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1

Ng, Colin, Kurt Magri, Ryan Giordmaina, and Duncan Whitwell. "Bilateral Total Hip and Unilateral Knee Arthroplasties in a Young Adult with Arthropathy-Associated Intestinal Epithelial Dysplasia (Tufting Enteropathy)." Case Reports in Orthopedics 2018 (October 30, 2018): 1–4. http://dx.doi.org/10.1155/2018/4630759.

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Intestinal epithelial dysplasia (tufting enteropathy) is an uncommon congenital disorder. Furthermore, its association with chronic inflammatory arthropathy is rarely documented in the literature. Low prevalence rates of 1 in 100,000 live births in Western Europe exist, with higher rates in North Africa and Middle Eastern countries. Malta, being a small Mediterranean island at the cusp between Europe and North Africa, has an anecdotal sevenfold prevalence rate. This is the first documented case report of a patient with both intestinal epithelial dysplasia and severe bilateral hip and knee arthropathy that required simultaneous bilateral hip followed by, after a short interval, unilateral knee arthroplasties. Our aim is to highlight the rapid progression of associated arthropathy as well as the successful treatment with joint arthroplasties in such extreme cases. Surgical treatment may be a necessity despite best medical efforts to halt the disease.
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Cuschieri, Sarah, Josanne Vassallo, Neville Calleja, Nikolai Pace, and Julian Mamo. "The Effects of Socioeconomic Determinants on Hypertension in a Cardiometabolic At-Risk European Country." International Journal of Hypertension 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/7107385.

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Background. A relationship has been established between socioeconomic status and hypertension. The aim of this study was to determine the prevalence of hypertension and to explore the links between hypertension and socioeconomic factors in the adult population of Malta. Methods. A national representative cross-sectional health examination study was performed between 2014 and 2016. Sociodemographic and medical history data was gathered by validated questionnaires while blood pressure was measured. Prevalence rates of known hypertension, newly hypertension, and global hypertension were calculated. Associations between sociodemographic characteristics and hypertension were identified through logistic regression models. Results. Hypertension contributed to 30.12% (CI 95%: 28.71–31.57) of the study population, with a male preponderance. The majority was known hypertensive (73.59% CI 95%: 71.01–76.02), with only three-quarters on medication. Multivariant analyses showed that increasing age and body mass index, male gender, and living in Gozo, Western district, and Northern Harbour district were associated with having hypertension. Conclusion. Hypertension is a problem in Malta especially in the male population and with increasing age and body mass index. Education did not exhibit any associated risk for having hypertension, which is inconsistent with the literature, while habitat localities played a role in hypertension development.
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3

Cleary, Brian, Maria Loane, Marie-Claude Addor, Ingeborg Barisic, Hermien E. K. de Walle, Carlos Matias Dias, Miriam Gatt, et al. "Methadone, Pierre Robin sequence and other congenital anomalies: case–control study." Archives of Disease in Childhood - Fetal and Neonatal Edition 105, no. 2 (June 22, 2019): 151–57. http://dx.doi.org/10.1136/archdischild-2019-316804.

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ObjectiveMethadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS.Design/settingThis case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995–2011.PatientsCases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks’ gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview.ResultsAmong 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1–12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2).ConclusionsThese findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk–benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.
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4

Saliba-Gustafsson, Erika A., Alexandra Dunberger Hampton, Peter Zarb, Nicola Orsini, Michael A. Borg, and Cecilia Stålsby Lundborg. "Factors associated with antibiotic prescribing in patients with acute respiratory tract complaints in Malta: a 1-year repeated cross-sectional surveillance study." BMJ Open 9, no. 12 (December 2019): e032704. http://dx.doi.org/10.1136/bmjopen-2019-032704.

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ObjectiveTo identify factors that influence general practitioners’ (GPs’) oral antibiotic prescribing for acute respiratory tract complaints (aRTCs) in Malta.DesignRepeated, cross-sectional surveillance.SettingMaltese general practice; both public health centres and private GP clinics.Participants30 GPs registered on the Malta Medical Council’s Specialist Register and 3 GP trainees registered data of 4831 patients of all ages suffering from any aRTC. Data were collected monthly between May 2015 and April 2016 during predetermined 1-week periods.Outcome measuresThe outcome of interest was antibiotic prescription (yes/no), defined as an oral antibiotic prescription issued for an aRTC during an in-person consultation, irrespective of the number of antibiotics given. The association between GP, practice and consultation-level factors, patient sociodemographic factors and patient health status factors, and antibiotic prescription was investigated.ResultsThe antibiotic prescription rate was 45.0%. Independent factors positively associated with antibiotic prescribing included female GP sex (OR 2.3, 95% CI 1.22 to 4.26), GP age with GPs ≥60 being the most likely (OR 34.7, 95% CI 14.14 to 84.98), patient age with patients ≥65 being the most likely (OR 2.3, 95% CI 1.71 to 3.18), number of signs and/or symptoms with patients having ≥4 being the most likely (OR 9.6, 95% CI 5.78 to 15.99), fever (OR 2.6, 95% CI 2.08 to 3.26), productive cough (OR 1.3, 95% CI 1.03 to 1.61), otalgia (OR 1.3, 95% CI 1.01 to 1.76), tender cervical nodes (OR 2.2, 95% CI 1.57 to 3.05), regular clients (OR 1.3, 95% CI 1.05 to 1.66), antibiotic requests (OR 4.8, 95% CI 2.52 to 8.99) and smoking (OR 1.4, 95% CI 1.13 to 1.71). Conversely, patients with non-productive cough (OR 0.3, 95% CI 0.26 to 0.41), sore throat (OR 0.6, 95% CI 0.53 to 0.78), rhinorrhoea (OR 0.3, 95% CI 0.23 to 0.36) or dyspnoea (OR 0.6, 95% CI 0.41 to 0.83) were less likely to receive an antibiotic prescription.ConclusionAntibiotic prescribing for aRTCs was high and influenced by a number of factors. Potentially inappropriate prescribing in primary care can be addressed through multifaceted interventions addressing modifiable factors associated with prescription.Trial registration numberNCT03218930
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5

Fsadni, C., P. Fsadni, T. Piscopo, and C. Mallia Azzopardi. "Laryngeal Leishmaniasis in Malta." Journal of Infection 54, no. 2 (February 2007): e61-e63. http://dx.doi.org/10.1016/j.jinf.2006.04.003.

