OAR@UM Collection:

A qualitative study : the experience of general practitioners with elderly patients with osteoarthritis

Thu, 01 Jan 2015 00:00:00 GMT

Title: A qualitative study : the experience of general practitioners with elderly patients with osteoarthritis Abstract: Background: Osteoarthritis is a degenerative condition commonly effecting elderly patients in the community. There is a "demographic transition" leading to an ageing population. Aim: To perform a qualitative study about how general practitioners (GPs) look at osteoarthritis, its effects on patients' lives as regards the biopsychosocial model. The aim is to analyse the GPs' perspectives about the local available sources and any possible improvements. Methods: Interpretative phenomenological analysis (IPA) was used as it allows discovering the details of each individual GP. Two GPs who have been practising for more than 5 years within the community where selected through the Malta Association for Family Doctors. Snow balling was used to recruit the other two. Semi-structured interviews were then conducted transcribed and analysed. Results: There was a common feeling that dealing with such a common disease is challenging within the community and there is a need for a specialised osteoarthritis clinic in the community to cater for all these patients' needs via a multidisciplinary team. The need for a holistic approach was agreed amongst all the participants. Conclusion: Osteoarthritis is a common, challenging condition which is treated by GPs; but being multi-faceted input from other professionals is required. Description: M.SC.FAMILY MEDICINE

Pharmacogenetic aspects of thiopurine methyltransferase in Maltese individuals.

Thu, 01 Jan 2015 00:00:00 GMT

Title: Pharmacogenetic aspects of thiopurine methyltransferase in Maltese individuals. Abstract: Thiopurine methyltransferase (TPMT) is an important enzyme for the metabolism of thiopurine drugs, and pharmacogenetic variability has been associated with serious adverse effects in treated patients. There is currently no information on TMPT gene variants in the Maltese population. The aims of this project were to (i) identify the frequencies of the clinically relevant alleles *2, *3B and *3C and (ii) screen the TPMT gene promoter for novel variants. DNA was obtained from patients suffering from Crohn's disease, and from anonymous random samples maintained at the Malta Biobank. Genotyping and promoter screening were carried out using PCR-RFLP, tetraprimer ARMS-PCR and Sanger sequencing. Assays were designed and optimized accordingly. Where necessary, bioinformatic tools were used for assay design and analysis of results. We identified the following allelic frequencies: TPMT*2: 0% (n=390) including both Crohn's and Biobank cord blood samples, TPMT*3B: (n=390) of which 41190 or 2.1 % of Crohn's patients' samples and 11200 or 0.5% Biobank cord blood samples, TPMT*3C: (n=856) of which 11172 or 0.6% of Crohn's patients' samples and 3/684 or 0.4% Biobank cord blood samples. Promoter sequencing (n=126 chromosomes) revealed 3 SNPs (4567T>A, 4621T>A, 4793A>T) and 5 different homozygous or heterozygous deletions of 17 or 34bp starting at different points between positions 4989-5023 (cumulative allelic frequency 36.9%, n=138)(NCBI Accession NG_012137.2). Two of these deletions were tandem repeats (VNTRs), while another deletion was in incomplete VNTR due to two mismatches. We also identified a hypervariable region terminating approximately 40bp upstream of the transcriptional start site (TSS) having multiple heterozygous SNPs that could not be electronically deconvoluted to indel variants. TPMT pharmacogene allelic frequencies are comparable to international reported values. The identified promoter variability could potentially confer important transcriptional regulatory influences, especially due to its TSS proximity. Further molecular and clinical studies are required to investigate this. Description: M.SC.PHARMACOLOGY

Self-efficacy, self-care and outcomes in persons with diabetes.

