河南省居民慢性病现况调查及患者生活质量分析

目的：健康相关生活质量是新一代健康指标，可将生命作为一个整体做出主观评价。慢性病所引起的非致死性失能后果严重威胁居民的生活质量，本文旨在探讨河南省居民慢性病患病情况及其患者的生活质量。方法：调查于2000—01／12在河南省的12个城市、40个县城(乡镇)、151个村(居委会)展开。采用随机分层抽样方法抽取3000名居民，应用世界卫生组织制定的调查表进行家庭问卷调查。调查内容包括：社会人口学特征，慢性病的患病情况(患病率及顺位)以及慢性病患者的生活质量的调查。慢性病的定义为：调查的前1年内，自觉有病并经过医务人员明确诊断或自觉有病，虽未经义务人员诊断，但采取了医疗措施者。生活质量调查依据WHO对生活质量定义和描述，参照中文普适性生活质量量表中生活质量的评分方法，从生理、心理、社会适应能力3个维度、18个健康领域，具体用42个不同的指标来描述，每个指标按照健康状况最好到最坏依次可记为1，2，3，4，5分，可能得分范围为42～210分。为使得分与生活质量呈正相关，按公式：生活质量得分=[1-(实际分值一最低可能分值)／(最高可能分值一最低可能分值)]对原始量表中得分进行转换，使分值在1～100分，分值越高，生活质量水平越高。结果：本次共抽样调查3000户家庭，发放访谈问卷3000分，实际回收合格访谈问卷3000份，回收率为100％。在3000名调查对象中，慢性病的患病率为53．6％，患1种，2种，3种及以上慢性病的患病率分别为26．9％，13．2％和23．5％，慢性病总例次患病率达107．7％，城市为119．8％，农村为101．2％，男性为116．0％，女性为124．3％，患病率前四位依次为胃炎或胃溃疡(13．5％)、视力问题(13．1％)、压抑或焦虑(12．3％)和背痛或椎间盘问题(11．9％)。慢性病患者在生理分值、心理分值、社会适应能力分值及总生活质量分值都明显低于正常人[(90．13&;#177;9．26，82．76&;#177;11．77，94．06&;#177;9．55，89．21&;#177;8．38)，(94．99&;#177;4．92,90．63&;#177;7．57,98．09&;#177;4．24,94．62&;#177;4．31)，P&;lt;0．05]，心理纬度分值明显低于生理纬度和社会适应能力纬度的分值。随患慢性病种类的增加，生活质量3个纬度的得分及总分都明显下降。结论：河南省居民慢性病患病率处于高水平，无论是从生理、心理、社会适应能力或综合评分，慢性病患者的生活质量都明显下降，心理纬度分值更低，说明心理健康对生活质量的影响不容忽视，因慢性病的病程较长、治愈率低，患者易产生心理压力、情绪不稳定，对生活不满意，造成生活质量下降。     

血液透析患者生活质量的横断面调查

目的了解血液透析患者的生活质量水平。方法采用WHO生活质量BREF量表（WHO quality of life questionnaire BREF,WHO QOL BREF）对48例维持性血液透析患者进行横断面评估,对各领域分值与营养状况、年龄和文化程度进行相关分析。结果患者的各领域分值无性别差异,与营养状况、年龄和文化程度无明显相关;患者在接受医疗、护理、生活指导和精神支持等各方面顺应性良好。结论提供有效的干预措施以改善患者健康相关的生活质量,是医疗、护理的目标,是疗效评价的重要参数。     

北京市郊区维持性血液透析患者生活质量调查

目的了解北京市郊区维持性血液透析(MHD)患者的生活质量。方法采用肾脏病生活质量简表(KDQOL-SF)对62例北京市郊区MHD患者进行问卷调查。结果①北京市郊区MHD患者生活质量得分中最低的是躯体职能、最高的是透析鼓励；②SF-36部分各纬度分值显著低于一般人群；③与解放军总医院MHD患者比较在社会支持、透析鼓励、患者满意度、全面健康评价领域得分高于解放军总医院患者(P＜0．05)：而在社会功能、总体健康、躯体功能、躯体职能、情感职能、疼痛、精力状况、情感状况、症状与不适、肾病影响、性功能、睡眠、工作状况13个领域得分郊区患者显著低于解放军总医院患者(P＜0．05)；④男性在认知功能领域得分高于女性,具有统计学意义；⑤相关性分析显示年龄对生活质量分值有较大影响,未发现血红蛋白与生活质量分值有显著相关；⑥ANOVA分析显示不同医疗费来源的患者生活质量有所不同。医保或公费医疗组好于农村合作医疗和自费组。结论北京郊区MHD患者生活质量整体水平较低,因此应把向患者提供有效的干预措施以改善患者的生活质量作为医疗和护理的重要目标。     

