The Malta Medical Students' Association (MMSA) wishes to express its concern for the news regarding the setting up of a new Barts medical school in Gozo.
The MMSA welcomes the fact that Barts Medical School is known for its excellence in the teaching of medicine and surgery and agrees that it would be an asset to the country's teaching resources.
by Sarah Craus and reviewed by Dr. D. Sammut
It is a known fact that Malta is one of the countries where obesity is a major problem. With over 60% of its population either overweight or obese, Malta has one of the highest rates of obesity in the world and the problem is escalating. Being overweight and obese are epidemic problemsand worldwide, at all ages, particularly in Westernised societies. The direct, indirect and long term health risks for the individual and population as a whole are indisputable. Unless tackled, the current Maltese obesity trends will result in an astronomical increase in morbidity and mortality from ischaemic heart disease, stroke and cancers. Overweight and obesity account for about 80% of cases of type 2 diabetes, 35% of ischaemic heart disease and 55% of hypertensive disease in Europe. In addition, obesity increases the risk for various cancers (breast, ovaries, colon, prostate), gallstones, impaired fertility, asthma, cataracts and various musculoskeletal disorders. Social stigma is another consequence of obesity and the condition has been linked to bullying, anxiety and depression (Sammut et. al, 2012) Obesity imposes an economic burden on society through increased direct medical costs incurred to treat the diseases associated with it, and indirect costs due to lost productivity because of absenteeism from work and premature death (Grech et al. 2007)
Dr Sammut (a GP who recently carried out an audit about adult obesity) suggests that one can walk to work or park few minutes away from the place of work so that he or she would be exercising daily. Many people use their private cars to go to work or travel even for a short distance. Studies show that people are interested in traveling for short distances by bicycles but they are discouraged by the lack of bicycle lanes present in our roads and the reckless driving. They are also discouraged by the huge amount of traffic on our roads, hence making it unsafe to go by bicycle.
Sammut thinks that the government needs to start aiming slightly below people's bulging waistlines, by laying siege to their pockets. Fast food such as pizza or cheesecakes is cheaper than healthy food and more readily available. Most women are very busy with work and they spend a lot of time outside their homes. This means that they have less time available to buy fresh fruit and vegetables and to cook healthy meals. They also have less time to exercise. Physical education is not offered as a subject in all schools after students leave their secondary school. This further augments the problem of obesity. Advertising by food companies has probably led to the increased consumption of energy-dense foods and drinks. Some even argue that the government should increase the prices of unhealthy food in the same way as it does with tobacco as both smoking and unhealthy food are harmful.
The influence of the mother’s body weight prior to conception and during pregnancy has a key bearing on the weight of the neonate at birth and thereafter. The National Obstetrics Information System reports that between 2007 and 2009, 37% of mothers were obese in early pregnancy and 49% were overweight.
The Malta Food and Nutrition Policy is being revised to take account of the national epidemic of obesity and the current food consumption patterns. The new food and nutrition policy will concentrate on improving the availability, accessibility, and affordability of fruit and vegetables. Fruit and vegetables are being given for free each week to children at school in order to encourage healthy eating and minimize the problem of obesity (School Fruit and Vegetable Scheme).
According to a report by the EU and the World Health Organization, 29.5% of Maltese children aged 11-15 were either overweight or obese, far higher than the EU average. A sedentary lifestyle is one of the major causes of obesity in both adults and children (Graph 1). Most people tend to spend a lot of hours watching TV or on their computer instead of engaging in physical activity. Urbanization has led to a decrease in physical activity.
Graph 1 – Participation in physical activity
(A Healthy Weight for Life: A National Strategy for Malta 2012 – 2020)
In July 2013, the government launched an outreach team about anti-obesity. This team is found at various popular places such as in Valletta and leaflets are distributed in order to stress the importance of exercising, at least half an hour three times a week. This campaign also encourages people to eat a Mediterranean balanced diet based mainly on fruit and vegetables, grains, olive oil, beans, nuts and legumes. Poultry, eggs and meat should not be consumed daily.
