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Educator leaders play a vital role in fostering educators' and students' mental health and wellbeing. Through qualitative research, this paper provides insights from eight education leaders working in State Schools in Malta on their perceptions of, and experiences in, the promotion and support of mental health and wellbeing among educators and students. The objective of the study is to examine how mental health and wellbeing are being promoted, addressed, and supported in schools. Eight semi-structured interviews were conducted with education leaders followed by a reflexive thematic analysis. Four themes emerged from the data, namely school philosophy, ethos, and leadership; mental health and wellbeing in schools; loss and grief; and COVID-19 and its impact on mental health and wellbeing in schools The findings suggest the need for more proactive and supportive considerations of mental health and wellbeing in schools in Malta, along with the implementation and evaluation of mental health and wellbeing whole-school projects in schools.

Climate change is a major environmental challenge society is facing. While young children will experience the impacts of climate change for longer, research into their perceptions of climate change is scant. To address this gap, this qualitative case study presents the perceptions of climate change of 10 young Maltese children (4-7 years). Data were collected through semi-structured conversational interviews and photograph interpretation. Results revealed that children held some understanding of the scientific concept of climate change. Nevertheless, misconceptions about climate change were more common. The findings also revealed a lack of application of any such knowledge to new situations. Finally, this study offers research and pedagogical implications, noting the need for educators, researchers and policymakers to consider the educational frameworks that help successfully shape climate change learning in early childhood.

Nurture Groups (NGs) and Learning Support Zones (LSZs) started to operate as a pilot project in state schools in Malta in 2008. There are more than 60 NGs and LSZs in primary, middle and secondary schools in Malta, out of a total of 89 state schools, with more than a hundred educators supporting children and young people through the nurture approach. This small-scale study aimed to present and discuss the experiences of eight educators (teachers) and learning support zone educators (LSEs) working in NGs and LSZs in schools in Malta. Using semi-structure interviews, the study also described personal characteristics that the participants feel they need to have in their role as NG or LSZ educators, their experiences and the challenges they face. Findings from this study suggest that the role of a NG or LSZ educator is a role that brings about positive change. Also, participants suggested that a NG or LSZ educator needs to have several positive personal attributes. Findings in the current study suggest that there is the perception of a lack of understanding on the nurture approach from mainstream educators.

Policymakers' understanding of the holistic nature and implications of sustainable development (SD) determines a nation's commitment to sustainability. The study involved in-depth interviews with 20 policymakers. The study identified underlying interconnections between policymakers' perceptions, commitment and awareness of SD and whether they developed the necessary values and attitudes required to promote sustainability at both local and national levels. These findings provided reflections for the development of Education for Sustainable Development programmes targeting policy makers to expedite implementation of SD in Malta.

This study focuses on the experiences of young people who are leaders of change in the environmental field. This study views environmental activism as a personal commitment towards pro-environmental behaviour. The motivations and challenges of such work are viewed as important to learn more not only about volunteering in environmental organisations, but also about pro-environmental behaviour. The main research problem was to explore these individuals' present and past life experiences, in the light of their activism, towards the issue of climate change. Narrative inquiry was chosen as a methodology for this research as it gives importance to experience and facilitates the study of an issue in all of its wholeness and complexity. The research involved in-depth interviews with three participants as well as living alongside the participants in an effort to build a relationship with them and to experience being an environmental activist. The participants were members of a local environmental organisation ñ Friends of the Earth (Malta). The outcomes of this study provide an opportunity for reflection on the factors that affect pro-environmental attitudes and behaviour and their implications on environmental education. This reflection will enable informed efforts to engage more young people in environmental activism. From the narratives produced, it is clear that there is no single factor that is optimal for promoting pro-environmental behaviour and environmental activism. These are, in fact, determined by a combination of interrelated factors.

A small state faces several challenges with regard to adult continuing education and training. The paper discusses some of these challenges with specific reference to the Mediterranean small island state of Malta. It starts with a general discussion of some of the issues affecting adult education in a small state such as Malta that paves the way for the more focused analyses in the second and third sections. These sections focus on a selection of just two topics from among the many that affect adult education in Malta, namely those of adult education and work and adult education for sustainable development. These analyses are tackled from the perspective of the small state condition. (Contains 11 notes.)

This article draws on the Sustainability Education in European Primary Schools (SEEPS) Project, which was an EU-funded project examining approaches to sustainability education. As part of that project the team developed a case study approach to the individual country contributions to the overall project, which concluded by developing a model based on whole institution approaches to school improvement towards sustainability. These case studies form the basis of this article. In the article we draw on case study materials from a range of European countries to examine how learners perceive their participation in school improvements towards sustainability to be conceived and received by school administrators and teachers. The article tries to develop a meta-analytical rather than descriptive account of the case studies in order to identify commonalities across the cases relating to the learner's participation in decisions about learning. (Contains 1 note and 1 figure.)

