Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis 英文参考文献.docVIP

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Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis 英文参考文献.doc

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Feasibility and Effectiveness of Basic Lymphedema Management in Leogane, Haiti, an Area Endemic for Bancroftian Filariasis 英文参考文献

FeasibilityandEffectivenessofBasicLymphedema ManagementinLeogane,Haiti,anAreaEndemicfor BancroftianFilariasis DavidG.Addiss1,2*,JackyLouis-Charles3,JacquelinRoberts1,FredericLeConte3,JoyannaM.Wendt1, MarieDeniseMilord3,PatrickJ.Lammie1,GerusaDreyer4 1Division of Parasitic Diseases, National Center for Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 2FetzerInstitute,Kalamazoo,Michigan,UnitedStatesofAmerica,3Ho?pitalSte.Croix,Leogane,Haiti,4Non-governmentalOrganizationAmauryCoutinho,Recife,Brazil Abstract Background:Approximately14millionpersonslivinginareasendemicforlymphaticfilariasishavelymphedemaoftheleg. Clinicalstudiesindicatethatrepeatedepisodesofbacterialacutedermatolymphangioadenitis(ADLA)leadtoprogressionof lymphedemaandthatbasiclymphedemamanagement,whichemphasizeshygiene,skincare,exercise,andlegelevation, can reduce ADLA frequency. However, few studies have prospectively evaluated the effectiveness of basic lymphedema managementorassessedtheroleofcompressivebandagingforlymphedemainresource-poorsettings. Methodology/PrincipalFindings:Between1995and1998,weprospectivelymonitoredADLAincidenceandlegvolumein 175 persons with lymphedema of the leg who enrolled in a lymphedema clinic in Leogane, Haiti, an area endemic for Wuchereriabancrofti.Duringthefirstphaseofthestudy,whenamajorfocusoftheprogramwastoreducelegvolume usingcompressionbandages,ADLAincidencewas1.56episodesperperson-year.AfterMarch1997,whenhygieneandskin careweresystematicallyemphasizedandbandagingdiscouraged,ADLAincidencedecreasedto0.48episodesperperson- year(P,0.0001).ADLAincidencewassignificantlyassociatedwithlegvolume,stageoflymphedema,illiteracy,anduseof compression bandages. Leg volume decreased in 78% of patients; over the entire study period, this reduction was statisticallysignificantonlyforlegswithstage2lymphedema(P=0.01). Conclusions/Significance:Basiclymphedemamanagement,whichemphasizedhygieneandself-care,wasassociatedwith