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PubMed1994

Evaluation of the costs to Medicare of covering therapeutic shoes for diabetic patients.

OBJECTIVE: A three-year demonstration was fielded in three states to evaluate the cost to Medicare of a therapeutic shoes benefit for Medicare Part B beneficiaries with severe diabetic foot disease. RESEARCH DESIGN AND METHODS: Eligible Medicare beneficiaries who applied were randomly assigned to either a treatment group that received the extra therapeutic shoe coverage or a control group that received only standard Medicare coverage. This study analyzes the Medicare payments and service use of 3,428 demonstration participants in California, Florida, and New York for whom data on a 12-month follow-up period were available. These results are comparable to those for the entire sample over a variable length follow-up period that averaged 20 months but ranged from 3 months to 3 years. RESULTS: Differences between groups are not statistically significant. However, Medicare payments for all services among the treatment group were $451 (3.8%) higher than those for all services among the control group. Similarly, Medicare payments for foot-care services were $318 (14.6%) higher among beneficiaries in the treatment group, which considerably exceeded the cost of the shoe benefit ($118). CONCLUSIONS: The demonstration produced no definitive evidence that expanding Medicare Part B to cover therapeutic shoes for beneficiaries with severe diabetic foot disease would increase total Medicare costs. However, our findings indicate that the demonstration was successful at increasing therapeutic shoe ownership and was instrumental in increasing beneficiaries' use of the shoes when walking outdoors.

Aged↗
PubMed2002

Development and performance of inactivated vaccines against foot and mouth disease.

The historical background of foot and mouth disease (FMD) vaccine production is briefly described. Improvements achieved through the use of monolayer and suspension cultures are outlined. Elements that are crucial in the production of modern vaccines are discussed, such as inactivation of viral antigen, successive concentration and purification of the antigen and the final formulation of the vaccine. Storage of concentrated antigen at ultra-low temperatures creates greater flexibility for the producer and has also enabled national and international organisations to establish vaccine banks. The purification of FMD viral antigens, including the removal of non-structural proteins (NSPs), enables the immune responses of vaccinated animals to be distinguished from the responses of animals infected with live FMD virus. Consequently, the combined use of purified vaccine and tests for the detection of antibodies against NSPs essentially provides a marker system to distinguish between vaccinated animals that subsequently become infected and those that have not. Bearing in mind the good record of modern vaccines in the control of outbreaks and the possibility of screening vaccinated herds for carriers, the author proposes that the OIE reconsider the differences between the requirements for regaining export status following the use of stamping-out as opposed to vaccination in outbreak situations.

Animals↗
PubMed2006

Epidemiological and aetiological study on tinea pedis and onychomycosis in Algeria.

Epidemiological studies on tinea pedis and onychomycosis, common fungal infections, have been conducted in many parts of the world. There are currently no studies of tinea pedis and/or onychomycosis in Algeria. The aim of this paper was to study the epidemiology of foot diseases, including tinea pedis and onychomycosis and to identify the aetiological factors of these infections in outpatients attending the Department of Dermatology of the Central Hospital of Army in Algiers, Algeria. A total of 1300 male subjects, mean age 35.9 +/- 16 years (range: 16-80) were recruited during the period November 2003 to November 2004 and were clinically examined. A complete dermatological examination was performed on all subjects, and skin and nail specimens of the feet were taken from those patients presenting signs of tinea pedis and/or onychomycosis for microscopy and fungal culture. Clinical diagnosis for tinea pedis and onychomycosis was suspected in 249 and 72 subjects, respectively, and confirmed in 197 and 60 cases, respectively, by positive cultures, resulting in a global prevalence of tinea pedis and toenail onychomycosis of 15% and 4.6% respectively. The age groups most commonly infected were 50-59 and 20-29 years. The yeast species Candida parapsilosis and the dermatophytic species Trichophyton rubrum were shown to be the most common pathogens in both tinea pedis (C. parapsilosis 20.4%; T. rubrum 17%) and onychomycosis (T. rubrum 35%; C. parapsilosis 28.3%). This is the first investigation dealing with fungal foot diseases in Algeria. The clinical and epidemiological data collected would serve as reference for future research and may be useful in the development of preventive and educational strategies.

Adolescent↗
PubMed1998

Hand, foot, and mouth disease: a case report.

Hand, foot, and mouth disease is a viral infection related to coxsackieviruses A5, A6, A9, and A10, coxsackieviruses B2 and B5, and echovirus 11. It generally affects children, but this article presents a clinical case of a young woman with hand, foot, and mouth disease. Patients with this disease have oral and skin lesions that may be confused with other diseases. The differential diagnosis is very important because both dental and medical professionals may misdiagnose the disease and sometimes prescribe an inappropriate medication.

