OAR@UM Collection:

Food supplement use, knowledge and perceptions among adults in Malta

Wed, 01 Jan 2025 00:00:00 GMT

Title: Food supplement use, knowledge and perceptions among adults in Malta Abstract: Background: Dietary supplement use is widespread globally, yet Malta lacks context specific evidence on who uses supplements, which products are taken, why they are used, and how risks and regulation are perceived. This thesis addresses that gap by profiling use, knowledge, and perceptions among Maltese adults and by testing how these relate to demographics and health behaviours, with the aim of informing education and proportionate regulation. Methodology: A quantitative, cross-sectional online survey targeted adults (≥18 years) residing in Malta. The instrument—adapted from established surveys and culturally tailored— captured demographics; supplement use (types, duration, concomitant use, purchasing and information sources); and Likert-scale perceptions (safety, benefits, necessity, substitutability, labelling, regulation, harm from misuse). After normality checks (Shapiro–Wilk and Kolmogorov–Smirnov), non-parametric analyses were applied: Chi-squared and Fisher’s exact tests for associations between categorical variables; Mann–Whitney U for two-group comparisons on Likert outcomes; Kruskal–Wallis for multi-group comparisons; and Kendall’s correlations among attitudinal scales (α=0.05). Ethical and data-protection standards were observed. Results: Supplement use among Maltese adults is widespread (66–70%) and primarily preventive. In the sample (n=449), use was highest among women (69.9%) and post-graduates (73.5%). Vitamins were most common (33.7%), followed by minerals (16.6%), sports products (14.6%), and fish oils (13.9%). Pharmacies and health shops dominated purchasing (88.8%), while physicians (26.1%), pharmacists (≈12%), and personal research were key information sources. The main motives were improving health/preventing problems (39.4%), supplementing the diet (14.9%), and boosting immunity (14.0%). Participants generally viewed supplements as safe and beneficial, rejected diet replacement, agreed labels were clear, and were uncertain about regulatory adequacy. Women were more likely to use supplements (p=0.005) and to consult health professionals before use (p<0.01). Use increased with education (p=0.001). Consultation varied by education (p=0.037) and physical activity (p=0.020). Information sources differed by gender (p=0.002; women: physicians, men: social media), age (p=0.009), and activity level (p=0.001), with more active individuals referencing nutritionists, academic sources, or social media. Purchasing channel also varied by age (p=0.038) and activity level (p=0.006), with more active users more inclined to buy through social media or physicians. Compared with non-users, users more strongly agreed that supplements are safe, beneficial, and necessary (all p<0.01), rejected diet replacement (p=0.024), and acknowledged misuse risks (p=0.044). Older adults (51–80 yrs) perceived lower necessity but greater label clarity and regulatory adequacy than younger adults. Consultation status influenced beliefs about safety, benefits, necessity, diet replacement, and harm. Belief in adequate regulation correlated with perceptions of safety, benefit, necessity, diet replacement, and label clarity, while safety correlated strongly with perceived health benefit and necessity. Conclusion: Users hold favourable yet discerning views: benefits are recognised, substitution for diet is overwhelmingly denied, and uncertainty about regulatory adequacy persists. Inferential results show that gender, education, and activity shape both uptake and attitudes; consultation pursuit and age further modulate perceptions in predictable ways. These findings suggest leverage points for policy and practice: strengthen pharmacist-led counselling, tailor public-health messaging to high-use groups (e.g., active and highly educated adults), and communicate regulatory safeguards more clearly—especially around concomitant use and product quality. Limitations include self-reporting, non-probability online sampling, and cross-sectional design; future mixed-methods and longitudinal work should link behaviours to clinical outcomes to guide proportionate regulation and education in Malta. Description: M.Sc.(Melit.)

Medication errors and their reporting : an insight into the acute hospital setting

Wed, 01 Jan 2025 00:00:00 GMT

Title: Medication errors and their reporting : an insight into the acute hospital setting Abstract: Medication errors represent a significant global public health concern, contributing substantially to preventable morbidity and mortality. Medication errors have far-reaching consequences, affecting patients, family members, healthcare professionals, and the wider healthcare organisations. Despite increasing efforts to put medication safety to the forefront, progress in this area has been limited. This dissertation, therefore, sought to explore the causes of medication errors and their reporting practices in the acute care setting in Malta. The study utilised an explanatory-sequential mixed methods design. The initial quantitative phase involved a retrospective analysis of Individual Case Safety Reports (ICSRs) from the EudraVigilance database between 2022 and 2025. These findings then informed the qualitative phase, which sought to augment and interpret the quantitative results. Semi-structured interviews were conducted with front-line healthcare professionals, including a mix of doctors, nurses and pharmacists, working within two local acute hospital settings, as well as with select key players within the field of medication and patient safety. The qualitative analysis was informed by Reason’s Accident Causation Model to classify the causes and contributory factors of medication errors, and by the Theoretical Domains Framework to explore the barriers and facilitators to reporting. The most notable finding from the quantitative phase was the absence of medication error reports originating from Malta during the study period. Using the international ICSRs from this database, the most common stages associated with medication errors were prescribing (27.2%) and administration (24.4%), with anti- infectives (23.1%) and nervous system agents (22.8%) being the most frequently implicated medication classes. Statistically significant associations (p < 0.01) were identified between error seriousness and both patient age group and reporter type. The qualitative phase identified key causes and contributory factors to medication errors. While active failures such as selecting the wrong medication, incorrect dose calculations or deviations from hospital protocols emerged, errorprovoking conditions, including heavy workload, time pressures, staff shortages, fatigue, the effect of look-alike and sound-alike medications and communication issues, were identified as the predominant factors leading to medication errors. Latent failures, linked to inadequate training and supervision, issues with staff allocation and roles, and problems with the quality of procured medications were also commonly cited. The main barriers to error reporting included hospital culture, fear of professional repercussions, insufficient awareness of reporting systems, and the timeconsuming nature of reporting. The qualitative insights from healthcare professionals’ interviews gave insight into the lack of reporting shown by the EudraVigilance data. The findings aligned with international literature on both the underlying causes and the barriers to medication error reporting. These findings highlighted how medication errors often stem from complex, multi-factorial causes, where gaps in defences align to allow for an error to occur. The barriers to reporting identified by front-line healthcare professionals provided crucial insight into potential reasons behind the significant underreporting locally and underscored the need for urgent action. Various recommendations from the study findings emerged and were categorised into micro (individual), meso (organisational) and macro (regulatory) level interventions. These included improving training and education on medication safety, fostering and sustaining an open patient safety hospital culture, implementing digital tools for medication use and addressing key issues such as procurement practices and staff shortages In conclusion, medication errors are an important public health concern in Malta, necessitating urgent measures to address their widespread causes and the evident barriers leading to their current under-reporting. Description: M.Sc.(Melit.)

