Music and the Brain – Can Playlists Help You Study?

If you are one of the 515 million (monthly) active users who listen to music on Spotify, then you know how music can help you get through the day. Today, Spotify has over four billion playlists to choose from whilst studying, so get your study mood on: shuffle, play, and switch the brain button on while you read about why music is an essential part of our lives!

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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. 

Busting out of the box

Magic wand
Aesthetic physician and artistic consultant Dr Joanna Delia traces her journey from medical student to successful business owner, telling Teodor Reljić that her experience at the University of Malta helped her resist excessive industry specialisation.  

Modern life is rigidly compartmentalised. Perhaps this is more true of the West than anywhere else, where the materialist, rationalist models that have aided efficiency and technological advancement also require us to absorb vast amounts of knowledge early on, and specialise later.  

Many educational systems reflect this tendency and the Maltese model is no exception. From a very young age, exams come in thick and fast, and cramming to pass them replaces a more holistic education. 

Dr Joanna Delia is not a fan of the word ‘holistic’—preferring the term ‘polyhedral’ for reasons that will be explained later—and has enjoyed a career trajectory that has flouted excessive specialisation. A doctor turned aesthetic physician with an interest in the world of contemporary art, Delia’s journey is an affront to such restrictive notions.

While she assures me that her own time at the University of Malta (UM) was nothing short of amazing, in recounting the roots of her intellectual curiosity, she is compelled to go even further back. 

‘Like every excited little girl, my dreams used to alternate and metamorph somewhere between wanting to be a writer like Emily Brontë or Virginia Woolf and a scientist who would make incredible discoveries and change the world like Marie Curie,’ Delia recalls. ‘I also wanted to be a doctor who would cure people in war-torn countries, yet fantasised about being Alma Mahler or a young Chanel surrounded by philosophers, drenched in fine clothes and surrounded by white rose bouquets…’

Delia recounts this awareness that we’re shaped to view these inclinations as contradictory. But for her, the intuitive desire to learn about and closely observe scientific phenomena matched the heights of aesthetic appreciation.

Vella’s own student enthusiasm did not come as immediately as all that, however. While she is now secure in her three-pronged role as writer, performer, and translator (also acknowledging her former role as a lecturer), forging an early path as a student meant first squinting through the fog. 

‘I just loved learning the science subjects… figuring out protein synthesis and DNA replication literally made me feel giddy, light headed, downright euphoric! I was a real geek,’ Delia says with disarming self-deprecation. ‘To me, it was just the same as reading an incredible work of literature or staring at a work of contemporary art alone in one of the silent, perfectly lit halls of a museum.’

Given this internal push-pull across various disciplines, Delia confesses that in terms of pursuing the later strands of her formal education, she ‘floated into medical school’ without feeling the need to strategise things much further. It was only upon graduation that the realities of being slotted into a specialised discipline dawned on her with an ominous pall.  

‘The day I graduated I felt a suffocating feeling: the thought that I had somehow sealed my fate,’ Delia says, though the sense of regret which followed did not linger for much longer.

‘Looking at one’s future through a tunnel vision perspective based on the imaginary restrictions of one’s degree is just that a self-imposed illusion,’ Delia observes. 

Her University years were active and inspiring, with Delia having happily taken on extra-curricular activities and also quietly rebelled against the notion of boxed-in specialised disciplines.

University and beyond  

‘University was amazing! I would repeat those years ten times over,’ Delia unapologetically enthuses. Though she does acknowledge that the Medicine course was challenging to begin with—citing the ‘competition among students’ as an additional factor—she looks back on both her time there, and her association with the UM’s Medical School, with immense pride. 

‘My lecturers were charismatic and experts in their field, which of course garners respect and made us feel honoured to be part of that system,’ Delia says, while also recalling her involvement in additional campus activities.

‘I was the chair of the environmental committee at KSU and served two terms as the Officer for the Sub-Committee on Refugees and Peace within MMSA. I loved my time on campus, and encourage all students to participate in campus affairs. We never stopped organising fairs, events, fundraisers, workshops, and outreach programmes with the community…’

Hinting at an essential discomfort with the idea of overbearing specialisation, Delia believes ‘the Maltese education system does not proactively encourage sharing knowledge’, but also notes that she did find hope, solidarity, and inspiration among her peers, from various faculties.’ I socialised with students from the architecture department, and attended their workshop parties. I was invited to history of art lectures and tours. I organised panel discussions to reduce car [use] on campus and lobby for [a] paperless [campus],’ Delia says. All these activities contributed to ‘a feeling of a hopeful future’. 

