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The Study on Disease Burden of Advanced Schistosomiasis and the Quality of Life of Patients

Author: DengYao
Tutor: ZhouXiaoNong
School: Disease Control and Prevention Center
Course: Epidemiology and Biostatistics,
Keywords: Late blood Quality of Life Disease burden Disability weight Family burden Social burden SF-36 Family Burden Interview Reliability Validity Brainstorming Consulting experts
CLC: R532.21
Type: Master's thesis
Year: 2008
Downloads: 194
Quote: 1
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Abstract

Schistosomiasis is a serious threat to the health of our people and hinder social and economic development is one of the important parasitic diseases. Advanced schistosomiasis (late blood) is due to a large number of infections in patients with long-term or repeated after schistosome cercariae not be timely treatment or inadequate treatment of liver fibrosis caused by portal hypertension syndrome. Blood of patients with late serious damage to health, labor and life long restricted caused poverty caused significant reduction in quality of life, to the family and the community have caused a certain impact. Currently schistosomiasis burden of disease studies and more limited to the DALY discussion, argument is to assess the global disease burden in 1996 was severely underestimated disability weight, the burden on families and social studies are rarely involved. This study aimed at a comprehensive evaluation of late blood disease burden and the patients' quality of life, for the prevention and relief late blood to provide a scientific basis for policy formulation. This study first night blood quality of life of patients were evaluated, and then from the patient, family, social three levels starting on the evening of blood disease burden were studied. Choose site survey points located in the Yangtze River region of Hunan and Hubei Jiangling County Hanson County. Hanson County when all registered 223 are symptoms of schistosomiasis patients were included in the survey, eventually participating in the survey were 202 cases, distributed in 122 villages; pair of Jiangling County in the book are symptoms of schistosomiasis patients with cluster sampling, 40 villages 124 cases of patients (county accounted for 25.83% of cases late blood) participated in the survey. Choose a 1:1 ratio while the control group. In addition, there are 318 families of patients involved in the family burden of investigation, the 326 cases of patients and control subjects and 162 village cadres involved in the social burden of investigation. Quality of life evaluation, this study SF-36 quality of life scale Chinese version as assessment tools. First night of blood used in relation to scale reliability, validity and responsiveness were evaluated, followed by patients and healthy controls on the quality of life scores were compared, and finally through stepwise regression affecting the quality of life in patients with a total score of factors for analysis. The results showed that SF-36 quality of life in the late evaluation of the blood of patients with good split-half reliability (split-half reliability coefficient of 0.954) and internal consistency reliability (8 dimensions Cronbachα coefficient range 0.863-0.875); validity Evaluation of validity good collection (collection of validity test success rate 97.14%), discriminant validity (discriminant validity test success rate of 87.86%) and criterion validity (with EQ-5D C self-assessment of quality of life in patients with VAS scores The correlation coefficient between 0.695) is still good, but the construct validity of the poor (only two dimensions at the factor loadings fully consistent with the theoretical model). Scale showed good reactivity (except physical function and emotional function floor effect were as high as 50.31% and 48.16%, the remaining dimensions floor effect and ceiling effect were lower than 17%). Late blood of patients each dimension scores were significantly lower than in healthy controls, the impact of high and low scoring factors include the following: the patient's age and educational level; local prevalence of schistosomiasis; patients with loss of appetite, palpitations, abdominal distension, abdominal pain, bloody stools and abdominal sticky vein revealed the presence or absence of other symptoms and signs; labor loss, clinical types. Late blood levels of patient population burden study evaluated the blood of patients with late disability weights. First, the use of EQ-5D C Scale for self-assessment of quality of life of patients, and then based on the results of self-assessment of blood according to formula late age disability weight (DW), the final impact of disability through stepwise regression analysis of the factors weights . The results showed that China's Yangtze River region late blood DW values ??ranging 0.394-0.492; affect DW factors include patient age values; loss of appetite, palpitations, abdominal distension, abdominal pain, diarrhea, ascites, splenic vein revealed the presence or absence of other symptoms and signs . Late blood family burden of the family burden Scale (FBS) for the assessment tools to evaluate various aspects of family burden in patients with severity. First of all FBS applied late blood family reliability and validity testing, followed by the various dimensions of family burden score analysis, the final score using stepwise regression multivariate analysis FBS. The results show FBS applied late blood has good split-half reliability (split-half reliability coefficient of 0.930), the internal consistency reliability (coefficient of each dimension Cronbachα range 0.691-0.734), a collection of validity (validity of the tests are successful collection 100%), discriminant validity (discriminant validity test a success rate of 97.22%) and construct validity (in addition to the financial burden of an entry, the rest were attributed to the corresponding entries are common factors); their reactivity is also more good (except family members physical health and mental health effects of two dimensions of the floor up to 60.06% respectively and 47.16%, the remaining proportion of floor effect dimension less than 27% the proportion of ceiling effect of each dimension is 0). FBS score analysis showed that the blood of patients with late family burden each dimension there are different degrees of burden, family economic burden compared to other dimensions are more significant. Multivariate analysis showed that the total score of the factors that affect the FBS, including family per capita income, expenditure is balanced, epidemic prevalence. Late blood social burden of establishing a social burden evaluation index system and conducted on-site evaluation. First, through literature review, brainstorming and expert consultation to determine late evaluation a social burden of blood, two indicators, and calculate the index weight; then refined into various issues related to two indicators, patient, villagers and village cadres for the survey questionnaires, and finally a social burden on the county staff late prevention of blood-depth interviews. The results show: Late evaluation index system of the social burden of blood by four-level indicators and 16 secondary indicators composition. 4-level indicators in order of importance for the social and economic order, the government's image, mass psychology and social stability. \). Site survey, 66.05 percent of the village cadres that the per capita income of the village late blood there are different degrees of impact; 56.17% of the village cadres, the village that night blood on employment have different degrees of impact; 26.07% of the villagers believe that the blood of their own psychological night will produce different degrees of impact; 80% of the villagers and village cadres are considered late blood on the village had no effect on various aspects of social stability. Each patient received late that year the amount of blood salvage about 4,100 yuan per capita; night satisfaction in all aspects of blood salvage were more than 85%; addition to existing aid, the 76.99% of the patients are still some need to be solved needs; Late-depth interviews showed that the blood of the local community in all aspects of existence to some extent. Taking these results, the following conclusions: (1) SF-36 for quality of life assessment in patients with late blood, but still need the actual situation on the part of the entries perfect; late blood in patients with psychological and physical quality of life were significantly lower , so in late prevention and relief work of blood, in addition to improve the patient's clinical symptoms, enhance its psychological care is necessary. (2) the blood of the Yangtze River region late disability weight range 0.394-0.492, which was significantly higher than the global burden of disease estimation results (0.005-0.006). (3) FBS evaluation applied to late blood family burden good performance; patient's family in every aspect there is a certain burden, but an economic burden is particularly prominent. Tip In addition to blood salvage late, but should be combined with other social forces on the night of blood family give some support; but also in the rescue process, should pay attention to promote functional recovery of their families. (4) nights of blood on the local socio-economic, psychological image of the government and the general public there are some aspects, such as the impact of the blood caused by late mitigate social burden should rely on the local government attaches to the work schistosomiasis endemic areas, relying on schistosomiasis epidemic prevention and control work effectively, and rely on the evening of blood Assistance Policy continuous improvement and effective implementation.

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CLC: > Medicine, health > Internal Medicine > Parasitic diseases > Helminthiasis > Trematodes > Schistosomiasis
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