Development of health services in Malta : past, present and future

As with other modern health systems, Malta has experienced significant changes in its health care landscape over the past two decades. Major changes have occurred, in the country itself and in its health care system, impacting both the provision and consumption of healthcare. The accession of Malta to the European Union has shaped Malta’s health system by catalysing change, standardising certain processes and bringing new legislation. Investments in the infrastructure and health workforce together with innovative management policies and techniques have enhanced the delivery of healthcare to patients. The digitalisation of healthcare has also had a major boost in the past two decades, revolutionising healthcare provision while narrowing the gap between the patient and the healthcare provider. Various strategies and policies have been published and implemented to enhance the delivery of clinical services with the aim of reducing the disease burden of the Maltese population, from diseases such as cancer and diabetes. This article traces these main developments in a descriptive and analytical manner and provides a number of insights for the future.peer-reviewe

Distribution and Abundance of the Dugong in Gulf of Carpentaria Waters: a basis for cross-jurisdictional conservation planning and management

[Extract] This survey provides the first synopsis of the distribution and abundance of the dugong in the Gulf of Carpentaria. The results of previous surveys of parts of this region in both Queensland and the Northern Territory have been difficult to interpret because of the potentially confounding influences of unpredictable dugong movements between areas within the region

Dugong distribution and abundance on the urban coast of Queensland: a basis for management. Final Report to Marine and Tropical Research Facility Interim Projects 2005-6

[Excerpt] The transitional funding from MTSRF plus supplementary funding from CRC Reef and CRC Torres Strait enabled the first survey of the entire urban coast of Queensland for dugongs to be carried out in November 2005. In addition, a reference block in Torres Strait was surveyed to provide a context for the survey of the urban coast. The results of the 2005 surveys are being presented to Traditional Owners and stakeholders at a series of workshops. The results of the 2005 survey have been analyzed in the context of results of previous surveys of various parts of this coast since the mid 1980s using comparable techniques. The results of the 20 year time series of surveys suggest that dugong numbers are now stable at the scale of the entire urban coast of Queensland although populations fluctuate at the level of individual survey blocks (usually bays), probably largely due to natural changes in seagrass habitats. The results of the surveys indicate that it will be important to: (1) develop cross-jurisdictional objectives for the management of dugongs at the scale of the entire region, and (2) co-ordinate management at both culturally and ecologically relevant scales

How the EAT-Lancet commission report 'Food in the Anthropocene' influenced discourse and research on food systems: a systematic review covering the first two years post-publication

In 2019, the EAT–Lancet Commission's report on food in the Anthropocene presented a planetary heath diet to improve health while reducing the environmental effect of food systems globally. We assessed EAT–Lancet's immediate influence on academic research and debate by conducting a systematic review of articles citing the Commission and others published from January, 2019, to April, 2021. The Commission influenced methods, results, or discourse for 192 (7·5%) of 2560 citing articles, stimulating cross-disciplinary research and debate across life sciences (47%), health and medical sciences (42%), and social sciences (11%). Sentiment analysis of 76 critiquing articles indicated that opinions were, on average, more positive than negative. Positive sentiments centred on benefits for informing policy, public health, and raising public awareness. Negative sentiments included insufficient attention to socioeconomic dimensions, feasibility, and environmental effects other than emissions. Empirical articles predominantly evaluated the effects of changed diets or food production on the environment and wellbeing (29%), compared current diets with EAT–Lancet recommendations (12%), or informed future policy and research agendas (20%). Despite limitations in EAT–Lancet's method, scope, and implementation feasibility, the academic community supported these recommendations. A broad suite of research needs was identified focusing on the effects of food processing, socioeconomic and political drivers of diet and health, and optimising consumption or production for environment and health

Audit on doctors’ documentation of overweight and obesity in children attending general children’s outpatient’s clinics in Malta

Background: Childhood obesity is a global epidemic and Malta is no exception. Despite local awareness, not all children seen at the general hospital's children's outpatients (COP) have their height and weight measured. An audit was carried out on the documentation of overweight and obesity in children, along with any advice given in this regard.Methods: The NICE guideline on obesity was used to define overweight and obesity. A cross-sectional study was conducted over 10 weeks between January and March 2020. Data on age, gender, weight, height, percentiles/BMI, doctor grade, presenting complaint, appointment frequency and previous anthropometric documentation were collected from clinical notes. All children attending general COP, between 2-15 years of age and free from chronic medical illnesses affecting BMI were included.Results: In 418 patients, weight and height were documented in 64.8% and 58.1% respectively, while percentiles were documented in 17.0%. Furthermore, BMI was documented in just 1.2% of cases, and 32% no anthropometric measurements documented whatsoever. Moreover, 29.7% of children who were previously flagged up as obese/overweight were not followed-up, and only 12% who were documented as obese, were investigated, albeit incompletely. Only 7% of known overweight children had dietary advice documented in their notes.Conclusion: COP's services are not attaining the standard as per current guidelines, which suggest that all children should be screened for obesity opportunistically. We recommend the distribution of a dietary guidelines leaflet to parents, continuous medical education for doctors, giving sustainable advice during follow ups and the introduction of a child obesity clinic.peer-reviewe

