Contents Message by the President...................2 Message by the Public Health Officer.......................................................3 Message by the Editors........................4 Diabetes..................................................5 Cardiovascular Diseases......................7 Asthma.....................................................9 Cancer......................................................11 Epilepsy ..................................................13 Eating Disorders....................................15 Anti-tobacco...........................................17 Antibiotics Awareness.........................19 Sun Protection.......................................21
Editors: Dawn Grech Gianluca Fava Design and Layout:
Jordy Borg
Writers: Maria Grazia Grech Georgiana Farrugia Julia Shaaban Suzanne Jane Ellis Gabriel De Giorgio Alexia Grech Ritianne Buhagiar Vidya Sundara Maria Brincat Michela Galea Erika Babatunde Proofreaders: David Borg Vanessa Mercieca
Climate Care in Public Health......................................................23 Blood and Organ Donation.................................................25
1st Edition: 2015 Printed by: Progress Press
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Message from the MMSA President You might have heard about the MMSA, either through a news item or through the work which many of our medical students do on a week-to-week basis. The Malta Medical Students’ Association is the social entity which represents the medical student body in Malta, prompting each and every medical student to use his newly-acquired knowledge to improve the society around him. Medical students are continually invited by our association to pursue philanthropic motives in educating the general public about their health. As an association, we believe that empowerment and advocacy are key to why medical students eventually become good doctors. And this process of empowerment is not simply an intrinsic effort, but should radiate to all the patients we come in contact with during our student years.
main scope remains that of making the public more health-conscious, enabling the Maltese community to make the necessary lifestyle decisions which will eventually led them to acquire a better overall state of well-being. This, in medical practice, remains the crux of all our efforts as future medical professionals.
It is for this reason that we are proud to present to you this booklet, with a comprehensive collection of all the work we do throughout the year. Our
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Gabriel Ellul MMSA President ‘14-’15
Message from the MMSA Public Health Officer ‘’An investment in knowledge pays the best interest’’ The Standing Committee on Public Health (SCOPH) is one of the standing committees within the MMSA. The main aims of this standing committee are to ensure a healthy society by educating and empowering the public on important health issues through the organisation of various campaigns, health checks, projects and more. For the past years, the MMSA, through SCOPH, organised a lot of health related outreaches. During these outreaches, the medical students engaged in conversations with the public about the importance of living a healthy lifestyle, avoiding tobacco use, protecting their skin from the harmful rays of the sun and so on. The people that we, as students, encountered in these endeavours were always intrigued and desired to learn more about different topics, however time was never on our side.
‘’The MMSA Health Education Booklet’’ was born. This booklet represents the way that we, as medical students, are already contributing to the health care of our society through the knowledge that we are privileged to have. After weeks of hard work, I am delighted to present to you the fruit of the future health care providers of our country – The MMSA Health Education Booklet. I invite you to flip through the pages of this booklet and delve into the details of our greatest wealth - our health.
Thus, one of my main aims as the MMSA Public Health Officer was to provide the public with the knowledge that they sought for in a simple and easy manner. This is from where the idea of
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Martina Gerada Public Health Officer ‘14-’15
Message from the Editors Dear readers, For the past few months, together with fellow students, members of the MMSA-SCOPH team and medical professionals, we have been working on putting together the Health Education Booklet. The aim of this booklet is to provide basic information on some of the more prevalent health conditions in the Maltese Islands in a clear yet comprehensive manner. Every article has been written by a medical student and subsequently reviewed by a medical professional in the field in order to ensure accuracy. We sincerely hope that you find this booklet of use and that you refer to it should you have any queries.
Dawn Grech, Gianluca Fava Health Education Coordinators ‘14-’15
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Diabetes
Diabetes, also known as diabetes mellitus, is a common chronic condition characterised by impaired fasting plasma glucose. It arises when the body does not produce enough insulin (type 1) or the body’s tissues become resistant to insulin (type 2). In 2008, diabetes caused 1.3 million deaths worldwide. The International Diabetes Federation estimates that roughly 10 percent of the Maltese population has diabetes. People with diabetes typically experience frequent urination, intense thirst and hunger, unusual weight loss and fatigue, amongst others. Obesity is one of the key risk factors for the development of diabetes. Obesity is the result of a combination of genetic and lifestyle factors, consisting of low levels of physical activity and consumption of excess calories. Hypertension, or high blood pressure, is also a major risk factor for diabetes. High blood pressure is generally defined as 140/90 mm Hg or higher. Moreover having a parent or sibling with diabetes also increase the risk of developing diabetes. Many people are diagnosed with diabetes when they develop one of its potentially life-threatening complications. If not controlled, diabetes can be a risk for complications that can
affect nearly every organ in the body. The INTERHEART case-control study estimated that people with diagnosed diabetes are at three times the risk of myocardial infarction compared to those without. Patients with either type 1 diabetes or type 2 diabetes are at high risk for several cardiovascular disorders: stroke, peripheral arterial disease, coronary heart disease, congestive heart failure and cardiomyopathy. Uncontrolled diabetes mellitus can cause nerve damage (neuropathy) which presents as numbness or tingling, that usually begins at the tips of the toes or fingers. Another complication of diabetes is kidney damage (nephropathy) which can lead to kidney failure since the elevated glucose levels damage the blood vessels that filter the blood. The same thing happens to the blood vessels in the eye due to the elevated glucose levels in diabetes, which results in eye damage (retinopathy). This can lead to blindness and increases the risk of other serious vision conditions, such as cataracts and glaucoma. However some of these detrimental effects can be counteracted by lifestyle changes, such as exercising, stopping smoking, maintaining a healthy body weight and eating a varied and well balanced diet.
