Evaluating the effects of sedentary behaviour on plantar skin health in people with diabetes

Henshaw, Frances R; Bostan, Luciana; Worsley, Peter; Bader, Dan L.

doi:10.1016/j.jtv.2020.09.001

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…In the present study, there were no clear differences in cytokine response between individuals with commodities, for example, diabetic and non‐diabetic patients. This is in contrast to a previous study wherein individuals with diabetes showed more expression of pro‐ and anti‐inflammatory cytokines, albeit in the sole of the foot known to be at risk of tissue damage in this population 45 . There were also no clear differences between the different locations, that is, sacrum and buttocks, of the skin damage as well as BMI and gender.…”

Section: Discussioncontrasting

confidence: 99%

“…This is in contrast to a previous study wherein individuals with diabetes showed more expression of pro‐ and anti‐inflammatory cytokines, albeit in the sole of the foot known to be at risk of tissue damage in this population. 45 There were also no clear differences between the different locations, that is, sacrum and buttocks, of the skin damage as well as BMI and gender. Owing to the pragmatic approach of the study, there were differences in the number of days between the first sebum sampling and the day redness was first reported by the clinicians, this ranged from 0 to 50 days.…”

Section: Discussionmentioning

confidence: 87%

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Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Jayabal

Abiakam

Filingeri

et al. 2023

International Wound Journal

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Pressure Ulcers (PU) are a major burden for affected patients and healthcare providers. Current detection methods involve visual assessments of the skin by healthcare professionals. This has been shown to be subjective and unreliable, with challenges associated with identifying erythema in darker colour skin. Although there exists a number of promising non‐invasive biophysical techniques such as ultrasound, capacitance measurements, and thermography, the present study focuses on directly measuring the changes in the inflammatory status of the skin and underlying tissues. Therefore, in this study, we aim to analyse inflammatory cytokines collected through non‐invasive sampling techniques to detect early signs of skin damage. Thirty hospitalised patients presenting with Stage I PU were recruited to evaluate the inflammatory response of skin at the site of damage and an adjacent healthy control site. Sebutapes were collected over three sessions to investigate the temporal changes in the inflammatory response. The panel of cytokines investigated included high‐abundance cytokines, namely, IL‐1α and IL‐1RA, and low abundance cytokines; IL‐6, IL‐8, TNF‐α, INF‐γ, IL‐33, IL‐1β and G‐CSF. Spatial and temporal differences between sites were assessed and thresholds were used to determine the sensitivity and specificity of each biomarker. The results suggest significant (P < .05) spatial changes in the inflammatory response, with upregulation of IL‐1α, IL‐8, and G‐CSF as well as down‐regulation of IL‐1RA over the Stage I PU compared with the adjacent control site. There were no significant temporal differences between the three sessions. Selected cytokines, namely, IL‐1α, IL‐1RA, IL‐8, G‐CSF, and the ratio IL‐1α/IL‐1RA offered clear delineation in the classification of healthy and Stage‐I PU skin sites, with receiver operating characteristic curves demonstrating high sensitivity and specificity. There were limited influences of intrinsic and extrinsic factors on the biomarker response. Inflammatory markers provided a high level of discrimination between the sites presenting with Stage I PU and an adjacent healthy skin site, in a cohort of elderly inpatients. Indeed, the ratio of IL‐1α to IL‐1RA provided the highest sensitivity and specificity, indicative that inflammatory homeostasis is affected at the PU site. There was a marginal influence of intrinsic and extrinsic factors, demonstrating the localised effects of the inflammation. Further studies are required to investigate the potential of inflammatory cytokines incorporated within Point of Care technologies, to support routine clinical use.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 87%

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Jayabal

Abiakam

Filingeri

et al. 2023

International Wound Journal

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“…Similar to the process of normalization used for epithelial (moisture) barrier outcomes, inflammatory biomarker values were normalized to a baseline value (time point zero) to accommodate individual variability in sebum values, as previously described. 15,18 A closer analysis of the data revealed their distribution was non-normal in nature, and nonparametric inferential statistical tests were therefore selected to analyze study outcomes. The Mann-Whitney U test was used to analyze differences in responses at the different time points of data collection.…”

