Ignite’s ‘Ugo Sultan’

Taking a look back at the events that occurred on our islands more than a hundred years ago, ‘Ugo Sultan’ will transport you to a 1920s Malta full of notable people that shaped the history of our country. However, it wouldn’t be an Ignite production if it didn’t have its own unique twist. Though based on real events and people, ‘Ugo Sultan’ is a satirical, fictional comedy that is sure to bring a smile on our audience’s faces.

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Moving to Malta

Moving to Malta
Our childhood years are meant to help us develop our sense of identity, belonging, culture, and home. But what happens to those for whom childhood is dominated by moving to a new country with a new language, culture, and social norms? Prof. Carmel Cefai speaks to Becky Catrin Jones.

Prof. Carmel Cefai

It’s a small world these days. Developments in technology and transport mean it’s much easier to pack your bags and head off for a fresh start in a foreign land. For many, the destination is Malta. As a beautiful island in the Mediterranean Sea with a booming economy, it is no surprise that it’s drawing the attention of bright sparks and aspiring families from Europe and beyond. In fact, Malta currently boasts the fastest growing EU population. 

Of course, it’s not always through choice that you might find yourself leaving your homeland behind. Humanitarian crises and ongoing wars in North and sub-Saharan Africa and the Middle East have seen thousands set sail under the most treacherous conditions in search of safety. For this population, Malta is often the first port of call between the dangers of home and the promise of hope in Europe. 

It seems strange to group these populations together, given the stark differences in the journeys that bring them to Malta and the life they seek here. But together, this influx of people has contributed to a sudden rise in interculturalism, where people from different backgrounds interact and influence one another. This is a reality all parties are having to adapt to.

Even in a fairytale scenario, childhood is challenging. Growing up when you’re far from home, look different to everyone around you, and don’t speak their language, makes the challenge reach a whole other level. Children’s wellbeing is an increasingly important and emotive topic to study in Malta, which is a signatory to the United Nations Convention on the Rights of the Child. A team of researchers from the Centre for Resilience and Socio-Emotional Health (University of Malta), set out to explore the situation. They questioned: How do you settle into a new home and identity when you are still trying to figure out who you are and where you are from? 

Finding the voices

Children are often a silent group. When analysing the wellbeing or effect of migration on a population, they are usually spoken for by adults. For this study, however, Prof. Carmel Cefai and his team wanted the child’s voice as well. The scope of the study was ambitious; every single contactable, non-Maltese child living in Malta was invited to take part and share their experiences. But this was a challenge.

‘Identifying and obtaining access to foreign children from age zero to 18 was not easy… Some schools suffered from research fatigue and did not wish to participate; whilst translation of instruments and data and use of interpreters drained the limited budget we had for this project.’ Maltese children were contacted and invited to participate too. After all, they are as affected as anyone else when around one in ten of their schoolmates are not Maltese.

The study focused on four main areas; social interaction and inclusion, education, subjective wellbeing and resilience, and physical health and access to services. They covered the experiences of children up to 18 years of age, from various schools, who were either settled into their own family houses or still in open shetlers following a difficult journey to Malta. They also aimed for a balance in migrants’ nationalities; European, North American, African, Middle Eastern, or East Asian; as the experiences of each population are understandably different. Cefai and his team found that the experiences of migrant children in their everyday life are quite positive. In some areas, even more positive than those of Maltese children, with only 8% reporting difficulties in their psychological wellbeing compared to 10% in the native population. Overall, they found that migrant children feel safe, listened to, and cared for by the adults in their communities. Despite the language barriers, most feel like they have a support network, and enough friends though more often than not those friends are other foreign children, not Maltese.They are able to keep up at school, and generally do as well as their Maltese peers, with teachers reporting high levels of engagement.

Adapting to a new world

All is not rosy. Bullying in schools is quite common, though less frequent than that reported by native Maltese children. One in five migrant children also do not feel they have enough friends.

Younger children seem to be more included and engaged than secondary school ones, and in general females fared better in the study than male classmates. That said, age and gender weren’t the main influencers when it came to predicting how well the children engaged at school and in their communities. ‘The study suggests that there are different layers of reality, with the big picture hiding the socio-economic, psychological, and social difficulties encountered by a substantial minority,’ remarks Cefai.

Unsurprisingly, those who speak Maltese feel more engaged than those who don’t, and those who aren’t confident in English are in an even worse position. However, the factor producing the biggest differences between the overall wellbeing, health, and education of the children is their country of origin. ‘The health, wellbeing, and relative comfort enjoyed by many children of European economic migrants contrast sharply with the poverty, poor accommodation, psychological difficulties, learning difficulties, and experiences of discrimination of many children from Africa and the Middle East’, says Cefai. Western Europeans and American children scored highly over all criteria, whereas African and Middle Eastern children are far more likely to be lonely or suffering from social or economic difficulties.

