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1.
Quality of life differs among headache diagnoses: analysis of SF-36 survey in 901 headache patients 总被引:2,自引:0,他引:2
This paper presents the results of health-related quality of life (HRQoL) in 901 patients consecutively visiting a headache clinic of a national medical center in Taipei, Taiwan. HRQoL was evaluated with the Medical Outcome Study-Short Form (SF-36) and the Hospital Anxiety and Depression Scale (HADS). According to the classification criteria for chronic daily headache (CDH) proposed by Silberstein et al. (Neurology 47 (1996) 871) five hundred and ninety-three (66%) patients had CDH, of whom transformed migraine (TM) was diagnosed in 310, and chronic tension-type headache (CTTH) in 231. One hundred and ninety-three patients had episodic migraine. All SF-36 scale scores significantly correlated with the HADS scores and the intensity and frequency of pain. Compared with the normative data, a pervasive multi-dimensional decline of the SF-36 scores was noted among the headache patients except for the physical functioning scale. The decline was most remarkable in the role limitations of physical and emotional dimensions and in the bodily pain. An increasing impairment of the SF-36 scores was noted from migraine to CTTH to TM. After controlling for the HADS, age, gender, education, and chronic illness by multiple linear regression analyses, the patients with TM had the worst SF-36 profile; whereas, the patients with CTTH and migraine had compatible results. This study is the first to demonstrate that the SF-36 scores differ among headache diagnoses. Psychological distress, as well as the percentages of the types of patients, greatly influenced the SF-36 scores in hospital-based headache samples. Our findings also suggest that improvement in the pain profile as well as psychological well-being can predict a generalized improvement in the SF-36 scales in headache patients. 相似文献
2.
BACKGROUND: The Short Form-36 (SF-36) and Migraine Disability Assessment (MIDAS) questionnaires are two of the most commonly used tools to measure outcomes in people suffering from headaches. Nevertheless, little is known about their interrelationship in patients with headache. OBJECTIVES: The aim of this study was to investigate the interrelationship between SF-36 and MIDAS questionnaires in patients with migraine. METHODS: We enrolled 231 patients with migraine (male/female: 43/188, mean age 35.3+/-8.1) who visited our headache clinic. They completed the SF-36, MIDAS, and a headache intake form. RESULTS: The correlation coefficients between the MIDAS score and 8 domains of the SF-36 ranged from -0.30 for the mental health domain to -0.53 for the social functioning domain (P<0.01). Canonical correlation analysis showed that the overall overlap between the 2 instruments was moderately strong (canonical correlation coefficients r=0.707 and 0.572). The overall measured redundancies for MIDAS and SF-36 scales in this study were 35.4% and 11.5%, respectively. The stepwise linear regression model showed that the social functioning domain alone explained 27.9% of variance in the MIDAS scores. Bodily pain, physical functioning, and general health domains added an additional 11.4% of the explained variance in the regression model. CONCLUSION: Despite the fact that these two measures were considerably correlated, the MIDAS and SF-36 were found to measure different aspects of the impact of headache for the sample investigated. The MIDAS questionnaire does not cover the emotional domain; therefore, an accompanying psychological questionnaire might help assess the outcome for headache studies. 相似文献
3.
