Impact médical hospitalier du pied diabétique en Suisse [Hospitalizations due to diabetic foot in Switzerland].

OBJECTIVE: Evaluate the hospital impact of diabetes, foot ulcers and amputations linked to diabetic foot in Switzerland. METHODS: Data from the medical statistics of Swiss hospitals between 2003 and 2008. RESULTS: Over 6 years, the annual hospital admission rate of diabetic patients increased by 38%, the number of hospitalised patients and of admissions by 44% and 51%, respectively. For ulcers, these figures were 112% and 194%, and for amputations 26% and 34%, respectively. Amongst patients hospitalised in 2005 with ulcer or for amputation, about 25% were hospitalised 2 years and 33% 1 year before or after. Length of stay decreased by 10%, but hospital mortality remained stable below 10%. CONCLUSION: Hospital admissions with diabetic foot problems are an important public health issue, and are getting worse.

Health management practices and disease prevalence in dairy sheep systems in Argentina

A cross-sectional survey of 19 dairy sheep farms in Argentina was carried out with the purpose to know farm management, health practices, and occurrence and mortality of diseases. The survey comprised 40% of all sheep milking farms in Argentina. A questionnaire was conducted by way of personal interviews with sheep owners during farm visits. The proportions of farms reporting routine vaccination for clostridial diseases, contagious ecthyma, pneumonia and mineral and vitamin parenteral administration were 63%, 47.3%, 16.6% and 42.1% respectively. Regular treatment against lice was used in 37.5% of the farms, and 89.5% o the farmers treated against gastrointestinal nematodes (GIN). The mean number of GIN drenches per farm was 2.26±1.78 annually. In 68.4% of the milking flocks the California Mastitis Test was regularly done and 55.6% of the farmer managers had sampled their flocks once a year for Brucella ovis antibodies. During the pre-mating period respectively 68.4% and 50% of farmers clinically examined their rams and ewe for general health and teeth condition. The udders of ewes were frequently inspected at the start of each milking period. The most important parasite problems noticed were GIN (reported by 57.9% of farmers), lice (57.9%) and scabies (10.5%) and the most frequent infectious diseases were ecthyma (73.7%), pneumonia and other respiratory problems (57.9%), clinical mastitis (55.6%), clostridial diseases (36.9%) and foot lameness (35.2%). Photosensitivity (47.4%) and ruminal acidosis (42.1%) were reported as other frequent toxic or metabolic disorders. Owners mentioned that the mean lifespan or milk productive time per ewe was 4.5±1.4 years. Perinatal lamb mortality was 8.5% and the total flock mortality rates, above the first 24 h of life was 6.9%. The high rates of lamb mortality during the pre-weaning (10.3%) and post-weaning (5.9%) periods indicate that this problem, as well as the most prevalent diseases, should be the subject of further studies.

Pathogens occuring in the winter pea-maize-winter wheat rotation, their host specificity and the potential of compost in suppressing foot and root disease of peas

The overall aim of the work presented was to evaluate soil health management with a specific focus on soil borne diseases of peas. For that purpose field experiments were carried out from 2009 until 2013 to assess crop performance and pathogen occurrence in the rotation winter pea-maize-winter wheat and if the application of composts can improve system performance. The winter peas were left untreated or inoculated with Phoma medicaginis, in the presence or absence of yard waste compost at rate of 5 t dry matter ha-1. A second application of compost was made to the winter wheat. Fusarium ssp. were isolated and identified from the roots of all three crops and the Ascochyta complex pathogens on peas. Bioassays were conducted under controlled conditions to assess susceptibility of two peas to Fusarium avenaceum, F. solani, P. medicaginis and Didymella pinodes and of nine plant species to F. avenaceum. Also, effects of compost applications and temperature on pea diseases were assessed. Application of composts overall stabilized crop performance but it did not lead to significant yield increases nor did it affect pathogen composition and occurrence. Phoma medicaginis was dominating the pathogen complex on peas. F. graminearum, F. culmorum, F. proliferatum, Microdochium nivale, F. crookwellense, F. sambucinum, F. oxysporum, F. avenaceum and F. equiseti were frequently isolated species from maize and winter wheat with no obvious influence of the pre-crop on the Fusarium species composition. The spring pea Santana was considerably more susceptible to the pathogens tested than the winter pea EFB33 in both sterile sand and non-sterilized field soil. F. avenaceum was the most aggressive pathogen, followed by P. medicaginis, D. pinodes, and F. solani. Aggressiveness of all pathogens was greatly reduced in non-sterile field soil. F. avenaceum caused severe symptoms on roots of all nine plant species tested. Especially susceptible were Trifolium repens, T. subterraneum, Brassica juncea and Sinapis alba in addition to peas. Reduction of growing temperatures from 19/16°C day/night to 16/12°C and 13/10°C did not affect the efficacy of compost. It reduced plant growth and slightly increased disease on EFB33 whereas the highest disease severity on Santana was observed at the highest temperature, 19/16°C. Application of 20% v/v of compost reduced disease on peas due to all four pathogens depending on pea variety, pathogen and growing media used. Suppression was also achieved with lower application rate of 3.5% v/v. Tests with γ sterilized compost suggest that the suppression of disease caused by Fusarium spp. is biological in origin, whereas chemical and physical properties of compost are playing an additional role in the suppression of disease caused by D. pinodes and P. medicaginis.

