OAR@UM Collection:

Use and knowledge of medicines among adolescents in Malta

2020-11-06T07:06:07Z

Title: Use and knowledge of medicines among adolescents in Malta Authors: Darmanin Ellul, Rita Abstract: Research on adolescents has mainly focused on the use of alcohol, tobacco and illegal drugs but little has been done to investigate use and knowledge of medicines among this age group. The aim of this study was to investigate self-reported use and knowledge of medicines among adolescents in Malta. A self-administered questionnaire was used to survey the use and knowledge of medicines among fourth-form Junior Lyceum students. Data were collected among 474 boys and girls of mean age 15 years who were selected by stratified random sampling. The questionnaire investigated medicine knowledge, the prevalence of self-reported health complaints and medicine use during the previous 3 months for ear problems, hay fever and cough and cold; gastrointestinal problems; headache; and menstrual pain. Students also gave information on their use of eye drops, vitamins, topical skin medication, painkillers for sport injuries and antibiotics. A total of 52.0% of students experienced 3 or more health complaints and a total of 90.3% took between 1 to 9 different medicines during the previous 3 months. Statistically, girls used a significantly greater number of different medicines than boys (p < 0.01). The pharmacy was the most common source for obtaining medicines in the majority of responses (26.8%-76.9%). Of concern is that, 24.5% of the students reported that they had taken medicines without adult guidance. Furthermore, 24.7% of the respondents reported that they had obtained information about medicines from the media, friends, schoolmates or young relatives. Although in most cases, more than half of the students gave correct answers in the quiz assessing the students' knowledge of medicines, there were 40.6% of the items for which incorrect responses were obtained by a considerable 30.0% or greater proportion of the students. Another significant finding was the higher mean score obtained for knowledge of medicines by those who regularly took medicines when compared with those who did not report this behaviour (p < 0.05). Furthermore, those who took more than 2 medicines during the previous 3 months attained a higher mean score in their knowledge of medicines than those who did not take any medicine (p < 0.01). Of concern is that, those who took medicines without adult guidance were shown to possess less knowledge of medicines than those who either took medicines with adult guidance or else had not taken any medicine during the previous 3 months (p < 0.01). These findings show that a high proportion of adolescents used medicines with respect to common health complaints. Furthermore, in spite of the widespread use of medicines, the results showed that basic knowledge about the appropriate handling of medicines was lacking among the participants. Considerable proportions took medicines without any adult guidance and reported informal sources of information about medicines. Furthermore, the participants appeared to have been gaining knowledge about medicines through their medicine consumption practices rather than before using medicines. This leads to a potential risk, particularly in the case of autonomous use of medicines. It is therefore suggested that more information about medicines be built into school health education programs in the future.

Intentions enacted: what role for prospective memory?

2018-11-02T14:19:44Z

Title: Intentions enacted: what role for prospective memory? Abstract: The complexity of our everyday lives often requires that an intended action needs to be postponed until a more opportune moment arises in which the delayed intention can be completed. Different cognitive mechanisms contribute to the successful remembering of delayed intentions, from the time the intention is formed, during the retention interval until finally it is retrieved and completed. The objective of this thesis was to look at how an intended action is represented and how the nature of the representation relates to subsequent retrieval. Chapter one begins with an overview of the literature and highlights the different stages of prospective memory. The two key areas to this thesis, namely the literature concerning the enactment effect and the intention superiority effect are introduced and reviewed. The second half of this chapter described different methodological approaches and introduces the paradigms relevant to this thesis. Finally, the specific questions and aims of the experiments were briefly overviewed. Intended enactment was compared to overt enactment in order to examine whether similar processes underlie the retrospective and prospective memory for actions. In chapter two this comparison was explored in terms of recall in memory whereas in chapter three the activation state of enacted and intended actions was investigated using a recognition latency paradigm. The results of chapter two indicated that intended enactment does not convey an advantage to memory for the content of the actions, whereas, the reliable enactment advantage was replicated. In chapter three, a heightened level of activation was found for both enacted and intended actions. A similarity in the underlying representations was proposed, with motoric information present in both enacted and intended contributing to the increased accessibility in memory. Additionally, a cost effect on a secondary task was found as a result of maintaining the intended action at a heightened level of activation. Chapter four explored whether age-related decrements in prospective memory result from decreased accessibility to intention-related material The results indicated that older adults benefited from both the enacted and intended enactment advantage but evidence of demands on more limited resources were suggested. Together the findings of chapters two, three and four indicated that similar properties characterize the representation of overt and intended actions but they act upon memory differentially, with additional processes specific to the prospective component of delayed intentions. Finally in chapter five, the effects of the duration of the delay and the effect of elaborating the context of an intended action were explored. The findings point towards different demands necessary in maintaining an intention over a shorter period of time compared to longer retention intervals. Indications of the importance in specifying the retrieval context when forming longer-term intentions were observed. In the last chapter, the goals of the thesis were reviewed with suggestion for future directions in understanding intentions. Description: PH.D.