Adult↗
PubMed2000

International approach to eradication and surveillance for foot-and-mouth disease in the Americas.

Foot-and-mouth disease (FMD) was introduced into the Americas in 1870. At that time the disease was described simultaneously in the North coast of the United States of North America, the Province of Buenos Aires in Argentina, the central region of Chile, Uruguay, and South Brazil. At the beginning of the twentieth century the disease spread to the rest of Brazil, Bolivia, Paraguay, and Perú. In 1950 the disease was introduced into Venezuela, and in the same year to Colombia, and from there to Ecuador. The United States of America eradicated an outbreak of FMD in 1929. Outbreaks of FMD were also eradicated from Mexico in 1947 and from Canada in 1952. The last outbreak that occurred in Mexico in 1954 was also eradicated. In 1951 the Americas Animal Health Authorities decided to establish a Pan-American Foot-and-Mouth Disease Center (PANAFTOSA), initially as a special program within the American States Organization (OAS). The center was later transferred to the Pan-American Health Organization (PAHO). In the early 1970s PANAFTOSA developed a proposal for a continental surveillance system for vesicular diseases, which was approved by Agriculture Ministers at an International Meeting for FMD and Zoonoses (RICAZ). Since then, PANAFTOSA dedicated all efforts to collaborate with each country in the implementation of the system and to receive, analyze, and distribute a weekly report of vesicular diseases. The model was elaborated using coordinate grid maps, one for the South American Continent, others for each country in the region. The reports from each country consist of the grid location for any suspicious outbreak of vesicular disease. Using the information gathered during visits to the countries, as well as weekly reports, and by studying the most frequent animal movements within the region, PANAFTOSA developed a proposal for FMD eradication. This plan was approved by the Government of South America and implemented in cooperation with PANAFTOSA. The hemispheric plan for FMD eradication (PHEFA), has been implemented and today Chile and Uruguay are FMD free without vaccination; Argentina, Paraguay, and the states of Rio Grande do Sul and Santa Catarina in Brazil are also recognized by the OIE to be FMD Free, with vaccination. The use of the continental surveillance system is the main strategy for achieving the eradication of FMD in South America. At this time PANAFTOSA is working to improve the system, and to add other diseases indicated by the governments of the Americas.

Animals↗
PubMed1986

Vasospastic tendency and Raynaud's phenomenon in smelter workers exposed to arsenic.

The long-term drinking of water with a high content of inorganic arsenic can lead to Raynaud's phenomenon, acrocyanosis, and gangrene of the lower legs ("black foot disease"). We have measured the systolic blood pressure in the finger after local cooling in 47 workers from a copper smelter who were habitually exposed to moderate amounts of arsenic dust. The controls were 48 workers not exposed to arsenic. The concentration of inorganic arsenic including its metabolites in urine was determined. We found a difference between As-exposed workers and the controls in the finger systolic pressure at skin temperatures of 10 degrees C and/or 15 degrees C expressed as a percentage of the pressure at 30 degrees C (FSP%), P less than 0.01; and the prevalence of Raynaud's phenomenon, P less than 0.05. A low FSP% was taken to indicate vasospastic tendency. There was a covariation between the duration of exposure to arsenic and the decrease in finger systolic pressure between the measurements at 30 and 10 degrees C (P less than 0.05). The uptake of arsenic at the time of the study probably did not exceed 300 micrograms/day. This was confirmed by estimation of the urinary excretion. The average total arsenic uptake was estimated to be about 4 g over 23 years, which is less than the total uptake of 20 g of arsenic by subjects who developed black foot disease. Increased vasospastic reactivity in the fingers and Raynaud's phenomenon in smelter workers seems to be due to functional alterations in the vessels caused by inhalation of arsenic.

Adult↗
PubMed2002

Foot and mouth disease: the experience of South Africa.

Foot and mouth disease (FMD) is endemic in African buffalo (Syncerus caffer) in the Kruger National Park (KNP) and surrounding game parks in South Africa. The last outbreak of the disease in domestic stock outside the FMD control zone occurred in 1957. Due to the success in containing the disease, the country was accorded zone freedom from FMD without vaccination by the Office International des Epizooties (OIE: World organisation for animal health) in 1995. This status was lost in September 2000 when the first-ever recorded case of serotype O in South Africa was diagnosed in a piggery in KwaZulu-Natal after the illegal feeding of untreated swill. In November 2000, an outbreak of FMD caused by serotype South African Territories (SAT) 1 was diagnosed in a feedlot within the free zone of Mpumalanga Province. The SAT 1 outbreak was traced to cattle in the FMD control zone south of the KNP after the game-proof fence surrounding the KNP was severely damaged by floods. This enabled buffalo to come into direct contact with cattle outside the KNP. A further outbreak caused by SAT 2 was diagnosed within the FMD control zone in February 2001, also as a result of buffalo having escaped from the KNP. All these outbreaks were successfully contained, with the re-instatement of zone freedom from FMD without vaccination by the OIE in May 2002. These outbreaks made it necessary to re-examine the methods of control and containment of FMD that have been practised for many years and which are in line with accepted international practices. The authors describe the rationale for the different control strategies that were followed, the need for a multidisciplinary approach to disease control, the interface between control and technological and diagnostic support and the lessons learned. Some suggestions for future control strategies are also offered.

