Diabetic neuropathic foot ulcers and amputation

A neuropathic foot ulcer is a severe complication of diabetes that can result in a more severe complication, a lower extremity amputation. We conducted a cohort study of 24,616 individuals with a diabetic neuropathic foot ulcer treated within a multicenter wound care network. A total of 1653 (6.7%) individuals had an amputation and 46.3% of these amputations were of a toe or ray (minor amputation). In the more than 10-year follow-up period that we studied, the percentage of those who had an amputation varied between 5.6% and 8.4%. Of those who had an amputation, the percentage that had a minor amputation increased over time from 4.0% in the earliest years to more than 60% in the later years of observation. The single most important determinant of amputation was the observation of fascia, tendon, and bone at the initial assessment. In conclusion, about 7% of those with a diabetic neuropathic foot ulcer will have an amputation and in the past 10 years there has been a remarkable increase in the number of minor as compared to major amputations.     

Sleep Problems in Two-Year-Olds

The parents of children aged between 18 and 32 months attendinga south-west London general practice were asked to completea questionnaire and diary about their child's sleep behaviour.Of the 142 parents approached, 116 (82%) responded and 99 completedboth the sleep diary and questionnaire. One-quarter of the respondentswere found to be troubled by their child's sleeping patterns.Analysis showed that the children of these parents had moredisturbed sleeping-waking rhythms, and slept less time bothduring the day and night compared with the children of parentswho had no complaints about the child's sleeping pattern. Nodemographic or social factors were found to be associated withdisturbed sleep patterns. However, children with sleep problemswere less often given an attachment object at bedtime, lessoften cuddled on waking at night and more often taken into theirparents' bed than other children. These findings raise the possibilitythat modification of the way parents handle the child with sleepproblems might effect an improvement in the child's sleep.     

Patient Characteristics Associated with the Labelling of Asthma

Patient characteristics associated with the asthma label wereinvestigated in 262 children, aged 8 years, who reported wheezingillness in the previous 12 months. Children were first identifiedby a screening questionnaire administered to the parents ofall 8 year old schoolchildren in Croydon, south London. Interviewswere conducted with those reported to have had a wheezing illnessin the previous 12 months to obtain details of the child's illness,medical care, demographic and socioeconomic characteristics.Multivariate analysis showed that the likelihood of being labelledasthmatic was increased in those who had a parental historyof hayfever [odds ratio (OR) = 2.24, 95% confidence interval(Cl) = 1.22–4.14] or at least two allergic provoking factors(OR = 3.83, 95% Cl = 1.44–10.15). No significant associationswere found between asthma labelling and children's socioeconomiccharacteristics or use of general practitioner services. Thesefindings suggest that wheeze is likely to be labelled asthmawhen the clinical history suggests an allergic aetiology.