Psychopathology and quality of life burden in chronic daily headache: influence of migraine symptoms
A. Autret S. Roux S. Rimbaux-Lepage D. Valade S. Debiais 《The journal of headache and pain》2010,11(3):247-253
The aim of this study is to compare the psychopathology and the quality of life of chronic daily headache patients between
those with migraine headache and those with tension-type headache. We enrolled 106 adults with chronic daily headache (CDH)
who consulted for the first time in specialised centres. The patients were classified according to the IHS 2004 criteria and
the propositions of the Headache Classification Committee (2006) with a computed algorithm: 8 had chronic migraine (without
medication overuse), 18 had chronic tension-type headache (without medication overuse), 80 had medication overuse headache
and among them, 43 fulfilled the criteria for the sub-group of migraine (m) MOH, and 37 the subgroup for tension-type (tt)
MOH. We tested five variables: MADRS global score, HAMA psychic and somatic sub-scales, SF-36 psychic, and somatic summary
components. We compared patients with migraine symptoms (CM and mMOH) to those with tension-type symptoms (CTTH and ttMOH)
and neutralised pain intensity with an ANCOVA which is a priori higher in the migraine group. We failed to find any difference
between migraine and tension-type groups in the MADRS global score, the HAMA psychological sub-score and the SF36 physical
component summary. The HAMA somatic anxiety subscale was higher in the migraine group than in the tension-type group (F(1,103) = 10.10, p = 0.001). The SF36 mental component summary was significantly worse in the migraine as compared with the tension-type subgroup
(F(1,103) = 5.758, p = 0.018). In the four CDH subgroups, all the SF36 dimension scores except one (Physical Functioning) showed a more than 20
point difference from those seen in the adjusted historical controls. Furthermore, two sub-scores were significantly more
affected in the migraine group as compared to the tension-type group, the physical health bodily pain (F(1,103) = 4.51, p = 0.036) and the mental health (F(1,103) = 8.17, p = 0.005). Considering that the statistic procedure neutralises the pain intensity factor, our data suggest a particular vulnerability
to somatic symptoms and a special predisposition to develop negative pain affect in migraine patients in comparison to tension-type
patients. 相似文献
4.
Jane T. Osterhaus Ph.D. Raymond J. Townsend Pharm.D. Barbara Gandek M.S. John E. Ware Jr. Ph.D. 《Headache》1994,34(6):337-343
SYNOPSIS
Objective: Compare adult migraineurs' health related quality of life to adults in the general U.S. population reporting no chronic conditions, and to samples of patients with other chronic conditions. Methods: Subjects (n=845) were surveyed 2–6 months after participation in a placebo-controlled clinical trial and asked to complete a questionnaire including the SF-36 Health Survey, a migraine severity measurement scale and demographics. Results were adjusted for severity of illness and comorbidities. Scores were compared with responses to the same survey by the U.S. sample and by patients with other chronic conditions. Results: Response rate was 67%. After adjustment for comorbid conditions, SF-36 scale scores were significantly (P 0.001 ) lower in migraineurs, relative to age and sex-adjusted norms for the U.S. sample with no chronic conditions. Some health dimensions were more affected by migraine than other chronic conditions, while other dimensions were less affected by migraine. Measures of bodily pain, role disability due to physical health and social functioning discriminated best between migraineurs, the U.S. sample, and patients with other chronic conditions. Patients reporting moderate, severe and very severe migraines scored significantly (P £ 0.001 ) lower on five of the eight SF-36 scales than the U.S. sample. Conclusions: Migraine has a unique, significant quality of life burden. 相似文献
Objective: Compare adult migraineurs' health related quality of life to adults in the general U.S. population reporting no chronic conditions, and to samples of patients with other chronic conditions. Methods: Subjects (n=845) were surveyed 2–6 months after participation in a placebo-controlled clinical trial and asked to complete a questionnaire including the SF-36 Health Survey, a migraine severity measurement scale and demographics. Results were adjusted for severity of illness and comorbidities. Scores were compared with responses to the same survey by the U.S. sample and by patients with other chronic conditions. Results: Response rate was 67%. After adjustment for comorbid conditions, SF-36 scale scores were significantly (P 0.001 ) lower in migraineurs, relative to age and sex-adjusted norms for the U.S. sample with no chronic conditions. Some health dimensions were more affected by migraine than other chronic conditions, while other dimensions were less affected by migraine. Measures of bodily pain, role disability due to physical health and social functioning discriminated best between migraineurs, the U.S. sample, and patients with other chronic conditions. Patients reporting moderate, severe and very severe migraines scored significantly (P £ 0.001 ) lower on five of the eight SF-36 scales than the U.S. sample. Conclusions: Migraine has a unique, significant quality of life burden. 相似文献
5.
6.
SYNOPSIS
Background: To analyze the differences in quality of life associated with headache diagnoses using the Medical Outcomes Study Short Form Health Survey (SF-20).
