Attention Deficit Hyperactivity Disorder : an overview

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioural disorder found more commonly, but not exclusively, in school-age children. The hallmarks of the condition are inattention and hyperactivity/ impulsivity, which often go together. Although the term ADHD was coined relatively recently, ADHD has in fact been described as early as 1902. This review article will go through the most important historical aspects of the condition, and will also give an account of what is known about the aetiology of ADHD. The diagnostic criteria issued by the American Psychiatric Association in DSM-5, have been last updated in May 2013. This article will highlight the differences between DSM-5 and the previous version, DSM-IV-TR, and will also touch upon the latest developments in electroencephalographybased investigations and imaging studies for ADHD. Although the condition cannot be cured, symptoms can be managed using various modalities such as behaviour intervention strategies and medication, such that the individual affected by ADHD can have the least possible disruption to social and academic functioning.peer-reviewe

The management of nocturnal enuresis in children

Introduction : Nocturnal enuresis is more prevalent in the male gender. Studies such as that by Butler & McKenna (2002) show how nocturnal enuresis is hereditary, with approximately 50% of the children affected if one parent has suffered from it. The main cause for nocturnal enuresis can be drinking late in the evening or not passing urine before going to sleep, resulting in excessive urine volume. A detailed history needs to be taken, eating and drinking habits should also be assessed, and any drinks or food that can increase the chances of bedwetting should be removed or reduced. Management: Management has to be adapted to the child and his/her family requirements. Prescribing the right medication and ensuring compliance is important but is only part of the management plan. Lifestyle changes should be advised. A very simple bedwetting vibrating alarm can be considered. If symptoms persist, pharmacological treatment should be prescribed together with the bedwetting alarm. Conclusion: Nocturnal enuresis is a common condition in a young child, however it requires a careful assessment and management in cooperation with the child’s parent or carer. Physicians need to be aware of when the child needs to be referred.peer-reviewe

Good parenting

Doctors need to realize that when one of their patients becomes a parent all of a sudden, everyone around them becomes an expert on parenting. They will start getting plenty of advice which will not always be the right one. That is where we, as doctors need to be vigilant. Parenthood can be very difficult. There is no right or wrong way of bringing up a child. This article is intended to give you the tools so you can give your patients the best advice based on the latest scientific evidence. Keep in mind that the evidence suggests that parents are happier than non-parents regardless of how tired they might feel at the end of the day. As Nelson et al. (2013) suggested, parents feel most fulfilled when they raise their children, as compared to the fulfillment they obtain from doing other things.peer-reviewe

Sociological framework applied to a case report of diabetes in adolescence

A case report concerning a 10 year old girl with Latent Autoimmune Diabetes in the Young is described. Diagnosis, prevalence in Malta, and patient support are described and followed by a discussion of how diabetes affects the family of similar cases. Research on a Sociological Paradigm describing Microsystems, Mesosystems, Exosystems, and Macrosytesms is discussed with reference to the case report.peer-reviewe

A qualitative study : the experience of general practitioners with older adult patients with osteoarthritis

Background: Osteoarthritis is a degenerative condition commonly effecting older adult patients in the community. There is a “demographic transition” leading to an ageing population. -- Objectives: To perform a qualitative study about how general practitioners (GPs) look at osteoarthritis, and its effects on patients’ lives as regards the biopsychosocial model. The aim is to analyse the GPs’ perspectives about the local available sources and any possible improvements. -- Method: Interpretative phenomenological analysis (IPA) was used as it allows the discovery of the details of each individual GP. Two GPs who have been practising for more than 5 years within the community volunteered through the Malta College of Family Doctors. Snowball sampling was used to recruit another two. Semi-structured interviews were then conducted, transcribed and analysed. -- Results: There was a common feeling that dealing with such a widespread disease is challenging within the community and there is a need for a specialised osteoarthritis clinic in the community to cater for all these patients’ needs via an interdisciplinary team. The need for a holistic approach was agreed amongst all the participants. There were four major themes: (i) osteoarthritis as a major health concern, (ii) the GP – a key role in the management of osteoarthritis in the community, (iii) challenges in community care and (iv) the future of primary care in the management of osteoarthritis. -- Conclusion: Osteoarthritis is a common, challenging condition which is treated by GPs; but being multi-faceted, input from other professionals is required.peer-reviewe

Real and virtual challenges facing medicine in Malta

Since the early days of medical practice, health care followed a simple and predictable pattern of interaction between doctors and patients. This pattern remained unchallenged for many years. The doctor was always perceived as being the most knowledgeable, and indeed was expected to act in an authoritative manner. Patients were rarely, if ever, expected to participate in decisions regarding their health and well-being. Moreover, treatment options were inevitably limited.peer-reviewe

Epidemiology of mixed vaginitis and its management

Vaginitis is a common reason for visits to a health care provider, accounting for 6 million visits per year. Symptoms associated with vaginitis can cause substantial distress, resulting in time lost from work and altered self-esteem. It is estimated that over a billion dollars is spent annually on both self-treatment and visits to a medical provider.peer-reviewe

Teacher participation in the management of schools

Participation - the idea of having a share in management and in profits - could be considered as the new concept to be applied in the Maltese Economy as far as the 'employed' are concerned, in the 1980s. The principle, when it comes to Education, may be examined in terms of various sectors - students, parents, teachers, private schools, local state schools, national policy and government. It is therefore pertinent to note what has been said so far as regards Teacher Participation. It has been claimed that it "is not incompatible with a sound educational policy". Far back in 1969, CASE (England) declared that teachers should have a right to be involved at all levels of planning and consultation on matters of vital educational concern. For the teacher's role in education is changing: he cannot act in an authoritarian atmosphere. He has to be accepted as the social operator who collects ideas, hypotheses and changes and makes them known to the masses. He is an animator and promoter of ideas, necessities and cultural and social fermentations.peer-reviewe

The development of foster care within the Maltese Islands : understanding the local scenario

This paper outlines the developments of foster care within the Maltese Islands. Fostering originally developed informally. Prior to the introduction of residential care, children who needed care were mostly looked after by the extended family. However, at the turn of the twentieth century, residential services emerged and came to dominate the child-care sphere. Foster care in Malta was formally recognized only recently following the professionalization of social welfare services and the recognition of foster care as an individualized service to children. A legal framework regulating fostering services was first enacted at the end of 2007. This paper reflects on such developments and documents how fostering has evolved in Malta from the turn of the twentieth century.peer-reviewe

Understanding contact between children in out-of-home care and their family of origin : Maltese foster carers’ viewpoints

Foster carers are amongst the main actors facing the challenges on a day-to- day basis when contact related issues arise. Twenty-one Maltese foster carers reported their views about contact and discussed the benefits and their concerns regarding contact between fostered children and the families of origin. Foster carers’ views were elicited and subjected to a thematic analysis. This paper presents different themes reported by foster carers about contact between children and the families of origin. Emotions were present when contact experiences were discussed by foster carers. Despite the difficulties and apprehension, carers believed in children maintaining contact. Some carers even went to great lengths in supporting children to establish contact with their families of origin. This paper also explores how managing contact is mitigated through the support of social work intervention.peer-reviewe