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Nursing practice guideline for foot care for patients with diabetes in ThailandNamwong, Tassamon January 2014 (has links)
Although medical practice guidelines for diabetic foot care exist globally, there is no clear guideline for nurses to direct clinical foot care practices for diabetic patients in Thailand. The purposes of this qualitative study were to explore the current practice of diabetic foot care and to develop a nursing practice guideline for effective foot care. The research design included two phases, consisting of situation exploration and practice guideline development. For the first phase, semi structured interviews were conducted among fifteen diabetic patients, five nurses, and five nurse educators at Prapokklao hospital, Thailand to discover their knowledge and practice in foot care. A content analysis approach was used in data analysis. The findings revealed that, although foot care education was available, diabetic patients lacked knowledge and had poor foot self-care practice. Nurses and educators also had inadequate knowledge about effective diabetic foot care and they had scarcely ever provided advanced practice for foot care. Moreover, patients had not been categorised regarding their foot risk level, nor had they received appropriate levels of foot care to manage their particular situations. For the second phase, a nursing practice guideline was developed. The classical Delphi technique was applied to examine experts’ agreement on the practice guideline contents. A questionnaire was developed, based on the first phase’s information and critical literature review using Soukup’s model. Twenty diabetic foot care experts from around Thailand completed the questionnaire. The acceptance of experts’ agreement was 94-100% in all aspects. A final guideline was developed which consisted of the initial risk assessment of foot ulceration and specific guidance on the interventions. This guideline, based upon local specialist expert opinion, provides a clear resource for referral and standardised procedures for evaluating footwear and screening to detect the risk of foot complications. In conclusion, this current nursing practice guideline for diabetic foot care was the first guideline for Thai nurses to care for diabetic patients in a Thai cultural context, and is based on local specialist experts’ opinion. This foundation work provides the basis for further research and evaluation concerning the prevention of foot complications and foot management for diabetic patients, including evaluating the effectiveness of the current risk assessment form and risk classification procedures.
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Effects of instruction on knowledge and practices of foot care in diabeticsWalker, Sherrie K. January 2001 (has links)
The purpose of this study was to determine if there was a difference in physical selfconcept due to level of physical activity or the subject's frame of reference. Participants included female students in two HSC-160 courses and members of the Ball State University women's softball, field hockey, and basketball teams in the fall of 2000. The study was conducted using a demographic questionnaire, the Physical Self-Description Questionnaire (PSDQ), and a physical activity log. Subjects received instructions to complete the PSDQ comparing themselves to either someone more physically fit or less physically fit. Subjects chose one of three physical activity levels, nonparticipant, exercisers, or athlete, based on definitions given on the demographic questionnaire. Results of the study indicated that as the level of physical activity increased, so did physical self-concept scores. Results did not find a significant difference in frame of reference and level of physical activity. / School of Nursing
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Using Cellphones to Advance Diabetic Foot Care Practice: A Review of the LiteratureFang, Qiuna 01 January 2020 (has links)
Preventing diabetic foot ulcers among patients diagnosed with diabetes is an important element of care as diabetic foot ulcers present major medical, psychosocial and economic threats. In addition, about 20% of the diabetic foot ulcer cases will ultimately require amputation and cause greater mortality rates. The purpose of this literature review was to evaluate cellphone use to promote diabetic foot care practices among patients with diabetes. Six electronic databases were searched for articles which included text messaging and or phone interventions geared at improving foot care practices. A total of 14 articles dated 2009-2019 met the inclusion criteria and were included in the review. Cellphone use for text messaging and phone calls to advance diabetic foot care practices appears to be promising. Cellphone interventions among clients diagnosed with diabetes were found to have higher adherence with foot examinations, more frequent foot checks, and better overall performance score of diabetic foot ulcer preventive behaviors. This literature review supports cellphone use for text messaging and phone calls to improve diabetic foot care practices. Particularly among populations with health disparities and limited access to healthcare cellphone improves access to care, is uncomplicated and presents a cost-effective approach to improving diabetic foot care practices.
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Healthcare workers' perceptions on diabetic foot ulcers (DFU) and foot care in Fiji: a qualitative studyRanuve, M.S., Mohammadnezhad, Masoud 05 August 2022 (has links)
Yes / To explore the perception of healthcare workers (HCWs) on diabetic foot ulcers (DFU) and foot care in Rotuma, Fiji.
