title: Negative attitudes to transition in post-communist Albania and acute coronary syndrome.
abstract: OBJECTIVE
  The authors assessed the association of acute coronary syndrome (ACS) with attitudes to the socioeconomic aspects of rapid change in transitional Albania.
  
  
  METHODS
  A population-based case-control study conducted in Tirana, Albania, in 2003-2006 included 467 nonfatal ACS patients (370 men, 97 women; 88% response) and a population-sampled control group (469 men, 268 women; 69% response).
  
  
  METHODS
  Reaction to transition was assessed as a composite score of 3 items capturing attitudes toward socioeconomic aspects of transition in Albania.
  
  
  RESULTS
  Using logistic regression, there was a strong linear relationship of the attitude score with ACS. When categorized as negative, intermediate, or positive attitudes, the age- and sex-adjusted odds ratio (OR) for the negative versus positive categories was 3.0; 95% confidence interval (CI) = 2.1, 4.3; p for linear trend <.01, which persisted on adjustment for socioeconomic characteristics, psychosocial factors, and conventional coronary risk factors, OR = 4.4; 95% CI = 2.7, 7.2; p for linear trend <.01. The association appeared to be stronger in the more vulnerable, lower socioeconomic segment of Albanian society.
  
  
  CONCLUSIONS
  In a country moving rapidly from rigid Stalinism to a free market-oriented society, the authors found a strong association of negative attitudes toward transition with coronary health. The authors hypothesized that the stressor effect of inadequate coping with change in transitional Albania is a plausible mechanism linking a negative perception of transition with excess coronary risk.
authors.affiliation: Department of International Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. genc.burazeri@inthealth.unimaas.nl
authors.forename: Genc
authors.initials: G
authors.lastname: Burazeri
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000523:psychology*; D000328:Adult; D000368:Aged; D000415:Albania; D001290:Attitude; D003148:Communism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires