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PubMed2006

Utilization of pulverized fuel ash in Malta.

In Malta all of the waste produced is mixed and deposited at various sites around the island. None of these sites were purpose built, and all of the waste is above groundwater level. The landfills are not engineered and do not contain any measures to collect leachate and gases emanating from the disposal sites. Another waste, which is disposed of in landfills, is pulverized fuel ash (PFA), which is a by-product of coal combustion by the power station. This has been disposed of in landfill, because its use has been precluded due to the radioactivity of the ashes. The aim of this study was to analyze the chemical composition of the pulverized fuel ash and to attempt to utilize it as a cement replacement in normal concrete mixes in the construction industry. The levels of radiation emitted from the ashes were measured by gamma spectrometry. The results of this study revealed that although at early ages cement replacement by PFA resulted in a reduction in compressive strength (P=0), when compared to the reference concrete at later ages the strengths measured on concrete cores were comparable to the reference concrete (P>0.05). The utilization of PFA up to 20% cement replacement in concrete did not raise the radioactivity of the concrete. In conclusion, utilization of PFA in the construction industry would be a better way of disposing of the ashes rather than controlling the leachate and any radioactivity emitted by the landfilled ashes.

Coal↗
PubMed1997

Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta.

This study used a cross-sectional, correlational design to test a model of absence and turnover of registered nurses developed from a review of the research literature (Gauci Borda and Norman, 1997). Testing the model involved comparing the relationship between job satisfaction, kinship responsibility, pay, employment opportunity, intent to stay in employment and absence for male and female registered nurses. All registered nurses (n = 254) working in clinical areas on a full-time shift basis, in one large general hospital in Malta were surveyed by questionnaire and their absence data were obtained from the hospital personnel records. A response rate of 67% (n = 171) was achieved. The results showed that nurses were satisfied with their job and intended to stay in their present employment for the next 12 months. Relationships between variables differed between male and female nurses, with job satisfaction being associated with intent to stay for male nurses but not for females and kinship responsibility and intent to stay being associated with absence in female but not male nurses. In contrast to many previous studies of nurses, an association was found between job satisfaction and absence. Several variables, including fear of change, which may influence intent to stay of Maltese nurses, were identified. The proposed model of absence and turnover stood up reasonably well to testing, but the results for the whole sample, and the sub-samples of male and female nurses supported different parts of the model. The main implication for future research is that male and female nurses should be studied separately due to differences found between the two groups.

Absenteeism↗
PubMed1999

Automation of follow-up and data analysis of paediatric heart disease in Malta.

Widely available computer programs have been used to set up a database for patients with congenital heart disease in Malta. This database is used for clinical follow-up and research, and has been tailored to provide formatted output of specified results of follow-up as tables and graphs that are automatically updated with ongoing changes in the dataset. The system is easy to use, being menu- and icon driven and can be operated with minimal training. It has resulted in great saving of time not only in clinical practice, but also in the production of reports and analysis of data, as spreadsheets need only be created once and are then updated at will. The system also incorporates a patient summary generator and a on-screen picture library for patient explanation and teaching purposes.

Cardiac Catheterization↗
PubMed1999

Cerebral palsy in Malta 1981 to 1990.

Of 55200 Maltese children born in the Mediterranean islands of Malta and Gozo in the birth years 1981 to 1990 inclusive, 134 fitted the case definition of cerebral palsy (CP). Children were allocated to prenatal, perinatal, and postnatal groups according to strict criteria and to various CP syndromes using the Swedish classification. The study was undertaken between 1994 and 1996 and the period prevalence rate was calculated. The control group comprised 134 children who were matched for sex and born immediately before or after the index subjects in the same hospital. Data related to risk factors were extracted from medical records and collected by interview with parents/carers. Unadjusted odds ratios (OR) with 95% confidence intervals for a range of risk factors were calculated. For risk factors with a relatively high prevalence in the population, such as prematurity and low birthweight, ORs were calculated from case-control data. For low-prevalence risk factors, such as breech presentation and multiple pregnancy, ORs were calculated against the whole population data for the 10-year birth cohort. The prevalence rate of CP in the geographically defined, stable population of the Maltese islands was similar to that in the UK and higher than that for Sweden, but the rates for different types of CP were markedly different from most developed countries, with a higher rate of spastic tetraplegias. Risk factors were as expected and similar to those reported from other developed countries. The study shows a strong social gradient with a higher than expected proportion of CP in children of unskilled manual workers.