Using a qualitative study design, two focus group discussions (FGDs) were conducted among HCWs. A semistructured open-ended questionnaire was used to guide the discussion session. Each FGD was audiorecorded and was transcribed. The transcriptions were then manually analysed using thematic analysis.
Rotuma hospital, Fiji.
HCWs who were working in Rotuma hospital for at least a year and were involved in clinical foot care of type 2 diabetes mellitus patients were included.
There were five main themes, namely, depth of knowledge, quality of care in practice, factors of influence on practice, lack of resources and capacity building. Participants had superficial knowledge that showed lack of in-depth scientific knowledge. A lack of staffing in the clinics affected the delivery of service. Additionally, patients defaulting clinics, late presentations with DFU and traditional medicine also affected the quality of healthcare service in clinics. There was also a need for a multidisciplinary team to prevent and manage DFU. HCWs mostly advised on glycaemic control and ignored offering foot care advice in clinics due mainly to the lack of sound knowledge on foot care. There was also a lack of resources, infrastructure, space and professional development opportunities, which negatively impacted how HCWs deliver foot care services to patients.
HCWs lack significant in-depth knowledge on DFU and foot care. In addition, these are the availability of traditional medicine that delays presentations to hospital, further reducing the quality of services. HCWs need to keep their knowledge and skills updated through regular in-service training on foot care. Resources, infrastructure and supply chains need to be maintained by those in power to ensure HCWs deliver quality foot care services.
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Comunicação participativa: a chave para o ensino no cuidado dos pés do paciente diabético / Participatory communication: The basis for the teaching of foot care in the diabetic patientRodriguez, Ma. Del Carmen Perez 20 December 2007 (has links)
Entre 40 e 70% das amputações em extremidades inferiores são relacionadas à diabetes, e 85% estão precedidas de ulcera no pé. A transcendência e a gravidade desta complicação permitem considerar que o ensino para a pessoa com diabetes deve ter por finalidade, a incorporação de habilidades que o capacite para o auntocuidado, de forma integrada com a sua escala de valores. Sendo assim, o presente estudo teve como objetivo validar a efetividade de um programa de ensino fundamentado na comunicação participativa, com enfoque nos cuidados com os pés, das pessoas com diabetes mellitus tipo 2. Trata-se de um estudo quaseexperimental, desenvolvido em dois grupos, um experimental e outro controle, formados aleatoriamente. No grupo controle, o programa de ensino foi baseado no método tradicional e no grupo experimental na comunicação participativa. As variáveis dependentes foram: hábitos de cuidado, conhecimentos sobre a doença; dados antropométricos e laboratoriais e condições dos pés. Os dados foram obtidos por meio de entrevista e exame físico, em três momentos: antes do inicio e no final do programa de ensino e outro após seis meses decorridos ao término da intervenção. Cada grupo foi constituído por 77 participantes, com media de idade de 52 anos, sendo o maioria do sexo feminino (90%), com escolaridade no ensino fundamental incompleto (76,6% grupo experimental e 81,8% grupo controle) e ocupação atividades domésticas (90%). Observose que no grupo experimental 40,3% e no grupo controle 42,9% apresentavam também hipertensão arterial. O teste de Qui-quadrado mostrou que não existiu diferencia significativa entre os grupos com relação a estas características. A comparação dos programas ao largo do tempo, em relação a cada variável, foi realizada pela metodologia de análise multivariada de perfis. Para avaliar o efeito de cada programa (antes e após o curso) e retenção do aprendizado (após o curso e depois de seis meses) utilizaram - se o teste t de Student. Cinco as variáveis (hábitos de cuidados, conhecimentos, resultados de laboratório, interrogatório e exame fisco) apresentam perfis distintos (p<0,001), constatando-se que o programa do ensino baseado na comunicação participativa é melhor do que o de metodologia tradicional. Para a variável somatometría as técnicas de intervenção produzirem efeitos semelhantes. / Between 40 and 70% of lower limb amputations occur from causes related to diabetes and 85% are preceded by an ulcer on the foot. The significance and gravity of this complication might argue that education for the diabetic person is intended to be trained to self-care, integrating it into his value system. For this reason this study was formulated with the aim to validate the effectiveness of a learning program based on participatory communication on foot care for people who suffer from diabetes mellitus of type 2. It is a quasi-experimental study developed into 2 groups, that is an experimental group and a control group consisting of randomly selection. In the control group, the education program was based on the traditional method of education and the experimental group the education program was based on participatory communication. The dependent variables were: care habits, knowledge about the disease, laboratory tests, anthropometric measurements, laboratory results and conditions of the feet. The data were collected through interviews and physical examination, in 3 stages: Before the start of the intervention, at the end of the program and six months after the intervention. Each group was formed by 77 members, with an average age of 52, most of them female (90%) with incomplete elementary education (76.6% experimental group and control group 81.8%), and the predominant occupation was: work from home (90%). For the diagnosis was observed 40.3% of the people in the experimental group and 42.9% of people in the control group, in addition to diabetes they were hypertension. The chi square test showed that there were no significant differences in relation to these features. The comparison of the programs over time, in relation to each variable was done through the method of multivariate analysis of profiles. To evaluate the effect of each program (before and after the course) and the retention of what they have learned (at the end of the course and after 6 months) was used Student\'s t test. Five of the variables (habits of care, knowledge about the disease, laboratory tests, interrogation and physical condition of the feet) had different profiles (p<0,001), noting that the education program based on participatory communication is better than based on the traditional methodology. To the variable \"somatometry\", the two methods produced similar effects. In all of the variables, in both groups, there was a slight decrease in the retention of knowledge after six months.
