Search Results (17)

Flooding is one of the most persistent and destructive natural hazards in West Virginia. However, community-scale assessments that connect social vulnerability with physical flood vulnerability are still limited. Existing floodplain management plans often focus on infrastructure and hydrology, overlooking how socioeconomic disparities shape resilience. This study assesses flood resilience in West Virginia communities by connecting socioeconomic vulnerability with physical flood vulnerability. Using data from the American Community Survey (ACS) and state floodplain maps, we developed a Socioeconomic Vulnerability Index (SEVI) and combined it with physical indicators, such as the percentage of residential buildings in the 100-year floodplain, the share of mobile homes in flood-prone areas, the presence of essential facilities and community assets within flood zones, and the proportion of roads submerged by at least one foot of water. Incorporated and unincorporated communities were analyzed separately to reflect differences in governance and service capacity. The results reveal that high flood vulnerability areas often coincide with high socioeconomic vulnerability, especially in the southern and southeastern counties, where long-term economic decline has increased risks. Communities like McDowell and Mingo face a combined challenge of social and physical vulnerability, adding pressure to populations already dealing with limited resources. These findings emphasize the importance of integrated resilience planning that combines physical protection with social support. Considering the increasing intensity of extreme precipitation events associated with climate change, these findings also highlight the importance of incorporating long-term climate considerations into flood resilience planning. Policy suggestions include expanding targeted flood insurance subsidies for low-income households, prioritizing the relocation or retrofitting of mobile homes and essential facilities, investing in green and open spaces, and encouraging community-based mitigation strategies. Together, these actions can lower long-term flood risks while addressing structural inequalities that make certain populations more vulnerable. Full article

Green spaces in subtropical cities are important for providing ecological services that support human well-being and serve as reservoirs for diverse microbial communities, which in turn support ecosystem functions. However, studies on the characteristics of the phyllosphere microbial community and public health risks associated with putative pathogens in various urban green spaces exposed to anthropogenic stress remain limited. To address this gap, we collected leaf samples from forests, greenbelts, parklands, and wetlands across Wuhan, China, and analyzed the bacterial and fungal communities via next-generation sequencing (NGS) techniques. For bacterial and fungal communities, alpha diversity was significantly greater in low-traffic zones than in high-traffic zones. Beta diversity analysis revealed distinct clustering of bacterial and fungal communities according to the urban green space type. Anthropogenic factors (foot traffic) influence green space type to shape microbial community structure, function, and stability, with shifts significantly associated with soil physicochemical properties via Mantel tests and redundancy analysis. The relative abundance of Enterobacter and Enterococcus was significantly greater in high-intensity parklands (HIPS) and high-intensity greenbelts (HIGS) (41.84, 38.32%), respectively. Our findings provide important information for the sustainable management of urban green spaces by regulating microbial communities, offering new insights into ecosystem health and human well-being. Full article

Background: Foot injuries are common among Umrah pilgrims due to prolonged walking, overcrowded conditions, and inadequate preventive measures, such as inappropriate footwear or walking barefoot. Despite their potential impact on mobility and overall pilgrimage experience, these conditions remain underreported and insufficiently addressed in public health strategies. Objectives: This study aims to assess the prevalence and types of foot problems among Umrah pilgrims, examine their associations with demographic characteristics and comorbidities, analyze the utilization of medical attention for foot pain, and assess the use of preventive measures to reduce foot-related health risks during the pilgrimage. Methods: A cross-sectional study was conducted throughout the 2024 G (1445 H) Umrah season at the Grand Mosque, Makkah. The study recruited 1138 Umrah pilgrims aged 18 and older who performed the pilgrimage. A structured questionnaire was administered to collect data on demographic characteristics, chronic diseases, foot conditions, medical-attention-seeking behavior, and preventive practices. Pilgrims with pre-existing foot conditions were excluded from participation. Results: Foot diseases were reported by 46% of participants. The most common foot injuries included sprains/strains (18.7%) and muscle pain/cramps (4.9%), with the leg and forefoot being the most affected areas. Significant associations were observed between foot diseases and lower education levels (p = 0.03), chronic liver disease (p = 0.04), and cardiovascular disease (p = 0.04). Despite the high prevalence of foot-related conditions, only 9.6% sought medical attention, and 14.9% reported using preventive measures. Conclusions: The study highlights a substantial burden of foot problems among Umrah pilgrims, with limited utilization of healthcare services and preventive strategies. Targeted interventions, including educational campaigns and improved screening for high-risk individuals, are essential for enhancing foot health and ensuring a safer pilgrimage experience. Full article

