Planning in education : local school buildings

A paper by Dr. Edwin Mintoff edited from a study by Alexander Borg, Christopher Borg, and Victor Sladden. This study formed part of a thesis project presented in 1993/1994 in partial fulfillment of the degree leading to B.E & A (Hons.) in the Urban Design Stream which Dr. Mintoff co-ordinates.peer-reviewe

Congenital neuroblastoma

A 3-day-old baby girl was noted to have abnormal posture and paucity of movement of the left foot. Examination revealed flaccid weakness of the left lower limb. The rest of the neurological examination was normal. MRI revealed an extramedullary extradural intracanalicular lesion extending from caudal to the 10th thoracic vertebral body to L4 and a paraspinal mass from level of L1 to L4 vertebral bodies which was in continuity with the intracanalicular mass through the right L1/L2 neural foramen. This was diagnosed as congenital dumbbell neuroblastoma. Congenital Spinal Neuroblastoma is a solid tumor of the spinal cord which arises in utero. Neuroblastoma has an incidence of 1 in 7000 live births, ranking it as the commonest neoplasm in fetuses and neonates.peer-reviewe

Health and development in the Maltese Islands

After analysing the major theoretical contributions to health and development, the author develops a dialectical materialist approach. Health, both physical and mental, is defined as a movement of energy that is simultaneously conserved and expanded. It is reality in movement. It is the vital ingredient of labour power and the capacity to create. Fundamental to humanity's health, both on a personal and public level, is productive activity. The relations and forces of production are the main determinants of public health. The relative power of the oppressed and the contemporary means of production affect both the type and spread of disease. In the specific historic Investigation of health and development in the Maltese Islands, the prevalence of contemporary diseases is appraised with reference to the balance of forces between nations, classes and the sexes. The particular significance of imperialism, merchant capital and religion is discussed. Examination of three major diseases, cholera, undulant fever and cancer, between 1837 and 1987, is the empirical basis of the thesis. The transition from high mortality rates to high morbidity rates in the past forty years reflects Malta's late and uneven development. Health policy to overcome disease is limited because health and disease are manifestations of the mode of production. Health in developing countries is placed in the dialectic of imperialism and development, chauvinism and development and, essentially, the dialectic of capitalism and development

Cancer in Malta : trends in mortality and incidence rates of lung and breast cancer

Health and development are interlinked. This paper is a first step in the epidemiology of lung and breast cancer in Malta over the last thirty years. It provides raw material and suggestive correlations. Cancer has become a major cause of illness and death in every age group, but in particular the over sixties. A significant increase in lung cancer mortality and in particular breast cancer morbidity and mortality is apparent. Locational studies show a higher incidence in particular of lung cancer in the Inner Harbour Region where the docks, shipbuilding, many textile and other industries, and the coal-fired power station, are located and where the working class is concentrated. The lack of government controls on known carcinogens such as asbetos, together with clear results of occupational cancer studies done in say USA or Britain, indicate that there is an urgent need to control and eliminate local carcinogenic hazards.peer-reviewe

A review of the practice of requesting skull x-rays from the Emergency Department of St Luke’s Hospital

Background: In the Emergency Department (ED) of St. Luke's Hospital (SLH), head injuries are a common presentation. Although there are various guidelines which recommend approaches to the management of head injuries, these are not followed locally and the authors feel that a significant number of unnecessary skull x-rays (SXR) are being ordered by doctors. In this review we wished to observe the current trends in head injury investigations at the SLH ED and compare these with the NICE head injury guidelines. We also wanted to determine the impact that the NICE guidelines would have on these trends if they were to be instituted. Methods: The study is retrospective and observational. The demographics together with the rates of SXRs, CT scans and admissions were determined for patients presenting with head injury between the 1st of February and the 31st March 2006. The study also looked at the predicted rates had NICE guidelines been applied. Results: 387 patients were studied in a 2 month period. Of this total, only 2 patients (0.5%) had indications for a SXR but 312 patients (80.6 %) had this investigation. Out of this total of SXRs only 6 had positive findings (1.9%) and these went on to have a CT brain. A total of 72 patients had a CT scan of the head and of these 10 (13.9%) had positive findings. According to NICE guidelines 70 patients had indications for a CT. One hundred and twenty one patients (31.3%) were admitted, 201 were discharged (51.9%) and 65 patients (16.8%) discharged themselves against medical advice. Conclusion: The implementation of NICE guidelines would greatly reduce the rates of SXRs and hence reduce costs and radiation exposure. It also seems that the rates of CT scans will not change significantly.peer-reviewe

Why dread what is preventable?

