Implementing a digital public health project - lessons learned?

The demand for the digitalisation of public health has been ongoing for more than a decade. The COVID-19 pandemic was the tipping point that accelerated the ideation, implementation, and scale-up of such public health projects. Despite the well-needed push, the same challenges that face every similar implementation will nonetheless be the same if not accentuated. The scope of the presentation is to highlight the difficulties and facilitators that such implementations and evaluations bring forward. We will also see what we can learn as public health professionals to ensure that present and future information systems are well-planned. We have to ensure that they do not succumb to the pressure of well-intended stakeholders who are yearning for such solutions to help their business workflows. This presentation will be enhanced with the lessons learned from implementing, monitoring, and following up on Malta's national contact tracing app and Customer Relationship Management systems based on Microsoft Dynamics 365 technologies that tackled the Test, Track and Trace workflows that were integral to the COVID response in Malta.

Asthma, rhinitis and eczema in Maltese 13-15 year-old schoolchildren -- prevalence, severity and associated factors [ISAAC]. International Study of Asthma and Allergies in Childhood

BACKGROUND

Allergic conditions, especially asthma, seem to be increasingly common the world over. The International Study of Asthma and Allergies in Childhood [ISAAC] was the first worldwide study carried out with standardized questionnaires in order to create a reliable global map of childhood allergy.

OBJECTIVES

The Maltese Islands were one of the centres participating in this study and in this paper the data obtained from 4184 13-15 year olds from 22 state and three private schools [88.7% response rate], and also data obtained from some added 'local' questions addressed to the same children, are included. in order to evaluate the problem of allergic conditions in Maltese schoolchildren.

RESULTS

27.9% of the participants were wheezers 'ever' while 16% were current wheezers. Of the latter children 15.1% were experiencing nocturnal wheezing at least once a week and 22% had a wheezing episode severe enough to limit speech. Nasal problems were present in 52.7% of these teenagers and 47.4% of all respondents persisted with these symptoms up to the year of answering the questionnaire. Hayfever had been diagnosed in 32.3% of all the children. 12.8% of respondents had a recurring itchy rash suggestive of eczema for at least 6 months of their lives and 10% had it currently. This was slightly lower than the global mean, unlike the case of wheezing, which in Malta was more common than the world average, and rhinitis, for which we had the second highest cumulative prevalence rate in the world. Multiple variables such as gender, smoking, family history of atopy, pets, soft furnishings and living in busy roads affected the prevalence and severity of the allergic conditions studied.

CONCLUSIONS

Allergic conditions are very common in Maltese schoolchildren and are causing a lot of hardship to these same youngsters. The results of this study should serve as a stimulus to try and decrease this suffering through better management of these conditions, measures to control possible detrimental factors and further research on asthma, allergic rhinitis and eczema.

The prognostic value of blood glucose in diabetic patients with acute myocardial infarction

The aim of the study was to investigate prospectively the prognostic value of blood glucose on admission in diabetic and non-diabetic patients with an acute myocardial infarction. Three hundred and thirty-three diabetic and 565 non-diabetic patients were admitted with acute myocardial infarction during the study period of 3.5 years. There was a significant association between mortality and blood glucose on admission in diabetic patients (regression coefficient, r = 0.92, 0.5 < p < 0.02) but not in non-diabetic individuals (r = 0.69, 0.2 < p < 0.5). Age- and sex-standardized mortality was higher in the diabetic group (12.2% vs 7.4%, p < 0.03), but was identical if standardized also for blood glucose on admission. We conclude that a high blood glucose on admission is a bad prognostic indicator in a diabetic patient with an acute myocardial infarction. The excess mortality in diabetic patients with acute myocardial infarction can be attributed to the higher proportion with hyperglycaemia.

Absence of circadian variation in the onset of acute myocardial infarction in diabetic subjects

OBJECTIVES

To investigate the circadian pattern of acute myocardial infarction in non-insulin-dependent diabetic patients and to compare it with that of controls.

BACKGROUND

Previous studies have shown that there is a circadian variation in the incidence of acute myocardial infarction, but there are few data on diabetic subjects.

METHODS

A hospital based prospective case-control study.

RESULTS

196 diabetic patients and 196 age and sex matched controls were admitted with a diagnosis of acute myocardial infarction during the study period. IN 32 diabetic patients and 38 controls, the time of onset of myocardial infarction was unknown; in 34, 44, 42, and 44 diabetic patients the onset was in the first to fourth quarters respectively (chi 2 = 1.66, NS). The corresponding figures for the controls were 30, 56, 45, and 27 (chi 2 = 13.9, P < 0.005). The difference between the two groups was highly significant (chi 2 = 10.3, P < 0.025).

CONCLUSIONS

Diabetic subjects do not show a significant circadian variation in the onset of acute myocardial infarction.

Factors that influence outcome in diabetic subjects with myocardial infarction

OBJECTIVE

To compare the outcome of acute myocardial infarction in NIDDM patients and nondiabetic control subjects. The relation of glycemic control, duration of diabetes, and major diabetic complications to the outcome of acute myocardial infarction in diabetic subjects was investigated.

RESEARCH DESIGN AND METHODS

This was a prospective, hospital-based, case-control study.

RESULTS

One hundred and ninety-six NIDDM patients and 196 nondiabetic control subjects with acute myocardial infarction were entered into the study. 23.5% of diabetic subjects and 34.2% of control subjects received thrombolytic therapy (P < 0.05). Diabetic subjects showed signs of reperfusion less often than control subjects (P < 0.05). Mortality was higher in the diabetic group (17.3 vs. 10.2%, P < 0.05). Pump failure (38.3 vs. 16.8%, P < 0.01) and cardiogenic shock (9.7 vs. 3.6%, P < 0.05) also occurred more frequently in diabetic subjects. Loss of heart rate variability was correlated with both pump failure and mortality; proliferative retinopathy was correlated with pump failure. Glycemic control and other diabetic complications did not correlate with outcome.

CONCLUSIONS

Our findings confirm the higher mortality and incidence of pump failure in acute myocardial infarction with co-morbid diabetes. They suggest that the less frequent use of thrombolytic therapy, lower reperfusion rates, and more advanced coronary artery disease might be contributory. The presence of autonomic neuropathy and microvascular disease probably also contribute to poor outcome; other major diabetic complications and diabetic control did not influence outcome.