Suchergebnisse

Intro -- Preface -- Acknowledgements -- Contents -- About the Author -- Chapter 1: What Is a PhD? Am I Ready for This Commitment? -- Why Should I Read for a PhD? -- What Am I Getting Myself into? -- What Types of PhDs Are Out There? -- Chapter 2: The Initial Steps Towards a PhD -- Getting a PhD in the United States -- US Entry Requirements -- Student Visas -- The US PhD Programme -- Getting a PhD in the United Kingdom -- UK Entry Requirements -- The UK PhD Application -- Getting a PhD in Europe -- Entry Requirements -- Chapter 3: Proposal, Permissions and Funding -- The Proposal -- The Background, Aim and Objectives -- The Study Design (Methodology) -- Expected Outcomes -- Permissions -- Funding -- Funding of the University's Tuition Fees -- Funding for Your Research Project -- Chapter 4: The Fieldwork -- Defining the Population -- Preparation for the Health Survey -- Questionnaire -- Health Examination -- Recruitment of Fieldworkers -- Pilot Study -- Setting Up Your Fieldwork -- Laboratory Fieldwork -- References -- Chapter 5: The Art of Data Analysis -- Parametric or Non-parametric? -- Descriptive Analysis -- Analytic Studies -- Reference -- Chapter 6: Putting Pen to Paper to Publication -- Structuring a Scientific Paper -- Targeting the Most Appropriate Journal -- References -- Chapter 7: Writing the Thesis -- Thesis vs. Research Manuscripts -- The Structure of a Thesis -- Reference -- Chapter 8: The Hurdles Along the Way: A Personal Experience -- Chapter 9: Getting Ready for the Oral Defence -- Preparing for the Big Day -- Preparing for Your Examiners -- After the Oral Defence -- Chapter 10: What Comes After the Completion of a PhD? -- Academia -- Public and Private Sectors -- Personal Experience -- Index.

Obesity is a global epidemic and its pathophysiology has been well explored. However, many countries are still straggling with obesity inequalities. Malta, a small European state, has been widely reported to be an obesogenic country. The aim was to explore the obesity phenotype of the adult population of this country and explore for potential obesity drivers. ; peer-reviewed

A note of appreciation and acknowledgement is forwarded to Professor Julian Mamo, Professor Josanne Vassallo and Professor Neville Calleja for their continuous support and advice during the academic progression. ; Aim: The small European Mediterranean island state of Malta is a highly prevalent type 2 diabetes (T2DM) country. Over recent decades drastic environmental, cultural and ethnic changes occurred and it was considered timely to undergo a cross-sectional survey to establish up-to-date prevalence of T2DM, its socio-geographical distribution and ultimately estimating the economic burden of T2DM. Methods: A health examination survey was conducted (2014-16) including a representative sample of the adult population stratified by 18-70 years, gender and locality (n=3,947; males n=1,997 male). The survey consisted of a socio-demographic questionnaire, various health examination measurements and blood samples for fasting blood glucose (FBG). Prevalence for T2DM (depending on medical history, medication and FBG >7mmol/L) were calculated for the general population as well as for each of the districts making up the Maltese Islands. The economic burden of T2DM for 2017 and projected burden for 2045 were calculated using secondary sources and by incorporating 2% compound interest per annum respectively. Results: A total response rate of 47.15% was obtained, with a mean age of 48 years for males and 46 years for females. Out of the total adjusted population (n=3,947, male n=1,998), the prevalence of T2DM was of 10.31%, with 6.31% already known to have T2DM while 4% were newly diagnosed. Females were diagnosed with T2DM at an earlier age than the males. No significant geographical T2DM prevalence differences were established. The total annual diabetes health care expenditure was approximately €107,316,517.82 for 2017, while the projected expenditure for 2045 was estimated at €244,136,040. Conclusion: Malta is a country with a high prevalence of diabetes. The females were observed to be at an earlier risk of developing undiagnosed diabetes compared to males. Although geographical location did not appear to have significant effect on T2DM distribution, this disease contributes to a high economic burden. The expected exponential increase in diabetes prevalence is subsequently expected to affect negatively the healthcare expenditure. This puts forward the recommendation for development of early screening programmes as part of preventive action strategies. ; The author is extremely grateful for the strong support forthcoming from the University of Malta (through the Medical School and Research Innovative Development Trust department) and from the Alfred Mizzi Foundation as major sponsors, as well as that of a host of others, including Atlas Health Insurance (Malta). The in-kind support and encouragement of the Parliamentary Secretariat for Health of the Government of Malta is also gratefully acknowledged. ; peer-reviewed

