Sporting tournaments and changed birth rates 9 months later: a systematic review.

Introduction: Major sporting tournaments may be associated with increased birth rates 9 months afterwards, possibly due to celebratory sex. The influence of major sporting tournaments on birth patterns remains to be fully explored. Methods: Studies that examined the relationship between such events and altered birth metrics (number of births and/or birth sex ratio (male/total live births)) 9(±1) months later were sought in PubMed and Scopus and reported via standard guidelines. Database searches were conducted up to 7 November 2022. Results: Five events led to increased birth metrics 9(±1) months later and these included the Super Bowl, the 2009 UEFA Champions League, the 2010 FIFA World Cup, the 2016 UEFA Euros and the 2019 Rugby World Cup. Several la Liga soccer matches also had effects. With a few exceptions, major American football, Association football (soccer) and Rugby apex tournaments in Africa, North America, Asia and Europe were associated with increases in the number of babies born and/or in the birth sex ratio 9(±1) months following notable team wins and/or hosting the tournament. Furthermore, unexpected losses by teams from a premier soccer league were associated with a decline in births 9 months on. Conclusions: This systematic review establishes that major sporting tournaments have a notable impact on birth patterns, influencing both birth rates and sex ratios. Emotional intensification during these events likely triggers hormonal shifts, driving changes in sexual activity and subsequently shaping birth rates, often positively, about 9 months later. The context is crucial, especially when a region/country hosts a major single-sport tournament or participates for the first time, as population excitement is likely to be at its peak. These findings hold significance for healthcare planning and highlight the role of societal events in shaping demographic trends. PROSPERO registration: CRD42022382971.

STROBE, CONSORT, PRISMA, MOOSE, STARD, SPIRIT, and other guidelines - Overview and application.

The purpose of research is to seek answers and new knowledge. When conducted properly and systematically, research adds to humanity's corpus of knowledge and hence to our general advancement. However, this is only possible if reported research is accurate and transparent. Guidelines for all the major types of studies (STROBE, CONSORT, PRISMA, MOOSE, STARD, and SPIRIT) have been developed and refined over the years, and their inception, development, and application are briefly discussed in this paper. Indeed, there are currently over 250 of these guidelines for various types of medical research, and these are published by the EQUATOR network. This paper will also briefly review progress in acceptance and adoption of these guidelines.

Inconsistency in the Application of Glasgow Coma Scale in Pediatric Patients.

OBJECTIVE: The Glasgow Coma Scale (GCS) is widely used to objectively describe the extent of patients' impaired consciousness. However, there are known variations in scoring GCS both in adults and children which may impact patient management. The aim of this audit was to assess the application of GCS by medical and nursing staff in pediatric medical patients. SUBJECT AND METHODS: An online questionnaire was distributed amongst doctors and nurses working in the Department of Child and Adolescent Health at Mater Dei Hospital in Malta. The participants assigned GCS for 8 case scenarios involving children of different ages with varying levels of consciousness. Results were analyzed by calculating percentage agreement and by Cronbach's alpha. RESULTS: Sixty-six participants were studied, with a response rate of 52%. Performance was poor overall, with Cronbach alpha 0.53. Correlation was better at the upper and lower ends of the scale and the worst performance was for verbal response. Only respondents with 5-10 years of experience achieved acceptable consistency in the application of the GCS (Cronbach alpha 0.78). CONCLUSION: There is considerable variation in application of GCS in pediatric patients, highlighting the need for education and training to improve consistency for this commonly used neurological assessment tool.

The epidemiology of CHD in Malta.

BACKGROUND: CHD refers to structural cardiac abnormalities which comprise the commonest group of congenital malformations. Malta is a small island in the central Mediterranean with excellent diagnostic and therapeutic facilities. It is unique in the European population as termination of pregnancy is illegal. This study was carried out to ascertain patterns in CHD prevalence in comparison with EUROCAT data (European Surveillance of Congenital Anomalies). METHODS: Anonymised data were obtained from the EUROCAT website for 1993-2020. RESULTS: There were a total of 22,833,032 births from all EUROCAT Registries, of which 121,697 were from Malta. The prevalence rate for Malta CHD was 32.38/10,000 births (at the higher end of the range). Malta had a significant excess of commoner, comparatively non-severe CHDs. For most of the severe lesions analysed rates reported were higher than EUROCAT average, however, apart from Ebstein's anomaly, they all fell within the ranges reported from the different registries. DISCUSSION: Wide variations in reported CHD prevalence are known, and the Malta rates may be higher for milder defects due to quicker pickup prior to spontaneous resolution. There may also be a higher pickup of milder forms of more severe conditions. For the more severe conditions, lack of termination may be the explanation. These factors may result in the higher neonatal mortality observed in Malta.

BEAT-IT: A de-novo cardiac screening programme in Maltese adolescents.

