/library/oar/handle/123456789/33639 2025-12-22T22:23:22Z /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/123456789/40440 Title: Obstetrics and neonatal care in small islands Abstract: The promotion of a healthy pregnancy and safe childbirth is a major goal of most, if not all, health care systems. The WHO states that all women should have access to basic maternity care during pregnancy and delivery. Malta and Gozo have been monitored continuously thanks to the National Obstetric ¸£ÀûÔÚÏßÃâ·Ñ System and its predecessor projects. The data for a ten year period (1999-2008) was analysed for Malta and Gozo. The data was also analysed to compare with data collected from other similarly populated islands or states such as Gibraltar, Liechtenstein, the Shetland Islands and the Faroe Islands. The number of deliveries, island to island transfer, primiparous and multiparous rates, assisted and non-assisted deliveries, delivery complications and mortality rates of over 40,000 births were calculated for the Maltese Islands. The trends showed a gradual drop in birth rates in all islands with a stable and low complication rate. Primiparous births are becoming more common with the average age of the mothers slowly increasing possibly due to socioeconomic shifts. The numbers of single mothers is increasing drastically with a gradual decrease in births to married mothers mirroring this change. Assisted deliveries are becoming more and more common with the rates of caesarean deliveries increasing drastically over the past decade with no increase in maternal mortality. Malta and Gozo are both experiencing lower birth rates with the latter experiencing the lower rates. The socio-demographics of the maternal population are changing with more unmarried and older mothers giving birth to fewer children. The healthcare centres available in Gozo require an investigation into possible reforms. Data is needed to ensure that the most effective strategies for safe motherhood are integrated into essential service packages. Obstetric care in Gozo is comparable with that of other small island communities with similar populations and health systems. Description: M.SC.PUBLIC HEALTH 2009-01-01T00:00:00Z /library/oar/handle/123456789/40350 Title: Bridging the gap between health education and lifestyle practices in Maltese diabetic adults : identifying target groups and areas Abstract: This study was carried out among type 1 and type 2 adult diabetic patients attending Mater Dei, Mosta and Floriana diabetes clinics. It measures diabetes knowledge, diabetes-related distress and self-care, the relationship between these three parameters and factors influencing them. The study was carried out between October 2008 and February 2009. The study population was obtained through a sequential sample of 356 patients, 257 from Mater Dei Hospital, 39 from Floriana Health Centre and 60 from Mosta Health Centre. Patients were recruited on the day of their follow-up visit at one of the clinics, informed consent was obtained and details were extracted from the patient file. Patients were contacted at a later date to carry out a telephone interview. Of those eligible to participate, 313 responded, giving a response rate of 89.7%. The questionnaire administered collected Socio-demographic data and diabetes-related data. In addition, it contained three validated tools, namely the Michigan Diabetes Research Centre's Diabetes Knowledge Test to assess knowledge about Diabetes, the Joslin Diabetes Centre's Problem Areas in Diabetes questionnaire assessing diabetes-specific emotional distress, and the Self-Care Inventory - revised developed by the University of Miami to assess the patients' perceived level of self-care. The study has been approved by the University of Malta Research Ethics Committee, the data controllers of Mater Dei Hospital and Primary Health Care and the Head of Department of the Mater Dei Diabetes Clinic. Results revealed the mean diabetes knowledge score to be 50.23%. Diabetes-related distress was generally low (mean score 26.6%). Adherence to self-care was generally good (mean score 66.6%). Diabetes knowledge correlated positively with the self-care score, but not with diabetes-related distress. Although diabetes-related distress was found to correlate negatively with the diet and positively with the hypoglycaemia care and general prevention self-care sub-scores, there was no correlation with the total self-care score. While most results were in agreement with international studies, important factors influencing these three aspects of diabetes were identified. Age was found to be significantly associated with diabetes knowledge, as well as diabetes-related distress, while gender, body mass index and a family history of diabetes also influenced the latter factor. On the other hand, self-care was found to have a significant relation with the level of education and the type of diabetic medication one was taking. These results allow for the inception of recommendations for action, including self-care training programmes geared towards at risk groups, such as the elderly and those with poor education, providing psychological support to vulnerable patient groups, and increasing the importance given to self-care in the patient's management, both on a personal level and during interactions with healthcare professionals. Description: M.SC. PUBLIC HEALTH 2009-01-01T00:00:00Z /library/oar/handle/123456789/39986 Title: Perceived and actual cardiovascular disease risk factors, and the obstacles to reduce them, among a representative sample of the current and future medical profession in Malta Abstract: Background The aim of this study was to quantify the actual and perceived cardiovascular risk among medical students, community and hospital physicians in Malta and to study the cues and reasons for action. The objectives were to study the cues and reasons for action in medical students and doctors that could influence the adoption of less or more healthy lifestyles among medical health professionals, to identify the obstacles in the current and future medical health professionals' own cardiovascular disease risk reduction, to measure the prevalence of physical activity, tobacco consumption and body mass index among a representative sample of Maltese current and future health professionals and to assess and compare the current true and perceived risks for cardiovascular disease among current and future Maltese health professionals. Research Design and Methods 150 subjects were invited to take part in this study. They were randomly selected from the whole list of practicing Maltese physicians and of medical students. There were 60 hospital doctors, 60 community doctors and 30 medical students. The participants replied to a questionnaire regarding their perceived risk for cardiovascular disease. Blood pressure, body mass index and their waist and hip were measured. The subjects also had their blood tested for a lipid profile and blood glucose. The European SCORE (Systematic Coronary Risk Evaluation) risk charts were used to calculate the 10 year risk of fatal cardiovascular disease.Results A response rate of 71 % was achieved in this study. 46 hospital doctors, 39 community doctors and 21 medical students took part. 42.5% of the participants were females while 57.5% were males. The total prevalence of tobacco smoking was found to be 4.7%. 35.8% of the participants reported themselves as leading a sedentary lifestyle. More than half of all participants were in the overweight and obese ranges. 14% had a higher than normal blood pressure on examination. Almost 60% of the community doctors were in the moderate and high risk groups of waist to hip ratio, followed by 46% of hospital doctors and almost one third of medical students. Two-thirds of the participants had <1 % SCORE risk of fatal cardiovascular disease in 10 years while almost 2% had >5% risk. There was a statistically significant correlation between the actual and perceived risk of having a fatal cardiovascular event in the next 10 years (p-value 0.014). However there was a statistically significant difference between the actual and perceived levels of blood pressure, total cholesterol and glucose levels. The perceived barriers, benefits and cues to action toward cardiovascular risk were also analysed in the discussion. Conclusion The agreement between self reported 10 year cardiovascular mortality risk and that using the SCORE charts was good. However, the results suggest that doctors have a myriad of poor risk factor for cardiovascular disease, although tobacco and lack of physical activity do not feature in this. This study also provides food for thought on how doctors feel about giving advice to their patients when they themselves demonstrate poor risk factors. Description: M.SC. PUBLIC HEALTH 2009-01-01T00:00:00Z