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Written by: Alexia Grech Reviewed by: Dr. Sarah Cuschieri MD P.G. Dip. Diabetes (Cardiff)
It is important that physical activity is part of everyone’s daily routine since increased physical activity helps to maintain weight loss and is linked to reduced blood pressure, reduced resting heart rate and increased insulin sensitivity. A balanced diet involves eating more fruits, vegetables and whole grains — foods that are high in nutrition and fibre and low in fat and calories. Although diabetes is a lifelong condition, it can be managed with proper treatment and care. The treatment depends on various factors such as the type of diabetes and is personalised according to the individual patient. Treatment of type 1 diabetes involves insulin therapy. Treatment of type 2 diabetes primarily involves monitoring of blood glucose, along with diabetes medications such as medicine that stimulate the pancreas to produce and release more insulin. Other medications may inhibit the production and release of glucose from the liver while others block the action of the stomach or intestinal enzymes that break down carbohydrates. Metformin is usually the first line treatment prescribed for type 2 diabetes. It must be emphasised that while pharmaceutical intervention is available, lifestyle changes have greater efficacy and
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are practical and cost effective, making its implementation possible in any primary health care setting. Longstanding positive behavioural adaptation and lifestyle modification will provide the answers to our fight against the impending epidemic of type 2 diabetes mellitus.
Cardiovascular Diseases Cardiovascular Disease (CVD) is defined as any condition characterised by dysfunction of the heart and blood vessels, i.e. of the cardiovascular system. Despite advancements in medicine, cardiovascular disease remains the leading cause of death, responsible for almost half (44.3%) of deaths in Malta. Atherosclerosis (lipid-laden plaque buildup inside blood vessels – “hardening of arteries” – caused both by ageing and diabetes, and by other conditions such as hypertension, smoking and hypercholesterolaemia), is the key player in CVD onset, of which the commonest is coronary artery disease (CAD). CVD is four times more common in men than in pre-menopausal females. Following menopause, the risk for CAD in females is as frequent as in males due to the decrease in protective oestrogen levels. There are modifiable and non-modifiable risk factors for CVD. A family history of CVD predisposes to an increased risk of developing the condition, and unfortunately this is a non-modifiable risk factor. The modifiable risk factors include the following: smoking, decreased physical activity, diets with a high fat content, inadequate diabetes and lipid control as well as inadequate blood pressure control. A healthy lifestyle may therefore.
lower the risk for developing CVD. CVD may lead to a number of complications which can shorten one’s life expectancy. These include: 1. Heart attack – the occlusion of blood flow through a coronary artery often secondary to a blood clot which may lead to decreased oxygen supply to the heart muscle leading to scarring and loss of heart function. 2. Heart failure – the pumping action of the heart is forfeited, leading to fluid accumulation in the lungs. 3. Stroke – the occlusion of cerebral arteries feeding the brain resulting in impaired neurological function. 4. Aneurysm – the dilatation / “ballooning” of arteries, possibly leading to rupture. 5. Peripheral artery disease – narrowing of the arteries of the lower limbs secondary to atherosclerosis, leading to intermittent claudication i.e. pain felt in lower limbs only when walking. 6.Sudden cardiac death – heart attacks are the leading cause of death which may occur secondary to lethal arrhythmias. 1 in 3 deaths from CVD is preventable. One cannot overemphasise the importance of trying to target and reduce one or preferably more of several risk factors
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Written by: Gabriel De Giorgio Reviewed by: Dr. Tiziana Felice MD MRCP (UK)
increased risk whilst male smokers have a 3-fold increased risk for CAD. Passive smoking should also be avoided. 5. Decrease body fat if overweight / obese, and get within your ideal BMI range (an approximate, but still indicative scale) 6. Regular aerobic exercise such as brisk walking, jogging and swimming is advised, at least for 1 hr, 4 times/week. Pie-chart displaying the incidence of different types of Cardiovascular Diseases and their incidence, as derived from a 2014 update of Heart Diseases and Stroke Statistics. (Taken from http://circ.ahajournals.org/content/129/3/e28/ F43.expansion.html )
which pre-dispose us all to CVD. Risk factors such as hypertension, hyperlipidaemia and diabetes need to be addressed and controlled with adequate diet and medication. The following may help to prevent CVD. 1. A low-fat, high-fibre diet rich in fruit and vegetables; as well as a diet rich in fish which have healthy omega-3 oils. 2. A low sugar diet is recommended – avoid unnecessary sugary drinks and sweetened products & food. 3. Limit alcohol consumption to an ideal daily limit of 1 & 2 units for women and men respectively (1-2 daily alcoholic units actually decrease CVD risk by 30%) 4. Smoking cessation is extremely important. Female smokers have a 6-fold
Medical attention is crucial once heart disease is diagnosed. Cardiovascular diseases are rarely completely reversible, and thus the goals of the the treatment/s (which vary widely according to the condition involved) are to stabilise the condition immediately, controlling the symptoms over the long term and when possible, providing a cure. At the time, occlusive CVD (i.e. resulting from blockage/s of artery/ies) is mostly stabilised by common surgical procedures such as angioplasty (and stents), heart bypass surgery and minimally invasive balloon valvuloplasty. Interferences with the heart’s electrical conduction system are frequently corrected by artificial pacemakers, ablation (surgical and non-surgical) and implantable cardioverter defibrilators (ICDs).