Surveillance of infectious intestinal disease in Malta

2020-11-23T11:57:00Z

Title: Surveillance of infectious intestinal disease in Malta Abstract: The magnitude, distribution and burden of infectious intestinal disease (IID) in Malta is not adequately understood. The aim of this thesis was to estimate the frequency of IID at community level, identify where and how cases are lost along the surveillance chain and to assess the factors that influence notification at general practitioner and laboratory level. A cross-sectional telephone, survey interviewed over three thousand persons from the general population in Malta over a 21 month period. This study estimated a period prevalence of 3.18% in the 28 days prior to the interview and a rate of 0.421 (95% cr 0.092-0.771) episodes of IID per person per year. IID had a seasonal distribution with bimodal distribution. Females in the 31 to 44 year age group and males aged up to one year of age were the most commonly affected. Most of the episodes were mild and self-limiting, with an average duration of illness of 6.79 days. However 6% of the cases required hospitalisation. The majority of the burden from lID rests on health care-seeking costs followed by lost productivity. The total estimated average cost per case is LM 46 which, if extrapolated to the total expected number of cases in the general population, would cost over seven million Maltese lira per year. The commonest aetiological agent causing IID at community level is the norovirus. Sentinel surveillance by 22 general practitioners covered over 55 thousand patient-doctor encounters during the study period of eight months. This study estimated a period prevalence of2.02% (95% cr 1.90-2.14) of persons consulting their GP for IID. A postal survey and a focus group study on general practitioners and hospital physicians respectively identified the Disease Surveillance Unit web site and medical school training as the main source of provision of information. Accessibility to notification forms is an important requirement. Enhancement of the surveillance system by making laboratory-confirmed cases notifiable by laboratories alone may work for certain diseases but is not recommended for foodborne illnesses where urgent action is required. Laboratories need to inform doctors of their stool-testing protocols for the range of enteric pathogens. It may be worthwhile assessing the feasibility of automated transfer of data from laboratories to the national surveillance system. Feedback from the DSU is welcomed by laboratories, general practitioners and hospital physicians with the web site being the preferred mode. Campylobacter was targeted for the assessment of risk factors. A case control study of almost 100 cases and two controls per case, identified rare/raw or undercooked poultry as an independent risk factor for campylobacteriosis (OR 12; 95% Cl 1.44-99.67; p=0.021), whilst eating at restaurants; pork cutlets; beefburgers; yoghurt and cream filled cakes were found to be 'protective factors'. For children aged less than ten years, who made up almost half of the cases, consuming chicken (OR 23.92; 95% Cl 1.33-431.03; p=0.031) was an independent risk factor, whilst eating at a restaurant, eating pasta with minced meat, beef steak, eating yoghurt or soft ice-cream were found to be 'protective factors' . This is the first epidemiological study providing information on the burden of acute gastroenteritis in Malta which has highlighted important issues in the surveillance of lID Recommendations have been put forward to improve the surveillance and hence the control of lID, in Malta. Description: PH.D.

The HIF system and Inhibitory PAS Domain Protein (IPAS) - a role in vascular remodelling

2020-11-19T16:08:05Z

Title: The HIF system and Inhibitory PAS Domain Protein (IPAS) - a role in vascular remodelling Abstract: In mammalian cells, the hypoxic response is mediated by a family of transcription factors known as hypoxia inducible factors (HI F). These are heterodimers composed of a tightly regulated alpha subunit and a constituitively expressed beta subunit (also known as aryl hydrocarbon nuclear translocator, ARNT). Three 0.- subunits have been identified so far, HIF-1 α, HIF-2 α and HIF-3 α. HIF-1 α and HIF-2 α are regulated mostly At the protein level via oxygen depedent degredation by the proteasome. Hypoxia leads to their stabilisation, binding to hypoxia responsive elements (HRE) and target gene transactivation. HIF-3 α is still poorly characterised. In mouse, a HIF- 3 α splice variant called inhibitory PAS domain protein has an inhibitory effect on HIF- 10. mediated activity. In humans a number of HII--3a splice variants have been reported. It was one aim of this study to investigate the roles of the largest isoform, HIF-3a1, and a smaller isoform resembling mouse IPAS, HIF-3a3, in the hypoxic response of endothelial cells. Both variants were expressed in vascular cells and in the vascular wall. HIF-3 α 1 but not HIF-3a3 was regulated by tile proteasome. Whilst both proteins were found to interact with HIF-1a and ARNT, HIF-3a1 was found to bind to the HRE and disturb HIF-1 α -DNA binding. A competition mechanism between HIF-3 α isoforms and HIF-1 α was found to cause downregulation of HIF-1 transcriptional activity resulting in decreased endothelial cell proliferation and angiogenesis under hypoxia. The second part of the study aimed to clarify the mechanism by which non-hypoxic stimuli can upregulate HIF-1a in pulmonary artery smooth muscle cells. HIF-1a upregulation by thrombin occurred via an ROS dependent mechanism by activation of the NADPH oxidase. This led to upregulation of NFKB activity which interacted with a novel binding site on the HIF-1a promoter and induced its transcription. Description: PH.D.