/library/oar/handle/123456789/33638 2026-06-14T06:55:23Z /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/123456789/33692 Title: Allele scoring of genetic risk in previous gestational diabetes mellitus (pGDM) Abstract: This research was intended to assess the association of two panels of candidate genes (HI and IV) in Maltese probands with a past history of severe Gestational Diabetes Mellitus (pGDM; 2hrBG>11.0mmol/l) GDM affects ~_7% of all pregnancies and is defined as carbohydrate intolerance with onset or first recognition during pregnancy. Twenty-Six pto bands with pGDM aged 19 - 42 years were recruited to this study. All were overweight or obese with a BMI in excess of 25 Kg I m2. The frequency of Panel IV SNPs was determined in the pGDM group and the Maltese Neonatal Reference DNA Pool (Malta BioBank) by quantitative real time PCR (qPCR). Genotype distribution and allelic frequencies were compared between patients and control group. Odds ratios (ORs) and relative risk (RR) with 95% confidence intervals (Cl) were calculated for both panels using SPSS software version17.0. All selected genes of Panel IH were significantly correlated (RR of 1.7 to 2.5) with pGDM except resistin (nt1326 G-7C). Panel IV SNPs showed an association to pGDM namely, positive (4 SNPs) and protective (5 SNPs). The patients with pGDM had accumulated allele scores (SNIPLOTYPEST M) between 4 and 8. The higher Sniplotype scores were associated with considerably higher RR values (R2= 0.96). Ethnic influence is suggested by the significant association of B1B2 and B1B1 genotypes of IL4 VNTR with pGDM. IL-1RN VNTR genotyping showed that the BA genotype frequency was more common in the pGDM (23%) than in controls (0 %). The General Linear Model analysis suggested that the best genetic predictor/s of all glucose biomarkers was MTHFRC677T in Panel HI and IL-6(rs1800795 CIG) in Panel IV. Moreover, FTO (rs9939609 A/T) was the best genetic predictor of multiple anthropometric measurements including (BMI and waist circumference). The two step cluster analysis showed that the Absolute HbA1c (=Hb A 1c % X Hb g I dL) was the most powerful factor in the clustering process, but short of being statistically significant. It can be seen that the summation of a few alleles from the inflammatory and metabolic pathways may be sufficient to determine genetic risk for GDM as in T2DM. Robust associations with phenotypic markers with quantitative biomarkers such as anthropometry and the absolute Hb A 1c require further exploration. Description: M.SC.PATHOLOGY 2009-01-01T00:00:00Z