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6

YÜCETÜRK KURTULMUŞ, Gamze. "Malta Dili Üzerine Tarihsel Bir Bakış." Ankara Üniversitesi Dil ve Tarih-Coğrafya Fakültesi Dergisi 58, no. 2 (December 28, 2018): 1837. http://dx.doi.org/10.33171/dtcfjournal.2018.58.2.31.

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Malta, küçük bir ada ülkesi olmasına rağmen, bulunduğu konum sebebiyle çok çeşitli milletlerin izlerinin görüldüğü önemli bir tarihe ve sürekli yenilenen, biçim değiştiren bir dile sahiptir. Arapçanın bir lehçesi olan bu dil, Latin harfleriyle yazılan tek Sami dildir. Dünya genelinde Maltaca çalışmaları, özellikle son yıllarda artmaya başlamış ve bu dil üzerine konferanslar düzenlenmiş, “Malta Centre”, “International Association of Maltese Linguistics” gibi dil merkezleri/dernekler kurulmuştur. Malta, çok derin dilsel ve politik tarihe sahipken Türkiye'de sadece Malta sürgünleri ve Osmanlı Devleti'nin 1565 yılındaki kuşatması üzerine yayınlara rastlanmaktadır. Malta dili ya da edebiyatına dair neredeyse hiç çalışma bulunmamaktadır. Bu makalede, söz konusu dilin kökeni, geçirdiği evreler, edebî dilin oluşumu ve bugünkü Maltaca üzerinde durulacaktır.
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Mifsud, Matthew, George G. Buttigieg, Charles Savona-Ventura, and Simon Delicata. "Reproductive health in Malta." European Journal of Contraception & Reproductive Health Care 14, no. 4 (January 2009): 249–57. http://dx.doi.org/10.1080/13625180903072047.

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8

Grech, A. "Treating of Schizophrenia in Malta." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70494-8.

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Malta is a small country in the middle of the Mediterranean. It is a member of the European Union and has a population of around 400,000. The culture is European, and around 99% of the population is Roman Catholic. There are no studies on the prevalence of schizophrenia in the Maltese population, but it is most likely that it is about 1%. During the last few years, thousands of illegal immigrants from Africa have been arriving in Malta especially during summer. It seems that the prevalence of schizophrenia in this subgroup is more than that in the local population. Studies are needed to study this phenomenon further to see if this is the case, but they are definitely being a big burden on the local psychiatric services. The National Health Service in Malta provides all treatment for schizophrenia free of charge. The pharmacological management of schizophrenia is similar to that of other European countries. Oral atypical antipsychotics are available within the National Health Services, but depot preparations are not yet available. For admissions there is a main Psychiatric Hospital, Mount Carmel Hospital, and two units in two General Hospitals. Community services are in the process of being developed. An NGO association, the Richmond Foundation also provides community and rehabilitation services. The Maltese family is still a relatively strong unit, with a lot of support in times of help being provided by the extended family. Thus in most psychosocial interventions, the family plays a central role.
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9

Bangaru, Himabindu, Varun V. Gaiki, and M. V. Ranga Reddy. "Comparative study of single dose preoperative antibiotics versus both preoperative and postoperative antibiotics in laparoscopic appendicectomy for nonperforated appendicitis." International Surgery Journal 4, no. 9 (August 24, 2017): 3092. http://dx.doi.org/10.18203/2349-2902.isj20173894.

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Background: Antibiotics are being administered both preoperatively and postoperatively even in uncomplicated nonperforated appendicitis. Studies regarding role of postoperative antibiotics in laparoscopic appendicectomy for nonperforated appendicitis are sparse. The aim of the study is therefore to study the efficacy of single dose preoperative antibiotics versus both preoperative and postoperative antibiotics in reducing surgical site infection in laparoscopic appendicectomy for uncomplicated nonperforated acute appendicitis.Methods: This is a prospective study done in general surgery department at Malla Reddy institute of medical sciences from September to April 2016.162 patients with nonperforated appendicitis were randomly allocated into two groups. 80 patients in Group A were given single dose of preoperative prophylactic antibiotics. No further antibiotics were given. 82 patients in Group B were given both preoperative and postoperative antibiotics. Postoperative surgical site infection and duration of postoperative hospital stay were compared between both groups. Statistical analysis was done using ANOVA, Fisher’s Exact test and Chi-square test wherever necessary.Results: There was no significant difference in the rate of surgical site infection in both groups. The mean duration of postoperative hospital stay was shorter in preoperative antibiotics only group (Group A). Age and gender had no significant association with surgical site infection. There was no deep incisional or organ space infection in this study.Conclusions: Single dose prophylactic antibiotics would be sufficient in cases of laparoscopic appendicectomy for simple uncomplicated nonperforated acute appendicitis. Postoperative antibiotic administration would not be necessary in these cases.
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10

Cordina, McElnay, and Hughes. "Societal perceptions of community pharmaceutical services in Malta." Journal of Clinical Pharmacy and Therapeutics 23, no. 2 (April 1998): 115–26. http://dx.doi.org/10.1046/j.1365-2710.1998.00142.x.

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11

Savona-Ventura, Charles. "The medical aspects of the 1565 Great Siege of Malta." Journal of the Royal Army Medical Corps 160, no. 1 (September 18, 2013): 79. http://dx.doi.org/10.1136/jramc-2013-000137.

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12

Dawn, Indranil, and Gouranga Biswas. "Assessment of serum Ischemia Modified Albumin (IMA) Levels in Acute Rheumatic Fever." International Journal of Human and Health Sciences (IJHHS) 5, no. 2 (October 4, 2020): 222. http://dx.doi.org/10.31344/ijhhs.v5i2.263.

