<b><i>Aims:</i></b> To determine the minimal clinically important difference (MCID) of the Dermatology Life Quality Index (DLQI) and its responsiveness to change in inflammatory skin diseases. <b><i>Methods:</i></b> A longitudinal study: at stage 1, patients completed the DLQI and a disease severity global question; at stage 2, a global rating of change in quality of life (QoL; Global Rating of Change Questionnaire, GRCQ) was added and used as an anchor to measure the MCID of the DLQI. <b><i>Results:</i></b> 192 patients completed stage 1 and 107 completed stage 2. The mean DLQI score at stage 1 was 9.8 and 7.4 at stage 2 with a mean change of 2.4 (p < 0.0001). 31 patients experienced a ‘small change' in their QoL (±3 and ±2) on the GRCQ. The mean corresponding change in DLQI scores was 3.3, which is regarded as the approximate MCID. <b><i>Conclusions:</i></b> Previous estimates of the MCID of the DLQI have varied from 3 to 5. Although this study demonstrated a MCID of 3.3, we recommend that the MCID in inflammatory skin diseases should be 4.

MicroCT analysis revealed a higher void volume for BioRoot RCS. The other techniques did not show a difference between the sealing ability of the sealers. The correlation between the three ex vivo methods of assessment was weak demonstrating their complementarity rather than their concordance.

BackgroundGram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres.MethodsStudies investigating adult hospitalised patients (2000–2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance.Primary Findings Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens’ incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84).InterpretationGram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative “target organisms” facilitate clinical practice and target research towards a defined clinical demand.

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Aim To evaluate the potential of thermography as an assessment tool for the detection of foot complications by understanding the variations in temperature that occur in type 2 diabetes mellitus (DM). Methods Participants were categorized according to a medical examination, ankle brachial index, doppler waveform analysis, and 10-gram monofilament testing into five groups: healthy adult, DM with no complications, DM with peripheral neuropathy, DM with neuroischaemia, and DM with peripheral arterial disease (PAD) groups. Thermographic imaging of the toes and forefeet was performed. Results 43 neuroischaemic feet, 41 neuropathic feet, 58 PAD feet, 21 DM feet without complications, and 126 healthy feet were analyzed. The temperatures of the feet and toes were significantly higher in the complications group when compared to the healthy adult and DM healthy groups. The higher the temperatures of the foot in DM, the higher the probability that it is affected by neuropathy, neuroischaemia, or PAD. Conclusions Significant differences in mean temperatures exist between participants who were healthy and those with DM with no known complications when compared to participants with neuroischaemia, neuropathy, or PAD. As foot temperature rises, so does the probability of the presence of complications of neuropathy, neuroischaemia, or peripheral arterial disease.

Background: The epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) infections, using bacteraemia as a marker, shows a striking geographical pattern in Europe. The prevalence of MRSA is low in Northern European countries, increases into central Europe and reaches its highest levels in the Mediterranean region. This has been attributed to varying levels of implementation of infection control and antibiotic stewardship (ICAS) programmes, but reasons for this variation have not been clearly established. Aim: To investigate the possible impact of national cultural dimensions on the epidemiology of MRSA in Europe. Methods: Median proportions of MRSA bacteraemia were sourced for countries participating in the EARS-Net surveillance network in 2010, and correlated with the national cultural dimension scores of Hofstede et al. Findings: Significant associations were identified between MRSA proportions and the cultural constructs of uncertainty avoidance (UAI), masculinity (MAS) and power distance. Multiple regression models found significant associations for UAI, MAS and short-term orientation (R 2 adjusted ¼ 0.475; P < 0.001). The model was found to be predictive of MRSA trends identified in several European countries between 2006 and 2010. Conclusion: Implementation of ICAS programmes often requires behavioural change. Cultural dimensions appear to be key factors affecting perceptions and values among healthcare workers, which in turn are critical for compliance and uptake. Customizing ICAS initiatives to reflect the local cultural background may improve their chances of success.

The main purpose of this paper is to investigate the role of social and emotional learning (SEL) skills and resilience in explaining mental health in male and female adolescents, during the COVID-19 pandemic. Three self-report questionnaires were administered to 778 participants aged between 11 and 16 years (mean age = 12.73 years; SD = 1.73) and recruited from 18 schools in Northern Italy. The SSIS-SELb-S and the CD-RISC 10 assessed SEL and resilience skills respectively, while the Strengths and Difficulties Questionnaire (SDQ) was used to measure mental health in terms of internalizing problems, externalizing problems, and prosocial behavior. We found that SEL and resilience skills were positively and significantly associated with each other, negatively associated with internalizing and externalizing problems, and positively related to prosocial behavior. Three linear regression analyses showed the significant role of resilience, age, and gender in explaining the variance of internalizing problems; the significant role of SEL skills, resilience, age, and gender in explaining the variance of externalizing problems; and the role of SEL skills, age, and gender in explaining prosocial behavior. Importantly, we found that resilience fully mediated the relationship between SEL skills and internalizing problems, partially mediated the relationship between SEL skills and externalizing problems and didn't mediate the relationship between SEL skills and prosocial behavior. The paper concludes with a discussion of the limitations of the study as well as its practical implications.

Objectives Sociocultural factors have been hypothesized as important drivers of inappropriate antibiotic prescribing in European ambulatory care. This study sought to assess whether they can also explain the reported variation in broad-spectrum antibiotic (Br-Ab) use among EU/European Economic Area (EEA) countries. Methods Correlation and regression analysis were performed, using the bootstrap method, between Br-Ab ratios reported from 28 EU countries by the ECDC, and national Hofstede cultural dimensions and control of corruption (CoC) scores. Results Significant bootstrapping correlation coefficients were identified between Br-Ab ratios and the dimension of uncertainty avoidance (UAI) as well as CoC. However, following both bootstrapping multiple regression and generalized linear modelling, only UAI was retained as the sole predictor. A logarithmic model explained 58.6% of the variation in European Br-Ab variability solely using national UAI scores (P < 0.001). Conclusions Br-Ab prescribing appears to be driven by the level of UAI within the country. Any interventions aimed at reducing Br-Ab in high-consuming EU/EEA countries need to address this cultural perception to maximize their chances of success.