安徽省六安市3~6岁儿童生活质量和相关影响因素分析

目的 了解安徽省六安老区学龄前儿童生活质量及其关键影响因素,有效指导儿童保健工作。方法 2016年5－7月采用儿童生存质量测定量表PedsQOL 4.0中文版对2 512名3~6岁儿童家长进行问卷调查并做统计分析。结果 1)单因素分析显示,儿童生理、情感、社会和角色功能四维度及总得分5~6岁均高于3~、4~岁年龄组(P＜0.05);2)正常儿童生活质量指标得分高于患慢性病和近两周患病或受伤儿童(P＜0.01);3)有母亲陪伴的儿童所有生活质量指标都高于没有母亲陪伴的儿童(P＜0.01);4)有住房的儿童得分高于租房的儿童(P＜0.01);5)多重线性回归分析显示,对生活质量4个维度有显著影响的有 4个因素,分别为最近两周是否患病或受伤、慢性病、年龄以及是否与母亲住一起(P＜0.05或＜0.01)。结论 影响3~6岁儿童生活质量的关键因素是儿童的健康和有无母亲陪伴。因此,加强儿童保健,宣传亲子关系对提高老区儿童生活质量意义重大。     

脑卒中患者的生活质量评价量表及其运用

脑卒中 (stroke)作为常见的慢性病之一 ,不仅给患者带来躯体的残疾 ,常常还引起不同程度的功能障碍。在工业化国家 ,脑卒中居于成人伤残的首位 〔1〕。在我国 ,其发病率为 0 .3%～ 1.0 % ,致残率为70 %～ 80 % ,高于世界平均水平 〔2〕。近年来尽管随着治疗技术的提高 ,死亡率已大为减少 ,但是病人中 86 %的人有不同程度的后遗症 ,严重影响了患者的健康状况和生活质量 (quality of life,QOL ) ,并给社会及家庭带来沉重的经济负担 〔3〕。传统的测量脑卒中结局的指标主要是如死亡率、复发率以及残疾水平等负性健康指标 ,这些指标均不能全面…     

土源性线虫感染对儿童生活质量影响因素分析

目的:探讨土源性线虫(STH)感染对儿童生活质量的影响,为提高儿童尤其是STH感染儿童生活质量提供依据。方法:采用Kato-Katz法,对小学5～6年级儿童进行粪便病原学检查,一送三检查蛔虫、钩虫、鞭虫等土源性线虫虫卵,并按WHO标准感染度分级为轻、中、重度感染;应用SF-12量表对参与粪检的507例儿童进行问卷调查。结果:回收合格问卷472份。STH感染175例,感染率37.1%。中重度以上感染79例,感染率16.7%;中重度STH感染儿童生理评分(PCS)和心理评分(MCS)(14.32±3.69和16.08±4.17),低于轻度感染儿童PCS和MCS(15.54±3.37和17.30±4.39)及未受感染儿童PCS和MCS(16.86±3.37和18.68±3.84),差异有统计学意义(P<0.001);逐步回归分析显示,影响儿童生活质量的主要因素:土源性线虫感染、母亲文化、过去1个月经常腹痛、饭前便后不洗手、过去1个月是否患病等。结论:STH感染影响儿童生活质量。做好学龄儿童卫生保健,养成良好卫生习惯,重视儿童慢性疾病的预防与控制,提高父母文化是改善STH感染儿童生活质量的重要途径。     

世界卫生组织生活质量量表澳大利亚中文版研究：Ⅰ绪论

首先对世界卫生组织生活质量研究（WHOQOL）进行了简单回顾，然后阐述了新中心加入WHOQOL研究的原则和步骤。这些步骤包括WHOQOL件的翻译、重点讨论小组、新问题的创作和新版本的现场测试。对WHOQOL件的翻译应达到概念的、语义的和技术性的等值。章最后简单介绍了澳洲华人社会，并阐明了发展WHOQOL澳洲中版的意义。     