Animals↗
PubMed2003

Vaccines and foot-and-mouth disease eradication in South America.

Foot-and-mouth disease (FMD) vaccines have been a component of disease control and eradication strategies in South America ever since the first national programmes were created in the 1960s. By the mid 1970s, with the aid of international loans, FMD control programmes were implemented in almost every country and control measures strengthened. Livestock production forms are still a determining factor in the spread and prevalence of FMD and regional control/eradication strategies based on these forms were developed during the 1980s, as part of the Hemispheric Plan for FMD Eradication, developed by Panaftosa-PAHO/WHO and the South American countries. The widespread use of oil-adjuvant vaccines and the development of strategic schemes of coverage were instrumental in decreasing clinical disease and in controlling FMD to a point that eradication could be sought. This resulted in the recognition of countries and regions as free with and without vaccination Reappearance of FMD in Argentina, Southern Brazil and Uruguay were controlled with the aid of mass vaccination of bovines and other susceptible species, under special circumstances. Clinical FMD has been absent from Uruguay since August 2001; from Argentina since January 2002 and from Rio Grande do Sul, Brazil since July 2001. To prevent reintroduction of FMDV into free areas, national programmes must stress primary prevention activities with regional approaches and vaccination campaigns based on homogeneous coverage and timing, especially along international borders.

Animals↗
PubMed1994

The epidemiology of foot-and-mouth disease: implications for New Zealand.

Foot-and-mouth disease is an acute, highly communicable disease affecting cloven-hoofed animals, both domesticated and wild. It may well be the most contagious disease known in the animal kingdom. The key features that contribute to this include its ability to gain entry and initiate infection through a variety of sites, the small infective dose, the short incubation period, the release of virus before the onset of clinical signs, the massive quantities of virus excreted from infected animals, its ability to spread large distances due to airborne dispersal, and the persistence of the virus in the environment. These features, plus the ability of the virus to be disseminated through the movements of animals, animal products, people, and plant and equipment makes the disease very difficult to control. New Zealand has never experienced a foot-and-mouth disease epidemic, and the economic consequences of an outbreak would be disastrous, due to the eradication costs, the loss of productivity and the impact on the export of animals and animal products. The smuggling of meat products, embryos or semen into the country are perceived as the most likely ways in which the disease could be introduced. The New Zealand Ministry of Agriculture and Fisheries therefore operates a two-tier system of defense against foot-and-mouth disease. The first tier involves border protection through stringent import controls to prevent the entry of infectious material. If this barrier is breached, an emergency response programme is activated, involving a stamping-out eradication strategy. This paper attempts to draw on overseas historical outbreak experiences and research findings to gain insights into the epidemiology of foot-and-mouth disease as it would relate to New Zealand.

Journal Article↗
PubMedDate not supplied

Foot care assessment in patients with diabetes: a screening algorithm for patient education and referral.

The foot care behaviors of patients with diabetes were assessed by medical history, and their feet were examined for peripheral neuropathy, peripheral vascular disease, foot ulcers, and deformities. The sample consisted of 136 patients (14 with insulin-dependent diabetes and 122 with non-insulin-dependent diabetes). Mean age was 61 years and mean duration of diabetes was 13 years. Peripheral vascular disease was found in 25% of the patients, peripheral neuropathy in 33%, and 13% had both peripheral vascular disease and peripheral neuropathy. Potentially unsafe nail and foot care practices were identified, suggesting that routine diabetes care may not provide sufficient foot care education and follow-up for all patients. A screening algorithm was developed to provide guidelines for individualizing foot care education and referral of patients with diabetic foot disease. The recommendations included annual diabetes foot care assessments and education for those at low risk for foot amputation, intensive foot care education and more frequent follow-up for individuals with peripheral neuropathy or peripheral vascular disease, and referral to a foot care specialty clinic for individuals with peripheral neuropathy and peripheral vascular disease, or foot ulcers.

Adult↗
PubMed1999

Foot-and-mouth disease: current world situation.

Foot-and-mouth disease (FMD) has increased in significance as a major constraint to international trade in live animals and animal products as the World Trade Organization agreements remove other obstructions. A consequence will be reluctance to immediately declare the presence of FMD if it is thought possible to quickly eliminate its presence and so avoid trade embargoes. This will predispose to spread of disease between trading partners. In addition, as countries tend to increase the requirements for testing and certification of imported animals with the objective of reducing the risk of importing disease, the increased costs and delays that this involves will encourage the illegal trade and therefore have the converse result.

