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Objective To evaluate the effectiveness of a whole-process health education model among inpatients with ascites type of advanced schistosomiasis. Methods A “admission-hospitalization-discharge” whole-process health education model was created, 101 inpatients with ascites type of advanced schistosomiasis were given the whole-process health education. The scores of schistosomiasis control knowledge, attitudes towards schistosomiasis control and healthy behaviors, and awareness of schistosomiasis control knowledge, correct rate of attitudes towards schistosomiasis control and correct rate of healthy behaviors were compared among inpatients with ascites type of advanced schistosomiasis before and after implementation of the whole-process health education. Results The scores of schistosomiasis control knowledge, schistosomiasis control attitudes and healthy behaviors were all significantly higher among inpatients with ascites type of advanced schistosomiasis after implementation of the whole-process health education than before implementation (Z = −7.688, −3.576 and −4.328, all P values < 0.01). In addition, the awareness of schistosomiasis control knowledge increased from 54.3% to 82.7% (χ2 = 188.886, P < 0.01), and the correct rate of attitudes towards schistosomiasis control increased from 88.4% to 98.0% (χ2 = 22.001, P < 0.01), while the correct rate of healthy behaviors increased from 48.2% to 59.7% (χ2 = 11.767, P < 0.01). Conclusions The whole-process health education model may remarkably improve the awareness of schistosomiasis control knowledge and promote the formation of positive attitudes towards schistosomiasis control and correct behaviors among inpatients with ascites type of advanced schistosomiasis, which is of great significance to facilitate patients’ cure.
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Objective To investigate the spatial distribution characteristics of the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody, and to examine the correlation between the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province in 2020, so as to provide insights into advanced schistosomiais control in the province. Methods The epidemiological data of schistosomiasis in Hunan Province in 2020 were collected, including number of permanent residents in survey villages, number of advanced schistosomiasis patients, number of residents receiving serological tests and number of residents seropositive for anti-Schistosoma antibody, and the prevalence advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody were descriptively analyzed. Village-based spatial distribution characteristics of prevalence advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody were identified in Hunan Province in 2020, and the correlation between the revalence advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody was examined using Spearman correlation analysis. Results The prevalence of advanced schistosomiasis was 0 to 2.72% and the seroprevalence of anti-Schistosoma antibody was 0 to 20.25% in 1 153 schistosomiasis-endemic villages in Hunan Province in 2020. Spatial clusters were identified in both the prevalence of advanced schistosomiasis (global Moran’s I = 0.416, P < 0.01) and the seroprevalence of anti-Schistosoma antibody (global Moran’s I = 0.711, P < 0.01) in Hunan Province. Local spatial autocorrelation analysis identified 98 schistosomiasis-endemic villages with high-high clusters of the prevalence of advanced schistosomiasis, 134 endemic villages with high-high clusters of the seroprevalence of anti-Schistosoma antibody and 36 endemic villages with high-high clusters of both the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province. In addition, spearman correlation analysis showed a positive correlation between the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody (rs = 0.235, P < 0.05). Conclusions There were spatial clusters of the prevalence of advanced schistosomiasis and seroprevalence of anti-Schistosoma antibody in Hunan Province in 2020, which were predominantly located in areas neighboring the Dongting Lake. These clusters should be given a high priority in the schistosomiasis control programs.