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Introduction : Rheumatic fever (RF) is an autoimmune, multiorgan inflammatory disease. The patients develop carditis (50-78%), arthritis (35-88%), chorea (2-19%), erythema marginatum (< 6%) and subcutaneous nodules (< 1-13%). Ischemia modified albumin or cobalt binding albumin is one of new biomarker for inflammation and oxidative stress. Various previous studies indicate that acute rheumatic fever is associated with oxidative stress and inflammation. In the present study, we examined IMA, CRP, ESR and albumin levels in acute rheumatic fever.Material and method: This case control study was conductedbetween April 2017 to March 2018 in pediatrics department of Malda Medical College and Hospital. Study group composed of 42 children aged 5-18 years suffering from acute rheumatic fever diagnosed by modified jones criteria and they compared with 50 healthy age and sex match control. The IMA levels were compared among groups, and the association to acute phase reactants were investigated.Results: Values ofserumischemia modified albumin, ESR and C Reactive Protein were significantly higher in cases compared to control group (p value ≤0.001). But no significant differencewas found between values of serum albumin in cases compared to control group. Positive correlation was found between cases serum IMA and ESR, C-Reactive protein.Conclusion: Serumischemia modified albumin were significantly higher in children with acute rheumatic fever compared to control group, so IMA could be used as a biomarker in diagnosis of ARF. However, further multicenter and larger case studies are needed to provide stronger evidence.International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 222-225
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13

Grech, Paula, Sarah M. Vella, and Tonio Piscopo. "Leishmania donovani mucosal leishmaniasis in Malta." BMJ Case Reports 13, no. 11 (November 2020): e237687. http://dx.doi.org/10.1136/bcr-2020-237687.

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We report a case of a 76-year-old British man living in Malta who presented with a 7-month history of recurrent epistaxis and an enlarging right nasal vestibular lesion. Of note, his medical history included rheumatoid arthritis for which he was on long-term methotrexate. Blood results were unremarkable other than a mild lymphopaenia. Despite the use of various antibiotics and intranasal steroids, the lesion failed to resolve. This was eventually biopsied, and the histological picture was that of mucosal leishmaniasis. Leishmania donovani complex was detected by PCR. The patient was treated with liposomal amphotericin B on alternate days for a total of 20 doses. The lesion was found to have healed well at follow-up and the patient denied any further episodes of epistaxis.
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Borg, Nicole, Louisa Testa, Fiona Sammut, and David Cassar. "Attitudes of Medical Students in Malta Toward Psychiatry and Mental Illness." Academic Psychiatry 44, no. 6 (September 15, 2020): 709–13. http://dx.doi.org/10.1007/s40596-020-01304-y.

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15

Felice, Alexander E., Ruth Galdies, Joseph Borg, Godfrey Grech, Wilma Cassar, Christian A. Scerri, George P. Patrinos, and Sjaak Philipsen. "Does Quantitative Heterogeneity of Human Fetal Hemoglobin (Hb F) Reveal Friends or Foes of KLF1 in Globin Gene Switching ?" Blood 118, no. 21 (November 18, 2011): 1092. http://dx.doi.org/10.1182/blood.v118.21.1092.1092.

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Abstract Abstract 1092 The chemical heterogeneity of fetal hemoglobin (Hb F) due to variable ratios of the Gγ and Aγ globin subunits reflects genetic complexity because of common dimorphisms such as Hb F Sardegna (or Aγ75(E19) Ile>Thr; also known as AγT) in Caucasians, and common variants such the Gγ globin variant, Hb F Malta I (or Gγ117(G19) His>Arg) that is in tight linkage disequilibrium with the β globin variant Hb Valletta (or β87(F3) Thr>Pro) and is found in 1.8% of neonates from Malta. Comprehensive and integrated maternal and neonatal testing has led to the finding of triple compound heterozygotes with Hb F Malta I in association with Hb F Sardegna and Hb Valletta in whom all globin genes that are functional in the transition from fetal to adult Hemoglobin profiles are genetically tagged, and quantifiable with High Performance Liquid Chromatography in the neonate or mRNA in the adult in the context of diverse XMNI −158 C>T Gγ globin and (AT)XTY −540 β globin haplotypes. The interaction between XMNI and (AT)XTY revealed “conditional” cis-trans interplay that appeared to be under developmental control. A family with members carrying Hb F Malta I in association with a rare form of the Hereditary Persistence of Fetal Hemoglobin has also been found. The genetic cause has been traced to haplo-insufficiency of the putative erythroid master regulator KLF1, and, as confirmed by functional assays in vitro. However, levels of Hb F expression varied considerably (3.3% – 19.5%) while a second family from Malta with the same KLF1 mutation (p.K288X) had normal Hb F indicating interplay of KLF1 with modifying genes. These data, together with comparative expression profiling of human erythroid progenitors, indicated a small set of additional gene products that may interact positively (friends) or negatively (foes) at the level of commitment or expression in globin gene switching with significant effects on the Mean Corpuscular - Hb F. Whole genome sequencing on critically informative family members currently in progress may further uncover the complex genetic interactions in developmental globin gene control. Disclosures: No relevant conflicts of interest to declare.
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Muscat-Inglott, Matthew, and Clayton Camilleri. "Non-contact Anterior Cruciate Ligament Injuries in Association Football: A study of Modifiable Neuromuscular Risk Factors among Top Tier Players in Malta." MCAST Journal of Applied Research & Practice 4, no. 2 (December 14, 2020): 60–72. http://dx.doi.org/10.5604/01.3001.0014.5690.

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Given the general prevalence and consequences of anterior cruciate ligament injuries in international football, a non-experimental quantitative observational study was designed to explore locally contextualised risk factors and injury outcomes among top tier male players in Malta. The repeated tuck jump assessment was selected as a convenient, unobtrusive and field-based primary data collection instrument for non-clinical assessment of neuromuscular and other risk factors, among a sample of 27 local premier league players. A final tally of 44.44% of the participants eventually exceeded a predetermined field test cut-off score, indicating the need for definitive preventive measures locally. There were no significant differences in scores between players of different teams, playing positions, preferred shoe brand, or dominant foot, further indicating a generally systemic nature to local risk factor exposure. The most frequently observed neuromuscular deficits were, specifically, trunk dominance and leg dominance, providing a clear indication of how future interventions or programmes in Malta might actually be structured and prioritised.
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Ishizaka, Alessio, Alfred Quintano, Ashraf Labib, and Alexandros Apostolakis. "Do five-star hotel managers know their customers’ priorities? An AHP-Prioritised scorecard study." EuroMed Journal of Business 14, no. 2 (July 1, 2019): 137–67. http://dx.doi.org/10.1108/emjb-03-2018-0020.