They are more likely to be less proficient in English, which leads to difficulties in making friends with children from other cultures and which also contributes to problems in their education. Although they are generally nourished by their spiritual and religious communities, in all other areas these children report social and emotional difficulties and are also more likely to report facing prejudice and discrimination. Healthcare proved problematic; many parents and children worry that they are subjected to discrimination whilst using services, or do not have enough information to use them in the first place.

A land of opportunity

Despite the additional challenges that these particular migrant children face, the overriding feeling is one of acceptance and hope. Even children in open centres view Malta as a land of opportunity, even when some are in suboptimal housing and lack basic necessities. What children in open centres do not perceive is Malta as their home. Better living conditions in the community, more cultural  sensitivity, and openness to interculturalism may help to reduce the feeling of ‘us’ and ‘them’.

So what do Maltese children think? Again, the overall conclusions show that children are open, tolerant, and welcoming of this dramatic and quick rise in multiculturalism that has happened. However, on closer inspection, it seems that there is still a way to go before we can truly call ourselves an open and accepting society.

Relatively few Maltese children have many foreign friends, preferring to spend time with native peers. This hesitation is stronger in children who aren’t from a mixed community, whereas children in independent schools and more exposed to foreign children seem more at ease with the idea that the future might be even more multinational and intercultural. As many as one in three Maltese children also report feeling unsafe in culturally diverse communities, and worry about potential negative consequences of these changes in the future. There also appears to be particular prejudice against children from Africa and the Middle East in contrast to children from Europe, the US, Canada, and Australia.

What has become clear is that both foreign and native children could do with some reassurance. So what do Cefai and his team suggest we can work on to help everyone embrace this new culturally diverse reality?

A united future

‘[We need] to address the needs of marginalised and vulnerable children, particularly those coming from Africa and the Middle East’, says Cefai. There’s also a lot both populations could learn from each other; caring for their environment, sharing cultures, or even adopting healthier lifestyles. By encouraging more open and judgement-free spaces to play, learn, and share, we’ll take away the ‘us’ and ‘them’ ideology from a young age and replace it with one of acceptance, curiosity, and openness to new ideas. This will help prevent the dangerous spiral of segregation and ghettoisation, seen all over Europe.

Cefai suggests a space for more positive role models for those migrant children thrown into a foreign culture that doesn’t seem to have space for them. Having teachers, healthcare workers, or even political representatives who have similar backgrounds will foster this inclusive nature, showing that everyone has a voice when it comes to working together to make this country a home for all.

There’s work to be done with Maltese children. ‘Whilst it is encouraging that the majority hold positive attitudes towards interculturalism, it is worrying that as they grow older children’s attitudes tend to become less positive,’ says Cefai. ‘It’s our responsibility to ensure that educators, community leaders, and parents of Maltese children are part of a national initiative to embrace interculturalism.’

Although overall a positive study, Cefai and team have shown we still have a way to go until every child in Malta feels safe, happy, and at home. And in this ever-changing and diverse environment, Malta has real potential to be an example to its neighbours on how a successful multicultural society can work on every level. These children are our future. 

I <3 potato

Vegetables
Plant-based diets are going mainstream all over the world. Cassi Camilleri sheds light on the local vegan movement and how reducing our meat consumption can benefit us all.

Some label the rise of plant-based living as evidence of ‘trend culture’. And they’re not all wrong. Traditional media bombards us with countless headlines on the topic’s pros and cons. Hard-hitting advocacy films like Cowspiracy and Forks over Knives expose the horrors of the meat industry. Social media influencers share their experiences with the diet, turning it into lifestyle content. And now the market is following suit with vegan and veggie lines and options popping up everywhere.

In 2016, an Ipsos MORI survey for the Vegan Society identified that 3.25% of adults in the UK never eat meat in any form as part of their diet, equating to roughly 540,000 people. Vegan January—commonly known as Veganuary—is growing in popularity. This year, a record-breaking 250,310 people from 190 countries registered for the month-long vegan pledge. And Malta is no exception.  

While the official number of people following a plant-based or vegan diet are unavailable, interest is clear. Facebook pages Vegan Malta and Vegan Malta Eats have a combined following of over 16,500 people. 