Section: Discussionmentioning

confidence: 99%

“…Data from each outcome variable were imported into Microsoft Excel (Microsoft 365; Redmond, Washington) and normalized to baseline values (ie, postapplication value/baseline value). Similar to the process of normalization used for epithelial (moisture) barrier outcomes, inflammatory biomarker values were normalized to a baseline value (time point zero) to accommodate individual variability in sebum values, as previously described 15,18. A closer analysis of the data revealed their distribution was non-normal in nature, and nonparametric inferential statistical tests were therefore selected to analyze study outcomes.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Incontinence Pad Application on Loaded Skin With Reference to Biophysical and Biochemical Parameters

Abiakam,

Jayabal,

Abbas

et al. 2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: The purpose of this study was to evaluate temporal changes in skin responses following exposure to moisture alone or moisture in combination with mechanical loading. DESIGN: Comparison cohort with a repeated-measures design. SUBJECTS AND SETTINGS: The sample comprised 12 healthy volunteers. Participants were purposely sampled from 2 different age groups; half were 32 to 39 years old and half were 50 to 62 years old. Participants identified as White, Black, or mixed; 83% (n = 10) identified as White; 8 (67%) were female. METHODS: Four sites at the sacrum were challenged with the application of specimens taken from 2 absorbent products; the pad specimens were applied dry or saturated with synthetic urine (SU; pH = 8); a further site from the sacral skin was also selected and used as a control. Skin assessments were performed at different points in time: (1) 60 minutes after exposure to dry or SU-saturated pad specimens; (2) 60 minutes after exposure to pads and mechanical loading (application of pressure in the form of 45°C high sitting); and (3) 30 minutes after removal of all pads (recovery period). Outcome measures were transepidermal water loss (TEWL), stratum corneum (SC) hydration, erythema, pH, and skin inflammatory biomarkers measured at each of the time points described earlier. RESULTS: The control site and those exposed to dry pads showed minimal time-dependent changes irrespective of the parameter investigated. In contrast, significant increases in TEWL (P = .0000007) and SC hydration responses (P = .0000007) were detected at the sites under absorbent pad specimens after saturation with SU (exposure to moisture). In some participants, TEWL and SC hydration parameters were significantly higher during pressure application. Skin pH remained in the mildly acidic range throughout the test session, and no consistent trends were observed with erythema. Skin inflammatory biomarkers also exhibited considerable variability across participants; none changed significantly over time. Significant differences (P = .02) were also detected following the exposure of moisture in combination with pressure. CONCLUSION: We evaluated an array of parameters to identify changes following skin exposure to 2 absorbent pads in the presence and absence of SU and mechanical loading. Analysis revealed changes in skin barrier properties in the presence of moisture and/or pressure. This observation suggests a need for frequent pad changing as well as periods of skin off-loading to protect the skin health of individuals with incontinence.

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“…Values from TEWL, SC hydration, erythema and inflammatory biomarker concentrations were normalised to the baseline for each test session (post/pre-respirator application ratio) in order to enable comparisons of relative variations across the experimental time frame and between the participants. 8,22 Shapiro Wilk test and D'Agostino-Pearson were used to assess the distribution of the data. Accordingly, a parametric two-way analysis of variance with replication was employed to evaluate the effect of repeated respirator application derived from each test session and the difference between measurement sites for each parameter.…”

Section: Discussionmentioning

confidence: 99%

Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID‐19 pandemic

Abiakam

Jayabal

Mitchell

et al. 2022

Skin Research and Technology

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Background: Personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators. Materials and methods:A longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape. Results:The cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05). Conclusions:The most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.

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Evaluating the effects of sedentary behaviour on plantar skin health in people with diabetes

Cited by 7 publications

References 38 publications

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

Inflammatory biomarkers in sebum for identifying skin damage in patients with a Stage I pressure ulcer in the pelvic region: A single centre observational, longitudinal cohort study with elderly patients

The Effects of Incontinence Pad Application on Loaded Skin With Reference to Biophysical and Biochemical Parameters

Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID‐19 pandemic

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