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Asthma Asthma is a chronic respiratory disease, characterized by reversible airflow obstruction as a result of inflammation and increased contractibility of the smooth muscles surrounding the small airways. Typical symptoms of asthma include recurrent episodes of wheezing, coughing, chest tightness and shortness of breath. Sputum may also be produced. Such symptoms are usually worse at night or early in the morning, or in response to strenuous physical activity or exposure to cold weather.
to be major contributors in the manifestation of this common disease (Martinez, 2007). Smoking is also associated with a greater risk of asthma-like symptoms, hence it is recommended that it is limited both during and after delivery (Dietert, et al., 2011). Psychological stress may also be a causative factor, for stress alters the immune system and thus increases the airway inflammatory response to allergens and irritants (Thomas, et al., 2011).
Since 1970, the occurrence of asthma has increased significantly, most especially in developed countries. In fact, it is estimated that 235-300 million people globally are diagnosed with this condition every year – the majority of whom are youngsters (World Health Organization, 2011). A curious fact is that mild asthma attacks are twice as common in boys as girls, however severe asthma occurs at equal rates in both genders (Bornehag & Nanbeg, 2010). Contrastingly, adult women tend to suffer more from this condition (Gold & Wright, 2005).
It is vitally important to be aware that future asthma attacks can be easily prevented by avoiding exposure to potential allergens and irritants, which may include air pollution, tobacco smoke, animal dander, dust mites, pollen, sulfite-containing foods, as well as strong chemicals such as perfumes, spray paint, latex and aldehydes. Should triggeravoidance be insufficient, the use of prescribed medication is recommended.
The cause of asthma is not yet known, however, a combination of genetic and environmental factors are thought to
Acute asthma attacks are frequently treated with medications such as bronchodilators or corticosteroids. These drugs can be administered orally in the form of dissolved tablets, or else via a metered-dose inhaler, coupled with an asthma spacer.
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Written by: Georgiana Farrugia Reviewed by: Dr. Eleanor Gerada MD MRCP (UK)
An image comparing the appearance of the airways of normal people, asthmatic people and during an asthmatic attack.
The prognosis for asthma is generally good, especially in children. In fact, half of the asthma cases diagnosed throughout childhood will no longer carry the diagnosis after a decade (Crompton, 2006). One thing to be aware of is that there are a number of conditions that may occur more frequently in people suffering from asthma as opposed to members of the general population that do not suffer
from this respiratory disease. These conditions may include gastroesophageal reflux, rhino-sinusitis and obstructive sleep apnea (Boulet, 2009) and eczema.
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Cancer Cancer is an excessive growth of the body’s cells that is usually uncontrolled. It can either be malignant or benign. Cells are replaced when old ones die or become damaged. Sometimes, this tightly regulated process goes wrong and cell multiplication becomes excessive. This leads to a tumour. Cancers can affect almost all parts of the body. Some cancers are benign (innocent) and others are malignant (these are aggressive and have the ability to spread throughout the body and cause damage in doing so). They spread through the blood, veins, the lymph, or by growing out of an organ and invading another organ next to it. Inside every cell (except red blood cells) is a nucleus containing DNAthe genetic code unique to each of us – which controls everything a cell does including when it should die, when it should grow and divide. However, DNA is prone to damage from chemicals, the environment and genetic mutations, they can cause the cells to malfunction and grow too fast. According to the WHO, cancer was responsible for almost 1/3 of the
total deaths in Malta last year. Smoking, obesity, radiation, genetic mutations, dust particles, alcohol, drugs, certain infections and age are some of the risk factors. Each of these risk factors has been associated with a particular type of cancer. For example, breast cancer can be genetic and thus inherited through generations. A healthy lifestyle can make a contribution to reducing cancer risk. Below are some points worthy of note: ❖ A cigarette contains over 5000 toxic/cancer causing chemicals. Inhaling these chemicals targets the lungs, bladder, mouth, throat, pancreas, bowel, cervix, liver, stomach, ovary, nose, sinus and blood. Cigarettes with lower tar contain harmful chemicals. Cannabis also contains some of the same toxic and cancer causing chemicals. Marijuana increases tar exposure in the lungs. Shisha also is dangerous, as it is smoked for much longer than cigarettes. ❖ Alcohol affects liver, stomach, oesophagus (food pipe), throat, bowel, breast and mouth. Alcohol is digested in the liver cells, a by-product of which causes scarring (cirrhosis) of the liver leading to cancer. Alcohol protects the
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Written by: Julia Shaaban Reviewed by: Dr. Melanie Cutajar MD MRCP (UK)
heart in very small quantities. In excess it is a factor for heart disease and stroke.
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Radiation and UV (UVA and UVB) cause cancer too. Moles on the skin can become cancerous so check for any changes in appearance. Radiation from other sources like radioactive waste, nuclear industry and even radiotherapy (if not dosed correctly) can be causes of cancer. Often these hazards are occupational. Use of lead protective outer wear especially over the reproductive organs is important. ❖ Viruses like HPV, Hepatitis B can cause cancer. Human Papilloma Virus (HPV) causes cervical cancer in women, but both men and women can be infected with the virus, men being carriers of HPV. Once infected with certain types of the virus there’s an increase in cancer risk. Smear (or PAP) tests check the cells for pre cancerous changes. The HPV vaccine should also be taken to provide immunity to the virus. Hepatitis B infects the liver causing chronic inflammation and cancer.