河南省居民慢性病现况调查及患者生活质量分析

目的:健康相关生活质量是新一代健康指标,可将生命作为一个整体做出主观评价。慢性病所引起的非致死性失能后果严重威胁居民的生活质量,本文旨在探讨河南省居民慢性病患病情况及其患者的生活质量。方法:调查于2000-01/12在河南省的12个城市、40个县城(乡镇)、151个村(居委会)展开。采用随机分层抽样方法抽取3000名居民,应用世界卫生组织制定的调查表进行家庭问卷调查。调查内容包括:社会人口学特征,慢性病的患病情况(患病率及顺位)以及慢性病患者的生活质量的调查。慢性病的定义为:调查的前1年内,自觉有病并经过医务人员明确诊断或自觉有病,虽未经义务人员诊断,但采取了医疗措施者。生活质量调查依据WHO对生活质量定义和描述,参照中文普适性生活质量量表中生活质量的评分方法,从生理、心理、社会适应能力3个维度、18个健康领域,具体用42个不同的指标来描述,每个指标按照健康状况最好到最坏依次可记为1,2,3,4,5分,可能得分范围为42～210分。为使得分与生活质量呈正相关,按公式:生活质量得分=犤1-(实际分值-最低可能分值)/(最高可能分值-最低可能分值)犦对原始量表中得分进行转换,使分值在1～100分,分值越高,生活质量水平越高。结果:本次共抽样调查3000户家庭,发放访谈问卷3000分,实际回收合格访谈问卷3000份,回收率为100%。在3000名调查对象中,慢性病的患病率为53.6%,患1种,2种,3种及以上慢性病的患病率分别为26.9%,13.2%和23.5%,慢性病总例次患病率达107.7%,城市为119.8%,农村为101.2%,男性为116.0%,女性为124.3%,患病率前四位依次为胃炎或胃溃疡(13.5%)、视力问题(13.1%)、压抑或焦虑(12.3%)和背痛或椎间盘问题(11.9%)。慢性病患者在生理分值、心理分值、社会适应能力分值及总生活质量分值都明显低于正常人犤(90.13±9.26,82.76±11.77,94.06±9.55,89.21±8.38),(94.99±4.92,90.63±7.57,98.09±4.24,94.62±4.31),P<0.05犦,心理纬度分值明显低于生理纬度和社会适应能力纬度的分值。随患慢性病种类的增加,生活质量3个纬度的得分及总分都明显下降。结论:河南省居民慢性病患病率处于高水平,无论是从生理、心理、社会适应能力或综合评分,慢性病患者的生活质量都明显下降,心理纬度分值更低,说明心理健康对生活质量的影响不容忽视,因慢性病的病程较长、治愈率低,患者易产生心理压力、情绪不稳定,对生活不满意,造成生活质量下降。     

乳腺癌化疗患者心理弹性状况与生活质量的关系研究

目的研究乳腺癌化疗患者心理弹性状况与生活质量的关系。方法选择80例乳腺癌术后化疗患者作为研究对象,分别在患者开始化疗后1个月和6个月,采用Conner-Davidson心理弹性量表对患者心理弹性进行评估,同时采用乳腺癌患者生活质量测定量表(FACT-B)评价患者的生活质量,Spearman相关分析研究乳腺癌患者心理弹性状况与生活质量的关系。结果乳腺癌术后化疗患者心理弹性水平总体较低,开始化疗后1个月和6个月总分分别为(52.72±11.44)和(58.92±11.27)分,显著低于国内常模(65.4±13.9)分(P0.05),其中坚韧、自强、乐观各因子分值均低于国内常模(P0.05);化疗后6个月患者心理弹性总分和坚韧、自强因子分值高于化疗后1个月(P0.05)。皮尔森相关分析结果显示,患者心理弹性水平与生理维度、社会/家庭维度、情感维度和功能维度呈正相关(P0.05)。结论乳腺癌化疗患者心理弹性水平较低,且与患者生存质量相关。加强患者心理弹性,可以有效改善乳腺癌化疗患者的生存质量。     

