OAR@UM Collection:

Self-efficacy, self-care and outcomes in persons with diabetes.

Thu, 01 Jan 2015 00:00:00 GMT

Title: Self-efficacy, self-care and outcomes in persons with diabetes. Abstract: PURPOSE This dissertation aims to explore the relationship between self-reported self-efficacy, self-care and outcomes in adults with type 2 Diabetes Mellitus in Malta. RESEARCH DESIGN AND METHODS Using a cross-sectional research design, a questionnaire was distributed to 396 persons attending the diabetes clinics of a local public hospital and three health centres. Apart from collecting demographic information and details about disease characteristics, the levels of self-efficacy and diabetes self-care were measured using the Diabetes Empowerment Scale - Short Form (DES-SF) and the Summary of Diabetes Self-Care Activities scale (SDSCA) respectively. Outcomes were assessed by ascertaining the presence or absence of complications, and HbAlc values were used as a marker for glycaemic control. Variables which were found to be significantly associated with self-efficacy, self-care and outcomes in univariate analyses were used as predictors in multivariate regression models which identified the most significant predictors of self-care and outcomes, together with their odds ratios. RESULTS A response rate of 89.4% (N = 354) was achieved. Persons with higher levels of self-efficacy were found to have higher scores in the dietary and foot care areas of self-care. Furthermore, they were less likely to have uncontrolled diabetes and complications. Levels of self-efficacy were high in the study sample, confirming the results of other studies carried out locally. Self-efficacy was also found to vary independently of the demographic and disease characteristic variables collected, suggesting an absence of sub-groups of persons who are at-risk of having low self-efficacy. The study also gave insight on the levels of self-care amongst different population sub-groups. Respondents scored best in the dietary areas of self-care, and worst in 'Exercise' and 'Blood sugar testing'. Persons on insulin were found to have higher and lower scores in the 'Blood sugar testing' and 'Exercise' areas of self-care respectively when compared to persons who are not dependent on insulin. They were also more likely to report the presence of one or more complications. CONCLUSIONS This dissertation confirms that the concept of self-efficacy is also applicable locally since it is similarly associated with self-care and outcomes as reported in studies carried out abroad. The only exception is 'Exercise' self-care which was found to be very low, even in persons with high self-efficacy, suggesting the presence of additional barriers which were not studied in this dissertation. Further research to identify these barriers would assist policymakers and practitioners to devise measures to mitigate the effects of these barriers. The study identifies particular groups of persons who have low levels of self-care and this information could be used by practitioners to more easily identify these persons and offer additional advice to them during consultation. Public health policies which are aimed at improving outcomes of persons with diabetes would do well to consider the effect that self-efficacy-enhancing lifestyle interventions might have on improving outcomes. More research should be conducted in this field to assess whether these could provide a cost-effective alternative to expensive medications. The use of a screening tool might be advisable to identify those persons with low levels of self-efficacy who would stand to benefit most from these interventions since this study found no particular at-risk groups that could be targeted. 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"; M.SC.PUBLIC HEALTH

