The impact of COVID-19 on the EU’s neighbourhood: The South Caucasus. EPC COMMENTARY 23/03/2020

In this special series of commentaries, experts look at how countries neighbouring the EU are dealing with the Corona crisis, the challenges they face and the scope for EU support

Audit of the diagnosis and management of adult obesity in a Maltese general practice

Obesity is an escalating health problem all over the world. Unfortunately, Malta lies on the upper end of the spectrum of mean population BMI (body-mass index). Family doctors are well placed to identify cases of obesity and offer health education, medication, follow-up and referral when necessary to help their clients lose weight. They can also help prevent obesity and its complications. The authors, who work in the southern harbour area of Malta, carried out an audit of the diagnosis and management of adult obesity within their Group Practice during the year 2010. The performance of the Practice vis-à-vis obesity in adults is compared to the standards set by the European Practice Guidelines for the Management of Obesity (2008), and recommendations made.peer-reviewe

The global food crisis : supply and demand revisited

This study aims to show that the volatility in food prices between 2008 and 2011 cannot be explained merely by the market fundamentals of demand and supply. While global changes in demand and supply are bringing about radical changes to the food equation, evidence shows that market failure in the world grain market aggravated the problem. Excess liquidity, brought about by monetary growth policies after the subprime crises and financial meltdown in 2008, has stimulated speculation and hoarding. Strong incentives for financial operators to find better returns in places like the commodities market is attested by the six-fold increase in the number of ‘derivatives’ contracts made between 2002 and 2008. Furthermore, agriculture is one of the most heavily subsidized, protected, and distorted markets in the world. This is a key reason behind a decade long lack of progress in the Doha Round of the World Trade Organization (WTO). This study investigates the hypothesis that speculative activities are a major source of volatility in the agricultural commodities market and that this has significantly contributed to price inflation. It also explores Malta’s possible involvement in food commodity speculation, albeit on a small scale.peer-reviewe

A concept analysis of ‘GP trainer’ : a misnomer?

This article analyses the concept of the GP trainer. The framework developed by Walker and Avant (2005) is used. The aims were: 1) to clarify the concept and its fundamental qualities; and 2) to question whether the term trainer is apposite to the concept it represents. A literature search was performed in three databases and a search engine for the keywords [GP OR general practitioner] AND [trainer OR educational supervisor]. An online dictionary was used to define the noun trainer and the verb train. In addition, three colleagues were interviewed about how they conceptualised the GP trainer. Only six articles were found that address the desirable characteristics of the GP trainer. However, a large list of qualities was obtained from these studies and the other methods mentioned. The characteristics of the GP trainer were grouped using phenomenological tools into the three main categories of personal, professional and teaching attributes. Each category was further subdivided into the domains of knowledge, skills and attitudes. The GP trainer incorporates the three facets of ‘wise person’, ‘accomplished GP’ and ‘gifted teacher’. It is shown that the term educational supervisor describes the complex educational role of a teacher of GPs better than trainer.peer-reviewe

General practice organisation and healthcare reform : what do Maltese general practitioners think?

In Malta, two-thirds of primary healthcare is delivered by private general practitioners (GPs), mostly working single-handed without supporting staff. The combined lack of patient registration and transferable medical records lead to fragmentation of care, duplication of resources and suboptimal disease prevention and management. In 2009, the government proposed a reform to encourage partnerships which was shelved. The aim of this article is to explore the opinions of GPs about how practice organisation might influence them and their patients and to seek GPs’ views about possible healthcare reform initiatives. A postal cross-sectional survey of all specialists in family medicine resident in Malta. An instrument was designed, piloted and validated. SPSS® (v. 20) was used for analysis. One hundred and fifty (44%) questionnaires were returned. Respondents were representative of the sample as regards demographic and employment characteristics. Only 26% of GPs are female, but most work in partnerships or the public service. Seventy-seven per cent of private GPs work single-handed. Group practitioners are more likely to utilise electronic medical records and appointments, and to employ secretaries. Doctors acknowledge that although patients prefer one GP, partnerships can deliver better patient care. GPs believe that partnerships are beneficial for themselves, and would consider joining one. Females and young doctors favour partnerships. Respondents, particularly young doctors, favour patient registration and reform. Public doctors who work part-time privately oppose reform. Most GPs favour group practices and health reform, especially females and young doctors (whose proportions are increasing). Primary care should be urgently reformed and patient registration introduced. Public-private agreements would stimulate partnership formation. Public group practices could cater for means-tested citizens.peer-reviewe

