Malta’s mental health reform

In Malta as in many other countries, psychiatry has for years been the Cinderella of the Health Services with a tradition of not only being under-resourced but also of being an unpopular career choice amongst health care professionals. In this article the author describes the scope and the aims of the proposed Mental Health Reform.peer-reviewe

A review of neuroleptic malignant syndrome : incidence and features in Malta

This paper describes Malta’s first sample of Neuroleptic Malignant Syndrome (NMS) and reviews the current literature. A retrospective sample of all diagnosed cases of NMS was reviewed using Pope’s (1986) criteria. Twelve cases were identified yielding an incidence of 0.67%. The range of associated risk factors and complications agreed with other reports. There were also two cases of uncontrolled diabetes. Treatments commonly used were Bromocriptine and Levodopa. There were no deaths due to NMS and no recurrence on re-exposure. The sample is too small to draw any statistically significant conclusions, however, the results are mostly in line with those obtained from larger samples. Malta’s incidence is towards the lower end of the reported range of 0.02% to 3.23%, but higher than that reported in centres trying to recognise NMS early and reduce risk factors. This suggests that Malta could benefit from trying to adopt such measures. Given Malta’s small size, it would be relatively easy to disseminate such information. This study, despite its comprehensive sample, failed to reveal any other reported cases. Nor has it been demonstrated that diabetics were at higher risk of developing NMS or its complications. It would be important to explore these possibilities further in future studies.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

Factors invoved in onset and recovery from postnatal depression

Background: A wide variety of psychosocial variables have been implicated in the onset and recovery from postnatal depression. A number of these factors were examined on a representative sample of pregnant Maltese women attending St Luke's Hospital. Method: A random sample of 239 pregnant women were interviewed at booking using a detailed sociodemographic history, the Revised Version of the Clinical Interview Schedule (CIS-R) and Maltese translation of the Edinburgh Postnatal Depression Scale (EPDS). The CIS-R was again administered over the phone at 36 weeks and the EPDS sent by post. At eight weeks postpartum, the CIS-R, modified version of the Social Maladjustment Schedule and the EPDS were again administered to 95.8% of women. Results: Onset of depression in the postpartum was not predicted by depressive symptomatology during pregnancy, marital status, level of education, planning of pregnancy, woman's, partner's or family's reaction to pregnancy and marital adjustment. However being primiparous and employed during pregnancy were significantly associated with postnatal depression. In contrast, depressed women who remained depressed postnatally had a past personal psychiatry history and significantly higher scores on the CISR recorded at 36 weeks gestation. Limitation: The number of women examined in the study yielded a small number of depressed women, for which the results are limited in value. The sample is that of Maltese women booking in at the antenatal clinic, thus excluding women who present late, close to delivery date. The follow up period was limited to eight weeks postpartum only, excluding those who develop depressive episodes after 8 weeks. Conclusions: Some cases of postpartum depression may be traced back to pregnancy while others do not seem to be predictable during pregnancy further contributing evidence to the view that the prenatal period may be a separate entity from the postnatal period with regards to depressive illness.peer-reviewe

Is a picture really worth a thousand words? : some philosophical reflections on perceptual content

The challenge presented by this paper is twofold; the first is to show that theories of perception ride a seesaw which is unsatisfactory, the second is to present a way to dismount the seesaw that these theories ride. The proposed dismount is suggested in the form of nonconceptual content of perceptual experiential states. In part A of the paper the seesaw metaphor is set up by showing that theories of perception concern themselves mainly with two questions. One of these questions is the epistemic question, which inquiries into the justificatory role played by perceptual experiential states. Such inquires conclude that the content of perceptual experiential states is conceptual. The other question is the descriptive question, which inquiries into the nature of perceptual experiential states. Such inquires conclude that the perceptual experiential states are not conceptual. The seesaw effect comes to play because theories of perception deal with the epistemic and the descriptive questions in isolation of each other. Part B of the paper shows how the theories of perception ride the seesaw. On the one side of the seesaw there are theories of perception that claim that perceptual experiential states are contentless. Bertrand Russell's account of sense-data is used to illustrate such theories. It is shown that while these theories are phenomenologically plausible, they are incapable of accounting for the justificatory role perceptual experiential states need to play. On the other side of the seesaw there are theories of perception that claim that perceptual experiential states have content. The account of conceptualism by John McDowell is used to illustrate the position of such theories. These theories are inadequate in accounting for the phenomenological aspect of perceptual experiential states while they are able to account for the epistemological role played by perceptual states. This is what I call riding the seesaw. Riding the seesaw does not allow any room for progress for a theory of perception. Part C of this paper suggests a way of dismounting the seesaw by considering the notion of nonconceptual content of perceptual experiential states. The paper acknowledges that work is still necessary to sharpen the notion of nonconceptual content of perceptual states. However, nonconceptual content of perceptual experiential states is put forward as a better alternative in the light of the discussions in parts A and B