The reasons behind people’s decision to take up veganism are various, however three main motivators keep being cited: health benefits, ethics, and environmental concerns. For vegan business woman Rebecca Camilleri the process was natural and gradual. ‘There was no real intention behind it for me. But after a couple of months of following this diet, I noticed that my energy levels were better than before, and this encouraged me to learn more on how I needed to eat in order to nourish my body with the right nutrients to sustain my active lifestyle.’  

Researcher and nutritionist Prof. Suzanne Piscopo (Department of Health, Physical Education, and Consumer Studies, University of Malta) confirms that ‘moving towards a primarily plant-based diet is recommended by organisations such as the World Health Organization and the World Cancer Research Fund, for health and climate change reasons.’

Oxford academic Dr Marco Springmann has attempted to model what a vegan planet would look like, and the results are staggering. According to his calculations, should the world’s population switch to a vegan diet by the year 2050, the global economy would save $1.1 trillion in healthcare costs. We would also save $0.5 trillion in environmental costs, all while slashing greenhouse gas emissions by two-thirds. 

Despite all this, veganism has earned itself quite a few enemies along the way. The vitriol thrown back and forth across both camps is shocking. Relatively recently, UK supermarket chain Waitrose came under scrutiny after magazine editor William Sitwell responded to plant-based food article ideas from writer Selene Nelson with a dark counter offer—a series on ‘killing vegans’. Sitwell was since forced to resign. Nelson posited that the hostility stems from ‘a refusal to recognise the suffering of animals. Mocking vegans is easier than listening to them.’

Abigail Higgins from American news and opinion website Vox agrees that guilt plays a role in the hatred aimed towards veganism, but also proposes that the whole movement ‘represents a threat to the status quo, and cultural changes make people anxious.’ This notion is based on research on intergroup threats and attitudes by US researchers Walter G. Stephan and Cookie White Stephan. 

It however remains a reality that some of the loudest voices in veganism in the past have been militant. Some have invoked hatred and threats towards those that they perceive not to be sufficiently aggressive in promoting the cause. Piscopo calls for a respectful discussion.

‘Food is not only about sustenance and pleasure, but has symbolic, emotional, and identity value. Take meat for example. Some associate it with masculinity and virility. Others link it to food security as meat was a food which was scarce during their childhood. Some others equate it with conviviality as meat dishes are often consumed during happy family occasions. What is important is that we do not try to impose our beliefs, thoughts, and lifestyle on anyone.’

The way forward is a ‘live and let live’ approach, according to Rebecca Galea. When her journey started she had people ‘staring strangely at [her] food’. Even her family didn’t take her seriously. ‘They were very sceptical as their knowledge on veganism was very limited at the time,’ she remembers. Now, seeing the effect the switch has made to Rebecca’s life, her positive choices are naturally impacting theirs. ‘Everyone is free to make their choice,’ she says. Embodying the philosophy of leading by example, Rebecca has even set up her own business making delicious vegan nut butters, spreads, and more, to great success. ‘The more vegan options are available [in Malta], the more people will be attracted to learning and accepting the benefits of veganism. This might also lead to them following a vegan lifestyle!’

With that, and sharing valid, up-to-date research-based information, as Piscopo suggests, it seems there is no stopping this ‘trend’. And who would want to when veganism can lead to a lower carbon footprint and better health for everyone? 

I am online

Online
We’re always warned about what personal details we share on social media. But what does the language people use on platforms like Facebook and Twitter tell us about their wellbeing? Words by Dr Olga Bogolyubova.

Dr Olga Bogolyubova

Today being an Internet user means being a social media user. The two have become synonymous. 

According to the Global Web Index report, there are now over three billion people worldwide using at least one social networking site. The average Internet user has eight social media accounts and is active on at least three platforms. In our contemporary world, most of us spend a significant chunk of our lives online.  

This is a modern reality: we access information online, purchase goods and services online, search for jobs online, follow professional interests online, schedule events online, invest in relationships online (some of them purely virtual), and then spend the remaining idle time browsing through our news feeds.

Humans are social creatures, and like other big apes we care about hierarchies and group status. This is reflected in our behaviour on social media, where we actively engage in impression management. We select aspects of our lives to present online in the hopes that they will bring us more benefits, while editing out other parts that could cause negative consequences.

We want to look happy, popular, rich, and successful, or if that doesn’t work, at least try to come across as dramatic or alluring. But in a world where the line between reality and the digital world continues to blur, can we really separate our real-life characteristics from our online persona? Can we effectively hide aspects of our offline identity when online? Are we as good at concealing our true selves as we think we are?

