OAR@UM Collection:

Childhood asthma in the primary school environment

Tue, 01 Jan 2019 00:00:00 GMT

Title: Childhood asthma in the primary school environment Abstract: Background. There is a relatively high prevalence of school children with asthma in Malta, yet there is limited information about how these children are managed and supported while at school. Aims. The aim of this research was to gather data from relevant stakeholders using a mixed methods approach and, by doing so, provide a significant contribution to knowledge in this field. Methods. In the first phase of the study, a systematic review was performed to systematically review published literature to determine current asthma management practices by primary school teaching staff and any supporting legislation/ policies/ guidelines. In the second phase of the study, four key stakeholders, one from the Ministry for Education and Employment, two from the Ministry for Health and one from the Malta Union of Teachers (MUT) were interviewed to provide an aerial view of practices and polices relating to asthma in primary schools. In the third phase, a cross-sectional electronic survey investigating beliefs about medicines, knowledge of asthma, current practices, views and experiences relating to asthma was sent to all state primary heads of school and teachers in Malta. In the last phase, additional qualitative data was collected from teachers, parents of children with asthma and children with asthma through 3 separate focus group discussions. The Theoretical Domains Framework (TDF) was used as a basis for both the qualitative component and some aspects of the quantitative component of the research. Results. Findings of the systematic review mainly identified that: teachers were unable to deal with an asthma exacerbation, teachers lacked knowledge regarding exercise-induced asthma and there is poor communication with parents of children with asthma. The only documented asthma legislation was found in New York schools (USA) and three studies reported that they had no asthma management guidelines or policies in schools. The TDF domains which emerged most from the interviews were knowledge (knowledge of health policy communication, lack of awareness about asthma, approaches in dealing with students having asthma), beliefs about consequences (disadvantages and barriers in relation to policies), environmental context and resources (lack of support and resources), emotion (teachers' fear in supporting children with asthma) and goals (need for school asthma policies). Significant issues such as lack of knowledge regarding individual student health, inadequate preparation in dealing with students having asthma, low asthma knowledge scores (heads of school mean score of 4.8±3.8; teachers’ mean score of 5.5±3.3 out of a possible maximum of 14), and poor self-efficacy among teachers were identified from the responses of 19 heads of school and 167 teachers. Data collected also showed that teachers believe more in the benefit of medicines (mean=14.9) rather than their harm (mean=11.0) or overuse (mean=13.5). Heads of schools also believe more in the benefit (mean=15.3) than the harm (mean=9.0) or overuse (mean=11.8) of medicines. Data from focus groups with teachers, children with asthma and their parents were congruent with survey findings. Additionally, children demonstrated limited asthma knowledge and expressed their embarrassment in using the inhaler at school and in discussing their condition with the teacher. Communication barriers between the school and parents were also reported. Conclusion. Findings support the need for interventions to better support primary school children with asthma such as the establishment of effective communication between school staff and parents, staff training and standard procedures that are supported by policy. Protection by a law similar to 'good Samaritan' law should be offered to teachers thereby limiting the liability of the teaching staff when supporting students with medicines administration. Description: M.SC.PHARMACOLOGY