不同婴儿喂养方式对产妇生活质量的影响分析

目的通过分析与比对采用不同婴儿喂养方式的产妇生活质量之间的差异,探索有利于婴儿健康成长与产妇生活质量的科学喂养类型。方法运用一般资料问卷和SF-36健康测量量表收集1747名产妇进行问卷调查,分析健康测量量表分值与不同婴儿喂养方式(非母乳喂养、母乳喂养时间小于1个月、母乳喂养1～5个月和母乳喂养6个月以上)之间的关系。结果产妇生活质量与母乳喂养时间呈正相关性。通过比较母乳喂养6个月以上组和非母乳喂养组可发现,前者生理功能(92.83±12.10)和总体健康(75.89±16.41)两个维度的得分明显高于后者(90.03±14.72;70.20±19.86),差异具有统计学意义(P0.05);而母乳喂养6个月以上组的总体健康(92.83±12.10)和精神健康(69.31±15.30)两个维度的得分也明显高于母乳喂养小于1个月组的对应分值(70.46±18.89;65.73±15.84),差异具有统计学意义(P0.05)。此外,在对混杂变量进行调整后,与非母乳喂养组以及母乳喂养小于1个月组相比,母乳喂养6个月以上组的总体健康[75.58(1.09)]和精神健康[69.14(0.94)]两个维度分值仍然较高,差异具有统计学意义(P0.05)。同时,产妇的生活质量也与社会支持、婴儿健康状况以及产妇心理等因素相关。结论母乳喂养及其持续时间与产妇生活质量呈正相关关系。应采取有效护理干预措施,引导和鼓励具备母乳喂养条件的产妇坚持母乳喂养。     

ICU患者的事实记忆与健康相关生活质量的关系研究

目的 探讨重症监护室患者的事实记忆情况及其与健康相关生活质量的相关性.方法 选择患者116例,在其从外科ICU转出3 d内,采用标准化事实记忆问卷进行调查;在从ICU转出5个月时,采用中文版医学结局研究简明健康状况调查量表进行调查,分析2个量表得分之间的相关程度.结果 (1)男性患者事实记忆评分为(7.25±2.11)分,女性患者为(5.15±2.32)分,男性患者高于女性患者(P<0.05);(2)女性患者健康相关生活质量明显较男性患者差(P<0.05),且主要表现在心理健康方面;有关生理健康,女性患者在躯体疼痛方面差于男性患者(P<0.05);(3)相关分析表明,ICU患者事实记忆与健康相关生活质量呈正相关(r=0.297,P<0.05).结论 术后ICU女性患者较男性患者事实记忆差;转出ICU 5个月时,女性患者的健康相关生活质量较男性患者差,主要表现在心理健康方面;外科ICU患者事实记忆情况可能明显影响其健康相关生活质量.     

以提高自我效能感为原则的健康教育对老年冠状动脉性心脏病患者生活质量的影响

目的探讨以提高自我效能感为原则的健康教育对老年冠状动脉性心脏病患者生活质量的影响,为提高老年冠状动脉性心脏病患者的生活质量提供新思路。方法便利抽样法选取2008年8月至2009年12月在浙江医院心脏康复科进行治疗的120例老年冠状动脉性心脏病患者,按住院号末尾数单双号将其分成观察组和对照组,每组60例。对照组患者实施常规护理及常规健康教育,观察组患者在常规护理的基础上实施以提高自我效能感为原则的健康教育,重点为针对冠状动脉性心脏病危险因素的教育。采用一般自我效能感量表及冠状动脉性心脏病生活质量量表对两组老年冠状动脉性心脏病患者进行教育前、教育6个月后比较。结果健康教育前两组老年冠状动脉性心脏病患者的自我效能感明显低于全国常模,差异均有统计学意义(均P<0.05),健康教育前两组患者的生活质量总分值、生活质量各分值、自我效能分值的差异无统计学意义(均P>0.05)。健康教育6个月后,两组患者在生活质量总分及自我效能分值上均较健康教育前有所提高,差异均有统计学意义(均P<0.05)。且观察组患者的生活质量总分、生活质量各分值及一般自我效能分值均高于对照组患者(均P<0.05)。结论提高患者的自我效能感有利于老年冠状动脉性心脏病患者生活质量的提高。     