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Knowledge and practices regarding foot care among patients with Type 2 diabetes in Ho Chi Minh City, Vietnam : A quantitative studyThunberg, Stina, Hellenberg, Sofia January 2013 (has links)
Introduction: Previous research shows that knowledge and practice was low in type 2 diabetes patients and that women had better practice/self-care than men. Aim: The aim of this study was to investigate the knowledge and practices regarding foot-care among patients with type 2 diabetes in Ho Chi Minh City, Vietnam, and also investigate if there was any difference between genders in knowledge and practicing of foot care. Method: This study was a descriptive and cross-sectional design with quantitative method. The data was collected at the out-patient clinic of the University Medical Center in Ho Chi Minh City, Vietnam and 100 patients participated voluntarily to answer questionnaire. Orem’s self-care theory was used as theoretical framework. Data were analysed by using statistics. Result: The result shows that more than 70% of the patients had good knowledge of foot care and no significant differences between the genders in the knowledge. Their foot care practices were various. There was significant difference between men and women about using a hot water bottle or heating pad on the feet, and more women than men did. For type of shoes, there were differences between genders in wearing broad, round toes and shoes made of leather or canvas, and more men than women did. Conclusion: The knowledge of foot care was good, but the practice of foot care was low. There was not found any significant difference between the genders in knowledge, but some differences in the foot care practices. More information about foot care is needed to prevent complications with type 2 diabetes. / Introduktion: Tidigare forsknings resultat visar att kunskapen om egenvård och utförande av fotvård hos patienter med diabetes typ 2 var låg. Kvinnorna var dock bättre på att utföra egenvården än männen. Syfte: Syftet med denna studie var att undersöka kunskapen och utförandet av egenvård hos patienter med diabetes typ 2 i Ho Chi Minh City, Vietnam, samt att undersöka om det fanns några skillnader mellan män och kvinnor i kunskapen om egenvård inom fotvård samt dess utförande. Metod: För att undersöka detta gjordes en kvantitativ tvärsnittsstudie med hjälp av enkäter. Det var 100 patienter på en mottagning vid University Medical Center, Ho Chi Minh City, Vietnam, som deltog frivilligt. Orems egenvård teori användes som teoretiskt ramverk i detta arbete. Data analyserades av statistik. Resultat: Resultatet i denna studie påvisar att mer än 70 % av patienternas visade god kunskap och inga signifikanta skillnader fanns mellan kvinnor och män gällande kunskapsnivån. Utförandes av fotvården visade sig dock vara varierande och det fanns signifikanta skillnader mellan kvinnor och män gällande fotvården. Kvinnor använde sig oftare av varma pads och flaskor på deras fötter än vad männen gjorde. Kvinnor och män använde också olika typer av skor. Männen använde oftare breda skor med rundad tå, skor av läder eller canvas skor än vad kvinnorna gjorde. Slutsats: Kunskapen om fotvård hos diabetes patienter i Ho Chi Minh City var god, dock var utförandet av fotvården varierande i denna studie. Det visades ingen signifikant skillnad mellan kvinnor och män angående kunskapsnivån, dock fanns det skillnader angående utförandet av fotvården. Det behövs fortsatt information om fotvård för att patienter med typ 2 diabetes ska förhindra komplikationer
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Thermografische Ermittlung physiologischer Wärmeprofile und pedografische Untersuchungen an den Extremitäten sowie Haltungsanalysen beim Asiatischen Elefanten (Elephas maximus) in menschlicher ObhutSchmidt-Burbach, Jan 26 June 2009 (has links) (PDF)