Methods: A patient interview survey using the SF-20 Short Form Health Survey was conducted in a headache clinic within a multi-specialty group practice. All six health components of the SF-20 were included in the study, Headache diagnoses were made using IHS criteria.
Results: 208 consecutive headache patients were studied. Patients with cluster headache had a significantly higher (worse) pain score (P<0.018) and higher percentage of patients with poor health due to pain (P<0.005) than patients with migraine headache. There were fewer cluster patients with poor health associated with physical functioning than tension-type (P<0.020) or mixed headache (P<0.022) patients. Poor health associated with social functioning was greater for cluster (P<0.011) and tension-type headache (P<0.015) than for migraine. There was a significantly higher percentage of tension-type headache patients with poor health associated with mental health (P<0.002) than patients with migraine.
Conclusions: The SF-20 is a reliable and valid measure of quality of life for patients with different headache diagnoses. Distinct headache diagnoses are marked by unique patterns of impairment and quality of life. 相似文献
Background: To analyze the differences in quality of life associated with headache diagnoses using the Medical Outcomes Study Short Form Health Survey (SF-20).
Methods: A patient interview survey using the SF-20 Short Form Health Survey was conducted in a headache clinic within a multi-specialty group practice. All six health components of the SF-20 were included in the study, Headache diagnoses were made using IHS criteria.
Results: 208 consecutive headache patients were studied. Patients with cluster headache had a significantly higher (worse) pain score (P<0.018) and higher percentage of patients with poor health due to pain (P<0.005) than patients with migraine headache. There were fewer cluster patients with poor health associated with physical functioning than tension-type (P<0.020) or mixed headache (P<0.022) patients. Poor health associated with social functioning was greater for cluster (P<0.011) and tension-type headache (P<0.015) than for migraine. There was a significantly higher percentage of tension-type headache patients with poor health associated with mental health (P<0.002) than patients with migraine.
Conclusions: The SF-20 is a reliable and valid measure of quality of life for patients with different headache diagnoses. Distinct headache diagnoses are marked by unique patterns of impairment and quality of life. 相似文献
7.
8.
Ertsey C Manhalter N Bozsik G Afra J Jelencsik I 《Cephalalgia : an international journal of headache》2004,24(3):188-196
Health-related quality of life was studied in 35 episodic cluster headache (CH) patients during and after the cluster period, using a generic (SF-36) and a headache-specific (MSQ2.1) instrument. The results were compared with those of age- and sex-matched migraineurs (n = 53) and healthy persons (n = 62). During the cluster period patients had lower scores than controls in all SF-36 and MSQ2.1 domains. The difference was significant for most SF-36 and all MSQ2.1 domains. Although CH patients had lower scores than migraineurs on most scales, the difference was significant only on SF-36 scores measuring bodily pain and social functioning. There was a good correlation between the two instruments. After the termination of the cluster period the quality of life of patients was similar to that of headache-free controls. Generic and headache-specific QoL are severely impaired in CH and this impairment is at least as severe as in migraine. 相似文献
9.
Little is known about the course of chronic pain in the community. Such information is needed for the prevention and management of chronic pain. We undertook a 4-year follow-up study of 2184 individuals living in Grampian, UK to describe patterns and predictors of change in chronic pain over time. In October 2000, participants completed a postal questionnaire including case definition questions, the chronic pain grade questionnaire, the SF-36 and socio-demographic questions. Information from this questionnaire was compared to information collected from a similar questionnaire in 1996. A response rate of 83% was achieved for the follow-up study. The overall prevalence of chronic pain (pain or discomfort present either all the time or on and off for 3 months or longer) increased from 45.5% at baseline to 53.8% at follow-up. Seventy-nine percent of those with chronic pain at baseline still had it at follow-up. The average annual incidence was 8.3% and the average annual recovery rate was 5.4%. Individuals in the study samples who are in lowest quartile of SF-36 domains--physical functioning, social functioning and bodily pain at baseline--were more likely to develop chronic pain at follow-up, and respondents who were retired were less likely to develop chronic pain. Individuals in the study samples in the lowest quartile of SF-36 domains, bodily pain and general health at baseline, were less likely to recover from their chronic pain, as were those aged 45-74 compared with those aged 25-34. We concluded that chronic pain is a common, persistent problem in the community with relatively high incidence and low recovery rates. The lack of association between onset or recovery from chronic pain and most traditional socio-demographic factors, highlights the need to broaden the range of factors included in studies of chronic pain aetiology. 相似文献
10.
