Background Rates of skin cancer in Australia are amongst the highest in the world, with Western New South Wales (NSW) exhibiting very high prevalence. There is a large proportion of outdoor workers, including farmers, in Western NSW who have high levels of sun exposure and hence are at greater risk of developing skin cancer. Aims To characterise the current sun safety practices of farmers in Western NSW and explore their knowledge, attitudes and perceived barriers towards sun safety and its implementation. Methods A cross-sectional survey study was conducted using a self-directed questionnaire. Participants were recruited at field days held in Western NSW and through surveys distributed at general practices, local stores and online. Eligibility criteria were aged 18 years and over and currently working on a farm in the study region. Results Of the 144 participants, 89 (61.8%) were male with a mean age of 49 years. Knowledge of sun safety was relatively high with most questions answered correctly by greater than 80% of participants. Risk of developing skin cancer was underestimated in 58 (40.3%) participants. Of all participants, 89 (62.2%) identified one or more barriers to practicing sun safety. The most common barrier was forgetfulness in 62 (43.4%) participants. The identification of barriers was significantly associated with reduced engagement of sun safety practices (p = 0.009). Conclusions Knowledge of sun safety among farmers was high. There was, however, underestimation of risk of developing skin cancer. Addressing perceived barriers to implementing sun safety could improve sun safety practices in this cohort.

Groin lumps in females can be challenging due to unique anatomy and vast differential diagnostic pathologies. We report the case of a 39-year-old female presenting with a six-month history of painful left groin lump. Laparoscopic total extraperitoneal (TEP) hernia repair showed an incarcerated left indirect inguinal hernia sac containing part of the left fallopian tube and fimbrial cyst, a left fat-containing obturator hernia and associated with ectopic subcutaneous inguinal endometrioma. The anatomical differences in women suggest that individualized preoperative imaging modalities such as magnetic resonance imaging have a place before considering laparoscopic hernia repair, to successfully identify and synchronously treat any concomitant pathologies.

Background. Patients with comorbid type 2 diabetes mellitus (T2DM) and renal disease, particularly those treated with insulin, often require complex pharmacological treatment and management of other diabetes complications. Aims. To assess the achievement of metabolic targets and compare the current management of renal service attenders with insulin- and noninsulin-treated T2DM. Methods. Single-centre retrospective cross-sectional study involving medical record review of patients with T2DM aged ≥18 years who visited a metropolitan renal outpatient clinic in 2017. Univariable analysis and multivariable logistic regression were used to identify factors associated with insulin treatment. Results. Among 268 patients (45.5% insulin-treated), mean HbA1c was higher in insulin-treated vs. noninsulin-treated patients ( 8.0 ± 1.8 % (64 mmol/mol) vs. 6.8 ± 1.2 % (51 mmol/mol), p < 0.001 ). Significantly fewer insulin-treated patients had HbA 1 c ≤ 7.0 % (53 mmol/mol; 31.8% vs. 69.3%, p < 0.001 ). More insulin-treated patients had ischaemic heart disease (46.7% vs. 33.6%, p = 0.028 ), diabetic foot disease (15.6% vs. 4.8%, p = 0.003 ), retinopathy (40.2% vs. 11.0%, p < 0.001 ), and emergency attendance for severe hypoglycaemia (3.8% vs. 0% p = 0.042 ). Insulin treatment was more associated with chronic kidney disease stages 4-5 (adjusted odds ratio (aOR) 2.41, 95% CI 1.07-5.43), retinopathy (aOR 3.10, 95% CI 1.04-9.27), and podiatry review (aOR 5.06, 95% CI 1.20-21.38). Only 38 (14.2%) individuals were seen by a colocated public multidisciplinary diabetes service in 2017. Conclusions. Renal clinic attenders with T2DM, particularly if insulin-treated, remained at increased risk of diabetes-related complications, including severe hypoglycaemia, with limited input from the colocated hospital diabetes team. Approaches to increase coordination of diabetes care among renal patients should be investigated.