DOCSLIB.ORG

Socioeconomic Status and Its Impact on the Prevalence of Severe ADHD in the Maltese Islands

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Socioeconomic Status and Its Impact on the Prevalence of Severe ADHD in the Maltese Islands OriginalEditorial OrgOdRe Article Socioeconomic status and its impact on the prevalence of severe ADHD in the Maltese Islands Christopher Rolé, Nigel Camilleri, Rachel Taylor-East, Neville Calleja Abstract The main aim of this study was to assess Attention deficit hyperactivity disorder whether higher prevalence rates of ADHD were (ADHD) is a common disorder which presents in present in the districts, which are classically childhood. The core symptoms include; associated with a low socioeconomic status. All hyperactivity, impulsivity and reduced attention. If persons aged 0 to 18 years attending the left untreated this may possibly lead to various governmental clinics, having a documented impairments of function in other areas of one’s life, diagnosis of severe ADHD and therefore being such as lack of educational attainment, increased prescribed pharmacotherapy were identified and risk of accident-prone behaviour, substance misuse included in this study. Nine young people were and antisocial behaviours. Although the exact living in institutional care and were therefore aetiology is still not fully understood, various excluded from statistical analysis since this would studies have demonstrated the presence of both a skew that data in this study. A significant difference genetic and an environmental component. ADHD is (p<0.0001) in the point prevalence of ADHD highly hereditable, demonstrating a strong genetic between the six Malta districts was found, with component (0.75). Furthermore, increased rates of higher rates of ADHD occurring in the harbour ADHD have been linked with a low socioeconomic districts. Though not statistically significant, a status. positive correlation was demonstrated between the The islands of Malta have traditionally been ADHD prevalence and a number of socioeconomic divided for statistical purposes into 6 districts, with variables, these included; the rate of smoking certain districts more often being associated with (p=0.111), number of people classified as at-risk-of- low socioeconomic demographics. poverty per district (p=0.397), and number of people with no schooling per district (p=0.156). The overall point prevalence for ADHD in Malta obtained was 0.85, a value which is less than the average prevalence noted worldwide. The authors believe this value is an underestimation since the data collection in this study did not include ADHD Christopher Rolé M.D., M.Sc.* cases off pharmacological treatment and any Mount Carmel Hospital Attard , Malta ADHD cases assessed and treated in the private [email protected] sector. Nigel Camilleri M.D., MD Keywords Mount Carmel Hospital ADHD, prevalence, Malta, low socioeconomic Attard, Malta status c Rachel Taylor-East M.D., MSc Mount Carmel Hospital Introduction Attard , Malta Attention deficit hyperactivity disorder (ADHD) is the commonest childhood-onset mental Neville Calleja M.D., Ph.D. Directorate for Health information and Research disorder which manifests itself with symptoms of Pieta, Malta inattention, hyperactivity and impulsivity, with males being affected more than females.1 This *Corresponding author condition can have serious effects on the overall Malta Medical School Gazette Volume 03 Issue 03 2019 16 OriginalEditorial OrgOdRe Article functioning of a child, since it can influence the c. employment child’s education attainment together with his/her d. population density behaviour.2 ADHD symptoms can persist in e. being classified at risk of poverty adulthood with prevalence rates as high as 4.4% in f. being reared by a single mother the community.3 Evidence suggests that this g. number of nights spent abroad as a measure condition is highly heritable 4, several studies in of affluence different countries have demonstrated that ADHD is more prevalent in socioeconomically disadvantaged Methodology groups.5 Ethical approval and data collection The Maltese archipelago consists of 3 main A retrospective study was designed with the islands: Malta, Gozo and Comino. It is traditionally aim of calculating the point prevalence of severe divided for statistical purposes into six districts, ADHD in every district in Malta respectively. namely the Southern Harbour area, Northern Ethical approval was obtained from the Ethics Harbour area, the South-Eastern region, Western board of the University of Malta and permission for region, Northern region, and the 2 smaller islands data handling was obtained from the Data Gozo & Comino being considered as one district. Protection Office for Mental Health Services of The harbour regions, are considered less affluent Malta, located at Mount Carmel Hospital. areas with greater social deprivation and poverty.6 This project did not involve any direct