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Purpose Regular surveys by the Malta Hotels & Restaurants Association indicate a substantial improvement in the financial performance of five-star hotels in Malta in recent years. Therefore, the purpose of this paper is to investigate if this positive performance is primarily due to customer centricity by management. Design/methodology/approach The assessment is based on the findings of a quantitative study that compared the results of a demand side (customer survey) with those of a supply side (management survey). In total, 24 decision-choice criteria were framed within the four perspectives (financial, customer, internal process and employee learning/growth) of the balanced scorecard. Actual and potential customers of five-star hotels and hotel managers were asked to rank the decision-choice criteria and the balanced scorecard perspectives. The multi-criteria decision analysis was carried out by means of the AHP. Findings The study showed that managers in the five-star hospitality sector in Malta are in harmony with customer expectations given the strong positive correlation between the results of the customer and management surveys. Research limitations/implications This research is limited to the island of Malta but can be easily replicated for other touristic destinations. Practical implications This study has implication for hospitality customers, hotel managers and policy makers to help them to identify weak areas of hotel performance and improve them. Originality/value The paper has developed a Prioritised scorecard, a new hybrid balanced scorecard and AHP. Targets are therefore prioritised, which allow a better allocation of scarce resources.
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Muscat, Mark, Gianfranco Spiteri, Neville Calleja, Julie Haider, Stephen J. Gray, Jackie Maistre Melillo, Julian Mamo, and Paul Cuschieri. "Invasive meningococcal disease in Malta: an epidemiological overview, 1994–2007." Journal of Medical Microbiology 58, no. 11 (November 1, 2009): 1492–98. http://dx.doi.org/10.1099/jmm.0.011312-0.

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Since 1996, Malta has experienced an upsurge of invasive meningococcal disease (IMD) following an almost 30 year period with a negligible number of annually reported cases. We reviewed the 233 IMD cases notified during a 14 year period (1994–2007), and analysed epidemiological and laboratory surveillance data. The crude incidence per 100 000 inhabitants peaked in 2000 at 8.1 [95 % confidence interval (CI) 5.7–11.6] and again in 2006 at 8.9 (95 % CI 6.4–12.4), thereby placing Malta amongst the countries with the highest incidence of the disease in Europe. Of the total cases, 137 (59 %) were confirmed and 30 (13 %) were classified as probable. However, 66 cases (28 %) had no laboratory evidence of the disease and were classified as possible. Information on the serogroup was available for 114 cases. Serogroup B formed the largest proportion (76 %, n=87) followed by serogroup C (16 %, n=18). B : 4 : P1.19,15 strains (n=46) predominated throughout the study period since their first identification in 1998. With 28 deaths attributed to IMD, the overall case fatality rate was 12 %. Apart from stressing the importance of maintaining high vigilance for IMD, our findings underscore the importance of enhancing laboratory surveillance of the disease, including characterization of the meningococci. Until vaccines against a broad range of serogroup B meningococci become available for universal use, the main methods of control remain the early treatment of cases and the prevention of secondary cases.
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Bhuiyan, MAH, MB Banu, and M. Rahman. "Assessment of arbuscular mycorrhizal association in some fruit and spice plants of Rangamati hill district." Bangladesh Journal of Agricultural Research 42, no. 2 (June 7, 2017): 221–32. http://dx.doi.org/10.3329/bjar.v42i2.32810.

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Rhizosphere soils of some fruit and spice plants from the Hill Agricultural Research Station, Bangladesh Agricultural Research Institute, Raikhali, Rangamati were collected during 2011-12 and 2012-13 for counting Arbuscular Mycorrhizal (AM) spore population, determining colonization (%) in their roots and studying AM structure. Assessment of spore population was done by following the Wet Sieving and Decanting Method. The percentage of AM infection was estimated by root slide technique. The spore number of 100g rhizosphere soil was recorded ranging from 120 in rhizosphere soil of Malta plant to a maximum of 410 in Atafal and Sofeda plants during 2011-12 and from 75 in rhizosphere soil of Phalsa plant to a maximum of 327 in Amlaki plant during 2012-13. Different fruit and spice plants showed different percentages of root colonization by AM fungi. Among the fruit and spice plants, the highest colonization (40%) was found in Jabotica, Phalsa and Sofeda plant, and the lowest colonization (6.6%) was found in Rambutan plant during 2011-12, but in 2012-13 the highest (61.3%) was result was observed in Bilatigab plant and the lowest (18.7%) was in Misti lebu, Malta and Tetul plant. The AM fungal structure in the root system of the selected fruit and spice plants varied in irrespective of fruit and spice species. Some plants had vesicles. Hyphae were present in most of the plants. Some plant species recorded Arbuscules. Both oval and spherical shape vesicles were found in this study.Bangladesh J. Agril. Res. 42(2): 221-232, June 2017
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Maas, Suzanne, Paraskevas Nikolaou, Maria Attard, and Loukas Dimitriou. "Heat, Hills and the High Season: A Model-Based Comparative Analysis of Spatio-Temporal Factors Affecting Shared Bicycle Use in Three Southern European Islands." Sustainability 13, no. 6 (March 16, 2021): 3274. http://dx.doi.org/10.3390/su13063274.

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Bicycle sharing systems (BSSs) have been implemented in cities worldwide in an attempt to promote cycling. Despite exhibiting characteristics considered to be barriers to cycling, such as hot summers, hilliness and car-oriented infrastructure, Southern European island cities and tourist destinations Limassol (Cyprus), Las Palmas de Gran Canaria (Canary Islands, Spain) and the Valletta conurbation (Malta) are all experiencing the implementation of BSSs and policies to promote cycling. In this study, a year of trip data and secondary datasets are used to analyze dock-based BSS usage in the three case-study cities. How land use, socio-economic, network and temporal factors influence BSS use at station locations, both as an origin and as a destination, was examined using bivariate correlation analysis and through the development of linear mixed models for each case study. Bivariate correlations showed significant positive associations with the number of cafes and restaurants, vicinity to the beach or promenade and the percentage of foreign population at the BSS station locations in all cities. A positive relation with cycling infrastructure was evident in Limassol and Las Palmas de Gran Canaria, but not in Malta, as no cycling infrastructure is present in the island’s conurbation, where the BSS is primarily operational. Elevation had a negative association with BSS use in all three cities. In Limassol and Malta, where seasonality in weather patterns is strongest, a negative effect of rainfall and a positive effect of higher temperature were observed. Although there was a positive association between BSS use and the number of visiting tourists in Limassol and Malta, this is predominantly explained through the multi-collinearity with weather factors rather than by intensive use of the BSS by tourists. The linear mixed models showed more fine-grained results and explained differences in BSS use at stations, including differences for station use as an origin and as a destination. The insights from the correlation analysis and linear mixed models can be used to inform policies promoting cycling and BSS use and support sustainable mobility policies in the case-study cities and cities with similar characteristics.
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Clark, Marilyn, Jamie Bonnici, and Andrew Azzopardi. "Loneliness in Malta: Findings from the first National Prevalence Study." Journal of Social and Personal Relationships 38, no. 9 (May 31, 2021): 2751–71. http://dx.doi.org/10.1177/02654075211020120.

