Tobacco habits : attitudes and beliefs among the Maltese medical and dental profession

Health professionals, particularly doctors and dentists are the vanguard of any society’s battle against tobacco. They are knowledgeable on the impact of tobacco smoking on health and generally receive updated scientific information on this relationship. Doctors and dentists both witness the effects of smoking on their patients, often on a daily basis. They are inevitably viewed as role-models for health related behaviour, influencing that of their patients as well as their families. In their turn patients are quick to point out particular doctors who smoke as a justification for their own habits. It is, therefore, of particular interest to study the habits of doctors and dentists, as well as their attitudes to this particular form of risk behaviour and to assess their collective views.peer-reviewe

The male to female ratio at birth

The factors that influence the male to female ratio at birth are legion. Males are usually born in excess and stress decreases the ratio while wellbeing and good health tends to increase it. This paper reviews the multitudes of factors that have been implicated as affecting this ratio, from historical times to date.peer-reviewe

Gendercide : a review of the missing women

The term gendercide was first coined in 1985 and refers to the deliberate extermination of persons of a particular sex. The notion and its potential consequences had been conceived as far back as 1793, when the Marquis Nicolas de Condorcet had speculated “what might be [the effect] on humankind [of] the discovery of a means of producing a male or female child according to the will of the parents [...]. Supposing that this is likely to become a common practice, [...] would it [not] lead to [changes] in the social relations of human beings, whose consequences could be harmful to the peaceable development of that indefinite perfectibility with expectations of which we have flattered humankind?”peer-reviewe

Terrorist attacks and the male to female ratio at birth : the bombings of Madrid (3/2004) and London (7/2005)

Introduction: Males are usually in excess of females at birth and the ratio is often expressed as M/F (male divided by total births). Several factors have been shown to be associated with changes in M/F, including major terrorist attacks. These are associated with a transient lowering of M/F for a one month period, three to five months after such events. This study was carried out in order to ascertain whether the Madrid March 2004 bombings and the London July 2005 bombings were similarly associated with changes in M/F in their respective populations. Methods: Monthly live births by gender for Madrid and Spain for 2004 and for England and Wales for 2005 were obtained from the two countries’ National Statistics Offices. Results: There were no significant dips in M/F for any of the months following the March 2004 bombings in Madrid or in Spain. There were no significant dips in M/F for any of the months following the July 2005 London bombings. Discussion: Research to date has shown M/F dips following catastrophic or tragic events, including major terrorist actions with extensive media coverage. Equivalent dips were not noted in this study for the terrorist acts in these instances. The reasons for this may be one or a combination of the following. The population size was not sufficiently large in order to detect an M/F dip. Alternatively, the events were not felt to be sufficiently momentous by the populace such that an M/F dip was not produced. Yet another possibility is that these particular populations are somehow hardier and more resistant to such influences. Not all terrorist events universally cause a significant reduction in M/F.peer-reviewe

The male to female ratio at birth following the Scottish Independence Referendum, September 2014

Human male live births exceed female live births by approximately 3%. This sex ratio is conventionally expressed as M/F (male divided by total live births). Many factors have been implicated as influencing this ratio, such as stress. This phenomenon occurred following the Quebec sovereignty referendum of 1995. This study was carried out in order to ascertain whether the Scottish referendum of September 2014 had any effect on the M/F ratio in Scotland. Monthly live births by gender for Scotland were obtained from Scottish Office of National Records for the period January 2004 to July 2015. They were analysed for any significant period changes as witnessed in Quebec in 1995. There were 661166 total births (338850 male and 322316 female births), with an overall M/F of 0.5125 (95% CI: 0.5113-0.5137). There were no changes in M/F in the first five months after the referendum. However, there was a non-significant rise in M/F toward the end of 2014 which continued during much of 2015. The rise in M/F reached its peak in May-June 2015, 8-9 months after the referendum (M/F 0.5199 compared to M/F of 0.5124 for aggregated May-June values 2004-14). There was no significant drop in M/F in the Scottish population in relation to the Scottish referendum. This may be due to a type 2 error since this study was less powered (12 times smaller) than the Quebec study. The non-significant rise may have potentially been caused by increased coital rates as observed after the birth of Prince William in 1982 and for Hong Kong in relation to Dragon years. It will be interesting to analyse the rest of the UK data when this becomes officially available.peer-reviewe

