https://www.um.edu.mt/library/oar/handle/123456789/32354 2026-04-04T21:47:59Z https://www.um.edu.mt/library/oar/handle/123456789/50094 Title: Extended haplotype of the CTLA-4 Gene within the coeliac patients in the Maltese population Abstract: CTLA-4 plays a key role in regulating T lymphocyte-mediated inflammatory responses and contains several single-nucleotide polymorphisms (SNPs) known to alter function. The aims of this study were to determine the population frequency of six single nucleotide polymorphisms amongst the Maltese population, to identify association between the SNPs within the CTLA-4 and ICOS genes and to construct a set of haplotypes of the CTLA-4 gene within the coeliac patients' population. In this study 300 random consecutive neonates' samples and 100 samples from coeliac patients were tested for the following CTLA-4 variants: -1722 TIC, -658 CIT, -318 CIT, +49 AlG, CT60 AlG and ICOS IVS+173 TIC. A positive association was shown between the ICOS IVS+173C allele and the coeliac condition [OR (odds ratio) = 1.564, C.1. 1.125-2.174) and a negative correlation (protective effect) was shown for the CT60G allele (OR = 0.640; C.1. 0.460-0.889). An association was shown between the ICOS IVS+173C allele and an older age at diagnosis (OR = 2.24, P = 0.006, C.1. = 1.24-4.03). A similar association was shown with the CTLA-4 -318T allele (OR = 1.86, P = 0.047, C.1. 1.00- 3.46). A protective effect was shown between the CT60G allele and an older age at diagnosis (OR = 0.42, P = 0.02, C.1. 0.20-0.90) as well in both the GIT and non-GIT groups. Moreover an association between the ICOS IVS+173C allele and non-GIT group was noted. Twelve haplotypes were found to constitute 98% of the haplotypes present in the population. A possible protective locus linked with the BI haplotype might be present in the Maltese population whilst a deleterious locus might be present on the 'un-named' (UNN) haplotypes, UNN1 and UNN5. The data obtained in this study further confirms that the functional variation in the CTLA-4 gene predisposes to coeliac disease. Description: M.SC.PATHOLOGY 2007-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/41422 Title: Depression and anxiety in adolescents in Malta. Abstract: This cross-sectional study explores the prevalence of depression and anxiety in adolescents attending Form 3 class in Malta, these are usually 13 or 14 years of age. The study population was selected via weighted sampling based on gender and school type and was of 625 students. There were 569 respondents, giving a response rate of 91 %. The study was conducted in June 2006 in 23 state and non state schools. The students answered a self-assessment questionnaire at school in the presence of the teacher. Anonymity and confidentiality were maintained at all times. The questionnaire contained some demographic data and two validated tools namely the Depression Self-Rating Scale for Children by Dr Peter Birleson to assess depressive symptoms and the Revised Child Anxiety and Depression Scale-25 (RCADS-25) devised by Dr Peter Muris which has four sub scales assessing different forms of anxiety and a subscale for depression. Two other questions were included, one concerning bullying and the other pressure to study. The study had the approval of the University Research Ethics Committee and the Education Division and parental consent was obtained. Results revealed that the overall prevalence of depression in our study population was of 21.3%, although females had more than twice the prevalence of males. Students most at risk of developing depression are: • Children not living with both parents • Offspring whose father is unemployed (weakly) • Children whose mothers are in employment • Victims of bullying • Students who are either not pressured to study or those who are very pressured to study. Adolescents in Malta tended to be more anxious and depressed when compared to their Dutch counterparts. There is plenty of comorbidity between anxiety and depression, with panic disorder and depression being the most common closely followed by social phobia and depression, generalized anxiety disorder and depression and separation anxiety disorder and depression. These findings indicate that the problem is significant and interventions including health prevention and health promotion must be introduced in various sectors such as schools and primary care clinics. Targeted intervention is the most cost-effective as it yields the highest benefit. Approach to the problem should be multisectoral and commitment by all the stakeholders, namely, health, education, family and social affairs ministries, agencies, health care professionals, educators, students and parents, is necessary. Resources, although scarce, are present but need to be better allocated. This intersectoral approach is indispensable for the intervention to be both effective and efficient. Increasing awareness and promoting mental health are pivotal to decrease the burden of disease and improve the quality of life and psychological well-being of youths most at risk. Description: M.SC. PUBLIC HEALTH 2007-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/40599 Title: Assessing the risk of Legionella in the hotel industry in Malta. Abstract: Objectives: Different