is Malta’s first national study examining how adolescents understand food labels, make food choices, and are influenced by their home and school food environments. Led by Dr Sarah Cuschieri in collaboration with the Faculty of Medicine and Surgery and the Islands and Small States Institute (ISSI) at the University of Malta, the project aims to generate high-quality evidence to guide national strategies for nutrition improvement and obesity prevention. The study is funded by Xjenza Malta in partnership with the Ministry for Health and Active Ageing, reflecting its national significance and the commitment to improving adolescent health and wellbeing across Malta.
This PhD study, carried by Dr Elizabeth Grech, is a nested longitudinal cohort study building upon the SAHHTEK study, a national health and wellbeing survey led by Dr Sarah Cuschieri, who now serves as the principal supervisor, with Prof Neville Calleja as the co-supervisor. The research aims to analyze the metabolic status of the Maltese population, focusing on the incidence and progression of obesity, hypertension, diabetes, and hypercholesterolemiaover a ten-year period following the original and several years after the COVID-19 pandemic.
This study is being conducted in collaboration between the Ministry of Education, Sport, Youth, Research and Innovation and the University of Malta through the Research, Innovation and Development Trust (RIDT), supporting its efforts to generate impactful public health research.
The study will assess temporal changes in health status and their associations with socioeconomic, demographic, and lifestyle factors, including the potential impact of the pandemic. The study will generate high-impact epidemiological data, guiding health policy development and serving as a valuable resource for both public health authorities and scientific research communities.
The (Regular and Unplanned Care Adaptive Dashboard for Cross-border Emergencies) is a Horizon Europe-funded initiative aimed at enhancing healthcare system resilience during pandemics and health emergencies. The project is actively developing flexible and adaptable care models to ensure continuity of essential healthcare services while optimizing hospital resources for crisis management. Through innovative approaches such ascommunity-based care, digital health solutions, and improved patient flow management, RAPIDE seeks to minimize disruptions to routine healthcare during emergencies.
This four-year project is being conducted across multiple European countries, with Malta as one of the key testing sites. Research findings will be implemented in living labs, where real-world healthcare settings will trial adaptive care models to assess their feasibility and effectiveness. The project also aims to facilitate the cross-border application of these models to strengthen healthcare systems across Europe.
At the University of Malta, the RAPIDE project is being led by Dr Sarah Cuschieri (Principal Investigator), Prof Julian Mamo, and Mr Andrea Cuschieri, who are driving Malta’s contribution to this international research collaboration.
The "Green spaces on Health in Malta" project is being conducted in collaboration with Dr Sarah Scheiber from the Spatial Planning & Infrastructure Department, Faculty for the Built Environment, University of Malta, and Dr Therese Bajada from the Institute for Climate Change and Sustainable Development, University of Malta. This study explores the relationship between green space and health in Malta, a highly urbanized small island state with limited access to open spaces. The research aims to develop and test a methodological framework to assess how green spaces influence health outcomes, with potential applicability to other small island settings. Using the Normalized Difference Vegetation Index (NDVI) and spatial mapping techniques, the study integrates existing health data with locally relevant green space indicators. The findings will contribute to a spatial dataset, helping to identify health trends linked to green space access, with implications for urban planning, public health strategies, and sustainable development policies in Malta.
The "National Burden of Adolescent Idiopathic Scoliosis in Malta" project is being conducted under the leadership of Mr Stephan Grech, Spine and Orthopaedic Consultant with a special interest in spinal deformities, in collaboration with the Department of Trauma and Orthopaedics at Mater Dei Hospital, Malta. This study aims to explore and quantify the burden of adolescent idiopathic scoliosis (AIS), the most common spinal deformity affecting adolescents, particularly females, in Malta. By examining the incidence rates over the past 15 years, the project investigates the impact of the COVID-19 pandemic on scoliosis services and patient outcomes, considering delays in diagnosis and treatment. The study also explores the quality of life, wellbeing, and sleep patterns of individuals with AIS, assessing how these factors correlate with the severity of spinal deformity measured by the Cobb angle. Furthermore, the project examines the knowledge, attitudes, and experiences related to AIS among adolescents, their parents, healthcare professionals, and secondary school academic staff. This comprehensive approach aims to provide a clearer understanding of AIS in Malta, supporting the development of informed public health strategies and patient care protocols.