Narcolepsy is a lifelong disorder that is usually diagnosed in early adulthood, however most often symptoms begin in the childhood years. It is characterized by excessive day time sleepiness (EDS) and features of rapid eye movement (REM) sleep. It is under diagnosed in both children and adults due to the clinical heterogeneity. We report a case of a child presenting with excessive day time sleepiness, who was diagnosed with narcolepsy, which although is a rare disease, is very treatable, and early intervention will reduce its psychosocial impact. [ABSTRACT FROM AUTHOR]

This paper discusses the impact of the COVID-19 pandemic on the learning experience of students at a VET (Vocational Educational Training) Higher Education Institution in tourism education, namely the Institute of Tourism Studies (ITS) in Malta (EU). A sample of students who attended ITS between March 2020 and January 2022 generated the primary data. This revealed the students' experience in terms of their academic performance (both theoretical knowledge and practical skills), their personal well-being, and their perceived evaluation of the educational institution during the emergency caused by COVID-19. There is particular emphasis on elearning / remote learning and the challenges of conducting school-related practical work, going on work placement or work in the tourism industry (both part-time and full-time) apart from their studies. The data analysis revealed that the student experience at ITS was, in many aspects, similar to international trends. This was seen in terms of the impact of the pandemic's restrictions on face-to-face learning and the sudden shift to pure elearning in all courses. Students confirmed that since ITS had, in previous years, invested in the e-learning infrastructure, e-learning systems in place proved extremely effective when they were needed most. However, not all subjects were considered suitable for delivering online. In fact, students stated that most practical subjects and certain theoretical subjects are better delivered face-to-face. The way forward recommended by students is a blended system where the courses have both a face-to-face component and an online component. The latter not only provides more flexibility in learning, which is especially sought by mature and parttime students, but also reduces time wasted in travel to and from campus. Although research on the impact of the COVID-19 pandemic on education is widely available, little research focused on VET and Higher Education in Tourism, especially through the experience of learners. For this reason, this paper seeks to address this gap in knowledge. The major limitation of this research is that it was conducted in a volatile situation with ever-changing COVID-19 conditions, restrictions and challenges that had a direct impact on education. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the skin that is brought about by autoinflammation and hyperkeratosis at the pilosebaceous unit. The clinical severity of HS can be measured using static (Hurley Severity Scoring (HSS)) and/or dynamic (International HS Severity Scoring System (IHS4)) severity scoring instruments. However, few clinically available serological parameters have been found to correlate with disease severity. In this study, we sought to investigate the role of serum immunoglobulin (Ig) G, M and A levels as biomarkers of disease severity and to compare them with other, more conventional inflammatory indices, such as the erythrocyte sedimentation rate, C-reactive protein, the neutrophil–lymphocyte ratio, the platelet–lymphocyte ratio and the systemic immune-inflammation index. In this cross-sectional study, patients were recruited from the only dermatology referral centre in Malta, Europe, and subjected to clinical examination and the assessment of inflammatory and immunologic parameters. Serum IgG, M and A levels were assessed using the Atellica® NEPH 630 System (SIEMENS-Healthineers AF, Erlangen, Germany) nephelometric analyser. Serum IgG, M and A levels correlate with both dynamic and static HS severity scoring systems. Serum IgG behaves as a marker of severe HS disease as categorised by HSS and the IHS4. Our findings suggest that the serum IgG level can be used in the clinical setting as a biomarker of disease severity and, therefore, as an adjunct to clinical severity scoring. [ABSTRACT FROM AUTHOR]

A current and pertinent topic is that of gender studies within healthcare students and academic staff of healthcare courses. This commentary explores the feminization of healthcare studies and the extent to which women in Malta hold key roles in academia within the faculties of Health Sciences, Dental Surgery, and Medicine and Surgery at the University of Malta. Data were publicly available from the university website. Gender (male: female ratio) trends were elicited from the data representing each level of qualification as offered by each faculty, while top academic roles within each faculty were noted. As a general trend, the number of students studying healthcare courses has increased, with an increased female-to-male ratio. Yet, in academia, men still occupy top roles. Efforts should be made to cater for all races, ethnicities, genders, sexual orientations, and socioeconomic levels within the healthcare workforce to allow delivery of the best possible service. [ABSTRACT FROM AUTHOR]

The post‐2015 agenda calls for a 'data revolution in development' and recognises that statistical capacity amongst the workforce is a prerequisite for achieving it. Universities have a critical role to play in building this capacity. This paper reports insights from in‐depth interviews with development professionals in Malta, Spain, Turkey and the United Kingdom about current and future data skills needs. It presents recommendations on data skills training for aspiring development professionals informed by this evidence, with a particular focus on curriculum in social science related undergraduate programmes at universities. [ABSTRACT FROM AUTHOR]

