/library/oar/handle/123456789/36334 2025-12-24T11:00:50Z /library/oar/handle/123456789/111308 Title: The impact of physical activity in glycaemic control of type 2 diabetic adults amongst the Maltese population Abstract: Type 2 diabetes is one of the major causes of disability and death in Malta due to the complications accompanying this disease. For the well-being of the patient, and from a public health perspective, the development of effective intervention strategies is essential in order to reduce the incidence of Type 2 diabetes mellitus and its resulting complications. For the patient, and for society at large, early intervention programmes are beneficial especially from a cost benefit perspective. Physical activity has been considered by many international studies as having major influence on delaying the complications of diabetes due to its impact on the metabolic system. Exercise training also improves many other physiological and metabolic abnormalities that are associated with Type 2 diabetes mellitus such as lowering body fat, reducing blood pressure and normalising dyslipidaemia. In Malta however, research about the subject had not been carried out prior to this study. The findings of the present study may be used to help plan a more effective health promotion and education campaign with a view of reducing complications caused by Type 2 diabetes. Since physical activity has been shown in prospective studies to protect against the development of Type 2 diabetes mellitus, physical training programmes suitable for individuals at risk for Type 2 diabetes should be incorporated into the medical care system to a greater extent to help improve glycaemic control in people. Thirty-four persons with type 2 diabetes took part in a seven-month exercise programme. Data collection from the Intervention Group was a continuous process throughout the exercise programme and a questionnaire was also administered at the end of the exercise sessions. The findings from this study support those of international studies: that exercise improves glycaemic control, reduces weight and lowers lipid levels. Increased attendance for exercise was reflected in increased reduction of HbA 1 c, which is an indicator for improved glycaemic control. Recommendations for further studies will be suggested to investigate the effectiveness of dietary restriction and exercise. Description: M.SC.PUBLIC HEALTH 2004-01-01T00:00:00Z /library/oar/handle/123456789/43379 Title: A new approach to the management of weight problems in a primary health care setting. Abstract: Obesity has over the past few decades become a global public health problem and in Malta there is a high prevalence of overweight and obesity in adults as indicated by the WHO MONICA study carried out in 1984. The aims and objectives of this research were to determine the prevalence of weight problems of doctors and nurses working in the Maltese governmental Primary Health Care Department by means of a questionnaire; to look at their general health, dietary habits and lifestyles; to assess their awareness of weight problems, prejudice, positive and negative attitudes and to analyze their comments and suggestions and to make recommendations on how to increase the involvement of primary care professionals in dealing with weight problems. Deficiencies in relation to training and communication skills of doctors and nurses were also explored together with suggestions for dealing with these problems. The study population consisted of one hundred and fifty one doctors and nurses working at all the Health Centres in Malta, within the Primary Health Care Department. Besides answering a questionnaire, the study population had measurements of height and weight recorded by means of a stadiometer; the body mass index (BM I) could therefore be calculated. The waist circumference was measured in centimeters, by means of a standard tape measure and in fifty five individuals skinfold thicknesses were measured with calipers to estimate body fat percentage. The results showed that there was a moderately high prevalence of overweight and lower grades of obesity in doctors and nurses, especially in males. Although the study subjects knew what constituted a healthy diet, their irregular and long working hours made it difficult for them to maintain a healthy weight, this being exacerbated by a general lack of physical exercise. The risk of developing three main complications of excess weight: Type 2 diabetes mellitus, hypertension and coronary vascular disease was assessed using each subject's 8M I and waist circumference. In general, males from all categories had the highest disease risk whilst in females, risk, although present, was not so pronounced except for female nursing officers, due to their sedentary jobs. A training deficit and poor communication skills were found to be present as regards the management of patients with weight problems in both doctors and nurses. Special training courses in weight management were recommended by the majority of these healthcare professionals. The idea of setting up of 'Weight Management Clinics' at the Primary Health Care level was well supported by the great majority of doctors and nurses. These clinics, which would be a new innovation, in the Maltese governmental Primary Health care setting, would comprise a team consisting of a physician specialized in dealing with overweight and obesity, a nurse, a nutritionist, an exercise physiologist and a psychologist. This team would receive referrals of patients with excess weight problems, from both the primary and the secondary health care spheres in Malta. A holistic approach to the management of these patients would then be guaranteed which would result in successful weight reduction and healthy weight maintenance throughout life. Description: M.SC. PUBLIC HEALTH 2004-01-01T00:00:00Z /library/oar/handle/123456789/41420 Title: Enantioselective disposition of MDMA in Maltese users. Abstract: The amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA; "Ecstasy") is a popular drug misused by teenagers and young adults. The belief that MDMA is a safe drug has led to its widespread abuse worldwide. MDMA and its active metabolite, 3,4-methylenedioxyamphetamine (MDA), have serious