AIMS: Sudden cardiac death (SCD) in young individuals is often unexpected, provoking substantial emotional stress for family and friends of the deceased. Cardiac screening may identify individuals who harbour disorders linked to SCD. The feasibility and diagnostic yield of a nationwide cardiac screening programme in adolescents has never been explored. METHODS: All individuals eligible for cardiac screening (students aged 15 years) were systematically invited to enrol. Students were provided with a health questionnaire. ECGs were acquired at school. A physician led consultation was carried out on site. Participants with an abnormal screen were then referred for secondary evaluation to the nation's tertiary centre. Feasibility criteria included a) participation rate >60%, b) adherence to secondary evaluation >80%, and c) cost per individual screened equating to <€100. The diagnostic yield was also evaluated. RESULTS: At the end of enrolment, 2708 students gave consent (mean 15 years, 50.4% male), equating to 67.9% of the eligible cohort. Overall, 109 participants (4.0%) were referred for further evaluation. An abnormal electrocardiogram (ECG) was the most common reason for referral (3.7%). Fifteen individuals (0.6%) were diagnosed with a cardiac condition. Nine (0.3%) had a condition linked to SCD (n = 1 Long-QT syndrome, n = 1 Hypertrophic Cardiomyopathy, n = 5 Wolff-Parkinson White, n = 2 coronary anomalies). The yield was similar in athletes and non-athletes (p = 0.324). The cost per cardiac individual screened equated to €51.15. CONCLUSION: A nationwide systematic cardiac screening programme for adolescent athletes and non-athletes is feasible and cost-efficient, provided that responsible centres have the appropriate infrastructure.

The P value - and its historical underpinnings - pro and con.

The derivation and interpretation of P values derived from inferential testing remain somewhat vague and ambiguous in the minds of some researchers/editors/reviewers/readers. The British polymath Fisher famously averred: "the value for which P = 0.05, or 1 in 20, is 1.96 or nearly 2; it is convenient to take this point as a limit in judging whether a deviation is to be considered significant or not. Deviations exceeding twice the standard deviation are thus formally regarded as significant." This sometimes leads to an almost reductio ad absurdum mindset with an automatic discardment of studies with results where P > 0.05. It must be remembered that results may be negatively impacted by myriad factors that may be out of the researcher/s control, such as small sample sizes, small effects, bias, and random error. This paper briefly reviews the historical events leading to the acceptance of P ≤ 0.05 for statistical significance, the rationale behind the null hypothesis (H0), the meaning of P (and the potential for Type 1 and 2 Errors), α, ß, the possibility of using non-0.05 cut-offs when studies are "trending toward statistical significance," and the importance of including confidence intervals (CIs) in results. P values are vital but must be tempered by judicial consideration of CI and study design. P is a probability spectrum and not simply a binary significant/non-significant statistical metric. MeSH: 95% confidence interval, biostatistics, P value.

Artificial intelligence in medicine and research - the good, the bad, and the ugly.

Artificial intelligence (AI) broadly refers to machines that simulate intelligent human behavior, and research into this field is exponential and worldwide, with global players such as Microsoft battling with Google for supremacy and market share. This paper reviews the "good" aspects of AI in medicine for individuals who embrace the 4P model of medicine (Predictive, Preventive, Personalized, and Participatory) to medical assistants in diagnostics, surgery, and research. The "bad" aspects relate to the potential for errors, culpability, ethics, data loss and data breaches, and so on. The "ugly" aspects are deliberate personal malfeasances and outright scientific misconduct including the ease of plagiarism and fabrication, with particular reference to the novel ChatGPT as well as AI software that can also fabricate graphs and images. The issues pertaining to the potential dangers of creating rogue, super-intelligent AI systems that lead to a technological singularity and the ensuing perceived existential threat to mankind by leading AI researchers are also briefly discussed.

The Sex Ratio at Birth Is Higher in Maori than in Non-Maori Populations in Aotearoa New Zealand.

AIMS: The sex ratio at birth approximates 0.515 (male : total, M/T), with 515 boys per 485 girls. Many factors have been shown to influence M/T including acute and chronic stress. Increasing maternal age is associated with a decline in M/T. In Aotearoa New Zealand, circa 15% of the population identify as of Maori heritage. This populationis generally considered to be socioeconomically disadvantaged. This study analysed M/T for Maori and non-Maori M/T births in Aotearoa New Zealand and relates these to mean maternal age at delivery. METHODS: Live births by sex and maternal age at delivery were available from the website of Tatauranga Aotearoa Stats NZ for 1997-2021. RESULTS: This study analysed 1,474,905 births (28.4% Maori) Pooled data shows that Maori M/T is significantly higher than non-Maori M/T (chi = 6.8, p = 0.009). Mean maternal age at delivery was less for Maori mothers but this was not statistically significant. CONCLUSIONS: Several studies have shown that M/T is decreased in socioeconomically deprived populations, and for this reason Maori M/T is expected to be lower and not higher than non-Maori M/T. A lower mean maternal age at delivery might have explained the M/T differences noted in this analysis but this was not a statistically significant difference.