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Objective To analyze the epidemiological characteristics of newly reported advanced schistosomiasis cases in Sichuan Province, so as to provide the evidence for analyzing the causes and formulating targeted control measures of newly reported advanced schistosomiasis cases. Methods Individual case investigation forms for advanced schistosomiasis cases were collected from the Sichuan Provincial Epidemic Annual Report System from 2011 to 2022, and patients’ demographics, previous medical history and liver parenchymal grading were retrieved. All advanced schistosomiasis cases’ medical records were reviewed, and the subtypes of schistosomiasis-endemic villages where the cases’ household registration were, floating population, survival and death and time of death were collected. Results A total of 321 newly reported advanced schistosomiasis cases were found in Sichuan Province from 2011 to 2022, with a male to female ratio of 0.99 to 1. There were 274 cases at ages of over 50 years (85.4%), with the highest proportion seen at ages of 60 to 69 years (87 cases, 27.1%), and splenomegaly was the most common type (180 cases, 56.1%), with no dwarfism type detected. The highest number of cases was reported in 2011 (78 cases), followed by in 2022 (74 cases), and the highest number of cases were reported in Meishan City (199 cases, 62.0%), Dongpo District (131 cases, 40.8%), and hilly subtype areas (136 cases, 42.4%). As of the end of 2022, there were 111 deaths due to advanced schistosomiasis, with the highest number of deaths seen in 2018 (25 deaths), and the highest mortality was seen among patients with the ascites type (41.2%). There were 47 (37.3%), 40 (59.5%) and 4 (23.5%) cases with grade III liver parenchyma among patients with splenomegaly, ascites, and colonic proliferation types, respectively, and there was a significant difference in the grading of III liver parenchyma among three types of patients (H = 12.092, P < 0.05), with more severe liver parenchyma injuries seen among patients with the ascites type than among those with splenomegaly and colonic proliferation type (Z = 24.262 and 44.738, both Padjusted values < 0.05). Conclusions There have been newly reported advanced schistosomiasis cases in Sichuan Province during recent years, and patients with the ascites type should be given a high priority among advanced schistosomiasis cases in Sichuan Province. Intensified clue surveys are needed for early identification and treatment of advanced schistosomiasis cases, so as to increase the survival rate and improve the quality of life.
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Objective To understand the current situation of patients with advanced schistosomiasis in Suzhou, and to provide a basis for scientific management, medical assistance, and improvement of patients' quality of life. Methods Questionnaire survey, physical examination and B-ultrasound examination were performed on the registered patients with advanced schistosomiasis. The diagnosis and classification were carried out according to the “Schistosomiasis Control Manual”. The epidemiological and clinical characteristics, disease classification, and medical and financial assistance of all existing patients were analyzed. Results There were 2 420 cases of advanced schistosomiasis in Suzhou. Their distribution was highly correlated with the cumulative area of oncomelania snails and the cumulative number of schistosomiasis patients in each district (county) (r=0.949, P2=26.591, P2 =226.034, P<0.001), and the condition of patients with ascites was the worst. 1 438 patients' labor level was reduced, and 540 patients lost their labor ability, while only 442 patients were normal. Age increase (β=0.012，P<0.001), clinical classification being ascites type (β=0.346，P<0.001) and need for treatment (β=0.298，P<0.001) were risk factors for the loss of labor ability in patients with late schistosomiasis. The stable condition of the disease (β= -0.089，P=0.001) was a protective factor. Conclusion There are a large number of advanced schistosomiasis cases in Suzhou, and the epidemiological characteristics of advanced schistosomiasis patients in different districts (cities) are different. The relief work of advanced schistosomiasis in Suzhou should focus on the historical heavy epidemic areas, strengthen the nursing care of the elderly patients, and pay attention to the quality of life of patients with ascites. It is also important to strengthen the follow-up nursing of patients with splenomegaly to avoid turning into ascites. All districts and counties should be guided by the characteristics of local patients and formulate targeted scientific management methods and rescue policies to improve the quality of life of patients.