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Loneliness has been examined by an increasing number of scholars, being implicated in numerous detrimental outcomes for mental and physical health. However, most loneliness prevalence studies have focused on particular age groups, thus overlooking how loneliness differs across the lifespan. This study assessed loneliness prevalence in a nationally representative sample ( n = 1,009) of the Maltese population aged 11 years and above using the 11-item De Jong Gierveld Loneliness Scale, while also identifying associations between loneliness and sociodemographic factors. Results demonstrate that 43.5% of the Maltese population experiences some form of loneliness. The association between loneliness and age demonstrates a nonlinear relationship, with elevated loneliness rates among adolescents, which decrease slightly in early adulthood, before slowly increasing from age 35 onward. Loneliness is also significantly associated with education level, employment status, household composition, mortgage payment status, perception of income, presence of a disability, active citizenship, as well as self-rated physical health, coping ability, and subjective wellbeing. These findings indicate that loneliness is experienced in significant rates across the lifespan, and intervention efforts should be targeted toward individuals of all ages.
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Zammit, Christopher, David Bilocca, Silvia Ruggieri, Gaspare Drago, Cinzia Perrino, Silvia Canepari, Martin Balzan, et al. "Association between the Concentration and the Elemental Composition of Outdoor PM2.5 and Respiratory Diseases in Schoolchildren: A Multicenter Study in the Mediterranean Area." Atmosphere 11, no. 12 (November 29, 2020): 1290. http://dx.doi.org/10.3390/atmos11121290.

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Abstract: Exposure to outdoor air pollution has been shown to increase asthma symptoms. We assessed the potential role of particulate matter with aerodynamic diameter <2.5 μm (PM2.5) on respiratory condition in schoolchildren in the south Mediterranean area. A total of 2400 children aged 11–14 years were recruited, and data on their symptoms were collected through an ISAAC (International Study of Asthma and Allergies in Childhood)-based questionnaire. Outdoor PM2.5 was collected for 48 consecutive hours in the schoolyards of their schools and selected residential outdoor areas. The levels of PM2.5 were measured, along with its elemental composition. The incidence of an acute respiratory illness within the first 2 years of life was higher amongst Sicilian children when compared to Maltese children (29.7% vs. 13.5% respectively, p < 0.0001). Malta had a significantly higher prevalence of doctor‐diagnosed asthma, when compared to Sicily (18.0% Malta vs. 7.5% Sicily, p <0.0001). Similarly, current asthma (7.8% vs. 2.9%, p < 0.0001) and use of asthma medication in the last 12 months (12.1% vs. 4.9%, p < 0.0001) were more frequent amongst Maltese children. Total median PM2.5 was 12.9 μg/m3 in Sicily and 17.9 μg/m3 in Malta. PM2.5 levels were highest in the Maltese urban town of Hamrun (23.6 μg/m3), while lowest in the rural Sicilian town of Niscemi (10.9 μg/m3, p < 0.0001). Hamrun also exhibited the highest levels of nickel, vanadium, lead, zinc, antimony, and manganese, whilst the Sicilian city of Gela had the highest levels of cadmium, and the highest level of PM2.5 when compared to rural Sicily. Elevated levels of PM2.5 were positively associated with the prevalence of doctor diagnosed asthma (odds ratio (OR) 1.05), current asthma (OR 1.06), and use of asthma medication (OR 1.06). All elements in PM2.5 showed increased OR for doctor diagnosed asthma, while higher concentrations of Cd and Mn were associated with higher prevalence of rhinitis.
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Richards, Michael J. "Environmental Medical Association." Medical Journal of Australia 153, no. 8 (October 1990): 504. http://dx.doi.org/10.5694/j.1326-5377.1990.tb126183.x.

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Bausch, J., and B. B. Mandell. "WORLD MEDICAL ASSOCIATION." Lancet 334, no. 8663 (September 1989): 621–22. http://dx.doi.org/10.1016/s0140-6736(89)90743-5.

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Field, I. T. "World Medical Association." BMJ 308, no. 6945 (June 25, 1994): 1717. http://dx.doi.org/10.1136/bmj.308.6945.1717a.

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Roberton, J. S. "Medical Tennis Association." British Journal of Sports Medicine 19, no. 3 (September 1, 1985): 175. http://dx.doi.org/10.1136/bjsm.19.3.175.

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Giri, G. "World Medical Association." BMJ 308, no. 6933 (April 2, 1994): 921. http://dx.doi.org/10.1136/bmj.308.6933.921b.

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&NA;. "Southern Medical Association." Southern Medical Journal 91, no. 7 (July 1998): 605. http://dx.doi.org/10.1097/00007611-199807000-00001.

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Kaufman, Michele B. "American Medical Association." American Journal of Health-System Pharmacy 55, no. 1 (January 1, 1998): 95. http://dx.doi.org/10.1093/ajhp/55.1.95.

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Cassidy, J. "Islamic Medical Association." BMJ 343, sep07 1 (September 7, 2011): d5592. http://dx.doi.org/10.1136/bmj.d5592.

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Plested, William G. "American Medical Association." Disaster Medicine and Public Health Preparedness 1, no. 1 (July 2007): 7. http://dx.doi.org/10.1097/dmp.0b013e318067732d.

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32

Heeren, Alice. "Affective Rhetorics of Contagion." Latin American and Latinx Visual Culture 2, no. 2 (2020): 47–73. http://dx.doi.org/10.1525/lavc.2020.220005.

