/library/oar/handle/123456789/37994 2025-12-23T22:24:41Z /library/oar/handle/123456789/42003 Title: Pharmacoepidemiology of epilepsy in a paediatric neurology clinic. Abstract: Pharmacoepiemiology is the use of epidemiological methods to study the use of drugs and their effect on populations. Thus far, no pharmacoepidemiological studies regarding epilepsy have been carried out in Malta. Epilepsy is a common neurological condition and research initiatives have been promoted by the WHO's 2013 report on 'Priority Medicines for Europe and the World', emphasising the importance of addressing chronic non-communicable diseases which are characterised by high morbidity and mortality. This same document includes children among 'special groups' whose needs need to be addressed and in whom the management of illnesses needs to be prioritised since children are a vulnerable population with unique health needs. This study aimed to investigate pharmacoepidemiological aspects of epilepsy in population of Maltese children presenting to a paediatric epilepsy clinic by establishing whether local practices followed principles of rational prescribing and whether Maltese children with epilepsy had access to the best available care. In order to determine whether the care of children with epilepsy presenting to a specialist clinical followed principles of best prescribing practice, the clinical records of 76 children were reviewed retrospectively from the 31st December 2013 to the date of first presentation of each patient to hospital services for the management of epilepsy. Data collected was input into a spreadsheet and statistical data analysis was carried out. In order to determine whether Maltese children with epilepsy were able to access the best locally available care, pharmacy records were consulted in order to determine how many Maltese children with epilepsy were receiving free antiepileptic drug therapy in accordance with local the policy of providing free drug therapy for patients with specific chronic diseases in accordance with the fifth schedule of the Maltese legal code. In the paediatric epilepsy clinic, valproate was the most commonly prescribed AED overall (40.8%), possibly due to its good efficacy and wide spectrum of action. Lamotrigine was the most commonly prescribed newer AED (19.7%), as in other countries. The use of older AEDs exceeded that of newer ones, suggesting clinician confidence with working with time-tested drugs. The most commonly prescribed AED was combination was that of valproate with lamotrigine, which have a well known synergastic interaction. 48.7% of children were receiving AEDs as monotherapy, similar to studies from other countries. Around a third of the children (35.5%) were off AED therapy on the 31st December 2013 since they were in seizure remission. In 55.3% of cases the first AED started at diagnosis remained unchanged. AED selection was not affected by gender or comorbidity. It was also noted that lowest prevalence of children with epilepsy were living in Gozo. This could be due to travel issues since patients need to cross the Maltese channel by ferry in order to access the educated service at Mater Dei hospital, educational issues or issues of social stigma. The highest prevalence of children with epilepsy was found to be living in the South Harbour district of the Maltese Islands, an area which the latest concensus revealed to be at highest risk of poverty. This study identified that although the care available at the paediatic epilepsy clinic follows latest evidence and best practice principles, this care is not available to all Maltese children with epilepsy. A substantial number of children with epilepsy receive care from the generalist paediatricians. Hence the way forward would be to broaden the function of the clinic, provide more clinican training, design clinical practice guidelines and protocols, which could be extended to generalist paediatric teams and also community general practice teams. It was also found that an increasing duration of epilepsy did not lead to a decrease in the number of presentations to accident and emergency in view of seizure events, although children were receiving the best available care, even in terms of the selection of antiepileptic drugs used in clinical management. This calls for providing further education to children, parents, teachers, healthcare professionals and the general public in order to empower them in their role as part of the multidisciplinary management of the child with epilepsy, as well as minimising stigma. Results regarding demographic findings and selection of drug therapy are comparable to findings from studies from other countries but those regarding seizure semiology and aetiology