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Objective To examine the relationship between serum vitamin D level and immune imbalance in advanced schistosomiasis patients with liver fibrosis. Methods A total of 120 advanced schistosomiasis patients with liver fibrosis that were admitted to the Department of Schistosomiasis of The First Hospital of Jiaxing City from May 2016 to September 2018 were recruited as the observation group, and 50 healthy volunteers randomly sampled from the hospital during the same period served as the control group. The serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4+ cell proportion, CD8+ cell proportion, 25-hydroxyvitamin D [25(OH)D] levels were compared between the two groups. Liver fibrosis was classified into grade I, II and III according to the classification criteria of liver fibrosis by ultrasonography, and the serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4+ proportion, CD8+ proportion, 25(OH)D levels were compared among patients with grade I, II and III liver fibrosis. In addition, all patients were classified into the sufficient group, the insufficient group and the deficient group according to the serum vitamin D level, and the serum IgG antibody, IgA antibody, C3 complement, C4 complement, CD4+ proportion, CD8+ proportion, 25(OH)D levels were compared among these three groups. Moreover, the associations of the serum vitamin D level with these immune indicators were examined. Results The 120 advanced schistosomiasis patients with liver fibrosis included 58 men and 62 women, and had a mean age of (72.00 ± 3.00) years. There were 32 cases with grade I liver fibrosis, 46 cases with grade II liver fibrosis, and 42 cases with grade III liver fibrosis. There were no significant differences between the observation group and the control group in terms of serum D-dimer, total cholesterol (TC), triglyceride (TG), C3 complement or C4 complement levels (t = 2.467, 0.322, 0.790, -2.432 and -2.630, all P values > 0.05); however, there were significant differences seen in alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood calcium, blood phosphorus, IgG antibody, IgA antibody, CD4+ proportion, CD8+ proportion, and 25(OH)D levels (t = 5.130, 6.382, -1.341, 2.361, 8.708, 11.783, -2.995, -6.543 and -3.022, all P values < 0.05). In addition, there were significant differences in AST, ALT, blood phosphorus, IgA antibody, C3 complement, CD8+ cell proportion and 25(OH)D levels among patients with grades I, II and III liver fibrosis (F = 19.704, 16.254, 62.669, 49.347, 5.430, 5.434 and 5.783, all P values < 0.05). There were significant differences in ALT, blood phosphorus, IgA antibody, CD8+ cell proportion and 25(OH)D levels between patients with grades I and III liver fibrosis (all P values < 0.05), and significant differences were seen between patients with grades II and III liver fibrosis in terms of blood phosphorus, IgA antibody and CD8+ cell proportion (all P values < 0.05), while there was a significant difference in the CD8+ cell proportion between patients with grades I and II liver fibrosis (P < 0.05). Moreover, there were significant differences among the sufficient, insufficient and deficient groups in terms of IgG antibody, IgA antibody, C3 complement, CD4+ cell proportion and CD8+ cell proportion (F = 13.303, 59.623, 8.698, 9.969 and 12.805, all P values < 0.05), and there was a significant difference in the CD8+ cell proportion between the insufficient and deficient groups (P < 0.05). Pearson correlation analysis revealed that serum 25(OH)D level were negatively associated with IgG and IgA antibody levels (r = -0.754 and -0.773, both P values < 0.05), and positively associated with C3 complement, CD4+ cell proportion and CD8+ cell proportion in advanced schistosomiasis patients with liver fibrosis (r = 0.827, 0.850 and 0.830, all P values < 0.05). Conclusion Immune imbalance occurs in advanced schistosomiasis patients with liver fibrosis, and serum vitamin D level may correlate with immune imbalance in advanced schistosomiasis patients with liver fibrosis.
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Objective To investigate the epidemiological characteristics of current advanced schistosomiasis cases in China, so as to provide the scientific evidence for the precision management and medical care of advanced schistosomiasis. Methods The baseline data pertaining to the current advanced schistosomiasis cases in China were collected from the Epidemiological Dynamic Data Collection Platform (EDDC) operated by the Chinese Center for Disease Control and Prevention. The demographic characteristics, population and regional distribution and medical care of advanced schistosomiasis cases were analyzed with a descriptive method. Results A total of 31 889 cases with advanced schistosomiasis were reported in China by the end of June, 2019, and these cases were mainly identified in Hubei Province (7 737 cases) followed by in Jiangxi Province (7 256 cases), Hunan Province (5 615 cases), Anhui Province (5 236 cases) and Jiangsu Province (2 908 cases), accounting for 90.2% (28 752/31 889) of total cases in China. The current advanced schistosomiasis cases had a male/female ratio of 1.5∶1, and a mean age of (67.0 ± 11.2) years, with 92.6% (29 521/31 889) detected in individuals at ages of over 50 years. There were 97.6% (31 109/31 889) of the cases with an educational level of junior high school and lower, and 95.2% (30 359/31 889) with an occupation of farmers. Ascites (72.6%, 23 164/31 889) and splenomegaly types (26.3%, 8 386/31 889) were predominant in current advanced schistosomiasis cases in China, and there was a significant difference in the constituent ratio of disease types among current advanced schistosomiasis cases with different age groups (χ2 = 362.31, P < 0.01), with the ascites type as the predominant type of advanced schistosomiasis. Among the current advanced schistosomiasis cases, 88.9% (28 358/31 889) and 18.7% (5 973/31 889) had received medical treatment and surgical treatment, respectively. Conclusions The current advanced schistosomiasis cases are predominantly reported in five marshland and lake endemic provinces of China where schistosomiasis is not eliminated, and are mostly categorized as the ascites and megalosplenia types, with minor differences seen in gender and disease-type distributions. Precision medical care should be reinforced according to the epidemiological features of the current advanced schistosomiasis cases, and early screening and standard management and follow-up is required.