Genetic counselling is advised. A family history is very important to know as the cancer trait can be inherited just like any other gene. It is advisable to ask and find out as much as possible, including both male and female relatives. Generally the earlier it is discovered, the more successful the treatment. Radiotherapy uses radiation to kill cancer cells. Chemotherapy is a form of treatment that kills cancer cells. Sometimes cancers can be surgically removed especially if it compresses another organ.
For breast and testicular cancer, the best way to detect it early is to examine yourself regularly. It can be done very easily in the privacy of your own home or your GP can show you what to do. This is important for everyone. It’s wise to remember that not all lumps are cancer and not all cancers give lumps. If in doubt check it out.
❖ Genetic screening- e.g. BRCA 1 and 2 mutations which cause breast and ovarian cancer in women and breast cancer and prostate in men. These genes can be detected and in some cases preventative measures can be taken.
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Epilepsy Epilepsy is a brain related condition which manifests itself in the form of recurrent episodes of seizures of various types. The seizures, colloquially known as “fits�, occur when nerve cells in the brain transmit wrong signals for various reasons. The symptoms vary according to the type of seizure, of which there are over 40 types according to the International League against Epilepsy. Most commonly seizures can be classified as either focal or generalized, depending on where the abnormal electrical activity starts. People with epilepsy may experience abnormal sensations and emotions or behave strangely, while other symptoms include sustained muscle contractions or loss of consciousness. Some seizures are nonconvulsive such as absence seizures. The incidence of epilepsy is estimated at around 0.5-1% of the population worldwide, including Malta (6 million in Europe, and around 4000 in Malta). Epilepsy is of unknown aetiology in about 50% of people with this condition. However, in the other 50%, the condition may be due to various factors which can cause a reduction in seizure threshold. These factors include genetic influences, and presently ongoing research has identified several different genes which could be linked to this
condition, to varying degrees. The onset of epilepsy occurs most commonly during childhood, however the incidence may increase in the elderly due to conditions such as dementia and stroke. Other conditions such as tumors, infectious diseases such as AIDS and other disorders including cerebral palsy, can also increase the risk of epileptic seizures. In addition, epilepsy can be the result of a head injury, foetal brain damage or even drug and alcohol abuse. Present advances in medicinal therapy have lead to over 70% of cases of epilepsy being controlled and thus leading a normal life. However for the remaining 30% uncontrolled seizures might lead to some complications. Convulsive seizures can lead to injuries such as trauma and injury to face and teeth. Loss of consciousness due to seizures can lead to higher incidence of drowning, if the appropriate precautions are not taken. People with epilepsy should not drive unless they have been seizure free for one year, according to recent EU directives. Uncontrolled seizures during pregnancy may also induce dangers to both mother and baby, and it is known that certain anticonvulsants (epilepsy medication) increase the risk of birth defects.
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Written by: Ritianne Buhagiar Reviewed by: Dr. Maria Mallia MD MRCP (UK)
Status epilepticus, which is a medical emergency, occurs when convulsive, usually tonic clonic seizures persist without the patient regaining consciousness between seizures. This may lead to brain damage or cognitive dysfunction and may be fatal. Studies have shown that certain co-morbidities such as depression are more common in persons with epilepsy, such as depression however it is unclear whether this is related to the underlying condition or as a side effect of the medical therapy. Epilepsy also induces a small risk (1%) of sudden unexplained death (SUDEP). The cause is unidentified, but some research shows it could be related to underlying heart or respiratory conditions. In people with epilepsy it is important to take some common simple precautions in order to reduce the possibility of breakthrough seizures. These may include avoiding drugs of abuse and alcohol; taking all of medications as prescribed; avoiding bright, flashing lights and other visual stimuli; and limiting excessive time on videogames. It is also recommended for people with epilepsy to wear some type of identification such as an identity card in order for those around them to quickly recognise that the person is having a seizure and can thus give the required
assistance. People around a person having a seizure should remember the term TRUST as a mnemonic for first aid: Turn person on their side Remove harmful objects Use something soft under the head Stay Calm Time the seizure Nothing must be placed in the mouth and the person must not be held down. In most cases, epilepsy can often be well controlled by medication. There is an increasing number of antiepileptic medicines now available which can be used alone or in combination to treat seizures. It is very important that people with epilepsy also keep an epilepsy diary which may help the individual identify possible triggering factors for their seizures. For example, stress, lack of sleep and alcohol may increase seizure activity in some people, while in some females, seizures have been related to the menstrual cycle. Surgery is now possible in those people where the locus of the epileptic seizure has been identified.