Musculoskeletal injuries presenting to the emergency department are very common and a significant burden of work. This study aims to assess the impact of their management by musculoskeletal physiotherapists. METHOD A comparative analysis was selected with three outcomes: (1) patients' total length of stay in the emergency department, (2) patients' return rate with the same complaint, and (3) the referral rate to physiotherapy out-patients. Retrospective data over six months was collected from an electronic record of patients who presented with minor musculoskeletal injuries to the Emergency Department in Mater Dei Hospital, Malta. RESULTS Over a period of 6 months, 6,087 patients with minor musculoskeletal complaints presented to the emergency department. Of these, 11% were managed by a physiotherapist who worked a limited total of 30 hours per week. The length of stay in the emergency department for patients managed by physiotherapists had a mean of 202 minutes and a mode of 99 minutes, whilst those managed by doctors had a mean of 380 minutes and mode of 109 minutes. Of the patients who returned to the emergency department with the same complaint, 74% were managed by doctors only and 26% were managed together with the physiotherapist. Physiotherapists referred 26% of their patients for follow-up physiotherapy appointments whilst doctors referred only 11% of the patients. The latter two findings were statistically significant. CONCLUSION Timely physiotherapy intervention in the Emergency Department for minor musculoskeletal cases contributes to a shorter length of stay, lower return rate, and more specific referrals to physiotherapy out-patient [ABSTRACT FROM AUTHOR]

A 70-year-old lady presented three weeks after a mild SARSCoV- 2 infection with a nine-day history of worsening back pain, progressive lower limb weakness and paraesthesia, dysphagia, constipation and difficulty in completing full sentences. Outcome of her investigations were in keeping with a diagnosis of acute inflammatory demyelinating polyneuropathy. The patient made a rapid and full recovery after treatment with intravenous immunoglobulins (IVIG). [ABSTRACT FROM AUTHOR]

• Little is known of epilepsy care in small economically developed countries (pop:500 k) • This study is on clinical & risk features of adults with epilepsy (68) in Gozo, Malta. • 92% were compliant with their anti-seizure medication (ASM) with most on just one ASM. • 19% were on antipsychotics, 18% had an epilepsy care plan & none had SUDEP advice. • Stigma & shame play a significant role in small communities & access to care. People with epilepsy are at increased risk of multiple co-morbidities that may influence risk of adverse outcomes including impact on quality of life and premature mortality. These risk factors include potentially modifiable clinical characteristics associated with sudden unexpected death in epilepsy (SUDEP). For services to tackle risk, the clinical complexity of the target epilepsy population needs to be defined. While this has been comprehensively studied in large, economically developed countries little knowledge of these issues exist in small economically developed countries, like Malta (population: 500,000). This was a single centre study focused exclusively on patients attending Gozo General Hospital (GGH) Malta. STROBE guidance for reporting cross sectional studies was used to design and report the study. This was a retrospective review of standard care and SUDEP and seizure risks provided to all adults (over 18 years) with epilepsy attending GGH (2018–2021). The review identified 68 people and 92% were compliant with their anti-seizure medication. A fifth (21%) had an intellectual disability. Despite only one patient having a psychotic illness, 19% were on antipsychotic medication. Only 18% of patients had a specific epilepsy care plan, 6% nocturnal surveillance and none had received advice on SUDEP. Patient outcomes may be improved with increasing rates of personalized epilepsy care plans, appropriate nocturnal surveillance and reducing the prescription of antipsychotic medication as it is associated with greater risk of mortality. Issues such as stigma and shame appear to play a significant role in small communities and their access to care. [ABSTRACT FROM AUTHOR]

Objective: Amyotrophic lateral sclerosis (ALS) is a mostly sporadic neurodegenerative disease. The role of environmental factors has been extensively investigated but associations remain controversial. Considering that a substantial proportion of adult life is spent at work, identifying occupations and work-related exposures is considered an effective way to detect factors that increase ALS risk. This process may be further facilitated in population isolates due to environmental and genetic homogeneity. Our study investigated occupations and occupational exposures potentially associated with ALS risk in the isolated island population of Malta, using a case-control study design. Methods: Patients with ALS and randomly identified matched controls (1:1) were recruited throughout a four-year window, from 2017 through 2020. Data on educational level, residence, main occupation, smoking, and alcohol history were collected. Results: We found that compared to controls (44.4%), a higher percentage (73.7%) of ALS patients reported a blue-collar job as their main occupation (OR 2.04, 95% CI 1.2–3.72; p = 0.0072). Through regression analysis, craft and related trades occupations such as carpentry and construction (ISCO-08 major group 7), were found to be positively associated with ALS, with patients in this occupational category found to be more prone to develop bulbar-onset ALS (p = 0.0297). Overall, patients with ALS reported a significantly higher exposure to work-related strenuous physical activity (OR 2.35, 95% CI 1.53–3.59; p = 0.0002). Conclusion: Our findings suggest that manual workers particularly those working in the carpentry and construction industries have an increased ALS risk, possibly due to a history of intense or sustained physical activity. [ABSTRACT FROM AUTHOR]