Foot and Ankle Consensus study 2012

Lucy Gates Study Introduction PPT

Food and Health Forum meeting - nutritional approaches to cardiovascular health: workshop report

This report summarises the proceedings of a meeting held by the Food and Health Forum at the Royal Society of Medicine, London, on 12 October 2011. The objective of the meeting was to highlight nutritional strategies targeted at cardiovascular health. This included a review of the effects of various foods, nutrients and ingredients on maintenance of healthy cholesterol levels, endothelial function and blood pressure

Foot-and-mouth disease in tropical wildlife

This review of foot-and-mouth disease in cloven-hoofed, free-living animals, describes the disease, the wide range of the hosts, the carrier state, and the interrelationship between disease in domestic livestock and wildlife. This information becomes even more crucial to the development of control strategies when linked to the process of pathogenesis and the epidemiology of the disease.

Implementation of physiotherapeutic shares in the prevention of diabetes complications in a Family Health Strategy

Introduction In the Family Health Strategy (FHS), the treatment of Diabetes Mellitus (DM) includes education and lifestyle change strategies. Physiotherapists have a key role in this health setting. Objectives To implement actions of evaluation and guidelines for patients with type 2 DM who attend a Family Health Strategy (FHS), regarding diabetic foot and the practice of regular physical exercise in the control and prevention of the complications of Diabetes Mellitus. Methods 17 individuals from an FHS were evaluated, with the following procedures: clinical and anthropometric parameters, inspection, a questionnaire on diabetic neuropathy, tests of vibratory and tactile sensitivity, muscle function, range of motion, functional analysis, questions about exercise practice and guidance regarding controlling blood glucose and foot care. Results Deformities, dry skin, calluses, dehydration, ulceration, cracking and brittle nails were found. Peripheral neuropathy was not observed; tactile sensitivity was altered in the heel region and the vibratory sense was absent in 5% of individuals. A decrease in functionality of ankle movements was verified. Of the participants, 76% were sedentary, 24% knew about the benefits of practicing regular exercise, 25% had undergone a medical evaluation prior to performing physical exercise and, of these, 25% were supervised by a qualified professional. Discussion The implementation of physiotherapy actions in diabetics from an FHS was important for highlighting the presence of risk factors for diabetic complications. Conclusions Individuals attending the FHS need more information and programs for the prevention of diabetic complications.

