Testing for Loss of Protective Sensation in Patients with Foot Ulceration

2005 ◽  
Vol 95 (5) ◽  
pp. 469-474 ◽  
Author(s):  
William A. Wood ◽  
Michael A. Wood ◽  
Scott A. Werter ◽  
Joseph J. Menn ◽  
Scott A. Hamilton ◽  
...  
Keyword(s):  
At Risk ◽  
Diabetic Neuropathy ◽  
Cross Sectional ◽  
Actual Measurement ◽  
Foot Ulceration ◽  
Pressure Threshold ◽  
Static Touch ◽  
History Of ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Current recommendations for the prevention of foot ulceration and amputation include screening at-risk individuals by testing for loss of protective sensation at eight sites using 10-g (5.07) nylon monofilaments. Yet measurement of the cutaneous pressure threshold to differentiate one-point from two-point static touch stimuli may allow identification of these at-risk individuals earlier in the clinical course of diabetic neuropathy. The present study tested this hypothesis using a prospective, cross-sectional, multicenter design that included sensibility testing of 496 patients with diabetic neuropathy, 17 of whom had a history of ulceration or amputation. Considering the cutaneous pressure threshold of the 5.07 Semmes-Weinstein nylon monofilament to be equivalent to the 95 g/mm2 one-point static touch measured using the Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland), only 3 of these 17 patients with a history of foot ulceration or amputation would have been identified using the Semmes-Weinstein nylon monofilament screening technique. In contrast, using the Pressure-Specified Sensory Device, all 17 patients were identified as having abnormal sensibility, defined as greater than the 99% confidence limit for age, for two-point static touch on the hallux pulp. We conclude that patients at risk for foot ulceration can best be identified by actual measurement of the cutaneous sensibility of the hallux pulp. (J Am Podiatr Med Assoc 95(5): 469–474, 2005)

scholarly journals Stillbirth and infant death: mental health among low-income mothers in Mumbai

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Roberts ◽  
Solomon J. Renati ◽  
Shreeletha Solomon ◽  
Susanne Montgomery
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Low Income ◽  
Infant Death ◽  
Postnatal Depression ◽  
Perinatal Loss ◽  
Reproductive Age ◽  
Cross Sectional ◽  
History Of ◽  
Perinatal Grief

Abstract Background India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women’s mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae. Methods We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. Results Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention. Conclusions Understanding factors contributing to women’s suffering related to reproductive challenges in this pronatalist context is critically important for women’s wellbeing.

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

2014 ◽  
Vol 3 (1) ◽  
pp. 1-17 ◽  
Author(s):  
V. B. Narayanamurthy ◽  
Richa Poddar ◽  
R. Periyasamy
Keyword(s):  
Pressure Distribution ◽  
Biomechanical Properties ◽  
Distribution Parameter ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Wear Properties ◽  
History Of ◽  
Protective Sensation ◽  
Index Value ◽  
Loss Of Protective Sensation

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination.A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation.In this study we found newPRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

scholarly journals Influenza Vaccination in Coronavirus Times: Intention to Be Vaccinated by Primary Care Professionals in Central Catalonia (VAGCOVID)

2021 ◽  
Author(s):  
Raquel Muñoz-Miralles ◽  
Anna Bonet-Esteve ◽  
Anna Rufas Cebollero ◽  
Xavier Pelegrin Cruz ◽  
Josep Vidal Alaball
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Health Professionals ◽  
Online Survey ◽  
Health Workers ◽  
Cross Sectional ◽  
History Of ◽  
Primary Care Professionals