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.

Transient block during radiofrequency ablation well away from the His-Purkinje system: atrioventricular nodal artery trauma?

Cardiac arrhythmias occur at all ages. Cardiac mapping and ablation are established methods for curing arrhythmia substrates; however, complications may occur. We report a patient with transient Wenckebach heart block during radiofrequency ablation in the setting of Wolff Parkinson White syndrome despite the ablation catheter being well away from the atrioventricular node, and we speculate on the potential mechanism.

Regional differences in the sex ratio at birth in Mexico

Objective: The sex ratio at birth, defined as males/total (M/T) approximates 0.515 but is affected by many factors. Acute and chronic stress have been shown to lower M/T, and both regional and racial differences exist. This study analysed regional differences in M/T in Mexico. Material and Methods: Live births by sex and year were available for 1994-2020. Regional births were available for 2010-2020 for five regions: North, Centre, West, East and South. Results: There were 68,423,415 births for 1994-2020 and 25,436,687 for 2010-2020 (M/T=0.5060, 95% confidence interval: 0.5058-0.5062). M/T was <0.515 (p<0.0001). Live births correlated negatively with year (p<0.0001). M/T fell for 1994-2003 then rose to 2020 (p<0.0001). M/T was highest in North followed by West, South, Centre and East (p<0.0001). Conclusion: Chronic stress with socioeconomic deprivation may reduce M/T and may explain the low M/T found in this study from Mexico.

COVID-19 induced birth sex ratio changes in England and Wales.

Background: The sex ratio at birth (male live births divided by total live births) may be a sentinel health indicator. Stressful events reduce this ratio 3-5 months later by increasing male fetal loss. This ratio can also change 9 months after major population events that are linked to an increase or decrease in the frequency of sexual intercourse at the population level, with the ratio either rising or falling respectively after the event. We postulated that the COVID-19 pandemic may have affected the ratio in England and Wales. Methods: Publicly available, monthly live birth data for England and Wales was obtained from the Office for National Statistics up to December 2020. Using time series analysis, the sex ratio at birth for 2020 (global COVID-19 onset) was predicted using data from 2012-2019. Observed and predicted values were compared. Results: From 2012-2020 there were 3,133,915 male and 2,974,115 female live births (ratio 0.5131). Three months after COVID-19 was declared pandemic (March 2020), there was a significant fall in the sex ratio at birth to 0.5100 in June 2020 which was below the 95% prediction interval of 0.5102-0.5179. Nine months after the pandemic declaration, (December 2020), there was a significant rise to 0.5171 (95% prediction interval 0.5085-0.5162). However, December 2020 had the lowest number of live births of any month from 2012-2020. Conclusions: Given that June 2020 falls within the crucial window when population stressors are known to affect the sex ratio at birth, these findings imply that the start of the COVID-19 pandemic caused population stress with notable effects on those who were already pregnant by causing a disproportionate loss of male fetuses. The finding of a higher sex ratio at birth in December 2020, i.e., 9 months after COVID-19 was declared a pandemic, could have resulted from the lockdown restrictions that initially spurred more sexual activity in a subset of the population in March 2020.

The juvenile ECG pattern in adolescent athletes and non-athletes in a national cardiac screening program (BEAT-IT).

BACKGROUND: Anterior T wave inversion (TWI) is frequent in healthy adolescent individuals (juvenile ECG pattern), normalising after puberty. Its clinical implications are uncertain. AIM: This study assessed a) national prevalence of anterior TWI, b) ST segment morphology, c) proportion of individuals with a juvenile ECG pattern whose ECG normalises and d) factors predicting TWI persistence >16 years. METHODS: Adolescents (mean 15y) in Malta were systematically invited to enrol in a cardiac screening program. Subjects completed a health questionnaire and an ECG at their school. Participants with TWI were labelled as TWI in V1-V2 or extended TWI (V1-V3/4). The latter were followed at 1 year with a repeat ECG. Those with persistent extended anterior TWI were offered evaluation and surveillance. RESULTS: The prevalence of isolated anterior TWI was 5.0%, commoner in females (6.3%) independent of athletic ability. Extended TWI was commoner in female athletes (4.2%, non-athletes 2.1%). Females often had shallow TWI without overt ST segment abnormalities. Deep TWI and ST segment changes were more frequent in males. Only 0.2% of cases persisted ≥16 years of age. ST segment characteristics were not able to predict T wave normalisation. No events took place during follow up (40 ± 9 months). CONCLUSION: Anterior TWI is a frequent phenomenon in adolescents, especially in females. Female athletes are also more likely to have extended anterior TWI. Only 0.2% of cases have persistent anterior TWI at 16 years of age. Chest wall anatomy may explain this phenomenon in females. It is uncommon in males, hence why surveillance is more prudent.

