Health promotion and the community pharmacist

Health is a precondition for wellbeing and quality of life. It is also a basic human right and is essential for social and economic development. Increasingly, health promotion is being recognised as an essential element of health development. It is a process of enabling people to increase control over, and to improve, their health whether it is physical, mental, emotional or spiritual.peer-reviewe

Understanding the type and pace of organisational change in the Maltese budgetary framework

Purpose: This paper analyses the type and pace of organisational change expected in the Maltese budgetary framework. Drawing on the Greenwood and Hinings’ (1996) model, the paper provides an examination of the internal dynamics surrounding the budgetary framework in Malta, including stakeholders’ dissatisfaction, value commitments, power dependencies and capacity for action. The paper explores the different categories of performance budgeting systems (presentational, performance-informed and direct) and their bearing on the different levels of change. Design/methodology/approach: The study follows a qualitative approach using data gathered from documentary sources, corroborated with empirical evidence collected from in-depth, semi-structured interviews. The interviews comprised open-ended questions and they were conducted with senior politicians from the government and the opposition, including former ministers and Prime Ministers, and with senior civil servants. Findings: The findings indicate that a radical change to the existing Maltese budgeting system could be problematic, as the current system is an institutionalised practice and change could be resisted by the parties affected by the reform. The findings suggest that, within the Maltese scenario, the political ability required to make reforms happen is a further enabler of radical change. Originality/value: The paper provides an analysis of the expected change in the budgetary framework of a small EU country, identifying the enabling elements of such a change. The method of analysis could be extended to other countries which intend to embark on budgetary reforms. The study also assesses the relevant issues from a policy-making perspective, through access to senior politicians as policy makers, and senior civil servants who influence policy makers and are responsible for implementing policy.peer-reviewe

The Sacra Infermeria since 1800 : a historical survey

This article describes the historical aspect and the ordeals of the Sacra Infermeria as a hospital beginning from its construction in 1574 by the Knights of the Hospitaller Order of St. John of Jerusalem, through the two-year French interlude between 1798 and 1980, the years under the British rule, and on until the end of World War II, when the building was taken over by the Education Department. This paper is a result of extensive historical research in European archives especially the Vatican Library for the period of the Knights, the Public Record Office in London for the post-1800 years and the National Archives for both periods.peer-reviewe

Analysing correlation between the MSE index and global stock markets

The paper investigates the time-varying correlation between the Malta Stock Exchange (MSE) index, and five major international stock markets. An MGARCH-DCC approach is employed to measure the degree to which the MSE moves with other stock markets. Daily returns on these six stock exchange indices were computed and used to calculate dynamic conditional correlations (DCCs) between the markets. The results indicate that the local stock market appears not to be driven by the same forces that shape foreign stock markets, implying that local dynamics shape returns on the Exchange, rather than foreign events.peer-reviewe

Organ donation in Malta : what’s new?

Malta transposed Directive 2010/45/EU of the European Parliament and of the Council of 7 July 2010 on standards of quality and safety of human organs intended for transplantation (European Parliament and Council, 2010) on 12th October 2012 through Legal Notice 345 of 2012, entitled Organ Transplants (Quality and Safety) Regulations, 2012, Subsidiary Legislation to the Human Blood and Transplants Act (Cap483), enacted in 2006. This long awaited legislation provides a firm legal backing for transplantation services that are structured such as to ensure health and safety to both donor and recipient. The regulations apply to practices and procedures along the entire pathway from donation to transplantation of solid organs, and even beyond, to the collection of post transplant medical data. Malta has a good track record of safe working practices in transplant services. These have been offered since the early 1980’s, initially limited to corneal transplants, but soon followed by the first kidney transplant in 1983. Heart transplants are performed once a year, with the first being in 1996. (Transplant Support Group, Malta, 2013) Patients requiring liver transplants are referred to the UK while recently, in 2011, an agreement was reached with Palermo, Sicily for a lung transplant service. (ACCORD, 2012)peer-reviewe

A case of femoral hernia in a young male

Femoral hernia is an extremely rare condition in infants and children, and is rarely diagnosed before operation. A reducible lump in the groin of a child is by far most commonly that of an inguinal hernia. Conditions which one must bear in mind when confronted with a swelling in the groin in a young child are enlisted. Furthermore, a case report of a child with a one year history of a painful lump in the right inguinal region is described. He underwent two surgeries, wherein the first operation it was thought to be a small reducible right inguinal hernia, and a very small inguinal hernia was excised with no repair being performed. In the second operation the lump was found to be a femoral hernia.peer-reviewe

Transcutaneous calf-muscle electro-stimulation : a prospective treatment for diabetic claudicants?