脑卒中患者出院时生活质量及相关因素分析

目的 调查脑卒中患者出院时生活质量,并分析其相关因素.方法 利用横断面研究设计,采用自设问卷和脑卒中生活质量影响量表3.0版对94例来自4所三级甲等医院住院脑卒中患者一般情况和入院及出院时的生活质量进行测评.结果 出院脑卒中患者生活质量影响量表6个领域的总分为(502.79±90.05)分;相关分析显示,年龄、住院时间...     

下肢深静脉血栓导管接触性溶栓术后患者生活质量的影响因素

目的分析下肢深静脉血栓(DVT)导管接触性溶栓术后患者不同时点生活质量的相关因素。方法对80例下肢DVT行导管接触性溶栓治疗术后患者进行横断面调查,采用一般资料调查表、简明生活质量调查问卷(SF-36)、舒适状况(GCQ)评分量表、社会支持量表、DVT后综合征(PTS)评估量表分别对患者一般资料、舒适状况、社会支持情况、PTS严重程度进行评估,并对患者生活质量情况进行单因素方差分析和多元逐步线性回归分析。结果下肢DVT导管接触性溶栓治疗术后患者出院时、术后1个月、术后3个月生活质量评分逐渐上升,差异有统计学意义(P0.05)。多元逐步线性回归分析显示,溶栓时间、尿激酶用量、拔管后GCQ评分是DVT导管接触性溶栓术后患者出院时生活质量的影响因素;溶栓时间、尿激酶用量是下肢DVT导管接触性溶栓术后1个月患者生活质量的影响因素;PTS评分是下肢DVT导管接触性溶栓术后3个月生活质量的影响因素。结论下肢DVT导管接触性溶栓治疗术后患者不同时期的生活质量状况有所不同,医护人员应重视影响患者生活质量的相关因素。     

Worse quality of life in volunteer blood donors with hepatitis C

BACKGROUND: Health-related quality of life (HRQOL) encompasses many different aspects of health perceived by the individual, and its alterations in patients with hepatitis C virus (HCV) have been recently reported. The objective was to study a population of volunteer blood donors at different stages of HCV liver disease. STUDY DESIGN and METHODS: The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a generic tool, was used to evaluated HRQOL. The SF-36 scores of HCV patients were compared with those of matched healthy blood donors and at the sixth month in those who were submitted to antiviral treatment. Sex, drug use, and alcohol consumption were also evaluated. A total of 120 HCV chronic carriers were divided into three groups: 1) patients with no indication for liver biopsy (n = 37); 2) patients submitted to liver biopsy with mild liver disease (n = 40); and 3) patients with moderate to severe liver disease submitted to interferon plus ribavirin treatment (n = 43). RESULTS: HCV patients had significantly lower SF-36 scores when compared with matched healthy blood donors. There was no correlation between SF-36 scores and history of intravenous and/or inhaled drug use or alcohol consumption. Women had lower SF-36 scores than men in six domains. At the sixth month of treatment, patients who continued to be positive for the presence of HCV RNA (nonresponders) had lower quality of life than those who became HCV RNA-negative. CONCLUSION: Healthy blood donors with HCV showed significantly reduced HRQOL that was more marked in women. The presence of the virus is one of the possible explanations for the reduced HRQOL.     