Africa↗
PubMed1999

Predicting the level of herd infection for outbreaks of foot-and-mouth disease in vaccinated herds.

Foot-and-mouth disease (FMD) is a highly contagious virus infection of sheep, goats, cattle, pigs and other, non-domesticated species of artiodactyls, and causes both clinical and subclinical infection according to the natural or acquired immunity of the host. Within vaccinated dairy herds FMD may appear as an acute, mild or subclinical infection, dependent upon the immune status of the herd, the level of challenge and the efficacy of the vaccine used. In the large dairy herds of Saudi Arabia, sub-clinical FMD was on a number of occasions, found to have spread amongst the cattle before signs of disease were seen. Such undetected transmission resulted in a large incidence on the first day of diagnosis and curtailed the impact of post-outbreak vaccination (PoV). First day incidence (FDI) for these herds was found to correlate with the final cumulative incidence of clinical disease. Since FDI is available at the start of an outbreak it can be used as a predictive tool for the eventual outcome of an FMD outbreak. During the past 11 years 47 % of dairy herds examined in Saudi Arabia have experienced FMD initially as sub-clinical disease. For the remaining 53 %, waning vaccinal protection did not suppress clinical disease in the initially infected animals, and these showed severe rather than mild signs. Hence, in such herds there was a very low initial level of subclinical infection, so PoV was more effective, and the timing of PoV was found to give a good correlation with cumulative herd incidence: an early PoV resulted in low prevalence of clinically infected animals whilst late PoV permitted high prevalence. PoV timing can thereby be used in tandem with FDI as a predictive tool for future outbreaks, estimating the final cumulative incidence (or prevalence) of clinical FMD cases.

Animals↗
PubMed2002

Decision-support tools for foot and mouth disease control.

Recent experience with foot and mouth disease (FMD) has shown that large and very costly epidemics can occur in countries considered extremely unlikely to experience the disease. The consequences of an introduction are much more severe than in the past and effective control is more difficult to achieve. Few countries have developed effective risk management strategies and information-based response systems to respond to these developments. The authors describe the tools which can be employed to minimise the impact of a disease incursion, using the example of FMD. To make such systems effective, the development of a national farms database in advance, including geo-referencing, is highly desirable. This greatly enhances the power of the decision-support tools, which can then be applied as soon as a serious disease incursion has been detected. These tools include procedures to detect infected farms promptly, to protect as yet uninfected farms against exposure to virus and to manage control policies. Epidemiological evaluation and prediction tools have advanced particularly rapidly and can guide the choice of control policies during an outbreak. Integrated decision-support systems offer the best method of managing FMD outbreaks to minimise the cost and size of the epidemics.

Animal Husbandry↗
PubMed2002

Future research on foot and mouth disease.

The recent outbreaks of foot and mouth disease (FMD) in Argentina, Europe, Japan, the Republic of Korea, South Africa and Uruguay have brought to world attention the devastating effects of the disease in a naïve population and the social and economic costs of control and eradication. The fact that much still remains unknown about the natural history of FMD virus came as a surprise to some. This paper attempts to identify where research should be directed in order to be better prepared in the future.

Animals↗
PubMed1988

The long-term care of non-insulin-dependent diabetes.

The long term management of non-insulin-dependent diabetes falls into two categories: first, the supervision of glycaemic control; and second, the detection of complications, risk factors and their management. To aid the former, home/self monitoring is essential. Patients need to record their results so that they can be reviewed by their physician. At the same time, treatment including diet can be modified to improve control and education about diabetes can be continued. An annual screen is required to detect the long term complications of diabetes: retinopathy; nephropathy; macrovascular disease; neuropathy; and diabetic foot disease. The early detection of these complications is important to gain maximal benefit from available treatment. The care of non-insulin-dependent diabetics requires skillful organization and in most health districts represents a considerable workload.

Diabetes Mellitus, Type 2↗
PubMed2005

Pathogenesis of foot ulcers and the need for offloading.

Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

Casts, Surgical↗
PubMed1991

Anaerobic pathogenesis: collagenase production by Peptostreptococcus magnus and its relationship to site of infection.

Fifty isolates of Peptostreptococcus magnus from intraabdominal sepsis, nonpuerperal breast abscess, and diabetic foot infections were examined for collagenase activity using bovine type I collagen. Collagenase production was detected in a higher percentage of strains from nonpuerperal breast and diabetic foot specimens (P less than .001). This enzyme may be responsible for P. magnus playing a more central role in the pathogenesis of nonpuerperal breast abscess and diabetic foot disease than in intraabdominal sepsis.

Abscess↗