A glimpse into Long COVID characteristics and the mental health impact within a highly vaccinated population: a Malta observational study.

BACKGROUND: Post-acute COVID-19 consequences are gaining global recognition. This study explores Long COVID characteristics and associated mental health impact/s among the highly vaccinated adult population of Malta. METHODS: A social media survey gathered demographics, vaccination, and COVID-19 data. Generalised Anxiety Disorder and Patient Health Questionnaire-9 assessment tools were used for anxiety and depression. Quantitative analyses were performed. RESULTS: 41% reported Long COVID, mostly female, 30-39 years, absence of chronic disease/s and vaccinated. Shortness of breath commonest persistent symptom among males, and fatigue for females. Significantly higher depression scores were present in Long COVID cohort compared to no persistent symptoms (p=0.001) and never acquiring COVID-19 (p=<0.01). A significant higher anxiety scores was present for Long COVID cohort than never acquiring COVID-19 (p=<0.01). CONCLUSIONS: Long COVID occurs even in healthy individuals and vaccinated, while exacerbating mental health burdens. Urgent action is required to manage Long COVID and preventing the sequela.

A cross-sectional study exploring the Covid-19 vaccination landscape in Malta through social media: An insight into experiences, attitudes, and perspectives.

Background and Aims: Covid-19 vaccines were disseminated across Europe from the end of 2020. Malta had one of the fastest vaccination rollouts in Europe and by March 2022 most adults had their booster dose. The aim was to investigate adult's perspectives, experiences, and attitudes regarding vaccination in Malta. Methods: An anonymous online survey targeting adult social media users living in Malta was disseminated through social media, with a snowball technique. Demographic information, vaccination uptake, side-effects, perceptions, and experiences were gathered through quantitative and qualitative means. Participants were sub-grouped according to their vaccination status and descriptive analysis through frequency was performed. χ 2/Fisher test testing followed by logistic regressions were performed to assess the vaccination perspectives according to vaccination status. Results: Out of 611 participants 79.87% had the booster, 4.91% had two doses awaiting booster, 6.55% refused booster while, 8.67% refused any dose. Booster sub-group when compared to vaccine hesitant sub-group exhibited an association with the perception for the need to "continue wearing masks, maintaining physical distance and hand washing following vaccination" (odds ratio [OR]: 5.97 confidence interval [CI] 95%: 1.09-32.36 p = 0.04). Those waiting for the booster dose when compared to those refusing booster, exhibited an association with the perspective that "COVID-19 vaccine is the solution to returning to normality" (OR: 5.00 CI 95%: 1.12-22.35 p = 0.04). The commonest reason for inoculation was to protect against severe disease (63.08% CI 95%: 58.91-67.07). More pronounced booster adverse effects raised concern about future booster doses uptake. Unwillingness among anti-booster and vaccine hesitant arose among high socioeconomic background participants, with concern for vaccine safety and adverse effects. Conclusion: Vaccine hesitancy is low yet, vaccination unwillingness even among highly educated may act as a barrier to control the pandemic. Clear, transparent public health communication which targets concerns is crucial, with unified messages from governing bodies optimizing population safety.

Assessing the impact of the four COVID-19 variants and the vaccine coverage on mortality in Malta over 2 years: An observational case study.

Background: Mortality may quantify a population's disease burden. Malta, like other European countries, experienced COVID-19 surges in cases and mortality across the pandemic. This study assesses COVID-19's mortality impact, while exploring the effects of the four dominant COVID-19 variants and that of the vaccination coverage on the Maltese population. Methods: COVID-19 data (cases, mortality, positivity, and vaccination rates) was obtained from the websites of the European Center for Disease Prevention and Control and the Malta Ministry of Health. Data was categorized into the four periods according to reported dominant COVID-19 variant. Years of life lost (YLL) and Case-Fatality-Ratio (CFR) for each period were estimated. CFR was also estimated for the pre-vaccine and post-vaccine periods. Results: The original COVID-19 period (36 weeks) had the highest YLL (4,484), followed by the Omicron variant period (12 weeks; 1,398). The Alpha variant period (7 weeks) had the highest CFR (1.89%) followed by the Original COVID-19 (1.35%). The pre-vaccine (1.59%) period had higher CFR than the post-vaccine period (0.67%). Conclusion: Various factors contributed to mortality, but the variant's infectivity, transmissibility, and the effectiveness of the vaccine against the variant play an important role. Reducing mortality by embracing mass vaccination that targets current variants along with other non-pharmaceutical interventions remains paramount.