Knowledge, attitudes and practices of food safety in Maltese homes : a convenient sample study

Wed, 01 Jan 2025 00:00:00 GMT

Title: Knowledge, attitudes and practices of food safety in Maltese homes : a convenient sample study Abstract: Foodborne diseases (FBDs) are on the rise. They pose challenges to Public Health as well as direct implications on hospital systems. Specifically, to the domestic setting, foodborne outbreaks (FBOs) in Malta have also been noted to increase. Research on the knowledge, attitudes and practices of food safety in Maltese homes was conducted way back in 2006 and thus, this calls for new research to be undertaken. In this dissertation, a quantitative descriptive research method was selected and a questionnaire was formulated to collect data. To obtain a confidence interval (CI) of 95%, a minimum of 384 participants over the age of 18 years were required. To target different participants of different demographics, the electronically was based (Google Forms) questionnaire was distributed on Facebook and for participants aged 65 and over, telephone/mobile calls were made to engage such an age group to become involved. Statistical analysis was performed through the use of SPSS (Statistical Package for the Social Sciences) and statistical significance between genders and/or socio-economic factors was determined by Pearson chi-squared test and Fisher’s exact test. 1,022 (52% males) people participated in this survey. 91.3% (n=934) of the participants cook at home of which 51% are females. Males are statistically less likely to cook, nonetheless males are more likely to cook at barbeques. Overall, males were statistically more likely to engage in malpractices and in risky behaviour such as; eating raw Maltese sausage, consume well water and carry, store food in normal shopping bags during barbeques than females. However, at times males were statistically more likely to be knowledgeable on food related matters such as: survival of microbes in fridges and freezers and temperature danger zone. For the most part higher education levels were associated with safer practices and knowledge. Nonetheless this was not always the case; example consumption of well-water, not changing kitchen sponges, consuming meat which is rare or medium cooked. With regards to age, those aged 18-24 and ≥75 were for the most part statistically more likely to engage in unsafe practices such as: thawing methods, washing of hands and to lack knowledge on the freezers’ operating temperature and the temperature danger zone. When compared to other countries the Maltese at times fare better while in others do not. As to the previous local study, improvement in handwashing, washing of cooking equipment/utensils, purchasing behaviour, storage of raw meat and operating temperatures of fridges and freezers was observed. Regression was noted in these areas: consumption of well water and rare or medium: beef, hamburgers and minced meat. Recommendations have been put forward with the aim of improving the consumer’s level of food safety. Particular emphasis on collaboration with various stakeholders was made to achieve this. Objectives of this study were reached, hence there is enough information to formulate health policies and campaigns to specifically target sub-groups within the Maltese population. Description: M.Sc.(Melit.)

A preliminary comparative analysis of pesticides residues in illicit and regulated cannabis inflorescence in Malta

Wed, 01 Jan 2025 00:00:00 GMT

Title: A preliminary comparative analysis of pesticides residues in illicit and regulated cannabis inflorescence in Malta Abstract: Illicit cannabis consumption presents significant health risks due to the absence of regulatory monitoring in its cultivation, especially with regards to pesticide contamination. In contrast, licensed cannabis produced under regulated frameworks is expected to comply with strict safety standards. This study investigated and compared pesticide residues in illicit cannabis samples seized by law enforcement officers with licensed recreational cannabis inflorescences sourced from Cannabis Associations licensed with the Authority for the Responsible use of Cannabis in Malta. The primary aim was to determine whether illicit cannabis is more likely to contain pesticide contamination. This study thus helped assess public health risks and highlighting the impact of regulatory control. Twenty-four cannabis inflorescence samples were analysed: twelve illicit samples and twelve licensed samples. The methodology employed a QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) extraction protocol, followed by instrumental analysis using gas chromatography combined with mass spectrometry (GC-MS) and ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS). The findings demonstrated that pesticide residues were detected exclusively in illicit cannabis samples, while no pesticide contamination was found in licensed recreational cannabis provided by Cannabis Associations. Two organophosphate pesticides, dichlorvos and chlorpyrifos, were identified across multiple illicit samples. Statistical analysis using Fisher’s exact test confirmed a statistically significant difference in contamination between the two groups (two-sided analysis, p = 0.037). These results highlight the elevated risk associated with illicit cannabis use and emphasise the protective role of regulatory oversight in licensed production. Inhalation of organophosphate pesticide residues may contribute to acute and chronic toxicological effects, presenting a considerable public health concern for consumers of illicit cannabis. These findings support the implementation of strict monitoring frameworks in order to safeguard cannabis quality and strengthen the importance of consumer access to regulated products. Description: M.Sc.(Melit.)