Knowledge and practice of foot self-care behaviours in Irish diabetes patients with high-risk feet.

BACKGROUND: Diabetic foot disease is associated with significant morbidity and mortality. Patients at high risk of developing diabetic foot disease can reduce their risk, however, by practicing appropriate foot self-care behaviours. Despite this fact, and often despite education regarding appropriate foot care, patients frequently engage in risky foot care practices which place them at risk of foot ulceration. AIM: We aimed to assess knowledge of appropriate foot care behaviours in a cohort of Irish patients at high risk of developing diabetic foot disease attending a multidisciplinary foot clinic, and to assess foot self-care practice. We also aimed to determine predictors for suboptimal self-care behaviour. DESIGN: A questionnaire-based cohort study. METHODS: A multi-aspect questionnaire was designed by the diabetes foot care team, based on the principles of good foot care and the education provided to patients attending the diabetes podiatry clinic. RESULTS: One hundred forty-three participants with high-risk feet completed a questionnaire exploring foot care knowledge and practice. The responses revealed suboptimal foot care knowledge and practice. Participants frequently engaged in risky foot care practices, and were unable to consistently identify appropriate footwear for high-risk feet. Predictors of good foot care included a history of prior ulceration, podiatry attendance, microvascular complications of diabetes, and longer duration of diabetes. CONCLUSION: In this cohort of Irish patients with high-risk feet, foot care knowledge and practice varied widely. Participants frequently engaged in high-risk behaviours despite prior education. Improved strategies to impart diabetic foot care advice to patients with diabetes and high-risk feet are urgently required.

Host specificity shapes fish viromes across lakes on an isolated remote island.

Fish viromes often provide insights into the origin and evolution of viruses affecting tetrapods, including those associated with imporant human diseases. However, despite fish being the most diverse vertebrate group, their viruses are still understudied. We investigated the viromes of fish on Chatham Island (Rekohu), a geographically isolated island housing 9% of New Zealand's threatened endemic fish species. Using metatranscriptomics, we analyzed samples from seven host species across 16 waterbodies. We identified 19 fish viruses, including 16 potentially novel species, expanding families such as the Coronaviridae, Hantaviridae, Poxviridae, and the recently proposed Tosoviridae. Surprisingly, virome composition was not influenced by the ecological factors measured and smelt (Retropinna retropinna) viromes were consistent across lakes despite differences in host life history, seawater influence, and community richness. Overall, fish viromes across Rekohu were highly diverse and revealed a long history of co-divergence between host and virus despite their unique and geographically isolated ecosystem.