The livestock sector is a significant contributor to the economy and rural livelihoods, but it is exposed to high risk across the supply chain, which is detrimental and needs to be addressed for sustainable development. Therefore, this study aimed to identify the major risk mitigation strategies (RMSs) and associated factors that affect their adoption. This study conducted a comprehensive literature review to identify the eight major RMSs and prioritized them through an analytical hierarchical process (AHP). Thereafter, a multivariate probit (MVP) model was developed to identify the factors affecting the adoption of major RMSs. The primary RMSs are livestock insurance, vaccination of livestock, and advisory/extension services. Further, the multivariate probit regression analysis shows that ‘age’, ‘social category’, ‘economic status’, ‘educational level’, ‘income level’, ‘the total number of animals’, and ‘perceived risk of foot and mouth disease’ are significant factors that influence the adoption of RMSs. This study’s findings will be useful for livestock supply chain partners to mitigate the risks along the livestock supply chain. This research will also help policymakers to develop policies/plans for incorporating these RMSs by considering the influencing associated factors. Full article

Foot and ankle disorders are a very common diseases, represent a risk factor for falls in older people, and are associated with difficulty performing activities of daily living. With an increasing demand for cost-effective and high-quality clinical services, wearable technology can be strategic in extending our reach to patients with foot and ankle disorders. In recent years, wearable sensors have been increasingly utilized to assess the clinical outcomes of surgery, rehabilitation, and orthotic treatments. This article highlights recent achievements and developments in wearable sensor-based foot and ankle clinical assessment. An increasing number of studies have established the feasibility and effectiveness of wearable technology tools for foot and ankle disorders. Different methods and outcomes for feasibility studies have been introduced, such as satisfaction and efficacy in rehabilitation, surgical, and orthotic treatments. Currently, the widespread application of wearable sensors in clinical fields is hindered by a lack of robust evidence; in fact, only a few tests and analysis protocols are validated with cut-off values reported in the literature. However, nowadays, these tools are useful in quantifying clinical results before and after clinical treatments, providing useful data, also collected in real-life conditions, on the results of therapies. Full article

Background: Studies have shown that personal and economic reasons determine whether clinicians use diagnostic technology in their routine clinical biomechanical practice. This study aimed to identify the biomechanical management plan of local clinicians in relation to management of the diabetic high-risk foot and to investigate whether diagnostic technology is being used to determine the effectiveness of dispensed prescription orthoses in view of ulcer prevention. Methods: A mixed-methodologic approach was adopted in this study. A retrospective quantitative study was also conducted to access records of patients attending the biomechanics clinic at a local health biomechanics clinic. Outcomes of interest included the number and percentage of patients attending the biomechanics clinic, source of referral to this clinic, age and gender of patients, clinical diagnosis, management plan, and referral pathway. Following a phenomenologic approach, four experienced clinicians working in the private, primary, and tertiary health sectors were interviewed. Thematic analysis was used to analyze and interpret data. Results: Only low-risk patients living with diabetes mellitus were referred for a comprehensive biomechanical examination; the majority were referred by podiatrists. There was no record of diabetic high-risk patients being referred for a detailed biomechanical assessment within the health service. This study also confirmed that, because of the expenses and laborious work involved when using diagnostic technology to assess foot pressures, interviewed clinicians based their treatment plan and tested the efficiency of dispensed offloading devices on the basis of clinical experience and visual observation only. Conclusions: Waiting for signs of ulceration can be too late for the high-risk foot. A change in clinical practice is recommended where the integration of diagnostic technology, together with standard care, in view of ulcer prevention is warranted. (J Am Podiatr Med Assoc 113 (5), 2023) Full article