Invasive meningococcal disease (IMD) is a vaccine-preventable devastating infection that mainly affects infants, children and adolescents. We describe the population epidemiology of IMD in Malta in order to assess the potential utility of a meningococcal vaccination programme. All cases of microbiologically confirmed IMD in the Maltese population from 2000 to 2017 were analysed to quantify the overall and capsular-specific disease burden. Mean overall crude and age-specific meningococcal incidence rates were calculated to identify the target age groups that would benefit from vaccination. Over the 18-year study period, 111 out of the 245 eligible notified cases were confirmed microbiologically of which 70.3% had septicaemia, 21.6% had meningitis, and 6.3% had both. The mean overall crude incidence rate was 1.49/100,000 population with an overall case fatality rate of 12.6%. Meningococcal capsular groups (Men) B followed by C were the most prevalent with W and Y appearing over the last 6 years. Infants had the highest meningococcal incidence rate of 18.9/100,000 followed by 6.1/100,000 in 1–5 year olds and 3.6/100,000 in 11–15 year old adolescents. The introduction of MenACWY and MenB vaccines on the national immunization schedule in Malta would be expected to reduce the disease burden of meningococcal disease in children and adolescents in Malta. [ABSTRACT FROM AUTHOR]

European Directive 2013/59/EURATOM requires the establishment and use of diagnostic reference levels (DRLs) for diagnostic and interventional procedures. The purpose of this study was to establish local DRLs for a major tertiary public hospital. As the hospital is the only such hospital in Malta, the same data collected for setting local DRLs can also be used for setting national DRLs, making local DRLs de facto national DRLs. A retrospective survey of cumulative kerma-area product (KAP) and fluoroscopy time data from the cardiac catheterisation laboratory and interventional radiology suites was carried out. The effect of system upgrades on cumulative KAP was also assessed. Local DRLs were set for common cardiology and interventional radiology procedures. All DRLs compare favourably with those in European literature. A Philips Allura Clarity upgrade to the cardiac catheterisation laboratories led to significant reductions in cumulative KAP (p ≪  0.05) for most procedures. [ABSTRACT FROM AUTHOR]

BACKGROUND A major determinant of healthy growth and development is good nutrition during infancy and early childhood. The high level of marketing and wide-spread availability of commercially available complementary foods (baby foods) have led to various concerns about the nutritional content and potentially problematic marketing strategies used to promote these products, since this may adversely affect the parents' practices and the health status of young children. The aim of this pilot study was to assess the nutritional characteristics of commercially available foods for infants and young children under the age of 36 months in Malta, and to identify if these foods met the nutritional standards outlined in the WHO draft nutrient profile model (NPM) for this age group. METHODS A pilot study was carried out in two supermarkets and one large pharmacy that consented the photographing of over 243 food labels of foods marketed for infants and young children under 36 months in Malta. The nutritional quality of these foods was analysed using a validated World Health Organization NPM. RESULTS AND CONCLUSION Only 88 (36%) out of the 243 food products tested according to a draft of the WHO NPM met the appropriate nutritional standards criteria used by this model. Tested products were found to contain high amounts of sugar and salt. The findings suggest that the quality of most of the food and beverages marketed for infants and young children currently available on the local market are not suitable for infants and young children in this age group. [ABSTRACT FROM AUTHOR]

Bayesian chronological modelling of radiocarbon dates from the Brochtorff Circle at Xagħra, Gozo, Malta (achieved through the ToTL and FRAGSUS projects), provides a more precise chronology for the sequence of development and use of a cave complex. Artefacts show that the site was in use from the Żebbuġ period of the late 5th/early 4th millennium cal BC to the Tarxien Cemetery phase of the later 3rd/early 2nd millennia cal BC. Absolutely dated funerary activity, however, starts with a small rock-cut tomb, probably in use in the mid to late fourth millennium cal BC, in the Ġgantija period. After an interval of centuries, burial resumed on a larger scale, probably in the thirtieth century cal BC, associated with Tarxien cultural material, with the use of the cave for collective burial and other depositions, with a series of structures, most notably altar-like settings built from massive stone slabs, which served to monumentalise the space. This process continued at intervals until the deposition of the last burials, probably in the twenty-fourth century cal BC; ceremonial activity may have ended at this time or a little later, to be followed by occupation in the Tarxien Cemetery period. The implications for the development of Neolithic society on Malta are discussed, as well as the changing character of Neolithic Malta in comparison to contemporary communities in Sicily, peninsular Italy and southern Iberia. It is argued that underground settings and temples on Malta may have served to reinforce locally important values of cooperation and consensus, against a wider tide of differentiation and accumulation, but that there could also have been increasing control of the treatment of the dead through time. The end of the Maltese Neolithic is also briefly discussed. [ABSTRACT FROM AUTHOR]