Going deep

A few years back, Dr Michal Kosinski and his team set out to find answers to the above questions. They sought to determine if it would be possible to predict individual characteristics (such as age, gender, sexual orientation, and so on) and personality traits from Facebook Likes. 

Over 58,000 people volunteered to take part in the study and provided their Facebook Likes, demographic data, and answers to a set of psychometric measures.

Ethnic origin and gender were predicted from Likes with the highest level of accuracy (95% and 93%, respectively). Prediction of religion, political preferences, and sexual orientation was also good, with 75% to 85% accuracy. However, predicting personality traits turned out to be somewhat more difficult. 

In psychology, personality traits are described as characteristic patterns of thoughts, feelings, and behaviours and, by definition, these are latent variables, meaning that they are not directly observable but derived from answers to a set of questions. Even so, Kosinski’s research team did manage to demonstrate significant connections between the study participants’ personality traits and their Facebook Likes, with the trait of Openness showing the best predictive potential. 

The study has attracted a lot of attention. Other researchers have since been attempting to predict individual characteristics from various features of social media profiles. At first glance, some of the findings may look strange or even absurd. For instance, in one of the studies aimed at predicting personality traits from profile pictures, it was found that extroverted people are less likely to have profile pictures with nostrils showing. Sounds ridiculous… but it actually makes sense if you think about it. By definition, extroverted individuals are more likely to be mindful of other people’s perceptions of them, more likely to see themselves from another’s point of view. As a result, they’ll post better selfies and profile pictures when compared to introverts, who are more likely to upload casual snapshots as profile pictures.

This observation shows that we are unable to control the little details of our behavior. There as so many minute variables involved that it is impossible for us to keep track of them all. A lot of non-vital and therefore ‘unnecessary’ information slips through, yet it reveals a lot about us. This is also found in language. While we usually have no trouble controlling what we say, it is much harder to control how we speak. The topics of our conversations with friends and strangers are firmly under our control, but our use of pronouns and articles in everyday conversations is not. The style of our language is invisible to us.

Honing in on the invisible

James Pennebaker, Professor of Psychology at the University of Texas, USA, was among the first behavioural scientists to propose computational approaches for the study of these invisible, functional components of language.

Pennebaker’s research demonstrated that it is these ‘stealth’ elements that connect deeply with our psychological makeup and state of mind. His ideas provided a starting point for a lot of current social media-based research. After all, our online presence is still largely text-based and rooted in language, and it is only natural that a lot of social media research is based on linguistic analysis.

Many studies are exploring predictors of how online language is being used. For instance, in a recent Facebook-based study, conducted in collaboration with my colleagues from St. Petersburg State University, Russia, we explored connections between subjective wellbeing (i.e. level of satisfaction with one’s life and positive emotionality) and language used in wall posts.

We were able to show that individuals with lower levels of subjective wellbeing are more likely to use ‘should statements’ in their language. In psychotherapy there is a long-standing tradition to regard ‘should statements’ as a type of irrational thinking associated with distress and mental health problems. It is interesting that we were able to demonstrate the relevance of these classic, pre-Internet theories to the contemporary world.

Identifying markers of mental health problems in online language is another important strand of research. Anxiety and mood disorders are the most common mental health conditions, responsible for a significant burden worldwide. They are also treatable, so early identification is vitally important, and social media may provide a platform for screening, psychoeducation, and connection to treatment (including affordable digital interventions). Research can change these citizens’ lives.

Social media-based research on mental health disorders has consistently found an increased use of first person pronouns (I, me) by people with depression. The finding reflects the painful self-centeredness of the mind in mental illness. Some other findings include observations on language use in post traumatic stress disorder, seasonal affective disorder, and obsessive compulsive disorder, as well as on identification of suicide risk.

Social media can be risky, but is it the monster we are seeing splattered all over mainstream media? Research can help build systems that bring mental health interventions to low resource regions, and it can aid in identification of suicide risk and risk of violence. Ultimately, it can promote healthy living and save lives. 

Public health priority: Type 2 diabetes mellitus

Blood testing
What is Malta doing to address this very prevalent problem? Dr Sarah Cuschieri writes about a project called SAĦĦTEK.

Dr Sarah Cuschieri

In Malta, diabetes has been a health concern since 1886. In 1981, the World Health Organization performed the first national diabetes study in Malta and reported that the total prevalence of type 2 diabetes mellitus (T2DM) is 7.7% (5.9% previously known diabetics and 1.8% newly diagnosed diabetics).  