Socio-demographic determinants of diet quality in Australian adults using the validated Healthy Eating Index for Australian adults (HEIFA-2013)

Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011–2012 National Nutrition and Physical Activity Survey aged 18 years or above (n = 9435), with the validated 11-component Healthy Eating Index for Australians (HEIFA-2013), based on the 2013 Australian Dietary Guidelines. Differences in scores by demographics (ANOVA) and regression models for associations between the HEIFA-2013 score and demographic characteristics were conducted. The mean (SD) HEIFA-2013 score was 45.5 (14.7) out of 100 due to poor intakes of vegetables, fruit, grains, dairy and fat and high intakes of added sugar, sodium and discretionary foods. Lower mean HEIFA-2013 scores (SD) were found for males 43.3 (14.7), young-adults 41.6 (14.2) obese 44.1 (14.3), smokers 40.0 (14.2), low socio-economic status 43.7 (14.9) and Australian country-of-birth 44.2 (14.6) (p < 0.05). The overall diet quality of the Australian population is poor and targeted interventions for young-adults, males, obese and those with lower socio-economic status are recommended

Can designers be proactively supported as from product specifications?

During the design process, designers are concerned with two main types of issues - issues related to “what needs to be achieved” or “whats” and issues related to “how these needs will be met” or “hows”. A literature review carried out revealed that means which proactively make designers aware of artefact life-cycle consequences (LCCs) arising from both their “whats” and “hows” and which guide them on how to minimise or avoid any negative consequences, are lacking. This research thus contributes an approach framework to meet this aim. The approach framework developed is further implemented as a prototype computer-based tool and subsequently evaluated. Based on the feedback obtained from the evaluation, future research directions are also proposed.peer-reviewe

Intelligent life-oriented design solution space selection

Consideration of design specifications is a vital part of the product design process. When design specifications are met, not only is customer satisfaction increased, but product development times and costs are reduced through less iteration. Product quality is also likely to be higher if these specifications are systematically addressed. However, focusing on the functionality specifications of the product is not enough. For the product to be really successful, design engineers have to take into account the specifications for the whole product life cycle, not only those for the use phase. This means that fabrication and assembly specifications, product servicing, product retirement and other specifications of the product from conception to grave should also be taken into account. Traditional CAD tools tend to provide support for the solution phase of the design process, with the design specifications being overlooked. This is a major limitation of these tools given the vital importance of considering design specifications during the design process. Due to this, specifications management is still very paper-based and is kept separate from the actual solution generation as there is no way for the designer to know, via traditional CAD tools, whether a given specification is satisfied in the solution being developed unless it is manually checked each time the question arises. What engineering designers do in practice is they start off with reading the design specifications from the Product Design Specification (PDS), then move on to generate a Quality Function Deployment (QFD) chart to convert the customer ‘wants’ into technical specifications, then start to take decisions based on what has been stored in their memories from the PDS and QFD [Grech 2009]. Hence, in practice, it is quite difficult to trace whether the design solution satisfies the design specifications or not. [Excerpt]peer-reviewe

Multiple myeloma and its treatment contribute to increased platelet reactivity

Multiple myeloma (MM) and its precursor states, smoldering myeloma (SM) and monoclonal gammopathy of undetermined significance (MGUS) are associated with increased incidence of thrombosis, however the cause of this is unknown. Lenalidomide treatment of MM substantially improves patient survival, although significantly increases thrombotic risk by an unknown mechanism. This pilot study aimed to establish the impact of MM and its treatment with Lenalidomide on platelet function. We analyzed platelet function in MGUS, SM and MM compared to healthy controls. We report an increase in platelet reactivity in MGUS, SM, and MM where increases in fibrinogen binding, P-selectin exposure, altered receptor expression, elevated levels of aggregation and enhanced sensitivity to agonist stimulation were observed. We also demonstrate an increase in patient platelet reactivity post Lenalidomide treatment compared to pre-treatment. We show Lenalidomide treatment of platelets ex vivo increased reactivity that was associated with formation of larger thrombi at arterial shear rates but not venous shear rates. This study demonstrates a clear increase in platelet reactivity and prothrombotic potential in patients with MGUS, SM and MM which is elevated further upon treatment with Lenalidomide. Our observations suggest that more detailed studies are warranted to determine mechanisms of thrombotic complications to enable the development of new preventative strategies that specifically target platelets

Overtime in Europe : regulation and practice

Aquest informe s'elabora a partir de les diferents contribucions de la Network of Eurofound Correspondents, i pel que fa a Espanya la contribució ha estat de l'ALejandro GodinoDespite the well-known adverse effects of regular long working hours on workers' health, well-being and performance, many workers in the EU continue to work beyond their normal hours. Part of this additional working time is classified as overtime. This report takes a comparative overview of how overtime is regulated in the EU Member States, Norway and the United Kingdom, including its definition, the limits on its use and the compensation received by workers for working extra hours. The report assesses the extent of the phenomenon using national-level data, delves into the factors that explain it, and examines the potential consequences for workers and firms. Finally, the report summarises the current debate on the topic, as uncompensated working hours, structural overtime and monitoring of working hours are currently some of the most discussed work-related issues across the EU