Jo Nijs Benedicte Cloostermans Neil McGregor Peter Vaes Kenny DeMeirleir 《Physiotherapy theory and practice》2013,29(1):31-40
Identifying patients' activity limitations is crucial for teaching Chronic Fatigue Syndrome (CFS) patients to effectively manage their activity level. Therefore, a questionnaire to assess activity limitations/participation restrictions in CFS patients was recently constructed. In this study, the internal consistency, the discriminant validity, and the convergent validity of this measure, named the CFS-Activities and Participation Questionnaire (CFS-APQ), were investigated. Convergent and discriminant validity are considered two fundamental aspects of construct validity. An envelope containing the CFS-APQ and the Medical Outcomes Short Form 36 Health Status Survey (SF-36) was sent to 149 CFS patients. Eighty-eight out of 149 CFS patients (59.1%) filled in and returned the questionnaires. Cronbach's Alpha reliability coefficients were > 0.87. The CFS-APQ total scores correlated statistically significant with six out eight SF-36 subscales (bodily functioning, physical role functioning, bodily pain, general health perception, vitality and social functioning), with Spearman Rank correlation coefficients ranging from ? 0.34 to ? 0.78. The highest correlation coefficients were obtained between the CFS-APQ total scores and the subscales ‘physical functioning’ and ‘social functioning’, no significant correlations were observed with the SF-36 subscales emotional role functioning and mental health. In conclusion, the items of the Dutch version of the CFS-APQ have been found to have good internal consistency, and these results substantiate both the convergent and the discriminant validity of the scores obtained with this questionnaire. 相似文献
11.
Quality of life in patients with postural tachycardia syndrome 总被引:8,自引:0,他引:8
Benrud-Larson LM Dewar MS Sandroni P Rummans TA Haythornthwaite JA Low PA 《Mayo Clinic proceedings. Mayo Clinic》2002,77(6):531-537
OBJECTIVES: To quantify quality of life and identify demographic and clinical correlates of functioning in a well-characterized sample of patients with postural tachycardia syndrome (POTS). PATIENTS AND METHODS: Prospective patients were those seen at the Mayo Clinic Autonomic Disorders Laboratory from September 2000 to June 2001. Neurologists made diagnoses of POTS according to established criteria. Patients completed a questionnaire packet that included measures of quality of life (36-Item Short-Form Health Survey [SF-36]) and symptom severity (Autonomic Symptom Profile). Additional clinical information was abstracted from medical records. RESULTS: Ninety-four patients (89% female; mean age, 34.2 years) were enrolled in the study. Patients with POTS reported impairment across multiple domains on the SF-36. Physical functioning, role functioning, bodily pain, general health, vitality, and social functioning were all significantly impaired compared with a healthy population (P<.01 for all) and similar to that reported by patients with other chronic, disabling conditions. Hierarchical regression analyses revealed that symptom severity (beta = -.36, P<.001) and disability status (beta = -36, P<.001) were independent predictors of SF-36 physical component scores, with the full model accounting for 54% of the variance (P<.001). None of the variables examined accounted for a significant amount of the variance in SF-36 mental component scores. CONCLUSIONS: Patients with POTS experience clear limitations across multiple domains of quality of life, including physical, social, and role functioning. Treatment should address the multiple and varied impairments experienced by these patients and may require a multidisciplinary approach. Future research must further delineate factors, both disease related and psychosocial, that predict functioning and adjustment in this population. 相似文献
12.
