OAR@UM Collection:

Health literacy in the context of Dementia in Malta.

Sun, 01 Jan 2017 00:00:00 GMT

Title: Health literacy in the context of Dementia in Malta. Abstract: As a consequence of global ageing and demographic changes, neurodegenerative disorders amongst older adults are leading to an ever increasing impact on public health (Chapman, D.P. et al. 2006). In 2015, there were 46.8 million people worldwide with dementia (Alzheimer's Disease International, 2015). The same report estimated that there would be a projected increase to 74.7 million cases in 20 years time, and to 131.5 million cases in 50 years' time.. It is therefore important to invest in good public health knowledge in order to increase the level of health literacy on dementia with the aim of increasing the likelihood of having earlier diagnosis rates that will secure better treatment outcomes. Health literacy is defined as the capability of a person to understand and process basic health information in order to be able to make appropriate health decisions (Peerson and Saunders, 2009). Dementia is a syndrome of the brain resulting in a disturbance of memory, thinking process, learning capacity, language and judgment (World Health Organisation, 2012). Dementia is usually subdivided into three main stages; early (symptoms include forgetfulness and difficulty in communicating), middle (increase in forgetfulness, difficulty managing daily tasks and disorientation of time and place), and late (unable to recognise relatives, agitation and unaware of the things around them). Dementia is devastating, not only to the affected individuals, but also to relatives who, in the majority of cases, act as main carers. To care for an individual with dementia requires time, money and support from a myriad of sources including governmental and non-governmental organisations. There is still lack of awareness on dementia in the Maltese Islands. For a significant number of individuals, memory loss is still considered as part of normal ageing and therefore no medical advice is sought in time. Thus, the aims of this study were to investigate the level of knowledge of the Maltese general adult population regarding dementia (focusing mainly on Alzheimer's disease (AD)); and to study the potential for increasing awareness through the organisation of public seminars. In tum the objectives of this study were; to analyse the knowledge among the general adult population by relating to four demographic variables (age, gender, level of education and location) and analysing an improvement in dementia knowledge following the delivery of seminars on the subject. The methods chosen for the study were two. For phase 1, the target population was the adult general population of the Maltese Islands. During this phase the general public's knowledge about dementia, in particular AD was analysed by conducting 400 telephone interviews. Following completion of phase 1, statistical analysis was carried out to evaluate topic areas where the public mostly lacked knowledge, and formulated a questionnaire that was used as the measurement tool during phase 2. The target population for the second phase of the study were individuals who attended a number of day centres in Malta ("Zurrieq", "B'Kara" and "Mosta"). Results from the survey in phase 1 indicated that the majority of the participants (mean age: 75.6 years) mostly feared of getting cancer and AD. The survey revealed that more work needs to be done in order to increase the awareness about the availability of a reliable test to diagnose AD (being the most common form of dementia), and the availability of a medical treatment that will aid the person with AD to slow down the progression of the disease. Initiatives need to be devised in order to increase the public's knowledge about the different symptoms of AD, especially the severe symptoms which include hallucinations and anger. On a positive note, the majority of the participants agreed that they will seek medical advice either for themselves or a family member if they become aware of symptoms related to AD. Since dementia is a public concern, the findings from this study can be a source of information for both policy makers and health care professionals in formulating new policies and agendas in this sector. Such initiatives will surely aid persons with dementia and their carers in enhancing their quality of life whilst reducing stigma that is normally associated with dementia. Description: The research work disclosed in this publication is funded by the Strategic Educational Pathways Scholarship (Malta) . The scholarship is part-financed by the European Union - European Social Fund (ESF) under Operational Programme II - Cohesion Policy 2007-2013, "Empowering People for More Jobs and a Better Quality of Life" Operational; M.SC.PUBLIC HEALTH

Cervical cancer and screening: knowledge, awareness and attitudes of women in Malta