Adolescent↗
PubMed1982

Antibody to cytomegalovirus in Malta.

Antibody to cytomegalovirus (CMV) was sought in sera from Malta using immunofluorescence. Seven per cent of the infants, 36% of the school children, increasing to 100% of the adults aged over 40 years were found to have antibody. Most infection occurred in pre-school children and adults over 25 years of age. This pattern of antibody acquisition appears different from that described for other countries.

Adolescent↗
PubMed2006

Challenges in identifying the methodology to estimate the prevalence of infectious intestinal disease in Malta.

Routine surveillance systems capture only a fraction of infectious intestinal disease (IID) that is actually occurring in the community. Different methodologies utilized among various international studies in the field were reviewed in order to devise an appropriate survey to obtain current estimates of prevalence of IID in Malta. An age-stratified retrospective cross-sectional telephone study was selected for the study due to its feasibility in terms of limited resources necessary (funds, time and human). The disadvantages of this type of study include the inherent biases such as selection bias (sampling, ascertainment and participation bias) and information bias (recall and observer bias). A pilot study was carried out using a random age-stratified sample of 100 persons over a 3-month period. A total of 5.0% (95% CI +/-4.27) of the population was estimated to have suffered from IID during that period. This estimate was used in order to assist in sample size calculations for a large-scale community study. It also served to test the survey instrument and methodology and to identify operational problems.

Adolescent↗
PubMed2007

The magnitude and distribution of infectious intestinal disease in Malta: a population-based study.

Routine sources of information on infectious intestinal disease (IID) capture a fraction of the actual disease burden. Population studies are required to measure the burden of illness. A retrospective age-stratified cross-sectional telephone study was carried out in Malta in order to estimate the magnitude and distribution of IID at population level. A random sample of 3504 persons was interviewed by a structured questionnaire between April 2004 and December 2005. The response rate was 99.7%. From the study, the observed standardized monthly prevalence was 3.18% (95% CI 0.7-5.74) with 0.421 (95% CI 0.092-0.771) episodes of IID per person per year. The monthly prevalence was higher in the <5 years age group and in females aged 31-44 years. The mean duration of illness was 6.8 days and a median duration of 3 days. A bimodal seasonal distribution was observed with peaks in June-July and October-November.

Adolescent↗
PubMed1998

Epidemiology and diagnosis of ventricular septal defect in Malta.

Malta is a small island with minimal changes in its population, making it an ideal location for epidemiological and historical studies dealing with congenital heart malformations. Ventricular septal defect was studied retrospectively from 1930 to 1994. A sharp and significant decline in age at diagnosis was found, predating echocardiography. All defects are now diagnosed by echocardiography, which has resulted in an increased prevalence of this lesion as seen at birth, particularly of minor defects. The prevalence of ventricular septal defect from 1990 to 1994 was 3.85/1000 live births, with 3.03/1000 not needing surgery and 0.83/1000 requiring operative intervention. Half the defects closed spontaneously. The majority of ventricular septal defects overall, and those spontaneously closing, were muscular defects. The overall prevalence at birth was significantly higher than that reported in recent studies using similar methodologies, implying that the reported rate is more likely to be the true prevalence at birth of clinically detectable defects.

Age Distribution↗
PubMed1999

Epidemiology, and diagnostic and surgical trends in atrioventricular septal defect in Malta.

Atrioventricular septal defect (AVSD) is a common congenital cardiac malformation, associated with Down's syndrome. AVSD causes heart failure, and if not treated early, irreversible pulmonary hypertension. In Malta, a decline in age at diagnosis and at surgery was present from 1944 to 1994. The birth prevalence was 0.31/1000 live births, within the range obtained from a literature review. Down's syndrome children are now treated as are non-syndromic children.

Down Syndrome↗
PubMed1999

Trends in presentation of congenital heart disease in a population-based study in Malta.

Differing pathological haemodynamics in cardiac malformations lead to varying modes and timings of presentation. This study identifies historical trends in presentation of congenital heart disease in a population-based study. All patients diagnosed as having congenital heart disease in Malta between 1960-1994 were included (n = 868). Analysis was carried out on trends in referral sources, modes of presentation and birth prevalence. The number of patients diagnosed with congenital heart disease increased over the period under study. For both patients not requiring intervention (n = 283) and those requiring intervention (n = 585), the proportion diagnosed prior to hospital discharge increased (p < or = 0.005). There was a decreasing trend for general practitioners to refer cases (p < 0.0001), and an increasing trend for paediatricians to refer such patients (p < or = 0.0003). The commonest presentation to the general practitioner was an incidental finding (92%), while paediatricians referred more patients for cyanosis or heart failure (p < or =, 0.005). For lesions not requiring intervention, the commonest lesion referred was ventricular septal defect from all sources. For lesions requiring intervention, the commonest lesion detected prior to hospital discharge was tetralogy of Fallot. Atrial septal defects were the commonest lesions detected after discharge by both paediatricians and general practitioners. An increase in the proportion of hospital diagnoses is attributed to increasing rate of hospital delivery, and greater training and experience in doctors performing neonatal examinations prior to discharge. Patients diagnosed after discharge are increasingly diagnosed by paediatricians due to an increasing pool of paediatricians and better parent awareness and education.

Family Practice↗
PubMed1999

The importance that community pharmacists in Malta place on the introduction of pharmaceutical care.

The results from a study to assess the importance Maltese pharmacists placed on various aspects of pharmaceutical care and their willingness to provide such care are reported. A modified version of the Behavioural Pharmaceutical Care Scale (BPCS) questionnaire (consisting of three dimensions and 14 domains) was mailed to the 198 privately owned community pharmacies in Malta. A total of 99 questionnaires were returned following two reminder telephone calls. Pharmacists were asked to score the importance of each pharmaceutical care activity contained in the modified BPCS on a 6 point Likert scale ranging from 0 to 5. The overall score for the questionnaire, which illustrated the importance pharmacists attributed to various aspects of pharmaceutical care, ranged from 90 to 170 with a mean score of 134.8. There was little difference recorded between the scores for the three dimensions. The Referral and Consultation domain recorded a slightly higher score than the other two domains. Younger pharmacists obtained significantly higher scores (p < 0.05; Kruskal-Wallis test) in the Verification of Patient Understanding domain. Approximately 72% of respondents indicated that they were willing to provide pharmaceutical care, but remarked that a number of issues e.g. reimbursement, qualified support staff, GP-pharmacist co-operation, had to be addressed. A series of strategic steps are needed to help pharmacists resolve these issues before pharmaceutical care programmes could be offered by Maltese community pharmacists.

Age Factors↗
PubMed2000

Surveillance of wild polioviruses in patients with acute flaccid paralysis in Malta during 1998 and 1999.

Certification of global poliomyelitis eradication can only be accomplished when all countries have been certified as having achieved wild poliovirus eradication. In order to achieve certification of eradication of poliomyelitis in Malta an active acute flaccid paralysis (AFP) surveillance system comprising the whole population was set up. Surveillance became effective in January 1998. During 1998, there were nine reported cases of AFP (non-polio AFP rate: 2.38 per 100,000 population) two of whom were children under 15 years of age (non-polio AFP rate: 2.52 per 100,000 for the population aged <15 years). In 1999 five cases of AFP were reported (non-polio AFP rate: 1.32 per 100,000 population). One case occurred in a child under 15 years (non-polio AFP rate: 1.28 per 100,000 for population aged <15 years). Virological investigation did not detect any wild or Sabin-like polioviruses.

