Background:Lymphatic filariasis(LF)remains one of the world’s most debilitating parasitic infections and is a major contributor to poor health in many endemic countries.The provision of continuing care for all those ...Background:Lymphatic filariasis(LF)remains one of the world’s most debilitating parasitic infections and is a major contributor to poor health in many endemic countries.The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations’Sustainable Development Goals.The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district,through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention.Methods:Selected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State’s health administration.The six training sessions(from 5 June 2017 to 25 May 2018)included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients.The learning achieved by attendees was assessed by pre-and post-training tests.The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records,6 months after the conclusion of the training sessions.Results:One hundred and eighty-four medical personnel(91 doctors and 93 nurses)from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care(EPC)for lymphoedema patients at all the participating institutions.Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic,with a total of 3,477 new patients receiving training in EPC.Conclusions:Generalist health personnel,when appropriately trained,can provide quality lymphoedema care in public health settings and patients when provided services close to their home,are willing to access them.This is a feasible strategy for integrating long term care for LF patients into the national health system,and is a clear example of moving towards equity in health care for the medically underserved,and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.展开更多
Background:Lymphatic filariasis(LF)is one of the primary causes of lymphoedema in sub-Saharan Africa,and has a significant impact on the quality of life(QoL)of those affected.In this paper we assess the relative impac...Background:Lymphatic filariasis(LF)is one of the primary causes of lymphoedema in sub-Saharan Africa,and has a significant impact on the quality of life(QoL)of those affected.In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district,Malawi.Methods:A random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated.Two mobility tests were undertaken,namely the 10 m walking test[10MWT]and timed up and go[TUG]test,and a subset of 10 casescontrol pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting.Retrospective economic data was collected from all 31 case-control pairs,and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period.Results:Cases had a significantly poorer overall QoL(cases=32.2,controls=6.0,P<0.01)and mobility-specific(cases=43.1,controls=7.4,P<0.01)scores in comparison to controls.Cases were also significantly slower(P<0.01)at completing the timed mobility tests,e.g.mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls.An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases(10MWT correlation=−0.06,95%CI=(−0.41,0.30)),indicating that their perceived disability differed from their measured disability,whereas the results were consistent for controls(10MWT correlation=−0.61,95%CI=(−0.79,−0.34)).GPS summaries indicated that cases generally walk shorter distances at slower speeds than control,covering a smaller geographical area(median area by kernel smoothing:cases=1.25 km2,controls=2.10 km^(2),P=0.16).Cases reported earning less than half that earned by controls per week(cases=$0.70,controls=$1.86,P=0.064),with a smaller proportion of their earnings(16%vs 22%,P=0.461)being spent on healthcare.Conclusions:Those affected by lymphoedema are at a clear disadvantage to their unaffected peers,experiencing a lower QoL as confirmed by both subjective and objective mobility measures,and lower income.This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.展开更多
Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema ...Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema is still elusive.Management is tailored according to clinical features,investigations and expectations of each patient.Lymphoedema patients should undergo a trial of conservative management with compression therapy,manual lymphatic drainage and external sequential compression devices.Early lymphoedema is treated by lymphovascular anastomosis,where the lymph vessels are connected to the subdermal veins by supermicrosurgery.In late cases when the limb is fibrotic,vascularised lymph node transfers are done,where lymph nodes are transferred from a healthy area to the affected area.In advanced cases,when the limb is fibrotic with cutaneous folds and skin changes,surgical debulking is done.In lymphoedema,along with accumulation of lymphatic tissue,there is also fat deposition,which can be removed by liposuction.One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.展开更多
目的:对淋巴水肿病人生活质量影响量表(Lymphoedema Life Impact Scale,LLIS)进行汉化,并检验其信效度。方法:对量表进行翻译、专家评定、预调查后,选取362例淋巴水肿病人进行调查,评价量表信效度。结果:专家权威系数为0.84,Kendall专...目的:对淋巴水肿病人生活质量影响量表(Lymphoedema Life Impact Scale,LLIS)进行汉化,并检验其信效度。方法:对量表进行翻译、专家评定、预调查后,选取362例淋巴水肿病人进行调查,评价量表信效度。结果:专家权威系数为0.84,Kendall专家协调系数为0.16(P=0.02)。中文版LLIS各条目重要性均分为3.64~4.00分,变异系数为0~18.41%,满分比为72.73%~100.00%,总体Cronbach'sα系数为0.907,正式调查2周后各条目组内相关系数(ICC)为0.71~0.96,平均ICC为0.85,条目水平的内容效度指数(I-CVI)为0.91~1.00,平均量表水平的内容效度指数(S-CVI/Ave)为0.99,相对拟合指数(CFI)为0.960,非规准适配指数(TLI)为0.953,标准化残差均方根(SRMR)为0.048,近似误差均方根(RMSEA)为0.047。结论:中文版LLIS具有良好的信度和效度。展开更多
基金All the Kerala based activities described in this manuscript (planning, advocacy, training and implementation) were supported by the Government of Kerala through the Department of Health and Family Welfare, and by the Govt. TD Medical College, Alappuzha. In addition, the publication of the completed study was supported by the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) , which is funded at The Task Force for Global Health primarily by the Bill & Melinda Gates Foundation (OPP1190754) , by UK aid from the British government, and by the United States Agency for International Development through its Neglected Tropical Diseases Program. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission.
