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PubMed1999

Seasonality in live births with congenital heart disease in Malta.

This study was carried out to analyse seasonal variations in live births with congenital heart disease in the overall population of Malta. Included were all patients diagnosed as having congenital heart disease by echocardiography, cardiac catheterization, surgery or post mortem, by 1 year of age, and who were born between in Malta between 1990 and 1994. Results were analysed by X2 and by Edwards' cyclic method. There were 231 cases of live born congenital heart disease, which were divided into 114 cases not requiring intervention and 117 cases requiring intervention. Although the overall prevalence of congenital heart disease did not demonstrate any seasonal variation, the lesions requiring intervention showed a significant peak in September by Edwards' method (p = 0.03), which was enhanced by seasonal analysis (p = 0.003). These results were confirmed by conventional X2 and X2 for trend. The lesions not requiring intervention, which were comprised almost entirely (96%) of mild pulmonary stenosis and small ventricular septal defects, failed to show any seasonal trend. The literature regarding such seasonal trends in these malformations and statistical analysis of seasonality of congenital heart disease are reviewed. An environmental factor such as a maternal viral infection or treatment of such infections during the first trimester of pregnancy from November to January may precipitate congenital heart disease in predisposed Maltese foetuses.

Female↗
PubMed2003

Chromoblastomycosis imported from Malta.

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented fungi. It is primarily a disease of the tropics and subtropics. It is uncommon in the UK where it may occur as an imported disease. We describe a 42-year-old lady who developed chromoblastomycosis on her right forearm from Cladosporium, after visiting Malta. The lesion resolved after treatment with itraconazole for 6 months. To our knowledge there are no previous reports of chromoblastomycosis from Malta. We review the clinical course, diagnosis and management of this condition.

Adult↗
PubMed2003

Characteristics of superficial mycoses in Malta.

BACKGROUND: A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. METHODS: In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. RESULTS: The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. CONCLUSIONS: In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.

Adolescent↗
PubMed2002

Sun awareness and sun protection practices in Malta.

BACKGROUND: Concern regarding the rising incidence of melanoma and non-melanoma skin cancers in Malta has led to the organization of annual campaigns since the early 1990s. These aim to inform the public of the dangers of sun exposure and to promote sun protection. OBJECTIVE: To help guide future campaigns, a survey was carried out to evaluate current sun protection measures among the Maltese people and to assess their level of knowledge regarding harmful effects of the sun on the skin. STUDY DESIGN: A total of 559 pedestrians were interviewed in the main street of the capital city of Malta in the summer of 1999. RESULTS: Self-reported rates of regular sunscreen and hat use in adults exposed to the spring/summer sun between 10.00 h and 15.00 h were 51% and 32%, respectively, for leisure activities, and 25% and 37%, respectively, for outdoor work. Men reported using sunscreen less often than women during both leisure and work. The fairer-skinned outdoor workers actually reported making less use of a sunscreen and/or hat than their darker counterparts, and rates of sunscreen and/or hat use during leisure and work were not found to increase with the amount of time spent in the sun. Almost 75% of sunscreen users were using a sun protection factor of at least 15. Parents reported much higher rates of regular sunscreen and hat use by their young children than by themselves, with 87% of children under 12 years of age reported to be using sunscreen and 78% reported to be wearing a hat. The great majority knew that injudicious sun exposure is associated with skin cancer and skin ageing, but 48% were still regarding a suntan achieved without skin burning as 'healthy' The mass media was by far considered to be the main source of information for the general public regarding effects of the sun on the skin. CONCLUSIONS: The positive impact of past campaigns can be seen in the high reported rates of sun protection in children. However, much remains to be done with adults in order to change their attitude about a 'healthy suntan' and to convince them that it is worthwhile to protect themselves from the sun.

Adolescent↗
PubMed2003

Prevalence of methicillin-resistant Staphylococcus aureus in eight African hospitals and Malta.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs 60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

Africa↗
PubMed1998

Spectrum of congenital heart disease in Malta. An excess of lesions causing right ventricular outflow tract obstruction in a population-base study.

AIMS: To quantify birth prevalence and spectrum of congenital heart disease in the Island population of Malta, and compare these rates with previous studies. METHODS: All patients diagnosed as having congenital heart disease by echocardiography, cardiac catheterization, surgery or post-mortem by 1 year of age between 1990-1994 were included. There were 231 cases of live born congenital heart disease with a birth prevalence of 8.8/1000 live births. The commonest lesions were ventricular septal defect, pulmonary stenosis and tetralogy of Fallot. The rates of individual lesions were compared with two recent epidemiological studies with similar methodologies. RESULTS: Although the overall birth prevalence of congenital heart disease was similar in three studies, significantly higher rates of pulmonary stenosis, tetralogy of Fallot and double outlet right ventricle were found in Malta, all of which predispose to right ventricular outflow tract obstruction. In contrast, there were lower rates of lesions causing left ventricular outflow tract obstruction. A higher rate of ventricular septal defect was also found. The Maltese gene pool may contain an inherent predisposition towards lesions causing right ventricular outflow tract obstruction.