We have previously reported on the ubiquitous presence of perchlorate in the deposited and airborne fine dusts of Malta and shown that the source of the chemical in the dusts of this small central Mediterranean island is fireworks. There are no local geologic or anthropogenic sources of perchlorate other than firework manufacture and display. The hypothesis was tested that ground-deposited perchlorate will be mobilized in runoff and would partly migrate to the water table and eventually also affect tap water, one third of which being derived from groundwater. Forty four percent of 36 groundwater samples contained perchlorate above detection limit with mean and median values of 1.09 and 1.1 μg L−1. Sixty-two percent of 16 runoff samples collected during storms contained perchlorate above detection limit with mean and maximum concentrations, respectively, of 50.8 and 129 μg L−1, values which are far too high to be explained by atmospheric inputs given that rainwater perchlorate levels are typically <3 μg L−1. Between 42 and 89% of the tap waters analyzed in three sampling campaigns contained perchlorate above detection limit and had mean concentrations ranging from 0.4 to 1.6 μg L−1 suggesting contamination levels similar to those reported from China but lower than levels reported from the USA. The phenomenon of contamination of the water resources of Malta by perchlorate is probably unique in that it results not from geologic or industrial inputs but from an intense and prolonged pyrotechnic activity that is deeply rooted in the popular culture of the islanders. • Perchlorate was detected in forty-four percent of the groundwater samples with a mean value of 1.09 μg L−1. • Sixty-two percent of 16 runoff samples contained perchlorate above detection limit with mean concentrations of 50.8. • Between 42 to 89% of the tap waters from three sampling campaigns contained perchlorate above detection limit. • The quality of Malta's limited water resources seems to be affected by contamination from firework production and displays. [ABSTRACT FROM AUTHOR]

Highlights • We explore the feasibility of repurposing abandoned agricultural land in Malta. • Potential for conversion to community allotment gardens is assessed. • Results show available suitable land and interest from potential users/managers. • Institutional barriers identified include the lack of an enabling policy framework. • Collaborative management options may be best suited for such a scheme. Abstract Agricultural land abandonment is a key driver of land use change in Europe. At the same time, urban land cover is expanding rapidly, often resulting in increasingly limited public access to green spaces. Within this context, this exploratory study sought to explore the feasibility of siting community allotment gardens on abandoned agricultural land within the small island state of Malta. Such an initiative could serve a dual purpose, i.e., limiting degradation of abandoned land on the one hand, and providing increased opportunities for community interaction with nature, on the other. Feasibility was explored in three steps, focusing on place, people, and policy , respectively. First, land within the peri-urban regions of three municipalities was identified and evaluated for suitability on the basis of specific criteria adapted for the local context. Second, interviews were employed to explore the views of members of the public and of other relevant stakeholders, and to identify potential coalitions of support. Finally, existing legal and policy frameworks for land-use planning were evaluated to determine the extent to which they are able to accommodate such land repurposing. Results showed that suitable land is available within all three municipalities considered. Furthermore, there is clear public support for the establishment of such allotments, as well as moderate interest by respondents in participating actively through rental of plots. However, institutional barriers in the policy sphere would need to be addressed. Key recommendations include the creation of a dedicated allotments policy, empowerment of local government authorities, and establishment of collaborative partnerships between governmental and non-governmental actors. Successful implementation of such a project would also require better streamlining of land ownership data and an ability to ensure security of tenure. [ABSTRACT FROM AUTHOR]

The re-election of the Labour Party with an increased majority in the 2017 Maltese national election bucks the trends of incumbent punishment experienced in most South European countries during the ‘Great Recession’ and of the decline of social democratic parties in Europe in the past 50 years. This Maltese ‘exceptionalism’ is explained by the Labour Party’s centrist shift, the country’s pure two-party system, and the economic prosperity which encouraged voters to opt for continuity. These factors allowed the governing party to win, despite corruption allegations deriving from the Panama Papers. Although a third party entered parliament for the first time since 1966, the fundamentals of the party and electoral systems have not changed and this development may not be long-lived. [ABSTRACT FROM PUBLISHER]

Copyright of Journal of Language & Law / Revista de Llengua i Dret is the property of Revista de Llengua i Dret and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Education is the first milestone in the care pathway of all diabetic patients. The aim of this study was to assess the educational knowledge and awareness among a diabetic patient cohort and compare this knowledge to a previously conducted study. Acquiring information on diabetes knowledge is essential for both clinicians and policy makers. Interviews using validated questionnaires covering various aspects of diabetes knowledge were conducted among a diabetic cohort between August and September of 2014 at the state hospital in Malta. The majority exhibited correct knowledge on diabetes and related complications. Knowledge levels appeared to have improved and were influenced by gender, type of diabetes and length of diabetes awareness. We conclude that educational approaches should be targeted towards every diabetic individual and should start immediately after diagnosis. This would lead to improved self-care, with a reduction in diabetic complications and a decrease in health-care expenditure. [ABSTRACT FROM AUTHOR]