Im Zuge systematisch durchgeführter thermografischer Untersuchungen an 95 Asiatischen Elefanten in europäischen Zoos konnten physiologische Wärmeprofile aller nicht von Fußkrankheiten betroffener Elefanten erstellt werden. Um eine objektivere Befundung zu ermöglichen, wurden dafür definierte Messbereiche an den Füßen festgelegt und deren Temperaturdaten als Wärmekurven für jeden Zeh dargestellt. Es zeigte sich, dass die Bandbreite von Temperaturen gleicher Messbereiche starken individuellen Schwankungen unterliegt, weshalb eine Befundung nicht anhand absoluter Temperaturwerte erfolgen sollte. So wurden über gleichen Messbereichen unterschiedlicher Elefanten Temperaturunterschiede von bis zu 8 °C festgestellt. Auch die Umgebungsfaktoren während der Untersuchung tragen zu dieser Varianz bei. Bei Umgebungstemperaturen zwischen 17,5 °C und 23 °C stellt sich durch Erhöhung der Außentemperatur um 1 °C eine um 0,5 °C erhöhte Wärmeabstrahlung über der Haut dar. Eine Erhöhung der Luftfeuchte um 1 % verursacht eine um 0,03 °C vermehrte Wärmeabstrahlung. Die Wärmeprofile stellten sich für die Kronsaum- und Hufwandbereiche der Zehen eines Fußes von medial nach lateral in einem parabelförmigen Verlauf dar, wobei die höchsten Temperaturen an den kranialen Zehen gemessen wurden. Die Differenz zwischen Kronsaum- und Hufwandbereichen blieb dabei konstant. Die Temperaturen der Zehenregion oberhalb des Kronsaums folgten nicht dieser Parabelform, lagen aber, außer an der jeweils medialen Seite, konstant unterhalb der Kronsaumtemperaturen. Bei Vergleich mit thermografischen Befunden erkrankter Zehen zeigte sich meist ein starker Anstieg der Zehenregiontemperatur weit über die Kronsaumtemperaturen hinaus, weshalb sich dieses Verhältnis als Indiz für ein akutes Enzündungsgeschehen nutzen lässt. Ein gleichmäßiges Wärmeprofil, welches möglichst dicht dem in dieser Arbeit entwickelten Profil gleicht und konstante Temperaturdifferenzen zwischen den einzelnen Messbereichen aufweist, ist ein gutes Indiz für einen gesunden Fuß. Thermografische Befundungen sollten immer mit Hilfe herkömmlicher visueller Auswertung und zusätzlich der Erstellung eines Wärmeprofils vorgenommen werden, um die Subjektivität zu minimieren. Erstmalig wurden in dieser Arbeit drei Elefanten mittels Pedografie untersucht, um Aufschlüsse über die Druckverteilung unter dem Elefantenfuß zu erhalten. Wie bei Menschen und pedografisch vermessenen Rindern fanden sich auch beim Elefanten charakteristische Druckprofile. Druckspitzenwerte tauchten hierbei vor allem im kranialen Bereich der Füße als Druckleiste, aber auch im kaudalen Bereich in Form zweier Druckpfeiler auf. Experimente mit einer Methode zur Simulierung weicheren Untergrundes schienen die Druckspitzenwerte etwas abzuschwächen und das allgemeine Druckprofil einzuebnen, waren aber nur schwer auszuwerten. Die Methode eignet sich ebenso zur Erfassung der tatsächlich belasteten Fläche der Füße, welche sich bei stärkerer Belastung, beispielsweise dreibeinigem Stehen, vergrößerte. Trotz noch einiger methodischer und technischer Probleme, eröffnet sich mit der Pedografie ein sicherlich lohnenswertes Forschungsfeld für weitere Studien, die einen besseren Einblick in die Druckphysiologie des Elefantenfußes gewähren könnten. Weiterhin wurden in dieser Arbeit Daten der Elefantenhaltungssysteme von 17 besuchten europäischen Zoos, sowie Daten über Häufigkeit und Art der Gliedmaßenkrankheiten und anderer gesundheitlicher Parameter aller 95 untersuchter Elefanten ausgewertet. Hierbei zeigte sich immer noch starker Verbesserungsbedarf im Hinblick auf Innengehegegrößen und die verwendeten Bodenmaterialien. Auch Bewegungsprogramme für den Aufenthalt im Außengehege wurden nur in weniger als der Hälfte der Zoos eingesetzt. Positiv fiel auf, dass die Elefanten in den besuchten Zoos kaum noch angekettet werden und falls doch, nur kurzzeitig zu Untersuchungszwecken. Den Daten der Haltungsanalysen entsprechend, fielen die Auswertungen zur Fußgesundheit aus: Nur 36 % der untersuchten Elefanten litten bisher noch niemals unter Fußerkrankungen. Allein zum Zeitpunkt der Untersuchung wurden bei 27 % der Tiere akute Erkrankungen festgestellt, die unter Behandlung standen. Hierbei handelte es sich hauptsächlich um Abszesse oder andere entzündliche Veränderungen im Bereich des Nagelbetts. Weiterhin wurden 30 % der Elefanten als übergewichtig eingeschätzt und 36 % der Tiere zeigten stereotype Bewegungsmuster. / A total of 95 Asiatic Elephants in 17 European zoos were systematically examined using a high resolution thermographic camera and physiologic heat profiles of elephant’s feet without known foot diseases were established. To allow a more objective evaluation of thermographic findings, the feet and toes were divided schematically