Ankle X-ray use at Mater Dei's accident and emergency department

Aim: To determine the amount of X-rays performed at the Accident and Emergency Department (A&E) at Mater Dei Hospital to investigate ankle injuries. Objectives: A comparison between the X-ray report and the examining physician’s request was also performed. The audit will propose the possibility of implementing a standard protocol of care for ankle injuries namely, based upon the Ottawa Ankle Rules. Methods: A retrospective observational study was carried out between the 20th September and the 20th December 2015. All ankle X-rays performed at A&E during this period were analysed using the Picture and Archiving System (PACS). Results: The commonest reason for requesting an X-ray following a traumatic event was to identify the presence of a fracture. Only 27.8% of these X-ray reports identified a fracture. X-rays were also requested for non-traumatic injuries very often due to swelling. Physicians’ requests often contained minimal clinical details but only one request had no details whatsoever. Conclusion: Ankle X-rays were most commonly performed to identify a fracture but very often no fracture was identified. Fractures were a relatively uncommon finding raising the possibility of inappropriate prescription of X-rays. Use of guidelines or an alternative investigation could be beneficial in order to reduce inappropriate radiography usage. Appropriately filled in request forms including clinical presentation would help the communication between the physician and the radiologist.peer-reviewe

The diabesity health economic crisis - the size of the crisis in a European island state following a cross-sectional study

Background: Diabetes type 2 and obesity are well-established global epidemics and contributors to clinical, social and economic health burdens. The prevalence rates of these diseases are still on the rise among countries resulting in a corresponding public health burden. The Mediterranean island of Malta, known for it’s high diabetes and obesity rates, provides a good fundamental basis to portray the economical health burden of these diseases. Method: A recent randomised stratified representative cross-sectional survey conducted in Malta tackling diabetes, obesity and other determinants, was used to work out the population prevalence of these diseases. The cost burden of diabetes and obesity, based on published data, was incorporated to the established population prevalence rates, in order to estimate the Maltese economical burden. Projections to the year 2050 by a bottom-up prevalence based design were performed. Results: One eight of the Maltese adults (25 to 64 years) suffered from diabetes out of which approximately 10,000 adults were unaware of the disease. Alarmingly, more than a third of the Maltese population suffer from obesity. The approximate health care costs (direct and indirect) for the diabetic adult population was of €29,159,217 (€21,994,676 - €38,919,121) annually, amounting to 3.64% (2.75–4.875%) of the total health expenditure in Malta. The obesity cost burden was of €23,732,781 (€21,514,972-€26,049,204) annually contributing for 2.97% (2.69–3.26%) of the total health expenditure. The projected prevalence and costs for 2050 exhibited an estimated cost burden increase of €33,751,487 (€25,458,606–€45,048,473) for the diabetes mellitus population and €46,532,294 (€42,183,889–€51,074,049) for the obese population. These projected cost burdens are expected to increase exponentially the total health care expenditure in Malta by 2050. Conclusion: Having an understanding of the prevalence and the economic cost burden of diabetes and obesity within a country, along with projections of the expected burden will enable policy and public health officials to clearly visualize this growing problem. It also helps in establishing effective preventive strategies and screening programs targeting these epidemics.peer-reviewe

Climate change, malaria and neglected tropical diseases : a scoping review

To explore the effects of climate change on malaria and 20 neglected tropical diseases (NTDs), and potential effect amelioration through mitigation and adaptation, we searched for papers published from January 2010 to October 2023. We descriptively synthesised extracted data. We analysed numbers of papers meeting our inclusion criteria by country and national disease burden, healthcare access and quality index (HAQI), as well as by climate vulnerability score. From 42 693 retrieved records, 1543 full-text papers were assessed. Of 511 papers meeting the inclusion criteria, 185 studied malaria, 181 dengue and chikungunya and 53 leishmaniasis; other NTDs were relatively understudied. Mitigation was considered in 174 papers (34%) and adaption strategies in 24 (5%). Amplitude and direction of effects of climate change on malaria and NTDs are likely to vary by disease and location, be non-linear and evolve over time. Available analyses do not allow confident prediction of the overall global impact of climate change on these diseases. For dengue and chikungunya and the group of non-vector-borne NTDs, the literature privileged consideration of current low-burden countries with a high HAQI. No leishmaniasis papers considered outcomes in East Africa. Comprehensive, collaborative and standardised modelling efforts are needed to better understand how climate change will directly and indirectly affect malaria and NTDs