Agreement on "being sufficiently active for health" measured objectively by pedometer and subjectively by IPAQ questionnaires

Background: Measuring physical activity is complex and to achieve reliable and accurate measurements is challenging. Physical activity can be assessed subjectively using a variety of self report questionnaires, diaries, or logs or objectively using devices such as pedometers and accelerometers. This study aimed to test agreement on "being sufficiently active for health" measured objectively by pedometer and subjectively by International Physical Activity Questionnaires. Methods: Local government workers wore a Yamax Digi-walker pedometer for a one week period after which time they completed the Long Version of the International Physical Activity Questionnaire to allow a comparison between objective and subjective measures of physical activity. Results: Analysis of pedometer data showed that 49% of participants were sufficiently active for health (10,000 steps in a 24 hours period was used to define "sufficiently active for health). IPAQ classification of physical activity revealed much higher perceived levels of physical activity with 18.9% classified as achieving medium levels of activity and 73% achieving high levels of activity. Conclusions: In this study pedometers were shown to be more accurate measurements of physical activity with the self-report survey vastly over-estimating the actual physical activity achieved. Use of subjective measures of physical activity may under-estimate the true picture of physical activity behaviour in populations and wherever possible more objective measures should be used

Non-pigmented skin lesions: how many are non melanoma skin cancer?

BACKGROUND Nonmelanoma skin cancer (NMSC) is the most common cancer in Australia and thus the most costly to treat. Despite the high prevalence of NMSC, little is known about the rate of malignancy in excised or biopsied nonpigmented lesions. METHOD An audit of 912 reports relating to nonpigmented skin samples from 749 patients processed during January 2005 in Tasmania. RESULTS Nonmelanoma skin cancer was present in 60.6% of samples from specialists and 44.5% from nonspecialists/primary care doctors (p<0.001); 1.6 skin lesions were excised or biopsied in order to identify one malignant or pre-invasive lesion (1.3 for specialists and 1.7 for nonspecialists). The number of NMSCs increased with age and were more common in men. DISCUSSION Medical practitioners are efficient in their management of nonpigmented skin lesions in both primary and secondary care

Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial

Objectives: There is limited published research studying the effect of antibiotic prophylaxis on surgical site infection (SSI) in dermatological surgery, and there is no consensus for its use in higher-risk cases. The objective of this study was to determine the effectiveness of a single oral preoperative 2g dose of cephalexin in preventing SSI following flap and graft dermatological closures on the nose and ear. Design: Prospective double-blinded, randomised, placebo controlled trial testing for difference in infection rates. Setting: Primary care skin cancer clinics in North Queensland, Australia, were randomised to 2 g oral cephalexin or placebo 40–60min prior to skin incision. Participants: 154 consecutive eligible patients booked for flap or graft closure following skin cancer excision on the ear and nose. Intervention: 2 g dose of cephalexin administered 40–60min prior to surgery. Results: Overall 8/69 (11.6%) controls and 1/73 (1.4%) in the intervention group developed SSI (p=0.015; absolute SSI reduction 10.2%; number needed to treat (NNT) for benefit 9.8, 95%CI 5.5 to 45.5). In males, 7/44 controls and 0/33 in the intervention group developed SSI (p=0.018; absolute SSI reduction 15.9%; NNT for benefit 6.3, 95%CI 3.8 to 19.2). SSI was much lower in female controls (1/25) and antibiotic prophylaxis did not further reduce this (p=1.0). There was no difference between the study groups in adverse symptoms attributable to highdose antibiotic administration (p=0.871). Conclusion: A single oral 2 g dose of cephalexin given before complex skin closure on the nose and ear reduced SSI

Effect of a single preoperative dose of oral antibiotic to reduce the incidence of surgical site infection following below-knee dermatological flap and graft repair

Background: Surgical site infection (SSI) rates for below-knee dermatological surgery are unacceptably high, particularly following complex flap and graft closures. The role of antibiotic prophylaxis for these surgical cases is uncertain. Objective: To determine whether SSI following complex dermatological closures on the leg could be reduced by antibiotic prophylaxis administered as a single oral preoperative dose. Methods: A total of 115 participants were randomized to 2 g of oral cephalexin or placebo 40–60 minutes prior to surgical incision in a prospective, randomized, double-blind, placebo-controlled trial at a primary care skin cancer clinic in North Queensland, Australia. Results: Overall 17/55 (30.9%) controls and 14/55 (25.5%) intervention participants developed infection (P = 0.525). There was no difference between the study groups in adverse symptoms that could be attributed to high-dose antibiotic administration (P = 1). Conclusion: A single oral 2-g dose of cephalexin given before complex below-knee dermatological closure did not reduce SSI

Anaemia in early childhood among Aboriginal and Torres Strait Islander children of Far North Queensland: a retrospective cohort study