Relationship between CD4 count, viral burden, and quality of life over time in HIV-1-infected patients

BACKGROUND: Although surrogate markers such as CD4 counts and viral burden (HIV-1 RNA) are predictive of AIDS-related disease progression, little is known about the relationship between changes in surrogate markers and health-related quality of life (HRQOL) outcomes. This study investigated how changes in CD4/mm3 and viral burden (RNA copies/mL) are related to changes in HRQOL as indexed by the Medical Outcomes Study HIV Health Survey (MOS-HIV-30). METHODS: Subjects were HIV-1-infected patients with CD4 counts <300/mm3 enrolled in a double-blind, randomized clinical trial of delavirdine. As part of the clinical protocol, patients completed the MOS-HIV-30, from which the Physical Health (PHS) and Mental Health (MHS) summary scores were used for analyses. HRQOL and surrogate marker data assessed up to 2 years after randomization were analyzed for a total of 1,112 patients. RESULTS: Individual patients' initial status (intercepts) and rates of change (slopes) over time for log CD4, log RNA, PHS, and MHS were estimated with the use of empirical Bayes. Early response to treatment correlated with HRQOL better for RNA than for CD4. However, the relationship between weekly change and HRQOL was stronger for CD4 than for RNA. CONCLUSIONS: Surrogate markers are significantly associated with HRQOL outcomes. Improvements in HRQOL over time are associated with lower initial viral load and with increases in CD4 counts. Limitations concerning the restricted variability of the change scores are addressed.     

Effects of skeletal morbidities on longitudinal patient-reported outcomes and survival in patients with metastatic prostate cancer

Goals of work Patients with prostate cancer metastasized to bone frequently experience skeletal morbidities as a result of their disease. We sought to quantify the longitudinal effects on patient-reported outcomes of skeletal-related events (SREs) and to ascertain the declines in health-related quality of life (HRQOL) and pain experienced by patients who experienced SREs. Materials and methods Data are from a clinical trial for the treatment of SREs associated with advanced prostate cancer metastatic to bone. Outcome measures included the Functional Assessment of Cancer Therapy-General (FACT-G) and the Brief Pain Inventory. Among patients who survived 6 months after randomization, patients with no SREs in the initial 6 months after randomization were matched via propensity scores with those experiencing one or more SREs. Similarly, patients with one SRE were matched with a subset of patients with two or more SREs. Main results Patients with SREs in the initial period had significantly worse survival and HRQOL than those with no SREs. Significant differences were found between the pain differences, FACT-G total scores, and FACT-G physical, emotional, and functional subscales. Comparisons of patients with single vs multiple SREs showed similar patterns. Conclusions The presence of SREs is significantly associated with worse survival and poorer HRQOL in this patient population. Increasing SRE intensity shows a pattern of increasingly decreased survival and poorer HRQOL. Ms DePuy is now with INC Research, Raleigh, NC, USA.     

Health-related quality of life in long term-survivors of thoracoabdominal aortic aneurysm repair.

The purpose was to assess health-related quality of life (HRQOL) in long-term survivors of thoracoabdominal aneurysm repair. Between 1983 and 2001, 43 patients underwent thoracoabdominal aneurysm repair. Long-term survivors (13) were investigated. Two were lost to follow-up. The mean follow-up period was 6.2 years. HRQOL was measured by Short Form (SF)-36, constructed of 36 items grouped into eight scales measuring physical functioning, role limitations caused by physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations caused by emotional problems, and mental health. Additional questions specific for vascular disease were ascribed. The patients' relatives received corresponding questions, responding on behalf of the patients. Patient data scores were compared with a selection of individuals from the general population. The patients' SF-36 scores were generally poorer than that of the healthy population in both physical and mental dimensions. Patients who had a complicated postoperative course generally scored lowest in physical dimensions. Comparing patients' scores with relatives scoring on behalf of the patients showed no statistical differences. According to disease-specific questions, impotence and pain were reported as major long-term postoperative problems. Patients with uncomplicated postoperative courses all reported improved health status (six) compared with the preoperative status, whereas five patients with complicated postoperative courses reported poorer health status. Nine of 11 patients experienced the same or improved HRQOL, and two patients reported reduced HRQOL after surgery. Ten of 11 patients evaluated the operation as successful. Although the sample size in this study is small, those who had postoperative complications or reported a decreased physical function in the years after surgery generally had low scores in almost all dimensions of the SF-36. When disease-specific questions were related to thoracoabdominal aneurysm surgery, most patients reported an acceptable HRQOL.     

Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion

The purpose of this cross-sectional study was to assess the relationships between demographic, clinical and pain variables and health-related quality of life (HRQOL) in patients who had undergone instrumented spinal fusion because of chronic low back pain (CLBP). The sample comprises 101 patients (70% women, mean age 46 years) who had received surgery between 1993 and 2000. The SF-36 Health Survey was used to assess HRQOL. Pain was assessed by sensory, affective and evaluative subgroups of the Norwegian Pain Questionnaire (modified McGill Pain Questionnaire). Age, work status, number of years after surgery, physical training, other chronic conditions and affective and evaluative pain (all p < 0.05) were the most prominent factors affecting HRQOL. The highest adjusted R(2) to explain the variance was physical function (52%) and the lowest was emotional role limitations (15%). Pain, particularly affective and evaluative pain, contributed more to the explained variance of HRQOL than demographic and clinical variables.     

The prognostic association of health-related quality of life scores with survival in breast cancer

Goals of work

There is extensive data showing that health-related quality of life (HRQOL) tools measuring the activities of daily life provide prognostic information in cancer. However, similar information on HRQOL tools measuring patient satisfaction with their life is sparse. The Ferrans and Powers quality of life index (QLI) is one such instrument. This study evaluated the association between HRQOL, as measured by the QLI, and survival in breast cancer.

Materials and methods

We examined a consecutive case series of 251 histologically confirmed breast cancer patients treated at Cancer Treatment Centers of America® between April 2001 and November 2004. QLI measures overall HRQOL and the HRQOL in four major subscales: health and physical functioning, social and economic, psychological and spiritual, and family. All scores range from 0 to 30 with higher scores indicating a better HRQOL. Study patients were dichotomized into two groups based on the median scores for all QLI subscales. Kaplan–Meier method was used to calculate survival. Log-rank test was used to study the equality of survival distributions. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of HRQOL and clinical factors.

Results

Patient satisfaction with health and physical subscale was significantly associated with survival (p?=?0.0006), with the median survival for low and high scores being 17.8 and 35.3 months, respectively. Similarly, patient satisfaction with overall HRQOL was significantly associated with survival (p?=?0.0006), with the median survival for low and high scores being 17.8 and 34.6 months, respectively. Patient satisfaction with health and physical subscale and overall HRQOL were found to be predictive of survival independent of the effects of stage at presentation.

Conclusions

This study suggests that baseline patient satisfaction with health and physical functioning and overall HRQOL, as measured by QLI, provides useful prognostic information in patients with breast cancer independent of stage at presentation.

     

The discriminative ability of the 12-item short form health survey (SF-12) in a sample of persons infected with HIV

BACKGROUND: Self-reported health-related quality of life (HRQOL) assesses constructs that transcend laboratory-based clinical parameters. Corroboration of the hypothesized relationships between the 2 types of health indicators (ie, clinical and HRQOL) could provide evidence of the validity of an HRQOL measurement tool. OBJECTIVE: The purpose of this study was to evaluate the ability of scores on the mental component summary (MCS-12) and physical component summary (PCS-12) of the 12-Item Short Form Health Survey (SF-12) to discriminate between HIV-infected persons in predefined disease-severity groups based on surrogate markers. METHODS: This cross-sectional study involved the collection of clinical data (ie, CD4 cell count, viral load [HIV-1 RNA copies/mL]) from patients' medical records and HRQOL data from the SF-12 at 2 HIV specialty clinics. The ability of SF-12 summary scores to discriminate between patients stratified by disease severity (ie, CD4 cell count <200 vs > or = 200/mm3; HIV-1 RNA >55,000 vs < or = 55,000 copies/mL) was assessed by receiver operating characteristic curve analysis. RESULTS: Data were collected from 478 patients. The scores from the PCS-12 were able to discriminate between groups of patients stratified by disease severity based on CD4 cell count (P < 0.001) and HIV-1 RNA copies/mL (P < 0.01). MCS-12 scores did not discriminate between disease-severity groups. CONCLUSIONS: Although the SF-12 is a brief generic measure of HRQOL, these findings provide further evidence of the validity of the SF-12 and suggest that it may be a practical way to monitor health status from the perspective of the HIV-infected patient.     

