/library/oar/handle/123456789/32039 2025-12-23T01:34:53Z /library/oar/handle/123456789/111319 Title: Does summation of HMIP SNPs differentiate between the Hb F of the β°Codon39 and the β+IVS-I-6C thalassaemia heterozygotes? Abstract: This research was intended to confirm the observations of Daw (2012) regarding the differential effect of summation of SNPs at the HMIP locus on (absolute) Hb F levels between β thalassemia (thal) heterozygotes with, either the β°Codon39T, or the β+IVS-I-6C mutations. The β°Codon39T mutation has been known to result in higher Hb F among heterozygotes and homozygotes. However, with the exception of the confounding effect of the conditional dimorphism (C/T) at -158 in the Gγ promoter, known as the XmnI site, an adequate explanation has not been available. The total dataset was increased from 167 of Daw, to 277 in this study. Furthermore, the thalassaemia heterozygotes with mild anaemia were separated from the rest with normal Hb level. Two cis regulatory loci, the Xmnl site and the (AT)xTy polymorphism as well as two trans regulatory sites, BCL11A and HMIP polymorphism were sequenced. Neither one of the trans or cis- regulatory sites nor the BCL11A were found to have significant effect on Hb F level. However, the Hb F of the 35 β°Codon39T heterozygotes with total Hb ≥ 10 g/dl was significantly different from that of β+IVS-I-6C hetetrozygotes (P < 0.005). In particular, those with HMIP (++++) haplotype had Hb F of (24 ± 9 N=8) in the β°Codon39 thalassaemia and (9 ± 2 N=10) in the β+IVS-I-6C thalassaemia even when all cis and trans heterogeneities tested were accounted for. Any explanation appeared inadequate at this stage, but functional experiments could serve to distinguish between alternative mechanisms including the possibility of a trans-regulator that bound both the HMIP locus and the p globin gene around β°Codon39T competitively or cooperatively. A much larger data set is being sought together with the direct quantification of the absolute HbF by immuno-assay and the enumeration of F-erythrocytes by flow cytometry, in order to put the observation on more solid ground and explore possiable mechanisms. Description: M.SC.BIOMED.SCI. 2013-01-01T00:00:00Z /library/oar/handle/123456789/44865 Title: Medication adherence practices among patients attending the primary health care medical consultant clinics in Malta Abstract: This study aimed to explore factors of adherence/non-adherence among patients attending the medical consultant follow-up clinic within five health centres in Malta These health centres were B'Kara, Gzira, Paola, Rabat and Mosta This was a quantitative cross-sectional study and regarded both current and past practices regarding treatment adherence to medication. The research objective aimed to assess: a) Prevalence of medication adherence within the said population b) Barriers to adherence practices c) If socio-demographic and socioeconomic factors within the chosen population affect medication adherence. d) If polypharmacy can affect medication adherence. e) If attendance to the medical clinics affects adherence to prescription medication. As the population chosen for the study is being followed-up at the medical consultant clinic [MCC], the research aimed to see if patients who attend for follow-up are more likely to adhere to their medications. For study eligibility patients had to be over 40 years of age, in possession of a Schedule V card as they had to be suffering from a chronic disease, and attending for MCC follow-up in one of the said clinics at the time the data collection took place. Structured interviews were carried out using the ©MMAS-8 questionnaire. A sample size of 480 patients was needed to achieve a 95% confidence level and a 5% confidence interval. A response rate of 85% was achieved after 401 questionnaires were collected by the researcher using face to face interviews with the patients involved in the study. Of the respondents 159 (39.65%) were male and 242 (60.53%) were female. Age distribution ranged from 40 to 80+years, the most prevalent age group in the cohort of patients was in the 60-69 age groups. Statistical analysis was carried out using STATA-software and Microsoft excel. Where population numbers were >5 the Pearson chi squared test was used. The Fishers' exact test was used to analyse the categorical variables in tables that had numbers <5. Spearman correlation coefficient, a measure of association between two variables was used to calculate if there is an association between number of tablets taken by respondents and adherence to medication. A p-value of less than 0.05 was considered as being statistically significant. Results of the study revealed an overall medium medication adherence level of 6.5. As predicted in the literature effects of non-adherence were gender, socioeconomic factors, smoking and polypharmacy especially in the older age group. A borderline p-value was achieved for age and patients who self-manage their medications. From the data collected educational level, marital status and living situation did not show any association to adherence levels. Future research would need to be more specific to involve other populations, as this study involved a specific population within a specified environment. Research should also include other disease and conditions to be able to assess if medication non-adherence exists within other areas and disease conditions. Description: M.SC. PUBLIC HEALTH 2013-01-01T00:00:00Z /library/oar/handle/123456789/42984 Title: Beliefs and attitudes on antibiotic use in Malta : informing intervention strategies Abstract: The use of antibiotics in the treatment and prophylaxis of bacterial diseases has contributed greatly to the reduction of the burden of infectious disease. However, trends show that with time, the emergence and spread of antibiotic resistance IS continuously threatening the effective treatment of some important infections. Amongst the determinants of inappropriate antibiotic use, literature has underlined patient education level, expectations of physicians and patients, cultural aspects, regulatory practice, and antibiotic price as the main contributing factors. The main aim of this research was to assess the knowledge, attitudes and perceptions of antibiotic users and to identify any changes in antibiotic consumption since the last survey done in 2009. The second part of the study was to determine the knowledge, attitudes and perceptions of prescribers. The combined aim was to get information to be able to inform strategies for effective interventions to promote appropriate antibiotic use. After a comprehensive literature review, it was established that the best way to achieve the aims was to carry out two retrospective cross-sectional surveys, one with the public and one with prescribers. Results from these studies showed that since 2009, when antibiotic consumption for Malta was last studied through a Eurobarometer study, there has been a 17% reduction in antibiotic consumption and a further improvement