Treating the patient not just the disease? : Delving deeper into the possible link between affective disorders and coronary heart disease through statistical analysis of a random sample of Maltese people

Background: Ischemic heart disease is the leading cause of death in Males in Malta and globally. Affective disorders are the commonest psychological problem. This cross-sectional study utilizes a multiple regression model utilizing binary logistic to delve deeper into the link between affective disorders and coronary heart disease and also the link between coronary heart disease and anxiety and depression separately. Methods: The study was performed in the small Mediterranean island of Malta through the European health interview survey (EHIS), at a national level involving 5500 participants. The response rate attained in the actual field work was 72%. Statistical analysis involved performing chi-squared tests on all contributing variables and retaining those variables that were significant to both diseases. These were then placed in a multiple regression model using forward stepwise binary logistic to retain only the most significant variables. Results: Age, gender, BMI, diabetes prevalence, depression prevalence, anxiety prevalence, hypertension prevalence, affective disorders( having either anxiety or depression), smoking status, frequency of alcohol intake, and educational level all had a significance of <0.05, some; than less than 0.01. On fitting a multiple regression model, Anxiety (p=0.033), age (p=<0.001), gender (p=<0.001), hypertension (p=0.016) retained their significance in the model. Diabetes could not be analyzed due to power issues. Conclusion: BMI was not retained in the model having been replaced by associated conditions such as hypertension, together with age and gender as strongly associated risk factors. Anxiety nevertheless retained its independent association with coronary heart disease, in spite of the presence of the other stronger predictors described above.peer-reviewe

Investing in the health of the 41-60 year old : reaping the return in the 60+ population?

Introduction: Ageing brings an increased burden on healthcare systems. In Malta cardiovascular disease is the main cause of morbidity and mortality accounting for approximately 40% of all deaths. It is assumed that effective prevention strategies targeted at the middle-aged population would translate in better health outcomes in our elderly population. Aim: To investigate how lack of awareness of conditions such as high blood pressure and high blood glucose level in the 41-60-year age group could influence the health status of future generations of elderly in our population. Methodology: Two risk factors for cardiovascular disease namely raised blood pressure and raised blood glucose were identified for analysis: (i) The comparison of perception and measurement of the selected risk factors assessed in 2 cohorts aged 41-60 years at two different time points: (a) 1981/4 and (b) 2008/2010; (ii) The analysis of any changes in perception and measurement of these risk factors over time between the 1981/4 sample and a follow-up sample drawn from the first cohort 30 years later, now 60 plus years of age. Results: Awareness for hypertension has increased in the 41-60-year olds over the 30-year period. However, awareness for diabetes has decreased in the same cohorts. Awareness for both hypertension and diabetes has increased as the 41- 60-year olds reach 60+. Conclusion: Improved perception for hypertension and diabetes in the 60+ group is not matched with better control of the condition. Medical intervention in the 41-60-age group in the 2008/2010 sample has resulted in better control of blood pressure, but not of blood glucose. These results highlight the need for stepping up awareness and screening for these conditions especially in the 41-60 group coupled with better control.peer-reviewe

Men and women : together in sickness and health?

One of the highest ranked works of non-fiction of the twentieth century is titled ‘Men are from Mars and Women are from Venus’. While most of us may actually agree with such a statement in a generic setting, one would question whether this should hold true in terms of health outcomes and practices. This review attempts to pose this question within the context of the Maltese population and reflects on some reported differences in health behaviour and status between the two genders. Indeed, differences noted in terms of lifestyle practices in other countries and cultures, particularly in the Western world are noted in Malta as well. Maltese women appear to make better lifestyle choices in general; however, there is a lower perceived risk or awareness compared to men for a number of conditions, such as diabetes or obesity. It is unclear whether such behaviour is likely to arise from lack of awareness or simply denial. Nevertheless, Maltese women also exhibit higher rates for utilization of healthcare services, and are more likely to utilize certain types of medications, just like their counterparts elsewhere. Of particular concern is the degree of disability and activity limitation that women are likely to face in their elderly years. Such disparity has serious implications for an ageing population and call for gender-targeted investment along the life course to help reduce such disparity.peer-reviewe

Health behaviour counselling in primary care : general practitioner : reported rate and confidence

Aims: The study aimed to identify variables associated with General Practitioners’ (GPs’) self-reported rate of health behaviour change counselling and confidence in counselling abilities. Methodology: This study was a repeat of a similar study carried out at the Mayo Clinic in 2007. The same tool and methodology were used with the permission of the authors. Variables measured by the questionnaire included: participants’ characteristics, physical activity, smoking status, healthy eating behaviour, self-reported rate of counselling behaviour, extent of training in counselling, perceived importance of counselling, confidence for health behaviour change counselling. A comparative analysis of the results was made.peer-reviewe