房颤特异性生活质量量表的汉化和信效度评价

目的 对房颤特异性生活质量量表AFEQT进行汉化和信效度评估。方法 按照跨文化调试过程指南对AFEQT量表进行汉化,对重庆市某三甲医院230名新发非瓣膜性房颤患者进行问卷调查,并通过因子分析等方法评估量表信效度。结果 量表总的 Cronbach’s α 系数、分半信度系数和重测信度系数分别为0.912、0.900和0.947。量表内容效度指标（scale-content validity index,S-CVI）为0.94,条目内容效度指标（item-content validity index,I-CVI）在0.85到1.00之间。因子分析评价量表结构效度,提取到的4个公因子累计贡献率为69.20%,结构与量表设计的4个维度相符合。结论 AFEQT量表汉化后有较好的信效度。     

癌症患者生活质量测定量表EORTC QLQ-C30的应用概况

生活质量研究是目前国际性研究热点之一，美国食品药品管理局(FDA)已经明确规定将生活质量作为抗癌新药评价的必需项目之一，而对癌症患者生活质量测定的前提是其测定工具(量表)，国外学者开发了许多用于癌症患者生活质量测评的量表，对国外应用较广的EORTC QLQ-C30测定量表的考评和应用情况进行综述，以期达到让国内同行更加了解该量表并合理应用该量表的目的。     

西雅图量表测量冠心病患者生活质量的评价

西雅图量表(SAQ)是由美国学者Spertus等人设计应用于冠心病患者特定的功能状态及生活质量的自测量表。共分为5大项19个条目：躯体受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意度、疾病认识程度。条目总分为100分，评分越高，病人生活质量及机体功能状态越好。国外应用表明，此量表具有良好的信度、效度、反应度。该量表1996年被引进到中国，本文主要针对中译本西雅图量表进行信度、效度和反应度的系统评价。结果报告如下。     

北京市家长用婴幼儿发育迟缓筛查量表的编制研究

目的编制一套适用于家长填写和评估的儿童发育迟缓筛查量表,早期发现儿童发育偏离,有效改善儿童发育迟缓状况。方法编写量表,由儿童发育临床专家进行修改和补充。初步编制完成八个年龄组的适龄量表。采用横断面研究,随机选取8个年龄组各110名儿童及家庭,家长填写筛查量表,社区医生核对,采用因素分析进行统计确定量表项目。选取每个年龄组30名儿童及家庭进行量表信效度研究;对填写6月龄、18月龄、36月龄量表的儿童进行小儿智能发育筛查量表(Denver Developmental Screening Test,DDST)评估,检验量表信度和效度。为研究量表应用情况,在高危儿门诊针对6月龄、18月龄、36月龄发育迟缓转诊儿童,采用Gesell发育诊断法进行评估,每个月龄测查30名儿童,验证其特异性及应用价值。结果全量表Cronbach'α系数0.500~0.793,评分者(家长与医生)一致性在0.53~0.91之间。内容效度各子量表与全量表间相关系数均0.5,与小儿智能发育筛查量表(Denver Developmental Screening Test,DDST)一致性达94%,对发育迟缓儿童筛查具有较好的特异性。结论量表具有较好的信度和效度,在社区儿童保健医生管理下,应用于家庭对儿童发育迟缓的筛查,具有应用价值。     

儿童生存质量测定量表PedsQLTM的结构及应用概况

近30多年来，健康相关生存质量（Health-related quality of life。HRQOL）的研究倍受注目。已形成一个国际性研究焦点。生存质量测评已被广泛应用于癌症、慢性病及某些特殊人群的研究，为治疗方法或干预措施的筛选、卫生资源分配的决策等提供综合依据。我国小儿生存质量研究起步较晚，目前尚未建立合适的儿童生存质量评价量表体系。儿童生存质量测定量表系列（The Pediatric Quality of Life Inventory Measurement Models，PedsQL^TM）由美国加州圣地亚哥儿童医院和健康中心（children’s Hospital and Health Center，San Diego，California）的James W Varni教授领导的研究小组研制，是研究儿童生存质量的系统性测量工具。PedsQL^TM广泛应用于美国国内不同儿童群体中，近年已被翻译成多种语言，形成不同文化、不同语言环境下的多种版本，应用于德国、荷兰、澳大利亚等全世界53个国家和地区。目前我国台湾PedsQL^TM中文国语版、香港中文粤语版正在调适应用阶段，中国内地尚未曾引进该量表。本文对PecksQL^TM的结构和应用进行简要阐述，以期使国内同行能够对该量表体系有一定的了解。     