Abstract BackgroundInfluenza vaccination is the main measure of prevention against the epidemic flu, which annually produces a significant increase in the pressure on healthcare systems, in addition to influencing the absenteeism of health workers. Although it is recommended that health professionals be vaccinated, their vaccination coverage is low. The lack of knowledge about the evolution of influenza in the context of the SARS-CoV-2 coronavirus pandemic led to the continued recommendation of influenza vaccination to people at risk and to professionals. The aim of the study is to determine the intention to vaccinate against seasonal flu of health professionals in the 2020-21 campaign in the context of the SARS-CoV-2 pandemic, and to analyse the factors that influence it.MethodsCross-sectional study through a structured online survey aimed at Primary Care professionals in the region of central Catalonia.ResultsA total of 610 participants responded to the survey, 65.7% of whom intended to be vaccinated against the flu in this campaign and 11.1% did not yet know or did not answer. The intention to be vaccinated against flu is associated with the professional category, the years of professional practice, the fact of making face-to-face guards, and the perception of the risk of suffering from flu. It is also related to a history of influenza vaccination in the previous year and to having been vaccinated on another occasion. The profile of professionals who intend to be vaccinated against flu includes professionals with a history of vaccination, who were on duty and perceived that their staff were at risk of becoming ill with flu.ConclusionsDuring the SARS-CoV-2 pandemic, many professionals show a clear intention to get vaccinated against the flu, but there are still some who doubt it. In order to improve influenza vaccination coverage among health professionals, it is necessary to design strategies aimed at professionals who are hesitant or reluctant to vaccination.

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

2018 ◽  
pp. 444-460
Author(s):  
V. B. Narayanamurthy ◽  
Richa Poddar ◽  
R. Periyasamy
Keyword(s):  
Pressure Distribution ◽  
Biomechanical Properties ◽  
Distribution Parameter ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Hypertrophic Response ◽  
History Of ◽  
Protective Sensation ◽  
Index Value ◽  
Loss Of Protective Sensation

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination. A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation. In this study we found new PRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

scholarly journals Social Determinants Predict Outcomes in Data From a Multi-Ethnic Cohort of 20,899 Patients Investigated for COVID-19

2020 ◽  
Vol 8 ◽  
Author(s):  
Dara J. Lundon ◽  
Nihal Mohamed ◽  
Anna Lantz ◽  
Heather H. Goltz ◽  
Brian D. Kelly ◽  
...  
Keyword(s):  
At Risk ◽  
New York ◽  
Social Determinants ◽  
Disease Burden ◽  
Close Contact ◽  
Cross Sectional ◽  
History Of ◽  
Race Ethnicity ◽  
Sectional Analysis ◽  
Zip Code

Importance: The COVID-19 pandemic exploits existing inequalities in social determinants of health (SDOH) in disease burden and access to healthcare. Few studies have examined these emerging disparities using indicators of SDOH.Objective: To evaluate predictors of COVID-19 test positivity, morbidity, and mortality and their implications for inequalities in SDOH and for future policies and health care improvements.Design, Setting, and Participants: A cross sectional analysis was performed on all patients tested for COVID-19 on the basis of symptoms with either a history of travel to at risk regions or close contact with a confirmed case, across the Mount Sinai Health System (MSHS) up until April 26th 2020.Main Outcomes and Measures: Primary outcome was death from COVID-19 and secondary outcomes were test positivity, and morbidity (e.g., hospitalization and intubation caused by COVID-19).Results: Of 20,899 tested patients, 8,928 tested positive, 1,701 were hospitalized, 684 were intubated, and 1,179 died from COVID-19. Age, sex, race/ethnicity, New York City borough (derived from first 3 digits of zip-code), and English as preferred language were significant predictors of test positivity, hospitalization, intubation and COVID-19 mortality following multivariable logistic regression analyses.Conclusions and Relevance: People residing in poorer boroughs were more likely to be burdened by and die from COVID-19. Our results highlight the importance of integrating comprehensive SDOH data into healthcare efforts with at-risk patient populations.

scholarly journals Wives and Mothers at Risk: The Role of Marital and Maternal Status in Criminal Activity and Incarceration

2009 ◽  
Vol 90 (3) ◽  
pp. 293-300 ◽  
Author(s):  
Marianne Berry ◽  
Toni Johnson ◽  
Margaret Severson ◽  
Judy L. Postmus
Keyword(s):  
At Risk ◽  
Young Children ◽  
Criminal Activity ◽  
Economic Crime ◽  
Violent Crimes ◽  
Cross Sectional ◽  
The Social ◽  
History Of ◽  
Maternal Status

As the numbers of women entering prison are increasing, more attention is being paid to the social circumstances of criminally involved women. Crime research has highlighted the familial roles of women more than men, focusing on the social and personal roles of women. This study examines a cross-sectional sample of 423 women in one state, assessing the associations of motherhood and intimate partnership with criminal activity. The study finds that criminal activity, particularly economic crime, is highly related to motherhood. Economic crime is predicted by having a higher number of young children, while both economic and violent crimes are predicted by a woman's history of victimization; marriage does not reduce these risks.