A Year of COVID-19 Pandemic Roller-Coaster: The Malta Experience, Lessons Learnt, and the Future.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic had a global impact. The study explores the various COVID-19 experiences in Malta over the past year and provides a snapshot of acute and post-acute COVID-19 symptoms, as well as national vaccination roll-out and hesitancy. METHODS: Data on medical access, lifestyle habits, acute and post-acute COVID-19 symptoms, and vaccination hesitancy was gathered through a social media survey targeting adults of Malta. COVID-19 data were gathered from the Malta Ministry of Health COVID-19 dashboard. RESULTS: Malta controlled COVID-19 spread exceptionally well initially. Since August 2020, the positivity rate, mortality, and hospital admission rates saw a fluctuating incline. From COVID-19 onset, a decrease in physical activity and an increase in body weight was reported. Most participants acquiring COVID-19 were asymptomatic but nontrivial proportion experienced post-acute symptoms. The majority opted to take the COVID-19 vaccine with only a minority expressing safety concerns. CONCLUSIONS: Malta has experienced roller coaster events over a year. The population faced elevated levels of morbidity, mortality, and economic hardship along with negative and positive risk-associated behaviors. Vaccination in combination with population adherence to social distancing, mask wearing, and personal hygiene are expected to be the beacons of hope in the coming months.

An observational study of the Covid-19 situation following the first pan-European mass sports event.

BACKGROUND: All events in Europe, including EURO2020 football championship, were postponed due to Covid-19 in 2020. Instead, Euro2020 took place in 2021, as mitigation measures were relaxed, cross-country mobility increased and the Delta variant was spreading across Europe. This study explored the possibility of an increased Covid-19 spread across Europe following EURO2020 matches. METHODS: Covid-19 data on cases, vaccination and delta variant for participating countries, host cities/regions and neighbouring countries, for May till July 2021, were obtained from European Centre for Disease Prevention and Control, Our World in Data, Johns Hopkins COVID-19 Dashboard and the UK Government website. EURO2020 data were obtained from the Union of European Football Associations official website. RESULTS: A general increase in Covid-19 positivity trend in Europe was observed following a week of EURO2020 matches across most countries and host cities. A similar trend was observed for the Delta variant sample positivity rate. The increased incidence was mostly among the young generation (<49 years). A decline in positive cases was observed on a national level for most countries following the Finals match. CONCLUSION: The EURO2020 was an anticipated mass sports event, and it was the first-time spectators were allowed to enter stadiums in Europe. Stadiums instituted several mitigations to safeguard the spectators although reports of transmission were still present. The major challenges were the gatherings outside the stadiums that might have contributed to these observations. Targeted restrictions might be required during mass sport events especially in the presence of highly transmissible variant(s) and low vaccination rates among the young generation.

Back pain: An aftermath of Covid-19 pandemic? A Malta perspective.

BACKGROUND: Back pain is the commonest musculoskeletal complaint across the world. The Covid-19 pandemic led to mitigating measures including remote working that enhanced a sedentary lifestyle. The aim of this study was to investigate whether back pain complaints have increased from pre-Covid-19 to during the Covid-19 period among the adult population of Malta, while exploring the possible contributing factors. METHODS: An online survey was distributed through social media targeting the adult population of Malta. Questions on sociodemographic data, occurrence of back pain pre-Covid-19 and since the onset of Covid-19 was gathered, along with changes in behavioural attitudes, daily routine and physical activity. Descriptive and multiple logistic regression analyses were performed. RESULTS: Out of the 388 responders, 30% experienced chronic back pain pre-Covid-19, 49% experienced back pain since Covid-19, with the majority of the latter claiming that they never experienced back pain before Covid-19. Significant changes were present in daily routine and physical activity (PA) patterns. Indeed, continuously sitting down (OR: 15.53; p ≤ 0.01), no PA (OR: 4.22; p ≤ <0.01), once a week PA (OR: 5.74; p ≤ <0.01), two to three times PA a week (OR: 2.58; p = 0.05) and four to five PA a week (OR: 3.46; p = 0.02) were associated with experiencing new onset back pain since the onset of Covid-19, when adjusted for sex, age, education and employment status. CONCLUSION: The pandemic has changed population behaviour resulting in an enhanced back pain occurrence. This is anticipated to impact the individual's disability adjusted life years as well as increase the burden on the economy and healthcare services. A designated multidisciplinary action plan is recommended to reduce back pain impact.

Insight into the Occurrence of Common Non-communicable Diseases at a Population Level and the Potential Impact During the Coronavirus Pandemic - a Need for a Syndemic Healthcare Approach?