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Eating Disorders Eating disorders are characterised by an abnormal attitude or relationship with food which leads to a marked change in eating habits such as extreme over or under eating. There are three main types of eating disorders, Anorexia Nervosa, Bulimia Nervosa, and atypical eating disorders such as Binge Eating Disorder (B.E.D). Anorexia Nervosa is characterised by severe food restrictions, excessive exercise and sometimes vomiting in order to control body weight. Most people suffering from anorexia nervosa do not view themselves as being underweight but see a fat person; this leads to the cycle of the negative behaviours and food restrictions. People with bulimia on the other hand will go through a cycle of binging and purging; eating large amounts of food in one sitting (binging) then feeling guilty and trying to reverse it and get rid of the ingested food by throwing up, using laxatives or diuretics (purging). Atypical eating disorders are grouped separately as they don’t fall into the same category as anorexia and bulimia. The most common is B.E.D, which is characterised by compulsive eating or food addition. Eating disorders are not necessarily about food but are about
dealing with emotions. It can be a way for some people to return control into their lives after a traumatic event or be used as a coping mechanism. Anyone can develop an eating disorder, regardless of age, race or gender. Nevertheless, it is more common in females, particularly young women and adolescents. There are many suggested causes and risk factors for developing eating disorders, including: •Genetic variations •Family history of depression, substance misuse or eating disorders •Major life changes such as a new job, school, divorce, going through puberty •Stressful events or trauma including physical illnesses or abuse •Having certain personality traits such as having an obsessive or compulsive personality •Mental health problems including depression, anxiety, bipolar disorder and body dysmorphic disorder •Social and environmental pressures such as friends and family commenting on weight, seeing others on diets/ obsessing over weight or being in a society that values a low body weight •Causes with no specific or known origin
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Written by: Erika Babatunde Reviewed by: Dr. Claire Cassar MD
There are many emotional and psychological complications associated with eating disorders such as low selfesteem, body dysmorphic disorders, anxiety and depression. In addition, physical complications to one’s health develop, where the most severe can lead to death. Complications arising Anorexia Nervosa sufferers include:
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•Thinning of the bones (osteopenia or osteoporosis) •Anaemia and muscle wasting / weakness •Low metabolic rate and internal body temperature •Low blood pressure and pulse •Damage to heart function and rhythm (arrhythmias) •Brain damage •Multi-organ failure leading to death In Bulimia Nervosa complications include: •intestinal irritation caused by laxative abuse •Vomiting leads to worn tooth enamel and chronic sore throat, •Severe dehydration and electrolyte imbalance from loss of fluids. Tackling the early signs of an
eating disorder will help to prevent the progression and its possible life threatening consequences. Things to watch out for: Are you displaying these behaviours? •Feeling guilty after eating •Missing meals •Lying about eating •Eating in secret •Eating large or very small amounts of food •Being secretive •Mood swings •Feeling depressed and out of control •Worrying about food If you suspect that you may be suffering from an eating disorder, it is important to become aware of your habits, and accept them. Communication is also very important when dealing with an eating disorder. Speaking to close family, friends or a doctor will help you to further understand and come to terms with these feelings and seek further help. It must be made clear that it is a great strength to reach out for support, and you should never be ashamed.
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Smoking Current global smoking patterns involve 50% of young men and 10% of young women becoming smokers. Tobacco linked deaths will rise from five million in 2010 to more than ten million by 2030. Thus, between 2000 and 2050, smoking will claim the lives of 450 million adults. Furthermore, at least half of these adults will die before the age of 702. Tobacco is consumed in various ways, smokeless tobacco and cigarette smoking being the two major forms. Cigarette smoking accounts for 6585% of the global tobacco consumption. Active smoking can lead to a number of conditions, such as respiratory disorders, cardiovascular hazards, cerebrovascular accidents and even hernias, besides increasing ones risk of developing cancer. These statistics demonstrate the growing problem of tobacco usage, and indicate that something needs to be done. Higher taxes, regulations on smoking and raising public awareness can lead to the prevention of at least 115 million smoking-associated deaths in the coming decades, including 25-million cancer deaths. Pulmonary diseases caused by tobacco often results in chronic obstructive pulmonary disease (COPD) and emphysema. Cigarette smoking also
Cigarette smoking also increases risk of death from pneumonia. It is reported that 50% of smokers eventually develop COPD. COPD is characterised by chronic airflow obstruction. COPD is incurable but it can be managed with the right treatment, which mostly revolves around symptom control and prevention of exacerbations, smoking cessation and immunisation. Chronic bronchitis is essentially long-term inflammation of the lungs and airways. It causes a cough and productive of phlegm, often referred as “smoker’s cough”5. Emphysema on the other hand is when air is trapped in the lungs. The air is trapped in air sacs called alveoli making them abnormally dilated and less flexible. It leads to difficulty in taking deep breaths. Cigarette smoke has adverse effects on the cilia that line the respiratory tract. The cilia along with mucous secretions act as defence mechanisms against foreign bodies. But cigarette smoke slows down the beating of the cilia, until they become paralysed and disappear all together. Cigarette smoke also leads to the production of an enzyme known as ‘elastase’, which breaks down the elastic tissue of the lungs making them less flexible.
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Written by: Vidya Sundara Reviewed by: Dr. Eleanor Gerada MD MRCP (UK)
Smoking results in a two to four fold elevated risk of coronary heart disease. Nicotine and carbon monoxide are the major players in the cardiovascular effects of smoking. They greatly affect the oxygen supply/demand of the cardiac muscle, and the development of atherosclerotic plaques. Lung cancer is the most common cause of cancer deaths in both males (23%) and in females (21%). Tobacco smoke is a multi-organ site carcinogen as it also affects the lower urinary tract, upper digestive tract, nasal cavity, stomach, liver and kidney and many more. Cigarette smoke consists of a lot more then the triad of Nicotine, Carbon Monoxide and Tar.Tobacco smoke is a mixture of more than 5,000 chemicals. Other dangerous chemicals that are found in tobacco smoke are: acetone, methanol, naphtalene, cadmium, and arsenic. Several myths about tobacco are still heard. a) Switching to ‘light’ cigarettes will cut my risk. False. In fact the reality is that the only
proven way to cut your risk is to stop smoking altogether. Those who do switch to light cigarettes often find other ways to compensate the nicotine reduction. Evidence suggests that they may hinder prevention and cessation efforts. b) Having one cigarette won’t hurt me. False. It has been found that even occasional smoking increases mortality and increased risk for smoking-related diseases. c) I’m the only one who is hurt by my smoking. In pregnancy, it has been associated with a higher risk of having a small-for-gestation baby. Furthermore, COPD prevalence has been linked with increased exposure to passive smoke. Second-hand smoke is shown to increase the risk of both fatal and non-fatal cardiac events. Finally, passive smoking has been found to be a predisposing or aggravating factor of childhood asthma. The only proven method of reducing the risks of smoking is to quit. Hence it is vital for the public health sector to invest in their anti-smoking campaigns and raise awareness amongst the public about this killer disease.