contact In published literature it was reported that people with patients, their carers nor their attending living in the harbour areas have higher rates of physicians. Data accessed throughout this project psychosis.7 involved a retrospective case note review of the The Government of Malta has set up two patents clinical files as well as clinic databases clinics that assess and treat children and adolescent (where available). This demographic data collected, with mental disorders. These are the Child and included; the name and identification number, age Young People’s services (CYPS) located at St of the patient and address as well as diagnosis and Luke’s Hospital, Malta and the Gozo Psychiatry treatment modality being used as per February outpatient’s clinic. A number of independent 2017. All data were stored on a password protected psychiatry clinics are also found throughout the private computer with confidential access Maltese islands. Government based child and throughout the whole project as per data protection adolescent clinics accept referrals for youngsters law of the laws of Malta (DPA chapter 440). aged 0 till 18. Patients may be referred by any Records of all patients under 18 years of age, doctor working both in the private and government who ever attended these clinics (included sector, including general practitioners, psychiatrists discharged patients), were studied. All patients who and paediatricians. After the age of 18, patients received a diagnosis of ADHD by a psychiatrist followed at these clinics are referred to mainstream were highlighted for further analysis. Although adult psychiatry services. these clinics do not have established written The aims of this study included: protocols for the diagnosis of ADHD, literature 1. to retrospectively estimate the point prevalence suggests that treatment should only be initiated in of severe ADHD in children aged 0 to 18 years severe cases.8 Hence, in order to aim for high on treatment attending governmental clinics as specificity, only patients receiving treatment were per February, 2017, both in general and at selected implying the presence of severity of district level ADHD. Cases where a diagnosis of ADHD was 2. to assess whether a significant difference exists done but was not sufficient enough to warrant a in the point prevalence of severe ADHD pharmacological intervention were excluded. between the six districts in Malta. All data were imputed in a confidential 3. to assess whether a correlation exists between Microsoft Excel® file, containing demographic data rates of severe ADHD in those ages 0 to 18 as well as diagnosis and treatment modality. In years per district and a number of order to protect identification of patients all socioeconomic variables, including: patients’ names and identification numbers were a. smoking converted to a generated personalised identification b. education system, which was subsequently used throughout Malta Medical School Gazette Volume 03 Issue 03 2019 17 OriginalEditorial OrgOdRe Article the whole project. Patients’ addresses were people considered below the poverty line is double examined and every patent was allocated to one of the amount of people considered at or above the the six districts, as per Census of Populations and poverty line.15 Hence smoking can be considered a Housing of 2011.9 factor associated with low socio-economic status. Patients living in institutional care were excluded from the study in view of their current Demographic data of the Maltese islands living address being unreflective of the original Information related to the demographic data of demographic address. It was acknowledged that a the Maltese islands was obtained from the last number of families do move home and change their National census carried out in 2011 with results address. However, following discussions with the published preliminarily in 2012 and with the final medical statistician, in view that the number of official report published in 2014.9 These inter-district translocations tends to be mutual and publications can be accessed freely on the internet random it was deemed unnecessary to exclude from the National Statistics Office as well as patients whose family changed address before purchased from the above-mentioned office itself. February 2017. Data collected from the census included, total It was also acknowledged that a small number population according to the Maltese districts, of children are reared in foster families. However, including population per age group, population following discussions with the medical statistician density per district, level of education and since the number of fostered children in Malta and employment for individuals aged 15+. Further Gozo is very low, it was considered too small as to information was obtained about the lifestyle
Load more

Recommended publications
  • EUROPEAN COMMISSION Brussels, 8.10.2019 COM(2019)