Since then, we have seen that percentage increase through self-reported questionnaire studies such as 2008’s Maltese European Health Interview Survey, which reported a T2DM prevalence of 8.3% in the population aged between 20 and 79. In 2010, it rose again to 10.1%, according to the Maltese European Health Examination Survey. And while this information is definitely useful, it cannot help researchers and doctors investigate what elements contribute to the diabetes epidemic in Malta.  

The economic boom over the last four decades has permanently changed the Maltese Islands. With it came a change in lifestyle habits, like car use and diet, and an influx of different cultural and ethnic populations settling on the islands, which meant that it was time to update our understanding of T2DM in Malta; its prevalence, determinants, and risk factors. 

I undertook the project “SAĦĦTEK – The University of Malta Health and Wellbeing study” to find out more about T2DM in Malta. SAĦĦTEK was a cross-sectional study that will effectively act like a snapshot in time.

The study population included a randomised sample of adults that had been living in Malta for at least six months and held a permanent Maltese identification card, irrelevant of their country of origin.

How is your health? 

Top row: Ayrton Borg Axisa, Bernard Schembri, Ryan Camilleri Middle row: Bader A. Ali, Russell Bonnici, Andrew Chilton Bottom row: Angeline Sapiano, Sarah Cuschieri, Fatemah Abdullah

The survey took place between November 2014 and November 2015, and involved 4,000 people (18 to 70 years of age) who were statistically chosen from the national registry. We set up examination hubs in each town where the participants came in to complete socio-demographic questionnaires. While participants were there, we also took several measurements, including blood pressure, weight, height, and waist circumference. Finally, we took blood samples to check for their glucose levels during fasting periods, genetic analysis, and lipid profile (cholesterol and fats in the blood). 

In the end, 47.15% of the invited adults actually attended the health survey. From these, we found that the prevalence of type 2 diabetes was 10.39%, with males being more affected than females. From the total T2DM group, 6.31% were known diabetics, while the remaining 4.08% were newly diagnosed with T2DM during the study. The numbers mean that over the past couple of decades there has been a rise in the diabetes rate in adults. Higher levels of T2DM mean that related diseases, such as obesity and heart problems, will also be more common. 

In fact, study participants were often overweight (35.66%) or obese (34.11%). The weight increase is very relevant because it puts pressure on the body’s organs, including the pancreas, which has a direct link to T2DM development.

An increase in weight increases waist size, and this too comes with its own set of problems called the metabolic syndrome—increased blood pressure being one of many. A third of survey participants reported a high blood pressure (30.12%), again with a male majority.

Tobacco smoking was also prevalent at 24.3% (male majority). Smoking is linked to T2DM development, increased blood pressure, and stroke.

What are the implications?

The survey results are a major public health concern. An unhealthier population means higher demands on Malta’s healthcare services.

In 2016 diabetes cost Malta an estimated €29 million, while obesity cost an estimated €24 million. The increased disease rate identified means that Malta’s bills are set to rise.

Men seem to have a worse health profile than women. Older males with a high body mass index (BMI) were more likely to suffer from high blood pressure. The majority had normal levels of glucose but abnormal lipid profiles, so even though the sugar levels were normal, they were still at risk when it came to acquiring diseases such as heart problems. Those diagnosed with a metabolic syndrome were five-fold more likely to also have T2DM. There is no denying—the gender gap is a concern.

The survey shows that more public health research is in dire demand. Malta’s underlying problem appears to be the increasing overweight-obesity problem. A number of initiatives have already been put in place by the Health Promotion and Disease Prevention Directorate as well as the establishment of “Dar Kenn Għal Saħħtek”, but there is more to be done.

Gender sensitive action is needed. Government, private entities, communities, and NGOs all need to work together to change the harmful lifestyle choices that have become the norm today. Sedentary lifestyles need to change and high intakes of fat, sugar, and salt need to decrease to alleviate Malta’s weight and diabetes problem. A diabetes screening programme also needs to be introduced to help citizens help themselves. 

Early diagnosis of this disease will benefit all of Malta’s health and wellbeing and safeguard its health services. What more could we hope for? 

Read more:

Cuschieri, S., Vassallo, J., Calleja, N., Pace, N., & Mamo, J. (2016). Diabetes, pre-diabetes and their risk factors in Malta: A study profile of national cross-sectional prevalence study. Global Health, Epidemiology and Genomics, 1. https://doi.org/10.1017/gheg.2016.18

Cuschieri, S., Vassallo, J., Calleja, N., et al. (2016). The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study. Arch Public Health; 74: 52.

Cuschieri, S., Vassallo, J., Calleja, N., et al. (2016). Prevalence of obesity in Malta. Obes Sci Pract 2016; 2: 466–470.