Sun, 01 Jan 2017 00:00:00 GMT

Title: Cervical cancer and screening: knowledge, awareness and attitudes of women in Malta Abstract: Background Cervical cancer is an important global public health problem. It is the fourth most common cancer in females worldwide and seventh most common cancer overall. Every year (three year average, 2013-2015), there are 12 new cases of cervical cancer in Malta, which affect mostly women of working age. Since females are at the prime of their productive life, cervical cancer leads to significant psychological, social and economic strain on the affected individual and their family. The 5 year relative survival rate of CC cases for Malta was 54.73% (2000-2007), which ranks Malta as the second country with the worst 5 year survival rate in Europe. Studies have shown inequalities in the knowledge on cervical cancer and attendance for screening. Women who have lower socioeconomic status and educational level have reduced knowledge and attend less for screening than others, which places them at an increased risk of having invasive cancer of the cervix. The World Health Organisation states that early detection and treatment of cancer can be achieved through education to increase awareness of symptoms and screening programmes. This study comes at an opportune time due to recent introduction of the National Cervical Cancer Screening programme locally and aims to assess the knowledge and attitudes of 25-61 year old females, residing in Malta, on cervical cancer and screening. Methodology A cross-sectional telephone-based quantitative survey was conducted between October 2016 and February 2017. The survey tool was based on the Cervical Cancer Awareness Measure questionnaire. The tool was tested for validity and reliability and piloted. A random stratified sample, representative of the Maltese population was obtained from the Malta Identity Card Register. Data collected during the fieldwork was then analysed using univariate and multivariate logistic regression analysis. Results 407 females between 25-64 years were interviewed giving a response rate of 85.9%. There was moderate knowledge on cervical cancer symptoms and risk factors while there was very poor awareness of the role of the Human Papillomavirus in cervical cancer. Knowledge of cervical cancer risk factors and symptoms was significantly associated with the level of education (p-value: <0.001), with the highly educated group being more knowledgeable. . 69% of the sample attended for screening every 3 years. Those who attended for screening regularly were more likely to be females with children (p-value: 0.001), having had a close family member with cancer (p-value: 0.002), and those who were in the 35-44 and 45-54 year age groups (p-value: 0.000). The main reasons for nonattendance were embarrassment, fear of the test and fear of a bad result. The findings of this study conform in most instances with results found in the international literature. Conclusion This research is the first national representative study that provided an overview of the local knowledge, awareness and attitudes on cervical cancer and screening. There is an inequality gap between different groups of females in terms of knowledge of cervical cancer which can be reduced through health education campaigns. The outcomes also provide important information regarding the attitudes and barriers to cervical screening which can be of use in health service planning particularly in further development of the national cervical cancer screening programme. Description: M.SC.PUBLIC HEALTH