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Objective To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. Methods The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People’s Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. Results The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively. Conclusions SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.
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The etiology, pathology, clinical features and prognosis of megalosplenic advanced schistosomiasis have their specific features, and therefore, the perioperative management of this disorder has special countermeasures. The review analyzes the difficult problems in the perioperative management of megalosplenic advanced schistosomiasis, including ultra - low platelet counts, extensive and severe adhesive splenomegaly, massive hemorrhage during surgery and portal vein thrombosis, and proposes countermeasures to tackle these problems, with aims to guide the clinical treatment and cure of schistosomiasis, thereby improving the prognosis, reducing complications and improving the quality of life.
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Objective To examine the effect of rational emotive therapy on negative emotions among advanced schistosomiasis patients with repeated hospitalizations. Methods A total of 97 advanced schistosomiasis patients with anxiety and depressive emotions that were hospitalized in Xiangyue Hospital of Hunan Institute of Schistosomiasis Control for three times or more were enrolled, and given rational emotive therapy for 4 weeks in addition to routine nursing care. The scores for anxiety, depression and quality of life were estimated in patients before and after the rational emotive therapy using the Self-Rating Anxiety Scale (SRS), the Self-Rating Depression Scale (SDS) and WHOQOL-BREF Form. Results The SAS and SDS scores were significantly lower 4 weeks following rational emotive therapy than before the intervention (SAS score, 45.40 ± 7.77 vs. 59.25 ± 9.29, t = 14.021, P < 0.01; 51.48 ± 8.01 vs. 63.93 ± 9.59, t = 12.991, P < 0.01). The percentages of patients with moderate and severe anxiety and depression were significantly lower 4 weeks following rational emotive therapy than before the intervention (P < 0.01), and the scores for each item in the quality of life were all significantly greater 4 weeks following rational emotive therapy than before the intervention (P < 0.01). Conclusion Rational emotive therapy may improve the negative emotions and the quality of life of advanced schistosomiasis patients with repeated hospitalizations.
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Objective To compare the approaches used for the assessment of disability adjust life years (DALYs) for advanced schistosomiasis japonica, so as to provide scientific evidence for accurate assessment of the burden of advanced schistosomiasis japonica. Methods The patients with advanced schistosomiasis japonica receiving treatment and assistance programs in Hunan Province in 2017 were enrolled, and the years lived with disability (YLD) for the patients with advanced schistosomiasis japonica was calculated using the common global burden of disease (GBD) estimation method, the modified GBD method with addition of common syndromes of advanced schistosomiasis japonica, and the quality of life assessment method. Results The YLDs of patients with advanced schistosomiasis japonica, the mean YLDs per capita, and the percentages of YLD were 673.94, 728.77 person-years and 1 761.99 person-years; 0.181, 0.196 person-years and 0.474 person-years; and 10.61, 11.48 person-years per 100 thousand persons and 27.75 person-years per 100 thousand persons with the common GBD method, modified GBD method and the quality of life method, respectively. The YLDs of the patients with advanced schistosomiasis japonica in Hunan Province estimated with the modified GBD method and the quality of life method were 8.14% and 2.61 times higher than that with the common GBD method. Of the major symptoms included in the calculation, the 5 symptoms with the greatest contribution to the burden of advanced schistosomiasis japonica included ascites, moderate anemia, severe anemia, diarrhea and hematochezia. Conclusion The quality of life method may more comprehensively assess the YLDs in patients with advanced schistosomiasis japonica than the common and modified GBD methods.
