WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 | 4 | 5 |   ...   | 8 |

«Sithara S Pillai Dissertation submitted in partial fulfillment of the requirement for the award of the degree of Master of Public Health Achutha ...»

-- [ Page 1 ] --

THE IMPACT OF DIABETIC FOOT ULCER ON HEALTH RELATED

QUALITY OF LIFE (HRQL) AND EMPLOYMENT AMONG RURAL

DIABETIC POPULATION IN SOUTH KERALA

Sithara S Pillai

Dissertation submitted in partial fulfillment of the

requirement for the award of the degree of

Master of Public Health

Achutha Menon Centre for Health Science Studies,

Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala, India October 2012 Acknowledgments I am grateful to God Almighty for giving me life and the strength to go through this course successfully.

I would like to convey my sincere gratitude and appreciation to my guide Dr V. Raman Kutty for his unreserved assistance in doing this research. His encouragement, support and guidance from the initial to the final level enabled me to build up an understanding of the subject. This thesis would not have been as standardized as it is now without his great support.

This research would not have been possible without the support of Dr G. Vijaya Kumar and his team at Medical Trust Hospital, Kulanada, Panthalam.

I would like to acknowledge the Kerala state council for science, technology and environment for funding the project.

I extend my sincere thanks to Dr. Sankara Sarma, Dr. K.R. Thankappan and Dr. Mala Ramanathan for their inputs while analyzing the data.

I would like to thank all other faculty of Achutha Menon Centre for Health Science Studies for providing me their valuable suggestions to improve the study.

Finally I would like to convey my heartfelt thanks to my caring husband for his support throughout the study period.

Certificate I hereby certify that the work embodied in this dissertation entitled “Impact of diabetic foot ulcer on health related quality of life and employment among rural diabetic population” is a bonafide record of original research work undertaken by Ms. Sithara S Pillai, in partial fulfilment of the requirement for the award of the “Master of Public Health” degree under my guidance and supervision.

Dr. V. Raman Kutty, Professor, Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala October 2012 Declaration I declare that the work embodied in this dissertation entitled “Impact of diabetic foot ulcer on health related quality of life and employment among rural diabetic population” is the result of my original field research. It has not been submitted to any other university or institution for the award of a degree.

Sithara S Pillai Master of Public Health scholar Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala October 2012

–  –  –

To my husband Vivek Venugopal for his encouragement and support throughout the study;

To my parents Sasidharan Pillai and Rethnamma S Pillai for the value of education they instilled in me.

Abstract Background: With a diabetic prevalence of 8.6% India is ranked at the top with respect to the burden of diabetes. HRQL (Health related quality of life) information is necessary to measure the effectiveness of the treatment, patient management and policy decisions.

Diabetic foot ulcer is an important complication of diabetes and increasingly affects the working population. Evidence on HRQL, employment related factors and expenditure related factors is extremely rare in Kerala- particularly among rural diabetic population. This study was conducted with an objective to measure the health related quality of life among diabetic patients with healed and unhealed foot ulcer in the rural population.

Method: A cross sectional survey among 118 diabetic foot ulcer patients (mean years of age was 57.66 ± 7.71; 66.9% were males) selected randomly from the patients attending the outpatient department of a major diabetic care centre. Information was collected on sociodemographic variables, disease and treatment related factors, family life, employment and expenditure using a pre-tested structured interview schedule. The twenty nine item DFS- SF was used to measure the health related quality of life, after validation of the scale among the same rural diabetic population. For the working population the economic loss was calculated by total value of man days lost.

Results: The mean ± SD of total HRQL score for healed and unhealed group is 74.86 ± 12.11 and 59.92 ± 15.41 respectively. After adjusting for ulcer duration and sex the difference between the mean scores was 16.75 (95% CI = [-22.66, -10.81]). Median value of total man days lost was 26000 Rs with a range of 450 to 720000 Rs.

Conclusion: The mean HRQL score is significantly different between healed and unhealed groups even after adjustment for other predictors. There is a considerable economic burden imposed on households by diabetic foot ulcer which warrants greater attention to this condition. A multidisciplinary approach is needed to reduce the social and economic consequences of diabetic foot ulcer.