Double Outlet Right Ventricle↗
PubMed1980

African swine fever in Malta, 1978.

In March 1978 an outbreak of African swine fever (ASF) occurred in Malta. The disease spread rapidly and by April 13, ASF had been found on 304 premises involving 25,100 pigs. A census carried out on April 15/16 showed that there were at least 1440 premises containing 70,700 pigs on the island. A slaughter policy was implemented and depopulation of known infected premises started on April 15. Pigs which appeared normal on these premises were stored in freezers for subsequent processing for human consumption and by the end of June more than 4500 carcases were in cold store. The most consistent clinical signs were fever, anorexia and reluctance to move. Haemorrhagic lymph nodes and petechial haemorrhages in the kidneys were the predominant macroscopic lesions. A serum survey, using the immunoelectroosmophoresis technique, was carried out on 2409 sera from 200 farms collected at the Government abattoir during a four-week period. Of these sera, 308 (12.8 per cent) from 65 (32.5 per cent) of the farms contained antibodies to ASF virus. By August the original pig population had been reduced to one-third and a second census taken on August 15/16 showed that a total of 501 owners and 13,975 pigs remained. The decision was taken to slaughter all the remaining pigs and by the end of January 1979 there were no pigs in Malta. The outbreak cost an estimated 5 million pounds and provided the first occasion when any country had slaughtered all members of a species of domestic animal in order to eliminate a disease.

Abattoirs↗
PubMed2003

Sick leave certification: a unique perspective on frequency and duration of episodes - a complete record of sickness certification in a defined population of employees in Malta.

BACKGROUND: In Malta, sickness certificates are needed from the first day of illness, and are issued by family physicians (FPs) either employed by the government primary health care system, self-employed in private practice, or employed by an employer for this purpose alone. The latter system, when applied by the employer, is compulsory. In order to contribute to the debate on the role of the FP in this context, electronic data collected by a group of company-employed FPs was used to study the phenomenon of sickness certification. This database is a complete record of the selected employees' sick leave certification during the study period. METHODS: Data collected by company-employed FPs from a defined population was used: all employees of selected Maltese companies served by a group of FPs. The database included episode-based data from home visits over three years (01/01/1997 - 31/12/1999), by 9 company-appointed FPs regarding 421 employees of five companies. RESULTS: 3015 episodes of sickness absenteeism, with an average duration of 2.9 days, were documented. Employees who did intensive manual work had relatively higher rates. Furthermore, a relatively higher incidence of work injury, sprains and strains, anxiety and depression and low back pain as found in manual workers, and in male workers. This trend was shown to be statistically significant. CONCLUSIONS: The frequency of sick-leave certification in Malta is comparable to that in other European countries, but the average duration of certificates is much less than reported in other studies that generally did not include data on short-term illness and certification. This has important implications on future research in the field. A number of common disorders were found to be significantly more prevalent causes of sickness certification in manual workers, amongst them anxiety and depression.

Absenteeism↗
PubMed2000

[The Knights of Malta].

The Knights of Malta - an historical outline of the largest and oldest acting Christian and Maltese Order and a description of their activities in Poland and outside the country. The Maltese Order originated in the XI century, when it was founded after the conquest of Jerusalem in 1099. Its activity that time consisted of taking care of injured knights, pilgrims and the poor. Over the centuries the ideals of the order remained unchanged. Saint Jan Jerozolimski's Foundation (Maltese Help), which acts nowadays, became the executive organ of Polish Maltese Bachelors Association. It gathers volunteers and workers in the health service, nurses and people, who are not professionally connected with medicine. Those people all devote their free time and energy to those in need. The Foundation also deals with the organisation of medical sanitary services, first aid courses and providing equipment for hospitals. The Knights of Malta are still looking for young volunteers who are willing to support society.

Foundations↗
PubMed1989

Nutrition policy development and implementation in Malta.

The paper highlights experiences in the development and implementation of the food and nutrition policy in Malta. As one could expect there has been tangible progress in certain areas but less so in others. Some background information on the food and health status of the Maltese population is given first as this was the reason for the establishment of the policy in Malta in the first place.

Female↗
PubMed1978

Diabetes as a coronary risk factor in Malta.