into defined areas for measurement purposes, based on anatomical features for which the temperature data was then plotted to produce heat curves for each area. Measurements of temperatures pertaining to similar areas of different elephants showed strong individual fluctuation. Temperature variation was as high as 8 °C in similar areas between elephants. Thus, evaluation of thermographic findings should never be based on absolute temperature readings alone. This strong variation is partly caused by environmental factors during the examination. With environmental temperatures between 17,5 °C and 23 °C, a one degree increase of this temperature will cause a 0,5 °C increase of the heat radiation of the feet. An increase of air humidity by 1 % will cause an increase of 0,03 °C of the measured thermographical heat radiation. The physiological heat profiles for coronary and hoof wall areas of the toes showed an arched, parable-like shape when plotted from the medial over the cranial to the lateral toes. The highest temperature readings were found on the cranial toes. The difference between coronary and hoof wall temperatures of similar toes were constant all over the foot. The physiological heat profiles of the toe areas above the coronary region did not show this arched shape but stayed below the coronary temperature readings except on the medial toe. On comparison with thermographic findings of inflammated toes, a strong increase of this area above the coronary band was found which exceeded the temperature of the coronary region. This characteristic can be used as an indicator for acute inflammations. A regular heat profile, which resembles closely the physiological heat profile created in this study and which shows constant temperature differences between the defined areas of the single toes, is a good indicator of healthy foot. It is recommended that thermographic examinations always are evaluated using conventional observation of the heat patterns in conjunction with the additional creation of a heat profile to minimize subjectivity by the clinician. For the first time three elephants were examined in this study using a new pedographic method to gain information on the pressure distribution below the elephant’s foot. As found in humans as well as in pedographically examined cows, the pressure distribution in elephant’s feet showed a characteristic profile. Pressure peaks showed up especially in the cranial area of the foot, possibly the border between sole and pad, as well as in the caudal region in the shape of two pressure pillars. Experiments with a method to simulate softer ground seemed to lower the pressure peaks slightly in favor of a broader distribution, but were very difficult to evaluate, especially considering the small sample size. This method is also suited to register the actual area size put under pressure by the elephant, which was shown to rise under increased pressure, e. g. three legged standing. Despite some encountered methodical and technical problems, pedography of elephants is going to be a very promising field for further scientific studies in order to acquire more information on the physiology of pressure distribution. Data on husbandry conditions of the 17 visited zoos and as well as data on frequency and type of foot diseases and other health parameters of all 95 examined elephants were also collected and evaluated. A strong need for improvement was observed in terms of enclosure sizes and the surface materials used in indoor enclosures. Also, daily routines to increase activity of the elephants in the outdoor enclosures were found to be carried out only in half of the visited zoos. On a positive note, elephants in the evaluated zoos were hardly ever chained and if so, only for examination purposes. According to the data of the husbandry evaluation the information on the current status of foot health showed the need for improvement: Only in 36 % of the examined elephants foot problems were so far not encountered. On the time of examination 27 % of the animals were found to be under ongoing treatment for foot diseases. Mostly these were abscesses or other inflammation processes in the area of the nail’s laminar tissue. Out of the study sample, 30 % of the elephants were estimated to be overweight and 36 % showed stereotypic movement patterns.