There are many ways of tackling the growing problem of an overweight population and it is vital to recognise that any initiatives taken to address this issue are important investments in the future. By improving the lifestyles of children in Malta we are likewise improving the health of the adults that these children will one day grow into. An overall healthier population will alleviate much of the unnecessary burden on European healthcare systems. For this to be achieved, however, cooperation is needed – not only across member states, but also between policy-makers and citizens themselves (Casa, 2012)
‘Tax fast foods, says doctor about Malta’s obesity problem.’ (February 2013) Jacob Borg www.maltatoday.com
‘Childhood obesity: a critical Maltese health issue’ (2007), Journal of the Malta College of Pharmacy Practice, Issue 12. Victor Grech
‘Audit of the diagnosis and management of adult obesity in a Maltese general practice’, 2012
Daniel Sammut, David Sammut, Jason Bonnici. Malta Medical Journal Volume 24 Issue 01
‘Comparison of body mass index of a national cohort of Maltese children over a 3-year interval’ (2011). Victoria Farrugia Sant’Angelo, Victor Grech. Malta Medical Journal Volume 23 Issue 01
A Healthy Weight for Life: A National Strategy for Malta 2012 – 2020
Solving problems associated with rising obesity (2012), David Casa http://www.independent.com.mt/mobile/2012-12-01/opinions/solving-problems-associated-with-rising-obesity-462422022/
by Sarah Craus
APH complicates 3–5% of pregnancies. It is bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and prior to the delivery of the baby. APH can lead to both fetal and maternal morbidity and mortality1 such as hypoxia, intrauterine growth retardation, infection, anaemia and post-partum haemorrhage1.
Causes of APH include placenta praevia and placental abruption (Figure 1a and b respectively2).
Risk factors include a previous pregnancy complicated by abruption or placenta praevia, multiparity, low BMI, advanced maternal age, pre-eclampsia, fetal malpresentation and smoking.
History and examination are vital when a woman presents with APH3. If there is a suspicion of placenta praevia, a vaginal examination should not be carried out as this leads to catastrophic bleeding. Ultrasound can be used to confirm the presence of a placenta praevia and then the mother should be kept in hospital until delivery, which is normally via caesarean section at 37 weeks.
If the mother is between 24+0 and 34 +6 weeks of gestation, dexamethasone should be given as the fetus’s lungs are not yet well developed. Tocolysis should not be used if the mother is hemodynamically unstable, has suffered major APH or there is evidence of fetal compromise4. The fetus should be monitored using a CTG to detect any signs of fetal distress.
In the acute setting, maternal blood should be taken for a complete blood count and coagulation screen, as well as to obtain a cross match. Oxygen should be given at 15L/minute via a mask with reservoir. Mother can be transfused with O negative blood if blood loss was significant (Figure 2).
Figure 2: Management of APH5
1. Calleja-Agius J, Custo R, Brincat MP, Calleja N. Placental abruption and placenta praevia. Eur Clin Obstet Gynaecol 2006; 2:121–7
2. Bleeding in Pregnancy/Placenta Previa/ Placental Abruption [http://www.stanfordchildrens.org/]
3. Royal College of Obstetricians and Gynaecologists. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27. London: RCOG; 2011
4. Royal College of Obstetricians and Gynaecologists. Tocolytic Drugs for Women in Preterm Labour. Green-top Guideline No. 1b. London: RCOG; 2011
5. Late Pregnancy Bleeding ELLEN SAKORNBUT, M.D., Family Health Center of Waterloo, Waterloo, Iowa, LAWRENCE LEEMAN, M.D., M.P.H., University of New Mexico, Albuquerque, New Mexico PATRICIA FONTAINE, M.D., M.S., University of Minnesota, Minneapolis, Minnesota. Am Fam Physician. 2007 Apr 15;75 (8):1199-1206.