https://www.um.edu.mt/library/oar/handle/123456789/103357 2026-04-20T18:53:21Z https://www.um.edu.mt/library/oar/handle/123456789/119695 Title: Characterisation of the relationship between fatigue, Vitamin D level, disease activity and interferon signature gene expression in systemic lupus erythematosus : a population based study Abstract: Vitamin D deficiency and fatigue are highly prevalent in Systemic Lupus Erythematosus (SLE). The main aim of this research was to analyse the relationship between vitamin D, fatigue, disease activity and interferon (IFN) signature gene expression in SLE. 92 patients with SLE were interviewed, had blood and urine tests, and filled questionnaires. Subsequently, 13 patients with vitamin D deficiency and 20 with vitamin D insufficiency were supplemented with vitamin D3. They were re-evaluated after 6 and 12 months. The expression of 12 IFN signature genes in blood at baseline and at 6 months was measured. In the final part of the research, the in vitro effect of calcitriol on the IFN signature gene expression in macrophages and dendritic cells was analysed. 56.5% of participants in the cross-sectional cohort had a high degree of fatigue (fatigue severity scale (FSS) >3.7). The strongest predictors of fatigue were depression (p<0.001) and pain (p<0.001) and no correlation with serum 25-hydroxyvitamin D and IFN signature gene expression was found. Higher disease activity measured by SLE disease activity index-2K (SLEDAI-2K) was noted in patients who were homozygous for the minor allele for the vitamin D receptor (VDR) polymorphism BsmI (p=0.046). In the prospective study, an improvement in SLEDAI-2K (p=0.028) and FSS (p=0.011) at 12 months were noted. The mean IFN signature gene expression score decreased from baseline to 6 months (from 2.69 to 2.10, p=0.083), and the IFN signature gene expression decreased for all 12 genes especially OAS1 (p=0.032) and SOCS1 (p=0.005). In the in vitro experiment, a significant reduction in IFN score was noted in dendritic cell and macrophage samples with calcitriol (p=0.014, p=0.012). This was also the case for Interferon Regulatory Factor (IRF) 8 expression in the macrophage culture (p<0.001). Vitamin D supplementation in SLE resulted in improved disease activity and fatigue. This could be explained by the suppression of the IFN signature gene expression, as confirmed in the cell culture experiment. Description: Ph.D.(Melit.) 2022-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/118288 Title: Health impact assessment of air quality in Malta Abstract: Air quality is a major public health issue globally, even more so in urban areas due to increasing population, demands and activities. The more notorious pollutants were investigated in this study. The potential impacts were estimated on the residents of Malta, through the application of the AirQ+ software to provide an estimate of the health impacts of exposure to ambient air pollutants, based on WHO recommendations. This study also stimulated debate on effects of air quality, air quality management in Malta by means of expert and lay interviews and to offer more operative and practical solutions for low air quality in Malta. Three potential interventions, practices and abatement strategies that target the decrease in air pollutants and lessen adverse health effects were also calculated using AirQ+ software, as estimates of the health gains to be made if policies and measures are put in place to provide cleaner air. The expected health gains were translated in terms of economic costs. Such findings can be used to inform national authorities and policymakers in devising strategies for prevention and health promotion according to best practices, helping to identify which measures provide the best returns in terms of air quality and above all population health gains. Description: M.Sc.(Melit.) 2022-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/118287 Title: Knowledge, attitude, behaviour and acceptability of HIV pre-exposure prophylaxis amongst at risk MSM on the Maltese islands Abstract: Introduction: Men who have sex with men (MSM) are at substantial risk of HIV infection i.e., an incidence of 3 or more per 100 person-years. Despite decades of research and public health interventions there is still a high burden of HIV new infections in this population. Daily PrEP was found to reduce HIV transmission by 86% in the PROUD clinical trial, while the IPERGAY clinical trial showed the same risk reduction using the on-demand PrEP. Literature identified various barriers to PrEP access and some of these included costs, drug efficacy, side-effects and not wanting to take daily tablets. Objectives: To assess the awareness, knowledge and attitudes about HIV prevention due to PrEP among the MSM population living in the Maltese islands. Risky sexual behaviours were also assessed, and how these have changed once PrEP was started. The role of how social determinants impacted awareness, knowledge, attitudes and acceptability were looked into. Finally, compliance to PrEP was also assessed. Methodology: An online anonymous questionnaire was sent to participants by various local NGOs and snowballing, and data from a GU clinic in Malta was collected. Findings were analysed using IBM SPSS 28 software, and survey data was weighted by age to make them more representative of the MSM population in Malta. Results: The vast majority were aware about PrEP (92.9%), but misinformation about PrEP was evident as a few participants did not know the correct dosing or confused PrEP with post-exposure prophylaxis. Interest to use PrEP was at 73%, and 53% thought that PrEP would meet their HIV prevention needs. Condom use went down when PrEP was started, but HIV testing rates increased. Compliance to this medication by MSM was low, with 83% of participants stopping it at some point. An interesting finding was that 0.6% of patients attending the GU clinic who on PrEP seroconverted and became HIV-positive. Age, nationality, relationship status, higher education and financial situation have various relationships with awareness about, interest to use and ever using PrEP. Discussion: While PrEP awareness is high, however there are barriers to its uptake which registered lower. Perceived HIV infection risk awareness amongst participating MSM is low. These misperceptions lead to increased risky sexual behaviours. Condom use decreased post PrEP initiation albeit having no objections to its use. Lack of knowledge about PrEP and the latter misperceptions are resulting in increased risk of other STIs which is similar to what was reported by Müller et al., (2022) in Germany. Daily PrEP users participating in this study admitted that they took it inconsistently, which is of great concern since acute HIV seroconversions tend to happen during times of inadequate adherence or when the drug is discontinued. Conclusion: Health education initiatives are required at both national and individual levels, to correct misinformation and address misperceptions about PrEP use and risk-taking behaviours. These initiatives could be targeted according to higher risk demographic profiles identified in this study. Barriers to PrEP access need to be addressed by policy makers through policy changes through free provision through schedule V of the Social Security Act Cap 318 Article 23 of the laws of Malta Description: M.Sc.(Melit.) 2022-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/118284 Title: Risk of type 2 diabetes in students attending the main tertiary education institutions in Malta Abstract: Introduction: Students attending tertiary education are in general young, healthy adults, however they are at an increased risk for picking up lifestyle habits that together with background risks and factors related to their status as students increase the risk of diabetes later in life. This has implications for the burden of diabetes in a high-risk population and requires targeted actions from a young age to mitigate. Aims and Objectives: This study aimed to assess the diabetes risk in tertiary education students by quantifying the prevalence of the risk, identifying the associated risk factors, and identifying measures that can help mitigate diabetes risk. Materials and Methods: A cross-sectional study was carried out amongst students at the University of Malta and MCAST via an online questionnaire. Self-reported data provided information about the socio-demographic factors, general health factors, genetic and environmental exposures, and behavioural risks for diabetes. The risk of diabetes was quantified using the FINDRISC score tool. Results: A total of 375 responses were collected. Most students were classified into the low-risk category of FINDRISC, while 24.8% had a slightly elevated risk, 6.1% had a moderate risk and 5.1% had a high risk of diabetes. Older age, excessive weight, having a family history of diabetes, reduced exercise levels, anxiety, and living with a partner or children were associated with an increased risk. Conclusion: The implementation of measures that tackle the commonest modifiable risk factors with a high impact on diabetes risk can help improve the general health of the student population and improve their prospects for the future. Description: M.Sc.(Melit.) 2022-01-01T00:00:00Z