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Objective To understand the status of current schistosomiasis patients after the interruption of schistosomiasis transmission in Sichuan Province, so as to provide the reference for the development of specific rescue and treatment schemes and the implementation of dynamic management of the patients. Methods The information of registered schistosomiasis patients in disease control and prevention institutions and medical institutions were reviewed in all schistosomiasis-endemic counties (districts) across Sichuan Province in 2018, and the data of all newly discovered schistosomiasis patients were collected and analyzed. Results A total of 1 558 current schistosomiasis cases were diagnosed in 11 endemic cities (prefectures) across Sichuan Province, and all were advanced cases. Megalosplenia and ascites were the predominant types of advanced schistosomiasis cases, and no age- (χ2 = 16.723, P > 0.05) or gender-specific difference (χ2 = 2.493, P > 0.05) was seen in the clinical types of current schistosomiasis cases. There were 9.3% of current schistosomiasis patients from poor households. There was a tendency towards a decline in the number of advanced schistosomiasis cases since 2012, and the number of schistosomiasis cases in 2018 reduced by 17.8% as compared to that in 2012. Conclusions Currently, all current schistosomiasis patients are advanced cases in Sichuan Province. In the future, multidisciplinary collaboration should be implemented to search for a feasible financial subsidy pattern and establish an effective care system for advanced schistosomiasis patients.
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Objective To compare the approaches used for the assessment of disability adjust life years (DALYs) for advanced schistosomiasis japonica, so as to provide scientific evidence for accurate assessment of the burden of advanced schistosomiasis japonica. Methods The patients with advanced schistosomiasis japonica receiving treatment and assistance programs in Hunan Province in 2017 were enrolled, and the years lived with disability (YLD) for the patients with advanced schistosomiasis japonica was calculated using the common global burden of disease (GBD) estimation method, the modified GBD method with addition of common syndromes of advanced schistosomiasis japonica, and the quality of life assessment method. Results The YLDs of patients with advanced schistosomiasis japonica, the mean YLDs per capita, and the percentages of YLD were 673.94, 728.77 person-years and 1 761.99 person-years; 0.181, 0.196 person-years and 0.474 person-years; and 10.61, 11.48 person-years per 100 thousand persons and 27.75 person-years per 100 thousand persons with the common GBD method, modified GBD method and the quality of life method, respectively. The YLDs of the patients with advanced schistosomiasis japonica in Hunan Province estimated with the modified GBD method and the quality of life method were 8.14% and 2.61 times higher than that with the common GBD method. Of the major symptoms included in the calculation, the 5 symptoms with the greatest contribution to the burden of advanced schistosomiasis japonica included ascites, moderate anemia, severe anemia, diarrhea and hematochezia. Conclusion The quality of life method may more comprehensively assess the YLDs in patients with advanced schistosomiasis japonica than the common and modified GBD methods.
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Objective To understand the status of current schistosomiasis patients after the interruption of schistosomiasis transmission in Sichuan Province, so as to provide the reference for the development of specific rescue and treatment schemes and the implementation of dynamic management of the patients. Methods The information of registered schistosomiasis patients in disease control and prevention institutions and medical institutions were reviewed in all schistosomiasis-endemic counties (districts) across Sichuan Province in 2018, and the data of all newly discovered schistosomiasis patients were collected and analyzed. Results A total of 1 558 current schistosomiasis cases were diagnosed in 11 endemic cities (prefectures) across Sichuan Province, and all were advanced cases. Megalosplenia and ascites were the predominant types of advanced schistosomiasis cases, and no age- (χ2 = 16.723, P > 0.05) or gender-specific difference (χ2 = 2.493, P > 0.05) was seen in the clinical types of current schistosomiasis cases. There were 9.3% of current schistosomiasis patients from poor households. There was a tendency towards a decline in the number of advanced schistosomiasis cases since 2012, and the number of schistosomiasis cases in 2018 reduced by 17.8% as compared to that in 2012. Conclusions Currently, all current schistosomiasis patients are advanced cases in Sichuan Province. In the future, multidisciplinary collaboration should be implemented to search for a feasible financial subsidy pattern and establish an effective care system for advanced schistosomiasis patients.
