Papers by Hugo Agius Muscat
Implementing a digital public health project - lessons learned?
European journal of public health, Oct 1, 2022
The demand for the digitalisation of public health has been ongoing for more than a decade. The C... more The demand for the digitalisation of public health has been ongoing for more than a decade. The COVID-19 pandemic was the tipping point that accelerated the ideation, implementation, and scale-up of such public health projects. Despite the well-needed push, the same challenges that face every similar implementation will nonetheless be the same if not accentuated. The scope of the presentation is to highlight the difficulties and facilitators that such implementations and evaluations bring forward. We will also see what we can learn as public health professionals to ensure that present and future information systems are well-planned. We have to ensure that they do not succumb to the pressure of well-intended stakeholders who are yearning for such solutions to help their business workflows. This presentation will be enhanced with the lessons learned from implementing, monitoring, and following up on Malta's national contact tracing app and Customer Relationship Management systems based on Microsoft Dynamics 365 technologies that tackled the Test, Track and Trace workflows that were integral to the COVID response in Malta.
Malta Association of Public Health Medicine, 2019
Research in Social and Administrative Pharmacy, 2019
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1998
Regional differnces in birth prevalence of congenital heart disease in Malta
Cardiology in the Young, 1999
AimRecent studies have shown a correlation between environmental pollutants and increased risk of... more AimRecent studies have shown a correlation between environmental pollutants and increased risk of selected congenital malformations. The South-East area of the Island of Malta is much more industrialised than the more rural North-West area. The aim of this study was to test the null hypothesis that there are no regional differences in Malta in the prevalence at birth of congenital cardiac malformations. Methods: Live born infants with congenital cardiac malformations born between 1990 and 1994 were allocated to 10 areas, and thence to 2 regions of 5 areas each, so as to constitute North-West and South-East Malta. Official publications gave population totals and growth rates. Those infants with congenital cardiac malformations were then compared between the different regions using χ2and the Mann-Whitney U test.ResultsThe overall prevalence of congenital heart disease at birth was 8.8/1000 live births. The birth prevalence for the South-East region (10.1/1000 LB – 95% CI 8.4–12.3/1000...
This is a brief overview of personal computing as it affects the Maltese GP of the 1990s. INTRODU... more This is a brief overview of personal computing as it affects the Maltese GP of the 1990s. INTRODUCfION. Computers have become ubiquitous in today's world. Computers are important, sometimes essential, tools for the handling of information. They are useful because they accept and store large volumes of data in a structured manner; these data can be manipulated, sorted and retrieved accurately, rapidly and consistently. However, a Health Warning
A glaucoma survey was carried out in Malta and Gozo. Using non-contact pulseair tonometer, 2245 p... more A glaucoma survey was carried out in Malta and Gozo. Using non-contact pulseair tonometer, 2245 participants selected on a random basis, aged 40 years and above, were examined and 3.29% were found to have glaucoma. Among them 1.69% were newly de tected glaucoma cases. The main risk factors were diabetes mellitus in the personal past history and glaucoma in the family history. Age was confirmed to be a risk factor, but arterial hyperten sion and myopia could not be proved as risk factors. About 4000 glaucoma cases were estimated to be present in Malta and Gozo at the time of the survey. Some other ocular conditions were also found in relatively high percentages: cataract-3.3%, myopic maculopathy-2.9% and diabetic retinopathy-1.5%.
The effective planning of a system and the training of personnel to run it requires accurate data... more The effective planning of a system and the training of personnel to run it requires accurate data regarding the use to be made of the system. For a health care system such data, apart from actual numbers of patients, will include age/ sex distribution, patient requests and expecta tions, and common presenting symptoms and diagnoses. Studies have been conducted in various countries to collect such data' and while they have demonstrated general similarities among countries, they have also shown important regional differences. The present study arose as a result of discussions during a course on Family Medicine held by the University of Malta attended by ten doctors working in Govern ment Health Centres, as it was noted that no such information has been published for Malta.
Food and health in Malta. A situation analysis and proposals for action. The Malta case study
An increase in the severity of wheezing and rhinitis but not eczema in 5- to 8- year old Maltese children over a decade (ISAAC - Malta)
The International Study of Asthma and Allergies in Childhood (ISAAC) is the largest standardised ... more The International Study of Asthma and Allergies in Childhood (ISAAC) is the largest standardised worldwide epidemiological research programme ever undertaken on allergies in children. The severity of a condition is a good measure of disease burden. The aim of our study was to investigate the current prevalence and severity of childhood allergic conditions in Malta, and analyze time trends by comparing the results with data obtained from phase 3 of the ISAAC study in 2001, in which Malta participated. The same validated standardized ISAAC questionnaire and protocol was used. Data was obtained from 3071 5- to 8-year-olds in 60 randomly sampled primary state schools over 2013 and 2014.52.4% were boys while 47.6% were girls. Data from our study shows that the prevalence of these 3 allergic conditions namely asthma, allergic rhinitis and eczema, has significantly increased. The trends in severity of symptoms are shown in Table 1. These results indicate a rise in severity of symptoms of wheezing and rhinitis but not eczema in Maltese children over the last decade. The substantial disease-related morbidity this produces needs to be ameliorated through better management of these conditions and further research in this area.
Outcome of Unstable Angina in Patients with Diabetes Mellitus
Diabetic Medicine, 1997
This prospective hospital-based, case-control study compares the outcome of unstable angina in no... more This prospective hospital-based, case-control study compares the outcome of unstable angina in non-insulin dependent diabetic patients and non-diabetic control subjects. One hundred and sixty-two diabetic patients and 162 non-diabetic control patients with unstable angina were entered into the study. The 3-month mortality was 8.6% (95% confidence interval, CI = 4.4-12.9%) in diabetic patients and 2.5% (CI = 0.1-4.9%) in control patients (p = 0.014). The 1-year mortality was 16.7% (CI = 10.9%-22.4%) in diabetic patients and 8.6% (CI = 4.4%-12.9%) in non-diabetic patients (p = 0.029). Diabetic patients received beta-blockade and underwent coronary angiography and angioplasty less frequently than controls; the frequency of unstable angina, of acute myocardial infarction, and coronary artery bypass grafting was similar in both groups at 1 year of follow-up. It is concluded that diabetic patients with unstable angina have a higher mortality than non-diabetic patients and that this difference is largely accounted for by early (first 3 months) mortality.
Journal of the Royal Society of Medicine, 1989
regularly for the past two weeks. She was hospitalized and transfused three units of fresh frozen... more regularly for the past two weeks. She was hospitalized and transfused three units of fresh frozen plasma. On the next day, her INR fell down to 3.6. She was, therefore, discharged and told not to use the ointment. Six weeks later, when seen at clinic, she was well and had no more bruises. She was taking warfarin 4 mg daily and her INR was 2.2. Blood salicylate levei was zero. Discussion Salicylates, in general, are contraindicated in patients taking warfarin because of increased risk of bleeding. In high dose, salicylates depress prothrombin formation in the liver and also displace warfarin from protein binding sites", They also have effects on platelets which cause a tendency to bleed even in the presence of a normal INR3-5. These actions, although highly variable5.7 from one patient to another, may be lethal when major bleeding happens to occur. Salicylates, taken in the form of topical ointment, have not been reported to interact adversely with warfarin. The anticoagulation status of our patient had been very stable since her operation. She had taken no additional medications to account for the acute rise in INR apart from methysalicylate ointment. Significant percutaneous absorption of the ointment had occurred as evidenced by a blood salicylate level of 2.5 mmol/l. The acute rise in INR of our patient had, therefore, to be explained by drug interaction between
Research in Social and Administrative Pharmacy, 2018
solution. The 2 factors were interpreted as 'Communication, information sharing and shared decisi... more solution. The 2 factors were interpreted as 'Communication, information sharing and shared decision making initiated by GP' and 'Shared decision making initiated by CP' (52,9% variance explained, Cronbach's alpha: 0,764 and 0,708). The model demonstrated adequate fit (Х2/df¼1,659, CFI¼0,910, RMSEA¼0,074). The significant demographic predictors of collaboration were age, years worked as a registered pharmacist, location of the pharmacy, current position, number of general practitioners from whom the community pharamcist regularly received prescriptions, total population of the city where the pharmacy's located and hours spent in continuing education. Conclusions: The results of the study provide evidence for the validity of the FICI-and ATCI-P in measuring attitudes towards and frequency of collaboration between German CPs and GPs. A model of collaboration in which behaviour and extent of collaboration is directly influenced by individual and contextual characteristics is supported. However, a comparison with the Australian study suggested that Australian CPs' conceptualisation of their professional role in patient care is broader than is the case among the German pharmacist cohort and this translates into a broader scope for their inter-professional communication and collaboration.
Early Human Development, 2018
Data protection (DP) protects crucial and humane fundamentalsthe respect of human rights, particu... more Data protection (DP) protects crucial and humane fundamentalsthe respect of human rights, particularly protecting aspects of privacy and confidentiality for living and identifiable persons. DP is enshrined in legislation, and this paper will outline the duties of potential data controllers (researchers) when applying for access to data, when processing said data, and what to do with it at the end of the study.
An increase in the severity of rhinitis and a reduction in severity of wheezing and eczema in 12- to 15- year old Maltese children over two decades (ISAAC-Malta)
European Respiratory Journal, 2015
The International Study of Asthma and Allergies in Childhood (ISAAC) is the largest standardised ... more The International Study of Asthma and Allergies in Childhood (ISAAC) is the largest standardised worldwide epidemiological research programme ever undertaken on allergies in children. The severity of a condition is a good measure of disease burden.The aim of our study was to investigate the current prevalence and severity of childhood allergic conditions in Malta, and analyze time trends by comparing the results with data obtained from previous phases of the ISAAC study in 1995 and 2002, in which Malta participated. The same validated standardized ISAAC questionnaire and protocol was used. Data was obtained from 3263'12- to 15-year-olds' in 16 randomly sampled secondary schools over 2013 and 2014.46.6% were boys while 53.4% were girls. Data from our study shows that in this age group, the prevalence of wheezing and rhinitis has significantly decreased, while that of eczema has plateaued. The trends in severity of symptoms are shown in Table 1. ![Figure][1] These results indicate a rise in severity of rhinitis, a reduction in severity of wheezing and eczema in Maltese 12- to 15- year old children over the last two decades. The substantial disease-related morbidity rhinitis produces needs to be ameliorated through better management of this condition and further research in this area. [1]: pending:yes
Decreasing prevalence of wheezing and rhinitis but not eczema in 12- to 15- year old Maltese children over two decades (ISAAC-Malta)
European Respiratory Journal, 2015
The prevalence of asthma, rhinitis and eczema has been increasing worldwide, as a result of which... more The prevalence of asthma, rhinitis and eczema has been increasing worldwide, as a result of which, these allergic conditions became some of the most common conditions of childhood. The International Study of Asthma and Allergies in Childhood (ISAAC) was the largest standardised worldwide epidemiological research programme ever undertaken on allergies in children. The aim of our study was to investigate the current prevalence and severity of childhood allergic conditions in Malta, and analyze time trends by comparing the results with data obtained from previous phases of the ISAAC study in 1995 and 2002, in which Malta participated. The same validated standardized ISAAC questionnaire and protocol was used. Data was obtained from 3263 '12- to 15-year-olds' in 16 randomly sampled secondary schools over 2013 and 2014.The cohort consisted of 46.6% boys and 53.4% girls. The trends in prevalence are shown in Table 1. ![Figure][1] These results indicate a significant decrease in both the cumulative and current prevalence for both wheezing and rhinitis with the prevalence of eczema remaining stable over the last two decades in Maltese schoolchildren. The public health conundrum of overdiagnosis of all these three allergic conditions is however of some concern. [1]: pending:yes
Gender differences in the prevalence and severity of wheezing, rhinitis and eczema in 5- to 8- year old and 12- to 15- year old Maltese children (ISAAC-Malta)
European Respiratory Journal, 2015
The International Study of Asthma and Allergies in Childhood (ISAAC) was the largest standardized... more The International Study of Asthma and Allergies in Childhood (ISAAC) was the largest standardized worldwide epidemiological research programme ever undertaken on allergies in children. The aim of our study was to investigate the current prevalence and severity of childhood allergic conditions in Malta. The validated standardized ISAAC questionnaire and protocol was used. Data was obtained from 3071 '5- to 8-year-olds' in 45 randomly sampled primary state schools over 2013 and 2014 in which52.4% were boys while 47.6% were girls; and from 3263 '12- to 15-year-olds' in 16 randomly sampled secondary schools over 2013 and 2014 in which46.6% were boys and 53.4% were girls. The gender differences in allergic conditions are shown in Table 1 and Table 2. ![Figure][1] These results indicate that allergic conditions in 5- to 8- years are more prevalent in boys; while in adolescence the pattern changes, being more prevalent in girls. On the other hand, these allergic conditions tend to be more severe in girls in both age groups. Hormonal differences or gender-specific differences in environmental exposures maybe to blame; but more research in this area is needed. [1]: pending:yes
Rising trends in the prevalence of wheezing, rhinitis and eczema in 5- to 8- year old Maltese children over a decade (ISAAC - Malta)
The prevalence of asthma, rhinitis and eczema has been increasing worldwide, as a result of which... more The prevalence of asthma, rhinitis and eczema has been increasing worldwide, as a result of which, these allergic conditions became some of the most common conditions of childhood. The International Study of Asthma and Allergies in Childhood (ISAAC) was the largest standardised worldwide epidemiological research programme ever undertaken on allergies in children. The aim of our study was to investigate the current prevalence and severity of childhood allergic conditions in Malta, and analyze time trends by comparing the results with data obtained from phase 3 of the ISAAC study in 2001, in which Malta participated. The same validated standardized ISAAC questionnaire and protocol was used. Data was obtained from 3071 5- to 8-year-olds in 60 randomly sampled primary state schools over 2013 and 2014.52.4% were boys while 47.6% were girls. The trends in prevalence are shown in Table 1. ![Figure][1] These results indicate a rise in both the cumulative and current prevalence of wheezing, rhinitis and eczema in Maltese children over a span of 11 years. This has important implications in terms of: quality of life, economic burden and mortality. [1]: pending:yes
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Papers by Hugo Agius Muscat