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial

Background: Polyneuropathy is a complication of diabetes mellitus that has been very challenging for clinicians. It results in high public health costs and has a huge impact on patients' quality of life. Preventive interventions are still the most important approach to avoid plantar ulceration and amputation, which is the most devastating endpoint of the disease. Some therapeutic interventions improve gait quality, confidence, and quality of life; however, there is no evidence yet of an effective physical therapy treatment for recovering musculoskeletal function and foot rollover during gait that could potentially redistribute plantar pressure and reduce the risk of ulcer formation. Methods/Design: A randomised, controlled trial, with blind assessment, was designed to study the effect of a physiotherapy intervention on foot rollover during gait, range of motion, muscle strength and function of the foot and ankle, and balance confidence. The main outcome is plantar pressure during foot rollover, and the secondary outcomes are kinetic and kinematic parameters of gait, neuropathy signs and symptoms, foot and ankle range of motion and function, muscle strength, and balance confidence. The intervention is carried out for 12 weeks, twice a week, for 40-60 min each session. The follow-up period is 24 weeks from the baseline condition. Discussion: Herein, we present a more comprehensive and specific physiotherapy approach for foot and ankle function, by choosing simple tasks, focusing on recovering range of motion, strength, and functionality of the joints most impaired by diabetic polyneuropathy. In addition, this intervention aims to transfer these peripheral gains to the functional and more complex task of foot rollover during gait, in order to reduce risk of ulceration. If it shows any benefit, this protocol can be used in clinical practice and can be indicated as complementary treatment for this disease.

Perception of social support by individuals with diabetes mellitus and foot ulcers

OBJECTIVE: To evaluate the perception of social support and the relationship of sociodemographic, clinical and metabolic control variables in individuals with diabetes mellitus and foot ulcers in an outpatient unit. METHODS: A quantitative cross-sectional approach was carried out using a social support network inventory. RESULTS: Participants had a high perception of social support; family and health professionals were identified as the main support sources. Fasting plasma glucose values were directly related with social support. CONCLUSION: Family members were identified as the main support source, which emphasizes their importance in the health care process.

Usage of complementary medicine across Switzerland. Results of the Swiss Health Survey 2007

QUESTIONS UNDER STUDY: This study investigated the use among the Swiss adult population and regional dissemination of various methods of complementary medicine (CM) provided by physicians or therapists in Switzerland. METHODS: Data of the Swiss Health Survey 2007 were used, which comprised a telephone interview followed by a written questionnaire (18,760 and 14,432 respondents, respectively) and included questions about people's state of health, health insurance and usage of health services. Users and non-users of CM were compared using logistic regression models. RESULTS: The most popular CM methods were homeopathy, osteopathy, acupuncture and shiatsu/foot reflexology. 30.5% of women and 15.2% of men used at least one CM method in the 12 months preceding the survey. Lake Geneva region and central Switzerland had more CM users than the other regions. Women, people between 25 and 64 years of age and people with higher levels of education were more likely to use CM. 53.5% of the adult population had a supplemental health insurance for CM treatments. 32.9% of people with such an insurance used CM during the 12 months preceding the survey, and so did 12.0% of people without additional insurance. CONCLUSIONS: Almost one fourth of the Swiss adult population had used CM within the past 12 months. User profiles were comparable to those in other countries. Despite a generally lower self-perceived health status, elderly people were less likely to use CM.

ANKLE IMPEDANCE AND ANKLE ANGLES DURING STEP TURN AND STRAIGHT WALK: IMPLICATIONS FOR THE DESIGN OF A STEERABLE ANKLE-FOOT PROSTHETIC ROBOT

