A Study to Explore the Parental Impact and Challenges of Self-Management in Children and Adolescents Suffering with Lymphedema

Maltreatment, homicide and access to specialised palliative care among children and young adults with a life-limiting condition: a nationwide population-based study

OBJECTIVE

This study compared the differences in the rates of maltreatment and homicide deaths between children and young adults with and without a life-limiting condition (LLC) and determined whether this affects the likelihood of receiving specialised palliative care (SPC) services before death.

DESIGN

A nationwide retrospective observational study.

SETTING

Taiwan.

PATIENTS

Children and young adults aged 0-25 years with LLCs and maltreatment were identified within the Health and Welfare Data Science Centre by International Classification of Diseases codes. Deaths were included within the Multiple Causes of Death Data if they occurred between 2016 and 2017.

MAIN OUTCOME MEASURES

Rates of maltreatment, homicide deaths and SPC referrals.

RESULTS

Children and young adults with underlying LLCs experienced a similar rate of maltreatment (2.2 per 10 000 vs 3.1 per 10 000) and had a 68% decrease in the odds of homicide death (19.7% vs 80.3%, OR, 0.32; 95% CI 0.18 to 0.56) than those without such conditions. Among those with LLCs who experienced maltreatment, 14.3% (2 out of 14) had received SPC at least 3 days before death. There was no significant difference in SPC referrals between those who experienced maltreatment and those who did not.

CONCLUSIONS

The likelihood of being referred to SPC was low with no significant statistical differences observed between children and young adults with maltreatment and without. These findings suggest a need for integrating SPC and child protection services to ensure human rights are upheld.

Children and young people with lymphoedema: a project to assess the education needs of healthcare professionals

Healthcare professionals need adequate preparatory education to treat children and young people with lymphoedema confidently and competently. This collaborative international project, based on existing literature and expert focus groups, seeks to identify the nature of that education need and in what format it could be addressed.

Conservative and integrated management of genital lymphoedema: case reports for men

Genital oedema of primary and secondary aetiology is gaining increased recognition; it occurs in people of all ages, although accurate prevalence remains unknown. While reports of surgical intervention are quite common, clear description of conservative management is rare, and, overall, diagnosis and management remain largely delayed. Conservative management of genital oedema requires imaginative use of compression bandages and support garments, adapted manual lymphatic drainage, enablement of exercise and activities required for school/employment and diligent skin care to avoid cellulitis. The aim of this article is to present case reports from two European countries discussing five males of differing ages and with genital oedema of different aetiology as examples of conservative management of male genital oedema. The case reports include an adolescent boy with genital oedema since age 1 year, a 49-year-old man treated for penile cancer, a 60-year-old man treated for primary rectal lymphoma, a 48-year-old man with morbid obesity and a 49-year-old with obesity and recurrent infections. The latter two cases integrate surgery and conservative care. Case reports can be a useful means of addressing education needs related to rarer conditions and sharing practice where diagnostic criteria and specific protocols of care are lacking.

Development of Self-Efficacy Tools for Parents and Professionals Caring for Children and Young People with Lymphedema (ILF Parent SE and ILF Professional SE)

Background: Self-management is a key aspect of lymphedema treatment and self-efficacy is a key factor linked to long-term adherence to treatment. The study aimed to generate self-efficacy scales to support the care of children and adolescents with lymphedema to support self-management. Methods and Results: Parents of children with lymphedema and the professionals caring for them were recruited during a lymphedema educational camp. Six individual semistructured focus groups were undertaken in Italian, French, and English (three for parents and three for professionals) with simultaneous translation. Scale item generation was developed using interpretative phenomenological analysis and adopted Bandura's self-efficacy concept. Two self-efficacy tools were developed from research with 26 parents and 14 professionals. The parental tool (ILF parent SE) has 6 domains and 44 items: school; home and leisure; understanding the condition and treatment, and managing child and parent emotions. The professional tool (ILF Professional SE) has 4 domains and 21 items. This scale has two parts; the first indicates the level of professional autonomy in decision making, and the second covers assessment and treatment, patient understanding, and managing emotional reactions. Both tools adopt a 0- to 100-point scale using a 10-unit interval with 0 (cannot do) through to 100 (high certainty of being able to do). Initial face validity has been undertaken. Conclusion: Self-efficacy has emerged as a complex issue faced by parents and professionals involved with children and young people with lymphedema. By being able to assess the challenges parents face in self-efficacy individualized programs can be developed that will assist families in managing this complex disease and lead to greater well-being. Increased professional self-awareness will help the development of mentorship programs to support professionals dealing daily with the stress of managing a rare disease in which the outcome may be uncertain.