Obesity is a global epidemic. It is responsible for increased patient morbidity and mortality. Significant related pathologies including diabetes mellitus compound the overall risks. Obesity is a significant financial burden. This includes direct and indirect medical costs, amounting to millions of euros each year. Multiple European studies have outlined a steady incline in obesity prevalence rates. Tackling obesity is no easy task. Policy makers aiming to reduce obesity rates should adopt an evidence-based approach. This entails adopting both micro- and macro-interventions tweaked to each country's individual requirements. The ideal way forward would be to tackle obesity from the individual, population-wide and food industry angles. The key towards a successful intervention is for each country to carry out well-planned health examination studies, in an attempt to pin point local risk factors. Having a correct individualized picture, each country can move forward and draw policies and interventional procedures. The aim should be to primarily improve the quality of life. Second, the country's capital expenditure is also reduced. ; peer-reviewed

Introduction: Diabetes mellitus in Malta has been an established major health problem for years. It has been linked with cultural, geographical, historical, genetic as well and a change from a Mediterranean diet to a Westernized diet. This diabetes burden has lead to establishment of diabetes clinics both in the central general hospital, as well as in the community. Over the past 50 years, there have been two major epidemiological diabetes studies conducted to evaluate diabetes in the Maltese population. Diabetes in Malta: To date, there is no established national diabetes plan or diabetes register in Malta, although there has been the formation of a governmental diabetes focus group. The time is right for an updated prevalence study to look at the current Maltese generation and their changing determinants including diabetes risk factors and genetics, followed by the development of preventative strategies and policies. Conclusion: Over the years, diabetes burden has increased and become a public health and national financial concern. It is of utmost importance to address this national disease. An updated prevalence study would provide the evidence-based backbone for the development of diabetes preventive strategies and policies. The combination of which will enable the Maltese health services to be improved and better equipped to come to grips with this epidemic. ; peer-reviewed

Targeting and reducing health inequities is a requisite for public health. The Maltese Islands are divided into six geographical districts with a total area of 316 km2. It is anticipated that the close geographical proximity and social integration would result in similar population health status. This study aims to identify whether geographical health inequities exist despite the small country area. A cross-sectional health examination survey was conducted. Participants with type 2 diabetes (T2DM) and impaired fasting blood glucose (IFG) were identified, depending on their medical and drug history and fasting blood glucose levels. Those with body mass index ≥30 kg/m2 were labeled as obese. Different health status was compared between the residents in the different districts according to demographic, socioeconomic, lifestyle, and medical history. Regression analysis was carried out to identify links between the different districts, BMI, IFG, and T2DM diagnosis, while adjusting for confounders. Geographical inequities were evident despite the close proximity. The Gozo district exhibited distinctive metabolic inequities compared to the other districts. An independent relationship was present between IFG diagnosis and residence in Gozo and Northern districts. Obesity was linked to residing in Gozo. Health inequities were evident between the close districts of the Maltese Islands despite similar socioeconomic, lifestyle, and healthcare provision. Psychosocial factors might be the underlying causes for these inequities. Public health officials and government should work to enhance public education and set up local policies and interventions to target these inequities.