–  –  –

Glossary of abbreviations Abstract Chapter 1: Introduction and review of literatures





1.1. Introduction

1.2. Background

1.3. Prevalence studies 1.3.1. Global scenario 1.3.2. Indian scenario 1.3.3. South India or Kerala scenario

1.4. Pathways to foot ulceration

1.5. Treatment modalities

1.6. Health related quality of life (HRQL)

1.7. Translation and validation of diabetic foot ulcer scale short form (DFS -SF) 1.7.1. The procedure of validation

1.8. Studies on impact on employment

1.9. Family consequences studies

1.10. Expenditure or economic impact studies

1.11. Diabetes education – Prevention and care of foot ulcer Chapter 2: Rationale and objectives of the study

2.1. Rationale for the study

2.2. Objectives of the study 2.2.1. Major objectives 2.2.2. Minor objectives Chapter 3: Methodology

3.1 Operational definitions

3.2. Formative research 3.2.1. Conceptual framework

3.3. Study design

3.4. Translation and validation of the DFS – SF 3.4.1. Linguistic validation 3.4.2. Measures of reliability and validity 3.4.3. Study setting 3.4.4. Sample size 3.4.5. Sample selection procedures 3.4.6. Data collection techniques 3.4.7. Data analysis

3.5. Cross sectional survey 3.5.1. Study setting 3.5.2. Sample size 3.5.3. Sample selection procedures 3.5.4. Sample selection criteria 3.5.5. Data collection techniques 3.5.6. Data storage and cleaning 3.5.7. Variables under the study – Definitions and characteristics 3.5.8. Data analysis 3.5.9 Analysis of HRQL score 3.5.10. Analysis of employment characteristics 3.5.11. Family characteristics 3.5.12. Direct medical expenditure

3.6. Case study research 3.6.1. Study setting 3.6.2. Sample size 3.6.3. Sample selection procedure 3.6.4. Data collection technique 3.6.5. Data analysis

3.7. Ethical considerations Chapter 4: Results

4.1. Scale validation 4.1.1. Assessment of reliability 4.1.1.1. Temporal stability 4.1.1.2. Internal consistency 4.1.2. Assessment of validity

4.2. Cross sectional survey 4.2.1. Socio demographic and clinical characteristics of the study sample 4.2.2. HRQL measurement 4.2.3. Employment related characteristics 4.2.4. Family life related characteristics 4.2.5. Quantum and pattern of direct medical expenditure

4.3. Case study research

Chapter 5: Discussion

5.1. Scale validation

5.2. Cross sectional survey 5.2.1. Sample characteristics 5.2.2. HRQL measured using DFS –SF 5.2.3. Impact on employment related characteristics 5.2.4. Impact on family life 5.2.5. Quantum and pattern of direct medical expenditure

5.3. Qualitative analysis

5.5. Strengths and limitations of the study 5.5.1. Strengths 5.5.2. Limitations Chapter 6: Conclusion and recommendations References Annexure 1. Guidelines for formative research Annexure 2. Diabetic Foot Ulcer Scale-Short Form Annexure 3. Diabetic Foot Ulcer Scale – Short Model (Back translated version) Annexure 4. Report on cognitive debriefing of the translated version of DFS - SF Annexure 5. SF-36v2™ Health Survey Annexure 6. Consent form for referring patient for participating in the study Annexure 7. Interview schedule Annexure 8. R functions used for sample size estimation and data analysis Annexure 9. Guidelines for Case study research – Individual patient discussion Annexure 10. Participant information sheet Annexure 11. Informed consent for Interview Annexure 12. Informed consent for case study

–  –  –

Table 3.1: Predictor variables Table 3.

2: Outcome variables Table 3.3: Frame work used for analysis Table 4.1: Internal consistency for different domains of the score Table 4.2: Correlation matrix with SF 36 Vs DFS-SF Table 4.3: Socio demographic characteristics of the study sample Table 4.4: Disease characteristics of the study sample Table 4.5: Socio demographic and clinical characteristics in the two groups Table 4.6: Results of two factor ANOVA for Sub scale 1 – Leisure score Table 4.7: Results of two factor ANOVA for Sub scale 2 – Physical health score Table 4.8: Results of two factor ANOVA for Sub scale 3 – Daily activities score Table 4.9: Results of two factor ANOVA for Sub scale 4 – Emotions score Table 4.10: Results of two factor ANOVA for Sub scale 5 – Treatment score Table 4.11: Linear model of HRQL score on major predictors Table 4.12: ANCOVA showing adjusted difference in mean HRQL scores between healed and unhealed group Table 4.13: Employment related characteristics of the study sample Table 4.14: Estimates of the employment related characteristics Table 4.15: Results of Wilcoxon rank sum test to find out the predictors of total value of man days lost Table 4.16: Direct medical expenditure related characteristics