    EUROPEAN COMMISSION Brussels, 8.10.2019 COM(2019) 463 final REPORT FROM THE COMMISSION TO THE COUNCIL 2019 report on the economic and social situation of Gozo (Malta) EN EN 2019 REPORT ON THE ECONOMIC AND SOCIAL SITUATION OF GOZO (MALTA) Without prejudice to the ongoing negotiations on the Multiannual Financial Framework for the period 2021-2027, and in accordance with Declaration 36 on the island region of Gozo annexed to the Treaty of Accession of Malta, the Government of Malta requested in February 2019 the Commission to report to the Council on the economic and social situation of Gozo and, in particular, on the disparities of the social and economic development levels between Gozo and Malta and to propose appropriate measures, to enable the further integration of Gozo within the internal market. This report assesses the state of development of Gozo and the evolution of disparities within Malta. It provides an assessment by reviewing recent trends on a series of dimensions and indicators relevant for the development of Gozo, i.e. demography and labour market, structure of the economy and economic growth, geography and accessibility. The paper also provides a comparison of Gozo with the rest of Malta and with other European regions. Finally, it analyses how Cohesion policy addresses the development needs of Gozo. This report uses regional statistics produced by Eurostat and by the Maltese Statistical Office. 1. ANALYSIS OF THE ECONOMIC AND SOCIAL SITUATION IN GOZO 1.1. Geography and land use Gozo is the second most important island of the Maltese archipelago in terms of surface and population.
    [Show full text]
  • State of Populism in Europe
    2018 State of Populism in Europe The past few years have seen a surge in the public support of populist, Eurosceptical and radical parties throughout almost the entire European Union. In several countries, their popularity matches or even exceeds the level of public support of the centre-left. Even though the centre-left parties, think tanks and researchers are aware of this challenge, there is still more OF POPULISM IN EUROPE – 2018 STATE that could be done in this fi eld. There is occasional research on individual populist parties in some countries, but there is no regular overview – updated every year – how the popularity of populist parties changes in the EU Member States, where new parties appear and old ones disappear. That is the reason why FEPS and Policy Solutions have launched this series of yearbooks, entitled “State of Populism in Europe”. *** FEPS is the fi rst progressive political foundation established at the European level. Created in 2007 and co-fi nanced by the European Parliament, it aims at establishing an intellectual crossroad between social democracy and the European project. Policy Solutions is a progressive political research institute based in Budapest. Among the pre-eminent areas of its research are the investigation of how the quality of democracy evolves, the analysis of factors driving populism, and election research. Contributors : Tamás BOROS, Maria FREITAS, Gergely LAKI, Ernst STETTER STATE OF POPULISM Tamás BOROS IN EUROPE Maria FREITAS • This book is edited by FEPS with the fi nancial support of the European
    [Show full text]
  • COASTAL AREA MANAGEMENT in MALTA Note
    COASTAL AREA MANAGEMENT IN MALTA Note This document was prepared by the Priority Actions Programme Regional Activity Centre (PAP/RAC) of the Mediterranean Action Plan (MAP-UNEP). The authors of the document are Louis Vella, Christine M. Tanti and Avertano Rolé. Zeljka Skaricic contributed to its general revision and finalisation, and Viktor Popovic designed and prepared the document for printing. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the United Nations Environment Programme or the Mediterranean Action Plan concerning the legal status of any state, territory, city or area, or their authorities, or concerning the delimitation of its frontiers or boundaries. The views expressed in this document do not necessarily represent the views of the United Nations Environment Programme. © 2005 Priority Actions Programme Regional Activity Centre, Split ISBN 953-6429-56-X This publication may be reproduced in whole or in part in any form of educational and non-profit purposes without special permission from the copyright holder, provided acknowledgement of the source is made. PAP would appreciate receiving a copy of any publication that uses this material as source. No use of this publication may be made for resale or any other commercial purposes whatsoever without prior permission in writing from the copyright holder. For bibliographic purposes this document may be cited as: PAP/RAC: Coastal Area Management in the Maltese Islands, Priority Actions Programme Regional Activity Centre, Split, 2005. TABLE OF CONTENTS List of Plates iv List of Figures iv List of Tables v List of Boxes v List of Acronyms vi ACKNOWLEDGEMENTS vii PREFACE ix EXECUTIVE SUMMARY xi CHAPTER I / Introduction 1 1.