Terwindt Gisela M. Ferrari Michel D. Launer Lenore J. 《The journal of headache and pain》2003,4(1):s35-s41
Population-based studies have shown that migraineurs have reduced HRQoL independent of depression. Furthermore, HRQoL is reduced with increasing migraine attack frequency. In both population-based and clinic-based studies, CDH patients have reduced HRQoL, most marked in subjects with analgesic overuse. In one population-based study, no difference in HRQoL was found between patients with transformed migraine (TM) and patients with CTTH. However, the number of patients in this study was relatively small. In a clinic-based study, SF-36 scores in patients with chronic daily headache (CDH) depended on the percentage of the type of patients in the sample: the greater the proportion of patientsa with TM, the more impaired the SF-36 scores. 相似文献
13.
The objective was to
determine the impact of migraine
on health-related quality of life
(HRQOL) among Canadians.
Analysis was based on the public
use microdata set of the Canadian
Community Health Survey (CCHS),
limited to those aged ≥15 residing
in Manitoba. HRQOL was measured
using the SF-36 survey,
which covers 8 health concepts.
Multivariate linear regression was
used to model each SF-36 scale
against age, gender, education,
income, migraine status and presence
of mood or anxiety disorders.
Of the 7236 CCHS respondents,
9.7% reported a diagnosis of
migraine. Reported migraine predicted
statistically significant
(p<0.0001) lower HRQOL in all
SF-36 domains with profound
impairment of physical role, bodily
pain and general health. Those
reporting a mood disorder scored
significantly lower in all domains
with pronounced effects on emotional
role, social functioning and
general health. Reported anxiety
disorder was associated with lower
HRQOL in 6/8 domains. Canadians
with migraine report significant
impairment in HRQOL compared to
the general population, independent
of psychiatric morbidity. 相似文献
14.
Migraine is associated with functional impairment. The migraine disability assessment (MIDAS) questionnaire is a scientific instrument which captures headache-related disability. The Italian version of MIDAS was developed through a multistep standardized methodology. Studies on Italian clinical samples confirmed that migraine patients are disabled in all activity domains. Migraine exhibits a peculiar disability pattern: non-work activities are more affected than work activities; among patients in paid work, most continue working with a headache attack. We also found that MIDAS disability grades correlate with health-related quality of life scores at the SF-36 survey, namely with the extent to which physical health, emotional state and pain interfere with functioning in different roles. We conclude that MIDAS (also in its Italian version) is a reliable and useful instrument for assessing the impact of migraine on patients' daily activities, and that it can used not only in clinical practice but also in clinical research. 相似文献
15.
16.
Background.— Using standard quality of life and disability measures may not accurately capture these constructs in specific health populations such as headache patients. Modifying the wording of standard measures such as the Short‐Form 36 (SF‐36) should be considered in order to make them more applicable to specific patient populations. Objective.— To investigate the possibility that headache patients may not consider their headaches when responding to SF‐36 questions pertaining to health, physical health, pain, and bodily pain. Methods.— The wording of several SF‐36 questions were adapted for a headache population by making specific reference to “headaches” when asking people to rate the impact of health issues on their life. The results of the modified “Headache” SF‐36 were compared with a similar population of transformed migraine patients who had completed the “Standard” SF‐36. Results.— Significant differences were found between scores for the “Standard” SF‐36 group and the “Headache” SF‐36 group across all SF‐36 variables except for “General Health.” Conclusions.— Misinterpretation of the concepts of “health,”“physical health,”“pain,” and “bodily pain,” although commonly used by the SF‐36 in many populations, could influence responses on this measure, as respondents may not relate their head/headaches to these constructs. To ensure that accurate data are obtained in relation to the quality of life of headache patients, consideration should be given to using a form of the SF‐36 that has been modified to allow appropriate interpretation of the questions completed by headache patients. 相似文献
17.