methodologies have in time been undertaken in order to find a suitable method to quantify risk exposure for different sources of Legionella. This study is an attempt to trying to identify, quantify and model the potential of risks prevailing in Maltese hotels. Methodology: A number of hotels (n = 59), representing 54 % of the total population, were chosen using stratified random sampling, to ensure proportionate representation, both for location and category. The auditing pro-forma was pre-tested. Consequently, an ad hoc score-based questionnaire was developed, to ensure the best possible data capture on the risks of exposure arising from certain practices and processes. The basic assumption was that risk potential was related to the probability of a system or management failure occurring. Likert-type rankings were used to reduce bias and subjectivity. Standard quality assurance protocols were observed. Auditors were covered by training sessions to ensure uniformity. Data compiled from the literature review was subjected to a series of statistical and mathematical computations, and risk factors and weightings were generated. Statistical tools, including Monte Carlo simulation led to the development of a Probability Events Tree and consequently of a Legionella Risk Model (LRM), which in turn generated a Total Estimated Risk Index (TERI) for each hotel. A monitoring study was conducted separately in order to test the reliability and the applicability of the model. A random sample, (n= 720) covering for six input, namely boiler and calorifier temperatures, return flow temperature and plant room; roof tank temperatures and free chlorine levels in roof tank water, as well as free chlorine levels in sentinel taps. Results: Total Estimated Risk Indices (TERIs) obtained by the Legionella Risk Model (LRM), revealed that mean TERI was 151.11 ± 26.72, denoting that there is still much more to be done by hoteliers in order to minimise the risk of Legionellosis. 50% of the hotels (n = 30) exceeded the critical Probability Exposure Risk Index threshold (TERI= 150), whilst 30% (n = 18) of the hotels audited fell in the high risk zone. TERIs were correlated against field data Positive correlations obtained for estimated risk in relation to temperatures of cold water in roof tanks (r =+0.113, P= < 0.0001) and cold water in sentinel taps (r = +0.037, P= < 0.0001); whilst negative correlations were obtained when estimated risk was plotted against MSI ( r = - 0.199, P= < 0.0001), chlorine levels in roof tank water (r = - 0.061, P= < 0.0001), chlorine level in cold water sentinel taps (r = - 0.312, P= < 0.0001) and nevertheless in relation with the temperature of hot water in sentinel taps ( r = - 0.018, P= < 0.0001). Conclusion: The results obtained indicate that management of risks in Maltese hotels is lacking. Recommendations all point to the adoption of more stringent monitoring and control programmes and initiatives, and that a National Legionella Prevention Policy needs to be instituted. Keywords: Travel-associated Legionnaires' disease; Risk assessment for Legionella; Legionella risk modelling for hotels; Risk of Exposure to Legionella in Malta. Description: M.SC. PUBLIC HEALTH 2007-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/38640 Title: Asthma knowledge among parents of asthmatic children and the functional severity of asthma in their children Abstract: There is widespread evidence that childhood asthma is increasing, especially in industrialized countries (Kuehni et al, 2001; Kwong et al, 2001; Akinbami et al, 2003; NCHS, 2006; Russell, 2006) although additional years of data collection are necessary in Malta to confirm such a trend locally. Consequently, there is high utilization of health care services which has a large financial impact on health care systems, families and societies (Lozano et al, 1999; Stevens et al, 2004). Within this context, it is prudent to identify childhood asthma as a significant and important public health problem which requires further study in the local Maltese settings. Asthma knowledge among parents of asthmatic children and how this relates to asthma outcomes in their children was reviewed in the literature. A cross-sectional observational study was carried out at the Children's Outpatient department of St.Luke's hospital, where 140 parents accepted to participate over a 3 month interval. Data was collected through face to face structured interviews. Results indicated that parents' asthma knowledge was good while doctors, nurses and other health care professionals were cited as the most valuable source of information. The majority of children were classified as having low to mild functional severity scores. Functional severity scores were found to be significantly associated to the age of the child and to having a bird. Overall, asthma knowledge scores among parents of asthmatic children were found to be significantly correlated to functional severity scores in their children, even after adjusting for the age of the child and for having a bird. In conclusion, recommendations, in light of the findings were drawn up, so as to provide groundwork for clinical practice, public health education and research. Description: M.SC. PUBLIC HEALTH 2007-01-01T00:00:00Z