This article explores recent changes in long-term care (LTC) for older persons in Malta, resulting from restructuring or other contextual factors related to the international financial crisis. The ageing population continues to grow, while traditional ways of providing care for the ageing population are progressively dwindling. Waiting lists for residential care have grown longer, although publicprivate partnerships have served to shorten these lists to some degree. Community care services are not keeping pace with need, and the frail elderly wishing to remain in their own homes often cannot do so without significant assistance from other sources. Service recipients fall into four groups: those affording private residential care; those granted a government-subsidized residential bed; those cared for at home by relatives; and those similarly cared for by nonfamily live-in caregivers with (or without) input from family members. Existent data are reviewed and analyzed along with a focus group of 30 stakeholders to explore this topic further. Future recommendations are made and consequences are explored as caregiving options move away from the responsibility of the traditional family system toward greater pressure on stateprovided care, use of expensive private care, and waiting lists to secure services. [ABSTRACT FROM AUTHOR]

The 2014 European election in Malta did not put the party system under stress, and in many ways resembled past elections. The two parties that have dominated Maltese politics since independence shared the seats equally between them. Once again, the ‘third’, green party failed to obtain parliamentary representation, as did the far-right party despite doubling its votes. The good fit with the second-order election model marked Malta as Southern Europe's misfit. While the comparatively weak impact of the economic crisis was a contributory factor, a combination of institutional, cultural-historical and contextual factors provide a more accurate explanation. Political institutions are particularly relevant because they reinforce the perfect two-party system – the key to Malta's political stability – and shield it from the challenge of outsiders. [ABSTRACT FROM PUBLISHER]

Copyright of Hellenic Studies / Etudes Helleniques is the property of Centre for Hellenic Studies & Research Canada-KEEK and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Family doctors are in a unique position to advocate health promotion and disease prevention, though it is known that this is not always given its due importance due to various reasons. Aim: To assess the knowledge, attitudes and practices of Maltese family doctors in health promotion and disease prevention. The results of the study were compared with a similar study in 2000. Methodology: A validated questionnaire was sent in 2011 to all Maltese general practitioners (GPs) and GP trainees. The results were analysed statistically. A focus group was conducted to discuss the results and develop a set of recommendations. Results: An improvement was seen in health promotion practice since 2000. Family doctors look after their own health better. However, they have difficulties regarding which prevention guidelines they should follow. Time constraints remain the biggest obstacle to promoting health. GPs who are involved in postgraduate teaching activities find it easier to promote health (p<0.05), while doctors working in both private and public settings find it most difficult (p<0.05). GPs who smoke find it harder to advise on smoking cessation (p<0.05), while doctors who are obese find it more difficult to recommend exercise (p<0.05). Conclusions and recommendations: Health promotion practice by family doctors is on the increase, yet there is clearly room for enhancement of their service. Web-based training, lectures and seminars would help family doctors to enhance their knowledge. Flyers, posters and video-clips in waiting areas could increase patient awareness on healthy lifestyles. [ABSTRACT FROM AUTHOR]

Notwithstanding the high rates of pertussis infant vaccination coverage in developed countries, Bortedella pertussis infections are manifesting a changing epidemiological pattern of disease. Of notable concern is the rise of pertussis in adolescents and adults. This changing picture is largely attributable to waning immunity after natural infection or vaccination. The belief that pertussis is chiefly a childhood disease is a common misconception. A significant rise of pertussis cases in Malta in older age groups was recorded in 2011. The addition of an adolescent and/or an adult booster dose against pertussis should be strongly considered. [ABSTRACT FROM AUTHOR]

The divorce referendum held in Malta on 28 May 2011 was another watershed in Maltese politics, particularly because it confirmed the secularising trends in Maltese society and exposed the complicated cleavages within the Maltese electorate. The result was a major political embarrassment for the ultra-conservative Prime Minister and leader of the Nationalist Party, particularly after he doggedly voted against the divorce bill in parliament notwithstanding the referendum result. The Catholic Church was also embarrassed after leading an aggressive ‘no’ campaign that did not resonate with the demands of society or the expectations of progressive Catholics. While the issue has severely affected the ruling Nationalist Party's chances of winning the next general election, due in the first quarter of 2013, it may have forced the Church finally to contemplate serious reforms. [ABSTRACT FROM PUBLISHER]

From the candidate country in the EU's 2004 Enlargement with the lowest levels of support for EU membership, the situation in Malta has changed since accession so that all mainstream political parties now support membership. After presenting factors influencing attitudes to Europe, the article analyses party euroscepticism from Maltese independence in 1964 to the present, focusing on the Malta Labour Party. The examination of public opinion focuses on the period before and after the 2003 referendum on EU membership. The significant role of the eurosceptic media is also noted. [ABSTRACT FROM AUTHOR]