Thu, 01 Jan 2015 00:00:00 GMT

Title: Self-efficacy, self-care and outcomes in persons with diabetes. Abstract: PURPOSE This dissertation aims to explore the relationship between self-reported self-efficacy, self-care and outcomes in adults with type 2 Diabetes Mellitus in Malta. RESEARCH DESIGN AND METHODS Using a cross-sectional research design, a questionnaire was distributed to 396 persons attending the diabetes clinics of a local public hospital and three health centres. Apart from collecting demographic information and details about disease characteristics, the levels of self-efficacy and diabetes self-care were measured using the Diabetes Empowerment Scale - Short Form (DES-SF) and the Summary of Diabetes Self-Care Activities scale (SDSCA) respectively. Outcomes were assessed by ascertaining the presence or absence of complications, and HbAlc values were used as a marker for glycaemic control. Variables which were found to be significantly associated with self-efficacy, self-care and outcomes in univariate analyses were used as predictors in multivariate regression models which identified the most significant predictors of self-care and outcomes, together with their odds ratios. RESULTS A response rate of 89.4% (N = 354) was achieved. Persons with higher levels of self-efficacy were found to have higher scores in the dietary and foot care areas of self-care. Furthermore, they were less likely to have uncontrolled diabetes and complications. Levels of self-efficacy were high in the study sample, confirming the results of other studies carried out locally. Self-efficacy was also found to vary independently of the demographic and disease characteristic variables collected, suggesting an absence of sub-groups of persons who are at-risk of having low self-efficacy. The study also gave insight on the levels of self-care amongst different population sub-groups. Respondents scored best in the dietary areas of self-care, and worst in 'Exercise' and 'Blood sugar testing'. Persons on insulin were found to have higher and lower scores in the 'Blood sugar testing' and 'Exercise' areas of self-care respectively when compared to persons who are not dependent on insulin. They were also more likely to report the presence of one or more complications. CONCLUSIONS This dissertation confirms that the concept of self-efficacy is also applicable locally since it is similarly associated with self-care and outcomes as reported in studies carried out abroad. The only exception is 'Exercise' self-care which was found to be very low, even in persons with high self-efficacy, suggesting the presence of additional barriers which were not studied in this dissertation. Further research to identify these barriers would assist policymakers and practitioners to devise measures to mitigate the effects of these barriers. The study identifies particular groups of persons who have low levels of self-care and this information could be used by practitioners to more easily identify these persons and offer additional advice to them during consultation. Public health policies which are aimed at improving outcomes of persons with diabetes would do well to consider the effect that self-efficacy-enhancing lifestyle interventions might have on improving outcomes. More research should be conducted in this field to assess whether these could provide a cost-effective alternative to expensive medications. The use of a screening tool might be advisable to identify those persons with low levels of self-efficacy who would stand to benefit most from these interventions since this study found no particular at-risk groups that could be targeted. Description: The research work disclosed in this publication is funded by the Strategic Educational Pathways Scholarship (Malta). The scholarship is part-financed by the European Union - European Social Fund (ESF) under Operational Programme II - Cohesion Policy 2007-2013, "Empowering People for More Jobs and a Better Quality of Life"; M.SC.PUBLIC HEALTH

A preliminary study of the population, ecology and genetic characters of the Mediterranean box jellyfish (Carybdea marsupialis in the island of Malta).

Thu, 01 Jan 2015 00:00:00 GMT

Title: A preliminary study of the population, ecology and genetic characters of the Mediterranean box jellyfish (Carybdea marsupialis in the island of Malta). Abstract: The only known Cubozoan species to inhabit the Mediterranean is Carybdea marsupialis (Linnaeus, 1758). Recently, historical reconstruction together with new genetic and morphological data suggests that it is an endemic species to the Mediterranean Sea. The main aim of this project was to identify the factors associated with the increase in numbers of C. marsupialis in Maltese waters. Hence, monitoring of the abiotic/biotic factors and individual abundance of this species was carried out every two weeks between July 2014 and July 2015. The method of choice exploited the photopositive response of Cubozoans to aggregate around artificial lights to carry out quantitative counts against a time period of 30 minutes. Individuals were collected through the deployment of a hand net and local samples were genetically compared to samples obtained from Spain and Tunisia, along with the Atlantic samples from Cadiz, in southwest Spain. DNA was extracted with phenol:chloroform:isoamyl alcohol followed by an ethanol precipitation. Genetic characterisation was carried out through the analysis of the mitochondrial 16S rDNA region and the region between the 18S and 28S of the rDNA. /n vitro experiments to document the development of C. marsupia/is. from the egg stage to that of the primary polyps were also successfully undertaken. Over the whole time period, the Birzebbuga site had an overall total of 590 caught individuals against the 324 from the Msida site. A Mann-Whitney U-Test was run for the Msida and Birzebbuga sites and a statistical difference (p-value<0.05) in the morphometric parameters of individuals from both sites was observed nearly throughout the whole study period. Furthermore, principal component analyses (PCAs) and Spearman's rank correlation coefficient (rs) highlighted the fact that populations of both sites were strongly and positively correlated with sea water temperature and negatively correlated to phytoplankton and chlorophyll levels. MegaBlast database comparison confirmed that the sequence amplified was in fact that of Carybdea sp. Nonetheless, the sample with the highest substitutions per site was that of Cadiz. All Mediterranean samples shared >98% of identical base pair sequence and the homology between them indicates close genetic homology. The clear presence of distinct bases in the Cadiz sample may reflect a number of situations. The specimen may have been misidentified at the stage of collection. If this is so, this study highlights the importance of using genetic and molecular studies in addition to traditional morphometric studies to identify C. marsupialis. Alternatively, although less likely, the specimen may represent more distantly related species of C. marsupialis. In any case, further studies are recommended. Key words: 16S rDNA, 188 and 288 rDNA, abiotic/biotic factors, Carybdea marsupialis, Cubozoa, morphometric parameters, population studies. Description: M.SC.MEDICINE&SURGERY