Systematic review of topical interventions for the management of odour in patients with chronic or malignant fungating wounds.

Chronic wounds adversely affect the quality of life of individuals and odour is a well-recognised associated factor. Odour can affect sleep, well-being, social interactions, diet and potentially wound healing. This systematic review aims to examine the effectiveness of topical interventions in the management of odour associated with chronic and malignant fungating wounds. A systematic review guided by PRISMA recommendations of randomised controlled trials where odour intensity/odour is the primary outcome was undertaken. Inclusion criteria were adults (18 years and over) with chronic venous, arterial, diabetic or pressure ulcers or with malignant fungating wounds where odour has been managed through topical application of pharmacological/non-pharmacological agents. Searches were conducted in CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, and Web of Science. Eligibility screening, risk of bias assessment and data extraction was completed by authors working independently. Searches retrieved 171 titles and abstracts (157 post de-duplication). Thirteen studies were retained for full text review of which five (n = 137 individuals) examining the following treatments remained: metronidazole (n = 4), silver (n = 1). Meta-analysis was not possible but individual studies suggest improved outcomes (i.e., reduced odour) using metronidazole. Treatment options to manage wound odour are limited and hampered by lack of clinical trials, small sample sizes, and absence of standardised outcomes and consistent measurement. Whereas metronidazole and silver may have a role in controlling wound odour, robust and well-designed interventions with rigorous procedures and standardised odour outcomes are necessary to evaluate their contribution.

Intracluster correlation estimates from a World Health Organisation STEPwise approach to surveillance (STEPS) survey for cardiovascular risk factors in Vellore, Tamil Nadu, India.

OBJECTIVES: Most World Health Organisation (WHO) STEPS surveys use cluster sampling to assess the prevalence of risk factors for non-communicable diseases (NCDs) for which design effects need to be estimated using intracluster correlation (ICCs) coefficients, for sample size calculation. Although there are many reports of risk factor surveys reported from developing countries, there are very few reports of ICCs for risk factors for NCDs, which can inform planning the appropriate sample size needed for such surveys. This study reports the ICCs for NCD risk factors, obtained from a WHO STEPS survey conducted in Vellore district, in the state of Tamil Nadu, South India. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study was carried out in 48 urban clusters (wards) and nine rural clusters (villages) between 2011 and 2012, using the WHO STEPS methodology for assessing behavioural, anthropometric, physical and biochemical risk factors. The ICC estimates for various risk factors were obtained using loneway and xtmelogit commands using STATA to study clustering of risk factors. RESULTS: The number of respondents was 6196 adults aged 30-64 years. The median ICC of cardiovascular risk factors in the urban area was 0.046, while it was 0.064 in the rural area. Clustering was higher for behavioural risk factors such as physical activity (ICC: 0.179 rural, 0.049 urban) and fruit and vegetable intake (ICC: 0.105 rural, 0.091 urban) as compared with physical risk factors (ICCs for hypertension: 0.044 rural, 0.006 urban; body mass index: 0.046 rural, 0.041 urban) and biochemical outcomes such as fasting plasma glucose (ICC: 0.017 rural, 0.027 urban). CONCLUSIONS: This study provides estimates of ICCs for cardiovascular risk factors from Vellore, South India, as such data have not been reported from WHO STEPS surveys in India or neighbouring countries. Such estimates of ICCs if reported from various WHO STEPS being carried out across the country can contribute to better planning of epidemiological surveys. Clustering of behavioural risk factors at village/ward level as seen in this study points to the need for community-based interventions for health promotion, as spatial clustering influences behaviour, which in turn affects chronic disease outcomes.