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This article focuses on the photographs of Augusto Malta, the official photographer of the city of Rio de Janeiro, made between 1904 and 1929. It departs from the work of Brian Massumi, Sara Ahmed, and Anna Gibbs on affect theory to argue that Malta's images were responsible for supporting a rhetoric of contagion used to justify the violent biopolitical policies of the Brazilian republican government. Furthermore, I assert that this rhetoric depended on the mobilization by Malta of affects widely circulated in the popular media of the period. This study aims to bring affect theory into dialog with the vast body of existing historical, visual, and sociological literature on the so-called Brazilian Belle Époque. This period in the history of Brazil, and especially of Rio de Janeiro, has been amply studied by scholars from diverse disciplines. Nevertheless, engagement with theories of affectivity and the work of Malta, especially in English-speaking scholarship, remains limited. This article speaks to the implication of photography, architecture, and urban planning in medical and biopolitical discourses, contributing to the study of the mechanisms that produce and reproduce myths of progress and the emancipating power of reason in early twentieth-century Latin America. Este artículo se centra en las fotografías de Augusto Malta—el fotógrafo oficial de la ciudad de Río de Janeiro—realizadas entre 1904 y 1929. Toma distancia con respecto al trabajo sobre la teoría del afecto de Brian Massumi, Sara Ahmed y Anna Gibbs para argumentar que las imágenes de Malta brindaron un apoyo efectivo a una retórica de contagio utilizada para justificar las violentas medidas biopolíticas del gobierno republicano de Brasil. Además, afirmo que esta retórica dependía de la movilización por parte de Malta de los afectos ampliamente difundidos en los medios populares de la época. Este estudio tiene como objetivo poner la teoría del afecto en diálogo con el vasto corpus de literatura histórica, visual y sociológica existente sobre la llamada Belle Époque brasileña. Este período en la historia de Brasil, y especialmente de Río de Janeiro, ha sido ampliamente estudiado por académicos de diversas disciplinas. Sin embargo, especialmente en la academia de habla inglesa, hay pocos trabajos que estudien la obra de Malta a la luz de las teorías de la afectividad. Este artículo habla de la implicación de la fotografía, la arquitectura y la planificación urbana en los discursos médicos y biopolíticos, contribuyendo así al estudio de los mecanismos que producen y reproducen mitos del progreso y el poder emancipador de la razón en la América Latina de principios del siglo XX. Este artigo se foca nas fotografias de Augusto Malta, o fotógrafo oficial da cidade do Rio de Janeiro, realizadas entre 1904 e 1908. Partindo do trabalho de Sara Ahmed e Anna Gibbs sobre a teoria do afeto, argumenta-se que as imagens de Malta serviram para apoiar uma retórica do contágio usada para justificar políticas biopolíticas violentas do governo brasileiro republicano. Ademais, eu afirmo que esta retórica dependeu da mobilização por Malta de afetos largamente circulados na mídia popular daquele período. O objetivo desse estudo é colocar a teoria do afeto em diálogo com o vasto corpo de literatura histórica, visual e sociológica existente sobre a dita Belle Époque brasileira. Esse período da história do Brasil, e especialmente do Rio de Janeiro, tem sido amplamente estudado por acadêmicos de diversas disciplinas. No entanto, o envolvimento com as teorias da afetividade e o trabalho de Malta, especialmente na produção acadêmica em inglês, permanece limitado. Este artigo endereça a implicação da fotografia, da arquitetura e do planejamento urbano em discursos médicos e biopoliticos, contribuindo para o estudo de mecanismos que produzem e reproduzem mitos de progresso e do poder emancipatório da razão na América Latina do início do século XX.
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Tabone, Daniel, and Luke Vella. "Labour Migration into Malta and the Effect on the Maltese Economy." MCAST Journal of Applied Research & Practice 3, no. 1 (May 15, 2019): 42–68. http://dx.doi.org/10.5604/01.3001.0014.4373.

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Labour migration is a significant and yet still uncharted phenomenon in the context of the Maltese islands. This paper will examine the extent of the existence of the relationship between foreign workers and a set of macro-economic variables. Based on secondary data, time series data covering a 12-year period from 2006 to 2017 are used to establish and quantify the impact of inward labour migration onto the macroeconomic variables that make up the Maltese economy. These are tourism, minimum wage, gross domestic product, government expenditure, government revenue, the number of yearly crimes, total population, air pollution, unemployment rate, inflation, property prices, and inward foreign direct investment. The Pearson Correlation Coefficient is utilized to determine the association between the independent and the dependent variables and Simple Linear Regression to statistically estimate and quantify the correlation between the dependent and each independent variable. Results show that 11 out of the 12 macroeconomic variables have a statistically significant correlation with the increase of foreign workers as operationalized through the population of foreign workers. While the most statistically significant relationship was observed between foreign workers and the population, the least statistically significant relationship was observed between foreign workers and government revenue.
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Sacco, R., C. Micallef, G. Grech, C. Role, S. Mercieca, and A. Grech. "Psychiatric hospitals may enhance holistic care by introducing medical and surgical liaison teams." European Psychiatry 41, S1 (April 2017): S486. http://dx.doi.org/10.1016/j.eurpsy.2017.01.581.

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IntroductionPatients with mental health problems (MHP) are known to have more physical comorbidities compared to the general population.In Malta, Mount Carmel hospital (MCH) which is the main psychiatric hospital (consisting of both acute and chronic wards), is separate from Mater Dei hospital (MDH) which is the general hospital at which medical and surgical care is provided.Such a division in healthcare may result in inadequate focus on physical health amongst patients of high demand in this regard. This subsequently puts an increased strain on the general hospital through repeated referrals.ObjectivesThe purpose of this study is to show that inpatients with MHP have a significant number of comorbidities and require multiple referrals to a general hospital for medical and surgical attention.MethodsThree hundred and ninety-three inpatients at acute and chronic wards of MCH (during the first week of December 2016) were enrolled in the study.Treatment charts and iSOFT (healthcare IT software used in Malta) were used to determine patient's diagnosed comorbidities, number and type of referrals to MDH outpatient clinics (OPC), casualty and admissions at MDH over 1 year.ResultsResults of the audit indicate that a significant number of inpatients at MCH have medical comorbidities and the majority have been referred to MDH for OPC and casualty over the past year.ConclusionsHaving medical and surgical liaison teams in psychiatric hospitals may enhance patient care and reduce the pressure exerted on general hospitals.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Bonnici, W. "The "Very Long Hiccup" and the Emergence of the Army Medical Services in Malta." Journal of the Royal Army Medical Corps 143, no. 2 (June 1, 1997): 124–28. http://dx.doi.org/10.1136/jramc-143-02-14.

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36

Magro, R., J. A. Grech Meli, J. Debattista, N. Aquilina, K. Gatt, A. Borg, and C. Scerri. "AB0077 ASSOCIATION BETWEEN VITAMIN D RECEPTOR GENE POLYMORPHISMS AND SYSTEMIC LUPUS ERYTHEMATOSUS IN MALTESE PATIENTS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1068.2–1069. http://dx.doi.org/10.1136/annrheumdis-2021-eular.770.

