Coronary heart disease and diabetes mellitus

Much of the excess mortality in diabetic subjects is due to cardiovascular disease. Diabetic subjects are at increased risk of developing coronary artery disease and have a higher case fatality after acute myocardial infarction and after unstable angina. Diabetes is associated with microvascular disease, accelerated atherogenesis and left ventricular dysfunction. We review the data on the epidemiology, pathogenesis and management of coronary artery disease in diabetic patients.peer-reviewe

The Impact of Discipleship on Wellbeing in Intergenerational Congregations

People in the world are suffering from poor levels of wellbeing ( Beyond Blue, 2016; Depression and Other Common Mental Disorders: Global Health Estimates, 2017). A contributing factor is the decrease in social and spiritual connectedness currently experienced by many people. As intergenerational relationships are also in decline, this study explored how intergenerational Christian congregations could provide a potential avenue for connectedness. A mixed-method research approach was adopted to answer the question, how is a person’s wellbeing impacted by their level of social and spiritual connectedness as they are discipled in an intergenerational congregation? The sample for the quantitative data set comprised of 545 participants from five generations from 11 New South Wales Christian congregations. Ten of the congregations were of the Seventh-day Adventist denomination and one was of the Church of Christ denomination. A questionnaire comprising of 117 items was used to gather the quantitative data. The scales used included an Intergenerationality Index that was created for the study, and a Discipleship assessment tool. Semi-structured interviews with 14 participants from four of the congregations were also undertaken, which lead to the compilation of 496 minutes of discussion. The study found that intergenerationality positively influenced both wellbeing and discipleship and further discipleship also positively impacted wellbeing. The findings of the study add weight to the argument that intergenerational Christian congregations can act as a positive contributor to a person’s wellbeing, as well as an ideal context for social and spiritual connectedness through discipleship

Well-Being, Discipleship, and Intergenerational Connectedness

Leaders in Christian communities are all asking the same question: How can we bring the generations back together? InterGenerate addresses important questions of why we should bring the generations back together, but even more significantly, how we can bring generations back together. In this edited collection, ministers, church leaders, and Christian educators will find valuable, new generational theory perspectives, fresh biblical and theological insights, and practical outcomes backed by current research. InterGenerate offers important guidance on topics including intergenerational spiritual disciplines, transitioning from multigenerational to intergenerational, new research that focuses directly on intergenerational ministry and offers practical outcomes to implement, and benefits of intergenerational ministry for the most marginalized generations. An exciting and distinctive aspect of InterGenerateis the vast diversity of voices—men and women ranging in age from millennials to baby boomers, representing multiple countries and over a dozen denominations—all seeking ways to become more intentionally intergenerational in their outlook and practice

Training for flexibility and changing technologies

Malta's quest to become a full member of the European Union, offers a challenge to the island's industrial base - a challenge that involves a shift from a labour intensive, highly protected manufacturing industry to a knowledge-based capital intensive industry, open to fierce global market competition. One major implication of this shift is that the attraction of more foreign and local investment will no longer be based on an abundant, hard working and cheap labour force but on a multi-skilled, polyvalent human resource that is capable of adapting itself to continuous rapid changes in product development and international market requirements. This implication involves the provision of a different training system that caters for the development of a human resource that will be treated by operating organisations as a valuable asset to be continuously invested upon rather than as a factor of production whose cost should be kept at a minimum.peer-reviewe

Training for flexibility and changing technologies

Malta's quest to become a full member of the European Union, offers a challenge to the island's industrial base - a challenge that involves a shift from a labour intensive, highly protected manufacturing industry to a knowledge-based capital intensive industry, open to fierce global market competition. One major implication of this shift is that the attraction of more foreign and local investment will no longer be based on an abundant, hard working and cheap labour force but on a multi-skilled, polyvalent human resource that is capable of adapting itself to continuous rapid changes in product development and international market requirements. This implication involves the provision of a different training system that caters for the development of a human resource that will be treated by operating organisations as a valuable asset to be continuously invested upon rather than as a factor of production whose cost should be kept at a minimum.peer-reviewe

