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 Conclusion: BMI was not retained in the model having been replaced by associated conditions such as hypertension, together with age and gender as strongly associated risk factors.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

Clinical trials on medicinal products in Malta following EU accession

Following EU Accession, Malta has to adopt EU Directives as part of its own legislation. Three such directives concern the conduct of clinical trials in European countries ­ 2001/20/EC, 2003/94/EC and 2005/28/EC. These directives, and the respective guidelines explaining their implementation, have considerably changed the way clinical trials are conducted. While the participation of Malta in clinical trials is to be encouraged for various reasons, these have to be regulated according to the legislation set out by the European Union. In themselves, what these Directives strive to achieve are mainly the safety of the study subject and the protection of the investigators from serious consequences. This short article aims to give a brief overview of these changes to prospective investigators and hospital administrators.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

Monitoring of winter deaths

Active monitoring of weekly deaths at a European level will assist member states by providing rapid assessment of the impact of threats in order to further guide policy development and risk management. In January 2015 an excess all-cause mortality has been reported in some European Countries.peer-reviewe

Socioeconomic status and its impact on the prevalence of severe ADHD in the Maltese Islands

Attention deficit hyperactivity disorder (ADHD) is a common disorder associated with hyperactivity, impulsivity and reduced attention. If left untreated this may possibly lead to various impairments in other areas, such as lack of educational attainment, increased risk of accident-prone behaviour, substance misuse and antisocial behaviours. Although the exact aetiology is still not fully understood, various studies have demonstrated the presence of both a genetic and an environmental component. ADHD is highly hereditable, demonstrating a strong genetic component. Furthermore, increased rates of ADHD have been linked with a low socioeconomic status. The islands of Malta have traditionally been divided for statistical purposes into 6 districts, with certain districts more often being associated with low socioeconomic demographics. The main aim of this study was to assess whether higher prevalence rates of ADHD were present in the districts, which are classically associated with a low socioeconomic status. All persons aged 0 to 18 years attending the governmental clinics, having a documented diagnosis of severe ADHD and therefore being prescribed pharmacotherapy were identified and included in this study. 9 youngsters were living in institutional care and were therefore excluded from the study. A significant difference (p<0.0001) in the point prevalence of ADHD between the 6 Malta districts was found, with higher rates of ADHD occurring in the harbour districts. Though not statistically significant, a positive correlation was demonstrated between the ADHD prevalence and a number of socioeconomic variables, these included; the rate of smoking (p=0.111), number of people classified as at-risk-of-poverty per district (p=0.397), and number of people with no schooling per district (p=0.156). The overall point prevalence for ADHD in Malta obtained was 0.85, a value which is less than the average prevalence noted worldwide. The authors believe this value is an underestimation since the data collection in this study did not include ADHD cases off pharmacological treatment and any ADHD cases assessed and treated in the private sector.peer-reviewe

Trends in sun exposure awareness and protection practices in Malta : 1999-2004

Rising skin cancer incidence rates have led to sun awareness campaigns in Malta since the early 1990s. The aim of this study is to assess the impact of these campaigns by analysing trends in sun exposure-related knowledge and behaviour amongst the Maltese people. A total of 559 Maltese pedestrians aged 16-50 years were interviewed in 1999. The same questionnaire was used to interview 304 pedestrians in 2004. More people admitted spending leisure time outdoors during peak sunshine hours in 2004 than in 1999 (85.9% vs 62.4%, p<0.001). There was a drop in people regularly wearing a hat during outdoor leisure activities from 32.4% to 18.4% (p<0.001), and from 37.5% to 9.3% (p<0.001) during outdoor work activities. Rates of regular sunscreen use remained constant at about 50% using it for outdoor leisure activities, but dropped from 25.0% to 9.3% for outdoor work (p=0.02). In 2004, 96.1% of participants having children aged less than 12 years stated that they regularly used sunscreen on their children (87.0% in 1999, p=0.01), while 66.2% said that their children regularly wore a hat (78.4% in 1999, p=0.05). More people were regarding a suntan as unhealthy in 2004 than in 1999 (62.8% versus 37.0%, p<0.001). The mass media remained the most important source of health information.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

Running an international survey in a small country : challenges and opportunities

Background: National and international authorities recognize that health surveys are major sources of information on health conditions. Smaller states may prefer using health surveys to registries because they are cheaper to maintain. Nevertheless, smaller states carry out far fewer national health surveys than larger states. One reason could be that the value of surveys depends on the number of people interviewed rather than the proportion of the population. Therefore, survey costs per capita are substantially higher in smaller states. Methods: Malta is a small state with a population of under half a million. It forms part of the European Union, which has provided financial assistance and external expertise in performing international health surveys. We present the European Health Interview Survey in Malta as a case study to review the challenges for small states and the typical adaptations necessary for implementing national health surveys and meeting international health data obligations. Results: We identified the lack of health survey infrastructure, difficulties in recruiting the large samples recommended by international organizations, survey fatigue, and a lack of resources for marketing, incentivization, analysis and dissemination. Low-cost solutions have been devised to address some issues, such as marketing and incentives, which exploit specific characteristics of small states. Conclusion: In the absence of administrative data or epidemiological registers, surveys are important tools for evidence-based policy-making in small states. The experience of Malta could help other small states to minimize the resources required to run national health surveys.peer-reviewe

Malta’s changing demographics : projecting Malta’s future health system demands to 2030

Malta’s health system is constantly adapting to challenges. Recent demographic changes are delineated by an ageing native population and a mass inflow of foreign workers. These economic immigrants have contributed significantly to the solid growth of Malta’s economy, but have also added significant pressure on its infrastructure, including on the health care system. Using a purely demographic model, linear projections of health care demands were built using adjusted population projections by age-group and gender until 2030. Projections indicate that attendances at the Accident and Emergency Department, Primary Health Care Centres and psychiatric outpatient clinics will continue to increase, together with cancer incidence rates, a major health cost driver. Projected total number of births and attendances at the genito-urinary clinic are expected to decrease. Hospital admissions and bed night use is mostly driven by the ageing population who are expected to exert a strong pressure on public health care spending. Significant policy and infrastructure responses are likely to be required to increase capacity of the primary health sector as well as to address bed shortages.peer-reviewe