Dangerous creatures of the Maltese sea : injuries and treatment : part 2

This is the second of a two-part article intended to give information about different organisms which inhabit the Maltese sea and which are potentially harmful. Doctors working in the primary health setup and sometimes also in secondary care are often faced with injuries related to these organisms. The nature of the injury and its treatment is then discussed. Treatment however is not evidenced based as little if any studies have been conducted in this field of medicine. After the first article considered venomous organisms, this second article will review sea creatures that may cause injury through bites, spines and electricity.peer-reviewe

Silver service : 25 years of activities by the Malta College of Family Doctors (1990-2015)

The Malta College of Family Doctors is an autonomous academic institution that was formally set up in 1990 with the object to encourage, foster and maintain the highest possible standards in family medicine in Malta, and to sustain and improve the professional qualifications of members of the medical profession in Malta who are engaged in family medicine.peer-reviewe

Family doctors and health promotion : do we practise what we preach?

Introduction: A survey on `Attitudes and Knowledge of General Practitioners (GPs) in Prevention and Health Promotion' was carried out in 2000 by EUROPREV (European Network for Prevention and Health Promotion in General Practice / Family Medicine). Method: All local general practitioners (GPs) known to the Malta College of Family Doctors were mailed a questionnaire to elicit beliefs and attitudes in practice, possible barriers in implementing preventive activities, and their personal health behaviour. Results: The response rate was 50% (156 replies out of 313). A difference was found between GPs' beliefs that certain preventive and health promotion activities should be done and their actually doing them in clinical practice. Forty-nine percent found some or great difficulty in carrying out such activities, mainly due to heavy workload and lack of time, problems in patients' accessibility to these activities, and patients' doubts about their effectiveness. Discrepancies were revealed between GPs' health promotion beliefs and their own personal behaviour. Discussion: As this study is based on GPs' self-reporting of activities, more objective evidence is needed through audit of properly-kept medical records. A practical protocol of health promotion activities needs to be devised for, and distributed to, family doctors. Health promotion activities may be facilitated by reduction of doctors' workload through patient registration and an appointment system. As doctors seem to prefer ordering investigations to giving verbal advice, other healthcare professionals could provide the latter. GPs should set an example to their patients by adopting a healthy lifestyle to reinforce their advice regarding health promotion.peer-reviewe

It’s time we made smoking history! Tobacco control in Malta : the present and the future

Tobacco products have no safe level of consumption. They are the only legal consumer products that cause ill health and premature death when used exactly as the manufacturer intends. Unless concerted action is taken quickly, 250 million of today’s children will die prematurely from an avoidable cause -tobacco use. The above declarations are not the author’s, but statements of the World Health Organisation (WHO). This article is a brief overview of tobacco control in Malta regarding the present situation and plans for the future, and is based on the following WHO Ten-Point Programme for Successful Tobacco Control.peer-reviewe

Lifestyle, prevention, change & support : the views & attitudes of patients in Maltese family practice

Introduction: General practitioners (GPs) are advised to consider their patients' views and attitudes in order to facilitate the success of preventive and health promotion interventions. This study explored patients’ views and beliefs about the importance of lifestyle and preventive interventions, and assessed their readiness to make lifestyle changes and to receive support from GPs. Methodology: Ten Maltese GP practices participated in a cross-sectional survey conducted by the European Network for Prevention and Health Promotion in Family Medicine/General Practice across 22 European countries during 2008-9. From each practice, 40 consecutive patients stratified by gender and age (10 males and 10 females aged 30-49 years, and 10 males and 10 females aged 50-70 years) were asked to complete a purposely- designed and piloted questionnaire. Results: Seventy-seven per cent of smokers, ~60% of unhealthy eaters, inadequate exercisers and those with abnormal weight, but only 11% of excessive drinkers thought they needed to improve their unhealthy lifestyles. Thirteen per cent of smokers, 30% of excessive drinkers, and ~50% of patients with problems of diet, exercise and weight were confident they would succeed. Sixty per cent of patients with diet, exercise and weight problems, 50% of smokers and just 8% of excessive drinkers would have liked GPs’ support. Conclusion: GPs and healthcare professionals need to discuss risky lifestyles with patients to help them personalise such risks, and should offer their support to those wishing to change so as to improve their confidence and chances of success. Such discussion and support are especially important for excessive drinkers.peer-reviewe