Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 194
Filtrar
1.
Public Health ; 198: 270-272, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34492507

RESUMO

OBJECTIVES: COVID-19 is a health burden threatening the elderly and those with comorbidities. Malta is an ageing and cardiometabolic country. The study depicts how Malta protected the elderly and the effect of vaccination on this subpopulation. STUDY DESIGN: Observational study with quantitative analyses. METHOD: Data were obtained from Malta's COVID dashboard, Institute for Health Metrics and Evaluation and Maltese newspapers. The case-fatality ratio (CFR) and Years of Life Lost (YLLs) for COVID were calculated. Comparisons were made between COVID-19 mortality and YLL to the pre-COVID leading mortality causes. Comparative observations were made between positive and mortality cases stratified by age groups in relation to the cumulative vaccination doses. RESULTS: The elderly were cocooned during the first wave (CFR 0.98) through the Vulnerable Act, with only 10.80% of positive cases and seven out nine deaths above 65 years. The Vulnerable Act was not reinstated again, with 13.68% of positive cases and 91.34% (n = 369) of deaths above 65 years during the second wave (CRF 1.39). The elderly were given priority in COVID-19 vaccination rollout leading to an inverse relationship between positive cases/mortality and vaccination coverage. CONCLUSION: The elderly should be protected with timely restrictions to reduce morbidity, mortality and burden on healthcare systems. Vaccination is key to protecting the elderly, although mitigation measures, such as physical distancing, are still required to prevent the resurgence of infections and hospitalizations, especially in this group.


Assuntos
COVID-19 , Pandemias , Idoso , Vacinas contra COVID-19 , Humanos , Malta/epidemiologia , Pandemias/prevenção & controle , SARS-CoV-2
3.
Ulster Med J ; 90(1): 16-21, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33642629

RESUMO

Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which can have a strong impact on patients' quality of life including influence on various social aspects and psychological ramifications. The aim of the study was to assess the prevalence and consequences of IBS in medical students and junior doctors in Malta. Method: An online survey was sent out to all medical students enrolled at University of Malta and all doctors training with the Malta Foundation Programme. Key Results: The prevalence of IBS was 17.7% (total number =192), with 6.2% being previously diagnosed with IBS and the rest (11.5%) having symptoms consistent with IBS according to the Rome IV criteria. There was no statistically significant difference in BMI and in activity level as determined by the Godin Leisure-Time Exercise Questionnaire between IBS and non-IBS group.Absenteeism was significantly commoner in students/ doctors with IBS (47.1%) than in those without IBS (9.5%; p=0.0001). Of those previously diagnosed with IBS, 66.7% self-medicated compared to 45.4% of those diagnosed through the questionnaire. 71.6% of those in the IBS group tried dietary modification as to control their symptoms.On the Kessler 6 Distress scale, 91.2% of the IBS group had a score >6, with 44.1% having a score >13. The mean Visceral Sensitivity Index Score was 40.1 (95% CI 33.6 - 46.6). Conclusion: IBS is prevalent, yet under-recognized, in medical students and junior doctors. Measures should be instituted for timely, confidential detection and management of IBS and its related psychological consequences.


Assuntos
Síndrome do Intestino Irritável/epidemiologia , Corpo Clínico Hospitalar/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Síndrome do Intestino Irritável/psicologia , Masculino , Malta/epidemiologia , Corpo Clínico Hospitalar/psicologia , Prevalência , Qualidade de Vida , Distribuição por Sexo , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Adulto Jovem
4.
Pharm. pract. (Granada, Internet) ; 19(1): 0-0, ene.-mar. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-201721