世界卫生组织生活质量量表澳大利亚中文版研究：Ⅱ翻译和移植

报告了对WHOQOL量表向中的翻译和移植。对WHOQOL的翻译遵循了WHO推荐的程序，这包括前向翻译、逆翻译和对译的双语和单语考查。对答题尺度的翻译采用了直观类比法，重点讨论小组发现有些因素有所的问题条目不能在中国化中有效地反映这一因素，还发现一些对中国人的生活质量很重要但未被WHOQOL所涵盖的因素。问题创作小组以此为依据建议和创作了新的因素和问题并形成了WHOQOL澳洲中版。     

Quality-of-Life Concerns of Chinese Patients With Advanced Cancer

This study aimed to examine the quality of life (QOL) of patients with advanced cancer in Hong Kong. Ninety participants were recruited from the oncology ward of the study hospital. They responded to a 28-item, 8-subscale multidimensional questionnaire and a single-item scale that measured QOL in a face-to-face interview. Participation in health care decisions, food-related concerns, and existential distress were some QOL concerns that require health care professionals' attention. Walking ability predicted the level of QOL in certain QOL domains that surfaces patients' need for rehabilitation. That the QOL domain value of life was the most important domain that predicted overall QOL calls for meaning-of-life interventions for palliative care.     

Performance of a Bayesian Approach for Imputing Missing Data on the SF-12 Health-Related Quality-of-Life Measure

Background

Missing data in health-related quality-of-life outcomes are an ongoing problem. The 12-item short form health survey (SF-12) scores are no exception. Data imputation is complicated, because missingness may be partially predicted by the missing data themselves.

Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures

IntroductionWe aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure.MethodsMean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences.ResultsSeven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44).ConclusionsFindings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.     

沈阳市10~12岁健康儿童肺功能与生长发育指标的关系分析

目的 了解沈阳市10~12岁健康儿童肺功能和生长发育情况并分析其相关性,为科学评价中国儿童肺功能发育提供科学依据。方法 整群抽取沈阳某小学5、6年级231名健康学生作为研究对象,测量最大呼气流速(peak expiratory flow,PEF)、第一秒用力肺活量(forced expiratory volume in one second,FEV1)和身体生长发育指标,探讨这些因素对PEF、FEV1的影响,通过多元逐步回归建立PEF、FEV1指标的预计方程。结果 FEV1、体重、腰围、臂围男生高于女生,差异有统计学意义;身高、坐高男女生差异无统计学意义;年龄、体重、身高、坐高、胸围与PEF和FEV1均为正相关(P<0.01)。将PEF、FEV1作因变量进行多元逐步线性回归分析发现男生PEF、FEV1均与体重、身高、臂围密切相关,同时FEV1和坐高也呈正相关;女生PEF和FEV1与坐高正相关,FEV1还和胸围关系密切(P<0.05)。结论 PEF、FEV1与性别、体重、身高、臂围、坐高、胸围关系密切,并且对男女儿童的PEF、FEV1影响不完全相同。     

Identifying Adherence Patterns Across Multiple Medications and Their Association With Health Outcomes in Older Community-Dwelling Adults With Multimorbidity

ObjectivesTo classify older people with multimorbidity according to their adherence patterns and to examine the association between medication adherence and health outcomes.MethodsThis is a secondary analysis of a cohort study. Community-dwelling adults aged ≥70 years were recruited from 15 general practices in Ireland in 2010 (wave 1) and followed up 2 years later (wave 2). Participants had ≥2 RxRisk-V multimorbidity conditions at wave 1 and had ≥2 dispensations of RxRisk-V medications (wave 1-wave 2). Average adherence across RxRisk-V conditions was estimated based on continuous multiple-interval measure of medication availability (CMA7 function in AdhereR). Group-based trajectory models were used to group participants’ adherence patterns for RxRisk-V medications. Multilevel regression was used to examine the association between adherence and (1) EuroQol 5-dimension (EQ-5D) utility (linear) and (2) vulnerability, using the Vulnerable Elders Survey (≥3 defined as vulnerable; logistic) at wave 2, controlling for potential confounders.ResultsAverage adherence (CMA7) was 77% across 501 participants. Group-based trajectory models identified 5 adherence groups: (1) initial low adherers, gradual increase; (2) high adherers, sharp decline; (3) steady adherers, gradual decline; (4) consistent high adherers; and (5) consistent nonadherers. Higher average adherence was associated with a significant increase in EQ-5D utility (adjusted β = 0.11, robust standard error 0.04). Group 5 was associated with significantly increased vulnerability compared to group 4 (adjusted odds ratio = 1.88; 95% confidence interval 1.01-3.50).ConclusionIncreased average adherence was associated with higher EQ-5D utility. Adherence grouping did not significantly impact utility. Suboptimal adherence to multiple medications in older adults with multimorbidity was associated with vulnerability.     