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Objective To compare the expression of serum vitamin D in advanced schistosomiasis patients with grade I and II hepatic fibrosis, and to preliminarily examine its associations with the internal diameter of the main portal vein and progression of hepatic fibrosis. Methods The medical records of 126 advanced schistosomiasis patients with grade I and II hepatic fibrosis referred to Jiaxing First Hospital from March 2012 to September 2015 were retrospectively analyzed. The internal diameter of the main portal vein and serum 25-hydroxyvitamin D3 [25(OH)D3] level were measured. The progression of hepatic fibrosis was followed up, and the serum vitamin D level was compared between patient with disease progression and stable disease. Results The 126 advanced schistosomiasis patients included 72 men and 54 women, and had ages of 62 to 80 years. There were 58 cases with grade I hepatic fibrosis and 68 cases with grade II hepatic fibrosis. There were significant differences between patients with grade I and II hepatic fibrosis in terms of hemoglobin, white blood cell count, prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen or 25(OH)D3 level (all P > 0.05), and significant differences were seen in alanine aminotransferase, aspartate aminotransferase, blood calcium, blood phosphorus levels and the internal diameter of the main portal vein (all P values < 0.05). In addition, a lower serum 25(OH)D3 level was detected in patients with broadened internal diameter of the main portal vein than in those with normal internal diameter of the main portal vein [(19.08 ± 1.36) nmol/L vs. (25.61 ± 6.69) nmol/L, P < 0.05]. Following 3-year follow-up, there were 73 cases with progression of hepatic fibrosis, and a significantly lower serum vitamin D level was found in patients with disease progression than in those with stable disease [(20.00 ± 0.81) nmol/L vs. (25.47 ± 5.91) nmol/L, P < 0.05]. Conclusions Vitamin D deficiency is common in advanced schistosomiasis patients with hepatic fibrosis, and it may be associated with the internal diameter of the main portal vein and the progression of hepatic fibrosis disease.
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Objective To understand the disease burden of patients with advanced schistosomiasis in Jiangsu Province. Methods Totally 450 patients with advanced schistosomiasis from southern, northern and central Jiangsu were chosen by the stratified sampling method, and surveyed by the self-designed economic burden questionnaire in 2015. The economic burden of the patients was analyzed by the descriptive analysis method, and its determinants were explored by the multiple linear regression analysis. Results A total of 450 subjects were surveyed and 434 valid questionnaires were recovered with the recovery rate of 96.44%. The per capita economic burden of advanced schistosomiasis patients was 10 217 Yuan in Jiangsu Province in 2015, including 7 221 Yuan in direct economic burden and 2 996 Yuan in indirect economic burden. The average lost labor force time was 140 days for the patients, and was 23 days for the family. The multiple linear regression analysis showed that the marital status, hospitalization health service utilization, and self-reported health score impacted on the disease economic burden. Conclusion The disease burden of patients with advanced schistosomiasis in Jiangsu Province is heavy.
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Objective To understand the disease burden of patients with advanced schistosomiasis in Jiangsu Province. Methods Totally 450 patients with advanced schistosomiasis from southern, northern and central Jiangsu were chosen by the stratified sampling method, and surveyed by the self-designed economic burden questionnaire in 2015. The economic burden of the patients was analyzed by the descriptive analysis method, and its determinants were explored by the multiple linear regression analysis. Results A total of 450 subjects were surveyed and 434 valid questionnaires were recovered with the recovery rate of 96.44%. The per capita economic burden of advanced schistosomiasis patients was 10 217 Yuan in Jiangsu Province in 2015, including 7 221 Yuan in direct economic burden and 2 996 Yuan in indirect economic burden. The average lost labor force time was 140 days for the patients, and was 23 days for the family. The multiple linear regression analysis showed that the marital status, hospitalization health service utilization, and self-reported health score impacted on the disease economic burden. Conclusion The disease burden of patients with advanced schistosomiasis in Jiangsu Province is heavy.