Objective: Early childhood anaemia affects health and neurodevelopment. This study describes anaemia among Aboriginal and Torres Strait Islander children of Far North Queensland. Methods: This retrospective cohort study used health information for children born between 2006 and 2010 and their mothers. We describe the incidence of early childhood anaemia and compare characteristics of children and mothers where the child had anaemia with characteristics of children and mothers where the child did not have anaemia using bivariate and multivariable analysis, by complete case (CC) and with multiple imputed (MI) data. Results: Among these (n=708) Aboriginal and Torres Strait Islander children of Far North Queensland, 61.3% (95%CI 57.7%, 64.9%) became anaemic between the ages of six and 23 months. Multivariable analysis showed a lower incidence of anaemia among girls (CC/MI p<0.001) and among children of Torres Strait Islander mothers or both Aboriginal and Torres Strait Islander mothers (CC/MI p<0.001) compared to children of Aboriginal mothers. A higher incidence of anaemia was seen among children of mothers with parity three or more (CC/MI p<0.001); children born by caesarean section (CC/MI p<0.001); and children with rapid early growth (CC/MI p<0.001). Conclusion: Early childhood anaemia is common among Aboriginal and Torres Strait Islander children of Far North Queensland. Poor nutrition, particularly iron deficiency, and frequent infections are likely causes. Implications for public health: Prevention of early childhood anaemia in ‘Close the Gap’ initiatives would benefit the Aboriginal and Torres Strait Islander children of Far North Queensland – and elsewhere in northern Australia

Risk factors for surgical site infection after minor dermatological surgery

BACKGROUND: Surgical site infection (SSI) after dermatologic surgery is associated with poor outcomes including increased recovery time, poor cosmesis, and repeat visits to doctors. Prophylactic antibiotics are prescribed to reduce these adverse outcomes. Identifying risk factors for SSI will facilitate judicious antibiotic prophylaxis. OBJECTIVE: To identify risk factors for SSI after minor dermatologic surgery. METHODS: Individual patient data from four large randomized controlled trials were combined to increase statistical power. A total of 3,819 adult patients requiring minor skin procedures at a single facility were recruited over a 10-year period. The main outcome measure was SSI. MAIN RESULTS: A total of 298 infections occurred, resulting in an overall incidence of 7.8% (95% confidence interval [CI], 5.8–9.6), although the incidence varied across the four studies (P = .042). Significant risk factors identified were age (relative risk [RR], 1.01; 95% CI, 1.001–1.020; P = .008), excisions from the upper limbs (RR, 3.03; 95% CI, 1.76–5.22; P = .007) or lower limbs (RR, 3.99; 95% CI, 1.93–8.23; P = .009), and flap/two-layer procedures (RR, 3.23; 95% CI, 1.79–5.85; P = .008). Histology of the excised lesion was not a significant independent risk factor for infection. CONCLUSIONS: This study demonstrated that patients who were older, underwent complex excisions, or had excisions on an extremity were at higher risk of developing an SSI. An awareness of such risk factors will guide evidence-based and targeted antibiotic prophylaxis

Targeted Prevention in Bulimic Eating Disorders: Randomized Controlled Trials of a Mental Health Literacy and Self-Help Intervention

[Extract] Eating disorders (EDs) in the community are associated with high burden and poor quality of life (Mathers et al., 2000, Hay & Mond, 2005). It is also known that people with EDs have frequent chronic medical complications (Mehler, 2003), increased risk of obesity especially for the more common bulimic EDs such as binge eating disorder (Neumark-Sztainer et al., 2006; Hudson et al., 2007)) and high levels of co-morbidity with both depression and anxiety (Hudson et al., 2007). However, there is a wide gap between the presence of a disorder and its identification and treatment. It is well-documented that the overwhelming majority of people in the community with an ED do not seek help for their eating behaviours (Hart et al., in press; Welch & Fairburn 1994), and that even fewer access appropriate or evidencebased treatments (Cachelin & Striegel-Moore,2006; Mond et al., 2009). This is problematic as many randomised controlled trials support the efficacy of treatments, such as cognitivebehaviour therapy for bulimic EDs (Hay et al., 2004) and unmet treatment needs likely add to the general community burden from psychiatric disorders (Andrews et al., 2000). In addition, these disorders often become chronic with longitudinal studies indicating persistence of symptoms over many years (Fairburn et al., 2000, Evans et al., 2011)

The reproducibility of acquiring three dimensional gait and plantar pressure data using established protocols in participants with and without type 2 diabetes and foot ulcers