Individuals with end-stage kidney disease (ESKD) on dialysis are at a high risk of developing foot ulcerations and undergoing subsequent lower extremity amputation (LEA), which can exert significant impacts on their quality of life and contribute to rising healthcare costs. We aimed to identify risk factors associated with LEA in patients with ESKD to predict LEA progression and eventually prevent it. We used 18 years (2002–2019) of data from the Korean National Health Insurance Service (KNHIS). Data were collected from patients with ESKD who underwent renal replacement therapy (RRT) and had no history of amputation caused by trauma or toxins. The risk factors were compared between patients with or without LEA. We collected data from 220,838 patients newly diagnosed with ESKD, including 6348 in the LEA group and 214,490 in the non-LEA group. The total incidence of LEA was 2.9%. Older age, male gender, lower income, non-metropolitan residence, diabetes mellitus, dialysis treatment (compared to kidney transplantation), microvascular disease, peripheral vascular disease, endovascular procedure, and endovascular operation were associated with an increased risk of LEA. Thus, individuals with ESKD who are at a higher risk for LEA should be closely monitored, and kidney transplantation should be considered as a preventative measure. Full article

The existing Scoggins Dam and reservoir are in Washington County, Oregon, and the title is held by the U.S. Bureau of Reclamation (Reclamation). Reclamation has previously identified dam safety concerns related to the existing embankment dam. Regional project sponsors, including Clean Water Services, have identified the need for expanded storage capacity in the reservoir to meet growing water demands and address water quality issues in the Tualatin River downstream of the dam. As part of efforts to resolve dam safety issues and increase the water storage in the reservoir, a comprehensive feasibility level design of a new 185-foot-high Roller Compacted Concrete (RCC) dam. Extraordinary seismic hazards have been identified in the region associated with the Cascadia Subduction Zone (CSZ). Further, any dam alternative carried forward for funding, final design, and construction will have to meet the Public Protection Guidelines (PPG) of Reclamation that require a formal quantitative risk analysis. A risk-informed design approach was adopted to configure the layout and cross-section properties of the dam. A multi-phase site characterization program and preliminary RCC mix design program were performed to support the design. In addition, models were developed, and an extensive suite of both (two-dimensional) 2D and (three-dimensional) 3D structural analyses were performed for seismic loadings with total durations of over 200 s, strong shaking of over 140 s, and peak ground accelerations of over 2 gravitational accelerations (g) (up to 50,000-year return period event). This paper describes the feasibility design configuration of the dam, including the seismic hazard characterization, structural analysis models, and seismic response modeling results. The expected performance of the dam relative to the risk-informed design criteria and Reclamation PPGs will be generally described. Full article

Background: Dietary intake is a recognised contributor to healing in diabetes-related foot ulceration (DFU). However, it is currently unknown how individuals with DFU perceive their diet, and what is deemed an acceptable dietary intervention. Therefore, the aims of this study were to explore perceptions of diet quality, previous dietary advice, and dietary interventions in individuals with DFU, and secondly to determine acceptable dietary interventions in individuals with DFU to assist with wound healing. Methods: A qualitative study using reflexive thematic analysis was undertaken. Individuals with active or recent history of DFU were recruited from a high-risk foot service. Semi-structured interviews were undertaken. Results: Nineteen participants were included with three themes identified: A complex relationship with food, perceptions of food, diet and dietitians, and self-management. Dietary misconceptions were common. Self-perceived diet quality varied, with most unaware of how diet could impact wound healing. Many expressed barriers relating to food agency (purchasing, preparing, and accessing food). Participants expressed a strong preference for personalised, face-to-face dietary advice and nutritional supplementation. Conclusions: There is a need for personalised dietary re-education and assistance with food agency in this cohort to overcome commonly held misconceptions of diet and improve dietary intake to facilitate wound healing. Full article