Background: First-line therapy for claudicants with diabetes include supervised exercise programmes to improve walking distance. However, exercise comes with a number of barriers and may be contraindicated in certain conditions. The aim of this study was to evaluate whether calf-muscle electro-stimulation improves claudication distance. Method: A prospective, one-group, pretest-posttest study design was employed on 40 participants living with type 2 diabetes mellitus, peripheral artery disease (ankle-brachial pressure index < 0.90) and calf-muscle claudication. Calf-muscle electro-stimulation of varying frequencies (1-250 Hz) was applied on both ischaemic limbs (N = 80) for 1 h per day for 12 consecutive weeks. The absolute claudication distance was measured at baseline and following the intervention. Results: The cohort (n = 40; 30 males; mean age = 71 years; mean ankle-brachial pressure index = 0.70) registered a mean baseline absolute claudication distance of 333.71 m (standard deviation = 208). Following 91.68 days (standard deviation = 6.23) of electrical stimulation, a significant mean increase of 137 m (standard deviation = 136) in the absolute claudication distance was registered (p = 0.000, Wilcoxon signed rank test). Conclusion: Electrical stimulation of varying low to high frequencies on ischaemic calf muscles significantly increased the maximal walking capacity in claudicants with type 2 diabetes. This therapeutic approach may be considered in patients with impaired exercise tolerance or as an adjunct treatment modality.peer-reviewe

Griscelli syndrome : a rare neonatal syndrome

Griscelli syndrome was first described by Griscelli and Siccardi in 1978 in a hospital in Paris. It is a rare autosomal recessive disorder resulting in pigmentary dilution of the skin and hair, presence of large clumps of pigment in hair shafts and an accumulation of melanosomes in melanocytes.2 It results in silver-grey hair along with variable cellular immunodeficiency or severe neurological impairment or both. The condition is rare in all countries and up to January 2003 only 60 cases had been described in the world medical literature. In most cases diagnosis occurs between the ages of 4 months to 7 years. The boy discussed here had silvery hair, eyebrows and eyelashes and was admitted at the age of five months to hospital with fever, hepatosplenomegaly and pancytopaenia.peer-reviewe

Hirschsprung’s disease

A 28-year-old, primagravida woman, gave birth to a boy at 40 gestational weeks. On delivery, the baby was found to have blood stained liquor. This was followed by non-bilious vomiting after feeds and a distended abdomen. He was transferred to NPICU at 36 hours of age due to persistent vomiting and failure to open his bowels. An initial diagnosis of septic shock necessitated the following management plan: nurse in an incubator, establish intravenous access and perform a septic screen. Nevertheless, at 50 hours of age, persistent bilious vomiting and abdominal distension persisted. An upper GI contrast study excluded a malrotation. Hirschsprung’s Disease was then suspected and confirmed on punch rectal biopsies. A surgical operation was carried out, which included a mapping laparotomy and a colostomy. Three days after the operation was performed, he developed wound dehiscence and required re-repair in theatre. The small and large intestine were cleaned and replaced in the abdomen and the stoma site secured. Swabs taken from the wound grew Enterococcus faecalis and Pseudomonas aueriginosa.peer-reviewe

Requirements for Topology in 3D GIS

Topology and its various benefits are well understood within the context of 2D Geographical Information Systems. However, requirements in three-dimensional (3D) applications have yet to be defined, with factors such as lack of users' familiarity with the potential of such systems impeding this process. In this paper, we identify and review a number of requirements for topology in 3D applications. The review utilises existing topological frameworks and data models as a starting point. Three key areas were studied for the purposes of requirements identification, namely existing 2D topological systems, requirements for visualisation in 3D and requirements for 3D analysis supported by topology. This was followed by analysis of application areas such as earth sciences and urban modelling which are traditionally associated with GIS, as well as others including medical, biological and chemical science. Requirements for topological functionality in 3D were then grouped and categorised. The paper concludes by suggesting that these requirements can be used as a basis for the implementation of topology in 3D. It is the aim of this review to serve as a focus for further discussion and identification of additional applications that would benefit from 3D topology. © 2006 The Authors. Journal compilation © 2006 Blackwell Publishing Ltd