COVID-19 mitigated restrictions have avoided countless deaths and infections while simultaneously disrupting livelihoods and economies. The global loss of gross (world) product is unprecedented as COVID-19 has inflicted both supply-side and a demand-side shocks. While public health measures have mitigated morbidity and mortality with positive effects on cross-country economic results, the decline in global Gross Domestic Product is leading to diminished spending on healthcare, the environment, and social wellbeing. In addition to the current challenges, there will also be various long-term implications of lasting illness ("long COVID") which are still to be determined. Numerous and varied economic stimuli packages have been instituted by different countries aiming to revive economies in the short term and thereby also mitigate long-term implications. In line with these measures, as a result of the COVID-19 vaccine roll-out, European countries have initiated discussions on vaccine-immunity passports to enhance mobility and assist economic recovery. However, this will not resolve the economic scars, the impaired innovation outcome and the healthcare fatigue that are expected to linger for years. While uncertainty is certain, this very uncertainty highlights the need for unbiased and rigorous quantitative evaluations of all possible decisions. A "nuanced approach" to the easing of restrictions must take into account the balance of immediate mortality and both short- and long-term morbidity versus the even longer-term risks of widening health, education and wealth inequalities and decreased life expectancy among the more socially and economically vulnerable. ; peer-reviewed

A current and pertinent topic is that of gender studies within healthcare students and academic staff of healthcare courses. This commentary explores the feminization of healthcare studies and the extent to which women in Malta hold key roles in academia within the faculties of Health Sciences, Dental Surgery, and Medicine and Surgery at the University of Malta. Data were publicly available from the university website. Gender (male: female ratio) trends were elicited from the data representing each level of qualification as offered by each faculty, while top academic roles within each faculty were noted. As a general trend, the number of students studying healthcare courses has increased, with an increased female-to-male ratio. Yet, in academia, men still occupy top roles. Efforts should be made to cater for all races, ethnicities, genders, sexual orientations, and socioeconomic levels within the healthcare workforce to allow delivery of the best possible service.

Background: Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems' reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level. Methods: We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies. Results: Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population. Conclusions: Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level. ; peer-reviewed

Background: COVID-19 vaccines reduce morbidity and mortality, but mass vaccination faces multiple challenges leading to different vaccination rates in different countries. Malta, a small European country, has achieved a very rapid vaccination rollout. This paper presents a narrative review of Malta's vaccination strategy and its impact on the country's COVID-19 situation. Methods: Data was obtained through a literature review of Maltese newspapers and from Malta's COVID-19 government dashboard. A comprehensive summary of vaccination operations was provided by Malta's COVID-19 vaccination team. Results: Malta comprised part of the European Commission joint procurement and obtained the maximum vac- cines that were eligible from all manufacturers. Four tier priority population groups were set up, with both vaccine doses (where applicable) allocated and stored for each individual. Multiple hubs were set up to simultaneously administer first and eventually second doses accordingly. To date (August 9, 2021) 398,128 of the population are fully vaccinated and 405,073 received the first dose, with both morbidity and mortality declining progressively as vaccination coverage progressed. Conclusion: Malta has successfully implemented a COVID-19 strategy that rapidly covered a substantial proportion of the population over a short period of time, with herd immunity reached by end of May 2021. Low population vaccination hesitancy and high vaccine doses availability were two major factors in this success. ; peer-reviewed

Background Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems' reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level. Methods We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies. Results Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population. Conclusions Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level. ; Peer reviewed

BACKGROUND: Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems' reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level. METHODS: We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies. RESULTS: Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population. CONCLUSIONS: Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are ...