differ between published studies. Despite its limitation of small numbers, selection bias and lack of computerised records as a data source, it may serve as a basis for further pharmacoepidemiological, qualitative and pharmacoeconomic studies which could guide local drug-related policy and facilitate access to care, providing equity for all citizens. Description: M.SC.PHARMACOLOGY 2014-01-01T00:00:00Z /library/oar/handle/123456789/41716 Title: The characterisation of the Maltese honey bee using morphometric and mitochondrial DNA analysis. Abstract: This study aimed to determine the status of the Maltese honey bee using morphometric and mitochondrial DNA analysis. In addition, the presence of introgression from neighbouring honey bee subspecies was investigated. Between October and December 2013, Apis mellifera samples were collected from 52 colonies across the Maltese Islands. Eight to ten bees per colony from a total of 35 colonies were dissected and examined for the 35 standard morphometric parameters proposed by Ruttner et al. (1978). Colony means were then calculated and compared to a number of reference subspecies (obtained from the Institut fÏ‹r Bienenkunde, Oberursel) using Principal Components Analysis, Factor analysis and K-means cluster analysis. The DNA from two samples for each of the 52 colonies were subjected to mitochondrial DNA analysis. The latter involved the amplification of the intergenic region between the Cytochrome oxidase C sub-unit I (COl) and Cytochrome oxidase C sub-unit ii (COII) genes, using the primer pair E2-H2. The latter intergenic region spans repeats of non-coding sequences, known as the P and Q sequences. Samples of each amplified fragment were subjected to RFLP analysis using the restriction endonuclease Oral, as well as to Sanger sequencing. Multiple alignment as well as manual investigation for specific nucleotide changes, with the aim of designating a specific mitochondrial haplotype, was then carried out. A neighbour-joining phylogenetic dendrogram was also constructed to observe clustering patterns. PCA and K-means cluster analysis confirmed the identity of the Maltese honey bee, A. m. ruttneri, as a separate subspecies, as well as showing the potential presence of a subpopulation. Introgression was minimally observed with the Sicilian subspecies and was absent with respect to the Italian subspecies. 83% of the samples were found to display the African lineage mitochondrial haplotypes A8, A9 and A4, whilst 17% of the samples were found to pertain to the European haplotypes Cl, C2 and M7. The sequences of the different COl-COll intergenic regions for the native A. m. ruttneri were established for the first time in the Maltese Islands. Some samples displayed a novel Po structure, that was never reported in previous studies. The use of both morphometry and mitochondrial DNA analysis provided a more complete picture of the status of the Maltese honey bee. Due to shared common North African haplotypes (A8 and A9), the Maltese honey bee could not be distinguished from the Sicilian subspecies based on mitochondrial DNA analysis. However, morphometry offered better resolution in completely distinguishing between these two subspecies. It was postulated that the origin of both the Maltese and Sicilian subspecies took place during the Messinian Crisis, through a northern migration of the North African A. mellifera subspecies. Aside from supporting the A. mellifera dispersion routes proposed by Garnery et al. (1992), this study gave further insight to the gaps present in the latter routes, showing possible evidence for the migration of North African bees towards Europe. The distinct nature of the Maltese honey bee was surprising after the infestation by the Varroa mite and subsequence importations of non-native bees and although only a small percent of colonies were found to pertain to non-native European haplotypes, proper regulation of imported honey bee nucs must be carried out to safeguard the native Maltese subspecies. Description: M.SC.MEDICINE&SURGERY; The research work disclosed in this publication is partially funded by the Master it! Scholarship Scheme (Malta), This Scholarship is part-financed by the European Union - European Social Fund (ESF) under Operational Programme 11 - Cohesion Policy 2007-2013, "Empowering People for More Jobs and a Better Quality Of Life." 2014-01-01T00:00:00Z /library/oar/handle/123456789/39644 Title: An investigation into the beliefs about medicines using the belief about medicines questionnaire - BMQ Abstract: Investigating beliefs about medicines has been of interest over the past years, with studies aiming to better understand theoretical reasons behind the development of such beliefs. Studies have already