In a retrospective survey of 1,118 admissions for acute ischemic heart disease (AIHD) at St. Luke's Hospital in Malta in 1963-72, there were 945 (84.5%) cases of acute myocardial infarction (AMI) and 173 (15.5%) cases of acute coronary insufficiency (ACI). The proportion of patients with diabetes was 30.2% (30.7% in AMI, and 27.7% in ACI; age-corrected rates at greater than or equal to 40 years). This was significantly higher (P less than 0.01) than the corresponding rate of diabetes (20.2%) in the general population of Malta. There was a significantly greater prevalence of diabetes among women than among men with AIHD: the proportion with diabetes was 50.0% among women with AMI and 41.3 among women with ACI. The diabetes was mostly of the maturity-onset type. The high frequency of AIHD among diabetics seemed to be chiefly attributable to the effects of the diabetic state, either directly or indirectly through its association with other risk factors: obesity, physical inactivity, excessive eating and high plasma cholesterol levels. Diastolic hypertension and chronic bronchitis and emphysema associated withe heavy smoking were no more common in diabetics than in nondiabetics with AMI.

Adult↗
PubMed2002

Mass movements and conservation management in Malta.

Mass movements at an environmentally sensitive but very popular leisure site in Malta were investigated in order to establish whether they were naturally occurring or whether they might in some way have resulted from the chronic long-term degradation of the site. Field surveys of the slopes were undertaken and physical and geotechnical properties of the Maltese Blue Clay Formation, which forms the slopes, were determined from laboratory analysis of samples. Slope stability was analysed using the infinite slope model; analysis of two 1996 mudflows indicates that these mass movements are natural processes. A landslide hazard analysis based on this finding suggested that whilst future mudflows constitute a small hazard, the risk of harm arising from them is even smaller. The implications of this for conservation management of the site are important, given the objective of restoring and then maintaining a natural ecological environment at the site. The mudflows are integral components of this natural environment, shaping the landscape and the ecological communities. The provision of information to visitors constitutes a valuable education and management tool that should further reduce the risk of harm and promote responsible recreational use of the site. However, it is essential that managers understand the nature of all relevant components of an environmentally sensitive site, in order that appropriate management strategies are devised. In the case discussed, these might include avoiding unnecessary future intervention on the clay slopes.

Conservation of Natural Resources↗
PubMed2004

Increasing age at diagnosis of celiac disease in Malta.

OBJECTIVE: Recent studies have shown that celiac disease is being diagnosed at a progressively later age. This paper analyses trends in age at diagnosis in a closed island population. METHODS: Patient case notes of all known patients with celiac disease were retrieved and demographic information, mode of presentation including symptomatology and diagnostic criteria were obtained. Over the period 1985 to 2000, information was available on 42 patients with celiac disease. All were aged 14 years. RESULT: The mean age at diagnosis showed an increasing age, with a constant disease incidence. A highly significant positive correlation was found for age at diagnosis with time (rho=0.4, p=0.009). CONCLUSION: It is thought that breast feeding, with later introduction of gluten containing products in the diet, leads to a later presentation of celiac disease. In Malta, over the period under study, the breast feeding rate rose from 20% to 60%. Our findings support the hypothesis that breast feeding offers a degree of protection against the early development of celiac disease, without actually reducing the incidence of the disease.

Age of Onset↗
PubMed2005

Biochemical indices of renal osteodystrophy in dialysis patients on the island of Malta.

OBJECTIVES: Renal osteodystrophy (ROD) has never been studied on the small Mediterranean island of Malta, which has a largely inbred population. The genetic contribution to the pattern of renal osteodystrophy is being increasingly recognized. We were, thus, interested in studying indices of bone turnover in Maltese end stage renal failure patients. MATERIALS AND METHODS: Sixty unselected patients, representing 65% of all patients undergoing dialysis in the island's renal unit, were prospectively investigated over a period of 5 months with respect to symptoms, calcium/phosphate chemistry, intact parathyroid hormone (iPTH) and bone alkaline phosphatase (bAP). Bone histomorphometry, which is the gold standard in the diagnosis of ROD, was not within the reach of our small unit. Biochemical markers may not be as sensitive and specific as bone biopsy for individual patient diagnosis of ROD sub-type but they can give a fairly good indication of the spectrum of bone turnover on a population basis. The optimum combination of biochemical marker cut-offs available from studies in the literature was then employed to estimate bone turnover. RESULTS: The following biochemical picture emerged: 42% had iPTH < 79.7 pg/ml (which cut off has a reported specificity of 93.7% for low turnover bone disease), 45% had iPTH > 100 pg/ml and bAP > 10 ng/ml (which combined cut off has a reported specificity of 100% for high turnover bone disease), while 13% could not be classified (ie had intermediate values). CONCLUSIONS: Based on biochemical data, the pattern of bone turnover seems to be comparable to the European average. Further indepth study using bone histomorphometry is warranted.

Alkaline Phosphatase↗
PubMed1991

Low physical activity and worsening of glucose tolerance: results from a 2-year follow-up of a population sample in Malta.

