The new Mental Health Act and the family doctor

The new Mental Health Act (2012), is expected to enter fully into force in October 2014. This Act will completely replace the Mental Health Act which we have known and worked with over the last 30 years. Essentially this new Law will bring with it challenges and opportunities for all health care professionals involved in the care of persons with mental disorders. The new Mental Health Act follows the trend of modern legislation, which essentially adopts an individual human rights approach and places an emphasis on the protection of such rights in vulnerable groups in society, in this case persons with a mental disorder. The Act also mirrors the wider changes in knowledge, perception and attitudes towards mental diseases and mental health which have taken shape over the past decades. The new Mental Health Act provides the family doctor with a modern legislative framework which promotes the rights of the person with mental disorder whilst ensuring the required level of protection.peer-reviewe

The rights of persons with mental disorders

This article is a reaction paper to a previous article published in The Synapse 2014 Volume 13 Issue 1 which can be found through this link : https://www.um.edu.mt/library/oar//handle/123456789/13822Reference is made to the paper by Dr Anthony Zahra and Dr Nigel Camilleri entitled “An Overview of the New Mental Health Act for the Maltese Islands” published in the The Synapse Magazine, Volume 13 Issue 01. The authors here submit their comments, remarks and clarifications from a patient rights’ perspective. In the previous article, the authors suggest that a specific reference to either the World Health Organisation International Classification of Diseases or the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders could provide more definite guidance to users of the Mental Health Act. However if legislation is too prescriptive or prefers one international classification over another, then it may diminish clinical autonomy and as a result hamper rather than guide the service provider. As a result this may negatively impact the beneficiary of the service.peer-reviewe

The rights of persons with mental disorders

This article is a reaction paper to a previous article published in The Synapse 2014 Volume 13 Issue 1 which can be found through this link : https://www.um.edu.mt/library/oar//handle/123456789/13822Reference is made to the paper by Dr Anthony Zahra and Dr Nigel Camilleri entitled “An Overview of the New Mental Health Act for the Maltese Islands” published in the The Synapse Magazine, Volume 13 Issue 01. The authors here submit their comments, remarks and clarifications from a patient rights’ perspective. In the previous article, the authors suggest that a specific reference to either the World Health Organisation International Classification of Diseases or the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders could provide more definite guidance to users of the Mental Health Act. However if legislation is too prescriptive or prefers one international classification over another, then it may diminish clinical autonomy and as a result hamper rather than guide the service provider. As a result this may negatively impact the beneficiary of the service.peer-reviewe

Teenage pregnancy in Malta

Introduction Underage pregnancy may blight a young woman’s life. Teenage pregnancy rates vary widely across the world and have poorer pregnancy outcomes than non-teen pregnancies. Local Personal, Social and Career Development Education (PSCD) teaching is stipulated per curricula. This study was carried out by the Divisions of Education and Health in order to ascertain whether there are any differences in teenage pregnancy rates between State and non-State schools. Methods Ethical approval and data protection approval was obtained. The Health Division, identified pregnancies with mothers with age ≤18 years, for 2011-2015. Secondary schoosl attended were identified and an anonymised dataset was then passed on to the principal investigator for analysis. Results Teenage deliveries were significantly less in Non-State when compared to State schools, for each year studied, as well as for the aggregate of the total (p<0.0001). There was also a declining trend for teenage pregnancies in Non-State schools only (p=0.02). Discussion Abstinence-only sex education is a form of sex education that teaches abstinence from sex only. “Abstinence-plus” programs encourage sexual abstinence as the most effective means of HIV prevention and unwanted pregnancy avoidance, but also advocate condom use and partner reduction. It is suggested that the PSCD teaching methods in the different schools are compared as well as other factors that may reduce teenage pregnancy.peer-reviewe

The development of public mental health in Malta

Public health practitioners in Malta have been drivers of public mental health reform throughout the last twenty-five years. However, early political and financial support for the implementation of policy and strategy dwindled over the years. Whilst services continued to expand, these were not matched with the adequate injection of human and financial resources. Twenty years later, the mental health service is still experiencing problems of underfinancing as reflected by the dire state of the psychiatric hospital infrastructure, poor leadership, management and accountability structures, and a largely insufficient albeit dedicated workforce. In 2012, the enactment of the new Mental Health Act and the establishment of a Commissioner for Mental Health recharged a national focus on mental health. Mental health is now a subject for the local media, the public is more receptive, NGOs and professionals are more vocal, the significance of mental health in schools, homes, and the workplace is taking root, and the subject has gained increasing political will, culminating with the launch of a Mental Health Strategy document for consultation in December 2018. This is our window of opportunity to ensure that policies and strategies are now translated into resources and action that reap sustained improvement in population mental health and well-being for this and future generations.peer-reviewe

