress toward a goal of preventing chronic diseases like diabetes and heart disease on a national level. Their findings hold lessons for other locations, including Hawaiʻi.

A global effort is underway to prevent chronic diseases, rather than focus on treating people once they become ill. Toward this goal, the small European country of Albania launched an innovative health program in 2015, called “Si je?” which encourages middle-age adults to go to their local community health center every year for a free check-up. The program is aimed at shifting healthcare resources toward disease prevention through personal contact with primary healthcare providers.

“Right now, there is a growing understanding worldwide that in order for a nation to be healthy, it has to have a health system that aims to prevent chronic diseases, not just treat patients once they are sick,” said Tetine Sentell, lead author of the study and an associate professor with UH Mānoa Office of Public Health Studies in the Myron B. Thompson School of Social Work. “Our new study shows that the Si Je? program is working—it is building a culture of prevention and health in Albania.”

Study results and challenges

Researchers analyzed the screening database created from this program and conducted interviews with 15 health center directors. Results showed that about 270,000 people got a checkup during the program’s first year, which is more than a quarter of the number of people who were eligible. The program also successfully strengthened links between communities and health centers and had higher-than-expected participation rates in rural communities. As in Hawaiʻi, family members were important motivators to getting check-ups and screening.

But challenges remain. The researchers noted a need for greater participation among some groups. For example, men had lower participation than women.

Building a culture of prevention

The study found that Albania, like Hawaiʻi, seeks to build a culture of prevention that will reduce health inequities by increasing patient-centered relationships with clinicians and the healthcare system and by diversifying the primary healthcare workforce to meet community needs.

“Lessons can be learned by studying country-wide transformative programs such as Si Je? that extend far beyond Albania,” said Catherine M. Pirkle, assistant professor of public health and a co-author of the study.

“For example, the activities to reinforce community-clinical linkages resemble similar efforts in Hawaiʻi, which may help us here as we seek to strengthen the relationships and bridges between our primary care centers with the communities they serve,” Pirkle said.

The study was published online November 30 in Prevention Science and is a collaborative outcome from Sentell’s Fulbright Specialist program stay in Tirana, Albania in January 2017.

As women age, their ability to get around affects their quality of life. A new study shows that older women’s physical functioning declines more rapidly if they develop urinary incontinence, according to public health researchers at the University of Hawaiʻi at Mānoa.

Catherine Pirkle and Yan Yan Wu, both assistant professors in the Office of Public Health Studies in the Myron B. Thompson School of Social Work, collaborated with researchers in Brazil, Colombia and Canada to recruit approximately 900 women in their sixties and seventies from those three countries plus Albania. About 25 percent of women over age 60 experience urinary incontinence.

Study participants completed a short test of physical functioning, which included measuring the speed of their usual walking pace, checking their balance and testing how fast they could stand up from a chair. The women also completed a questionnaire about their health, which included a query about whether they had experienced any leakage of urine in the past week. After two years, the women repeated the physical functioning test.

Pirkle said the researchers were surprised by how much physical function had decreased over a two-year period in women who had reported experiencing urine leakage at the study’s start.

“The loss of physical function in this group was quite large and happened very rapidly,” said Pirkle. “We know that, as women age, they tend to experience more functional limitations and disability than men do. But the reasons for this gender gap are not clear.”

Cycle of incontinence and decreasing physical activity

Wu said one supposition is that women who experience incontinence start to engage in less physical activity out of fear of losing urine. This could lead to a vicious cycle, as a reduction in physical activity leads to worsening incontinence and overall health.

But it’s possible that other factors, such as giving birth to many children, may contribute to both urinary incontinence and a physical performance decline. Pirkle and Wu said the next step for the research team is to look at whether women’s reproductive lives, such as the number of children they have and their history of gynecological or obstetric problems, influence their risk of incontinence, as well as other health outcomes of importance to older women.

The study was published in the September 2018 Journal of Aging and Health. Pirkle and Wu’s collaborators on the study include Luana Caroline de Assunção Cortez Corrêa and Saionara Maria Aires da Câmara of the Federal University of Rio Grande do Norte in Brazil; Afshin Vafaei of Lakehead University in Canada; and Carmen-Lucia Curcio of Universidad de Caldas in Colombia.

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