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Antibiotics Awareness Antibiotics are made by microorganisms and they are chemicals which kill or stop the multiplication of other bacteria and other microorganisms. The term may be incorrectly used to refer to synthetic substances, which have the same use (the proper term should be antimicrobials in this case). They can be taken in many ways including orally, as an injection and even via the skin. A doctor may prescribe antibiotics to treat an infection or to prevent an infection. An infection is treated with antibiotics when: •it is not too severe but a cure cannot be achieved otherwise (such as severe acne) •it can spread to other people easily (such as chlamydia which is easily transmitted sexually) •these help shorten time for recovery significantly (such as in urinary tract infections) •if left untreated, may lead to complications which may be serious and even life-threatening (example in the case of a pneumonia) A doctor may give antibiotics to prevent infection when: •the patient has a weakened immune system (ex. in sickle cell anaemia)
•before surgery Antibiotics are useless against viral infections such as the common cold and influenza. Different antibiotics target different organisms. The choice of antibiotic and the dose also depends on the age, health of the patient, and severity of the disease. Other factors include pregnancy and whether any other medicine is being taken. Apart from that there are factors which affect how well the antibiotic will work including what food the drug is taken with and genetic variability between patients. Occasionally antibiotics may give rise to side effects. Common side effects include diarrhoea, nausea and vomiting. Rarely, the patient may be allergic to a drug. The reaction may vary from a rash to anaphylactic shock - an extreme reaction that includes swelling of the lips, shortness of breath and loss of consciousness. It is important to inform your doctor if you notice any side-effects or signs of allergy, if you know that you are allergic to a particular drug or if you think you may have taken an overdose. Today, antibiotics are being prescribed with extreme care because, over the years, they have been used and abused so much that resistance is
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Written by: Maria Grazia Grech Reviewed by: Dr. Melanie Cutajar MD MRCP (UK)
developing. Resistance is when a bacterium undergoes some form of change which protects it from the action of the antibiotic. Therefore use of the antibiotic is futile as the organism is not killed or rendered ineffective. This is an extremely serious issue because new strategies and new antibiotics to combat infections need to be discovered and currently the industry is struggling to keep up. There are various things a patient can do to help slow down this process: •Do not insist on being given antibiotics if you have a viral infection. Not only will an antibiotic be useless but it may cause side effects. Do ask for medicine which can help ease the discomfort of a sore throat, relieve a blocked nose, or bring a fever down etc.
that is not severe, and adhere to professional advice. This is because if antibiotics keep being used to treat trivial diseases, they will eventually become ineffective. •Take the medication for as long as the doctor prescribes it even if you feel fine, and do not skip doses. This may sound contradictory, however having sub-lethal amounts of the antibiotic in your body can lead to some of the bacteria developing resistance since the infection would not be completely eradicated. •Do not borrow antibiotics that have been prescribed for other persons. They might not be ideal for you even if you are experiencing similar symptoms, and in fact may even be harmful.
•Take vaccinations such as the seasonal influenza vaccine. This will protect you against the influenza virus with the added benefit that you will be less likely to develop complications that may include bacterial infections such as post influenza pneumonia. •Do not take antibiotics for an infection
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Sun Protection Spending a lovely day outdoors whilst soaking up some sunshine is always something to look forward to, not only because it is utterly enjoyable but also essential. Sunlight is a vital source of Vitamin D, thus playing an important role in calcium metabolism and preventing osteoporosis, a condition where bones become brittle and are more likely to fracture. However, the consequences of long-term inappropriate sun exposure outweigh all the associated health benefits. According to the Skin Cancer Foundation, 65% of melanomas and 90% of all non-melanoma skin cancers are related to sun exposure. Apart from that, ultraviolet radiation also contributes to increase the risk of developing cataracts; a progressive clouding of the eye lens that leads to loss of vision. In spite of all this, the good news is that the risk of such conditions can be minimised by practicing appropriate sun exposure protection measures. Sun protection is essential, not only when spending a day by the beach or seaside as most people think but also when going outdoors, irrespective of the time spent in the sun. This is because ultraviolet light radiation has a cumulative effect on the human body. Moreover, sun safety is
crucial for infants because they are more susceptible to sun damage since their skin possesses less melanin; the pigment that gives colour to skin, hair and eyes whilst providing some protection against the sun. Limiting sun exposure is of utmost importance, especially in summer, between 11am and 4pm when the sun’s rays are at their peak and when the UV index is greater than 3. Other vital measures include seeking shade, wearing sun protective clothing and hats with a wide brim. Furthermore, applying sunblock is always a must. When choosing a suncream, it is important that it has a sun protection factor (SPF) greater than 15, along with a broad spectrum of protection against both UVA and UVB rays since both damage the skin. UVA causes skin pigmentation and photo ageing while UVB causes sunburn. Both UVA and UVB contribute to the development of skin cancer. Sunblock must be applied generously on every part of skin exposed to sunlight including lips, ears, nose and bald scalps. Also, it is highly crucial that it is reapplied every 2 hours and after swimming, exercising, or sweating so that its benefits do not wear off. Ditching sunscreen in order to get the perfect tan will only do more harm than
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Written by: Michela Galea Reviewed by: Dr. Michael J. Boffa MD FRCP MSc
good. Sunglasses must also be worn in order to protect the eyes from the harmful UV rays. The ideal sunglasses are large framed that block 99-100% of UV rays coming from various different angles. These usually carry the label “UV absorption up to 400nm” or “Meets ANSI UV Requirements”. Sun protection measures should always be taken seriously. If any abnormal-looking malignant skin lesions
are observed, it is important to seek dermatological advice as soon as possible because many are curable if they are dealt with at an early stage. Spending long hours in the sun without adequate safety measures can have serious repercussions on the human body. Like everything else in life, sunshine should be enjoyed in moderation!