People suffering from non-communicable diseases (NCDs) are at an increased risk for severe Covid-19. The aim was to determine the burden of common NCDs at a population level, assess Covid-19 impact while exploring whether a syndemic approach is merited to deal with NCDs and Covid-19. Baseline data from a Malta national representative survey. Individuals with type 2 diabetes (T2DM), hypertension, cardiovascular disease, dyslipidaemia and overweight-obese status were considered. Prevalence for single disease and multimorbidity were used to estimate population burden. Covid-19 impact at a population level was estimated through local Covid-19 infectivity rates. Years of life lost (YLL) and mortality rate were calculated using Covid-19 data and compared to corresponding NCDs data reported by global burden of disease (GBD) study. Half the study population (n = 3947) had a single NCD while a third had multimorbidity. Of these, 6.55% were estimated to be at risk of Covid-19 and require admission. Covid-19 YLL over 12 months was 5228.54 years, which is higher than the estimated YLL for hypertension and T2DM by GBD study for Malta. Health systems and policies should be re-focused to accommodate both Covid-19 and NCDs simultaneously through a targeted syndemic approach with primary healthcare playing a central role. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42399-021-01064-2.

Obesity population at risk of COVID-19 complications.

Introduction: Global public health is challenged by two concurrent epidemics; COVID-19 and obesity. Considering the global prevalence of obesity, exploring relationships with COVID-19 are of clinical importance. The aim was to provide a comprehensive summary and recommendations on this relationship between COVID-19 and obesity. Method: A literature search was performed to prepare a narrative review of COVID-19 and obesity. Results: An obesity state promotes chronic inflammation, vitamin D deficiency, hinders immunity and causes mechanical lung compression. These increase susceptibilities to COVID-19 infection, complications including the requirement of invasive ventilation. Existing co-morbidities enhances these complications. Preventive measures of social distancing and self-isolation may increase stigmatisation and psychological deterrents. Hence, special recommendations targeting this vulnerable population are required. Conclusion: The obese population is a COVID-19 vulnerable group, requiring special attention during this pandemic to avoid complications and healthcare systems burden. Lacking COVID-19 vaccination, regular physical activity and a healthy diet are recommended with attention to mental health. A prolonged quarantine duration and administration of prophylactic vitamin D may be considered.

COVID-19: a one-way ticket to a global childhood obesity crisis?

Obesity is a global epidemic based on three major pillars of (i) genetic (ii) behavioural and (iii) environmental determinants. The latter two pillars have been challenged during the course of the COVID-19 pandemic across all population age groups including children. The closure of schools resulted in decreased organised physical activity, increase in sedentary lifestyle and screen time with the possibility of stress-induced indulgence in high calorie dense and sugary foods, resulting in higher susceptibility to weight gain. The uncertainty faced by many Northern Hemisphere governments as the new scholastic year looms closer whether to open schools again or not further enhances the stress on the children and their family. Re-opening of schools is beneficial for children's mental and physical health, and general wellbeing including the 'combating' of the childhood obesity epidemic. The family unit has also been challenged during this pandemic especially if the parent/s suffered redundancy. There have been attempts at seeing a silver lining as some families have embraced lockdowns as a means to strengthen their family bonds, increase homemade meals apart from the various virtual opportunities that were streamed on social media to encourage children to perform physical activity at home or in safe environments. However, curbing the viral spread while protecting population health will remain top priority until an effective COVID-19 vaccine is available. It is imperative to address other co-existing problems such as childhood obesity, which if uncontrolled may have a long-term profound health and economic consequence of higher eminence than the actual COVID-19 infection. The prevention and management of childhood obesity should be set as a priority at an individual, community and population level during this pandemic.

COVID-19 and diabetes: The why, the what and the how.

BACKGROUND: The novel coronavirus SARS-CoV-2 has taken the world by storm. Alongside COVID-19, diabetes is a long-standing global epidemic. The diabetes population has been reported to suffer adverse outcomes if infected by COVID-19. The aim was to summarise information and resources available on diabetes and COVID-19, highlighting special measures that individuals with diabetes need to follow. METHODS: A search using keywords "COVID-19" and "Diabetes" was performed using different sources, including PubMed and World Health Organization. RESULTS: COVID-19 may enhance complications in individuals with diabetes through an imbalance in angiotension-converting enzyme 2 (ACE2) activation pathways leading to an inflammatory response. ACE2 imbalance in the pancreas causes acute ß-cell dysfunction and a resultant hyperglycemic state. These individuals may be prone to worsened COVID-19 complications including vasculopathy, coagulopathy as well as psychological stress. Apart from general preventive measures, remaining hydrated, monitoring blood glucose regularly and monitoring ketone bodies in urine if on insulin is essential. All this while concurrently maintaining physical activity and a healthy diet. Different supporting entities are being set up to help this population. CONCLUSION: COVID-19 is a top priority. It is important to remember that a substantial proportion of the world's population is affected by other co-morbidities such as diabetes. These require special attention during this pandemic to avoid adding on to the burden of countries' healthcare systems.