Trans fats : attitudes towards reformulation

Thu, 01 Jan 2015 00:00:00 GMT

Title: Trans fats : attitudes towards reformulation Abstract: Background: The consumption of food high in trans fats has been associated with a number of conditions including cardiovascular disease (Mozaffarian D, 2006), gallstones (Tsai C J & Willett W C et aI., 2005), diabetes (Odegaard & Pereira, 2006), infertility (Chavarro J E & Rosner B A et al., 2007), endometriosis (Missmer S A & Malspeis S et al., 2010), Alzheimer's disease (Morris M C, 2004) as well as some cancers (Teegala S M & Willett W C et al., 2009). Scientific evidence in recent years has proved that the consumption of industrially produced trans fats, even at low levels, raises levels of LDL cholesterol whilst decreasing the levels of HDL cholesterol. Thus, causing an increased risk of cardiovascular problems (Mozaffarian D & Jacobson M F et aI., 2010). In response to the high intakes of trans fats the EU Platform on Diet, Physical Activity and Health has proposed a regulation to set limits on the amount of trans fats permissible in food products. Global recommendations are to replace the trans fats in foods with other fats, preferably polyunsaturated fatty acids (PUFAs) in order to optimise the health benefits. The problem is that, little is known if any, regarding the impact of implementing such bans in Malta. The aim of this study is to examine the knowledge, attitudes and practices of industry and general public to trans fat reformulation of food products by using healthier fats in Maltese produce. Method: Main methodology used in this study consists of qualitative research mainly interviews and focus groups. Four different focus groups, representing the consumers were interviewed. These were mainly university students, youths in the workplace, mothers and the elderly. Manufacturers and importers were chosen from a list obtained from the Commerce Licensing Department and the GRTU. Six interviews were done with manufacturers and another six interviews were done with importers. Informed consent was obtained from all of the participants. All information was recorded and transcribed. Data was open-coded, organised and presented according to key themes. Results: There is a general lack of overall knowledge and awareness on trans fats among consumers. Most of the consumers are willing to change their eating habits to be healthier but admitted to requiring more information and skills to do so. Most of the importers and manufacturers said they are against a total ban on trans fats and believe more in educating the public, making them more aware of the health implications associated with trans fats. Nutrition labelling can help in preventing excessive consumption of trans fats but at the end the consumer is free to choose what they want to consume. Manufacturers and importers believe that the way towards trans fat reformulation is through creating a consumer demand through consumer education and local campaigns. Both manufacturers and importers emphasise that the local companies have to adapt with time to reach the required challenges that are continuously taking place in the food industry. Interviewees indicated that some companies especially the smaller ones might not be able to adapt or have sufficient capacity to reformulate their products to reduce trans fats. Conclusion: Trans fats reformulation in Malta needs expertise to be feasible. A collision exists between a total ban of trans fats and freedom of choice through consumer education and local campaigns. If we have to move forward with reformulation there needs to be a total collaboration between the food industry in Malta and the government through a stepwise approach. Consumer education needs to be enhanced through campaigns specifically targeted on trans fats, thus creating a consumer demand. Ultimately through better communication, concrete objectives can be set and there should be continuous monitoring. Description: M.SC.PUBLIC HEALTH

Risk factors for age-related macular degeneration in a Maltese hospital population

Thu, 01 Jan 2015 00:00:00 GMT

Title: Risk factors for age-related macular degeneration in a Maltese hospital population Abstract: Background: Age-related macular degeneration (AMD) remains the prevailing cause of blindness among elderly persons living in industrialized countries. As a consequence of population ageing and with the ongoing treatment of cataracts, it is estimated that AMD will become ever more important as an eye condition which determines quality of life in the later stages of existence. It remains an irreversible disease, without an effective cure despite the large number of epidemiological studies conducted. Aim: This study aims to examine those risk factors in an elderly (55+) Maltese hospital population that have a strong to moderate association with AMD, namely history of cigarette smoking, previous cataract surgery, history of cardiovascular disease and hypertension. Method: A hospital-based population was used to recruit cases and controls in a 1:1 ratio. 41 patients diagnosed with AMD were compared with 41 controls. A structured interview was used to collect the data that was analysed using SPSS version 22. A 3-step process was used to identify the risk factors associated with AMD. In step 1 each risk factor was included separately in a univariate analysis. In the second step the associations (odds ratios) were adjusted for age and gender. Those risk factors with a p-value less than the 0.05 level of significance in step 2 were retained and entered into an automated 'stepwise' entry method using binary logistic regression (step 3). Results: This study showed a statistically significant association between AMD and age (odds ratio (OR) for those 55 to 65 years vs. those over 75 years 0.11, 95% confidence interval (CI) 0.03 - 0-43, p-value (P) <0.00), gender (OR for males vs. females 3.03,95% CI 1.12 - 8.19, P = 0.03), diabetes (OR for yes vs. no 5.14,95% CI 1.65 - 15.98, P <0.00), and iris colour (OR for light vs. dark 4.55, 95% CI 1.49 - 13.85, P<0.00). We have been unable to demonstrate any association between AMD and smoking, previous cataract surgery, cardiovascular disease and hypertension. Conclusion: This study has demonstrated a strong association between AMD and age, gender, diabetes and iris colour. Interpretation of the results found in this case-control study conducted on a Maltese hospital population should be considered within the context of the study's small sample size and other limitations. Most risk factors should be confirmed by larger prospective studies. More robust evidence, which currently lacks for most risk factors, except age and smoking, will then warrant, were ethically possible, the conduction of study designs higher up in the hierarchy of research evidence, i.e. randomized controlled trials. Description: The research work disclosed in this publication is funded by the Strategic Educational Pathways Scholarship (Malta). The schola rship 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"; 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.