Diabetes-related foot disease (DFD) is a major public health concern due to the higher risks of hospitalisation. However, estimates of the prevalence of DFD in the general population are not available in Australia. This study aims to estimate the prevalence of DFD and diabetes-related lower-extremity amputation (DLEA) among people aged 45 years and over in New South Wales (NSW), Australia. The NSW 45 and Up Study baseline survey data of 267,086 persons aged 45 years and over, linked with health services’ administrative data from 2006 to 2012 were used in our study. Of these, 28,210 individuals had been diagnosed with diabetes, and our study identified 3035 individuals with DFD. The prevalence of DFD, diabetic foot ulcer (DFU), diabetic foot infection (DFI), diabetic gangrene (DG), and DLEA were 10.8% (95%CI: 10.3, 11.2), 5.4% (95% CI: 5.1, 5.8), 5.2% (95%CI: 4.9, 5.5), 0.4% (95%CI: 0.3, 0.5), and 0.9% (95%CI: 0.7, 1.0), respectively. DFD, DFU, DFI, DG, and DLEA were the most common among those who were older, born in Australia, from low-income households (<AUD 20,000), or were without private health insurance. Interventional messages to reduce all forms of DFD should target those who are from high-risk groups. Full article

Long-term future prediction of geographic areas with high rates of potentially preventable hospitalisations (PPHs) among residents, or “hotspots”, is critical to ensure the effective location of place-based health service interventions. This is because such interventions are typically expensive and take time to develop, implement, and take effect, and hotspots often regress to the mean. Using spatially aggregated, longitudinal administrative health data, we introduce a method to make such predictions. The proposed method combines all subset model selection with a novel formulation of repeated k-fold cross-validation in developing optimal models. We illustrate its application predicting three-year future hotspots for four PPHs in an Australian context: type II diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and “high risk foot”. In these examples, optimal models are selected through maximising positive predictive value while maintaining sensitivity above a user-specified minimum threshold. We compare the model’s performance to that of two alternative methods commonly used in practice, i.e., prediction of future hotspots based on either: (i) current hotspots, or (ii) past persistent hotspots. In doing so, we demonstrate favourable performance of our method, including with respect to its ability to flexibly optimise various different metrics. Accordingly, we suggest that our method might effectively be used to assist health planners predict excess future demand of health services and prioritise placement of interventions. Furthermore, it could be used to predict future hotspots of non-health events, e.g., in criminology. Full article

A topical desiccating wound agent containing methanesulfonic acid, dimethylsulfoxide and amorphous silica was evaluated in three in vitro models for its efficacy against biofilms produced by Pseudomonas aeruginosa (ATCC-15442) and Staphylococcus aureus (ATCC-6538). The in vitro biofilm models used were; the MBEC Assay^®, Centre for Disease Control (CDC) Biofilm Reactor^® and a Semi-solid biofilm model. A 30-s exposure of a topical wound desiccating agent was used in each model. A complete eradication of viable cells was demonstrated in all models for both strains (p < 0.0001). Imaging with scanning electron microscopy (SEM) was performed where possible. All three models demonstrated complete eradication of viable cells with a 30 s application of a topical wound desiccating agent. Full article