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Background:Vitamin D deficiency is highly prevalent in patients with systemic lupus erythematosus (SLE). Vitamin D acts through the vitamin D receptor (VDR) that is present in most cells, and it can regulate the transcription of over 200 genes. The expression of vitamin D receptors by a variety of cells belonging to the innate and adaptive immune systems has created interest with regards to the role of vitamin D in the pathogenesis of SLE. Several polymorphisms of the VDR gene have been described, namely Bsml, Apal, Taql and Fokl. A number of VDR gene polymorphism genotypes have been associated with increased risk of SLE mostly in Asians and Africans.1Objectives:The aim of this study was to establish whether an association was present between VDR gene polymorphisms and SLE susceptibility in a cohort of SLE patients living in Malta. A further aim was to assess the relationship between these VDR gene polymorphisms and SLE disease characteristics.Methods:59 SLE patients living in Malta and attending Rheumatology clinic at Mater Dei Hospital were recruited for the study after providing informed consent. The patients were over the age of 18 years and fulfilled the SLICC classification criteria for SLE. The patients were interviewed and blood samples were taken. RNA extraction was performed from whole blood. QuantiGene Plex technology was used to measure the expression of 12 interferon (IFN) signature genes in the extracted RNA.93 cord blood samples obtained from individuals living in Malta were used as a control. DNA extraction was carried out from the blood samples obtained from the patients and controls. The VDR gene was screened and the regions containing the VDR polymorphisms were amplified for each patient. The amplified regions were then digested with their respective restriction enzymes in order to view the patient’s genotype via restriction fragment length polymorphism. Statistical analysis, including odds ratio (OR), was carried out to gauge the significance in the association of these polymorphisms with SLE.Results:94.9% of SLE patients were female and they had a mean age of 44.5 years. All the patients were of Caucasian ethnicity. 13.6% had vitamin D deficiency (serum 25-hydroxyvitamin D <20ng/ml) and 25.4% were vitamin D insufficient (serum 25-hydroxyvitamin D 20-29ng/ml). The results showed that when ApaI polymorphism was present as a homozygote for the variant allele there was a significant decrease in SLE prevalence (OR=0.39, CI 0.17-0.87, p=0.02). The results were also analysed by placing the polymorphs into haplotypes. The haplotype containing all wild-type alleles for the VDR gene and the haplotype containing all wild-type alleles with the variant allele for FokI had an increased prevalence of SLE (OR= 1.95, CI 1.12-3.38, p=0.01 and OR= 2.36, CI 1.13-4.91, p=0.02 respectively).The patients who were homozygous for the variant allele for BsmI had a significantly higher SLE disease activity index-2K (SLEDAI-2K) (mean 5.00) compared to those that were heterozygous (mean 2.66; p=0.010). No significant difference was noted in damage, IFN signature gene expression, organ manifestation and autoantibody profile between the different genotypes for the 4 VDR polymorphisms. SLE patients who were homozygous variant for the ApaI or TaqI polymorphisms had an increased prevalence of fibromyalgia (OR=7.50, CI 1.47-38.16, p=0.02 and OR=12.00, CI 1.80-80.05, p=0.02 respectively).Conclusion:The study showed that in the Maltese population the presence of the VDR gene polymorphism haplotype containing all wild-type alleles and the haplotype containing all wild-type alleles with the variant allele for FokI are associated with an increased risk of SLE. Moreover the homozygous variant genotype for BsmI was associated with a higher SLE disease activity. The homozygous variant genotype for ApaI and TaqI was associated with a higher risk of fibromyalgia in SLE patients.References:[1]Zhou TB, Jiang ZP, Lin ZJ, Su N. Association of vitamin D receptor gene polymorphism with the risk of systemic lupus erythematosus. J Recept Signal Transduct Res. 2015;35(1):8-14.Acknowledgements:The Faculty of Medicine and Surgery, University of Malta provided funding for this research.Disclosure of Interests:None declared
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37

Summerfield, Derek. "Medical ethics: the Israeli Medical Association." Lancet 350, no. 9070 (July 1997): 63–64. http://dx.doi.org/10.1016/s0140-6736(05)66265-4.

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38

Prosor, Ron. "Medical ethics: the Israeli Medical Association." Lancet 350, no. 9078 (August 1997): 669. http://dx.doi.org/10.1016/s0140-6736(05)63367-3.

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39

Malnick, Stephen DH. "Medical ethics: the Israeli Medical Association." Lancet 350, no. 9078 (August 1997): 669. http://dx.doi.org/10.1016/s0140-6736(05)63368-5.

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40

Mahler, Ch. "Medical ethics: the Israeli Medical Association." Lancet 350, no. 9078 (August 1997): 669. http://dx.doi.org/10.1016/s0140-6736(05)63369-7.

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41

Summerfield, Derek. "Medical ethics: the Israeli Medical Association." Lancet 350, no. 9078 (August 1997): 669–70. http://dx.doi.org/10.1016/s0140-6736(05)63370-3.

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42

Felice, Alexander, Joseph Borg, Wilma Cassar, Ruth Galdies, Monica Pizzuto, Maryrose Caruana, and Christian Scerri. "Hb F Malta I in Association with Hb F Sardinia (AyT) and Hb Valletta in Heterozygotes: Quantification of the Six Globins Suggests Developmental Control of the XMN-I Site and Interplay with the (AT)xTy Sequence in Connection with Globin Gene Switching." Blood 108, no. 11 (November 16, 2006): 3830. http://dx.doi.org/10.1182/blood.v108.11.3830.3830.