Cytokine mediated in vitro transcriptional activity of the CCR4 gene promoter

Tue, 01 Jan 2019 00:00:00 GMT

Title: Cytokine mediated in vitro transcriptional activity of the CCR4 gene promoter Abstract: Orthopaedic trauma patients may require a load bearing scaffold to assist their recovery. Ideally such a scaffold would be biodegradable, with its degradation rate matching that of bone growth and with pore diameter in the range of 100 µm to 800 µm. Research being carried out on iron-based scaffolds suggests that this can be achieved. This work is aimed to develop a reliable fabrication process for biodegradable iron scaffolds, based on the replication method combined with stereolithography (SLA) 3D printing. The replication method is a powder metallurgy technique which uses a perishable polymer template that is coated with a slurry containing the desired iron-based final material. Instead of using said slurry, a dry coating technique was developed which made use of the inherent tackiness of the 3D printed polymer templates, to attach the powder. The metallic coated polymer template is then heat treated at a low temperature to partially sinter the powder coating to form an interconnected lattice. This is then followed by a high temperature heat treatment to completely burn away the polymer template and fully sinter the metallic scaffold implant. In this work, the technique was developed further by incorporating SLA 3D printing to produce the polymeric templates thus making it possible to produce patient specific scaffolds at a very low price. Two template types were developed namely, cubic and gyroid type templates. To develop this adapted replication method, the SLA 3D printing polymer was analysed using dynamic mechanical analysis, differential scanning calorimetry and furnace heat treatments, to determine the softening and degradation temperatures. The 3D printed templates were analysed using optical microscopy and scanning electron microscopy to analyse their strut and pore size. Coated templates were subsequently analysed using weighted coating mass uptake and X-ray Microscopy. Scanning electron microscopy with electron dispersive spectroscopy was employed to characterise the powder used and the final heat-treated iron lattices. For both template types, the minimum achievable pore and strut size was 600 µm and 420 µm respectively. The optimal pore and strut size was set to 1000 µm and 700 µm, to minimise pore clogging for gyroid templates and to cater for the shrinkage experienced during heat treatment. The best heat treatment achieved used milled iron powder (particle diameter about 1.5 µm), coated using the dry coating method and heat treated with the first dwell at 175°C for 2 hours and a final dwell at 1120°C for 3 hours. Description: M.Sc.(Melit.)

The burden of type 2 diabetes mellitus, dysglycaemia and their co-determinants in the adult population of Malta

Tue, 01 Jan 2019 00:00:00 GMT

Title: The burden of type 2 diabetes mellitus, dysglycaemia and their co-determinants in the adult population of Malta Abstract: The main aim was to determine the burden of diabetes mellitus, dysglycaemia and their co-determinants within the adult population of Malta. Furthermore, specific objectives included an exploration of the Maltese co-determinants of T2DM including links between different anthropometric, biochemical, and socio-demographic factors as well as between ten specific genetic SNPs and T2DM. This was aimed to provide the required evidence to empower public health efforts to target prevention as well as to develop nation-wide policies and strategies. Methodology The cross-sectional study’s target population was adults residing in Malta for at least 6 months aged between 18 and 70 years. The study population was selected from a national registry. A randomized stratified single stage sampling method was conducted to establish the study population. The strata for selection were age, gender and locality. Considering a possible 50% response rate and an expected pre-diabetes prevalence rate of 25% (based on published literature), the PiFace software® was used to estimate the sample size for this study. A sample of 4,000 adults was required. Permissions to conduct this study were granted from the University of Malta research ethics committee, the information and data protection commissioner, the Ministry for health, the chairman of the pathology department, the chief executive officer of Mater Dei Hospital and the laboratory of molecular genetics. A validated questionnaire and validated tools for health examination measures were utilized based on the European Health Examination Survey guidelines. A health examination hub was set up every weekend at governmental peripheral health clinics across all of the Maltese towns. In order to reduce information bias, a limited number of fieldworkers were enrolled, and trained regularly. Invitations to the randomly selected participants were sent offering a free health examination, two weeks prior to the examination appointment. Participants gave their informed consent and answered the socio-demographic questionnaire. This was followed by measurements for blood pressure, weight, height, waist and hip circumference. Blood samples for fasting plasma glucose (FPG), lipid profile and a whole blood sample for genetic studies were drawn as the last stage of the examination. An oral glucose tolerance test was offered to those obtaining an impaired fasting plasma glucose (IFG) result. All the data gathered during the fieldwork was inputted by a single fieldworker to avoid bias. Secure inputting software was used that was programmed to perform data validation while inputting data. In order to compensate for non-respondents and maintain strata representation, a weighting factor was applied to each individual in the sample using the IBM SPSS software. The weighting data was only used when national representative population analysis was performed. Prevalence rates (T2DM, IFG, overweight-obesity; hypertension and the metabolic syndrome) were established for each category of age and gender. Socio-demographic, anthropometric and biochemical parameters were analysed (descriptive and analytic) and associated links were investigated with T2DM and IFG by using the IBM SPSS software. Non-parametric statistical testing using the Mann-Whitney U test and the Kruskal Wallis test were performed since the data did not follow a normal distribution. Dunn’s test was used as a post-hoc test following Kruskal Wallis testing. The Chi-squared test was used to identify significance between categorical variables. The Spearman’s correlation testing was performed to test for associations between variables. Binary logistic regressions and multiple regression analysis were performed to identify the independent associated risk factors for T2DM and IFG. Using regression analysis and receiver operating curves, a Maltese specific diabetes risk score was established. The cost burden for T2DM and obesity was calculated based on cost per case rates obtained from the scientific literature, after adjusting for gross domestic product (GDP) per capita and for deflation. A 2% compound interest per annum was added on the cost burden obtained for obesity from local data. A sub-population of the participating study population was randomly selected from within each different metabolic profile category (dysglycaemic, metabolically abnormal and metabolically normal) to undergo case-control genetic analysis. DNA extraction from whole blood samples gathered during the fieldwork, followed by real time PCR genotyping for ten identified literature based single nucleotide polymorphism (SNPs) was performed. Descriptive and analytic analyses were performed using IBM SPSS software. A case-control design was followed to evaluate this sub-population’s biochemical and anthropometric phenotype in relation to the 10 SNPs under study. Multiple regression analysis was performed to identify any associated links between the 10 SNPs and a diagnosis of T2DM. Description: Ph.D.(Melit.)