Cancer cases and deaths in the Maltese Islands have been rising while most other killers, such as heart disease or diabetes, have been declining. Whilst the overall cancer rate remains below most industrialised countries, the increase of breast and lung cancer, especially since the 1970's, has been phenomenal. I t is the purpose of this paper to examine possible causes and suggest preventive action.peer-reviewe

Oral Health Related Quality of Life in Children with Osteogenesis Imperfecta

Background: Osteogenesis Imperfecta (OI) is a genetic condition resulting from a mutation in the genes involved in the modification or biosynthesis of collagen. The study involved two parts and took place in the OI department at Great Ormond Street Hospital (GOSH). Aims: To investigate the oral health related quality of life of children aged eight to sixteen-years-old with OI. Service Evaluation: Methodology: Five questions designed to assess if children with OI are receiving adequate dental care. Results: 86 participants (43% female, 57% males, mean age 8.31) 78 (91%) of children were receiving some form of dental care. 49 (57%) of participants reported one or more dental concerns. 27/41 (66%) of the mixed dentition group reported at least one type of concern; most frequently appearance [18/41 (44%)]. Conclusions: Dental concerns in children with OI are present. It is important to have ongoing dental care to address concerns. Questionnaire: Methodology: Ethical approval and consent were obtained The Child Oral-Health Impact Profile – Short Form (COHIP-SF) was used, with demographic and qualitative data Children aged 8 – 16 years participated between January – October 2019 Statistical analysis with parametric and non-parametric tests Results 106 children participated (44 female, 62 male, mean age 11.93 years) COHIP-SF Data A higher COHIP-SF score indicates better OHRQoL (maximum score, 76). The median score was 59. Children reporting mild OI had higher median score (62) than those reporting severe OI (55) [P=0.087]. When comparing mixed (=12, n=60), no statistically significant difference in OHRQoL was seen [P= 0.977]. The 3 COHIP-SF domains are Oral Health, Functional and Socio-Emotional Well-Being. There was no significant difference between severities for each domain. Perceived severity was not associated with significantly lower OHRQoL scores for females [P=0.125] or males [P=0.406]. Limited data on the presence of Dentinogenesis Imperfecta did not impact overall score [P=0.109] but was significant in the Oral Health domain [P=0.033]. Qualitative Data Common themes were the need for braces (straightness/ gaps between teeth), discolouration, pain and function. Conclusions: This study confirmed that children with OI have dental concerns, including oral health, functional and socio-emotional well-being. This was related to severity of OI. Compared to the general child population, children with OI had similar OHRQoL scores

Relationship of hyperglycaemia, hypoglycaemia, and glucose variability to atherosclerotic disease in type 2 diabetes

Objective: Type 2 diabetes mellitus (T2DM) is known to be associated with increased cardiovascular risk. The aim of this study was therefore to investigate the independent effects of hyperglycaemia, hypoglycaemia, and glucose variability on microvascular and macrovascular disease in T2DM. Methods. Subjects with T2DM of 7.8mmol/L (β=15.83, p=0005) was the sole independent predictor of albuminuria in generalised linear regression. Conclusions. This study demonstrates that hypoglycaemia is associated with the occurrence of atherosclerotic disease while hyperglycaemia is associated with microvascular disease in a Caucasian population with T2DM of recent duration.peer-reviewe

Rational intention, rational action

Sometimes, the intentions most promoting one's interests might result in the performance of actions not most promoting one's interests. For example, being the sort of person who intends to keep promises might most promote one's interests - since then others would be more inclined to enter into beneficial agreements with one - even though some of the resulting actions of promise-keeping do not most promote one's interests. A plausible view about the nature of rationality is that the rational intentions for an agent to have are those which most promote their interests, but what are we to say when such intentions result in the performance of actions not most promoting their interests? On the one hand, some say that since such actions are the result of intentions it is plausibly rational to have, then they too must be rational: on this view of the matter, if it is rational to have or to adopt a certain intention, then it is always rational to act upon it. On the other hand, others say that since such actions do not most promote the agent's interests, then they must be irrational: on this view of the matter, since the rational intentions are those which most promote the agent's interests, then surely the rational actions must also always be those most promoting the agent's interests. What, then, is the relation between the rationality of intention and that of action? Addressing this issue is the task for this thesis