toxic effects related to the amphetamine-like actions of both drugs. The pharmacology of MDMA displays both sympathomimetic activity and a distinct set of effects (closeness to others, euphoria, increased friendliness towards others, empathy), which led to the creation of a distinct pharmacological class (Entactogens). The effects of MDMA, a consequence of an acute serotonin (5-HT) release, are increased wakefulness, sense of energy and postponement of fatigue, leading to increased muscular activity and endurance, one of the reasons for its popularity in "rave" parties. The excessive muscular activity coupled with a direct effect on the thermoregulatory system in the brain causes an increase in body temperature, which can lead to rhabdomylosis, often with fatal outcomes. The serotonin-releasing properties of MDMA and MDA enantiomers are different and the S-enantiomers, of both drugs, are more potent than the R-enantiomers. The importance of R-(-)-MDMA, S-(+)-MDMA, R-(-)-MDA and S-(+)MDA in acute intoxication (OD) cases, was examined and compared with drug screening (DS) cases, where toxicity was not evident. Urine samples, from both case groups, were analysed by Gas Chromatography-Mass Spectrometry (GC-MS) using a homochiral-derivatizing agent on an achiral Gas Chromatography (GC) column. The results were evaluated by a Mann-Whitney non-parametric statistical analysis. The concentrations of R-(-)-MDMA and S-(+)-MDMA were elevated in OD cases by a statistically significant amount (asymptotic significance 2-tailed <0.05 and <0.001 respectively), but R-(-)-MDA and S-(+)-MDA urinary concentration differences were not statistically significant between the case samples (asymptotic significance 2-tailed >0.05 for both enantiomers). These findings may indicate a potential direct role of MDMA enantiomers in acute intoxication. The RIS MDMA ratio was lower in OD cases (median value 1.6) than in DS cases (median value 2.9), and is possibly indicative of the more important contribution of the S- enantiomer in acute toxicity. The RIS MDMA ratio may possibly be a useful indicator in the clinical evaluation of MDMA toxicity in clinical cases when other trauma (such as head injury) confounds the diagnosis. Description: M.SC.PHARMACOLOGY 2004-01-01T00:00:00Z /library/oar/handle/123456789/33957 Title: A comparison of the effects of paracetamol and a corticosteroid against a non-steroidal anti-inflammatory drug on the sequelae following the surgical removal of mandibular third molars Abstract: The reduction of postoperative discomfort from oral surgical procedures is an area of great concern to all practicing dental surgeons, as well as their patients. Pain, swelling and trismus (limitation of opening) are the common sequelae after surgical removal of impacted mandibular third molars, and a wide variety of therapeutic measures have been used to reduce the incidence ofthese sequelae. The factors contributing to the postoperative pain, oedema, and trismus (a form of loss of function) are complex, but many of the contributing factors are related to the inflammation following tissue trauma. These may, therefore, be reduced in intensity or severity by pharmacologically controlling the extent of the inflammatory process. In most cases, unless contraindicated, non-steroidal anti-inflammatory drugs (NSAIDs) have been used to prevent postoperative pain, while corticosteroids appear to have maximal effect in controlling oedema, but have minimal analgesic effects. In this double-blind randomised controlled clinical trial, a combination of oral paracetamol Ig and oral dexamethasone lmg four times daily, was evaluated against oral diclofenac sodium 50mg three times daily, for the control of postoperative pain, swelling and trismus following the surgical removal of mandibular third molars under local anaesthesia. The purpose for such a study was to find an alternative drug regimen for the control of the common postoperative sequelae of oral surgery, especially for those patients in whom the usual drug regimens (e.g. NSAIDs) are contraindicated. Postoperative pain was recorded 8-hourly by the patients using a visual analogue scale pain chart for 7 days, while facial swelling and trismus were assessed by the investigator on the second, fourth and seventh postoperative days. Facial swelling was determined using a measuring tape, while trismus was evaluated by measuring maximal interincisal opening. ANOVA for repeated measures analysis indicated that the patients in the paracetamol and dexamethasone group experienced an overall mean reduction of 36% in pain (p<0.05), of 76% in facial swelling (p>0.001) and of 56% in trismus (p>0.001) as compared to the patients in the diclofenac sodium control group. Levene's test for equality of variances showed that the inter-patient variation with respect to pain, swelling and trismus in the paracetamol and dexamethasone group, was also significantly less than that in the diclofenac sodium group (p<0.05). Pearson bivariate correlation tests show that the reduction in swelling and trismus (p<0.05) are significantly correlated in both groups. None of the patients reported any adverse drug reactions. It could therefore be concluded that in the absence of contraindications, a combination of oral paracetamol Ig and oral dexamethasone lmg four times daily, was significantly superior to oral diclofenac sodium 50mg three times daily, in safely reducing the postoperative pain, swelling and trismus following the surgical removal of mandibular third molars under local anaesthesia in otherwise healthy patients. Also, a more predictable and consistent patient response could be expected with paracetamol and dexamethasone combination therapy than with the diclofenac sodium. This may be especially beneficial for those patients in whom the usual drug regimens (e.g. NSAIDs) are contraindicated. The use of paracetamol and dexamethasone• combination therapy following this kind of oral surgical procedure, may also obviate the need for the common hospital practice to admit patients overnight in order to allow parenteral administration of opioid analgesia if necessary, thus reducing healthcare costs and avoiding opioid-associated adverse effects. Description: M.SC.PHARMACOLOGY 2004-01-01T00:00:00Z