RESUMO

BACKGROUND: The pandemic is at a paradoxical stage, with vaccine roll out initiated but a significantly elevated level of infection and death. Hope for recovery lies in high equitable vaccine uptake. OBJECTIVE: The study aimed to: i) explore attitudes and factors influencing attitudes, towards the COVID-19 vaccine amongst people living in Malta, ii) identify the reasons as to why individuals are unsure or unwilling to take the vaccine. METHODS: Two consecutive, short, anonymous online surveys using social media platforms were used to gather data from adult individuals. The first study was open to residents in Malta, while the second study invited international participation. Study 1 consisted of 17 questions inspired by the Theories of Planned Behaviour and Reasoned Action. Study 2 asked participates whether they were willing, unwilling or unsure of taking the vaccine and their reasons for being unsure or unwilling. RESULTS: A total of 2,529 individuals participated in Study 1 and 834 in Study 2. In both studies respondents were predominantly female having a tertiary education. Over 50% declared that they were willing to take the vaccine, with males being more willing (t=5.83, df=1164.2, p < 0.00005). Opinions of significant others- family and friends (r=0.22, p < 0.005) and health professionals (r=0.74, p < 0.005) were associated with willingness to take the vaccine. Vaccine hesitancy was present in the study population with 32.6% being unsure and 15.6% declaring that they were not willing to take the vaccine. Females were more likely to be unsure (Chi-squared=14.63, df=4, p = 0.006). Lack of vaccine safety was the main reason cited for unwillingness to take the vaccine. Predictors for willingness to take the vaccine were: i) The belief that the COVID-19 vaccine will protect the health of the people who take it; ii) Valuing the advice of health professionals regarding the effectiveness of COVID-19 vaccine; iii) Having taken the influenza vaccine last year and; iv) Encouraging their elderly parents to take the vaccine. CONCLUSIONS: COVID-19 vaccination information campaigns should promote group strategies, focusing on emphasising the safety of the vaccine and offer reassurance, especially to women


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Programas de Imunização/estatística & dados numéricos , Vacinação em Massa/estatística & dados numéricos , Atitude , Intenção , Vírus da SARS/patogenicidade , Vacinas/administração & dosagem , Programas de Imunização/organização & administração , Pandemias/prevenção & controle , Estudos Transversais , Inquéritos e Questionários/estatística & dados numéricos , Movimento contra Vacinação/estatística & dados numéricos , Malta/epidemiologia
5.
Public Health ; 192: 33-36, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33611169

RESUMO

OBJECTIVES: Multimorbidity, defined as the co-occurrence of at least two chronic diseases, is a common occurrence with ageing and a recognised public health concern, especially during the COVID-19 pandemic. The multimorbidity population is more susceptible to the virus, its complications, and death. The study aimed to explore the multimorbidity characteristics and their associations at a population level for the first time in Malta. Such data enables adequate priority and policy planning due to COVID-19's predilection for this population. STUDY AND METHODS: Baseline data was collected from 3,947 adults recruited between 2014-2016 through a cross-sectional study. A single-stage sampling strategy was implemented and stratified by age (18 -70 years), sex and locality. Participants were invited to attend a health examination survey consisting of a questionnaire, anthropometric and biological measurements. Descriptive (chi-square) and analytic (regression modelling) statistics were used to determine the characteristics and associations of the multimorbidity population. The chronic diseases considered for multimorbidity were type 2 diabetes, obesity, hypertension, myocardial infraction, coronary heart disease and dyslipidaemia. RESULTS: Multimorbidity was present in 33% (95% confidence interval 31.54-34.47) of the study population, with a male predominance. Hypertension and myocardial infarction were the commonest multimorbidity combination from a young age group (20-30 years). Low socio-economic status and residing on the island of Gozo were positively associated with multimorbidity. CONCLUSION: Multimorbidity in Malta was evident from a young age, with the highest occurrence among the low socio-economic status and residents of Gozo, bringing forward the need for preventive action. An adaptive healthcare system and policies are recommended to prevent, support, and manage multimorbidity non-communicable diseases while bracing for the current COVID-19 pandemic.