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Abstract Although the precise biochemical mechanisms of globin gene switching remain elusive, considerable insight is gained by in vivo expression profiling through quantification of the hemoglobin / globin phenotype of informative heterozygosities and homozygosities / compound heterozygosities in the context of specific regulatory DNA sequence diversity such as the XMN-I or the [(AT)xTy] sequence polymorphisms. The quantification of normal and abnormal globins of Hb F Malta-I (or a2b2, 117(G19)His>Arg) heterozygotes which are in tight linkage disequilibrium with Hb Valletta (or a2b2 287(f3)Thr>Pro) i.e. Gyo, GyFMalta-I, AyI, bV and bA together with extensive haplotyping of homozygotes and heterozygotes including the XMN-I dimorphism in the Gy promoter and the (AT)xTy polymorphism (BP1 binding site) 5′ to the b globin genes had suggested that the XMN-I dimorphism was largely inactive in the normal newborn. In contrast the Hb F levels and the proportion of Gy globin in anemic adult beta-thalassemia homozygotes and compound heterozygotes differed significantly, depending on the XMN-I genotype (TT, TC or CC) Here, we document the occurrence of seven newborn who were heterozygous at three globin loci permitting quantification by reverse phase liquid chromatography of the six globin products; Gyo, GyFMalta-I, AyI, AyT, bV and bA in the context of genotypic variation at the XMN-I and (AT)xTy sequences. The data were compared with those of newborn HbF-Malta-I-Hb-Valletta heterozygotes and anemic adult beta thalassemia homozygotes / compound heterozygotes. The globin quantification together with haplotype data were analysed using the general linear model (two-way ANOVA) by SPSS version 12. The data excluded significant effect of the XMN-I dimorphism alone on relative y/b globin gene expression in the newborn. On the other hand, the (AT)xTy polymorphism with BP1 binding sites of 21 [(AT)7T7], 23 [(AT)9T5], or 25 [(AT)11T3], nucleotides in trans over-ride XMN-I. In contrast, it is the XMN-I dimorphism that over-rides the (AT)xTy diversity in the anemic adult beta thalassemia homozygotes or compound heterozygotes. The GyFMalta-I/Gyo ratio of the newborn heterozygotes with Hb F Malta-I and the AyT/AyI ratio of the newborn heterozygotes with HbF-Malta-I and HbF-Sardinia suggested that the developmental regulation of the XMN-I site may be subject to cis/trans interplay with the (AT)xTy sequences.
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43

Mercieca, Felicienne, Renzo Kerr Cumbo, and Dylan Seychell. "An Overview of Injuries in Senior Women’s Football in Malta." MCAST Journal of Applied Research & Practice 4, no. 2 (December 14, 2020): 180–201. http://dx.doi.org/10.5604/01.3001.0014.5696.

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The incidence of football injuries may be double the amount of injuries happening in sports such as basketball, and is estimated to range from 10 to 35 injuries per 1000 game hours. This high risk of injuries in football is evident in professional, amateur and recreational levels. Despite the significant increase in female participation as well as the well-known injury risks, research on women football players is very limited as most studies are still focusing on injuries experienced by the male gender . Considering the gap existing in the field of applied research, this study has explored the rate of injuries in senior Women football players in Malta. It has also looked at the underlying causes of these injuries during the 2018/2019 season. Ethical clearance was obtained from the Ethics Board within the Malta College of Arts Science and Technology, and permission was granted by the Malta Football Association. The sample was made up of 100 participants from 111 players over 16 years of age, within the 120 entire population of senior women football players in Malta. Data was collected through a self-designed online questionnaire which was first validated by three field professionals and then distributed to the participants. Statistical tests (inferential statistics) were used to identify relationships between variables. The Pearson correlation test was utilised to measure the existence and strength of a linear relationship between two variables. The study found that during the 2018/2019 season, in the BOV Women’s League in football, 63% of the players reported to have suffered at least one injury. With 88.89% of the strikers being injured, this position was seemingly, the one putting players at the highest risk for injury. While it was clear that the majority of injuries occurred during games (53.5%), the knee (35.3%) and ankle (34.1%) were the body part mostly injured, and ligament sprains (60.4%) were the highest type of injuries. The results of this study, contradict existing literature, and found that a negative coefficient with a weak correlation was obtained for both age (r = -0.098) and mass (r = -0.043) when correlated to the number of injuries.
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Jackson, Mike. "British Medical Association Complete Home Medical Guide – Third editionBritish Medical Association Complete Home Medical Guide – Third edition." Nursing Standard 25, no. 21 (January 26, 2011): 30. http://dx.doi.org/10.7748/ns2011.01.25.21.30.b1158.

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45

Cuschieri, Sarah, and Massimo Libra. "Adherence to the Mediterranean Diet in Maltese Adults." International Journal of Environmental Research and Public Health 18, no. 1 (December 22, 2020): 10. http://dx.doi.org/10.3390/ijerph18010010.

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Background: Populations living in Mediterranean islands are experiencing a nutrition transition process from traditional to Westernized dietary patterns. No information on this matter regarding individuals living in Malta have been published to date. The aim of this study was to assess the level of adherence of the Maltese people to the Mediterranean diet and which factors were associated with it. Methods: A nationwide cross-sectional study was conducted in the island of Malta between 2014 and 2016. A literature-based Mediterranean diet adherence score was used to assess the level of adherence to the dietary pattern. Results: Out of 3947 adults, the overall Mediterranean diet adherence score mean was 7.19 (SD 1.91): being female, non-smoker, and having older age was associated with higher adherence to the Mediterranean diet. Less clear pattern of association was found for educational and occupational status, for which medium educational level and a high occupational level were associated with lower adherence to Mediterranean diet. Higher adherence was finally associated with consumption of healthier food groups (more rice and dark bread and less pasta and white bread; more all plant-food groups and fish, less animal-food sources, including fast foods; more light cheeses and yogurt were more frequently consumed among higher adherent individuals in spite of regular ones). Conclusions: Adherence to the Mediterranean diet in Malta is lower than in those of populations living in companion Mediterranean islands. Given the lack of data on this topic, further studies should be conducted among the Maltese people and public health nutrition interventions should be planned to improve current eating habits toward more traditional dietary patterns.
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Joseph, Peter C. J. "The World Medical Association." Medical Journal of Australia 155, no. 11-12 (December 1991): 819. http://dx.doi.org/10.5694/j.1326-5377.1991.tb94046.x.

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47

Pietroni, P. C. "British Holistic Medical Association." Holistic Medicine 5, no. 1 (January 1990): 1. http://dx.doi.org/10.3109/13561829009037835.

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&NA;. "American Occupational Medical Association." Journal of Occupational and Environmental Medicine 27, no. 8 (August 1985): 594–97. http://dx.doi.org/10.1097/00043764-198508000-00025.

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&NA;. "American Occupational Medical Association." Journal of Occupational and Environmental Medicine 27, no. 8 (August 1985): 598–99. http://dx.doi.org/10.1097/00043764-198508000-00026.

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Mitchell, Edith Peterson. "The National Medical Association." Journal of the National Medical Association 108, no. 1 (February 2016): 1–3. http://dx.doi.org/10.1016/j.jnma.2016.01.001.

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