Epidemiology of blood pressure and hypertension in the adult Maltese community

Raised blood pressure is thought to be highly prevalent among the Maltese community. This has been a clinical impression probably partly based on the assumption that the Maltese prevalence rates are consistent with the epidemic rates obtained in most European countries and the United States. A study was undertaken in order to acquire scientific information on blood pressure, hypertension and its awareness among the Maltese population aged between 25 and 64 years. The mean systolic blood pressures were 138 mmHg (SD 16) for males and 138 mmHg (SD 20) for females. The mean diastolic blood pressures were 86.2 mmHg (SD 10) for males and 85.5 mmHg (SD 11) for females. The prevalence of hypertension was 26%. Only about 10% of persons suffering from hypertension had their blood pressure under adequate control.peer-reviewe

Humanities and Medical Science : HUMS : a novel programme at the University of Malta

Medical practice and the health sciences have the well-being of mankind as their essential focus and their aim is to promote and protect health, to heal when possible, and always to limit harm and alleviate suffering. Practitioners of the medical and health sciences not only look upon their competences and attitudes as both science and art, but despite an often necessary professional detachment, many are often introspective about the human condition and the wider dimensions and implications of their practice.peer-reviewe

Lung health and outdoor air pollution : a review

The lung is one of the interfaces between the body and the exterior environment. The maintenance of lung health depends on several factors, among them one’s genetic makeup, the environment, socioeconomic circumstances and natural ageing. Persons respond differently and uniquely to environmental circumstances, and this often makes the exposure-disease relationship difficult to assess. Air pollution most commonly causes irritation of the respiratory tract, resulting in discomfort, cough and breathlessness. It is also a major factor in exacerbating existing respiratory diseases and may also be the potential cause of lung disorders. The relationships between air pollution, increased incidence of respiratory conditions and severity of airway diseases are well recognized and robustly supported by epidemiological, toxicological and clinical studies. Outdoor air pollution is caused by aerosols and gases in amounts that may affect health, and the major contaminants in urban environments are a wide variety of particulate matter and ozone. Common specific lung disorders are known to be linked with urban air pollution: asthma and chronic obstructive pulmonary disease are frequently exacerbated following exposure to contaminated air, while with regard to lung cancer, the relationship is a causal one. Air pollution also poses a significant public health problem and concomitant approaches are necessary in order to improve air quality and to lessen the negative impact of airborne pollution on lung health. Control and mitigation of this problem requires effective health education, and sound preventive strategies through a combined community, administrative and political approach.peer-reviewe

Effectiveness of blood pressure control in a small community

The aim of this study was to examine the degree of control of blood pressure with respect to individuals on anti-hypertensive drug therapy attending a Health Centre for repeat prescription. Despite their being on anti-hypertensive drug therapy, only 35% of the individuals were found to be normotensive, 27% were in the borderline range whereas 38% were found to be hypertensive. The relatively high prevalence of poorly controlled patients suffering from high blood pressure is partly a reflection of the degree of non-compliance by patients to prescribed drug regimens although this is difficult to either qualify or quantify. Education of the patient vis-à-vis his medical condition and its treatment is of great importance as is regular monitoring and effective control of raised blood pressure by the family physician.peer-reviewe

Regular follow-up as part of an Asthma management plan : a study of hospitalised patients in Malta

Objective: To study the management of specific sub-groups of patients with asthma in Malta, using locally published guidelines for comparison. Method: A piloted, structured interview among patients between the ages of 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 minutes. The four-year prospective study started in February 1997 (one year before publication of the Malta guidelines) and finished in January 2001 (three years after publication). Main outcome measures: · Inhaled steroids on admission · Patient partnership: use of a written self-management plan and home peak flow monitoring · Patient compliance with inhaled steroids Results: 304 patients (68% females; mean population age 33.9 years SD 13.41) were interviewed over the four year period. Of the 304 patients, 32% were regularly followed up with the majority of patients (25.3%) being under specialist care; 54% of patients were not followed up as part of a long-term asthma management plan. It was not possible to obtain complete information in 14% of patients. The chi-square test was used to compare the two groups. With the exception of home peak flow monitoring, patients who were regularly followed up had statistically significant better management as recommended by the Malta asthma guidelines compared to those who were not regularly followed up. Conclusion: The findings of this study indicate that regular physician review results in better asthma management when assessed by comparison to published guidelines. However, despite regular follow up, certain aspects of patient care are inadequate in the light of the Malta asthma guidelines. It is suggested that the clinical pharmacist is well-placed to offer advice in order to promote adherence to guidelines.peer-reviewe

The final examination in medicine : time for change?