Assuntos
Envelhecimento , COVID-19/epidemiologia , Doença Crônica/epidemiologia , Adolescente , Adulto , Idoso , Doença das Coronárias/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Masculino , Malta/epidemiologia , Pessoa de Meia-Idade , Multimorbidade , Infarto do Miocárdio/epidemiologia , Doenças não Transmissíveis/epidemiologia , Obesidade/epidemiologia , Pandemias , Saúde da População , Fatores de Risco , SARS-CoV-2 , Classe Social , Adulto Jovem
6.
J Community Health ; 46(3): 618-625, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32936428

RESUMO

The second COVID-19 wave is sweeping the globe as restrictions are lifted. Malta, the 'poster child of Europe's COVID-19 first wave success' also fell victim shortly after it welcomed the first tourists on 1st of July 2020. Only four positive cases were reported over the successive 15 days. Stability was disrupted when two major mass events were organized despite various health professional warnings. In a matter of few just days, daily cases rose to two-digit figures, with high community transmission, a drastic rise in active cases, and a rate per hundred thousand in Europe second only to Spain. Frontliners were swamped with swabbing requests while trying to sustain robust case management, contact tracing and follow-up. Indeed, the number of hospitalizations and the need for intensive ventilation increased. Despite the initial cases were among young adults, within weeks a small spill off on the more elderly population was observed. Restrictions were re-introduced including mandatory mask wearing in specific locations and capping of the total number of people in a single gathering. Malta is an island and the potential for containment would have been relatively simple and effective and permitting mass gatherings was unwise. Protecting the health of the population should take centre stage while carrying out extensive testing, contact tracing and surveillance. Containment and mitigation along with public cooperation is the key to curbing resurgences especially with the influenza season around the corner.


Assuntos
COVID-19/epidemiologia , COVID-19/transmissão , Aglomeração , Pandemias , Adolescente , Adulto , Idoso , COVID-19/prevenção & controle , Busca de Comunicante , Humanos , Malta/epidemiologia , Pandemias/prevenção & controle , Vigilância em Saúde Pública , Adulto Jovem
7.
Int J Qual Health Care ; 33(1)2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33313859

RESUMO

INTRODUCTION: COVID-19 has challenged healthcare systems worldwide. Some countries collapsed under surge conditions, while others (such as Malta) showed resilience. Public health measures in Malta quickly reined in COVID-19 spread. This review summarizes pandemic preparedness measures in Malta and the impact on routine services. METHODS: A literature search was conducted using Google, Google Scholar and PubMed and by reviewing Maltese online newspapers. A comprehensive summary of internal operations conducted at Mater Dei Hospital (MDH) was made available. RESULTS: A hospital 'Incident Command Group' was set up to plan an optimal COVID-19 response strategy. A 'rapid response team' was also created to cater for the logistics and management of supplies. A 'COVID-19 Emergency Operation Centre' simulated different COVID-19 scenarios. All elective services were suspended and all staff were mandatorily trained in wearing personal protective equipment. Staff were also retrained in the care of COVID-19 patients. In preparation for potential admission surges, MDH underwent rapid expansion of normal and intensive care beds. Swabbing was ramped up to one of the highest national rates worldwide. The cost for hospital COVID-19 preparedness exceeded €100 million for Malta's half a million population. CONCLUSION: Malta and its sole acute hospital coped well with the first wave with 680 cases and 9 deaths. The increased ability to deal with COVID-19 (a principally respiratory pathogen) will serve well for the anticipated combined annual influenza and the COVID-19 second wave this coming winter.