–  –  –

Fig. 1 Causal pathways to foot ulceration Fig. 2 Conceptual framework Fig. 3 Deductive themes used for case study analysis Fig. 4 Mean HRQL score with 95% CIs comparing healed and unhealed groups in five

–  –  –

‘Need for national campaign to encourage physicians to remove patient’s shoes and socks and to examine the feet’ - Paul Brand (1914–2003) who added science to the art of foot care

1.1. Introduction Diabetes mellitus is one of the major chronic non communicable diseases that affect millions globally. Evidence shows that diabetes has become a major epidemic in newly industrialised and developing nations. With a diabetic prevalence of 8.6 percent, India is ranked at the top with respect to the burden of diabetes.1 Diabetes is a serious health problem that needs special attention and public health interventions in the 21st century.

Sandeep et al from the Madras Diabetes Research foundation summarize the situation of diabetes in India as follows: “Diabetes in India is no longer a disease of the affluent.

Studies have shown that poor diabetics are more prone to complications as they have less access to quality health care. This presents an alarming picture as the poor would find it more difficult to cope with the diabetes epidemic”.2 Diabetes has been classified as Type1 and Type 2. In Type 1, the person’s body is unable to produce insulin and he/she requires a continuous supply of insulin as treatment, whereas in Type 2, the person’s body cells fail to use the produced insulin or there may be some insufficiency of insulin.3 Uncontrolled blood glucose level for a long duration can damage heart and blood vessels, eyes, kidneys and nerves. People with diabetes are also prone to infections. In most of the high income countries diabetes has became a primary cause for cardio vascular diseases, blindness, kidney failure and lower limb amputation.1 The nerve and blood vessel damage due to the uncontrolled diabetes leads to a variety of foot problems. These conditions worsen in the presence of infection and lead to ulcer formation. This eventually increases the risk of a person for lower limb

–  –  –

that among people without diabetes.4 Effective control over blood glucose level, blood pressure and cholesterol can delay or even prevent the development of diabetes related complications.1

1.2. Background Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin that it produces.

Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes. Over a period of time, this leads to serious damage to many body systems, especially to nerves and blood vessels.5 Globally, the number of diabetics in 2011 is 366.2 million and the projected value for 2030 is 551.8 million. The prevalence of Type 2 diabetes is increasing all over the world and nearly 80 percent of the people with diabetes live in low and middle income countries. Around 4.6 million deaths in 2011 is attributed to diabetes.1 Population based studies across the world show that the incidence of Type 2 diabetes mellitus is increasing among young adults. This will lead to an increase in the prevalence of micro and macro vascular complications associated with diabetes.6 The large and growing population of India and the high prevalence of diabetes among its population have increased the burden of diabetes in India.7 In a review in the year 2000, Andrew J.M. Boulton stated that “The hallmark of diabetic foot problems in India is gross infection: major contributing factors for its late presentation include the frequency of barefoot gait, attempts at home surgery, trust in faith healers, often undetected diabetes, rodents nibbling at insensitive feet while the patients sleep on the floor, maggots pouring out of open wounds and red ants swarming inside the dressing ”.8

–  –  –



Pages:   || 2 | 3 | 4 | 5 |   ...   | 8 |


Similar works:

«National Medical Policy Subject: Capsular Tension Rings Policy Number: NMP89 Effective Date*: January 2004 Updated: February 2016 This National Medical Policy is subject to the terms in the IMPORTANT NOTICE at the end of this document For Medicaid Plans: Please refer to the appropriate State's Medicaid manual(s), publication(s), citations(s) and documented guidance for coverage criteria and benefit guidelines prior to applying Health Net Medical Policies The Centers for Medicare & Medicaid...»

«Living Life to the Fullest: Families Share their Ideas A resource of strategies for caring for an individual with Huntington’s Created for families by families Living Life to the Fullest: Families Share their Ideas A resource of strategies for caring for an individual with Huntington’s Created for families by families Please be advised that each person with HD is unique, with different and changing needs. Before using any of the suggestions contained in this booklet please consult your...»

