Climate Change Adaptation and Mitigation in a Small Archipelago: the Role of Ecotourism in Malta

The aim of this paper is to present the potential of ecotourism to develop into a niche contributing to climate change adaptation strategies whilst making the existing tourism industry more resilient. The paper provides an overview of mitigation measures adopted in Malta by the aviation, tourism and hospitality industry as well as policy makers in the archipelago to respond to major challenges that climate change poses for tourism. These changes are vital to lure ecotourists and to support ecotourism development. Six main themes emerged from the research in the context of the role ecotourism can play as an adaptation to climate change. These include (1) the impact of climate change on coastal tourism, (2) the role of ecotourism as an adaptation strategy, (3) the impact of climate change on marine ecotourism, (4) air and sea travel to the archipelago and inter-island travel, their impact on climate and mitigation strategies to reduce emissions, (5) measures being taken by the tourism industry to fight climate change and their influence on ecotourism, and (6) Gozo - transitioning from an eco-island to a carbon-neutral island. The paper concludes that while Malta and Gozo are working towards various environmental strategies, and Gozo has been earmarked to become a carbon neutral island, more concrete actions must be taken. The Archipelago has a track record of failing to reach objectives related to sustainability. Malta missed the 2020 target to increase its share of renewable energy to 10% and the 2020 target for Gozo to become an eco-island. Instead of such rhetoric, a tangible commitment with wide support along the political spectrum is needed to avoid abandoning key initiatives seeking sustainability with changes in administration

Small islands as ecotourism destinations : a Central Mediterranean perspective

A prerequisite for ecotourism development is the presence of natural environments, normally exhibited in protected areas, which serve as ecotourism venues. Little attention has been given to Mediterranean islands in terms of ecotourism. In this paper, nine islands in the central Mediterranean region were studied through a case study approach to investigate their potential as ecotourism destinations, taking into account the presence of protected areas and related aspects, including spatial dimensions and quality, to fulfil ecotourists. Larger islands with higher population densities were found to experience habitat fragmentation, and protected areas were thus in some cases relatively small and dispersed. In contrast, smaller, less populated islands were found to be more ideal ecotourism destinations due to limited anthropogenic impact and their capacity to fulfil the expectations of the ‘true specialists’, also known as ‘hard ecotourists’. Quality of ecotourism venues was found to affect ecotourist satisfaction. Ideal ecotourism sites on heavily impacted islands were found on the island periphery, in coastal and marine locations, with marine ecotourism serving as the ideal ecotourism product on such islands.peer-reviewe

Does absence of charismatic species impact the ecotourism potential of Central Mediterranean islands?

Central Mediterranean Islands tend to be devoid of large terrestrial charismatic fauna which usually serve as target species for ecotourism. This has raised questions on the potential of ecotourism in such destinations. However it has been argued that absence of charismatic megafauna should not be considered as a limitation. Ecotours were organised on nine islands in the central Mediterranean region. Interviews and focus groups were held with participants of the ecotours and stakeholders. It has been argued that most charismatic species are marine, touting marine ecotourism as the ideal tourism product. Furthermore, rather than focusing on charismatic species, the ecotourism product on such islands should revolve around the various coastal environments and habitats and other smaller species including non-mammals, especially endemic ones thus facilitating a broader approach to conservation. Owing to the remarkable biodiversity of plant species, charismatic megaflora and plants have also been identified as important targets for ecotourism. Furthermore, due to the intense environmental pressure and limited size of protected areas the overlap with cultural, rural and adventure tourism has been suggested. In order for the ecotourism product to be more competitive archipelago tourism also referred to as island hopping is also recommended, a proposal which is supported by the presence of endemic and sub-endemic species. Results show that absence of charismatic species does not limit ecotourism development on such islands.peer-reviewe

The potential of coastal ecotourism in Central Mediterranean islands : a case study from the Aegadian Archipelago

The study aims at identifying the challenges hindering the success of coastal ecotourism within a central Mediterranean archipelago - the Aegadian one, off the western coast of Sicily - and at identifying good practices in an attempt to propose a tourism model that addresses the environmental and socio -economic challenges of this archipelago. 4 study visits and 40 interviews with various coastal tourism stakeholders were carried out between October 2012 and October 2015. Whereas numerous challenges to coastal ecotourism have been identified, a number of success stories have been recorded, which confirm that should adequate policies be implemented and necessary actions taken, coastal ecotourism can serve as an alternative to the characteristic seasonal and mass tourism pattern currently dominating this archipelago.peer-reviewe

Designing ecotourism experiences through co-creation: The case of small central Mediterranean islands

Small islands in the central Mediterranean region are mostly considered sun, sea, and sand destinations, but many also have untapped ecotourism potential. To explore this, ecotour itineraries were designed with local ecotourism operators and community businesses on a group of islands. Ecotourists were then asked to participate in pre- and post-tour surveys to test the tours and provide key information on the package. Their motivations and expectations, their experiences, and levels of satisfaction with the itineraries developed were examined. Focus groups were held with return ecotourists or those who purchased more than one ecotour to further examine these elements, and to explore their reasons for loyalty. This research demonstrates that developing ecotours using a bottom-up approach, which embraces the specific natural attributes of the islands, can lead to high levels of satisfaction. This approach generated loyalty to the island destinations and to ecotourism in the region. Furthermore, co-creation together with ecotourists provided key information to small operators on how to increase satisfaction and identified improvements that need to be made, such as in the field of interpretation, group size, programme planning, and in terms of sustainability of sites and activities outside of the scope of the ecotours that have an impact on the experience

Rare but still there : a scoping review on endometriosis-associated ovarian cancer