Assuntos
COVID-19/epidemiologia , Hospitais Públicos/organização & administração , Humanos , Malta/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
8.
PLoS One ; 15(6): e0233641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525937

RESUMO

OBJECTIVE: To evaluate the effects of changes in risk factors between the first two pregnancies on the occurrence of placental abruption (PA) in the same woman. METHODS: Routinely collected obstetric data from Aberdeen Maternity and Neonatal Databank, the Maltese National Obstetric Information System and the Finnish Medical Birth Register were aggregated. Records of the first two singleton pregnancies from women who had PA in one pregnancy but not the other, were identified from this pooled dataset. A case-crossover study design was used; cases were pregnancies with abruption and matched controls were pregnancies without abruption in the same woman. Conditional logistic regression was used to investigate changes in risk factors for placental abruption in pregnancies with and without abruption. RESULTS: A total of 2,991 women were included in the study. Of these 1,506 (50.4%) had PA in their first pregnancy and 1,485 (49.6%) in a second pregnancy. Pregnancies complicated by preeclampsia {194 (6.5%) versus 115 (3.8%) adj OR 1.69; (95% CI 1.23-2.33)}, antepartum haemorrhage of unknown origin {556 (18.6%) versus 69 (2.3%) adjOR 27.05; 95% CI 16.61-44.03)} and placenta praevia {80 (2.7%) versus 21 (0.7%) (adjOR 3.05; 95% CI 1.74-5.36)} were associated with PA. Compared to 20 to 25 years, maternal age of 35-39 years {365 (12.2) versus 323 (10.8) (adjOR 1.32; 95% CI 1.01-1.73) and single marital status (adjOR 1.36; 95% CI 1.04-1.76) were independently associated with PA. Maternal smoking, BMI and fetal gender were not associated with PA. CONCLUSION: Advanced maternal age, pregnancies complicated with unexplained bleeding in pregnancy, placenta praevia and preeclampsia were independently associated with a higher risk of placental abruption.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Fatores Etários , Estudos Cross-Over , Feminino , Finlândia/epidemiologia , Humanos , Malta/epidemiologia , Idade Materna , Gravidez , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
10.
Eur J Clin Microbiol Infect Dis ; 39(10): 1885-1897, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32418063

RESUMO

Invasive meningococcal disease (IMD) is a vaccine-preventable devastating infection that mainly affects infants, children and adolescents. We describe the population epidemiology of IMD in Malta in order to assess the potential utility of a meningococcal vaccination programme. All cases of microbiologically confirmed IMD in the Maltese population from 2000 to 2017 were analysed to quantify the overall and capsular-specific disease burden. Mean overall crude and age-specific meningococcal incidence rates were calculated to identify the target age groups that would benefit from vaccination. Over the 18-year study period, 111 out of the 245 eligible notified cases were confirmed microbiologically of which 70.3% had septicaemia, 21.6% had meningitis, and 6.3% had both. The mean overall crude incidence rate was 1.49/100,000 population with an overall case fatality rate of 12.6%. Meningococcal capsular groups (Men) B followed by C were the most prevalent with W and Y appearing over the last 6 years. Infants had the highest meningococcal incidence rate of 18.9/100,000 followed by 6.1/100,000 in 1-5 year olds and 3.6/100,000 in 11-15 year old adolescents. The introduction of MenACWY and MenB vaccines on the national immunization schedule in Malta would be expected to reduce the disease burden of meningococcal disease in children and adolescents in Malta.


Assuntos
Infecções Meningocócicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Malta/epidemiologia , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/prevenção & controle , Pessoa de Meia-Idade , Sepse/epidemiologia , Sepse/microbiologia , Sepse/prevenção & controle , Vacinação , Adulto Jovem
11.
Vector Borne Zoonotic Dis ; 20(7): 529-534, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32267802

RESUMO

In a sanctuary located on the island of Malta, 23 clinically healthy cats randomly selected were sampled for blood and fleas. Only fleas were collected from 35 cats. All fleas were identified as Ctenocephalides felis, except for one specimen of Ctenocephalides canis. To the best of the authors' knowledge, this may be the first time to establish the occurrence of Bartonella koehlerae and B. clarridgeiae, as well as of Candidatus Mycoplasma haemominutum in the blood samples of 11 cats (47.82% [95% CI: 29.33-67.04]) with conventional PCR assays. One or more pathogens were found in 54 (96.42% [95% CI: 86.74-99.70]) out of 56 pooled flea samples, the most prevalent was Rickettsia felis. The DNA of Bartonella henselae, the commonest etiological agent of cat scratch disease, was detected first time in a pooled flea sample of a cat.