    [Show full text]
  • Local Government White Paper and Interrelated Regions and Districts
    LOCAL GOVERNMENT WHITE PAPER AND INTERRELATED REGIONS AND DISTRICTS Perit Joseph Magro B.Sc.(Eng.)(Hons.), B.A.(Arch.) Update Note to the Addendum “Interrelated Regions and Districts for Malta and Gozo” Annexed to the Study Paper “Proposals For An Improved Malta Electoral System” This note proposes another solution of interrelated regions and districts, now based on the six regions as detailed in the Local Government White Paper. It also serves as a comparative study to the one put forward in the Addendum where a similar organizational structure of interrelated regions and districts for Malta and Gozo was proposed, with the districts also serving as electoral divisions. October 2018 LOCAL GOVERNMENT WHITE PAPER AND INTERRELATED REGIONS AND DISTRICTS Table of Contents 1. INTRODUCTION ……………………………………………………………………………………………………………………… 3 1.1 Reference to the Local Government White Paper 1.2 Reference to the Addendum 1.3 Main Objectives of This Update Note to the Addendum 1.4 Parameters Governing this Exercise 2. THE REGIONS AS ESTABLISHED IN THE WHITE PAPER ……………………………..…..………………………… 4 2.1 Maps of the Regions 3. ESTABLISHING THE DISTRICTS ……………………………………………………………………………………………….. 5 3.1 Hamlets 3.2 Numbering of Regions and Districts 4. COMPARATIVE CASE STUDIES …………………………………………….……………..………………………………….. 6 4.1 Proposed Organizational Structure and Registered Voter Changes 4.2 District Seat Value 4.3 Registered Voter Changes between October 2007 and April 2018 5. CONCLUSION ………………………………………………………………………………………………………………………… 8 Appendix 1: Map of the (White Paper) Regions and Proposed Districts …..…..….………………….……… 9 Appendix 2: Map of the Existing Regions of Malta ……………………………………………………………….…… 10 Appendix 3: Map of the Regions as Proposed in the White Paper ………………………………………….…. 11 2 1. INTRODUCTION 1.1 Reference to the Local Government White Paper The Local Government White Paper, published on 19th October 2018, refers to the existing five Regions of Malta as established by Act No.
    [Show full text]
  • Proposals for an Improved Maltese Electoral System
    Study Paper PROPOSALS FOR AN IMPROVED MALTA ELECTORAL SYSTEM Perit Joseph Magro B.Sc.(Eng.) (Hons.), B.A.(Arch.) A Study Paper that analysis the results of all the twenty four General Elections held in Malta between 1921 and 2017 and proposes revisions to the current Single Transferable Vote System: - to make the electoral system fairer for all contesting candidates and political parties - to make the final result of the General Elections truly reflect the choices of the electorate April 2018 PROPOSALS FOR AN IMPROVED MALTA ELECTORAL SYSTEM Table of Contents EXECUTIVE SUMMARY ............................................................................................................................... 3 1. INTRODUCTION .................................................................................................................................... 5 1.1 Definitions of Terms used in the Document .................................................................................... 5 1.2 Background ...................................................................................................................................... 6 2. REGULATION OF THE REGISTERED VOTERS AND GENERAL ELECTION RESULTS ................................. 7 3. THE QUOTA IN EACH ELECTORAL DIVISION ....................................................................................... 10 3.1 The Current System ................................................................................................................... 10 3.2 The Proposed System ...............................................................................................................