This proposed study aims to investigate the complex, bi-directional relationship between obesity and climate change through the lens of small and island countries. These nations face unique and intensified vulnerabilities due to their geographic isolation, limited resources, and dependence on food imports.
The project will conduct a systematic review of the literature to identify shared structural drivers—such as food system transformations, climate-induced disruptions, urbanization, and socioeconomic inequalities—that contribute to both the obesity epidemic and environmental degradation. It will also introduce a conceptual framework to illustrate these interactions and support the development of integrated, context-specific responses.
By focusing on small states as natural laboratories, this project seeks to generate evidence that informs policies promoting both health and environmental sustainability.
This initiative is being developed in collaboration with the Chronic Disease Epidemiology Research Network (CDERN) and the Islands and Small States Institute at the University of Malta, leveraging interdisciplinary expertise to address these intertwined global challenges.
Aim
To investigate the association between environmental factors specifically air pollution,
population density, and the food environment and cardiometabolic health outcomes,
including obesity and related cardiometabolic conditions, among the Maltese population.
Rationale
Cardiometabolic diseases including obesity, type 2 diabetes mellitus, hypertension, and cardiovascular disease represent one of the leading public health challenges globally. These
conditions share common environmental, behavioural, and biological pathways, and
increasingly cluster as multimorbidity within individuals and populations. While individual
lifestyle factors are important, growing evidence highlights the critical role of structural and
environmental determinants in shaping cardiometabolic risk at the population level.
Environmental exposures such as air pollution, urban density, and food environments
contribute to chronic low-grade inflammation, metabolic dysregulation, and behavioural
patterns linked to cardiometabolic disease development. Air pollution, particularly long-term
exposure to particulate matter (PM鈧�.鈧�) has been associated with insulin resistance,
endothelial dysfunction, hypertension, and increased risk of obesity and cardiovascular
disease. Evidence from European and Asian studies suggests that these effects operate
independently of traditional lifestyle risk factors.
Population density interacts closely with urban design, transport systems, and access to green
and recreational spaces. In some settings, higher density supports active transport and
healthier behaviours. In Malta, however, high population density is coupled with heavy car
dependence, traffic congestion, limited walkability, and constrained green space availability,
potentially reducing physical activity while increasing exposure to air pollution—thereby
amplifying cardiometabolic risk.
The food environment including the availability, affordability, visibility, and marketing of
healthy versus unhealthy food options—plays a pivotal role in shaping dietary behaviours
linked to obesity, diabetes, and cardiovascular disease. Obesogenic and cardiometabolic-
unhealthy food environments tend to promote high consumption of energy-dense, nutrient-
poor foods, disproportionately affecting vulnerable populations.
Malta provides a unique and policy-relevant case study as a high-density small island state
with one of the highest car ownership rates in the European Union, a high burden of obesity
and diabetes, and emerging concerns related to environmental exposures and urban planning.
Examining how air pollution, population density, and food environments jointly influence
cardiometabolic health in Malta will generate insights applicable to other small, densely
populated settings. The findings will support evidence-informed national policies addressing urban design, transport, environmental health, and food systems, with the potential to reduce
cardiometabolic disease burden and related health inequalities.
The was a national cross-sectional health and wellbeing survey conducted between 2014 and 2016 to assess the metabolic health of the Maltese population. This was the first PhD study for Dr Sarah Cuschieri, conducted under the supervision of Prof Julian Mamo, Prof Josanne Vassallo, and Prof Neville Calleja. The study provided baseline epidemiological data on type 2 diabetes, impaired fasting blood glucose, obesity, hypertension, and metabolic syndrome, along with their associations with socio-demographic, lifestyle, and biological factors. SAHHTEK was the first representative study of its kind in Malta, offering critical insights into the country’s burden of non-communicable diseases (NCDs).
The study was made possible through funding from the University of Malta, specifically through the Medical School and Research Innovative Development Trust Department, and was majorly sponsored by the Alfred Mizzi Foundation, alongside contributions from other sponsors, including Atlas Health Insurance (Malta). Additionally, the project received in-kind support and encouragement from the Parliamentary Secretariat for Health of the Government of Malta.