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Climate Care in Public Health During the early 20th century lack of sanitation, clean water and pollution was a serious threat to the health of most populations around the globe. Today, climate change poses at least an equal threat. The fight against climate change not only relies on commitments of governments but also on the population’s commitment to initiatives for prevention/ adaptation in order to guarantee some success. Malta and Gozo are vulnerable to climate change impacts as they are islands, have a high population density and an ageing population. Populations most at risk to climate change effects are very young children, older people or people with chronic cardio-respiratory diseases. Most health effects of climate change are more likely to cause disability, hospitalisation and decreased quality of life rather than death. Climate change could make an existing health condition worse or increase the impact of current health threats, yet it is not considered as a serious issue by many. Average temperatures in Malta are predicted to rise by 2.8⠰C by 2100. Some months may have increased rainfall and other months less rainfall, but overall rainfall is predicted to decrease by 4% by 2050. Both these changes to our climate could have profound impacts
to our health. An increase in temperature causes more heat waves, aggravates air pollution and the health of people with pre-existing medical conditions. Heat-induced rashes, heat stroke, greater incidence of asthma and other respiratory diseases are more common during heat waves. Climate change may contaminate and even reduce water supplies and hence affect agricultural production thereby causing malnutrition. Other impacts of such climate change include increased migration owing to climate change in Africa, and there could be the possibility that new diseases could arise and pose threats. Flooding may cause sewage overflows which constitutes a serious public health risk. After flooding, houses may be damp and this has a detrimental effect on health. It may also cause an increase in road traffic injuries and congestion may affect emergency service response time. It is important for people to realise that they play an important role in fighting climate change around the world. Every individual has the capability and
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Written by: Suzanne Jane Ellis Reviewed by: Dr. Julian Mamo MD MSc PhD MFPH (UK)
responsibility to reduce their carbon foot-print, and this may be achieved by changing small things in their day-to-day lives. The easiest way to fight climate change is by being energy efficient in your own home. Switching to LED lightbulbs, unplugging TVs, computers and other electronics when they are not in use and washing clothes in cold or warm (not hot) water, will not only reduce your carbon footprint, but also your electricity bill. Cutting down on waste, recycling paper, plastic, metal and glass, and using organic waste as compost in your garden helps to reduce greenhouse gases like methane. Walking, cycling, car pooling, or using public transport when possible is another important step which should be taken, and allows the potential to significantly cut down on carbon emissions.
will be dealt with more effectively, thus decreasing the number of deaths and ill health from climate change impacts. By early identification of potential health risks associated with climate change, benefits increase and costs decrease. Additionally, adequate responses can be provided and deaths and diseases can be prevented.
By walking and cycling, personal fitness will increase, air quality will improve and population obesity rates, diabetes and heart disease will decrease. Planning for health effects associated with climate change should occur at local to national levels as impacts differ depending on location. By increasing surveillance, monitoring and using early warning systems in Malta, health threats
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Blood and Organ Donation Deciding whether to donate your blood or organs should not be taken lightly, so I want to start by clarifying both phrases: •Blood donation is voluntarily giving some of your blood to help someone else during surgery, after a trauma etc. •Organ donation is when a person gives their organs for transplant. It can occur whilst the donor is alive or once they are deceased. Living organ donation occurs when an individual voluntarily gives a part of an organ, tissue or one of a pair of organs to someone else. Deceased organ donation occurs after you pass away. In Malta, we have great facilities for donating blood: apart from the centre in St. Luke’s Square, G’Mangia, we have the Blood Mobile Unit that moves to different localities to ensure that transportation never hinders donors. Speaking from experience, the centre in G’Mangia is notably efficient – I made use of their facilities on numerous occasions and each time I was in and out in less than thirty minutes. Becoming an organ donor is a quick process. All you have to do is sign up online for an organ donor card or call the Transplant Support Group on:
21 223026 and within a few days you will receive your donor card. Signing up for this card does not oblige you to donate all your organs; you have the right to decide which organs you would not like to donate, for any reason, and which organs you would like to donate once you pass away. Do not worry, after you donate your blood your body will replace the fluid portion within 24-hours of donating and the blood cells will be replaced! Currently the kidneys, heart, liver, lungs, cornea, pancreas and the small bowel can be transplanted. During a blood donation, the unit of blood that is given can save up to 3 lives. The blood is either; •Separated into its different constituents and given to different patients depending on what they need for recovery. •Given as a whole to a patient during surgery or after a trauma. Many factors need to match or be very close to ensure a successful organ transplant; blood group, age and weight are taken into account before the
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Written by: Maria Brincat Reviewed by: Dr. David J. Camilleri MD MRCP (UK) FMCPath FRCpath transplant. The better the match, the better the results. Patients in need of an organ transplant are entered into a computerized list that is sorted based on the patients’ urgency. Organ donations can be transplanted to any patient in Europe. Since the organ donation occurs voluntarily, the donor is unable to dictate who the recipient is. Despite this, the family of the donor may request basic details such as the age and sex of the individuals who have benefitted from the donations. The confidentiality of the donor is maintained unless it is a live donation which usually occurs because the donor and patient would have a previous relationship. Do not let misinformation prevent you from saving lives. Here are some myths about organ donation: 1.Myth: “If I agree to donate my organs, the hospital staff will not work as hard to save my life.” Fact: A doctor’s primary goal is to save your life. 2.Myth: “Maybe I will not really be dead when they sign my death certificate.” Fact: Patients who wish to donate their organs undergo additional tests to confirm their passing.
