Aims/hypothesis We sought to identify factors related to shortterm outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. Methods Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n=2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31.The characteristics of the remaining 2,480 patients were: 1,465 men, age 68±15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. Results The healing rate without major amputation in surviving patients was 90.6% (n=1,867). Sixty-five per cent (n=1,617) were healed primarily, 9% (n=250) after minor amputation and 8% after major amputation; 17% (n=420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to comorbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. Conclusions/interpretation Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.

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The present study emphasizes the need to take into account the existence of different beliefs about health and illness, especially regarding gender, in the prevention and management of the diabetic foot.

Probability of ulcer healing is strongly related to comorbidity, extent of tissue involvement, and severity of PVD in patients with diabetes with severe PVD.

Being occupied/employed and having knowledge about the body and management of diabetes are important for positive health development. There are dissimilarities in beliefs about health and diabetes that influence self-care behaviour and health care seeking. Men's cultural backgrounds and spiritual beliefs need to be considered in diabetes care.

In a multicultural society the frequency of contact with migrant diabetic individuals will increase, as well as the need for knowledge about their beliefs about health and illness, which have rarely been studied. The aim of the present study was to explore beliefs about health and illness among migrant Yugoslavian and Swedish diabetic subjects that might affect their self-reported self-care practices and care-seeking behaviours. The study design was explorative, and a purposive sampling procedure was used. Fifteen females born in Sweden and 13 in former Yugoslavia, aged 33-73 years, with previously known diabetes mellitus were recruited from primary health care centres in southern Sweden. Median time of residence in Sweden was 5 years (range 2-30 years). Eight of the Yugoslavians had their diabetes diagnosed in Sweden. Focus-group interviews including scenarios of common problems related to diabetes mellitus were held. Yugoslavian females in general gave less tangible examples concerning beliefs about health and illness. Yugoslavians were orientated towards feelings related to their migratory experiences, enjoyed life by making deviations from dietary advice and retaining former traditions, and were less inclined towards self-monitoring and preventive foot care. They also expressed a passive role, depending on health care personnel, and discussed the influence of supernatural forces. Swedes expressed themselves in terms of medicine and a healthy lifestyle, took active part in their self-care and let self-monitoring guide their actions. Self-care was mainly practised to restore health when ill in both groups, and when help was needed it was sought in the professional sector (nurse or physician). Yugoslavians expressed higher confidence in physicians and used more natural cure medicine, side by side with biomedicine, while Swedes more frequently used alternative medicine. Demonstrated dissimilarities illustrate that beliefs about health and illness differ between migrant Yugoslavian and Swedish diabetic individuals, and are essential for self-care practice and care-seeking behaviour and must be considered when planning diabetes care.

Link to publication Citation for published version (APA): Lidfeldt, J., Nyberg, P., Nerbrand, C., Samsioe, G., Scherstén, B., & Agardh, C-D. (2003). Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes, Obesity and Metabolism, 5(2), 106-112. DOI: 10.1046106-112. DOI: 10. /j.1463106-112. DOI: 10. -1326106-112. DOI: 10. .2003 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Aim: The aim was to analyse any associations between socio-demographic and psychosocial factors and different features of the metabolic syndrome in a geographically well-defined population of middle-aged women.Methods: A population of 10 766 Caucasian women aged 50±59 years was investigated regarding biological and socio-demographic conditions, physical activity, dietary habits, aspects of quality of life, and subjective physical and mental symptoms. The screening instrument was used to discriminate subjects as positive or negative on one or more of a total of eight variables considered to be linked to the metabolic syndrome. IntroductionThe number of people suffering from diabetes is rapidly increasing, calling for actions from the health care system and society [1]. If the primary preventive work is to be successful, it is essential to analyse the total risk profile in the general population, meaning that we also must consider socio-demographic and psychosocial aspects, and not only biological factors. Obesity, hypertension, hyperlipidaemia and hyperglycaemia have convincingly been shown to increase the risk of Most studies, however, have been limited by numbers of study subjects or in their approach and variety of factors included. To our knowledge, no study has strived to perform a total analysis considering most aspects of daily life in a geographically defined population. Therefore, the main objective of the present study was to perform a comprehensive analysis of the sociodemographic, psychosocial and biological factors, and their possible association with features of the metabolic syndrome in a geographically well-defined population of middle-aged women. Patients and Methods SubjectsThe Women's Health in the Lund Area Study (WHILA) invited all women (n 10766; 96% being Caucasian) living in the Lund area of Southern Sweden by 1 December 1995, and who were born between 2 December 1935 and 1 December 1945, to a screening procedure taking place from 2 December 1995 until 3 February 20...

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