Prevention of birth defects

Folate is essential for normal cell division and as intrauterine fetal growth involves a process of rapidly dividing cells, there is a consequent increased requirement for folate at this time. Folate, and the synthetic form folic acid, is thus vital for the early development process of a healthy fetus and there is indisputable evidence that it can significantly reduce the risk of neural tube defects (NTDs). Further ongoing research suggests that folic acid supplementation in pregnancy is also associated with a decreased risk of other birth defects. This review gives an overview of the current literature related to the use of folic acid in the peri-conceptional period and prevention of birth defects, in particular NTDs.peer-reviewe

Two decades of action on nutrition for the Maltese population

Malta, like many other countries, has experienced significant challenges in nutrition over the past 20 years. Given the increasing prevalence of diet-related diseases and overweight and obesity across all ages, nutrition has been high on the Ministry for Health agenda over the past 15 years. Public Health practitioners in Malta have been drivers of public health nutrition reform throughout this period. The Health Promotion and Disease Prevention Directorate was set up to mainly focus on health promotion and non-communicable diseases including healthy nutrition in 2007. Over the years a number of strategies have been outlined targeting nutrition for the Maltese population including the Non Communicable Disease Strategy, the National Cancer Plan, the National Healthy Weight for Life Strategy, the Food and Nutrition Policy and Action Plan for Malta, Diabetes: A National Public Health Priority – A National Strategy for Diabetes 2016-2020, Whole of School Approach to Healthy Lifestyle: Healthy Eating and Physical Activity Policy and Strategy and the National Breastfeeding Policy and Action Plan 2015 – 2020. With input from WHO and the EU, Malta has participated in many surveys allowing for continuous monitoring and evaluation. In 2015, Malta embarked on a first National Food Consumption Survey, results of which will provide a baseline on eating habits to target priority areas for action, inform policy and monitor trends.peer-reviewe

Life expectancy, mortality and elections : their association during elections in Malta

Introduction: While life expectancy has increased over the past thirty years, such increases have not been constant around election times in Malta. This study seeks to explore the relationship between the time of elections in Malta and specific mortality rates. Aim: To determine if there is an association between mortality and elections in Malta. Method: Yearly age specific death rates for all-cause mortality, mortality from ischaemic heart disease, cerebrovascular disease, other heart diseases and all circulatory diseases as well as suicides were calculated from the Malta National Mortality Register for the period between 1985 and 2013. Years when elections and referenda were held between 1985 and 2013 were obtained from the Electoral Commission.1 The years 1985 – 2013 were coded using dummy variables to categorise them into pre-election, post-election, election year or any other year. Data was analysed using Poisson’s regression technique in STATA with Mortality Rate Ratio (MRR) presented as the outcome measure. Results: A significant increase in overall mortality during election years resulted for circulatory disease MRR 1.058 (p<0.001; 95% CI 1.029-1.087), cerebrovascular disease MRR 1.09 (p=0.002; 95% CI 1.032-1.155) and other heart diseases MRR 1.36 (p<0.001; 95% CI 1.276-1.449). A significant increase was also noted during pre- election years in circulatory disease MRR 1.046 (p=0.002; 95% CI 1.017-1.075) and other heart diseases MRR 1.33 (p<0.001; 95% CI 1.248-1.422) and post-election years for cerebrovascular disease MRR 1.08 (p=0.009; 95% CI 1.020-1.150) and other heart diseases MRR 1.19 (p<0.001; 95% CI 1.108-1.273)) relative to the other years. Conclusion: This ecological study provides an indication that mortality patterns may be associated with the electoral cycle in Malta. Further research on individual physical and psychological responses to political events, particularly around election time is warranted.peer-reviewe

Brucellosis Control in Malta and Serbia: A One Health Evaluation

Brucellosis, also known as \u201cundulant fever\u201d or \u201cMalta fever\u201d, is a zoonotic infection caused by microorganisms belonging to Brucella, a genus of gram-negative coccobacilli that behave as facultative intracellular pathogens of ruminants, swine and other animals. Brucellosis is a threat to public health, hence identifying the optimal way of preventing disease spread is important. Under certain circumstances, integrated, multidisciplinary \u201cOne Health\u201d (OH) initiatives provide added value compared to unidisciplinary or conventional health initiatives. Conceptualizing and conducting evaluations of OH approaches may help facilitate decisions on resource allocation. This article historically describes and compares Malta's 1995\u20131997 with Serbia's 2004\u20132006 brucellosis control programmes and quantitatively assesses the extent to which they were compliant with a OH approach. For both case studies, we describe the OH initiative and the system within which it operates. Characteristic OH operations (i.e., thinking, planning, working) and supporting infrastructures (to allow sharing, learning and systemic organization) were evaluated. We scored the different aspects of these programmes, with values ranging from zero to one (1 = strong integration of OH). Malta demonstrated a higher OH index (0.54) and ratio (1.37) than Serbia (0.49 and 1.14 respectively). We conclude that context and timing are key to determining how, when and why a One Health approach should be applied. The adoption of a true OH approach that involved systemic organization, leadership clarity and transdisciplinary communication, collaboration, and co-ordination was essential to Malta's successful eradication of brucellosis after several failed attempts. In contrast, contextual factors in Serbia permitted the successful adoption of a primarily sectorial approach for short term control of brucellosis. However, while a fully-fledged transdisciplinary OH approach was not initially required, it is likely to be key to maintenance of brucellosis control in the medium and long term. Through these two case studies, we demonstrate that One Health initiatives should be applied at the right place, at the right time, with the right people and using the appropriate conditions/infrastructure. Lastly, OH evaluations should include economic assessments to identify optimal of resources in these situations, thereby justifying funding and political support required

