Health and medication literacy and the desire to participate in pharmacotherapy decision making – comparison of two countries

Background

Health and medication literacy may be important factors in the outcomes of medical treatment. Similarly, shared decision making or lack of it may influence patient's behavior and adherence to medications.

Immunisation of migrants in EU/EEA countries: Policies and practices

In recent years various EU/EEA countries have experienced an influx of migrants from low and middle-income countries. In 2018, the “Vaccine European New Integrated Collaboration Effort (VENICE)” survey group conducted a survey among 30 EU/EEA countries to investigate immunisation policies and practices targeting irregular migrants, refugees and asylum seekers (later called “migrants” in this report). Twenty-nine countries participated in the survey. Twenty-eight countries reported having national policies targeting children/adolescent and adult migrants, however vaccinations offered to adult migrants are limited to specific conditions in seven countries. All the vaccinations included in the National Immunisation Programme (NIP) are offered to children/adolescents in 27/28 countries and to adults in 13/28 countries. In the 15 countries offering only certain vaccinations to adults, priority is given to diphtheria-tetanus, measles-mumps-rubella and polio vaccinations. Information about the vaccines given to child/adolescent migrants is recorded in 22 countries and to adult migrants in 19 countries with a large variation in recording methods found across countries. Individual and aggregated data are reportedly not shared with other centres/institutions in 13 and 15 countries, respectively. Twenty countries reported not collecting data on vaccination uptake among migrants; only three countries have these data at the national level. Procedures to guarantee migrants’ access to vaccinations at the community level are available in 13 countries. In conclusion, although diversified, strategies for migrant vaccination are in place in all countries except for one, and the strategies are generally in line with international recommendations. Efforts are needed to strengthen partnerships and implement initiatives across countries of origin, transit and destination to develop and better share documentation in order to guarantee a completion of vaccination series and to avoid unnecessary re-vaccination. Development of migrant-friendly strategies to facilitate migrants' access to vaccination and collection of vaccination uptake data among migrants is needed to meet existing gaps.     

The impact of the EU Directive on patients’ rights and cross border health care in Malta

The patients’ rights and cross-border health care directive was implemented in Malta in 2013. Malta's transposition of the directive used the discretionary elements allowable to retain national control on cross-border care to the fullest extent. This paper seeks to analyse the underlying dynamics of this directive on the Maltese health care system through the lens of key health system stakeholders. Thirty-three interviews were conducted. Qualitative content analysis of the interviews reveals six key themes: fear from the potential impact of increased patient mobility, strategies employed for damage control, opportunities exploited for health system reform, moderate enhancement of patients’ rights, negligible additional patient mobility and unforeseen health system reforms. The findings indicate that local stakeholders expected the directive to have significant negative effects and adopted measures to minimise these effects. In practice the directive has not affected patient mobility in Malta in the first months following its implementation. Government appears to have instrumentalised the implementation of the directive to implement certain reforms including legislation on patients’ rights, a health benefits package and compulsory indemnity insurance. Whilst the Maltese geo-demographic situation precludes automatic generalisation of the conclusions from this case study to other Member States, the findings serve to advance our understanding of the mechanisms through which European legislation on health services is influencing health systems, particularly in small EU Member States.     

Social work supervision in Malta: A specialism in the making

ABSTRACT

The leitmotif for this piece is the development of social work supervision in Malta as a specialism. As background, I present concentric circles of influence on supervision. I first consider Malta’s geo-socio-cultural context, then the professional status of social work, followed with a focus on supervision. I next introduce the supervisors and review pertinent research studies, followed by supervisor education and supervisory practices, and then propose recommendations for future practice and research. Finally, I ask: Can social work supervision in Malta be considered a specialism in the making? My answer is yes, but it is at a rudimentary stage of development.     

Closing the gap - Is type 2 diabetes awareness enough to prevent the growing epidemic?