Assuntos
Infecções Bacterianas/veterinária , Doenças do Gato/microbiologia , Infestações por Pulgas/veterinária , Animais , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Doenças do Gato/epidemiologia , Doenças do Gato/transmissão , Gatos , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Infestações por Pulgas/epidemiologia , Abrigo para Animais , Insetos Vetores/microbiologia , Malta/epidemiologia
12.
Early Hum Dev ; 145: 105043, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32311646

RESUMO

The world is in the grip of pandemic COVID-19 (SARS-CoV-2). Children appear to be only mildly affected but for those countries that are still preparing for their first wave of infections, it is salutary to have some estimates with which to plan for eventual contingencies. These assessments would include acute hospital admission requirements, intensive care admissions and deaths per given population. It is also useful to have an estimate of how many paediatric admissions to expect per given population. However it is only very recently that paediatric epidemiological data has become available. This paper will create an interactive spreadsheet model to estimate population and paediatric admissions for a given population, with the author's country, Malta, as a worked example for both.


Assuntos
Infecções por Coronavirus/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , COVID-19 , Criança , Pré-Escolar , Estudos de Coortes , Infecções por Coronavirus/terapia , Humanos , Lactente , Malta/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia
13.
J Community Health ; 45(3): 510-515, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31677047

RESUMO

Cholera reached the Maltese Archipelago for the first time ever in June 1837. It found a poor and destitute population that was not prepared for the epidemic. Many doctors feared contagion while others believed it was contracted from bad air or miasma. The first cases of cholera in Malta broke out at a hospital for the elderly and the infirm, the Ospizio in Floriana on 9th June 1837, reached a peak in the week between 12 July to 18 July and dwindled by the end of August 1837. The epidemic saw a death toll of 4252 from 8785 registered cholera cases when the Maltese population was 120,000. Contemporary foreign residents on the islands witnessed and recorded stories of heartlessness and harshness of terrified people. This degenerative behaviour, however, did not reach the callousness of rioting and murder that were observed in other countries. Also, during this dark time, there were people who showed compassion, kindness and selfless devotion to the sick and the dying. In the chaos that reigned during that summer, the inhabitants of one small town in the north of Malta organized themselves better than the rest with good results.


Assuntos
Cólera/epidemiologia , Epidemias/história , Idoso , História do Século XIX , Hospitais , Humanos , Internacionalidade , Malta/epidemiologia , Estações do Ano
14.
BMJ Open ; 9(12): e032704, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31857311