Missed clinical opportunities for HPV vaccination

Thu, 01 Jan 2015 00:00:00 GMT

Title: Missed clinical opportunities for HPV vaccination Abstract: Background: The introduction of vaccines against human papillomavirus (HPV) has essentially rendered cervical cancer a vaccine-preventable disease. Yet the uptake of the HPV vaccines has been much lower than anticipated all over the world, mainly due to missed clinical opportunities. These may be a consequence of gaps in the knowledge, attitudes and practices of healthcare professionals towards the HPV vaccines as doctors are known to play an important and influential role when it comes to patients deciding whether to accept vaccines or not. Identifying the barriers which prevent doctors from recommending these vaccines may help improve their recommendation practices and the uptake of the HPV vaccines. Method: The study consisted of both quantitative and qualitative methodologies. The quantitative aspect was a cross-sectional study performed by means of a postal questionnaire sent to doctors specialised in family medicine, paediatrics and obstetrics and gynaecology in the Maltese Islands. The questionnaire assessed the knowledge, attitudes and practices of these doctors with regards to the HPV vaccines and identified any perceived barriers they reported. The data gathered was analysed statistically to identify significant differences in the above-mentioned factors depending on physicians' age, gender and specialty as well as the patients' age and gender, amongst other things. The qualitative methodology consisted of three focus groups carried out with members of the three specialties referred to during which a set of recommendations was drawn up according to the main themes which emerged and which can help local doctors in their recommendation of the HPV vaccines to patients. Results: Quantitative: Of the 412 doctors to whom the questionnaire was posted 175 eligible participants returned a completed questionnaire (46.7%). The final respondent population was analysed and found to be representative of the original sample of doctors. The level of knowledge was found to be good although a significant difference was observed in level of knowledge according to physician's age (p=<0.001) and specialty (p=<0.001). Younger doctors and obstetricians and gynaecologists were found to have the highest level of knowledge about HPV and its vaccines. While doctors' attitudes towards the vaccines appeared positive these were more positive when it came to recommending the vaccines to females than males. Recommendation of the vaccine, however, was very low. Doctors were found to recommend the vaccine least to young adolescent females (11-12 years old); obstetricians and gynaecologists were most likely to recommend the vaccines to the two younger female age groups and had 9.3- (95% el, 2.8-30•7), 7.2- (95% el, 2.7-18.8) and 5.5- (95% el, 2.2-14) fold greater odds of "always" recommending the vaccines when compared to family doctors. The majority of physicians claimed that they "never" recommend the vaccines to male patients. The main barriers encountered by physicians in recommending the vaccines were related to cost and lack of parent education and understanding about HPV infection. Qualitative: The main barriers faced by physicians to recommending the HPV vaccines were vaccine cost and lack of parent education - effectively reiterating the same findings made in the survey. Recommendations for actions to improve recommendation of the vaccines included improving health literacy and patient education, methods to reduce the burden of the cost of the vaccines, lowering the recommended age group for vaccination and providing more education for the health care providers. Conclusion: While the level of knowledge of participants about HPV and its vaccines is good, and the attitudes towards the vaccines are positive, recommendation practices leave much to be desired. The cost of the vaccines seems to be a major barrier, something which is perhaps reflected in the fact that while uptake of the vaccine in Malta where it is available for free is very good, its uptake in other sectors where it needs to be bought out of pocket is very low. This, and a lack of patient knowledge, seem to impact uptake of the HPV vaccines the most in the Maltese Islands, and are amongst the main issues which need to be addressed in order for the full benefits of the HPV vaccines to be enjoyed by all those eligible to receive them.

Hepatitis B and hepatitis C in correctional facilities

Mon, 01 Jan 2007 00:00:00 GMT

Title: Hepatitis B and hepatitis C in correctional facilities Abstract: The aim of the study was to investigate the prevalence and incidence of Hepatitis B and C among local inmates and to recommend public health interventions to prevent and control transmission of these viruses among other inmates, to the prison staff and community. The incidence, prevalence and turnover rates for 2000 - 2006 were calculated using routine data available at the local Correctional Facility. Incidence of Hepatitis B ranged between 1119/100000/year and 2506/100000/year, and of Hepatitis C ranged between 11494/100000/year and 27985/100000/year. Prevalence of Hepatitis B ranged between 0.8% and 2.9% and of Hepatitis C ranged between 11.4% and 20.6%. The turnover rates ranged between 116% and 153%. Information about knowledge, attitudes and beliefs on Hepatitis B and C was collected among all Correctional Officers in Malta, using a structured self-administered questionnaire. Correctional Officers were found to have limited knowledge on Hepatitis Band C regarding mode of transmission, prevention and control, irrespective of their rank and length of service. They are eager to further their education on this topic (95%), the main reason being due to fear of transmission (91.7%) of such infections to their relatives at home. Correctional Officers show sympathy (84%) with inmates who are infected with Hepatitis B and C. Structured personal interviews were conducted with four prison officers working at the local Correctional Facility. There are no written policies or guidelines regarding Hepatitis Band C infections. Correctional Officers are introduced to the subject during their introductory' course but the need for further education is greatly felt. Correctional Officers and inmates have their blood tests routinely for Hepatitis B and C. Correctional Officers are routinely vaccinated for Hepatitis B, whereas inmates are not routinely vaccinated. No health education courses are organised on the subject. Medical care is a priority, and imnates are medically examined on admission and are then referred for specialist treatment when necessary. Counselling is carried out by the medical officer within the facility. Unfortunately, continuation of medical treatment after release is rather difficult due to lack of communication between the facility and outside community care. Inmates are encouraged to participate in daily jobs and education programmes. Outreach facilities are well established. There is strong opposition towards the introduction of needle and syringe exchange programmes and making free condoms available to inmates. Inmates are informed verbally of all services and activities that are available within the facility. Cristina Chircop Micallef Description: M.SC. PUBLIC HEALTH