Solving problems, the island way : human resourcefulness in action among the islanders of Gozo

This paper offers glimpses into how businesspersons, entrepreneurs and small business managers resolve their most pressing problems under conditions characterized by smallness and islandness in order to survive. Applying a nissological approach complemented by an action-oriented grounded method, the researcher explores and inductively analyses the mind-sets of islanders to explicate the basic socio-psychological process that influences how they resourcefully overcome problems associated with mistrust and powerlessness, transforming these into opportunities of trust-building and empowerment. Two concurrent and seemingly contradictory processes emerge from the analysis, suggesting that Gozitans – the residents of the small Mediterranean island of Gozo – apply both overt formal and covert informal processes to solve their problems.peer-reviewe

A case of a large, painless retroperitoneal mass causing hydronephrosis and biliary obstruction

A 56-year-old man presented with abdominal distention over a few months. He was otherwise well and routine blood tests were normal. Examination of the abdomen revealed a firm swelling. CT scan was performed for further evaluation.peer-reviewe

Changes in the Development of Social Policy in a Small Island Economy: Malta

This paper analyses the development of social policies in Malta, with a particular focus on events which have impacted on the country’s growth and subsequently on its social security system and policies involving housing, health, education migration and employment. In recent decades, with costs to sustain an ever-growing web of social services becoming more demanding, governments have tried to encourage more self-help and to lessen the heavy dependence on aid structures within the system, pushed at times by recommendations from regional and international institutions. The smaller the economy the more open it is likely to be. Consequently, it is impacted relatively stronger by external events. A heavy reliance on trade, migration and foreign direct investment necessitates balancing the interplay between external and internal activities. These horizontal interdependencies together with the decolonisation process impacted on Malta’s development of social policies and its social security system. Vertical interdependencies had a lesser impact on social policy in the early stages but have in recent years influenced its gradual transformation from a welfare state to a welfare society. The analysis shows that Malta’s social policies aided its economic development strategy in that different social policies sought to provide an equitable society. However, strains and long-term deficits in public finances later showed up the cracks in the structures, which became overused, abused and too wide encompassing. Malta faces challenges which may impact the sustainability of some policies, such as health, while instigating further government intervention in others, such as social housing. A more holistic perspective of all social policies is called for

The Department of Health Diabetes Mellitus health information technology database in Malta : a basis for a Maltese diabetes national register

Government Diabetes clinics in Malta share a Web based computerised system that offers a user friendly Windows based approach to day to day diabetes care. The system can also produce research related data and administrative reports to help local health care providers identify problems and implement programs to improve standards of diabetes care. The database can be used as the basis for a National Diabetes Registry. The system has a dataset shared with the European Union DG-SANCO EUBIROD System. EUBIROD can create comparative reports on data aggregated from various centres across Europe. This paper describes the function of the system and its evolution over a number of years. Some pending issues are discussed.peer-reviewe

The outcome of Gestational Diabetic pregnancies in the Maltese Islands

Gestational diabetes is generally associated with a higher morbidity and mortality for both the mother and child. Aims: The study aims to assess the outcome indicators of women suffering gestational diabetes and compare these to the remaining obstetric population. Research Design and Methods: Outcome indicators of women diagnosed during pregnancy as suffering from diabetes (GDM (defined as a 2-hour post-load blood glucose of >=8.6 mmol/l) n=297) were compared to the parameters of women with a presumed normal carbohydrate metabolism (n = 16059). Results: The incidence of gestational diabetes in the Maltese pregnant population is 1.81 % of total maternities. Women with GDM showed themselves to be at a significantly increased risk of developing hypertensive disorders during pregnancy and to require delivery by caesarean section. They were more likely to require intervention by induction of labour, while the delivery was commonly complicated by shoulder dystocia. The infants born to GDM women were more likely to be macrosomic or preterm and have a low Apgar score at birth and suffer from respiratory distress. The infants did not show a greater predisposition to be of low birth weight. Conclusion: It would appear that gestational diabetes remains a high-risk situation that increases maternal and infant morbidity in spite of the modern management options.peer-reviewe