Most medical programmes culminate in a final assessment, in order that participants may be tested and graded. In June 1995, at the University of Malta, a group of 53 medical students sat for their final examination; medicine was one of the three co-equal component subjects of this statutory qualifying examination. The scope of this paper is to analyze the results obtained in the final examination in medicine and to use this data to address such issues as aims of this examination, method and quality assurance of assessment. The result obtained by candidates in the final examination in medicine was correlated with their university entry qualifications. The composite mark for each candidate was split into its components and analysis took the form of description, correlation and clustering. Computation of Cronbach’s alpha facilitated anlaysis of reliability of each of the three parts of the examination. The findings of this paper suggest that there is room for improving the quality of assessment methods. A review of methods and procedures, with the dual purpose of decreasing bias and increasing specificity and sensitivity of this statutory examination will not only benefit candidates, but ultimately also the University of Malta. The final qualifying examination in medicine should have clearly defined objectives and methods of assessment should be aimed specifically at reaching them. It needs to be able to assess the ability to think critically about diagnosis and management and to ensure that the candidate has a satisfactory base of factual knowledge. It also needs to assess objectively the adequacy of basic clinical skills and candidates’ facility of communication.peer-reviewe

Tuberculosis in Malta and the school BCG vaccination programme

Background: Malta has one of the lowest incidence rates of tuberculosis in Europe and a comprehensive free-of-charge health care system. Objective: To investigate whether Malta satisfies the criteria recommended by the International Union Against Tuberculosis and Lung Disease (IUATLD) in order to consider the discontinuation of the present school BCG vaccination programme. Method: Review of World Health Organization (WHO), and IUATLD guidelines for BCG use and discontinuation. Examination of surveillance data pertaining to tuberculosis in Malta, for the years 1979 to 2008. Findings: Malta has a long-standing, well-developed surveillance, treatment and follow-up programme for tuberculosis. The average annual notification rate of smear positive pulmonary tuberculosis was about 2 per 100,000 person-years since 1990. This is well below rates recommended by the IUATLD for the discontinuation of routine BCG vaccination programs. Conclusion: Malta satisfies established international criteria for discontinuation of the school BCG vaccination programme and therefore the programme should be reconsidered.peer-reviewe

Cough : a defence mechanism and a symptom

Cough is a very frequent reason why patients consult their family doctor and seek advice from the community pharmacist. Together with breathlessness, it is one of the commonest symptoms of lung disease.1 Cough is not only a symptom, but also a very rapid defence mechanism that both protects and clears the airways. Coughing may also be looked upon as a means of spreading infection via droplets and contamination of objects.peer-reviewe

Swollen limbs and bone pain : a case report

A 50 year old man presented with peripheral oedema, abdominal distension and a pulmonary opacity on CXR. He subsequently perforated his sigmoid colon as a complication of diverticulitis with pericolic abscess. After colectomy his postoperative period was marked by severe hypokalaemia, metabolic alkalosis, hyperglycaemia and recurrent chest infections. Paraneoplastic Cushing's syndrome was diagnosed after finding elevated serum cortisol and ACTH levels. CT-guided biopsy of the lung lesion revealed small-cell carcinoma. Bone scan disclosed collapse of numerous thoracic vertebrae possibly due to osteoporosis or oncogenic osteomalacia. Treatment with steroid-synthesis blockers was commenced but the patient died before tumour-directed therapy could be started. Ectopic ACTH syndrome and oncogenic osteomalacia are discussed.peer-reviewe

Selection of medication in hospitalised elderly patients with Angina Pectoris

Objective: To evaluate medication changes in hospitalised elderly patients diagnosed with angina pectoris and to compare the selection of medication with evidence-based treatment guidelines. Design: Review of medical notes and patient interview. Setting: St. Luke's Hospital, Malta; January - May 2001. Subjects: 226 patients, aged 60 years or over, with a history of chronic stable angina and a discharge diagnosis of angina. Main outcome measures: Prevalence of use of antiplatelet agents, lipid lowering agents, beta-blockers, calcium channel blockers, nitrates, potassium channel openers and cellular anti-ischaemic agents; presence of co-morbidities, concurrent medication and adverse effects. Results: Prior to discharge, 77% of patients were receiving antiplatelet agents and 27% were receiving lipid lowering agents. The most frequent anti-ischaemic agents used were nitrates (97%) and second-generation dihydropyridine calcium channel blockers (59%). Beta-blockers were used in 31% of patients and non-dihydropyridine calcium channel blockers were used in 4% of patients. Potassium channel openers (nicorandil) and cellular anti-ischaemic agents (trimetazidine) were used in 5% and 19% of patients respectively. Of patients discharged on a single anti-ischaemic agent, 96% were prescribed nitrates, while 64% of those on two agents were prescribed nitrates and dihydropyridine calcium channel blockers. Beta-blockers, nicorandil and trimetazidine were generally used in conjunction with at least two other antiischaemic agents. The major medication changes involved the addition, or increase in dose, of amlodipine and isosorbide dinitrate. The major determinants affecting choice of medication were age and co-morbidities. Conclusion: Medication selection for chronic stable angina was not in accordance with treatment guidelines.peer-reviewe