Evaluation of Risk Factors Associated with Diabetic Foot Ulcers in Saudi Arabia

2019 ◽  
Vol 15 (3) ◽  
pp. 224-232 ◽  
Author(s):  
Mousab Yousef Al-Ayed ◽  
Mutasem Ababneh ◽  
Asirvatham Alwin Robert ◽  
Ahmed Salman ◽  
Abdulghani Al Saeed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Foot Ulceration ◽  
Factors Associated ◽  
Vascular Insufficiency ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Age Range

<P>Background and Aims: Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers. The selected participants were interviewed and examined, and their medical records were reviewed for sensory, vibratory, and painful neuropathies; vascular insufficiency; retinopathy; and dermatological variations. The Wagner’s classification system was employed to evaluate the stage of patients’ foot ulcers. Results: Among the study participants [mean age range: 56.4 ± 6.72 years; 53 males (65.4%)], cases of loss of protective sensation, foot deformity, amputation history, and dermatological abnormalities were notable. The Wagner gradation value of ulcers were grade 0 for 16% study population, grade 1 for 35.8%, grade 2 for 45.7%, grade 3 for 2.5%, and grades 4 and 5 for 0%. Approximately 19% of the patients had a previous case of amputation and 29.6% had nail disease. The most common footwear reported to be used by the patients was sandals shoes (46%). Conclusion: The issues of loss of protective sensation, vascular insufficiency, deformity, previous amputations, and dermatological abnormalities of the lower limbs were found to be most common among the foot ulceration patients. The study findings thus recommend regular foot examination, following basic hygiene habits, encouragement of the use of appropriate footwear, patient education about foot ulcers, and prompt treatment for minor injuries to prevent further ulceration in DM patients.</P>

scholarly journals Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0211140
Author(s):  
Alex L. Barwick ◽  
Sheree E. Hurn ◽  
Jaap J. van Netten ◽  
Lloyd F. Reed ◽  
Peter A. Lazzarini
Keyword(s):  
At Risk ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Foot Ulceration ◽  
Factors Associated ◽  
Populations At Risk

Do US Veterans Wear Appropriately Sized Shoes?

2006 ◽  
Vol 96 (4) ◽  
pp. 290-292 ◽  
Author(s):  
Brent P. Nixon ◽  
David G. Armstrong ◽  
Christopher Wendell ◽  
Jefferey R. Vazquez ◽  
Zinoviy Rabinovich ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Odds Ratio ◽  
Total Population ◽  
Medical Literature ◽  
Etiologic Factor ◽  
High Risk Population ◽  
Foot Ulceration ◽  
Shoe Size ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Poorly fitting footwear has frequently been cited as an etiologic factor in the pathway to diabetic foot ulceration. However, we are unaware of any reports in the medical literature specifically measuring shoe size versus foot size in this high-risk population. We assessed the prevalence of poorly fitting footwear in individuals with and without diabetic foot ulceration. We evaluated the shoe size of 440 consecutive patients (94.1% male; mean ± SD age, 67.2 ± 12.5 years) presenting to an interdisciplinary teaching clinic. Of this population, 58.4% were diagnosed as having diabetes, and 6.8% had active diabetic foot ulceration. Only 25.5% of the patients were wearing appropriately sized shoes. Individuals with diabetic foot ulceration were 5.1 times more likely to have poorly fitting shoes than those without a wound (93.3% versus 73.2%; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–21.9; P = .02). This association was also evident when assessing only the 32.3% of the total population with diabetes and loss of protective sensation (93.3% versus 75.0%; OR, 4.8; 95% CI, 1.1–20.9; P = .04). Poorly fitting shoes seem to be more prevalent in people with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. This implies that appropriate meticulous screening for shoe-foot mismatches may be useful in reducing the risk of lower-extremity ulceration. (J Am Podiatr Med Assoc 96(4): 290–292, 2006)

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