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Comunicação participativa: a chave para o ensino no cuidado dos pés do paciente diabético / Participatory communication: The basis for the teaching of foot care in the diabetic patientMa. Del Carmen Perez Rodriguez 20 December 2007 (has links)
Entre 40 e 70% das amputações em extremidades inferiores são relacionadas à diabetes, e 85% estão precedidas de ulcera no pé. A transcendência e a gravidade desta complicação permitem considerar que o ensino para a pessoa com diabetes deve ter por finalidade, a incorporação de habilidades que o capacite para o auntocuidado, de forma integrada com a sua escala de valores. Sendo assim, o presente estudo teve como objetivo validar a efetividade de um programa de ensino fundamentado na comunicação participativa, com enfoque nos cuidados com os pés, das pessoas com diabetes mellitus tipo 2. Trata-se de um estudo quaseexperimental, desenvolvido em dois grupos, um experimental e outro controle, formados aleatoriamente. No grupo controle, o programa de ensino foi baseado no método tradicional e no grupo experimental na comunicação participativa. As variáveis dependentes foram: hábitos de cuidado, conhecimentos sobre a doença; dados antropométricos e laboratoriais e condições dos pés. Os dados foram obtidos por meio de entrevista e exame físico, em três momentos: antes do inicio e no final do programa de ensino e outro após seis meses decorridos ao término da intervenção. Cada grupo foi constituído por 77 participantes, com media de idade de 52 anos, sendo o maioria do sexo feminino (90%), com escolaridade no ensino fundamental incompleto (76,6% grupo experimental e 81,8% grupo controle) e ocupação atividades domésticas (90%). Observose que no grupo experimental 40,3% e no grupo controle 42,9% apresentavam também hipertensão arterial. O teste de Qui-quadrado mostrou que não existiu diferencia significativa entre os grupos com relação a estas características. A comparação dos programas ao largo do tempo, em relação a cada variável, foi realizada pela metodologia de análise multivariada de perfis. Para avaliar o efeito de cada programa (antes e após o curso) e retenção do aprendizado (após o curso e depois de seis meses) utilizaram - se o teste t de Student. Cinco as variáveis (hábitos de cuidados, conhecimentos, resultados de laboratório, interrogatório e exame fisco) apresentam perfis distintos (p<0,001), constatando-se que o programa do ensino baseado na comunicação participativa é melhor do que o de metodologia tradicional. Para a variável somatometría as técnicas de intervenção produzirem efeitos semelhantes. / Between 40 and 70% of lower limb amputations occur from causes related to diabetes and 85% are preceded by an ulcer on the foot. The significance and gravity of this complication might argue that education for the diabetic person is intended to be trained to self-care, integrating it into his value system. For this reason this study was formulated with the aim to validate the effectiveness of a learning program based on participatory communication on foot care for people who suffer from diabetes mellitus of type 2. It is a quasi-experimental study developed into 2 groups, that is an experimental group and a control group consisting of randomly selection. In the control group, the education program was based on the traditional method of education and the experimental group the education program was based on participatory communication. The dependent variables were: care habits, knowledge about the disease, laboratory tests, anthropometric measurements, laboratory results and conditions of the feet. The data were collected through interviews and physical examination, in 3 stages: Before the start of the intervention, at the end of the program and six months after the intervention. Each group was formed by 77 members, with an average age of 52, most of them female (90%) with incomplete elementary education (76.6% experimental group and control group 81.8%), and the predominant occupation was: work from home (90%). For the diagnosis was observed 40.3% of the people in the experimental group and 42.9% of people in the control group, in addition to diabetes they were hypertension. The chi square test showed that there were no significant differences in relation to these features. The comparison of the programs over time, in relation to each variable was done through the method of multivariate analysis of profiles. To evaluate the effect of each program (before and after the course) and the retention of what they have learned (at the end of the course and after 6 months) was used Student\'s t test. Five of the variables (habits of care, knowledge about the disease, laboratory tests, interrogation and physical condition of the feet) had different profiles (p<0,001), noting that the education program based on participatory communication is better than based on the traditional methodology. To the variable \"somatometry\", the two methods produced similar effects. In all of the variables, in both groups, there was a slight decrease in the retention of knowledge after six months.