«Global Journal of Health Science; Vol. 5, No. 1; 2013 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education Exploring the Competency of the Jordanian Intensive Care Nurses towards Endotracheal Tube and Oral Care Practices for Mechanically Ventilated Patients: An Observational Study Abdul-Monim Batiha1, Ibrahim Bashaireh1, Mohammed AlBashtawy 2 & Sami Shennaq1 1 Faculty of Nursing, Philadelphia University, Jordan 2 Princess Salma Faculty of Nursing, AL al-Bayt...»

«Pink Himalayan Salt Top 14 Healing Secrets 1. Fights Diabetes & Normalizes Blood Sugar One of the most vital and crucial benchmark of our body health is our blood sugar level. Having too low or too high a blood sugar has its corresponding disadvantages and if the problem becomes extreme it can be very hard on our body. Chronic high blood sugar can result in developing a disease called diabetes. However, for people who are already diabetic, ample intake of Himalayan salt will put the body into...»

«WARNINGS AND PRECAUTIONS HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use  Activities requiring mental alertness: Avoid engaging in activities DICLEGIS safely and effectively. See full prescribing information for requiring complete mental alertness, such as driving or operating heavy DICLEGIS. machinery, while using DICLEGIS until cleared to do so by a healthcare DICLEGIS (doxylamine succinate and pyridoxine hydrochloride) provider...»

«DIABETIC RETINOPATHY for the Comprehensive Ophthalmologist SECOND EDITION Raj K. Maturi, M.D. Jonathan D. Walker, M.D. Robert B. Chambers, D.O., FAOCOO Diabetic Retinopathy for the Comprehensive Ophthalmologist SECOND EDITION Raj K. Maturi, M.D. Associate Clinical Professor Department of Ophthalmology Indiana University School of Medicine, Indianapolis Retina Service, Midwest Eye Institute Jonathan D. Walker, M.D. Clinical Assistant Professor Indiana University School of Medicine Fort Wayne...»

«ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT Plenadren 5 mg modified-release tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each modified-release tablet contains hydrocortisone 5 mg. For a full list of excipients, see section 6.1.3. PHARMACEUTICAL FORM Modified-release tablet. The tablets are round (diameter 8 mm), convex and pink. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Treatment of adrenal insufficiency in adults. 4.2 Posology and method of...»

«This guide is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this guide, Sage Products provides general information for educational purposes only. The information provided in this guide is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. Sage Products is not liable...»

«16 Chronic Periaortitis as a Systemic Autoimmune Disease Chang-Hee Suh Rheumatology, Ajou University School of Medicine Korea 1. Introduction Chronic periaortitis is an idiopathic disease whose hallmark is the presence of a fibroinflammatory tissue arising from the adventitia of the abdominal aorta and the common iliac arteries and extending into the surrounding retroperitoneum and frequently encasing neighboring structures such as the ureters and the inferior vena cava (Mitchinson, 1984;...»

«Package leaflet: Information for the user Bisoprolol HCT STADA 2.5 mg/6.25 mg, 5 mg/12.5 mg and 10 mg/25 mg film-coated tablets Bisoprolol/ Hydrochlorothiazide Read all of this leaflet carefully before you start taking this medicine becaus it contains important information for you.  Keep this leaflet. You may need to read it again.  If you have any further questions, ask your doctor or pharmacist.  This medicine has been prescribed for you only. Do not pass it on to others. It may harm...»

«Inderal® (propranolol hydrochloride) Tablets Rx only This product's label may have been revised after this insert was used in production. For further product information and current package insert, please visit www.wyeth.com or call our medical communications department toll-free at 1-888-383-1733 DESCRIPTION Inderal® (propranolol hydrochloride) is a synthetic beta-adrenergic receptor blocking agent chemically described as 2-Propanol, 1-[(1-methylethyl)amino]-3-(1-naphthalenyloxy)-,...»

«SELF-REGULATION FROM BIRTH TO AGE SEVEN: ASSOCIATIONS WITH MATERNAL MENTAL HEALTH, PARENTING, AND SOCIAL, EMOTIONAL AND BEHAVIOURAL OUTCOMES FOR CHILDREN Kate Elizabeth Williams RMT BMus PGDipMusThy MEd(Research) Supervisors: Professor Donna Berthelsen Associate Professor Sue Walker Professor Jan M. Nicholson This thesis is submitted for the degree of Doctor of Philosophy (PhD) School of Early Childhood Faculty of Education Queensland University of Technology ABSTRACT This research is focussed...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.