LIMPRINT in Italy

Background: To define the profile of patients presenting with chronic edema (CE) in three centers in Italy (Lymphoedema IMpact and PRevalence INTernational). Methods and Results: Data were collected in patients referred for CE between September 2016 and July 2017. A total of 1637 were recruited, 86.7% (1419) outpatients and 13.3% (218) inpatients with 80.6% (1319) female and mean age 54 years. Primary lymphedema occurred in 28.2% (461). In the 71.8% (1176) with secondary CE cancer occurred in 72% (846) and 28% (330) due to other causes. Data showed that 84.2% (226) had full upper body mobility, 15.5% (41) had limited mobility and 0.2% (2) had lost all mobility. Lower limb mobility status: 90.4% (1205) complete mobility, 8.4% (112) reduced mobility and 1.2% (21) wheelchair bound. Concurrent leg ulceration occurred in 32.9% (322) with 3.1% (51) having antibiotics. Treatment patterns varied with only 32.4% (530) receiving instructions in skin care, 61.2% (1002) multilayer compression and a further 67.8% (1110) compression garment with 17.6% (288) having sequential pressure therapy. Only 1.4% (23) had received psychological support. Out of the total 481/1637 (29.4%) were not prescribed any treatment. Only 50.4% (825) had access to subsidized treatments within the National and Regional Health Care System, whereas 49.6% (81) had to pay themselves with only half (50.9%) having access to treatment centers that were near their home. Conclusion: Results from this study and active lobbying have led to changes in reimbursement of care for primary and secondary lymphedema in Italy; this has led to a much more optimistic picture for those affected.

Primary lymphoedema

Lymphoedema is the swelling of one or several parts of the body owing to lymph accumulation in the extracellular space. It is often chronic, worsens if untreated, predisposes to infections and causes an important reduction in quality of life. Primary lymphoedema (PLE) is thought to result from abnormal development and/or functioning of the lymphatic system, can present in isolation or as part of a syndrome, and can be present at birth or develop later in life. Mutations in numerous genes involved in the initial formation of lymphatic vessels (including valves) as well as in the growth and expansion of the lymphatic system and associated pathways have been identified in syndromic and non-syndromic forms of PLE. Thus, the current hypothesis is that most cases of PLE have a genetic origin, although a causative mutation is identified in only about one-third of affected individuals. Diagnosis relies on clinical presentation, imaging of the structure and functionality of the lymphatics, and in genetic analyses. Management aims at reducing or preventing swelling by compression therapy (with manual drainage, exercise and compressive garments) and, in carefully selected cases, by various surgical techniques. Individuals with PLE often have a reduced quality of life owing to the psychosocial and lifelong management burden associated with their chronic condition. Improved understanding of the underlying genetic origins of PLE will translate into more accurate diagnosis and prognosis and personalized treatment.

International Camps for Children with Lymphedema and Lymphatic Anomalies: When Education Links with Psychosocial Research

Background: Lymphedema in children and adolescents is a rare and chronic condition. The management of their lymphedema is mainly driven by the adaptation of treatments used in adults. The aim of our study was to explore the needs and challenges the children and adolescents face during their management with the aim of finding ways to satisfy these needs and organize an hospital-based centre accordingly with an educational program. Methods and Results: Patients and their families were given the opportunity to meet other patients, their families and professionals during social activities organised annually and during two international camps. They were invited to take part in different semi structured focus groups and interviews. All patients and families described a long journey and relief when the diagnosis was obtained followed by the shock of being told that it was a chronic condition. Meeting other children with the condition was a relief. The impact of lymphedema on body shape and genitals was a source of distress. Rejection of the compression was part of journey. Lymphedema management had an impact on all the family members including siblings. Parents were responsible for their child self-management in young children which was described as demanding. It was followed by a complex transition phase to self-management. The impact was not the same according to the age the lymphedema had started. Conclusion: Acceptance and management of lymphedema is complex and invades many aspects of families' life. Self-management is demanding. Based on these results, the management of lymphedema in the centre included meeting other children and families and an educational program based on individual needs and follow-up. Clinical Trials.gov ID:NCT01922635.