An analysis of hypocalcaemia post thyroidectomy : diagnosis and predictors

BACKGROUND: Post-thyroidectomy hypocalcaemia is a common complication with significant short and long term complications. The aim of this study was to determine the incidence and predictors of post-thyroidectomy hypocalcaemia (corrected calcium <2.1mmol/l).METHOD: A total of 183patients who underwent total thyroidectomy between 2012 and 2015 in a national general hospital were included in this retrospective study. Clinical and biochemical data were obtained from electronic and hard copy medical records.RESULTS: Out of a total of 183 patients, 142 (77.6%) were female, while 41 were males (22.4%). Ages ranged from 15 to 84 years, with a mean of 50.6 years (SD 15.84 years). There was variation in the incidence of hypocalcemia dependent on the timing of measurement of calcium on post-op day 1 (POD1) and the measuring of calcium on subsequent days. The incidence of post-operative hypocalcaemia on day 1 was 17.5% (n=32). The indications for surgery included Graves’ disease (62 patients, 33.88%), multi-nodular goitre (50 patients, 27.32%), malignancy (28 patients, 16.39%), the presence of a thyroid nodule (22 patients, 12.02%), hyperparathyroidism (18 patients, 9.83%) and in 3 patients (1.63%)the indication was unclear. A lower preoperative uncorrected calcium was associated with post-thyroidectomy hypocalcaemia (P=0.048). However it was found that the incidence of post-thyroidectomy hypocalcaemia was underestimated by 55.5% if only POD1 measurement was used.DISCUSSION: Measuring calcium on POD1 may miss patients who would subsequently develop hypocalcaemia. Other possible contributing factors for post-op hypocalcaemia, including age, gender, histology and indication for surgery were not found to be statistically significant, and could not be used to predict who will develop hypocalcaemia. This emphasises the need for stringent guidelines for assessing and managing patients undergoing total thyroidectomy and possible associated hypocalcaemia.peer-reviewe

Priority knowledge needs for implementing nature-based solutions in the Mediterranean islands

Mediterranean islands face significant environmental challenges due to their high population density, reliance on imports, and water scarcity, exacerbated by increasing risks from climate change. Nature-based solutions (NbS) could address these challenges sustainably and with multiple benefits, but their uptake in policy and planning is limited, and stakeholder perspectives are conspicuously lacking from current research. Here, we report the results of a collaborative, multi-stakeholder exercise to identify priority knowledge needs (KNs) that could enhance the uptake of NbS in Mediterranean islands. We used a well-established iterative prioritisation method based on a modified Delphi process. This was conducted by the authors, environmental policy and practice stakeholders from across the Mediterranean islands, representing business, government, NGOs and research. We developed a long list of potential KNs through individual submissions, and prioritised them through voting, discussion and scoring. Excepting workshop discussion, all individual contributions were anonymous. We present the 47 resulting KNs in rank order, classified by whether they can be addressed by knowledge synthesis and further research, or demand action in policy and practice. The top priority KNs are i) a more precise definition of NbS, ii) which NbS are adapted to dry Mediterranean conditions? iii) how to increase the adoption and use of NbS in urban plans?, iv) how can buildings and built-up areas be modified to accommodate green infrastructure and v) cost-benefit analysis of urban green spaces. In collaboration with these stakeholders, our findings will determine future research strategies on NbS implementation in the Mediterranean islands

A review of nature-based solutions for resource recovery in cities

Our modern cities are resource sinks designed on the current linear economic model which recovers very little of the original input. As the current model is not sustainable, a viable solution is to recover and reuse parts of the input. In this context, resource recovery using nature-based solutions (NBS) is gaining popularity worldwide. In this specific review, we focus on NBS as technologies that bring nature into cities and those that are derived from nature, using (micro)organisms as principal agents, provided they enable resource recovery. The findings presented in this work are based on an extensive literature review, as well as on original results of recent innovation projects across Europe. The case studies were collected by participants of the COST Action Circular City, which includes a portfolio of more than 92 projects. The present review article focuses on urban wastewater, industrial wastewater, municipal solid waste and gaseous effluents, the recoverable products (e.g., nutrients, nanoparticles, energy), as well as the implications of source-separation and circularity by design. The analysis also includes assessment of the maturity of different technologies (technology readiness level) and the barriers that need to be overcome to accelerate the transition to resilient, self-sustainable cities of the future

Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders

Funder: Kennedy Trust Rheumatology Research Prize StudentshipFunder: DFG Cluster of Excellence “Precision Medicine in Chronic In-flammation” (PMI; ID: EXC2167)Funder: EC | EC Seventh Framework Programm | FP7 Ideas: European Research Council (FP7-IDEAS-ERC - Specific Programme: “Ideas” Implementing the Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities (2007 to 2013)); doi: https://doi.org/10.13039/100011199; Grant(s): 715772Funder: NWO-VIDI grant 016.178.056, the Netherlands Heart Foundation CVON grant 2018-27, and NWO Gravitation grant ExposomeNLFunder: Li Ka Shing Foundation (Li Ka Shing Foundation Limited); doi: https://doi.org/10.13039/100007421Abstract: Irritable bowel syndrome (IBS) results from disordered brain–gut interactions. Identifying susceptibility genes could highlight the underlying pathophysiological mechanisms. We designed a digestive health questionnaire for UK Biobank and combined identified cases with IBS with independent cohorts. We conducted a genome-wide association study with 53,400 cases and 433,201 controls and replicated significant associations in a 23andMe panel (205,252 cases and 1,384,055 controls). Our study identified and confirmed six genetic susceptibility loci for IBS. Implicated genes included NCAM1, CADM2, PHF2/FAM120A, DOCK9, CKAP2/TPTE2P3 and BAG6. The first four are associated with mood and anxiety disorders, expressed in the nervous system, or both. Mirroring this, we also found strong genome-wide correlation between the risk of IBS and anxiety, neuroticism and depression (rg > 0.5). Additional analyses suggested this arises due to shared pathogenic pathways rather than, for example, anxiety causing abdominal symptoms. Implicated mechanisms require further exploration to help understand the altered brain–gut interactions underlying IBS