3.Myth: “My family will be charged if I donate my organs.” Fact: The family is never charged for organ donation. 4.Myth: “I’m not in the best of health. Nobody would want my organs or tissues.” Fact: Although it may be the case that certain organs are not suitable, others may be transplantable. The decision needs to be made by a medical professional at the time of death. Do not count yourself out prematurely! For more information on blood donation, the National Transfusion Services can be contacted on: SMS: 79307307 E-mail: nbts@gov.com.mt For more information on organ donation, you may contact the Transplant Support Group on: Tel: 21 223026 E-mail: registration@transplantsupport. com.mt
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Eating Disorders
Smoking
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Sun Protection
Climate Care In Public Health
1. Robinson JK. Sun exposure, sun protection, and vitamin D. JAMA 2005 Sep 28;294(12):1541-1543. 2. Skin Cancer Foundation. Skin Cancer Facts. 2014; Available at: http://www.skincancer.org/ skin-cancer-information/skin-cancer-facts. Accessed February 2, 2015. 3. Roberts JE. Hazards of sunlight exposure to the eye. In: Giacomoni PU, editor. Sun Protection in Man. 1st ed. Amsterdam ; New York: Elsevier Science; 2001. p. 157. 4. Skin Cancer Foundation. Sun Safety Tips for Infants, Babies and Toddlers. 2014; Available at: http://www.skincancer.org/prevention/ sun-protection/children/sun-safety-tipsfor-infants-babies-and-toddlers. Accessed February 2, 2015. 5. Boughton B, Stefanek M, Gansler S T. Reduce your cancer risk : twelve steps to a healthier life. 1st ed. New York: Demos Health; 2010. 6. American Cancer Society. Skin Cancer Prevention and Early Detection. 2014; Available at: http://www.cancer.org/acs/ groups/cid/documents/webcontent/003184pdf.pdf. Accessed February 2, 2015.
1. Bauchner H, Fontanarosa PB. Climate change: A continuing threat to the health of the world’s population. The Journal of the American Medical Association 2014 October 15; 312(15): p1519-1519. 2. Gatt K. The impact of climate change on water resources. In: Environmental Health Directorate, Malta & WHO Regional Office for Europe, Ministry for Health, the Elderly & Community Care (eds.) Health effects of climate change in the Maltese Islands. Malta: Ministry for the Health, The Elderly & Community Care; 2010: p56-67. 3. Climate Change Committee for Adaptation, Malta. National Climate Change Adaptation Strategy. 2010 November 2010: pi-143. 4. Climate Change Will Worsen Public Health, Report Says. PT in Motion 2014 August; 6(7): p50-51. 5. Sammut CV, Micallef A. Future climate scenarios for the Maltese Islands. In: Environmental Health Directorate, Malta & WHO Regional Office for Europe, Ministry for Health, the Elderly & Community Care (eds.) Health effects of climate change in the Maltese Islands. Malta: Ministry for the Health, The Elderly & Community Care; 2010: p23-28.
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Blood and Organ Donation Health Directorate, Malta & WHO Regional Office for Europe, Ministry for Health, the Elderly & Community Care (eds.) Health effects of climate change in the Maltese Islands. Malta: Ministry for the Health, The Elderly & Community Care; 2010: pv.
1. Blood Services C. Frequently Asked Questions About Donating Blood. Available at: http://www.communitybloodservices.org/ db_faq.php. Accessed 02/01, 2015. 2. NHSBT. Organ and Tissue Donation. Available at: http://www.organdonation.nhs. uk/how_to_become_a_donor/questions. Accessed 02/01, 2015. 3. Staff MC. Organ Donation: Don’t Let These Myths Confuse You. Available at: http://www.mayoclinic.org/healthy-living/ consumer-health/in-depth/organ-donation/ art-20047529. Accessed 01/30, 2015. 4. National Blood Transfusion Services. Notice Board. 2013; Available at: https://ehealth. gov.mt/HealthPortal/health_institutions/ Units/nbts/introduction/nbts_default.aspx. Accessed 02/01, 2015. 5. Support Group T. Registration for Organ Donor Card. Available at: http%3A%2F%2Fwww.transplantsupport. com.mt%2Fdonor-registration. Accessed 02/01, 2015.
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