shown that the majority of people have negative beliefs about medicines, which might in tum have a negative effect on treatment outcomes and adherence. It is therefore important to assess beliefs about medicines since they can give insight into a better approach for having an effective health care system, with the intention of reinforcing positive beliefs in medication. This study aims to investigate whether students from different academic backgrounds hold different beliefs about medicines, and whether students' beliefs in medicines, as part of general health beliefs, differ from those of their mothers and maternal grandmothers. Medication beliefs were evaluated using the Beliefs about Medicines Questionnaire - BMQ, which is divided into two sections; BMQ-General (sub-scales: Overuse and Harm, 4 items per sub-scale) and BMQ-Specific (sub-scales: Necessity and Concerns, 5 items per sub-scale). The BMQ was first translated then validated in the Maltese language. The validation, using the Maltese BMQ, was carried out at Mater Dei Hospital, on four chronic illness groups comprising asthmatic, diabetic, cardiovascular, and depression patients, between June and September 2013. Investigation into medication beliefs of students, their mothers and grandmothers was carried out at University of Malta from October 2013 to January 2014. For the validation sample, the distribution and collection of the tool was carried out on the same day. This was also the case for the questionnaires distributed to students. Mothers' and grandmothers' questionnaires were collected a week later. The Validation of the BMQ showed acceptable internal consistency for the harm scale (a = 0.56), the necessity scale (a = 0.73) and the concerns scale (a = 0.66), however the overuse scale gave poor internal consistency (a = 0.48) due to the item on natural remedies which posed some difficulty in the Maltese validation sample. The final solution for Principal component analysis yielded a four factor structure representing the 4 sub-scales of the BMQ, with results being comparable to previous validations carried out in different languages. Internal consistency on the students sample confirmed validity of the BMQ scales (General: Overuse a= 0.64; Harm a= 0.52; Specific: Necessity a= 0.82; Concerns a= 0.69) A total of 738 students from 14 faculties participated in the study. Investigation of the beliefs about medicines in these students revealed that 83.7% believed that doctors overprescribed medicines (Score: 14.183±3.55), whereas a total of 28.6% believed that medicines were harmful in nature (Score: 10.054±0.44). A total of 104 students self-reported having a chronic condition, with 52.4% of these students believing that medicines were necessary for their chronic condition (Score: 14.540±4.79), while 38.1% of the students had some concerns about adverse effects (Score: 12.143±5.30). There were no significant differences present between students from different faculties for the overuse scale, however significant differences were found on the harm scale. Students from the Faculty of Medicine and Surgery and the Faculty of ¸£ÀûÔÚÏßÃâ·Ñ and Communication Technology perceived medicines to be less harmful than students [rom other faculties (p<0.05). Predictors of medication beliefs were found to be course background, living with parents and region. Students with a scientific background were more likely to perceive medication as less overused, less harmful and be less concerned about adverse effects. Students following a course leading to a patient-oriented profession, living with their parents and residing in the Northern Harbour district, South Eastern district, Western District, and Northern district were also more likely to perceive medicines as less harmful. Trans-generation analysis revealed that there was a gradient across medication beliefs, with younger generations having less negative views about medication when compared to the older generations. In the case of the overuse scale, significant differences were observed between students and mothers (students: 14.153±2.53; mothers±2.53, p=0.04); and students and grandmothers (students: 13.863 ±2.56; grandmothers: 14.715±2.37, p=0.00); but no significance difference was found between students' mothers and students' grandmothers, (mothers: 14.577±2.39; grandmothers: 14.715±2.38, p=O.55). Significant differences emerged on the harm scale between the students and their mothers, (students: 9.983±2.36; mothers 10.694±2.61, p=0.00); students and their grandmothers (students 9.750±2.48, grandmothers 11.476±2.80), p=0.00); and students' mothers and students' grandmothers (mothers 10.610±2.49, grandmothers 11.463±2.81,p=0.00). The Maltese version of the BMQ is a valid tool