Brucellosis Control in Malta and Serbia: A One Health Evaluation

Brucellosis, also known as “undulant fever” or “Malta fever”, is a zoonotic infection caused by microorganisms belonging to Brucella, a genus of gram-negative coccobacilli that behave as facultative intracellular pathogens of ruminants, swine and other animals. Brucellosis is a threat to public health, hence identifying the optimal way of preventing disease spread is important. Under certain circumstances, integrated, multidisciplinary “One Health” (OH) initiatives provide added value compared to unidisciplinary or conventional health initiatives. Conceptualizing and conducting evaluations of OH approaches may help facilitate decisions on resource allocation. This article historically describes and compares Malta's 1995–1997 with Serbia's 2004–2006 brucellosis control programmes and quantitatively assesses the extent to which they were compliant with a OH approach. For both case studies, we describe the OH initiative and the system within which it operates. Characteristic OH operations (i.e., thinking, planning, working) and supporting infrastructures (to allow sharing, learning and systemic organization) were evaluated. We scored the different aspects of these programmes, with values ranging from zero to one (1 = strong integration of OH). Malta demonstrated a higher OH index (0.54) and ratio (1.37) than Serbia (0.49 and 1.14 respectively). We conclude that context and timing are key to determining how, when and why a One Health approach should be applied. The adoption of a true OH approach that involved systemic organization, leadership clarity and transdisciplinary communication, collaboration, and co-ordination was essential to Malta's successful eradication of brucellosis after several failed attempts. In contrast, contextual factors in Serbia permitted the successful adoption of a primarily sectorial approach for short term control of brucellosis. However, while a fully-fledged transdisciplinary OH approach was not initially required, it is likely to be key to maintenance of brucellosis control in the medium and long term. Through these two case studies, we demonstrate that One Health initiatives should be applied at the right place, at the right time, with the right people and using the appropriate conditions/infrastructure. Lastly, OH evaluations should include economic assessments to identify optimal of resources in these situations, thereby justifying funding and political support required

Folic acid : recommendations and interventions to increase women’s peri-conceptional intake of folic acid

Folic acid is known to be beneficial in pregnancy and has been shown to prevent severe and devastating birth defects including neural tube defects. Health Authorities and Governments around the world have taken several initiatives in order to increase women’s peri-conceptional folic acid intake, varying from issuing guidelines, undertaking extensive health promotion campaigns to mandatory food fortification of staple foods with folic acid. These interventions have had varying success in preventing neural tube defects. This paper is a comprehensive review of the current literature, putting together and summarizing the various initiatives undertaken by different countries and their success or otherwise in increasing women’s peri-conceptional folic acid intake and preventing neural tube defects.peer-reviewe

Data_Sheet_1_Brucellosis Control in Malta and Serbia: A One Health Evaluation.ZIP

<p>Brucellosis, also known as “undulant fever” or “Malta fever”, is a zoonotic infection caused by microorganisms belonging to Brucella, a genus of gram-negative coccobacilli that behave as facultative intracellular pathogens of ruminants, swine and other animals. Brucellosis is a threat to public health, hence identifying the optimal way of preventing disease spread is important. Under certain circumstances, integrated, multidisciplinary “One Health” (OH) initiatives provide added value compared to unidisciplinary or conventional health initiatives. Conceptualizing and conducting evaluations of OH approaches may help facilitate decisions on resource allocation. This article historically describes and compares Malta's 1995–1997 with Serbia's 2004–2006 brucellosis control programmes and quantitatively assesses the extent to which they were compliant with a OH approach. For both case studies, we describe the OH initiative and the system within which it operates. Characteristic OH operations (i.e., thinking, planning, working) and supporting infrastructures (to allow sharing, learning and systemic organization) were evaluated. We scored the different aspects of these programmes, with values ranging from zero to one (1 = strong integration of OH). Malta demonstrated a higher OH index (0.54) and ratio (1.37) than Serbia (0.49 and 1.14 respectively). We conclude that context and timing are key to determining how, when and why a One Health approach should be applied. The adoption of a true OH approach that involved systemic organization, leadership clarity and transdisciplinary communication, collaboration, and co-ordination was essential to Malta's successful eradication of brucellosis after several failed attempts. In contrast, contextual factors in Serbia permitted the successful adoption of a primarily sectorial approach for short term control of brucellosis. However, while a fully-fledged transdisciplinary OH approach was not initially required, it is likely to be key to maintenance of brucellosis control in the medium and long term. Through these two case studies, we demonstrate that One Health initiatives should be applied at the right place, at the right time, with the right people and using the appropriate conditions/infrastructure. Lastly, OH evaluations should include economic assessments to identify optimal of resources in these situations, thereby justifying funding and political support required.</p