    [Show full text]
  • RRH: Rural and Remote Health Article: 5666
    Rural and Remote Health rrh.org.au James Cook University ISSN 1445-6354 ORIGINAL RESEARCH AUTHORS Tania Cardona1 MD (Melit), MSc, Specialist Trainee in Public Health Medicine * Neville Calleja2 MD, MSc (Lond), MSc PhD (Open), MFPH, C.Stat, C.Sci, FRSPH, DLSHTM, Public Health Consultant Glorianne Pullicino3 MSc (Public Health Medicine), MRCGP (INT), MMCFD, Assistant Lecturer CORRESPONDENCE *Dr Tania Cardona [email protected] AFFILIATIONS 1, 3 Department of Family Medicine, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta 2 Directorate for Information and Research, 95, Telgha ta’ Gwardamangia, Tal-Pieta, PTA 1313, Malta PUBLISHED 19 November 2020 Volume 20 Issue 4 HISTORY RECEIVED: 28 September 2019 REVISED: 18 August 2020 ACCEPTED: 15 September 2020 CITATION Cardona T, Calleja N, Pullicino G. Urban–suburban differences in the demographics and clinical profiles of type 2 diabetic patients attending primary healthcare centres in Malta. Rural and Remote Health 2020; 20: 5666. https://doi.org/10.22605/RRH5666 This work is licensed under a Creative Commons Attribution 4.0 International Licence ABSTRACT: Introduction: Social factors might bring about health inequities. Results: The logistic regression model predicting the likelihood of Vulnerable population groups, including those suffering from non- different factors occurring with suburban patients with diabetes as communicable diseases such as type 2 diabetes and depression, opposed to those residing in urban areas contained five might be more prone to suffering the effects of such inequities. independent variables (severity of depression, monthly income, This study aimed to identify patients with type 2 diabetes with blood capillary glucose readings, weight and nationality). The full depression in a primary care setting, with the objective of model containing all predictors was statistically significant, c2 (5, describing health inequities among urban and suburban dwellers.
    [Show full text]
  • The Social and Employment Situation in Malta
    DIRECTORATE GENERAL FOR INTERNAL POLICIES POLICY DEPARTMENT A: ECONOMIC AND SCIENTIFIC POLICY The Social and Employment Situation in Malta STUDY Abstract This document was provided by Policy Department A at the request of the Committee on Employment and Social Affairs. It gives an overview of the social and employment situation in Malta with a focus on indicators including social assistance and pension systems, social and employment legislation and policy, and about the inflow and integration of refugees, including tabulated data on these key topics. IP/A/IP/A/EMPL/FWC/2013-021 October 2016 PE 587.323 EN This document was requested by the European Parliament's Committee on Employment and Social Affairs AUTHOR(S) Mario VASSALLO, University of Malta RESPONSIBLE ADMINISTRATOR Stefan SCHULZ EDITORIAL ASSISTANT Irene VERNACOTOLA LINGUISTIC VERSIONS Original: EN ABOUT THE EDITOR Policy departments provide in-house and external expertise to support EP committees and other parliamentary bodies in shaping legislation and exercising democratic scrutiny over EU internal policies. To contact Policy Department A or to subscribe to its newsletter please write to: Policy Department A: Economic and Scientific Policy European Parliament B-1047 Brussels E-mail: [email protected] Manuscript completed in October 2016 © European Union, 2016 This document is available on the internet at: http://www.europarl.europa.eu/studies DISCLAIMER The opinions expressed in this document are the sole responsibility of the author and do not necessarily represent the official position of the European Parliament. Reproduction and translation for non-commercial purposes are authorised, provided the source is acknowledged and the publisher is given prior notice and sent a copy.