RESUMO

OBJECTIVE: To identify factors that influence general practitioners' (GPs') oral antibiotic prescribing for acute respiratory tract complaints (aRTCs) in Malta. DESIGN: Repeated, cross-sectional surveillance. SETTING: Maltese general practice; both public health centres and private GP clinics. PARTICIPANTS: 30 GPs registered on the Malta Medical Council's Specialist Register and 3 GP trainees registered data of 4831 patients of all ages suffering from any aRTC. Data were collected monthly between May 2015 and April 2016 during predetermined 1-week periods. OUTCOME MEASURES: The outcome of interest was antibiotic prescription (yes/no), defined as an oral antibiotic prescription issued for an aRTC during an in-person consultation, irrespective of the number of antibiotics given. The association between GP, practice and consultation-level factors, patient sociodemographic factors and patient health status factors, and antibiotic prescription was investigated. RESULTS: The antibiotic prescription rate was 45.0%. Independent factors positively associated with antibiotic prescribing included female GP sex (OR 2.3, 95% CI 1.22 to 4.26), GP age with GPs ≥60 being the most likely (OR 34.7, 95% CI 14.14 to 84.98), patient age with patients ≥65 being the most likely (OR 2.3, 95% CI 1.71 to 3.18), number of signs and/or symptoms with patients having ≥4 being the most likely (OR 9.6, 95% CI 5.78 to 15.99), fever (OR 2.6, 95% CI 2.08 to 3.26), productive cough (OR 1.3, 95% CI 1.03 to 1.61), otalgia (OR 1.3, 95% CI 1.01 to 1.76), tender cervical nodes (OR 2.2, 95% CI 1.57 to 3.05), regular clients (OR 1.3, 95% CI 1.05 to 1.66), antibiotic requests (OR 4.8, 95% CI 2.52 to 8.99) and smoking (OR 1.4, 95% CI 1.13 to 1.71). Conversely, patients with non-productive cough (OR 0.3, 95% CI 0.26 to 0.41), sore throat (OR 0.6, 95% CI 0.53 to 0.78), rhinorrhoea (OR 0.3, 95% CI 0.23 to 0.36) or dyspnoea (OR 0.6, 95% CI 0.41 to 0.83) were less likely to receive an antibiotic prescription. CONCLUSION: Antibiotic prescribing for aRTCs was high and influenced by a number of factors. Potentially inappropriate prescribing in primary care can be addressed through multifaceted interventions addressing modifiable factors associated with prescription. TRIAL REGISTRATION NUMBER: NCT03218930.


Assuntos
Antibacterianos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Infecções Respiratórias/tratamento farmacológico , Adolescente , Adulto , Idoso , Gestão de Antimicrobianos/estatística & dados numéricos , Estudos de Casos e Controles , Criança , Pré-Escolar , Tomada de Decisão Clínica , Estudos Transversais , Feminino , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Malta/epidemiologia , Pessoa de Meia-Idade , Infecções Respiratórias/epidemiologia , Adulto Jovem
15.
Int J Clin Pharm ; 41(3): 741-750, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006832

RESUMO

Background Medicine use review by pharmacists has the potential to improve anticoagulation therapy management in patients on warfarin. Objective To develop, implement and evaluate a pharmacist-led medication use review service for patients on warfarin. Setting Six community pharmacies in Malta. Method Patients (N = 100) aged 18 or older and on warfarin were recruited through pre-selected community-pharmacies. These patients were then invited to attend two sessions: a review session (t1) and a follow-up session after 2 months (t2). During the medication use review session, medication reconciliation was performed (a) to detect drug-related problems using the DOCUMENT classification system, (b) to develop an individualised care plan for each patient and (c) to recommend an action for each identified problem for physician, pharmacist or patient consideration. At t2, the degree of acceptance of the recommendations was determined by assessing the number of drug-related problems for which action was taken to address the problem. International normalisation ration (INR) control was evaluated by calculating the percentage Time in Therapeutic Range (TTR) at t1 and t2 using the Rosendaal linear interpolation method. Main outcome measures Frequency and type of drug-related problems detected; percentage of accepted recommendations; and INR control. Results A total of 481 drug-related problems were identified; 40% (n = 190) were related to warfarin treatment. Need for monitoring (30%; n = 145), lack of compliance (20%; n = 97) and need for patient education (19%; n = 90) were the top three problems identified. There was a significant correlation between frequency of the problems and number of chronic medications (Spearman Correlation 0.583, p < 0.001), number of comorbidities (Spearman Correlation 0.327, p = 0.001) and older age (Spearman Correlation 0.285, p = 0.04). A total of 475 recommendations were followed-up; 49% (n = 234) were referred for consideration by the physician. The percentage of recommendations accepted (84%; n = 397) was significantly higher than the percentage of recommendations not accepted (16%; n = 78) (p < 0.001). The time in therapeutic range improved significantly from 68.7% at t1 to 79.8% at t2 (p = 0.01). Conclusions The high percentage of accepted recommendations and the improvement in INR control indicate that a pharmacist-led medication use review service in community pharmacy contributes to improving anticoagulation therapy management in patients on warfarin.