Assessing impaired fasting blood glucose criteria for high-risk dysglycaemic populations: an experience from a European population state.

PURPOSE: Discrepancies exist between international bodies for the diagnosis of impaired fasting glucose (IFG). The aim of this study was to establish the IFG characteristics and evaluate the best diagnostic IFG criteria in a high risk dysglycaemic population. METHODS: An IFG population (n = 451) was identified from a national representative cross-sectional survey using a fasting blood glucose (FBG) ranging from 5.60 to 6.99 mmol/L. These participants were invited for a follow-up oral glucose tolerance test (OGTT). Both FBG results (health survey & OGTT) were evaluated in relation to different diagnostic IFG criteria (>5.6 mmol/L vs. >6.1 mmol/L) while comparing to the final OGTT glycemic diagnosis. RESULTS: Out of the total survey population (n = 1861), 24.34% was diagnosed with IFG. Approximately 50% of the IFG's (n = 227) attended for the OGTT. The majority of the IFG population were male with an overweight-obese status. If the FBG cut-off point of 6.1 mmol/L was followed, more than a quarter of the population attending the OGTT would have had a missed dysglycaemic status. CONCLUSION: High-risk dysglycaemic and body mass populations may establish a more accurate dysglycaemia diagnosis and outcome when following an FBG cut-off point of >5.60 mmol/L for IFG.

Closing the gap - Is type 2 diabetes awareness enough to prevent the growing epidemic?

BACKGROUND: Diabetes mellitus is a public health burden requiring a multi-sectorial approach including adequate population awareness to tackle this epidemic. The study was aimed to determine the level of diabetes awareness among a high-risk dysglycaemic population in relation to socio-demographic, lifestyle and family history of diabetes as well as to body mass index (BMI) and blood pressure measurements. Furthermore, the authors strived to explore any relationships between diabetes awareness and an oral glucose tolerance test dysglycaemia diagnosis. METHOD: Participants obtaining impaired fasting blood glucose in a representative health examination survey were invited to undergo an oral glucose tolerance test (OGTT). During the OGTT session, participants were invited to take part in a diabetes awareness questionnaire as well as have their weight, height and blood pressure measured. Association between awareness scores and different parameters (age, gender, education, residential district, smoking, alcohol habit, family history, BMI and blood pressure) were explored. RESULTS: Being a female, ageing, non-smoker and having a family history of diabetes had a positive association with adequate diabetes awareness. Even though generally good awareness was present, the majority of the participants were obese, with an elevated blood pressure and obtained a dysglycaemic status post OGTT. CONCLUSION: Diabetes awareness solely does not appear to engage individuals in preventive initiatives. Behavioural changes are required but these are only established after the motivational action gap has been overcome. Empowering community diabetes mellitus screening programs targeting the environment, social gradients and cultural norms while engaging in preventive interventions are recommended.

Antecubital Fossa Solitary Osteochondroma with Associated Bicipitoradial Bursitis.

Antecubital fossa lesions are uncommon conditions that present to the orthopaedic clinic. Furthermore, the radius bone is an uncommonly reported location for an osteochondroma, especially when presenting with a concurrent reactive bicipitoradial bursitis. Osteochondromas are a type of developmental lesion rather than a true neoplasm. They constitute up to 15% of all bone tumours and up to 50% of benign bone tumours. They may occur as solitary or multiple lesions. Multiple lesions are usually associated with a syndrome known as hereditary multiple exostoses (HME). Malignant transformation is known to occur but is rare. Bicipitoradial bursitis is a condition which can occur as primary or secondary (reactive) pathology. In our case, the radius bone osteochondroma caused reactive bicipitoradial bursitis. The differential diagnosis of such antecubital fossa masses is vast but may be narrowed down through a targeted history, stepwise radiological investigations, and histological confirmation. Our aim is to ensure that orthopaedic clinicians keep a wide differential in mind when dealing with antecubital fossa mass lesions.

Imaging of adult ocular and orbital pathology--a pictorial review.

Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology.