/library/oar/handle/123456789/31977 2026-05-24T08:43:34Z /library/oar/handle/123456789/43447 Title: Kamin blocking and latent inhibition in children with attention deficit hyperactivity disorder. Abstract: Literature supports the fact that maintaining the safety of patients within psychiatric hospitals has long been, and still is, a challenge. A common, widely accepted organisational response to reducing adverse patient outcomes such as suicide, self hmm and violence has been special observations, an intervention which, when used in mental health care, involves the allocation of one health care worker to provide intensive nursing care to an individual for a prescribed length of time. However research calls into question the therapeutic benefits of special observation, and with constantly rising health care costs and increased vulnerability to litigation and disciplinary action within the health sector, the efficacy of this intervention becomes even more important and contentious. The aim of this study was to establish the perceptions and expectations of clinical staff regarding special supervision within a Maltese psychiatric hospital. This qualitative study adopted a descriptive, cross sectional design and a mixed mode method consisting of a census survey (n=114 doctors and nurses) complimented by elite interviews with key administrative I managerial staff (n=5) was employed. Quantitative data was analysed statistically and content analysis was carried out on the qualitative data. Results showed that special supervision is utilised locally as an intervention mainly for the prevention of suicide or self-harm amongst psychiatric in-patients. Tt is also used for a number of other purposes such as preventing a patient from absconding or from injuring others. The question of efficacy of this intervention when offset against both cost and clinical/therapeutic effectiveness has not been established in this local study. However the study confirms that the intervention is fraught with ambiguities and that variations in prescribing and carrying out the intervention may result from varied perceptions and mismatched expectations of clinical staff and reflect idiosyncratic practice and poorly designed policies and protocols. Malta, like most other countries is constantly involved in a process of balancing the pressures of decreasing budgets against ensuring safe and effective patient care. Despite being unable to establish the actual costs of the intervention locally, the findings showed that special supervision can be a significant cost pressure and consequently the study raised several recommended alternatives aimed at reducing costs. The collective results also showed that there is an urgent need to develop a more collaborative and systematic approach between all the stakeholders that are involved in the intervention and the study suggested management recommendations aimed at achieving this, primarily through developing an agreed and auditable local policy but also including involvement of the patient and developing risk assessments and central recording systems. Whilst acknowledging ethical limitations, recommendations for further research were suggested that included further research into use of the intervention in peripheral cases and looking to international studies to provide benchmarks for local application. Finally, the study suggested ways that existing training and experience could be better harnessed in order to provide people with the skills that they need to carry out the intervention. Description: M.SC.PATHOLOGY 2009-01-01T00:00:00Z /library/oar/handle/123456789/43384 Title: Genetic and lifestyle risk factors and parkinson's disease : the dopamine connection. Abstract: Among the neurodegenerative disorders identified to date, Parkinson's disease (PO) is the second most frequent disorder, after Alzheimer's disease. Although the first records date back to 1817, there is little data about PO etiology. In this study, a candidate gene approach was applied in a case-control study using 178 cases and 402 controls collected from the Maltese population as part of the EU funded FP5 Geoparkinson study. Genetic and environmental risk factors which together or individually may lead to disease pathogenesis were investigated. Mutations in known PO-causing genes namely Leucine Rich Repeat Kinase 2 (LRRK2) (LRRK2 G2019S and LRRK2 R1441G) and Alpha-synuclein (SNCA) (SNCA G209A) were tested in cases only. None of the cases had the LRRK2 R1441G or SNCA G209A mutations however an allele frequency of 1.4% was obtained for the LRRK2 G2019S mutation which may have implications in genetic testing. These however explain only a few proportions of all PO cases. Therefore candidate genes selected on the potential for their involvement in the pathophysiology of dopaminergic systems were studied focusing on mutations and polymorph isms known to exist in the Maltese population. These include Quinoid Dihydropteridine Reductase (QOPR) G230, Sepiapterin Reductase (SR) IVS2-2A>G, which are known to cause tetrahydrobiopterin (BH4) deficiencies and Methylenetetrahydrofolate Reductase (MTHFR) A1298C and C677T. The allele frequencies obtained were 0.3% for both cases and controls tested for QDPR G230 and 0.7% for the SR IVS2-2A>G in controls. The odds ratios for the MTHFR 677 CT genotype and IT genotype were OR 1.0 (95% CI 0.7-1.6) and OR 0.9 (95% CI 0.5-1.6) whilst for the MTHFR 1298, the odds ratios for the AC and CC genotypes were OR 1.1 (95% CI 0.7-1.7) and OR 1.2 (95%CI 0.6-2.1) respectively. None of these variants were found to be contributors to PD. Tobacco use (especially before PO symptom onset), coffee consumption, and beer and spirit consumption were found to be protective for PO whilst antidepressants, anxiolytics and hypnotics showed an increased odds ratios. Since there may be overlap between the etiologies of PO and substance use, an analysis of genes that can influence substance use was performed in controls only. Possible associations between smoking and the dopamine transporter (OAT1), dopamine receptor 02 (OR02A) and Cytochrome P450 lBl (CYP1Bl) genes, antidepressants and CYP1B1, alcohol and the Glutathione-S-transferase (GSTM3), Microsomal Epoxide Hydrolase (EPHX1) and N-acetyltransferase 2 (NAT2) genes were observed in the Maltese control samples and confirmed in other Geoparkinson countries. Description: M.SC. PUBLIC HEALTH 2009-01-01T00:00:00Z /library/oar/handle/123456789/42629 Title: Influenza vaccine coverage survey among high risk groups in Malta. Abstract: Influenza illness affects up to 20% of the population annually. Whilst it is a mild disease in otherwise healthy young persons, in older persons and those with chronic conditions, it can result in increased hospital admissions, increased morbidity and mortality. Seasonal influenza vaccination is therefore recommended in :Malta for all persons aged 55 years or over and all persons with chronic medical conditions making them at high risk of complications from Influenza. Healthcare workers should also be vaccinated in order to reduce sick episodes and to protect vulnerable patients. No data has been published in Malta on vaccination coverage rates among these at risk groups. The main objective of this thesis was to measure vaccination coverage rates among these target groups in order to inform policy makers and recommend ways of improving vaccinatlon coverage. This thesis reports on three studies, a telephone survey among persons over 55 years of age, a mailed questionnaire to persons of any age suffering from chronic conditions and a survey of healthcare workers employed in various settings. Vaccination coverage was estimated for all groups and risk factors for vaccination identified. Reasons for non-vaccination were also explored. Vaccination coverage rates were 56.3% among persons aged 55 years or over; 55.3% among all persons with chronic diseases and 56.5% among healthcare workers. Vaccination coverage was highest among persons aged over 65 years who suffered from chronic conditions. Persons over 55 years of age were more likely to be vaccinated if they believed that influenza vaccination was effective, believed influenza to be a serious illness and were over 65 years of age. Persons with chronic conditions were more likely to be vaccinated if they were not employed, did not believe influenza vaccine cause influenza illness and believed that the vaccine was effective. Among healthcare workers, vaccination coverage depended mainly on their place of employment, if they did not believe that vaccination did caused influenza illness and if they believed that influenza vaccination was effective. Among all groups, being previously vaccinated was strongly associated with vaccination during the study season. Description: M.SC. PUBLIC HEALTH 2009-01-01T00:00:00Z /library/oar/handle/123456789/41414 Title: Health behaviour counselling in primary care : general practitioner-reported rate and confidence. Abstract: Aims The main aim of the study was to identify variables associated with GPs' self-reported rate of health behaviour change counselling and confidence in counselling abilities. The study also tried to elucidate the association of doctors' personal health behaviours with self-reported rate of health behaviour counselling and confidence in counselling abilities. Methodology A repetition of a study done at the Mayo Clinic, Rochester, USA, by Vickers, et al., (2007) was done using the same tool which was a self-filled questionnaire. 326 questionnaires were mailed to all GPs on the specialist register. The survey was completely anonymous. Self-reported items assessed rate of health behaviour change counselling, perceived importance of counselling, extent of counselling training, confidence in counselling abilities, and GP personal health behaviours. Comparison of the results of the 2 studies was made. Using the same questionnaire a semi-qualitative approach was used to identify GPs' barriers to and perceptions about health behaviour counselling. Results The response rate was 70 per cent. The male doctors were slightly overweight and their exercise frequency on a regular basis was low. Almost 74 per cent of the doctors never smoked. Quantitative analysis showed that perceived importance of counselling and confidence in counselling were associated with GP self-reported rate of health behaviour counselling. Years in practice, extent of training, and importance of counselling were significantly associated with confidence in counselling in a multiple regression model. Qualitative analysis revealed that the main perceived barriers to counselling were insufficient time, patients' non-compliance and patients not ready to change. Further analysis revealed that most of the doctors believed that counselling in health behavior change in primary care was very important and that they had to be role models for their patients as regards health behaviour. Discussion & Limitations Objective, validated measurement of health behaviour and counselling behaviour is preferable to the single self-reported items developed for use in this study. Only the general confidence in abilities to deliver health behaviour change counselling was assessed and not the confidence in overcoming the specific barriers to counselling. Additional research is needed to understand the relationship between doctor personal health behaviour, perception of patient opinion regarding doctor's health behaviour, and how these issues interact and impact doctor-patient communication about health behaviour. Further research in this area is needed to determine if multi-disciplinary training could improve the rate or impact of health behaviour counselling in primary care. Conclusions Perceived importance of counselling and confidence in counselling were associated with GP self-reported rate of health behaviour counselling. But extent of training in health behaviour counselling was not associated with GP self-reported rate of health behaviour counselling. This could be due to the lack of training for GPs in health behaviour counselling. Years in clinical practice, extent of training, and perceived importance of counselling were significantly associated with confidence in health behaviour counselling. One third of GPs reported difficulty counselling patients on behaviours that they struggled with themselves. Recommendations Doctors should be trained in motivational interviewing and the trans-theoretical method, which are so important in helping patients recognise the need for a change in their health behaviours. Description: M.SC.FAMILY MEDICINE 2009-01-01T00:00:00Z