Adjacent to Delia’s academic efforts were her course-related travels abroad, which contributed to expanding her horizons. ‘I did internships in Rio De Janeiro and travelled to India and Nepal through the Malta Medical Students’ Association (MMSA), both of which were incredible experiences.’ During this time, she gained a keener interest in art.

‘My sister was studying history of art and eventually read for a Ph.D. in Museology. I followed her as closely as I could; her subjects fascinated me and a lot of her excitement about art rubbed off on me…’ 

But first, her early medical career needed seeing to. Delia admits that medical students in Malta are somewhat privileged since they enjoy a relatively smooth changeover from academic to professional life. However, the change happens very rapidly.

‘Young doctors in Malta have the advantage of an almost flawless transition into a job. This also turns out to be the toughest time in your life, but at least there there is a continuity of support at the start of your profession,’ Delia says, citing the diligence and discipline instilled into her and her peers by their University tutors and lecturers. This rigour was crucial to ensure that those early years went on as smoothly as possible.

Pausing to reflect, Delia feels compelled to add that a culture that leaves more breathing room for exploration and enquiry could only be beneficial for the future of Maltese medicine. ‘I wish we had a stronger culture of research and publication in Malta. We need to somehow find time for it as it will not only improve the reputation of the institution but also nurture us as students, alumni, and professionals, and keep us on our toes,’ Delia says, adding that these ideas reflect the same culture of hard work that her course promoted, which rewards diligence and depth. ‘I believe in constantly keeping astride with knowledge by reading publications and actively pursuing ‘continued medical education’. I wish that the institution instilled more of this into its alumni,’ Delia muses.

This approach of constant enquiry arguably gave Delia a fount of knowledge and inspiration to draw from when she found herself at a forking road in her medical career. 

Expanding horizons  

”After a few years of working at the general hospital, I was lucky enough to be chosen to pursue some level of surgical training, but by that point I had realised that the life of a surgeon was not for me…’ 

This was an ‘extremely tough decision’, with regret once again raising its ugly head. ‘However, the 80-hour weeks, and above all the realisation that my professional life would be all about facing and treating ill and dying people, forced me to make a decision to leave the hospital,’ Delia says.

This pushed Delia to explore other careers, and she now juggles her love of both medicine and aesthetics in a sustainable way.

‘After I stopped working as a hospital doctor, there were too many things I was hungry to explore – one of them was medical aesthetics. I started pursuing training in London and Paris, and essentially spent years of salary training with the best doctors I could find.’

Joanna at work as an aesthetic physician Photo: People & Skin

After working at a reputable local clinic, Delia finally managed to go at it independently, opening up her own place.

‘It was nothing short of a dream come true. I had to search hard within myself and build up entrepreneurial and management skills. I learnt the hard way sometimes, business-wise, but I was also fortunate to find help from my friends who excel in other fields like marketing, photography and architecture, to help me build my brand and clinic,’ Delia recalls.

In the end, her resistance to rigid specialisation helped her to open a thriving business called Med-Aesthetic Clinic People & Skin. She couples this work to her position as head of the Advisory Board at the newly-opened Valletta Contemporary, a boutique showcase for local and international contemporary art run by artist and architect Norbert Francis Attard. 

Which brings her story back to a ‘polyhedral’ conception of the world. 

‘I believe everything in life is polyhedral. I prefer polyhedral to ‘holistic’. Every square, or rather, every cube we think we’re trapped in, can be pushed out and reconfigured to welcome other disciplines. I don’t believe any of us purposely split the two fields, but I believe we don’t allocate enough time to explore all the wonders we could discover if we used both their lenses to analyse the world. After all, even Einstein believed that the most important thing in science is creativity…’ 

Heartbreakers

Every person possesses the same genes within every cell. Their DNA provides the information to first create an entire functioning body and then keep it running. While all humans share more than 99.9% of their DNA, it is the subtle differences in our DNA that ensure individuality. Many differences are superficial effects, like hair colour, but some can have disastrous health effects. Scott Wilcockson talks to Dr Stephanie Bezzina-Wettinger (Faculty of Health Sciences, University of Malta) about her research on these subtle differences and how they can contribute to heart attacks.

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Rockets that Fail Safely

Spacecraft failures are spectacular. These unfortunate events are seared into the public memory. One reason why rockets can fail are software bugs. If a rocket’s computer system fails, that infamous blue screen leads to lost work hours, billions of Euro, and lives. Researchers from the Faculty of ICT and Faculty of Engineering (University of Malta) tell THINK about their collaboration with the European Space Agency (ESA) to test novel satellite software architecture to prevent rocket failure.

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