Smoking health professional student : an attitudinal challenge for health promotion?

Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5–5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1–13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1–8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8–13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.This work was supported by the World Health Organization (Grant: NCE: EU ICP FFC 100 XK 08).peer-reviewe

An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta.

OBJECTIVE: The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. DESIGN: We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. SETTING: Malta. SUBJECTS: Whole population, with a focus on children. RESULTS: Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored. CONCLUSIONS: Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed

Food environments in Malta: Associations with store size and area-level deprivation

Food environments are potential targets for interventions to reduce obesity prevalence, particularly in island settings that are typically dependent on food imports. This observational study aimed to characterise the availability, quality and price of foods and beverages in a nationally representative sample of grocery stores in Malta using the Nutrition Environment Measures Survey for Stores (NEMS-S) instrument, and to examine the association between area-level density of different types of food stores and the likelihood of children living in these areas being overweight or obese. Fieldwork was carried out between March and May 2014. There was a strong positive correlation between store size and NEMS-S score (p = <0.001), suggesting that smaller grocery stores generally offered a smaller range of products and fewer healthy food/beverage options than larger supermarkets. Across all stores, median prices of certain ‘healthier’ versions of foods were more expensive than their less healthy alternatives. A significant association between risk of childhood overweight, and density of confectionery stores in children's locality of residence, was found (OR 1.19; 95% CI: 1.04, 1.37). These baseline findings highlight opportunities to improve the food environment in Malta to support more healthful eating, and may be of particular interest to public health practitioners in island settings

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

End-of-fill study on collimator tight settings

In 2010 and 2011 the collimation system has been operated with relaxed settings, i.e. with retractions between different collimator families larger than the nominal settings that provide optimum cleaning. This configuration ensured a sufficient cleaning performance at 3.5 TeV while allowing larger tolerances on orbit control. Tighter collimator settings were proposed to push the cleaning performance and to allow larger orbit margins between TCDQ dump protection and tertiary collimators. With the same margins as with the relaxed settings, the β∗ could be reduced. After having verified with beam that the cleaning is improved as expected, the feasibility of tighter collimator settings must be addressed with high stored intensity. For this purpose, an end-of-fill study was proposed after a standard physics fill with 1380 bunches nominal bunches at 3.5 TeV, for a total stored energy of 95 MJ. During this test, primary and secondary collimators were moved to tight settings after about 8 hours of stable physics conditions in all experiments. This note summarises the operational procedure followed and the results of beam measurements during this study.peer-reviewe

Childhood obesity, food insecurity and climate change : a tale of two island groups

The Canary Islands and Malta are two island groups currently experiencing high childhood overweight and obesity rates, with prevalence reported at over 40% for Malta and 44.2% for the Canary Islands [using World Health Organisation (WHO) cut-off criteria]. This study compares the childhood obesity situation in both islands, taking into consideration their specific vulnerabilities, the main initiatives to address obesity in both countries, and reports on progress achieved. Children’s dietary and physical activity behaviours in both islands continue to be problematic, but other concerns such as the reliance on food imports and potential climate change impacts remain. Some strategies and initiatives are in place, but there are few progress indicators documented. Public health proposals should investigate the broader causes of obesity, and the potential link between childhood obesity and the specific vulnerabilities of small islands, to find more targeted solutions.peer-reviewe

Multi-turn losses and cleaning

In the LHC all multi-turn losses should occur at the collimators in the cleaning insertions. The cleaning inefficiency (leakage rate) is the figure of merit to describe the performance. In combination with the quench limit of the superconducting magnets and the instantaneous life time of the beam this defines the cleaning dependent beam intensity limit of the LHC. In addition, limits can arise from radiation-induced effects, like radiation damage and radation to electronics. In this paper the used collimator settings, the required setup time, the reliability of collimation (all multi-turn losses at collimators), and the achieved proton/ion cleaning inefficiency are discussed. Observed and expected losses are compared. The performance evolution during the months of operation is reviewed. In addition, the peak losses during high intensity runs, losses caused by instabilities, and the resulting beam life times are discussed. Taking the observations into account the intensity reach with collimation at 3.5 and 4 TeV is reviewed.peer-reviewe

Health and economic consequences of projected obesity trends in Malta

Background: Globally, there is increasing concern about the potential health and economic consequences of current obesity trends. This study assessed the impact of unchecked obesity and the benefits of reducing population weight levels in Malta. Methods: Body mass index rates, disease burden and direct health care costs for breast and colon cancer, coronary heart disease, diabetes, hypertension and stroke in Malta were projected to 2035 using a two-stage microsimulation model. Two scenarios were modelled for population weight reduction. Research: By 2035, uncontrolled overweight and obesity are projected to result in a 62% increase in stroke prevalence, a 27% increase in obesity-related cancers and a 16% increase in prevalence of hypertension. The prevalence of coronary heart disease developing as a consequence of obesity is expected to double within the next two decades. Associated cumulative direct health care costs will amount to around €814 million by 2035. However, a 5% reduction in the average population body mass index by 2035 is projected to result in a saving of €141 million in health expenditure on obesity-related conditions over the intervening 20 years. Conclusion: These findings have important implications for obesity policy in Malta and other European nations with similar health systems and levels of population obesity, thus highlighting the need for effective population-level preventive strategies.peer-reviewe

Последствия прогнозируемых тенденций ожирения для здравоохранения и экономики на Мальте

Общая информация: Во всем мире потенциальные последствия текущих тенденций в области ожирения для здравоохранения и экономики вы зывают нарастающее беспокойство. В настоящем исследовании дается оценка последствий неконтролируемого распространения ожирения и той пользы, которую инициативы по снижению массы тела могут прине сти для населения Мальты. Методы: С помощью двухэтапного имитационного микромоделирования были спроецированы, на период до 2035 г., показатели индекса массы тела, бремени болезней и прямых затрат на медицинское обслуживание в связи с раком молочной железы и раком толстого кишечника и прямой кишки, ишемической болезнью сердца, диабетом, гипертонией и инсультом на Мальте. Были смоделированы два сценария снижения массы тела у населения. Исследование: По прогнозу, к 2035 г. неконтролируемое распространение избыточной массы тела и ожирения приведут к повышению распространенности инсультов на 62%, связанных с ожирением онкологических заболеваний – на 27% и гипертонии – на 16%. Распространенность ишемической болезни сердца, возникающей в результате ожирения, как ожидается, за ближайшие два десятилетия удвоится. Связанные с этим суммарные прямые затраты на медицинское обслуживание к 2035 г. вырастут приблизительно до 814 млн евро. Вместе с тем, снижение среднего индекса массы тела среди населения на 5% к 2035 г. позволит в ближайшие 20 лет снизить расходы системы здравоохранения, связанные с про блемой ожирения, на 141 млн евро. Вывод: Результаты исследования важны для разработки стратегий борьбы с ожирением на Мальте и в других европейских странах со схожими системами здравоохранения и аналогичной распространенностью ожирения. Полученные данные подчеркивают необходимость эффективных стратегий профилактики на уровне всего населенияpeer-reviewe