Assuntos
Serviços Comunitários de Farmácia/normas , Revisão de Uso de Medicamentos/normas , Reconciliação de Medicamentos/normas , Farmacêuticos/normas , Papel Profissional , Varfarina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Revisão de Uso de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Seguimentos , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/normas , Masculino , Malta/epidemiologia , Reconciliação de Medicamentos/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Varfarina/administração & dosagem
16.
Atheroscler Suppl ; 36: 24-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30876529

RESUMO

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is an autosomal dominant condition raising the risk of premature cardiovascular disease up to twentyfold.[1] [2] It is under-diagnosed and undertreated, in spite of availability of effective treatment. Registers are recommended to assist in the recognition and improvement of the condition since treatment reduces morbidity and mortality. Disease registers enable longitudinal review and the application of continuous quality improvement methodology. The aims of this paper are to describe the process of setting up a new FH register in Malta based on phenotype, the preliminary results achieved, the barriers encountered, how these were overcome, and future plans for development. METHODS: The registry was established as an observational clinical study designed for a small healthcare system with limited resources. Effective process design requires attention to standards, capacity, outcome measurement and feedback, which have been incorporated. RESULTS: 43 individuals have been registered applying Dutch Lipid Clinic Network standards, including 9 Definite, 16 Probable and 18 Possible FH. Cascade testing has identified three younger, and one older FH individuals; amenable risk factors and target outcomes are available for feedback and action. Barriers included insufficient infrastructure, limited stakeholder involvement, time limitations impacting clinical care and data collection, poor recognition, awareness and referral, and limited cascade testing. Overcoming these required persistence, reorganizing clinical work, with some assistance from clinic nurses, forward planning to involve patients and raising FH awareness through presentations to various audiences. CONCLUSIONS: During this year the register was established and is functional: awareness is being raised. Future steps will target process improvement for effectiveness and sustainability.


Assuntos
LDL-Colesterol/sangue , Hiperlipoproteinemia Tipo II , Sistema de Registros , Projetos de Pesquisa , Adulto , Idoso , Anticolesterolemiantes/uso terapêutico , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/epidemiologia , Hiperlipoproteinemia Tipo II/genética , Masculino , Malta/epidemiologia , Pessoa de Meia-Idade , Fenótipo , Dados Preliminares , Prognóstico , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Adulto Jovem
17.
J Antimicrob Chemother ; 74(4): 1116-1124, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30624733

RESUMO

OBJECTIVES: To determine the 1 year antibiotic prescribing patterns by GPs for acute respiratory tract complaints (aRTCs) in Malta. METHODS: In this repeated cross-sectional surveillance study, GPs collected data for patients seen for aRTCs during a designated 1 week period each month, between May 2015 and April 2016. GPs received three text reminders during surveillance weeks and were contacted by phone at most four times during the year. GPs also received 3 monthly individual- and aggregate-level feedback reports on their antibiotic prescribing patterns. Descriptive statistics were used to examine patient, consultation and clinical characteristics, and to describe GPs' prescribing patterns. RESULTS: Participating GPs (n = 33) registered 4641 patients with an aRTC, of whom 2122 (45.7%) received an antibiotic prescription. The majority (99.6%) of antibiotics prescribed were broad-spectrum and the most commonly prescribed antibiotics were macrolides (35.5%), followed by penicillins with a ß-lactamase inhibitor (33.2%) and second-generation cephalosporins (14.2%). Specifically, co-amoxiclav (33.2%), clarithromycin (19.6%), azithromycin (15.1%) and cefuroxime axetil (10.9%) represented 78.8% of all antibiotics prescribed. Patients with tonsillar exudate (99.1%), purulent sputum (84%), otorrhoea (78%), tender cervical nodes (74.4%) and fever (73.1%) received most antibiotics. The diagnoses that received the highest proportion of antibiotic treatment were tonsillitis (96.3%), otitis media (92.5%) and bronchitis (87.5%). Wide variation in the choice of antibiotic class by diagnosis was observed. CONCLUSIONS: GP antibiotic prescribing in Malta is high. The abundant use of broad-spectrum antibiotics, particularly macrolides, is of particular concern and indicates that antibiotics are being used inappropriately. Efforts must be made to improve GP awareness of appropriate antibiotic prescribing.