A mass vaccination strategy is estimated to be the long-term solution to control COVID-19. Different European countries have committed to vaccination strategies with variable population inoculation rates. We sought to investigate the extent to which the COVID-19 vaccination strategies, inoculation rate, and COVID-19 outcome differ between Cyprus and Malta. Data were obtained from the Ministry of Health websites and COVID-19 dashboards, while vaccination data were obtained from the European Centre for Disease Prevention and Control until mid-June, 2021. Comparative assessments were performed between the two countries using Microsoft® Excel for Mac, Version 16.54. Both islands took part in the European Union's advanced purchase agreement and received their first batch of vaccines on 27 December 2020. The positivity rate and mortality between December and June differs between the two countries (average positivity rate Cyprus 1.34, Malta 3.37 p ≤ 0.01; average mortality Cyprus 7.29, Malta 9.68 p ≤ 0.01). Both the positivity rate and mortality for Cyprus declined due to strict public health measures and vaccination roll-out in early January (positivity rate by 95% and mortality by 58%). In contrast, for Malta, there was a sharp increase (64% p ≤ 0.01) with almost no public health restrictions in place and soaring cases during the Christmas and Carnival period until March, when lockdown measures were re-introduced. A distinctive difference between Cyprus and Malta in positivity rate (14 per 100,000 population; p ≤ 0.01) can also be observed between January and mid-April 2021. However, from April onwards it is evident that the positivity rate and mortality decline (positivity rate Cyprus by 82%, Malta by 95%; mortality Cyprus by 90%, Malta by 95%, p ≤ 0.01, respectively) in both countries as the vaccination roll-outs progressed, covering about 58.93% of the Maltese population, while Cyprus had fully inoculated about 38.03% of its population. The vaccine strategies and vaccination rates were similar for both countries; yet Malta had the fastest vaccine roll-out. Reluctancy to get vaccinated, significant differences in the vaccination appointment scheduling system, and the freedom of vaccination choice for the citizens in Cyprus may have contributed to a delayed vaccination roll-out. These potential contributing factors should be acknowledged and considered for future vaccination programs and potential COVID-19 boosters. ; peer-reviewed

A mass vaccination strategy is estimated to be the long-term solution to control COVID-19. Different European countries have committed to vaccination strategies with variable population inoculation rates. We sought to investigate the extent to which the COVID-19 vaccination strategies, inoculation rate, and COVID-19 outcome differ between Cyprus and Malta. Data were obtained from the Ministry of Health websites and COVID-19 dashboards, while vaccination data were obtained from the European Centre for Disease Prevention and Control until mid-June, 2021. Comparative assessments were performed between the two countries using Microsoft(®) Excel for Mac, Version 16.54. Both islands took part in the European Union's advanced purchase agreement and received their first batch of vaccines on 27 December 2020. The positivity rate and mortality between December and June differs between the two countries (average positivity rate Cyprus 1.34, Malta 3.37 p ≤ 0.01; average mortality Cyprus 7.29, Malta 9.68 p ≤ 0.01). Both the positivity rate and mortality for Cyprus declined due to strict public health measures and vaccination roll-out in early January (positivity rate by 95% and mortality by 58%). In contrast, for Malta, there was a sharp increase (64% p ≤ 0.01) with almost no public health restrictions in place and soaring cases during the Christmas and Carnival period until March, when lockdown measures were re-introduced. A distinctive difference between Cyprus and Malta in positivity rate (14 per 100,000 population; p ≤ 0.01) can also be observed between January and mid-April 2021. However, from April onwards it is evident that the positivity rate and mortality decline (positivity rate Cyprus by 82%, Malta by 95%; mortality Cyprus by 90%, Malta by 95%, p ≤ 0.01, respectively) in both countries as the vaccination roll-outs progressed, covering about 58.93% of the Maltese population, while Cyprus had fully inoculated about 38.03% of its population. The vaccine strategies and vaccination rates were similar for both ...

To date in Cyprus, there is no dedicated "Quality Improvement" body or Public Health authority. The long-awaited general healthcare system (known as GeSy or GHS) has been completed, mid-stream of the COVID-19 pandemic. A recently proposed resilience plan in response to the lessons learnt from the pandemic was put forward by the Government of the Republic of Cyprus to strengthen the capacity of the GHS and support public health defense. The negotiator of GeSy and Health Minister 2015–2018 also provided his view that the health system needs a holistic transformation of service provision. Recognizing failures and thinking from a syndemogenesis perspective how the envisioned patient-centric healthcare delivery can be achieved, we propose that the public health response could also be linked to a politico-economic one in shielding GeSy. We make such case for a syndemic strategy (simultaneous management of COVID-19 and pre-existing epidemics on the island) and the development of the five-district model where each main district hospital is to complement the activities of the GHS through developing: 1. A training Center for training and sharing of best practices for COVID-19 and other public emergencies. 2. A public health body. 3. A quality improvement institute. 4. A commissioning center on planning and streamlining healthcare services. 5. A clinical trial platform. The rationale is based on the management literature and use of existing resources and capabilities for transforming the GeSy and generating value. ; peer-reviewed