北京市海淀区6～15岁少儿体成分生长发育特征分析

目的探讨北京市海淀区少儿体成分年龄、性别差异,研究体成分发育规律,为今后研究儿童体成分生长发育变化积累数据。方法采用随机抽样方法测量6~15岁少儿体成分,其中男510名、女497名。采用双因素方差分析比较年龄、性别影响,单因素方差分析比较年龄差异,独立样本t检验分析性别差异,数据拟合建立回归曲线。结果男少儿随年龄增加相对总水分和相对蛋白质先持平、后减少、再持平、又增加、最后持平;相对无机盐先持平、后减少、再持平,又增加、最后持平;内脏脂肪面积先持平、后增加、再持平、又增加、再持平、最后增加。而女少儿随年龄增加相对总水分和相对蛋白质先持平、后减少、再持平、又减少、最后持平;相对无机盐先持平、后减少、最后持平;内脏脂肪面积先持平、后增加、再持平、又增加、最后持平。结论性别、年龄对体成分各指标有显著性影响;应在少儿时期分性别对体成分进行控制,从而为预防少儿肥胖提供参考价值。     

3~6岁幼儿生活自理能力问卷的编制

目的 编制3~6岁幼儿生活自理能力(家长版)问卷,为评估幼儿生活自理能力提供测量工具。方法 采取整群随机的方式抽取400名幼儿家长进行调查,通过探索性因素分析和验证性因素分析对问卷进行检验。结果 幼儿生活自理能力由穿衣情况、睡眠情况、进餐情况、盥洗情况和其他情况五因子33个题项构成,可解释变量54.841%,表示该量表整体模式的基本适配度较好;而总量表的内部一致性系数为0.915,各维度内部一致性信度在0.716~0.898之间,总量表的分半信度为0.800,各分量表的分半信度在0.735~0.854之间,表明该量表具有良好的信度。结论 构建的3~6岁幼儿生活自理能力问卷具有良好结构效度和信度,可作为评估幼儿生活自理能力的工具。     

Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss,as Measured by the PedsQL and Health Utility Index Mark 3

ObjectivesTo examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children.MethodsData were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots.ResultsChildren with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement.ConclusionsChildren with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.     

Development of the Bleeding and Pelvic Discomfort Scale for Use in Women With Heavy Menstrual Bleeding Associated With Uterine Fibroids

ObjectivesThis study aimed to define a cardinal symptom burden measure based on items from the Uterine Fibroid Symptom and Quality of Life questionnaire for use as a clinical trial endpoint.MethodsExploratory factor analysis was computed to assess the Uterine Fibroid Symptom and Quality of Life symptom severity scale factor structure, using phase 2 data. Pooled blinded data from phase 3 studies were used for the confirmatory factor analysis and the psychometric evaluation of the new measure. Exit interviews in 30 patients from phase 3 studies provided additional qualitative evidence. A meaningful change threshold was determined using anchor-based analyses supported by patient feedback in the exit interviews.ResultsThree factors emerged from the exploratory factor analysis. Factor 1, called the bleeding and pelvic discomfort (BPD) scale, consists of cardinal symptoms, measuring menstrual distress owing to heavy bleeding, passing blood clots, and feeling tightness or pressure in pelvic area. Patients generally understood the items in the scale and the recall period as intended. The BPD scale had good item performance and internal consistency reliability, strong item-to-total correlations, good item discrimination, known-groups validity, and ability to detect change. A 20-point change on the BPD scale was determined as the clinically meaningful change threshold.ConclusionsThe BPD scale assesses symptom burden owing to bleeding, passing blood clots, and pelvic pressure. The subscale is based on a subset of items selected to measure the cardinal symptoms of uterine fibroids in a clinical trial setting. The responder threshold evaluates whether patients experience a meaningful treatment benefit over the on-treatment period.