Assuntos
Antibacterianos , Revisão de Uso de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/normas , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Malta/epidemiologia , Pessoa de Meia-Idade , Padrões de Prática Médica , Vigilância em Saúde Pública , Qualidade da Assistência à Saúde , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/etiologia , Adulto Jovem
19.
Euro Surveill ; 23(43)2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30376912

RESUMO

From 1 January to 30 June 2018, 11 cases of Lymphogranuloma venereum (LGV; all preserved samples (n = 4) genovar L2b) were identified at the Genitourinary Clinic (GUC), Mater Dei Hospital, Msida, Malta. All cases were diagnosed in men who have sex with men (MSM); six participated in three group-sex parties. Here, we describe the outbreak and risk factors associated with LGV diagnoses in MSM in Malta in 2018.


Assuntos
Chlamydia trachomatis/isolamento & purificação , Coinfecção/diagnóstico , Surtos de Doenças , Homossexualidade Masculina , Linfogranuloma Venéreo/diagnóstico , Adulto , Chlamydia trachomatis/genética , Busca de Comunicante , Gonorreia/diagnóstico , Infecções por HIV/diagnóstico , Humanos , Linfogranuloma Venéreo/epidemiologia , Masculino , Malta/epidemiologia , Técnicas de Amplificação de Ácido Nucleico , Fatores de Risco
20.
Biomed Res Int ; 2018: 2385386, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30364091

RESUMO

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disorder. The aim of this study was to characterise the SLE patients living in Malta in order to estimate the prevalence and incidence of SLE and characterise the clinical presentation as well as identify any unmet needs. 107 SLE patients who fulfilled SLICC classification criteria were identified. These were invited to participate in the study by means of an interview, blood and urine tests, and filling of the following questionnaires: Fatigue Severity Scale (FSS), visual analogue scale (VAS) for fatigue, Hospital Anxiety and Depression Scale (HADS), VAS for pain, Pittsburgh Sleep Quality Index (PSQI), and modified Health Assessment Questionnaire (mHAQ). The estimated prevalence of SLE in Malta is 29.3 patients per 100,000 and the estimated incidence is 1.48 per 100,000 per year. 93.5% of SLE patients were female, and the mean age at diagnosis was 33.1 years. 60.8% were overweight or obese and body mass index (BMI) had a significant positive correlation with daily dose of prednisolone (R=0.177, p=0.046). 20.7% and 3.3% had a moderate and high disease activity, respectively, as measured by SLEDAI-2K. Disease activity had a significant positive correlation with functional disability measured by mHAQ (R=0.417, p<0.001). 56.5% had an abnormal level of fatigue (FSS >3.7) and 57.6% had a high level of anxiety (HADS ≥8). This study has identified a number of unmet needs of SLE patients, including obesity, uncontrolled disease activity, fatigue, and anxiety.


Assuntos
Fadiga , Lúpus Eritematoso Sistêmico , Prednisolona/administração & dosagem , Inquéritos e Questionários , Adulto , Idade de Início , Idoso , Estudos Transversais , Fadiga/sangue , Fadiga/tratamento farmacológico , Fadiga/epidemiologia , Fadiga/urina , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/urina , Masculino , Malta/epidemiologia , Pessoa de Meia-Idade , Prevalência
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...