Background: To investigate the effect of negative pressure wound therapy (NPWT) with and without instillation (NPWTi) on in vitro mature biofilm. Methods: Mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus were grown under shear (130 rpm) on polycarbonate coupons in a CDC biofilm reactor for 3 days. Coupons containing biofilms were placed in a sterile petri dish and sealed using NPWT or NPWTi. Coupons were exposed to treatment for 24 h with NPWT alone or with instillation of: Povidone iodine solution (PVP-I) (10% w/v equivalent to 1% w/v available iodine, BETADINE^®, Mundipharma, Singapore), surfactant based antimicrobial solution with polyhexamethylene biguanide (SBPHMB) (Prontosan^®, B Braun Medical, Melsungen, Germany), Gentamicin 1 µg/mL (GM) (G1264 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) Rifampicin 24 µg/mL (RF) (R3501 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) and NaCl 0.9% (Baxter, Deerfield, IL, USA). Bacterial cell viability and biofilm architecture pre-and post-treatment were assessed using colony forming units (cfu), Live/Dead viability staining, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Results: Significant reductions were obtained in S. aureus biofilm thickness (65%) and mass (47%) when treated with NPWTi as compared to NPWT only. NPWTi with instillation of SBPHMB, PVP-I and RF achieved between 2 and 8 log₁₀ reductions against S. aureus biofilm (p < 0.05–0.001). Conversely, PVP-I and SBMO achieved a 3.5 log₁₀ reduction against P. aeruginosa (p < 0.05). Conclusions: NPWT alters biofilm architecture by reducing biofilm thickness and mass, but this does not affect bacterial cell viability. NPWT with instillation of certain antimicrobials solutions may provide a further synergistic effect in reducing the number of viable biofilm microorganisms. Our in vitro model may be used for screening the effectiveness of antimicrobials used under instillation prior to animal or human studies. Full article

Foot self-care is key in preventing morbidity in high-risk diabetic patients. Motivational interviewing (MI) is an approach to encourage behavior change by patients that can be used in medical settings. The goal was to explore how podiatric physicians promote self-care in such patients and whether they use MI techniques. We conducted a 19-question online survey of US-based practicing podiatric physicians. Most answers were on a 5-point scale. The MI index was the sum of answers to five relevant questions. Of 843 podiatric physicians, 86% considered foot self-care to be very important for high-risk diabetic patients, and 90% felt that it was their role to discuss foot self-care with them; 49% felt that they had training and were successful in promoting behavior change, but most were definitely (38%) or possibly (46%) interested in learning more. Only 24% of respondents scored at least 15 of 20 on the MI index. Higher MI scores were associated with more face time and more time discussing foot self-care but were not related to podiatric physicians' age, sex, geographic location, percentage of time in surgery, or years in practice. Reported barriers to counseling were lack of reimbursed time and poor patient engagement. Most podiatric physicians view self-care behavior among high-risk diabetic patients and their role in promoting it as very important; most feel already proficient, but only a few demonstrate MI skills; most are willing to learn more. Success in behavioral counseling, such as MI, is likely to require more time and may be encouraged by a move from fee-for-service to outcome-based reimbursement. Full article

Studies have shown that lower-extremity problems in the homeless population have significant public health and economic implications. A combined community service and research project was performed to identify and address the foot and ankle care needs in a sample homeless population in San Francisco, California. A 37-question survey regarding general demographic characteristics, foot hygiene practices, associated risk factors, and self-reported lower-extremity pathologic conditions was completed by 299 homeless individuals who met the inclusion criteria. The service project included education on proper foot care and the distribution of footwear. The participants demonstrated mostly good efforts regarding foot hygiene but had high-risk factors, including smoking, alcohol use, and extended hours on their feet. More than half of the homeless individuals surveyed experienced foot pain. Approximately one in five had edema and neuropathic symptoms. The most commonly reported foot problems were dermatologic, but these conditions could pose serious sequelae in the setting of risk factors. The community service project was well received by the homeless community. This study demonstrates lack of resources and high-risk factors for lower-extremity complications in the homeless individuals studied. It is important in the realm of public health to keep lower-extremity health in mind because it plays an important role in preventing the spread of infection and lowering the social economic burden. Full article