A questionnaire for determining prevalence of diabetes related foot disease (Q-DFD): construction and validation

<p>Abstract</p> <p>Background</p> <p>Community based prevalence for diabetes related foot disease (DRFD) has been poorly quantified in Australian populations. The aim of this study was to develop and validate a survey tool to facilitate collection of community based prevalence data for individuals with DRFD via telephone interview.</p> <p>Methods</p> <p>Agreed components of DRFD were identified through an electronic literature search. Expert feedback and feedback from a population based construction sample were sought on the initial draft. Survey reliability was tested using a cohort recruited through a general practice, a hospital outpatient clinic and an outpatient podiatry clinic. Level of agreement between survey findings and either medical record or clinical assessment was evaluated.</p> <p>Results</p> <p>The Questionnaire for Diabetes Related Foot Disease (Q-DFD) comprised 12 questions aimed at determining presence of peripheral sensory neuropathy (PN) and peripheral vascular disease (PVD), based on self report of symptoms and/or clinical history, and self report of foot ulceration, amputation and foot deformity. Survey results for 38 from 46 participants demonstrated agreement with either clinical assessment or medical record (kappa 0.65, sensitivity 89.0%, and specificity 77.8%). Correlation for individual survey components was moderate to excellent. Inter and intrarater reliability and test re-test reliability was moderate to high for all survey domains.</p> <p>Conclusion</p> <p>The development of the Q-DFD provides an opportunity for ongoing collection of prevalence estimates for DRFD across Australia.</p

Back to basics in diagnosing diabetic polyneuropathy with the tuning fork!

OBJECTIVE- Several national and international scoring systems are used to diagnose diabetic polyneuropathy (PNP). The variety in these scores and the lack of data on validity and predictive value has led to a comparison and validation of the scores with clinical standards for PNP to determine the most powerful measurement for screening. RESEARCH DESIGN AND METHODS- Three matched groups were selected: 24 diabetic patients with neuropathic foot ulcers, 24 diabetic patients without PNP or ulcers, and 21 control subjects without diabetes. In all participants the scores from the International Consensus on the Diabetic Foot (ICDF) and the Dutch Nederlandse Diabetes Federatie-Centraal Beleids Orgaan (NDF/CBO) were tested. The Diabetic Neuropathy Symptom score, the Diabetic Neuropathy Examination score, Heart Rate Variability, the Nerve Conduction Sum score, and a San Antonio Consensus sum score were obtained as clinical standards. Reproducibility was tested in a separate study (13 patients). RESULTS- The construct validity and discriminative power of the ICDF and NDF/CBO scores were comparable, although monofilaments (NDF/CBO) scored lower. The predictive value was good for all scores, with the best results being obtained for the tuning fork (NDF/CBO). Reproducibility of the NDF/CBO scores (monofilaments and tuning fork) was high. CONCLUSIONS- The characteristics of the scores of tests recommended by ICDF and NDF/CBO are comparable. The single use of the 128-Hz tuning fork produces results similar to the extended scores of the ICDF and much better than those of monofilaments on validation and for predictive value. For screening we therefore advise the use of the tuning fork alone

Recent invasion by a non-native cyprinid (common bream Abramis brama) is followed by major changes in the ecological quality of a shallow lake in southern Europe

We present an example of how an invasion by a non-native cyprinid (common bream, Abramis brama (Pisces: Cyprinidae), hereafter bream) in a natural shallow lake in southern Europe (Lake Montorfano, northern Italy) may have adversely affected the state of the lake’s ecosystem. In less than two decades, bream became the most abundant species and characterized by a stunted population with asymptotic length 33.5 cm, an estimated mean length at first maturity of 19.6 cm, a total mortality rate of 0.64 year−1 and a diet overwhelmingly dominated by microcrustaceans. Following bream establishment, nutrients and phytoplankton biomass rose, the proportion of Cyanobacteria by numbers increased markedly and water transparency decreased. Total zooplankton abundance increased with a marked increase in small cladocerans and copepods, whereas the abundance of large herbivorous cladocerans did not change. The coverage of submerged macrophytes declined, as did the abundance of native pelagic zooplanktivorous fish. The composition of the fish community shifted towards a higher proportion of zoobenthivorous species, such as bream and pumpkinseed (Lepomis gibbosus). Our results indicate that bream affected water quality through bottom-up mechanisms, while top-down effects were comparatively weak. Selective removal of bream and perhaps stocking of native piscivores might improve the ecological status of the lake