During locomotion, turning is a common and recurring event which is largely neglected in the current state-of-the-art ankle-foot prostheses, forcing amputees to use different steering mechanisms for turning, compared to non-amputees. A better understanding of the complexities surrounding lower limb prostheses will lead to increased health and well-being of amputees. The aim of this research is to develop a steerable ankle-foot prosthesis that mimics the human ankle mechanical properties. Experiments were developed to estimate the mechanical impedance of the ankle and the ankles angles during straight walk and step turn. Next, this information was used in the design of a prototype, powered steerable ankle-foot prosthesis with two controllable degrees of freedom. One of the possible approaches in design of the prosthetic robots is to use the human joints’ parameters, especially their impedance. A series of experiments were conducted to estimate the stochastic mechanical impedance of the human ankle when muscles were fully relaxed and co-contracting antagonistically. A rehabilitation robot for the ankle, Anklebot, was employed to provide torque perturbations to the ankle. The experiments were performed in two different configurations, one with relaxed muscles, and one with 10% of maximum voluntary contraction (MVC). Surface electromyography (sEMG) was used to monitor muscle activation levels and these sEMG signals were displayed to subjects who attempted to maintain them constant. Time histories of ankle torques and angles in the lateral/medial (LM) directions, inversion-eversion (IE), and dorsiflexionplantarflexion (DP) were recorded. Linear time-invariant transfer functions between the measured torques and angles were estimated providing an estimate of ankle mechanical impedance. High coherence was observed over a frequency range up to 30 Hz. The main effect of muscle activation was to increase the magnitude of ankle mechanical impedance in all degrees of freedom of the ankle. Another experiment compared the three-dimensional angles of the ankle during step turn and straight walking. These angles were measured to be used for developing the control strategy of the ankle-foot prosthesis. An infrared camera system was used to track the trajectories and angles of the foot and leg. The combined phases of heel strike and loading response, mid stance, and terminal stance and pre-swing were determined and used to measure the average angles at each combined phase. The Range of motion (ROM) in IE increased during turning while ML rotation decreased and DP changed the least. During the turning step, ankle displacement in DP started with similar angles to straight walk and progressively showed less plantarflexion. In IE, the ankle showed increased inversion leaning the body toward the inside of the turn. ML rotation initiated with an increased medial rotation during the step turn relative to the straight walk transitioning to increased lateral rotation at the toe off. A prototype ankle-foot prosthesis capable of controlling both DP and IE using a cable driven mechanism was developed and assessed as part of a feasibility study. The design is capable of reproducing the angles required for straight walk and step turn; generates 712N of lifting force in plantarflexion, and shows passive stiffness comparable to a nonload bearing ankle impedance. To evaluate the performance of the ankle-foot prosthesis, a circular treadmill was developed to mimic human gait during steering. Preliminary results show that the device can appropriately simulate human gait with loading and unloading the ankle joint during the gait in circular paths.

Lameness and foot lesions in Swiss dairy cows: I. Prevalence.

Prevalences of foot lesions and lameness were recorded in 1'449 Swiss dairy cows during routine claw-trimming on 78 farms from June 2010 until February 2011. Lameness was present in 14.8 % of cows and on 80.8 % of investigated farms. Highest prevalences were seen for widened white line (80.7 %/100 %), signalling foot lesion (65.6 %/98.7 %), heel-horn erosion (34.2 %/88.5 %), digital dermatitis complex (29.1 %/73.1 %), severe hemorrhages (27.9 %/87.2 %), and Rusterholz' sole ulcers (11.5 %/74.4 %) at cow and herd level, respectively. Lower prevalences were found for subclinical laminitis (5.4 %/47.4 %), chronic laminitis (3.3 %/25.6 %), white line disease (4.7 %/42.3 %), double soles (2.6 %/33.3 %), interdigital hyperplasia (3.1 %/33.3 %), sole ulcers (0.4 %/6.4 %), toe infections caused by faulty claw-trimming (3.9 %/39.7 %) and by injury (0.1 %/2.6 %), deep lacerations (0.4 %/6.4 %), and interdigital phlegmona (0.1 %/1.3 %). Lameness and foot lesions were shown to represent important health problems of dairy cows under the conditions of the typical grass-based production system in Switzerland. Digital dermatitis has developed to the most relevant foot disease with a high impact on welfare of Swiss dairy cows within the past 10 years.

Lameness and foot lesions in Swiss dairy cows: II. Risk factors.

The objective of this study was to evaluate risk factors associated with foot lesions and lameness in Swiss dairy cows. Potential risk factors were recorded by means of examination of 1'449 Swiss cows and the management systems of 78 farms during routine claw-trimming, and during personal interviews with the associated farmers. Statistical analysis of animal-based and herd level risk factors were performed using multivariate logistic regression models. The risk of being lame was increased in cows affected by digital dermatitis complex, heel-horn erosion, interdigital hyperplasia, Rusterholz' sole ulcer, deep laceration, double sole and severe hemorrhages. Cleanliness, BCS, affection with other foot lesions, breed, importance of claw health to the farmer, frequency of routine claw-trimming, producing according to the guidelines of the welfare label program RAUS, and silage feeding were shown to be associated with the occurrence of some of the evaluated foot lesions and lameness. The identified risk factors may help to improve management and the situation of lameness and claw health in dairy cows in Switzerland and other alpine areas with similar housing and pasturing systems.