Health-related quality of life and tolerability in treatment-experienced HIV-1-infected patients on tipranavir versus comparator regimens

BACKGROUND: Antiretroviral therapy including tipranavir boosted with ritonavir (TPV/r) has shown superior viral suppression and immunological response compared with comparator ritonavir-boosted protease inhibitor (CPI/r) regimens in treatment-experienced HIV-1-infected patients. This study assesses the influence of adverse events (AEs) on health-related quality of life (HRQOL) and change in HRQOL in patients treated with TPV/r versus CPI/r regimens. METHODS: Changes in HRQOL over 48 weeks were assessed using Medical Outcomes Study HIV Health Survey (MOS-HIV) data combined from two randomized, open-label, Phase III studies (RESIST-1 and RESIST-2). Generalized estimating equations (GEE) were used to compare physical health and mental health summary scores and 10 subscale scores, and to compare scores of patients with and without AEs. To compare AE incidences in the two treatment groups, AEs were exposure-adjusted. RESULTS: There were 984 patients in the HRQOL analysis. AE occurrence and severity resulted in significantly lower MOS-HIV scores across both treatment arms (P<0.05). Overall incidence of AEs was higher in the CPI/r versus TPV/r group (562.8 versus 514.4 per 100 patient-exposure years); treatment-related AEs were more frequent in the TPV/r group (75.0 versus 56.6 per 100 patient-exposure years). HRQOL was maintained in patients on TPV/r over 48 weeks of treatment across all summary and subscale scores. Compared with CPI/r, TPV/r was associated with a significant but small (SD<0.2) improvement in pain scores (+4.8 points; P<0.05). CONCLUSIONS: HRQOL was maintained across both summary and all subscale scores from baseline to 48 weeks in the TPV/r and CPI/r treatment arms, despite the incidence of treatment-related AEs.     

Quality of life of stroke survivors: a 1-year follow-up study

OBJECTIVES: To examine the changes in and to identify determinants of health-related quality of life (HRQOL) during the first year after stroke. DESIGN: Prospective cohort study. SETTING: Regional university teaching hospital in China. PARTICIPANTS: Chinese survivors of stroke (N=303). Patients who were previously physically handicapped were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Barthel Index, Lawton Instrumental Activities of Daily Living (IADL), Chinese Mini-Mental State Examination, Geriatric Depression Scale (GDS), and the abbreviated Hong Kong Chinese version of the World Health Organization Quality of Life measure domain scores at 3, 6, and 12 months after the stroke. RESULTS: A total of 268 (88%) subjects completed the study. HRQOL data were available in 247 (82%) subjects at 3 months. Between 3 and 12 months, there was no significant change in Barthel Index and IADL scores, but there was significant increase in GDS scores. On multivariate analysis and multilevel modeling, there was a small but significant decrease in social interaction and environment HRQOL domain scores with time. GDS score was negatively associated with all 4 domains of HRQOL, whereas the Barthel Index score was associated with physical and psychological HRQOL domains only. Female sex, nursing home residence, welfare assistance, pain in affected limbs, soft diet or tube feeding, and lack of physical exercise were associated with poorer HRQOL. CONCLUSIONS: Environment and social interaction HRQOL may decrease after 1 year of stroke among Chinese stroke patients. Depression has a more generalized adverse effect on HRQOL than basic functional disabilities. Health care professionals should focus on treating depression; group exercises and self-help group activities may help in promoting socialization and reintegration into community life.     

The influence of participation on health-related quality of life in stroke patients

Purpose.?Limitations in participation may have independent influences on health-related quality of life (HRQOL) at early and late phases of stroke recovery.

Methods.?Consecutive stroke patients were interviewed at months 3 and 12 after stroke for modified Barthel Index (MBI), geriatric depression scale (GDS) and WHO QOL questionnaire (abbreviated Hong Kong version). London handicap scale (LHS) was used to measure limitations in participation. The influence of the six LHS domains on the four HRQOL domains, adjusted for MBI and GDS was analysed by structural equation modelling with a two-component analysis.

Results.?Complete data were collected in 500 and 433 subjects at months 3 and 12, respectively. On multivariate analysis, after adjustment for MBI and GDS, the independence and social integration domains of LHS had significant influence on physical and social HRQOL, respectively, at both 3 and 12 months post-stroke. The occupation domain was a significant factor of physical and environmental HRQOL at month 12, but not at month 3. Economic sufficiency had more influence on HRQOL at month 3 than at month 12. The mobility and orientation domains had no significant negative influence on HRQOL.

Conclusions.?In stroke patients, participation had significant independent influences on HRQOL.