for analysis of beliefs about medicines in the Maltese population. Description: M.SC.PHARMACOLOGY 2014-01-01T00:00:00Z /library/oar/handle/123456789/35048 Title: The validation of a guideline algorithm for the antibiotic treatment for infected lower limb wounds or ulcers Abstract: Lower limb and foot ulcers are a common complication arising from multiple causative factors including peripheral vascular disease, excessive pressure and neuropathy. Pharmacological management is introduced if an infection is present. Infections are identified through clinical manifestations (signs and symptoms). These include erythema, pus, cellulitis and malodour amongst others. Moreover in order to appropriately treat a wound infection through the use of antibiotics, it is necessary to correctly identify the infecting organisms, through the use of culture testing. Antibiotic guidelines are used in order to aid practitioners administering the correct antibiotics to treat infections. In fact the Antibiotic Team at Mater Dei Hospital (MDH) the main teaching hospital in Malta have created an algorithm for lower limb wound infections and ulcers. The aim of this study was to assess and validate this algorithm. In addition, other secondary objectives were identified such as the importance of proper cleaning of a wound prior to taking a wound swab, identifying the importance of proper antibiotic treatment, exploring the relationship between the Ankle Brachial Pressure Index (ABPI) and wound improvement, and identifying any other parameters which might be implicated in wound improvement. To achieve these aims, 80 patients were identified who fulfilled the inclusion and exclusion criteria through non-probability sampling. Patients were selected from MDH Surgical Out- Patients, MDH Tissue Viability Clinic, and St Vincent De Paul Residence for the elderly (SVPR). The methodology used included, first and foremost, obtaining informed consent from the selected patient following patient selection. Demographic data of the patient was then was then performed using a specific form designed by the researcher. A wound swab for culture and sensitivity was taken from the wound pre-cleaning and post-cleaning twice with saline as advised by the antibiotic team. The Levine technique was the method employed to take the wound swab. The Bates Jensen Wound Assessment Tool (BJWAT) was then filled up by the researcher. The Ankle Brachial Pressure Index, (ABPI) was then calculated, and patients were administered antibiotics by the doctor according to the algorithm. Patients were then assessed during two more visits, where the BJW AT and the demographic data were filled on each occasion as required to monitor wound improvement. Following data collection, the patients were classified according to risk for antibiotic infection and for severity of wound infection. Analysis of the results indicate that the algorithm created by the MDH antibiotic team was validated, with a p-value of <0.001 in all the parameters of the BJW AT. Results indicate a p-value of 0.010 for wound improvement in those individuals who were compliant versus those non- compliant with the algorithm. Results also indicate that wound cleaning is imperative for proper identification of wound bacterial flora. In fact findings showed that the highly mixed cultures decreased from 38 to 4 individuals from pre-cleaning to post-cleaning. Moreover, the importance of wound cleaning was evident since, a statistically significant result with a p- value of < 0.001 was obtained for difference in number of organisms pre-cleaning and post-cleaning. ABPI was found to be important for wound improvement, as individuals who had a decreased ABPI and who have had a revascularization procedure, obtained better mean results, even though no significant p-value was obtained. Other parameters which were found to effect wound improvement were steroids, antiplatelet drugs, analgesics, and IDDM and NIDDM. Hence it can be concluded that the algorithm is validated. Moreover this study highlights also the importance of proper wound cleansing prior to taking a wound swab in order to identify the true infecting organisms. This study will be of benefit to patients and also to stakeholders, in reducing the unnecessary use of inappropriate antibiotics, which increase antibiotic resistance and also reduces medical costs of unnecessary antibiotic administration and hospital stays. Moreover this study highlights the importance for a protocol for proper wound swabbing technique, for the identification of infecting microorganisms, which will in turn, increase the reliability and validity of wound swabbing hence guiding appropriate antibiotic treatment. Description: M.SC.PHARMACOLOGY 2014-01-01T00:00:00Z