in non-prescribed use, with 96% of respondents having obtained their antibiotics with a prescription. The most commonly used antibiotics are the beta-lactams, particularly co-amoxiclav. The use of the narrow spectrum antibiotics is almost non-existent. Antibiotics were taken primarily for sore throat, followed by chest infection and flu and were almost all prescribed by private community general practitioners. Topical antibiotic use is high and used for minor skin conditions. What is concerning is the high level of non-prescribed use for totally inappropriate indications. The knowledge of the antibiotic users was not good, in particular in terms of the viral cause of cold and flu and the fact that antibiotics do not kill viruses. Their attitudes were also not conducive to proper antibiotic use - more than half stated that they expect a prescription for antibiotics for a cold and that they know they need an antibiotic for a sore throat before they go to the doctor. Knowledge and attitudes were better in females and the better educated. This must be taken into consideration in any intervention strategies to improve antibiotic use. Almost all the physicians had prescribed an antibiotic in the previous week, the majority prescribing more than three. Personal knowledge and previous experience were the factors that doctors considered that influenced them most in their prescribing decisions, possibly showing that most of them work in isolation. Physicians underestimated the level of resistance in the community and attributed it more to hospital rather than ambulatory care. However, general practitioners were more knowledgeable about resistance levels than the non general practitioner cohort. Whilst they identified the major causes for increasing resistance as overprescribing of antibiotics, especially broad spectrum antibiotics and inappropriate use for viral infections, their behaviour was not found to be in congruence, as they admitted that they prescribe mostly broad spectrum antibiotics, the main reason given being lack of laboratory support. Another finding which corroborates the attitudes reported by the public was that more than half said that patients specifically ask them for antibiotics. Prescribers identified the availability of national resistance data and guidelines and protocols as the preferred measures for improving prescribing. Due to the fact that knowledge, attitudes and perceptions in the public survey were only studied in antibiotic users, the results do not necessarily reflect those of the general population. Other limitations which effect validity of the study are response and selection bias. The representativeness of the results of the physician survey is also limited by the low response rate and by responder bias because of the methodology chosen. In conclusion, it is evident that there is no simple relationship between knowledge and attitudes and more prudent antibiotic use. Future national antibiotic campaigns should be targeted to defined audiences and aim to improve use of antibiotics by prescribers and the public. With these data, a number of recommendations were made for the design of strategies to optimise use of antibiotics. Description: M.SC. PUBLIC HEALTH 2013-01-01T00:00:00Z /library/oar/handle/123456789/40423 Title: Genetic analysis of olive (Olea europea L.) varietes in the Maltese islands using DNA markers: method development and technique evaluation Abstract: The Maltese Islands have a long history of association with the cultivation of olive (Olea europaea L.). Being geographically isolated, the Islands host a number of indigenous varieties that show physical and agronomic traits that make the trees highly adapted to the local pedoclimatic conditions. Morphological marker identification of olive varieties is limited because it is subjective and influenced by the environment and farming practices. DNA molecular markers such as Random Polymorphic DNA (RAPD) and microsatellites embedded within the genome remain largely unaffected by the outside environment and therefore provide a more accurate method of identification. Locally, no previous genetic work making use of these markers has been reported for the olive. Therefore, the purpose of this study was to carry out a genetic diversity assessment focusing on three local cultivars of interest ("Bidni", "Bajda" and "Malti") and one form of the Maltese wild olive ("Oleaster") which were compared to two commercial Italian and Tunisian varieties ("Carolea" and "Tunezina" respectively). Development of the methods used for DNA extraction and marker amplification is discussed. The markers were chosen following strict selection criteria. A number of similarity indices, based on binary (presence-absence data) and allele frequencies, were used to provide estimates of the genetic similarity between any two varieties and to evaluate the performance of each. Cluster analysis was also carried out to generate dendrograms representing genetic relationships between the varieties. Additional tests that were carried out to determine the reliability and robustness of the methods are also discussed. A high inter-varietal genetic variability was found with both marker types. The total percentage polymorphic loci for RAPD markers was equal to 84.84% while an average of 4.86 alleles were detected per microsatellite locus. Indeed, one microsatellite locus generated six different allele combinations, allowing identification of all six varieties. Therefore, the local olive genome is composed of a very diverse group of cultivars, with "Bidni" and "Malti" standing out for their genetic uniqueness. This polymorphic content can be commercially useful in varietal identification for breeding programs, in obtaining certification of Maltese Olive Trees and in tracing the authenticity of Maltese olive oil. It has also been further demonstrated that the Maltese cultivars may exhibit significant genetic differences from other 0. europaea varieties because three out of seven microsatellite marker regions may not be conserved in the former. Tile marked differences generated in the two types of markers were attributed to the fact that they check for different parts of the genome. Cluster analysis has shown that similarity in the RAPD profile may not linked to geographic origin or fruit characteristics whereas a clear-cut separation is evident between Maltese varieties and foreign ones. Moreover, since "Oleaster", "Bidni" and "Malti" did not form any close clusters it is implied that perhaps their origins are not directly linked despite the fact that they are Maltese natives. In general, this work represented an important, preliminary step in setting up the methods for using DNA molecular markers to provide the very first insights regarding genetic diversity in local olives. It demonstrates that DNA markers can be used as a financially viable method of identification provided that the unique marker profiles are conserved by clone propagation. Description: M.SC.MEDICINE&SURGERY 2013-01-01T00:00:00Z