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Thermografische Ermittlung physiologischer Wärmeprofile und pedografische Untersuchungen an den Extremitäten sowie Haltungsanalysen beim Asiatischen Elefanten (Elephas maximus) in menschlicher ObhutSchmidt-Burbach, Jan 30 September 2008 (has links)
Im Zuge systematisch durchgeführter thermografischer Untersuchungen an 95 Asiatischen Elefanten in europäischen Zoos konnten physiologische Wärmeprofile aller nicht von Fußkrankheiten betroffener Elefanten erstellt werden. Um eine objektivere Befundung zu ermöglichen, wurden dafür definierte Messbereiche an den Füßen festgelegt und deren Temperaturdaten als Wärmekurven für jeden Zeh dargestellt. Es zeigte sich, dass die Bandbreite von Temperaturen gleicher Messbereiche starken individuellen Schwankungen unterliegt, weshalb eine Befundung nicht anhand absoluter Temperaturwerte erfolgen sollte. So wurden über gleichen Messbereichen unterschiedlicher Elefanten Temperaturunterschiede von bis zu 8 °C festgestellt. Auch die Umgebungsfaktoren während der Untersuchung tragen zu dieser Varianz bei. Bei Umgebungstemperaturen zwischen 17,5 °C und 23 °C stellt sich durch Erhöhung der Außentemperatur um 1 °C eine um 0,5 °C erhöhte Wärmeabstrahlung über der Haut dar. Eine Erhöhung der Luftfeuchte um 1 % verursacht eine um 0,03 °C vermehrte Wärmeabstrahlung. Die Wärmeprofile stellten sich für die Kronsaum- und Hufwandbereiche der Zehen eines Fußes von medial nach lateral in einem parabelförmigen Verlauf dar, wobei die höchsten Temperaturen an den kranialen Zehen gemessen wurden. Die Differenz zwischen Kronsaum- und Hufwandbereichen blieb dabei konstant. Die Temperaturen der Zehenregion oberhalb des Kronsaums folgten nicht dieser Parabelform, lagen aber, außer an der jeweils medialen Seite, konstant unterhalb der Kronsaumtemperaturen. Bei Vergleich mit thermografischen Befunden erkrankter Zehen zeigte sich meist ein starker Anstieg der Zehenregiontemperatur weit über die Kronsaumtemperaturen hinaus, weshalb sich dieses Verhältnis als Indiz für ein akutes Enzündungsgeschehen nutzen lässt. Ein gleichmäßiges Wärmeprofil, welches möglichst dicht dem in dieser Arbeit entwickelten Profil gleicht und konstante Temperaturdifferenzen zwischen den einzelnen Messbereichen aufweist, ist ein gutes Indiz für einen gesunden Fuß. Thermografische Befundungen sollten immer mit Hilfe herkömmlicher visueller Auswertung und zusätzlich der Erstellung eines Wärmeprofils vorgenommen werden, um die Subjektivität zu minimieren. Erstmalig wurden in dieser Arbeit drei Elefanten mittels Pedografie untersucht, um Aufschlüsse über die Druckverteilung unter dem Elefantenfuß zu erhalten. Wie bei Menschen und pedografisch vermessenen Rindern fanden sich auch beim Elefanten charakteristische Druckprofile. Druckspitzenwerte tauchten hierbei vor allem im kranialen Bereich der Füße als Druckleiste, aber auch im kaudalen Bereich in Form zweier Druckpfeiler auf. Experimente mit einer Methode zur Simulierung weicheren Untergrundes schienen die Druckspitzenwerte etwas abzuschwächen und das allgemeine Druckprofil einzuebnen, waren aber nur schwer auszuwerten. Die Methode eignet sich ebenso zur Erfassung der tatsächlich belasteten Fläche der Füße, welche sich bei stärkerer Belastung, beispielsweise dreibeinigem Stehen, vergrößerte. Trotz noch einiger methodischer und technischer Probleme, eröffnet sich mit der Pedografie ein sicherlich lohnenswertes Forschungsfeld für weitere Studien, die einen besseren Einblick in die Druckphysiologie des Elefantenfußes gewähren könnten. Weiterhin wurden in dieser Arbeit Daten der Elefantenhaltungssysteme von 17 besuchten europäischen Zoos, sowie Daten über Häufigkeit und Art der Gliedmaßenkrankheiten und anderer gesundheitlicher Parameter aller 95 untersuchter Elefanten ausgewertet. Hierbei zeigte sich immer noch starker Verbesserungsbedarf im Hinblick auf Innengehegegrößen und die verwendeten Bodenmaterialien. Auch Bewegungsprogramme für den Aufenthalt im Außengehege wurden nur in weniger als der Hälfte der Zoos eingesetzt. Positiv fiel auf, dass die Elefanten in den besuchten Zoos kaum noch angekettet werden und falls doch, nur kurzzeitig zu Untersuchungszwecken. Den Daten der Haltungsanalysen entsprechend, fielen die Auswertungen zur Fußgesundheit aus: Nur 36 % der untersuchten Elefanten litten bisher noch niemals unter Fußerkrankungen. Allein zum Zeitpunkt der Untersuchung wurden bei 27 % der Tiere akute Erkrankungen festgestellt, die unter Behandlung standen. Hierbei handelte es sich hauptsächlich um Abszesse oder andere entzündliche Veränderungen im Bereich des Nagelbetts. Weiterhin wurden 30 % der Elefanten als übergewichtig eingeschätzt und 36 % der Tiere zeigten stereotype