Copyright of Hellenic Studies / Etudes Helleniques is the property of Centre for Hellenic Studies & Research Canada-KEEK and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: To describe the epidemiology of the serosubtypes of Neisseria meningitidis serogroup B (MenB) in the most densely populated area in Europe and to review the MenB Porin A (PorA) based outer membrane vesicle (OMV) vaccines that could provide the broadest protection. Study design and setting: Active surveillance of invasive meningococcal disease in a population of 400,000 inhabitants in Malta from 1999 to 2006. Serogroup B isolates were serosubtyped and analysed by age and year. The suitability of OMV vaccines was then assessed. Results: Laboratory confirmation of invasive meningococcal disease was obtained in 48% (79/163) of notified cases. Serogroup B caused the majority of invasive meningococcal disease (76%, 60/79) with the greatest disease burden occurring in 0–14-year-old children (73%, 44/60). MenC caused 14% (11/79) of cases. The most prevalent MenB serotype:serosubtype combination was B:4:P1.19,15 which constituted 59% (34/58) of all phenotypeable MenB isolates. The PorA epitopes P1.15 and P1.19, detected in 74% (43/58) of isolates, were significantly more prevalent than serosubtypes with other PorA epitopes (χ 2: 7.18, P <0.01). Conclusion: An assessment of the usefulness of a MenB OMV vaccine in Malta requires further research. The wild-type OMV vaccine developed by the Finlay Institute (FI) in Cuba could potentially be used to control an outbreak with a MenB P1.19,15 clone. A multivalent OMV vaccine would however be needed for broader protection against the endemic heterogenous MenB strains. A serogroup B vaccine incorporating more conserved proteins than PorA would be more suitable for comprehensive control of meningococcal B disease. [Copyright &y& Elsevier]

The 2008 Malta election confirmed the Nationalist Party in power for a third consecutive term, but with a much reduced majority. It also instigated a change of leadership in the opposition Malta Labour Party and the subsequent election of a new leader from amongst the ranks of its MEPs. Unlike national elections in most other EU member states, EU membership featured very strongly in this election but in a peculiarly different way than it did in previous ones. Voter participation at 92.5% was below the 2003 rate of 95.96% and 1.32% less than the 1966-2008 average. [ABSTRACT FROM AUTHOR]

Malta, a very small state, a micro–state, has never resigned itself to smallness. The nature of such states’ vulnerability is seen as both inherent and contingent. Micro states can by following prudent domestic policies and by strategically positioning themselves in the regional and global system, strengthen their resilience to both these types of vulnerability. This article outlines how the EU may ‘enlarge’ such states in both economic and security–political terms. It offers such states increased opportunities for dealing with the social, economic, environmental and security challenges which they face thus helping them to reduce their vulnerabilities while increasing their resilience to exogenous and endogenous shocks. [ABSTRACT FROM AUTHOR]

Malta's first European Parliament election was as hotly contested as the national elections. Turnout was third highest in the EU. The traditionally pro-EU Nationalist Party in government secured only two of the five seats contested, while the Opposition MLP, which up to last year opposed membership, took the other three. Since November 2003, the MLP has changed course on Europe and has joined the Party of European Socialists. Voter participation and a revealed preference towards candidates with Europeanist credentials show that support for EU membership has solidified, as supported by public opinion surveys. Support for the EU has increased from just under 53 per cent to around 80 per cent, enabling Malta to steer a steadier course in the EU. [ABSTRACT FROM AUTHOR]

Discusses various issues concerning Malta's bid for European Union (EU) membership. Referendum and general election held in 2003 to decide on the country's EU membership; Stand of the Malta Labour Party on the issue; Concept of Maltese nationalism; Main results of membership negotiations.

Abstract Background A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. Methods In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. Results The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T . violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. Conclusions In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients. [ABSTRACT FROM AUTHOR]

Genetic risk for amyotrophic lateral sclerosis (ALS) is highly elevated in genetic isolates, like the island population of Malta in the south of Europe, providing a unique opportunity to investigate the genetics of this disease. Here we characterize the clinical phenotype and genetic profile of the largest series of Maltese ALS patients to date identified throughout a 5-year window. Cases and controls underwent neuromuscular assessment and analysis of rare variants in ALS causative or risk genes following whole-genome sequencing. Potentially damaging variants or repeat expansions were identified in more than 45% of all patients. The most commonly affected genes were ALS2, DAO, SETX and SPG11 , an infrequent cause of ALS in Europeans. We also confirmed a significant association between ATXN1 intermediate repeats and increased disease risk. Damaging variants in major ALS genes C9orf72, SOD1, TARDBP and FUS were however either absent or rare in Maltese ALS patients. Overall, our study underscores a population that is an outlier within Europe and one that represents a high percentage of genetically explained cases. [ABSTRACT FROM AUTHOR]