    [Show full text]
  • Malta Water Resource Review Is Intended to Provide a Strong and Objective Factual Knowledge Base on the Status of the Islands’ Water Resources and Trends in Water Use
    Malta water resources review FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS Rome, 2006 The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. All rights reserved. Reproduction and dissemination of material in this information product for educational or other non-commercial purposes are authorized without any prior written permission from the copyright holders provided the source is fully acknowledged. Reproduction of material in this information product for resale or other commercial purposes is prohibited without written permission of the copyright holders. Applications for such permission should be addressed to: Chief Publishing Management Service Information Division FAO Viale delle Terme di Caracalla, 00100 Rome, Italy or by e-mail to: [email protected] © FAO 2006 iii Contents Acknowledgements x Foreword xi List of acronyms xii Glossary xiii Executive summary xv 1. Introduction 1 The main challenges in managing Malta’s water resources 1 Meeting the demand for water 1 Protecting the resource base 1 Improving water governance 2 Supplying water at an acceptable cost 3 Improving the infrastructure 4 Increasing supply and limiting demand 4 Collaboration with FAO 4 Aims of the report 5 2. Basic facts about Malta 7 Physiography and demography 7 Historical developments 8 3. National economic and political setting 11 National economic, social and environmental objectives 11 National legislation 11 European water directives 12 Implementation of EU directives 14 4.
    [Show full text]
  • Characterization of Indigenous Lactic Acid Bacteria in Cow Milk of the Maltese Islands: a Geographical and Seasonal Assessment
    microorganisms Article Characterization of Indigenous Lactic Acid Bacteria in Cow Milk of the Maltese Islands: A Geographical and Seasonal Assessment Elisa Garroni 1, Agapi I. Doulgeraki 2,* , Foteini Pavli 1, David Spiteri 1 and Vasilis P. Valdramidis 1,3,* 1 Department of Food Sciences and Nutrition, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta; [email protected] (E.G.); [email protected] (F.P.); [email protected] (D.S.) 2 Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-Demeter, S. Venizelou 1, 14123 Lycovrissi, Greece 3 Centre of Molecular Medicine and Biobanking, University of Malta, MSD 2080 Msida, Malta * Correspondence: [email protected] (A.I.D.); [email protected] (V.P.V.); Tel.: +30-210-2845940 (A.I.D.); +356-2340-1157 (V.P.V.) Received: 16 April 2020; Accepted: 26 May 2020; Published: 28 May 2020 Abstract: A geographical and seasonal assessment of indigenous lactic acid bacteria (LAB) in Maltese cow milk was conducted in this study. To investigate this, milk was collected from different regions of Malta during winter and summer seasons. Total viable counts (TVC) and LAB population were enumerated. Afterwards, LAB were isolated and identified by molecular methods. According to the results, similar TVC were enumerated on winter and summer samples, while highest LAB population was detected on summer samples. LAB isolates were grouped in seven different clusters which were assigned to Lactobacillus casei, Pediococcus pentosaceus, Lactobacillus plantarum, Weissella paramesenteroides, Lactobacillus rhamnosus, Lactococcus lactis, and Lactococcus garvieae. In addition, Enterococcus and Streptococcus species were also isolated. Season seemed to affect the genus/species of LAB since Lactobacillus were mainly isolated from winter samples, while Lactococcus and Enterococcus species were the main genera identified in summer samples.
