OAR@UM Collection:https://www.um.edu.mt/library/oar/handle/123456789/341482026-06-03T23:11:34Z2026-06-03T23:11:34ZMedication errors in Malta : is there a cause for public health concern?https://www.um.edu.mt/library/oar/handle/123456789/427702020-11-12T05:46:49Z2011-01-01T00:00:00ZTitle: Medication errors in Malta : is there a cause for public health concern?
Abstract: Internationally, medication errors are considered to be a burden in hospitals and
in the community, causing significant morbidity and mortality and increased healthcare
costs (Phillips & Bredder, 2002; Ferner & Aronson, 2006; Bar-Oz et al., 2008). The
aim of this research was to gain understanding of the local situation on medication
errors to determine if they are a public health concern.
After a comprehensive literature review, a mixed method consisting of four
different approaches was used to achieve this aim. (1) The use of a pharmacovigilance
database in the identification of medication errors has been established (Alj et al., 2007;
Kunac & Tatley 2011), so a retrospective analysis of the 600 reports within the national
pharmacovigilance database was undertaken. (2) Questionnaires, on the causes and
prevention of prescribing and dispensing errors were distributed. (3) Key players in the
field were interviewed and (4) inquiry reports from the medical and pharmacy councils
were looked at for medication error related litigation.
Results showed that 17.9% of all adverse drug reactions were associated with
medication errors and could have potentially been prevented. Medication errors
occurred most often at the stages of prescribing (52%), therapeutic monitoring (26%),
patients' management of their own care (12%), dispensing (7%) and administration
(3%). Increasing age was a risk factor with most medication errors occurring in the 80-
89 year old age group. Distribution of results was similar to other studies but not for
administration errors. (Bates et aI., 1993; Leape et a1.l995; Kaushal 2002, Alj et al.,
2007; Kunac & Tately, 2011). This may be due to differing methods and operational
terminology or due to a less developed culture of reporting of ADRs within the hospital
setting. Most medication errors in this study originated from the community (65%) and
the medication classes most likely to be in error were the anti-inflammatory (28%) and
anti-bacterial medications (10%). When errors were classified using the psychological
theory most errors were likely to be knowledge-based and memory-based errors or rule-based
errors. For the questionnaire 48 doctors and 71 pharmacists responded to the
questionnaires. For both professions, human factors prevailed as the perceived cause of
errors and included overwork (doctors=29/43, pharmacists=37/69), high patient volume
(doctors=29/43 , pharmacists 36169) and fatigue from any cause (doctors=28/43 ,
pharmacists=38/69). System factors included medications with similar and confusing
names (21/43) for doctors and illegible handwriting (55/69) for pharmacists. For both
professions, reducing interruptions (doctors=20/43, pharmacists=56168) and for doctors
lack of availability of resources to consult with were identified as risk-reducing factors.
Both professions thought that keeping knowledge of medicines up to date
(doctors=41141, pharmacists 54/69), reducing workload (doctors=36/48 ,
pharmacists=54/69) and having medicine names that are distinctive (doctors=34/48 ,
pharmacists=53/69) were perceived as important to prevent errors. 2 key players were
queried through a series of open ended questions and information pertaining to patient
safety and incident reporting locally was obtained which contextualised the study. From
the regulatory council inquiry report it was established that litigation related to doctors
and pharmacists for medication error was very low (3 court cases from 154 inquiry
cases).
The objectives of this study have been met. This study has shown that
medication errors do occur and are an emerging challenge to public health. A number of
recommendations to address this issue have been made.
Description: M.SC. PUBLIC HEALTH2011-01-01T00:00:00ZPoverty and health in Malta.https://www.um.edu.mt/library/oar/handle/123456789/426312020-11-11T14:22:18Z2011-01-01T00:00:00ZTitle: Poverty and health in Malta.
Abstract: Objectives: The objective of this study was to assess for the relationship
between poverty and health. Poverty and health are intertwined.
Studies show that the poorer people are the worst is their health. In
all countries, poor or rich, health inequalities exist. It is not enough to
meet your basic needs. Being relatively poor in the country you live
puts one at a health disadvantage. Those who are in a higher social
class, better educated, have superior income and suffer less material
deprivation have better health.
Method: to reach this objective an ecological cross sectional design was
used. Data was collected from national routine sources. These were
than analysed statistically; all statistical analyses were adjusted for
age and gender. Health measures chosen were self-rated health and
having a chronic condition. Poverty was considered from a
multidimensional perspective. Linear regression was carried out to
check for statistical inferences. To complement the statistics, focus
groups with health professionals were carried out.