Sleepiness in post-duty house officers

Tue, 01 Jan 2019 00:00:00 GMT

Title: Sleepiness in post-duty house officers Abstract: Doctors from many departments in Malta’s main acute general hospital, Mater Dei Hospital are rostered to work “post-duty”, which involves working shift of over 30 hours. The majority of studies from a systemic review conducted for this thesis found that, on the whole, function was decreased and sleepiness increased in post-duty doctors. Although practice of working post-duty has been questioned behind closed doors, it has never been formally challenged. Mixed methodology was used to examine sleepiness in house officers post-duty. A cross-sectional analysis was carried out in two parts; pre- and post-duty sleepiness was measured using the Karolinska Sleepiness Scale (KSS) over a period of two and a half weeks. A descriptive phenomenological study sought to describe the lived experience of the phenomenon “working post-duty” in house officers. House officers were significantly sleepier post-duty. The mean difference between pre- and post-duty sleepiness, as measured by KSS, was 3.147 (CI95% 2.957 to 3.337, Paired T-test: P<0.000). The effect size between pre- and post-duty house officers was huge (Cohen’s D = 2.14) and the odds ratio for being excessively sleepy post-duty, as defined by having a KSS of seven or greater, was 57.31. The phenomenological study found three main themes which emerged to describe “working post-duty”: emotional and cognitive sequelae, unmet need and impaired performance. Doctors described that empathy, motivation and emotional energy were decreased post-duty, whilst self-doubt, sleepiness and the desire to drop everything and go home were increased post-duty. Additionally, doctors described that they have come close to having serious motor vehicle accidents post-duty, as well as admitting to disregarding things that they would otherwise lend importance to, such as being empathic with patients, or communicating a discharge plan. House officers have massively increased odds of being excessively sleepy post-duty, which poses a potential risk to themselves and to their patients. Deprivation of a basic need (sleep) may lead to obfuscation of usual occupational motivators (e.g. the need to abide by professional standards such as infection control protocols), leading to suboptimal performance in post-duty doctors. Immediate reform of doctors’ working hours is called for: it is recommended that the precautionary principle be invoked, and doctors are allowed to rest post-duty. Description: M.Sc.(Melit.)