文摘Background:Lymphatic filariasis(LF)remains one of the world’s most debilitating parasitic infections and is a major contributor to poor health in many endemic countries.The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations’Sustainable Development Goals.The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district,through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention.Methods:Selected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State’s health administration.The six training sessions(from 5 June 2017 to 25 May 2018)included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients.The learning achieved by attendees was assessed by pre-and post-training tests.The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records,6 months after the conclusion of the training sessions.Results:One hundred and eighty-four medical personnel(91 doctors and 93 nurses)from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care(EPC)for lymphoedema patients at all the participating institutions.Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic,with a total of 3,477 new patients receiving training in EPC.Conclusions:Generalist health personnel,when appropriately trained,can provide quality lymphoedema care in public health settings and patients when provided services close to their home,are willing to access them.This is a feasible strategy for integrating long term care for LF patients into the national health system,and is a clear example of moving towards equity in health care for the medically underserved,and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.
基金Liverpool School of Tropical Medicine with grant support from the UK Department for International Development(DFID)The funder did not have any role in any aspect of this study.
文摘Background:Lymphatic filariasis(LF)is one of the primary causes of lymphoedema in sub-Saharan Africa,and has a significant impact on the quality of life(QoL)of those affected.In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district,Malawi.Methods:A random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated.Two mobility tests were undertaken,namely the 10 m walking test[10MWT]and timed up and go[TUG]test,and a subset of 10 casescontrol pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting.Retrospective economic data was collected from all 31 case-control pairs,and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period.Results:Cases had a significantly poorer overall QoL(cases=32.2,controls=6.0,P<0.01)and mobility-specific(cases=43.1,controls=7.4,P<0.01)scores in comparison to controls.Cases were also significantly slower(P<0.01)at completing the timed mobility tests,e.g.mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls.An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases(10MWT correlation=−0.06,95%CI=(−0.41,0.30)),indicating that their perceived disability differed from their measured disability,whereas the results were consistent for controls(10MWT correlation=−0.61,95%CI=(−0.79,−0.34)).GPS summaries indicated that cases generally walk shorter distances at slower speeds than control,covering a smaller geographical area(median area by kernel smoothing:cases=1.25 km2,controls=2.10 km^(2),P=0.16).Cases reported earning less than half that earned by controls per week(cases=$0.70,controls=$1.86,P=0.064),with a smaller proportion of their earnings(16%vs 22%,P=0.461)being spent on healthcare.Conclusions:Those affected by lymphoedema are at a clear disadvantage to their unaffected peers,experiencing a lower QoL as confirmed by both subjective and objective mobility measures,and lower income.This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.
文摘Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection.The optimal treatment of lymphoedema is still elusive.Management is tailored according to clinical features,investigations and expectations of each patient.Lymphoedema patients should undergo a trial of conservative management with compression therapy,manual lymphatic drainage and external sequential compression devices.Early lymphoedema is treated by lymphovascular anastomosis,where the lymph vessels are connected to the subdermal veins by supermicrosurgery.In late cases when the limb is fibrotic,vascularised lymph node transfers are done,where lymph nodes are transferred from a healthy area to the affected area.In advanced cases,when the limb is fibrotic with cutaneous folds and skin changes,surgical debulking is done.In lymphoedema,along with accumulation of lymphatic tissue,there is also fat deposition,which can be removed by liposuction.One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.
文摘目的:对淋巴水肿病人生活质量影响量表(Lymphoedema Life Impact Scale,LLIS)进行汉化,并检验其信效度。方法:对量表进行翻译、专家评定、预调查后,选取362例淋巴水肿病人进行调查,评价量表信效度。结果:专家权威系数为0.84,Kendall专家协调系数为0.16(P=0.02)。中文版LLIS各条目重要性均分为3.64~4.00分,变异系数为0~18.41%,满分比为72.73%~100.00%,总体Cronbach'sα系数为0.907,正式调查2周后各条目组内相关系数(ICC)为0.71~0.96,平均ICC为0.85,条目水平的内容效度指数(I-CVI)为0.91~1.00,平均量表水平的内容效度指数(S-CVI/Ave)为0.99,相对拟合指数(CFI)为0.960,非规准适配指数(TLI)为0.953,标准化残差均方根(SRMR)为0.048,近似误差均方根(RMSEA)为0.047。结论:中文版LLIS具有良好的信度和效度。
