Neville Calleja

An overview of the European Health Examination Survey Pilot Joint Action

BackgroundHealth Examination Surveys (HESs) can provide essential information on the health and health determinants of a population, which is not available from other data sources. Nevertheless, only some European countries have systems of national HESs. A study conducted in 2006–2008 concluded that it is feasible to organize national HESs using standardized measurement procedures in nearly all EU countries. The feasibility study also outlined a structure for a European Health Examination Survey (EHES), which is a collaboration to organize standardized HESs in countries across Europe.To facilitate setting up national surveys and to gain experience in applying the EHES methods in different cultures, EHES Joint Action (2010–2011) planned and piloted standardized HESs in the working age population in 12 countries. This included countries with earlier national HESs and countries which were planning their first national HES. The core measurements included in all surveys were weight, height, waist circumference and blood pressure, and blood samples were taken to measure lipid profiles and glucose or glycated haemoglobin (HbA1c). These are modifiable determinants of major chronic diseases not identified in health interview surveys. There was a questionnaire to complement the data on the examination measurements.MethodsEvaluation of the pilot surveys was based on review of national manuals and evaluation reports of survey organizers; observations and discussions of survey procedures during site visits and training seminars; and other communication with the survey organizers.ResultsDespite unavoidable differences in the ways HESs are organized in the various countries, high quality and comparability of the data seems achievable. The biggest challenge in each country was obtaining high participation rate. Most of the pilot countries are now ready to start their full-size national HES, and six of them have already started.ConclusionsThe EHES Pilot Project has set up the structure for obtaining comparable high quality health indicators on health and important modifiable risk factors of major non-communicable diseases from the European countries. The European Union is now in a key position to make this structure sustainable. The EHES core survey can be expanded to cover other measurements.

The magnitude and distribution of infectious intestinal disease in Malta: a population-based study

Routine sources of information on infectious intestinal disease (IID) capture a fraction of the actual disease burden. Population studies are required to measure the burden of illness. A retrospective age-stratified cross-sectional telephone study was carried out in Malta in order to estimate the magnitude and distribution of IID at population level. A random sample of 3504 persons was interviewed by a structured questionnaire between April 2004 and December 2005. The response rate was 99.7%. From the study, the observed standardized monthly prevalence was 3.18% (95% CI 0.7-5.74) with 0.421 (95% CI 0.092-0.771) episodes of IID per person per year. The monthly prevalence was higher in the <5 years age group and in females aged 31-44 years. The mean duration of illness was 6.8 days and a median duration of 3 days. A bimodal seasonal distribution was observed with peaks in June-July and October-November.

Risk communication: climate change as a human-health threat, a survey of public perceptions in Malta.

BACKGROUND Scientific evidence shows that climate change is very likely the product of human behaviour and lifestyle. The effects of climate change on human health are diverse in nature and range from direct effects due to extreme weather events such as heat waves, floods and storms, to indirect effects such as those caused by water and food shortages. METHODS A telephone survey was conducted between January and February 2009, on a stratified representative random sample of the Maltese population over the age of 18 years (N = 310,819). RESULTS Five hundred and forty-three individuals successfully participated in the survey giving a response rate of 92.7%. The respondent sample was very similar to the target population by gender (P = 0.977), age (P = 0.767) and district (P = 0.812). The results of the study demonstrate a very strong relationship between the perception of climate change as a threat to health and well-being, support for climate change mitigation policy and a willingness to implement measures to address climate change. CONCLUSION The findings of this study show that the perception that climate change may claim lives, cause disease, reduce the standard of living and worsen water shortages, may be the strongest driver behind support for climate change mitigation policy and a willingness to act. It is recommended that, in order to gain more public support, climate change campaigns and risk communication strategies should frame climate change as a threat to human health and general well-being.

Long‐term survival after acute myocardial infarction and relation to type 2 diabetes and other risk factors

Diabetes mellitus (DM) is well established as a short‐term prognostic indicator after myocardial infarction (MI), but little long‐term data are available.

Estimating the burden and cost of infectious intestinal disease in the Maltese community.

The aim of this study was to estimate the burden of infectious intestinal disease (IID) and cost of illness at the community level from a societal aspect. A retrospective, age-stratified cross-sectional telephone study was carried out in Malta in 2004-2005. The number of cases, resources used and cost of resources were computed. The resources involved direct costs (health-care services, stool culture tests, medicines and personal costs) and indirect costs (costs from lost employment by cases and caregivers). This study estimated 0.421 (95% CI 0.092-0.771) separate episodes of IID per person per year in Malta which corresponds to 164 471 (95% CI 35 941-301 205) episodes of IID per year or 450 (95% CI 98-825) episodes of IID each day. The largest proportion of cost is due to provision of health-care services with euro10 454 901 [Maltese liri (Lm) 4 558 970] per year; followed by euro963 295 (Lm 2 209 393) in lost productivity; euro1 286 286 (Lm 561 078) in medicines; euro152 335 (Lm 66 452) in stool culture testing and euro71 487 (Lm 31 183) in personal costs, giving a total cost of illness of over euro16 million (7 million Lm) per year. The burden and cost of IID are high enough to justify efforts to control the illness. Such estimates are important to assess the cost-effectiveness of proposed specific interventions.