Background&nbsp; Several prospective studies have suggested that gait and plantar pressure abnormalities secondary to diabetic peripheral neuropathy contributes to foot ulceration. There are many different methods by which gait and plantar pressures are assessed and currently there is no agreed standardised approach. This study aimed to describe the methods and reproducibility of three-dimensional gait and plantar pressure assessments in a small subset of participants using pre-existing protocols.&nbsp; Methods&nbsp; Fourteen participants were conveniently sampled prior to a planned longitudinal study; four patients with diabetes and plantar foot ulcers, five patients with diabetes but no foot ulcers and five healthy controls. The repeatability of measuring key biomechanical data was assessed including the identification of 16 key anatomical landmarks, the measurement of seven leg dimensions, the processing of 22 three-dimensional gait parameters and the analysis of four different plantar pressures measures at 20 foot regions.&nbsp; Results&nbsp; The mean inter-observer differences were within the pre-defined acceptable level (&lt;7mm) for 100% (16 of 16) of key anatomical landmarks measured for gait analysis. The intra-observer assessment concordance correlation coefficients were &gt; 0.9 for 100% (7 of 7) of leg dimensions. The coefficients of variations (CVs) were within the pre-defined acceptable level (&lt;10%) for 100% (22 of 22) of gait parameters. The CVs were within the pre-defined acceptable level (&lt;30%) for 95% (19 of 20) of the contact area measures, 85% (17 of 20) of mean plantar pressures, 70% (14 of 20) of pressure time integrals and 55% (11 of 20) of maximum sensor plantar pressure measures.&nbsp; Conclusion&nbsp; Overall, the findings of this study suggest that important gait and plantar pressure measurements can be reliably acquired. Nearly all measures contributing to three-dimensional gait parameter assessments were within predefined acceptable limits. Most plantar pressure measurements were also within predefined acceptable limits; however, reproducibility was not as good for assessment of the maximum sensor pressure. To our knowledge, this is the first study to investigate the reproducibility of several biomechanical methods in a heterogeneous cohort

Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures

Hypothesis This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants. Methods Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (k), percentage agreement, and 95% confidence intervals (CIs). Results Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (k ¼ 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and k ¼ 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (k ¼ 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (k ¼ 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants. Conclusion Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teachin

Intensive versus conventional glycaemic control for treating diabetic foot ulcers

Background&nbsp; The estimated likelihood of lower limb amputation is 10 to 30 times higher amongst people with diabetes compared to those without diabetes. Of all non-traumatic amputations in people with diabetes, 85% are preceded by a foot ulcer. Foot ulceration associated with diabetes (diabetic foot ulcers) is caused by the interplay of several factors, most notably diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD) and changes in foot structure. These factors have been linked to chronic hyperglycaemia (high levels of glucose in the blood) and the altered metabolic state of diabetes. Control of hyperglycaemia may be important in the healing of ulcers.&nbsp; Objectives&nbsp; To assess the effects of intensive glycaemic control compared to conventional control on the outcome of foot ulcers in people with type 1 and type 2 diabetes.&nbsp; Search methods&nbsp; In December 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process &amp; Other Non-Indexed Citations); Ovid EMBASE; EBSCO CINAHL; Elsevier SCOPUS; ISI Web of Knowledge Web of Science; BioMed Central and LILACS. We also searched clinical trial databases, pharmaceutical trial databases and current international and national clinical guidelines on diabetes foot management for relevant published, non-published, ongoing and terminated clinical trials. There were no restrictions based on language or date of publication or study setting.&nbsp; Selection criteria&nbsp; Published, unpublished and ongoing randomised controlled trials (RCTs) were considered for inclusion where they investigated the effects of intensive glycaemic control on the outcome of active foot ulcers in people with diabetes. Non randomised and quasi-randomised trials were excluded. In order to be included the trial had to have: 1) attempted to maintain or control blood glucose levels and measured changes in markers of glycaemic control (HbA1c or fasting, random, mean, home capillary or urine glucose), and 2) documented the effect of these interventions on active foot ulcer outcomes. Glycaemic interventions included subcutaneous insulin administration, continuous insulin infusion, oral anti-diabetes agents, lifestyle interventions or a combination of these interventions. The definition of the interventional (intensive) group was that it should have a lower glycaemic target than the comparison (conventional) group.&nbsp; Data collection and analysis&nbsp; All review authors independently evaluated the papers identified by the search strategy against the inclusion criteria. Two review authors then independently reviewed all potential full-text articles and trials registry results for inclusion.&nbsp; Main results&nbsp; We only identified one trial that met the inclusion criteria but this trial did not have any results so we could not perform the planned subgroup and sensitivity analyses in the absence of data. Two ongoing trials were identified which may provide data for analyses in a later version of this review. The completion date of these trials is currently unknown.&nbsp; Authors&rsquo; conclusions&nbsp; The current review failed to find any completed randomised clinical trials with results. Therefore we are unable to conclude whether intensive glycaemic control when compared to conventional glycaemic control has a positive or detrimental effect on the treatment of foot ulcers in people with diabetes. Previous evidence has however highlighted a reduction in risk of limb amputation (from various causes) in people with type 2 diabetes with intensive glycaemic control. Whether this applies to people with foot ulcers in particular is unknown. The exact role that intensive glycaemic control has in treating foot ulcers in multidisciplinary care (alongside other interventions targeted at treating foot ulcers) requires further investigation