Endometriosis is a medical condition affecting at least up to 10% of women of reproductive age. This condition occurs when ectopic endometrial glands and stroma implant outside the uterus and there are several theories regarding the underlying origins of the disease. Endometriosis is one of the major causes of severe dysmenorrhoea, chronic pelvic pain and infertility. While endometriosis is generally a non-malignant condition, it rarely may transform into an invasive cancer, and increase the risk for epithelial ovarian cancer, notably endometrioid or clear cell ovarian cancer. Despite the increased risk, the mechanisms behind the development of endometriosis-associated ovarian cancer (EAOC) are not yet well understood. Recent investigations have delved into the intricate interplay between endometriosis and EAOC, exploring pathways involving oxidative stress, inflammation, hyperestrogenism, and the discovery of genetic mutations within endometriotic lesions that hint at a transition towards invasive carcinoma. Efforts have been made to identify intermediary lesions between endometriosis and EAOC, which may enable earlier detection of endometriosis at risk of malignant transformation or even prevention of the transformation altogether. However, given the rarity of this malignancy, there is still the risk of late or missed diagnosis, with the risk of inappropriate management being offered to the patient, and the higher risk of poor prognosis and increased morbidity and mortality. This scoping review aims to summarize existing data on EAOC, with a focus on endometrioid and clear cell histologic subtypes. It also provides insights into its identification, prognosis, and delineating management strategies, seeking to provide a holistic understanding of the complexities surrounding EAOC, facilitating further research and the development of more effective prevention and treatment approaches.peer-reviewe

Assessing the potential of Suez Canal shipping traffic as an invasion pathway for non-indigenous species in Central Mediterranean harbours

The shipping traffic visiting seven Central Mediterranean ports within Sicily and Malta over a period of one year (2013) and the ballast water volumes it transported was quantified and classified according to port of origin in order to assess the influence of traffic navigating through the Suez Canal on the marine biota of the same geographical area. Scraping and benthic sediment collection exercises were also conducted within the same ports and a list of non -indigenous species is reported.peer-reviewe

The state of ecotourism development in the Maltese archipelago

Whereas tourism in the Maltese Islands has been characterised by mass tourism, there has been a drive to promote a number of niches case in point ecotourism. Fifteen years have passed since the formal attempt to kick-start ecotourism in the Maltese Islands. In the light of this milestone, interviews with a wide range of stakeholders and analysis of tourism policies were conducted to investigate the development of the niche within the archipelago. Whereas continuous efforts have been recorded confirming devlopment of the niche, other existent challenges that hinder ecotourism development have been outlined by stakeholders.peer-reviewe

Sick leave certification: a unique perspective on frequency and duration of episodes - a complete record of sickness certification in a defined population of employees in Malta

BACKGROUND: In Malta, sickness certificates are needed from the first day of illness, and are issued by family physicians (FPs) either employed by the government primary health care system, self-employed in private practice, or employed by an employer for this purpose alone. The latter system, when applied by the employer, is compulsory. In order to contribute to the debate on the role of the FP in this context, electronic data collected by a group of company-employed FPs was used to study the phenomenon of sickness certification. This database is a complete record of the selected employees' sick leave certification during the study period. METHODS: Data collected by company-employed FPs from a defined population was used: all employees of selected Maltese companies served by a group of FPs. The database included episode-based data from home visits over three years (01/01/1997 – 31/12/1999), by 9 company-appointed FPs regarding 421 employees of five companies. RESULTS: 3015 episodes of sickness absenteeism, with an average duration of 2.9 days, were documented. Employees who did intensive manual work had relatively higher rates. Furthermore, a relatively higher incidence of work injury, sprains and strains, anxiety and depression and low back pain as found in manual workers, and in male workers. This trend was shown to be statistically significant. CONCLUSIONS: The frequency of sick-leave certification in Malta is comparable to that in other European countries, but the average duration of certificates is much less than reported in other studies that generally did not include data on short-term illness and certification. This has important implications on future research in the field. A number of common disorders were found to be significantly more prevalent causes of sickness certification in manual workers, amongst them anxiety and depression

Field Performance and Diagnostic Accuracy of a Low-Cost Instrument-Free Point-of-Care CD4 Test (Visitect CD4) Performed by Different Health Worker Cadres among Pregnant Women

Measuring CD4 counts remains an important component of HIV care. The Visitect CD4 is the first instrument-free low-cost point-of-care CD4 test with results interpreted visually after 40 min, providing a result of 350 CD4 cells/mm3. The field performance and diagnostic accuracy of the test was assessed among HIVinfected pregnant women in South Africa. A nurse performed testing at the point-ofcare using both venous and finger-prick blood, and a counselor and laboratory staff tested venous blood in the clinic laboratory (four Visitect CD4 tests/participant). Performance was compared to the mean CD4 count from duplicate flow cytometry tests on venous blood (FACSCalibur Trucount). In 2017, 156 patients were enrolled, providing a total of 624 Visitect CD4 tests (468 venous and 156 finger-prick samples). Of 624 tests, 28 (4.5%) were inconclusive. Generalized linear mixed modeling showed better performance of the test on venous blood (sensitivity 81.7%; 95% confidence interval [CI] 72.3 to 91.1]; specificity 82.6%, 95% CI 77.1 to 88.1) than on finger-prick specimens (sensitivity 60.7%; 95% CI 45.0 to 76.3; specificity 89.5%, 95% CI 83.2 to 95.8; P 0.001). No difference in performance was detected by cadre of health worker (P 0.113) or between point-of-care versus laboratory-based testing (P 0.108). Adequate performance of Visitect CD4 with different operators and at the point of care, with no need of electricity or instrument, shows the potential utility of this device, especially for facilitating decentralization of CD4 testing services in rural areas