The Malta Childhood National Body Mass Index Study: A Population Study

Objectives: Obesity is a chronic disease that often commences in childhood. More than a quarter of Maltese children are overweight or obese. The present study was carried out to measure height and weight (and body mass index) for all school children in Malta to precisely quantify the extent of the problem. Methods: Schooling in Malta is provided by: free state schools, subsidized Roman Catholic church–run schools, and independent private schools. All were included. Physical education teachers were trained in measurements on identical stadiometers. Bespoke spreadsheets were created using World Health Organization cut-offs for underweight, overweight, and obesity. Results: The present study included more than 46,027 children in more than 145 schools (ages 4.7–17 years). Less than 10% were unmeasured. Approximately 40% of school-aged children in Malta are overweight or obese. The proportion of obese was greater than that of overweight. Levels of overweight and obesity were significantly different: State>Church>Independent schools. Overall, and for both sexes and for school types, there was a trend for overweight and obesity to peak in years 5 to 8, then decline slightly. Overweight and obesity was secondary>primary schools, and boys>girls. The underweight group was small with no significant difference between the school types. Conclusions: The present study has confirmed high levels of overweight and obesity in Maltese children. It also provides proof of concept of scalability by demonstrating the feasibility of undertaking a relatively inexpensive study of an entire childhood population. The modus operandi (utilizing physical education teachers) could relatively easily be up scaled for any country.

Prevalence of obesity in Malta

Obesity is a global epidemic with the Mediterranean island of Malta being no exception. The World Health Organization (WHO) has identified Malta as one of the European countries with the highest obesity prevalence.

Diabetes, pre-diabetes and their risk factors in Malta : a study profile of national cross-sectional prevalence study

Background Type 2 diabetes mellitus constitutes a global epidemic and a major burden on health care systems across the world. Prevention of this disease is essential, and the development of effective prevention strategies requires validated information on the disease burden and the risk factors. Embarking on a nationally representative cross-sectional study is challenging and costly. Few countries undertake this process regularly, if at all. Method This paper sets out the evidence-based protocol of a recent cross-sectional study that was conducted in Malta. Data collection took place from November 2014 to January 2016. Results This study presents up-to-date national data on diabetes and its risk factors (such as obesity, smoking, physical activity and alcohol intake) that will soon be publicly available. Conclusion This protocol was compiled so that the study can be replicated in other countries. The protocol contains step-by-step descriptions of the study design, including details on the population sampling, the permissions required and the validated measurement tools used.

Invasive meningococcal disease in Malta: an epidemiological overview, 1994-2007

Since 1996, Malta has experienced an upsurge of invasive meningococcal disease (IMD) following an almost 30 year period with a negligible number of annually reported cases. We reviewed the 233 IMD cases notified during a 14 year period (1994-2007), and analysed epidemiological and laboratory surveillance data. The crude incidence per 100,000 inhabitants peaked in 2000 at 8.1 [95 % confidence interval (CI) 5.7-11.6] and again in 2006 at 8.9 (95 % CI 6.4-12.4), thereby placing Malta amongst the countries with the highest incidence of the disease in Europe. Of the total cases, 137 (59 %) were confirmed and 30 (13 %) were classified as probable. However, 66 cases (28 %) had no laboratory evidence of the disease and were classified as possible. Information on the serogroup was available for 114 cases. Serogroup B formed the largest proportion (76 %, n=87) followed by serogroup C (16 %, n=18). B : 4 : P1.19,15 strains (n=46) predominated throughout the study period since their first identification in 1998. With 28 deaths attributed to IMD, the overall case fatality rate was 12 %. Apart from stressing the importance of maintaining high vigilance for IMD, our findings underscore the importance of enhancing laboratory surveillance of the disease, including characterization of the meningococci. Until vaccines against a broad range of serogroup B meningococci become available for universal use, the main methods of control remain the early treatment of cases and the prevention of secondary cases.

Psychometric properties of the Belief about Medicines Questionnaire (BMQ) in the Maltese language

Background: Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind development of such beliefs. Objective: This study aimed to produce a culturally and contextually appropriate version of the Beliefs about Medicines Questionnaire (BMQ) in the Maltese language and to assess its psychometric properties. Methods: Medication beliefs were evaluated using the BMQ which is divided into two sections: BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). Following translation/back translation, the Maltese version of the BMQ was applied to patients having asthma, diabetes, cardiovascular disease or depression who attended out-patients’ clinics at the main state general hospital in Malta between June and September 2013. Cronbach’s alpha coefficient, alpha, was used to determine internal consistency of the BMQ and Principal Component Analysis using Varimax rotation with Kaiser normalisation was carried out to analyse component loading of the items on the respective sub-scales. Results: The Maltese version of the BMQ showed acceptable internal consistency for the harm scale (alpha=0.56), the necessity scale (alpha=0.73) and the concerns scale (alpha=0.66), however the overuse scale gave poor internal consistency (alpha=0.48) due to the item on natural remedies which posed some difficulty in the Maltese sample. The final solution for Principal Component Analysis yielded a four-factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous studies out in different languages. Conclusion: The Maltese version of the BMQ was found to have acceptable psychometric properties for the beliefs about medicines in the Maltese population.