Hepatitis B prevalence in two Maltese sub-populations

Hepatitis B surface antigen was measured by enzyme immunoassay in a random sample of 1258 healthy pregnant women attending the ante-natal clinics of St. Luke’s Hospital, Malta and Gozo General Hospital, Gozo, and 364 intravenous drug users attending the detoxification centre, SLH. Eight of the pregnant women and ten of the drug addicts were positive for the surface antigen, accounting for a prevalence of 6/1000 and 30/1000 for each cohort, respectively. This would be consistent with low/intermediate prevalence rate in accordance with WHO criteria.peer-reviewe

Estimated prevalence of dementia in the Maltese Islands

Dementia is a serious, common, world-wide neurodegenerative disease associated with severe loss of cortical brain. It is a major predictor of morbidity and mortality in the elderly costing the health services more than cardiovascular disease and cancer put together. Recent studies have also suggested that the global prevalence of dementia would double every twenty years and should reach approximately 82 million cases by the year 2040. Using EURODEM data, we report that the estimated number of individuals with dementia in the Maltese islands is 4,072. This figure is expected to almost double by the year 2035. We discuss the implications of the forecast increase in the number of people with dementia for Malta's health services and society.peer-reviewe

Getting to grips with the obesity epidemic in Europe

Obesity is a global epidemic. It is responsible for increased patient morbidity and mortality. Significant related pathologies including diabetes mellitus compound the overall risks. Obesity is a significant financial burden. This includes direct and indirect medical costs, amounting to millions of euros each year. Multiple European studies have outlined a steady incline in obesity prevalence rates. Tackling obesity is no easy task. Policy makers aiming to reduce obesity rates should adopt an evidence-based approach. This entails adopting both micro- and macro-interventions tweaked to each country’s individual requirements. The ideal way forward would be to tackle obesity from the individual, population-wide and food industry angles. The key towards a successful intervention is for each country to carry out well-planned health examination studies, in an attempt to pin point local risk factors. Having a correct individualized picture, each country can move forward and draw policies and interventional procedures. The aim should be to primarily improve the quality of life. Second, the country’s capital expenditure is also reduced.peer-reviewe

Smoking health professional student : an attitudinal challenge for health promotion?

Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5–5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1–13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1–8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8–13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.This work was supported by the World Health Organization (Grant: NCE: EU ICP FFC 100 XK 08).peer-reviewe

Malta : Mediterranean Diabetes hub : a journey through the years

Introduction: Diabetes mellitus in Malta has been an established major health problem for years. It has been linked with cultural, geographical, historical, genetic as well and a change from a Mediterranean diet to a Westernized diet. This diabetes burden has lead to establishment of diabetes clinics both in the central general hospital, as well as in the community. Over the past 50 years, there have been two major epidemiological diabetes studies conducted to evaluate diabetes in the Maltese population. Diabetes in Malta: To date, there is no established national diabetes plan or diabetes register in Malta, although there has been the formation of a governmental diabetes focus group. The time is right for an updated prevalence study to look at the current Maltese generation and their changing determinants including diabetes risk factors and genetics, followed by the development of preventative strategies and policies. Conclusion: Over the years, diabetes burden has increased and become a public health and national financial concern. It is of utmost importance to address this national disease. An updated prevalence study would provide the evidence-based backbone for the development of diabetes preventive strategies and policies. The combination of which will enable the Maltese health services to be improved and better equipped to come to grips with this epidemic.peer-reviewe