Is a picture really worth a thousand words? Some philosophical reflections on perceptual content

The challenge presented by this paper is two fold; the first is to show that theories of perception ride a seesaw which is unsatisfactory, the second is to present a way to dismount the seesaw that these theories ride. The proposed dismount is suggested in the form of nonconceptual content of perceptual experiential states. In part A of the paper the seesaw metaphor is set up by showing that theories of perception concern themselves mainly with two questions. One of these questions is the epistemic question, which inquiries into the justificatory role played by perceptual experiential states. Such inquires conclude that the content of perceptual experiential states is conceptual. The other question is the descriptive question, which inquiries into the nature of perceptual experiential states. Such inquires conclude that the perceptual experiential states are not conceptual. The seesaw effect comes to play because theories of perception deal with the epistemic and the descriptive questions in isolation of each other. Part B of the paper shows how the theories of perception ride the seesaw. On the one side of the seesaw there are theories of perception that claim that perceptual experiential states are contentless. Bertrand Russell's account of sense-data is used to illustrate such theories. It is shown that while these theories are phenomenologically plausible they are incapable of accounting for the justificatory role perceptual experiential states need to play. On the other side of the seesaw there are theories of perception that claim that perceptual experiential states have content. The account of conceptualism by John McDowell is used to illustrate the position of such theories. These theories are inadequate in accounting for the phenomenological aspect of perceptual experiential states while they are able to account for the epistemological role played by perceptual states. This is what I call riding the seesaw. Riding the seesaw does not allow any room for progress for a theory of perception. Part C of this paper suggests a way of dismounting the seesaw by considering the notion of nonconceptual content of perceptual experiential states. The paper acknowledges that work is still necessary to sharpen the notion of nonconceptual content of perceptual states. However, nonconceptual content of perceptual experiential states is put forward as a better alternative in the light of the discussions in parts A andB

Assessing the see-and-treat approach for the management of high-grade squamous intraepithelial cervical lesions

Objectives: To assess local histological outcomes in patients with HSIL cytology results on cervical smears, in both the see-and-treat and three-step approach. Study Design: A retrospective analysis of patients with HSIL on cervical cytology was performed, obtaining an 83 patient cohort. The histological result following the primary investigation (colposcopic-directed biopsy or excisional procedure) was noted for each patient together with their demographic variables and HPV status. Results: Of 83 patients with HSIL cytology on cervical smear, 43 underwent LLETZ as a primary procedure, while 40 patients underwent a colposcopic-directed biopsy. There was no statistically significant difference in terms of dermographics and HPV status between the two groups. In those patients who had LLETZ as a primary procedure, 29 had CIN2+ on histology. On the other hand, following colposcopic-directed biopsies, 17 resulted in CIN2+ on histology. Conclusion: The conventional approach within our local setting potentially has inferior sensitivity in picking up CIN2+ lesions when compared to the see-and-treat approach. On the other hand, primary excisional procedures were associated with an overtreatment rate of at least 20.9%, subjecting patients to unnecessary risks. Local improvement of colposcopic skill will aid to reduce this overtreatment rate and missed lesions at biopsy.peer-reviewe

Xeroderma Pigmentosum Group C Deficiency Alters Cigarette Smoke DNA Damage Cell Fate and Accelerates Emphysema Development

Cigarette smoke (CS) exposure is a major risk factor for the development of emphysema, a common disease characterized by loss of cells comprising the lung parenchyma. The mechanisms of cell injury leading to emphysema are not completely understood but are thought to involve persistent cytotoxic or mutagenic DNA damage induced by CS. Using complementary cell culture and mouse models of CS exposure, we investigated the role of the DNA repair protein, xeroderma pigmentosum group C (XPC), on CS-induced DNA damage repair and emphysema. Expression of XPC was decreased in mouse lungs after chronic CS exposure and XPC knockdown in cultured human lung epithelial cells decreased their survival after CS exposure due to activation of the intrinsic apoptosis pathway. Similarly, cell autophagy and apoptosis were increased in XPC-deficient mouse lungs and were further increased by CS exposure. XPC deficiency was associated with structural and functional changes characteristic of emphysema, which were worsened by age, similar to levels observed with chronic CS exposure. Taken together, these findings suggest that repair of DNA damage by XPC plays an important and previously unrecognized role in the maintenance of alveolar structures. These findings support that loss of XPC, possibly due to chronic CS exposure, promotes emphysema development and further supports a link between DNA damage, impaired DNA repair, and development of emphysema