Adolescent↗
PubMed2000

Epidemiology and prognostic factors in meningococcal disease in a small island population: Malta 1994-1998.

STUDY OBJECTIVE: To review the epidemiology of meningococcal disease in Malta over the period 1994-1998, and to identify factors at presentation and in the management of meningococcal disease which may influence mortality. DESIGN: All admissions with meningococcal disease to a national hospital in a population-based study over the period 1994-1998 were studied retrospectively. MAIN RESULTS: Fifty-six cases were diagnosed over 1994-1998, the incidence rising from 0.8/100,000 to 7.2/100,000 total population (p < 0.0001). The median time interval from arrival at hospital to administration of parenteral antibiotic decreased over the 5-year period from 4.4 to 1.2 hours (p = 0.025), with no significant change in the case-fatality rate. There was no association between the time interval from arrival at hospital to parenteral antibiotic administration, and mortality. The following features at presentation were associated with increased mortality: older age (p = 0.03), meningococcaemia compared with meningitis (p = 0.05), shock (p < 0.0001), disseminated intravascular coagulation (p = 0.0001), a normal/low white blood cell count (p = 0.0003), a low platelet count (p = 0.0001) and a high serum creatinine (p = 0.003). CONCLUSIONS: The upsurge of cases in the population was accompanied by a decrease in intervention time in the general hospital, probably due to increased awareness of the disease. This study did not show a positive relationship between early in-hospital administration of antibiotics and improved survival, probably because antibiotics were given earlier to those with fulminant disease and, with therefore, an inherently worse outcome. Stratification of cases by severity on admission is recommended in future studies.

Adolescent↗
PubMed2004

The impact of guidelines on long-term asthma care: a study of hospitalised patients in Malta.

OBJECTIVE: To compare actual practice to that recommended in asthma guidelines, published in Malta in February 1998, with respect to the management of asthma. These were the first national clinical guidelines to be published locally. METHOD: A piloted, structured interview was conducted with patients between 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 min. The four-year prospective study started in February 1997 (one year before publication of guidelines and aimed at collecting baseline data) and finished in January 2001 (three years after publication of the local guidelines). MAIN OUTCOME MEASURES: Inhaled steroids on admission. Patient partnership: use of a written self-management plan and home peak flow monitoring. Patient compliance with inhaled steroids. RESULTS: 304 patients (68% females; mean population age 33.9 years SD +/- 13.41) were interviewed over the four-year period. The difference in proportions test (Z-test) was used to analyse the data comparing years 2, 3 and 4 with year 1. No statistical differences were found when comparing the groups for inhaled steroid treatment on admission or availability of a home peak flow meter. Similarly, no differences were found between groups when comparing compliance with inhaled steroids. A statistically significant increase in availability of a self-management plan was found over the study period (3% in year 1; 1% in year 2; 11% in year 3; 9% in year 4), but the overall use of such plans remains disappointingly low. CONCLUSION: With the exception of an increased use of self-management plans, there appears to be lack of adherence to guidelines with consequent undertreatment of asthma, despite the fact that guidelines were published three years ago. This indicates a need to ensure better dissemination and implementation strategies to promote adherence. It is suggested that the clinical pharmacist is well-placed to promote adherence to guidelines.

Acute-Phase Reaction↗
PubMed1998

Societal perceptions of community pharmaceutical services in Malta.