Results: Initially self-rated health and having a chronic condition were
related to income, employment, alcohol and smoking. However, in the
linear regression models limitations due to a chronic condition and
education were found to have the strongest statistical relationship
with the health measure. Having a chronic condition was also
statistically related to vitality scores.
Conclusion: These results support the hypothesis that health is related to
poverty, with education being the most important predictor of health.
Income was not a strong predictor of health unlike what was
expected. Similar to other studies old age increased the risk of poverty
and poor health. Geographical differences in health were not found.
Description: M.SC. PUBLIC HEALTH2011-01-01T00:00:00ZThe implications of older motherhoodhttps://www.um.edu.mt/library/oar/handle/123456789/421082020-11-11T10:58:17Z2011-01-01T00:00:00ZTitle: The implications of older motherhood
Abstract: The Implications of Older Motherhood
Aim: To evaluate differences in the delivery and perinatal outcomes of the
parturient primiparous women >/35 years of age (at delivery) as compared to the
parturient primiparous women between the ages of 20-29 years (at delivery), of
the resident Maltese population delivering at the Central Delivery Suite, Mater Dei
Hospital.
Method: 133 participants were recruited between October 2010 and May 2011
(n=70 younger participants, n=63 older participants) of the primiparous
parturients at the CDS of MDH. The participants were sampled by taking a time
cross-section of the older parturients who matched the study criteria and for each
a matching younger parturient during the same period. A data collection sheet
similar to that used for the routine data collection of perinatal indicators across
Europe was completed for each participant.
Results: Univariate analysis found that 60.3% of the older mothers were delivered
by lower segment caesarean section (LSCS) (elective and emergency) as compared
to 34.3% of the younger mothers (p=0.02). These were also found to have a higher
composite risk of antenatal complications (p=0.04) and episiotomy (p=0.02). The
younger cohort was found to be associated with the increased presence of perineal
lacerations in vaginal deliveries (p=0.02) and to have a significant predilection for
inhalational and opiod analgesia during labour (p=0.019, 0.001 respectively).
Multivariate analysis was performed taking into account common confounders.
Associations with age persisted for the LSCS rate in the older cohort and the
presence of perineal lacerations in the younger one.
Discussion: The increased LSCS rate is well documented elsewhere. Some attribute
this to a physiological disadvantage of the older parturient whilst others attribute
this to physician bias. In view of the lack of statistical power, this study was unable
to show the association of some well-documented complications with age.
Conclusions: This research showed that the increased rate of LSCS in older
primiparous parturients is likely to be inflated due to physician bias although
further research involving a larger sample size is recommended to increase
confidence in the results and to look more specifically at the declared cause for
caesarean section.
Description: M.SC. PUBLIC HEALTH2011-01-01T00:00:00ZChildhood maltreatment and adolescent mental health and behaviourhttps://www.um.edu.mt/library/oar/handle/123456789/404122020-11-10T05:04:13Z2011-01-01T00:00:00ZTitle: Childhood maltreatment and adolescent mental health and behaviour
Abstract: Child maltreatment is defined by the WHO as constituting all those forms of
physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment
or commercial or other exploitation, resulting in actual or potential harm to the
child's health, survival, development or dignity. This study focused on maltreatment
in children and adolescents. The aim of this study was to determine whether
categories of maltreatment, either individually or in combination, was associated
with increased health risk behaviours and mental health problems in a community
sample of secondary school students. Nine state schools participated in the study. A
33 item self-report questionnaire was distributed to fifth-form students. The response
rate was 76%. The commonest category of maltreatment experienced was emotional
abuse and the least common was sexual abuse. 27.4% of respondents reported that
they had experienced one category of maltreatment whilst 16.6%, 11.1% and 6.5%
reported experiencing two, three and four categories of maltreatment respectively.
All categories of maltreatment except for emotional abuse were found to be
associated with increased rates of adolescent smoking. Consumption of alcohol was
only associated with sexual abuse, whilst illicit drug use was associated with physical
abuse, neglect and multi-type maltreatment. Adolescents who reported maltreatment
were more likely to be involved in school fights, but only some categories of
maltreatment were associated with breaking school rules and reporting poor school
performance. This study found a strong association between maltreatment and mental
health outcomes. Depression was associated with all categories of maltreatment
except for sexual abuse. Emotional abuse, neglect and multi-type maltreatment were
associated with increased levels of anxiety symptoms and with low self-esteem. The
presence of emotional abuse and neglect predicted adverse mental health outcomes.
Identification of risk factors showed that family characteristics are important
predictors for every category of maltreatment. The findings reported in this study
provide the evidence as background to developing the preventive and therapeutics
services required in the management of child and adolescent maltreatment.
Description: M.SC.PUBLIC HEALTH2011-01-01T00:00:00Z