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.

Stressor Effects on Sex Ratios and Births in the Maltese Population during the First Half of the 20th Century.

BACKGROUND: The sex ratio at birth (male/total = M/F) is expected to approximate 0.515. Stress is known to reduce livebirth M/F. In the first half of the 20th century, Malta was stressed by two World Wars. OBJECTIVES: This study was carried out in order to analyse changes in reproductive performance and M/F of stillbirths and livebirths in Malta during this period. METHODS: Livebirth and stillbirth data (1910-1951) were obtained from official published Maltese government reports. Stillbirths were defined as any antenatal loss after 28 weeks of gestation. RESULTS: This analysis studied 347,562 live and 11,662 stillbirths. For 1919-1951, M/F at birth was 0.517, stillbirth M/F was 0.664, implying 28/40 M/F = 0.522. Assuming conceptional M/F = 0.5, estimated M/F for fetal wastage before 28 weeks was approximately 0.434. There was a decrease in the overall birth rate starting after 1911 to 1921, more marked for 1941-1943 followed by an overshoot in 1943-48. There was a statistically significant drop in M/F livebirths during the periods 1916-21 and 1934-45. Stillbirths decreased significantly after 1935 (M>F). A stillbirth M/F drop in 1937-45 and rise in 1946-51 were statistically significant. CONCLUSIONS: Birth rate drops in both wars were ascribed to conscription, adverse living conditions and decreased fertility from nutritional restrictions. Both conflicts resulted in short post-war baby booms. The decrease in stillbirths is attributed to increase in antenatal attendances, hospital births and special food rations for pregnant women. The M/F observations suggest that the selective survival of both healthier female and male foetuses is favoured during times of stress.

What's best, online or on-site? The write a scientific paper course.

Background: The ability to publish is a career-critical skill but requires the acquisition of a wide and disparate skill set. The Write a Scientific Paper (WASP) course was created in Malta in 2010, an intensive, three-day event. WASP is an accredited event held in Malta, London, and Bahrain. The COVID pandemic forced WASP to go online. This study compared satisfaction with WASP online as opposed to in-person by analyzing course feedback pre- and post-pandemic. Methods: Google forms are used to collect anonymous feedback on a Likert scale for various aspects of each WASP. The period 2017 to 2022 was used to compare four courses on-site and five courses online. Feedback on: Rate lectures, handouts, WASP overall and how likely are you to recommend WASP was compared. Results: Response rates were >60% and almost all Cronbach's Alpha values were >0.7. High satisfaction scores were achieved in all four questions (>4/5). There were no significant differences except in lectures, which scored well but fared slightly worse overall online. Conclusions: Migrating online does not necessarily lead to change/s in presentation contents but transforms delivery. Our results indicate that WASP is accepted online but the slightly lower lectures score implies that WASP might be better delivered in-person than online. However, students remained happy to recommend WASP and this accords with other studies that overall, student satisfaction with online education is common. It is hoped that as the pandemic recedes, webinars complement and not continue to totally replace traditional in-person meetings.

Write a Scientific Paper course - Utility or otherwise?

Background: Publish or perish is a cliched mantra but publishing requires the acquisition of a wide set of disparate skills that are typically learned in a completely ad-hoc manner in an early period of one's career. The Write a Scientific Paper (WASP) course is delivered online by an experienced, international faculty of academics, including several medical journal editors. This study retrospectively analyzed the attendees' perceptions of the usefulness and the utility of WASP. Methods: An email questionnaire of 11 questions was sent to all previous WASP attendees, 370 subjects, in May 2022. The questions included the geographical locations of the subjects as well as the number of published articles before and since WASP course. Besides a couple of questions on rating and recommending the WASP course, some other related questions were also asked. Results: There were 68 responses (18%) with high agreement (Cronbach α = 0.92). The WASP course fared well across the different research-oriented dimensions and expectations and is mostly welcomed by young career professionals. Following WASP, a 9% increase in scientific writing and published articles engagement was reported. Discussion: WASP is an international and unique course that emphasises presentation skills using newspaper media theory. It highlights to the delegates the importance of understanding the conflicting tripod of forces that govern publishing. Authors wish to publish more; readers are inundated, wishing to read less, whereas journal editors' primary aims are to elevate their journals' impact factors. WASP endorsements and the testimonials are invariably positive. The transition to online barely affected satisfaction rates with WASP while permitting the enrolment of a more international faculty that includes even more journal editors. WASP's ultimate objective is to impart the faculty's collective experience to the delegates in this crucial, early aspect of career progress.