Germline genetic testing has implications that extend beyond the individual patient to relatives, particularly for high-penetrance variants implicated in hereditary cancer or neurodegenerative syndromes. Many countries encourage patient-led communication to inform at-risk relatives, although the efficacy and uptake of this approach varies. Alternative scenarios envisage direct contact mediated by clinicians. The familial disclosure of sensitive genetic information is also determined by complex socio-ethnic factors. To date, no study has explored whether relatives would want to be informed of familial genetic risk and their preferences on different methods of communication in Malta. We thus used a published instrument that utilizes hypothetical scenario methodology to survey the attitudes of the Maltese population (n = 334) to receiving genetic information from family members. Two vignettes on Huntington's disease and colorectal cancer were presented. We also explored preferences towards the communication of genetic risk, confidentiality, and disclosure policies. Our preliminary results show that most respondents want to be informed of their increased risk by a family member or a clinician and would opt to receive confirmatory genetic testing. Most respondents preferred being informed of genetic risk by a close relative, but in the case of non-disclosure would want to be informed by a clinician. Most respondents expressed preference in favour of the introduction of registries, legislative change and sharing of contact details to address cases of nondisclosure. Our findings contribute further to evidence that supports, in selected hypothetical scenarios, an envisioned change in disclosure of genetic data policy by the public that is different from current practice to date. [ABSTRACT FROM AUTHOR]

We report on the presence of perchlorate in the settleable dust of Malta, a small central Mediterranean island. Both dust fall collected directly as it precipitated from atmosphere over a period of one month and deposited indoor dust from domestic residences were studied. Perchlorate was determined by ion chromatography of water extracts of the collected dusts. Dust fall was collected from 43 towns during 2011 to 2013 and indoor dust was sampled from homes in the same localities. Perchlorate was detected in 108 of 153 samples of dust fall (71%) and in 28 of 37 indoor dust samples (76%). Detectable perchlorate in dust fall ranged from 0.52 μg g − 1 to 561 μg g − 1 with a median value of 6.2 μg g − 1 ; in indoor dust, levels were from 0.79 μg g − 1 to 53 μg g − 1 with a median value of 7.8 μg g − 1 , the highest recorded anywhere to date. Statistical analysis suggested that there was no significant difference in perchlorate content of indoor dust and dust fall. Perchlorate levels in dust fall escalate during the summer in response to numerous religious feasts celebrated with fireworks and perchlorate persists at low μg g − 1 concentrations for several months beyond the summer festive period. In Malta, perchlorate derives exclusively from KClO 4 , imported for fireworks manufacture. Its residue in dust presents an exposure risk to the population, especially via ingestion by hand to mouth transfer. Our results suggest that wherever intensive burning of fireworks takes place, the environmental impact may be much longer lived than realised, mainly due to re-suspension and deposition of contaminated settled dust in the urban environment. [ABSTRACT FROM AUTHOR]

Very few countries can afford to ignore the potential repercussions emanating from climate change. However, few afford to take the steps to ensure the laying of full-coverage groundwork structures that ensure future analytical studies. This paper deals with the stepped-approach taken by a Mediterranean island state, to ensure the creation of a baseline structure that covers all the territory in terms of physical, natural and social environments. Malta has taken on the task to implement a series of measures aimed at integrating environmental, spatial planning and social data in line with the implementation of the Aarhus Convention, the INSPIRE Directive and the SEIS initiative. The implementation of a project entitled "Developing national environmental infrastructure and capacity" co-financed under the 2007-2013 European Regional Development Funds (Structural Funds) Programme for Malta, is targeted to take national environmental monitoring capacity from a semi-analogue state to a fully interactive online system. This initiative has resulted in the creation of tools that scientists and the general public can access for their respective studies. The resultant hardware, software, innovative scans of the terrestrial and bathymetric domains, as well as the freely disseminated SEIS-based systems have created the right scenario for the analysis of climate change. [ABSTRACT FROM AUTHOR]

Purpose: Hospital length of stay (LOS) is not only a function of patient- and disease-related factors, but is also determined by other health system-wide variables. Managers and clinicians strive to achieve the best possible trade-off between patients' needs and efficient utilisation of hospital resources, while also embracing ethical decision making. The purpose of this paper is to explore the perceptions of the hospital's major stakeholders as to what affects the duration of LOS of inpatients., Design/methodology/approach: Using a data-triangulated case study approach, 50 semi-structured interviews were performed with management, doctors, nurses and patients. Additionally, the hospitals' standard operating procedures, which are pertinent to the subject, were also included in the thematic analysis., Findings: This study shows that LOS is a multi-dimensional construct, which results from a complex interplay of various inputs, processes and outcomes., Research Limitations/implications: The findings emerging from a single case study approach cannot be generalised across settings and contexts, albeit being in line with the current literature., Practical Implications: The study concludes that a robust hospital strategy, which addresses deficient organisational processes that may unnecessarily prolong LOS, is needed. Moreover, the hospital's strategy must be sustained by providing good primary care facilities within the community set-up, as well as by providing more long-term care and rehabilitation beds to support the hospital turnover., Originality/value: The subject of LOS in hospitals has so far been tackled in a fragmented manner. This paper provides a comprehensive and triangulated account of the complexities surrounding the duration in which patients are kept in hospital by key stakeholders, most of whom were hands-on in the day-to-day running of the hospital under study.