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Objective To evaluate the effect of clinical pathway(CP)on the implementation of advanced schistosomiasis pa-tients with ascites.Methods Totally 1 129 cases of advanced schistosomiasis patients with ascites but without other complica-tions were selected randomly from the Performance Evaluation and Management System for Medical Treatment of Advanced Schistosomiasis Patients in Hubei Province from year 2011 to 2013.Among the patients,754 cases were treated by CP(CP group),and 375 cases were treated with traditional methods(NCP group),and the hospitalization days,hospitalization expens-es,medicine proportions,treatment outcomes and degrees of satisfaction and health knowledge rates of the two groups were com-pared.Meanwhile,the variation of CP was calculated.Results The average length of hospital days of the CP group and NCP group were(13.85 ± 5.60)d and(17.92 ± 5.80)d,respectively,and the average hospitalization costs of the two groups were(4 699.14 ± 1 520.59)Yuan and(5 692.01 ± 1 616.66)Yuan,respectively,both the differences were statistically significant(both P＜0.05).Also the hospitalization cost structures of the two groups were remarkably different,the composition ratios of the inspection fee and accommodation fee in the CP group were lower than those in the NCP group,but the constituent ratios of the examination fee,diagnosis and treatment fee,drug charges and other expenses were higher than those in the NCP group(all P<0.05).The awareness rate of health knowledge in the CP group was higher than that in the NCP group(P<0.05),but there were no statistically significant differences in the treatment outcome and the degree of satisfaction between the two groups(both P>0.05).The variation rate of CP was 9.02％(68/754).Conclusions The implementation of CP can decrease the days of hos-pital stay and medical expenses,improve the awareness rate on health knowledge of the patients.The CP treatment with low vari-ation rate is applicable to advanced schistosomiasis patients with ascites but without complications.
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Objective To understand the clinical characteristics of newly discovered advanced schistosomiasis patients in Dongpo District,Meishan City,Sichuan Province,so as to provide the reference for enhancing the clinicians'awareness for diag-nosis and treatment of this disease and improving the therapeutic effect. Methods The data of medical records and schedule of case survey of 16 newly discovered advanced schistosomiasis patients in Dongpo District,Meishan City,Sichuan Province were collected and analyzed.Results The mean age of the 16 newly discovered advanced schistosomiasis patients was 63 years,and there were 10 cases at ages of over 60 years.The 16 cases included 8 men and 8 women,and 10 cases were detected in the histor-ical hyper-endemic areas. There were 11 cases with an ascitic type of advanced schistosomiasis,4 cases with a megalosplenia type,and one case with a colon proliferation type.The primary initial symptoms mainly included ascites,splenomegaly,hyper-splenism and portal hypertension.Following inpatient treatments, 15 cases achieved clinical improvments. Conclusions It is necessary to enhance the prevention and control of advanced schistosomiasis. If the patients with portal hypertension,hepato-splenomegaly,upper gastrointestinal hemorrhage visit a doctor,the clinicians should pay much attention to advanced schistoso-miasis and they need to comprehensively analyze the clinical data in combination with the epidemiological information,clinical features and laboratory examinations,and make a correct diagnosis and give treatments timely.
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Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are relat?ed to many special departments,such as gastroenterology,general surgery,neurology,endocrinology,radiology,traditional Chinese medicine,blood purification,endoscopy,intervention,and ICU. It is necessary to apply a multidisciplinary treatment (MDT)mode. However,the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team,formulate the formal working procedures,and standard?ize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.
Résumé
Advanced schistosomiasis,encompassing a wide range of pathologic entities and multi-complications,poses a se-rious threat on the patients'health. Through comprehensive analysis and evaluation on related aspects regarding clinical classifi-cation,main methods of auxiliary examination and treatment(including types of surgical procedure)of advanced schistosomia-sis,we think that the individual based multidisciplinary comprehensive treatment according to varying conditions of patients is the most optimal treatment mode of advanced schistosomiasis. It is further proposed that multidisciplinary collaborative diagnosis and treatment system should be undoubtedly established,multidisciplinary case discussions be regularly organized,and treat-ment expert teams be stably formed,in order to significantly improve the level of diagnosis and treatment of advanced schistoso-miasis,so as to reduce the misdiagnosis and improve the therapeutic effect in advanced schistosomiasis control.