BackgroundDiabetes mellitus is a public health burden requiring a multi-sectorial approach including adequate population awareness to tackle this epidemic. The study was aimed to determine the level of diabetes awareness among a high-risk dysglycaemic population in relation to socio-demographic, lifestyle and family history of diabetes as well as to body mass index (BMI) and blood pressure measurements. Furthermore, the authors strived to explore any relationships between diabetes awareness and an oral glucose tolerance test dysglycaemia diagnosis.MethodParticipants obtaining impaired fasting blood glucose in a representative health examination survey were invited to undergo an oral glucose tolerance test (OGTT). During the OGTT session, participants were invited to take part in a diabetes awareness questionnaire as well as have their weight, height and blood pressure measured. Association between awareness scores and different parameters (age, gender, education, residential district, smoking, alcohol habit, family history, BMI and blood pressure) were explored.ResultsBeing a female, ageing, non-smoker and having a family history of diabetes had a positive association with adequate diabetes awareness. Even though generally good awareness was present, the majority of the participants were obese, with an elevated blood pressure and obtained a dysglycaemic status post OGTT.ConclusionDiabetes awareness solely does not appear to engage individuals in preventive initiatives. Behavioural changes are required but these are only established after the motivational action gap has been overcome. Empowering community diabetes mellitus screening programs targeting the environment, social gradients and cultural norms while engaging in preventive interventions are recommended.     

Setting up the first genitourinary clinic in Malta and an audit of the initial performance

BACKGROUND: The first genitourinary (GU) clinic was set up in Malta in January 2000. An audit was conducted to evaluate the demand for such a service and its effectiveness during the first 6 years after its introduction. METHOD: Case notes from the first 6 years were reviewed, and data were collected for gender, age, sexual orientation, symptoms, diagnosis, condom use, referral source, total number of attendances, and contact tracing. RESULTS: The total number of attendances increased from 760 in the first year to 1832 in 2005. The male to female ratio decreased from 2.3 in 2000 to 1.6 in 2005, as more females attended. The number of partners treated per index case was 0.25. Eighty per cent of attendees were self-referred; 16% were referred by their general practitioner (GP). Only 10% admitted to using a condom regularly. Twenty-nine per cent of asymptomatic attendees in 2005 were diagnosed with a sexually transmitted infection (STI). Fifty-three cases of gonorrhoea were diagnosed by the GU clinic during the first 6 years, with 17% of isolates showing resistance to ciprofloxacin in 2005. A total of 38 cases of syphilis were diagnosed compared to only a handful of cases reported in the 25 years prior to the introduction of the service. CONCLUSIONS: The increasing attendance, as revealed by this audit, reflects a growing demand for the service offered by the GU clinic in Malta. Numerous STIs are being diagnosed and treated, including syphilis, which has re-emerged in Malta as it has in the rest of Europe. The prevalence of ciprofloxacin-resistant gonorrhoea has been increasing, a trend that has also been documented in other European countries. In addition to successful management of STIs, the GU clinic would further benefit from a public health campaign aimed at encouraging asymptomatic sexually active individuals to attend for an STI screen, while simultaneously promoting responsible sexual behaviour.     

Visions or Hallucinations? Lacan on Mysticism and Psychosis Reconsidered: The Case of St George of Malta

Mysticism has long featured in discussions among psychoanalysts and mental health practitioners, anthropologists and scholars of religion. In this paper I analyse the life and visions of a twentieth century mystic in the Catholic Mediterranean. Through this case study I seek to compare the psychoanalytic and to a lesser extent the psychiatric discussions of ‘hallucinations’ with the theological explanations of visions. Via a Lacanian discussion of the case of the first Maltese saint I argue that there are interesting points of convergence between the two. An adequate understanding of the cultural context within which visions are articulated as meaningful experiences is essential to our understanding and clinical treatment of people presenting symptoms associated with religious content. A psychoanalytical understanding can serve to enrich and enliven theological discussions on madness as a path to sanctity.