OBJECTIVE: To assess the views of the Maltese general public on services provided by community pharmacies in Malta and their opinions on the proposed extended role for pharmacies. METHOD: An interviewer-administered structured questionnaire was used to interview 912 members of the public (395 males, 517 females). RESULTS: The majority of respondents (70.8%) visited a pharmacy at least once a month, with females visiting more frequently than males (P< 0.01). Almost 31% stated that the main reason for visiting a pharmacy was to purchase prescribed medication, while 23-3% said that it was to obtain over-the-counter products. Women were more likely than men to be influenced by the pharmacist's advice when selecting an over-the-counter product (P< 0.05). The majority of respondents (62.8%) said that they usually bought their medicines from the same pharmacy and loyalty to a particular pharmacy increased with age. When treating minor ailments, respondents were more likely to consult their doctor or self-treat rather than seek advice from the pharmacist. The proposed extended role of the community pharmacist found support with the public, e.g. 90.2% felt that the pharmacist should promote health education, with the preferred method suggested being through individual advice; 85-7% were in favour of screening and monitoring services and 85.6% felt that the keeping of patient medication records would be useful. Almost three-quarters (74.6%) of respondents said that they would be willing to participate in pharmaceutical care programmes. When asked to suggest new activities for community pharmacy, respondents were most in favour of the pharmacist offering more advice on the treatment of minor ailments. CONCLUSION: Overall, the results obtained are encouraging and Maltese pharmacists should plan to provide new services to the community in the future.

Adolescent↗
PubMed1999

Atrial septal defect in Malta.

OBJECTIVE: To study diagnostic and surgical trends in atrial septal defect (ASD) in a population-based study, and estimate birth prevalence and spontaneous closure rates. METHODOLOGY: All patients in Malta diagnosed as having ASD and born between 1990 and 1994 were identified from various sources. This took place in the setting of a regional hospital supplying diagnostic services for the entire population. Echocardiographic follow-up was also undertaken for lesions not requiring intervention. RESULTS: A total of 190 patients born in this period were diagnosed as having ASD. Age at diagnosis and age at surgery have decreased significantly over the period under study (P < 0.0001). The mode of diagnosis has become entirely noninvasive, and the perioperative mortality decreased dramatically over time. For the period 1990-94, the incidence at birth for defects not requiring intervention was 2.0/1000 live births, defects requiring intervention 0.4/1000 live births. A total of 92% of 50 defects not requiring intervention closed spontaneously, and the remainder had spontaneously decreased in size on follow-up. CONCLUSIONS: ASD is a relatively benign malformation in which early and noninvasive diagnosis can be achieved, with an extremely low interventional mortality.

Cardiac Surgical Procedures↗
PubMed1994

The effect of diabetes and impaired glucose tolerance on mortality in Malta.

A random sample of the middle-aged population of Malta was studied in a diabetic survey in 1981. Among the 1537 survey responders, in 659 men and 878 women aged 40 years or more the prevalence of diabetes was 16% in men and 18% in women, and that of IGT 5% in both sexes. By the end of 1985, 90 subjects (49 men: 41 women) had died. Mortality/100 (95% CI) was among subjects with normal, impaired glucose tolerance and diabetes in the age group 40-59 years 12 (5-19), 25 (23-73), and 61 (17-148), and in the age group of more than 60 years, 102 (68-136), 148 (59-237), and 178 (122-234), respectively. Age standardized mortality/1000 was in men 51, 28, and 100, and in women 34, 33, and 72 in the three categories of glucose tolerance, respectively. Among diabetic subjects aged 40-64 years the risk of death was increased seven-fold as compared with normoglycaemic subjects. Among men there was an inverse association between body mass index and mortality in all categories of glucose tolerance. Among women, no clear trend between body mass index and mortality was found. The relative risk of death for subjects with diabetes adjusting for age, sex, and body mass index was 2.2 (odds ratio: 95% CI 1.40 to 3.42) as compared with non-diabetic subjects. The age-adjusted survival curves for normoglycaemic subjects were similar for men and women. Among subjects with abnormal glucose tolerance the survival was slightly better in women than in men (p = 0.056). About half of the deaths were from cardiovascular disease and 7% from diabetes mellitus.

Adolescent↗