The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: Development of an evidence-based global consensus

Foot problems complicating diabetes are a source of major patient suffering and societal costs. Investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure, provided it is goal-focused and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has been publishing and updating international Practical Guidelines since 1999. The 2015 updates are based on systematic reviews of the literature, and recommendations are formulated using the Grading of Recommendations Assessment Development and Evaluation system. As such, we changed the name from 'Practical Guidelines' to 'Guidance'. In this article we describe the development of the 2015 IWGDF Guidance documents on prevention and management of foot problems in diabetes. This Guidance consists of five documents, prepared by five working groups of international experts. These documents provide guidance related to foot complications in persons with diabetes on: prevention; footwear and offloading; peripheral artery disease; infections; and, wound healing interventions. Based on these five documents, the IWGDF Editorial Board produced a summary guidance for daily practice. The resultant of this process, after reviewed by the Editorial Board and by international IWGDF members of all documents, is an evidence-based global consensus on prevention and management of foot problems in diabetes. Plans are already under way to implement this Guidance. We believe that following the recommendations of the 2015 IWGDF Guidance will almost certainly result in improved management of foot problems in persons with diabetes and a subsequent worldwide reduction in the tragedies caused by these foot problems.

Quarantine and surveillance strategies for plant pathogen detection and control

Incursions of plant pests and diseases pose serious threats to food security, agricultural productivity and the natural environment. One of the challenges in confidently delimiting and eradicating incursions is how to choose from an arsenal of surveillance and quarantine approaches in order to best control multiple dispersal pathways. Anthropogenic spread (propagules carried on humans or transported on produce or equipment) can be controlled with quarantine measures, which in turn can vary in intensity. In contrast, environmental spread processes are more difficult to control, but often have a temporal signal (e.g. seasonality) which can introduce both challenges and opportunities for surveillance and control. This leads to complex decisions regarding when, where and how to search. Recent modelling investigations of surveillance performance have optimised the output of simulation models, and found that a risk-weighted randomised search can perform close to optimally. However, exactly how quarantine and surveillance strategies should change to reflect different dispersal modes remains largely unaddressed. Here we develop a spatial simulation model of a plant fungal-pathogen incursion into an agricultural region, and its subsequent surveillance and control. We include structural differences in dispersal via the interplay of biological, environmental and anthropogenic connectivity between host sites (farms). Our objective was to gain broad insights into the relative roles played by different spread modes in propagating an invasion, and how incorporating knowledge of these spread risks may improve approaches to quarantine restrictions and surveillance. We find that broad heuristic rules for quarantine restrictions fail to contain the pathogen due to residual connectivity between sites, but surveillance measures enable early detection and successfully lead to suppression of the pathogen in all farms. Alternative surveillance strategies attain similar levels of performance by incorporating environmental or anthropogenic dispersal risk in the prioritisation of sites. Our model provides the basis to develop essential insights into the effectiveness of different surveillance and quarantine decisions for fungal pathogen control. Parameterised for authentic settings it will aid our understanding of how the extent and resolution of interventions should suitably reflect the spatial structure of dispersal processes.

A psychosocial analysis of parent's decisions for limiting their young child's screen time: An examination of attitudes, social norms and roles, and control perceptions

- Objectives Preschool-aged children spend substantial amounts of time engaged in screen-based activities. As parents have considerable control over their child's health behaviours during the younger years, it is important to understand those influences that guide parents' decisions about their child's screen time behaviours. - Design A prospective design with two waves of data collection, 1 week apart, was adopted. - Methods Parents (n = 207) completed a Theory of Planned Behaviour (TPB)-based questionnaire, with the addition of parental role construction (i.e., parents' expectations and beliefs of responsibility for their child's behaviour) and past behaviour. A number of underlying beliefs identified in a prior pilot study were also assessed. - Results The model explained 77% (with past behaviour accounting for 5%) of the variance in intention and 50% (with past behaviour accounting for 3%) of the variance in parental decisions to limit child screen time. Attitude, subjective norms, perceived behavioural control, parental role construction, and past behaviour predicted intentions, and intentions and past behaviour predicted follow-up behaviour. Underlying screen time beliefs (e.g., increased parental distress, pressure from friends, inconvenience) were also identified as guiding parents' decisions. - Conclusion Results support the TPB and highlight the importance of beliefs for understanding parental decisions for children's screen time behaviours, as well as the addition of parental role construction. This formative research provides necessary depth of understanding of sedentary lifestyle behaviours in young children which can be adopted in future interventions to test the efficacy of the TPB mechanisms in changing parental behaviour for their child's health.