The relationship between the level of habitual physical activity and glucose intolerance was examined cross-sectionally and during a 2-year follow-up among a sample of 388 subjects in Malta. At baseline, the subjects were classified into three categories of physical activity, which was inversely related to the 2-h post challenge blood glucose (P = 0.02). In a multivariate analysis, age (standardized regression coefficient 0.23; P less than 0.001), family history of diabetes (0.20; P less than 0.001), and physical activity (-0.18; P = 0.002) were the strongest predictors of the 2-h blood glucose at baseline. The age standardized 2-year risk of glucose intolerance, i.e. impaired glucose tolerance or diabetes was consistently and inversely related to the level of physical activity. Among subjects with normal glucose tolerance at baseline (n = 127) those with low physical activity had a 2.7 times higher risk of glucose intolerance during follow-up than those with high physical activity (P = 0.1), and even a 3.7-fold risk of glucose intolerance at baseline (n = 196) when both the subjects with normal and impaired glucose tolerance at baseline were considered together (P = 0.005). Similar trends were observed for the risk of diabetes. The suggested protective effect of physical activity was independent of body mass, a family history of diabetes and gender. Within the limits of this small study we conclude that physical activity may have some importance in the primary prevention of impaired glucose tolerance and, possibly, non-insulin-dependent diabetes mellitus.

Adolescent↗
PubMed1994

Epidemiology in Malta from routine health information.

OBJECTIVE: To estimate the prevalence of diabetes in the Maltese Islands from data regarding drug consumption, and to assess the prescribing habits and management attitudes of local doctors. METHODOLOGY: The prescribed average daily dose of each type of anti-diabetic drug was calculated from random representative samples of patients (total 1,444) attending the Health Department's primary and secondary health centres as well as of patients seeing their private practitioners. This constituted circa 16% of the total estimated number of diabetics on drug therapy in Malta. The quantities of drugs consumed were obtained both from Government and private industry sources, whilst relevant data on therapy modalities, including proportions of patients on a combination of anti-diabetic preparations, were obtained from records held at the Dept. of Health. RESULTS: Applying the appropriate formulae (as proposed by Eurodiab. subarea C 1989 programme) the global prevalence of diabetes worked out to be 5.22%, an underestimate of circa 12% of the figure extrapolated from the recent population based epidemiological studies. Overall 51% of cases were treated with 'diet only', whilst less than 10% of subjects were managed with insulin. Compared to patients attending the better staffed and equipped health centres, those seeing their private physicians were proportionately less frequently put on insulin (5.7% vs 11.7%), and were prescribed a slightly higher mean daily dose (1.7 vs. 1.4 tab) of glibenclamide suggesting the need of better education of the patient (and probably also of the physician). CONCLUSION: This type of study proved to be relatively simple and inexpensive to perform. Although it cannot replace epidemiological field surveys it can still give a reasonably fair (albeit with limitations) estimate of diabetes prevalence in a population. Moreover it permits an important insight into local public health indicating ways to improve diabetes care.

Diabetes Mellitus↗
PubMed2006

Laryngeal leishmaniasis in Malta.

The localization of Leishmania spp. in the larynx is rare especially when not associated with immunosuppression or with visceral or cutaneous leishmaniasis. We present a case of isolated laryngeal leishmaniasis, the first of its kind documented in Malta and infrequently reported from the Mediterranean basin.

Animals↗
PubMed2005

TNFRSF11B gene variants and bone mineral density in postmenopausal women in Malta.

UNLABELLED: A number of polymorphisms in various genes have been identified and associated with bone mineral density (BMD) and with an increased risk of osteoporosis. OBJECTIVE: In this study, three single nucleotide polymorphisms (SNPs) within the TNFRSF11B gene were studied for association with an increased risk of osteoporosis in postmenopausal Maltese women (n=126). METHODOLOGY: Analysis was performed by PCR restriction fragment length polymorphism (RFLP) while BMD at the lumbar spine, femoral neck, Ward's triangle and trochanter was measured by DEXA. RESULTS: No significant association was observed between genotypes and BMD for all polymorphisms studied within this gene. Homozygotes CC (T(950)-C) were observed to have the highest BMD at all anatomical sites although statistical significance was not reached when comparing the three genotypes. A statistical significant difference was observed in the distribution of genotype frequencies for this polymorphism between normal individuals and those that were either osteopenic or osteoporotic at one or both anatomical sites, with the TT genotype associated more frequently with low BMD. The T(950)-C and G(1181)-C polymorphisms were in strong linkage disequilibrium with each other but not with the A(163)-G polymorphism further upstream in the OPG promoter. Statistical significance was reached when constructing haplotypes, where the A-T-G haplotype was found to be more frequent in individuals with low BMD. CONCLUSIONS: These results indicate the possible role of TNFRSF11B gene variants in postmenopausal bone loss in women in Malta.

Absorptiometry, Photon↗