Bewegungsmuster. / A total of 95 Asiatic Elephants in 17 European zoos were systematically examined using a high resolution thermographic camera and physiologic heat profiles of elephant’s feet without known foot diseases were established. To allow a more objective evaluation of thermographic findings, the feet and toes were divided schematically into defined areas for measurement purposes, based on anatomical features for which the temperature data was then plotted to produce heat curves for each area. Measurements of temperatures pertaining to similar areas of different elephants showed strong individual fluctuation. Temperature variation was as high as 8 °C in similar areas between elephants. Thus, evaluation of thermographic findings should never be based on absolute temperature readings alone. This strong variation is partly caused by environmental factors during the examination. With environmental temperatures between 17,5 °C and 23 °C, a one degree increase of this temperature will cause a 0,5 °C increase of the heat radiation of the feet. An increase of air humidity by 1 % will cause an increase of 0,03 °C of the measured thermographical heat radiation. The physiological heat profiles for coronary and hoof wall areas of the toes showed an arched, parable-like shape when plotted from the medial over the cranial to the lateral toes. The highest temperature readings were found on the cranial toes. The difference between coronary and hoof wall temperatures of similar toes were constant all over the foot. The physiological heat profiles of the toe areas above the coronary region did not show this arched shape but stayed below the coronary temperature readings except on the medial toe. On comparison with thermographic findings of inflammated toes, a strong increase of this area above the coronary band was found which exceeded the temperature of the coronary region. This characteristic can be used as an indicator for acute inflammations. A regular heat profile, which resembles closely the physiological heat profile created in this study and which shows constant temperature differences between the defined areas of the single toes, is a good indicator of healthy foot. It is recommended that thermographic examinations always are evaluated using conventional observation of the heat patterns in conjunction with the additional creation of a heat profile to minimize subjectivity by the clinician. For the first time three elephants were examined in this study using a new pedographic method to gain information on the pressure distribution below the elephant’s foot. As found in humans as well as in pedographically examined cows, the pressure distribution in elephant’s feet showed a characteristic profile. Pressure peaks showed up especially in the cranial area of the foot, possibly the border between sole and pad, as well as in the caudal region in the shape of two pressure pillars. Experiments with a method to simulate softer ground seemed to lower the pressure peaks slightly in favor of a broader distribution, but were very difficult to evaluate, especially considering the small sample size. This method is also suited to register the actual area size put under pressure by the elephant, which was shown to rise under increased pressure, e. g. three legged standing. Despite some encountered methodical and technical problems, pedography of elephants is going to be a very promising field for further scientific studies in order to acquire more information on the physiology of pressure distribution. Data on husbandry conditions of the 17 visited zoos and as well as data on frequency and type of foot diseases and other health parameters of all 95 examined elephants were also collected and evaluated. A strong need for improvement was observed in terms of enclosure sizes and the surface materials used in indoor enclosures. Also, daily routines to increase activity of the elephants in the outdoor enclosures were found to be carried out only in half of the visited zoos. On a positive note, elephants in the evaluated zoos were hardly ever chained and if so, only for examination purposes. According to the data of the husbandry evaluation the information on the current status of foot health showed the need for improvement: Only in 36 % of the examined elephants foot problems were so far not encountered. On the time of examination 27 % of the animals were found to be under ongoing treatment for foot diseases. Mostly these were abscesses or other inflammation processes in the area of the nail’s laminar tissue. Out of the study sample, 30 % of the elephants were estimated to be overweight and 36 % showed stereotypic movement patterns.
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