The findings led to the publication of several international peer-reviewed articles, contributing valuable evidence to the global scientific community. The study laid the groundwork for longitudinal follow-up research, leading to the ongoing PhD study on Malta’s metabolic health, which seeks to track health trends over time and assess the impact of evolving societal and environmental factors, including the post-pandemic landscape.
This study explored the impact of COVID-19 on the population of small islands and states, focusing on epidemiological trends, disease burden, and vaccination outcomes. It examined how the pandemic unfolded in Malta, assessing the spread of infection, public health measures, and the effectiveness of vaccination campaigns, while also identifying the challenges faced by small populations in data collection and healthcare resource allocation.
By analyzing Malta’s COVID-19 trajectory and comparing it with other small European states, the study highlighted differences in pandemic responses, resilience, and vulnerabilities. It also evaluated the broader health impact of the pandemic, including excess mortality, years of life lost, and public perceptions of vaccination and healthcare accessibility.
The findings underscore the importance of tailored public health strategies, improved surveillance systems, and adaptable healthcare policies to better prepare small island nations for future health crises. By providing a comprehensive epidemiological assessment, this study contributes to global discussions on pandemic preparedness and response, offering insights into strengthening health systems and policy frameworks in small states.
The "Impact of Long COVID on Population Health" project, conducted in collaboration with Prof Piotr Wilk and Prof Saverio Stranges from the Department of Epidemiology and Biostatistics at Western University, Canada, examined the long-term health consequences of COVID-19, with a particular focus on diabetes and obesity. Supported by the Internationalisation Partnership Award Scheme Plus 2023 (IPAS +), this study facilitated cross-institutional collaboration between the University of Malta and Western University, resulting in several international peer-reviewed publications. The research provided critical epidemiological insights into the relationship between Long COVID and metabolic health, exploring its potential role in exacerbating or triggering conditions such as diabetes and obesity. These findings contribute to global discussions on Long COVID’s impact, emphasizing the need for targeted healthcare interventions, policy adaptations, and long-term monitoring of at-risk populations.
The "Enhancing Research Engagement in Undergraduate Medical Education" project is carried out by Mr Andrea Cuschieri under the supervision of Dr Sarah Cuschieri. It examins how early exposure to research influenced medical students’ attitudes and participation in scientific inquiry. Over four years, the study assessed students’ perceptions of research, implemented hands-on research opportunities, and introduced a structured research training course through the Degree Plus programme (DPG0118). Initial findings revealed strong interest in research among students, yet a significant gap in participation due to perceived lack of opportunities. Direct involvement in a COVID-19 epidemiology study significantly improved students’ perceptions and reduced barriers to engagement, highlighting the importance of mentorship. Building on these insights, a structured research course (DPG0018) was developed to systematically address these challenges, with post-course evaluations demonstrating increased research knowledge and confidence. The study underscored the need for formal research training and mentorship within medical curricula to cultivate future physician-researchers, ensuring that evidence-based practice remained a cornerstone of healthcare advancement.
The "Multimorbidity and Medical Education" project explores how medical trainees understand, engage with, and are trained to manage patients with multiple chronic conditions. With multimorbidity becoming increasingly prevalent, particularly in ageing populations, there is a growing need to ensure that future healthcare professionals are adequately prepared to address the complexities of caring for patients with multiple coexisting diseases. This study investigates medical trainees’ knowledge, confidence, and attitudes toward multimorbidity, assessing how current medical curricula integrate this aspect of patient care. It also examines gaps in education and potential strategies to enhance training in managing multimorbid patients.
This study aims to assess the incidence, mechanisms, and clinical outcomes of spinal trauma cases admitted to Malta’s primary tertiary hospital between 2019 and 2024. By leveraging national-level hospital data, the research will examine injury patterns, management approaches, and long-term recovery outcomes, with particular attention to injury causes such as falls, road traffic accidents, and workplace trauma.
Designed to inform public health strategies on injury prevention and resource allocation in Malta’s centralized healthcare system, the findings will provide vital insights to improve acute care and rehabilitation services. Moreover, the lessons learned may be applied to larger countries with decentralized trauma systems.
This research is conducted in collaboration with the Department of Trauma and Orthopaedics at Mater Dei Hospital, and supported by the Chronic Disease Epidemiology Research Network (CDERN).