    [Show full text]
  • EURES Office, Who Can Offer Personalised Guidance on How and Where to Look for Work
    Living and working conditions – Revised structure A Rules on the free movement of workers 1. Finding a job 1.1. How to find a job 1.2. How to apply for a job 2. Moving to another country 2.1. Movement of goods and capital 2.2. Finding accommodation 2.3. Finding a school 2.4. Taking a car with you (includes information about driving licences) 2.5. Registration procedures and residence permits 2.6. Checklist for before and after your arrival in a new country 3. Working conditions 3.1. The paragraph that describes working conditions in Europe 3.2. Recognition of diplomas and qualifications 3.3. Types of employment 3.4. Employment contracts 3.5. Special categories 3.6. Self-employed persons 3.7. Payment 3.8. Working time 3.9. Leave (annual leave, parental leave, etc.) 3.10. Termination of employment 3.11. Representation of workers 3.12. Labour disputes – strikes 3.13. Vocational training 4. Living conditions 4.1. Summary of living conditions in Europe 4.2. Political, administrative and legal systems 4.3. Income and taxation 4.4. Cost of living 4.5. Accommodation 4.6. Health systems 4.7. Education systems 4.8. Cultural and social life 4.9. Private life (birth, marriage, death) 4.10. Transport New structure for the ‘Living and working conditions’ section 1/41 A Rules on the free movement of workers 1. Finding a job Jobseekers who have not yet arrived in Malta should contact the Malta EURES office, who can offer personalised guidance on how and where to look for work.
    [Show full text]
  • Water Scarcity in the Maltese Islands: Geopolitics and Management Issues
    Durham E-Theses Water scarcity in the Maltese islands: geopolitics and management issues Birdi, Narinder Singh How to cite: Birdi, Narinder Singh (1997) Water scarcity in the Maltese islands: geopolitics and management issues, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/4721/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk Water Scarcity in the Maltese Islands: Geopolitics and Management Issues Volume 1 of two volumes Narinder Singh Birdi Thesis submitted for the degree of Doctor of Philosophy The copyright of this thesis rests with the author. No quotation from it should be published without the written consent of the author and information derived from it should be acknowledged. University of Durham Department of Geography !997 0 iOV IBS? ABSTRACT The Maltese Islands have a history of water resource problems. A high proportion of the Maltese population has suffered over the past few years from water scarcity caused mainly by: (a) a shortage in water production and escalating water demands; (b) rising salinity levels in groundwater and tap water; (c) an undersized and deteriorating distribution system; and (d) increasing levels of groundwater pollution.
    [Show full text]
  • JMCFD December 2020
    www.mcfd.org.mt VOLUME 09 ISSUE 01 DECEMBER 2020 ISSN: 2304-8387 Ensuring Quality of Family Practice and Training Journal of the Malta College of Family Doctors CONTENTS The mission of the Journal of the Malta College of Family Doctors (JMCFD) is to deliver accurate, relevant and inspiring research, continued medical education and debate in family Global warming to global warning 03 medicine with the aim of encouraging improved patient care Prof. Pierre MALLIA through academic development of the discipline. As the main official publication of the Malta College of Family Doctors, the JMCFD strives to achieve its role to disseminate information Is a pneumococcal vaccine for on the objectives and activities of the College. the elderly appropriately Volume 9 • Issue 1 • December, 2020 recommended by Maltese Journal of the Malta College of Family Doctors geriatricians and general 127 The Professional Centre, Sliema Road, practitioners? 05 Gżira GZR 1633 - Malta Dr Nicole Marie ZERAFA, Email: [email protected] Dr Daniela BONELLO www.mcfd.org.mt/jmcfd Dr Marco GRECH Editor and Dr Antoine VELLA Prof. Pierre Mallia Quality improvement through Assistant Editors Dr Mario R Sammut, Dr Anton Bugeja, Dr Glorianne Pullicino evaluation of GP trainers’ continuing professional development in Malta 19 Copyright © Malta College of Family Doctors Dr Mario R SAMMUT All Rights Reserved. No part of this publication may be reproduced, and Dr Günther ABELA stored in a retrieval system, or transmitted in any form or by other means, electronic, mechanical, photocopying, recording or otherwise without prior permission, in writing, of the JMCFD. All articles published in the JMCFD including editorials, represent the Warfarin dosing and follow-up: opinion of the authors and do not reflect the official policy of the Malta College of Family Doctors or the institution with which the authors are adherence to the local guideline at a affiliated, unless this is clearly specified.
    [Show full text]