Impact of osteoarthritis and analgesic treatment on quality of life of an elderly population 总被引:2,自引:0,他引:2
To determine the quality of life of elderly patients with osteoarthritis (OA) compared with that of their peers with no chronic illnesses and to investigate the associations between analgesic use and quality of life. SUBJECTS: Patients >65 years of age with OA taking analgesics with (n = 33) and without (n = 26) comorbidities, and control patients with no chronic illness and not taking analgesics (n = 37). METHODS: Quality of life was assessed by the SF-36 and level of pain was measured by a visual analog scale. Multiple regression analysis was used to determine the medication characteristics and additional patient factors significantly associated with SF-36 scores. RESULTS: OA patients had significantly (p < 0.05) lower scores than control patients in all quality-of-life domains. OA patient scores were lowest for the domains of role-physical, bodily pain, and physical functioning. OA patients with comorbidities also had poorer general and mental health. Pain- and analgesic-related factors were significantly (p < 0.05) associated with physical health status, reduced vitality, general health, and social functioning. A better quality of life was associated with noncompliance, fewer visits to the physician, and taking oral nonsteroidal antiinflammatory agents. Presence of adverse drug reactions and sleep disturbance did not influence SF-36 scores significantly. CONCLUSIONS: Quality of life of elderly OA patients with and without additional comorbidities was significantly poorer than that of their healthy peers, particularly in the domains associated with physical status, but also affecting vitality, social functioning, and general health. Level of pain suffered and perceived effectiveness of analgesic medication in pain control were important factors associated with quality of life. 相似文献
18.
Rocha-Filho PA Gherpelli JL de Siqueira JT Rabello GD 《Cephalalgia : an international journal of headache》2008,28(1):41-48
Rocha-Filho PAS, Gherpelli JLD, de Siqueira JTT & Rabello GD. Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia 2008; 28:41–48. London. ISSN 0333-1024
We prospectively studied headache characteristics during 6 months after craniotomy performed for treatment of cerebral aneurysms in 79 patients. Semistructured interviews, headache diaries, the Hospital Anxiety and Depression Scale and the Epworth Sleepiness Scales, the Short Form-36 Health Survey (SF-36) and McGill Pain Questionnaire were used. Seventy-two patients had headaches, half before the fifth day after surgery. Changes were observed in headache diagnosis, side and site in the postoperative period. Headache frequency increased immediately after surgery and then decreased over time. Headache frequency was associated with depressive and anxiety symptoms. Pain intensity was higher in women and in patients with more anxiety symptoms. An incidence of post-craniotomy headache of 40% was observed according to International Headache Society classification criteria, 10.7% of the acute and 29.3% of the chronic type. The bodily pain domain of the SF-36 was worse in patients with more anxiety symptoms. Greater frequencies of headache were associated with lower scores on bodily pain and social functioning. 相似文献
We prospectively studied headache characteristics during 6 months after craniotomy performed for treatment of cerebral aneurysms in 79 patients. Semistructured interviews, headache diaries, the Hospital Anxiety and Depression Scale and the Epworth Sleepiness Scales, the Short Form-36 Health Survey (SF-36) and McGill Pain Questionnaire were used. Seventy-two patients had headaches, half before the fifth day after surgery. Changes were observed in headache diagnosis, side and site in the postoperative period. Headache frequency increased immediately after surgery and then decreased over time. Headache frequency was associated with depressive and anxiety symptoms. Pain intensity was higher in women and in patients with more anxiety symptoms. An incidence of post-craniotomy headache of 40% was observed according to International Headache Society classification criteria, 10.7% of the acute and 29.3% of the chronic type. The bodily pain domain of the SF-36 was worse in patients with more anxiety symptoms. Greater frequencies of headache were associated with lower scores on bodily pain and social functioning. 相似文献
19.
目的分析抑郁对老年高血压患者生命质量的影响。方法 73例老年高血压患者依据汉密尔顿抑郁量表测定结果进行分组,高血压合并抑郁28例为观察组,高血压不合并抑郁45例为对照组,比较2组SF-36量表评分的变化。结果观察组在生命质量的生理功能、生理角色功能、躯体疼痛、总体健康、活力、社会功能、情感职能和心理健康8个维度及总分评定上均高于对照组(P<0.05)。结论抑郁严重影响老年高血压患者的生命质量,应加强患者的心理疏导和社会支持。 相似文献
20.
OBJECTIVE: To assess and contrast the relative frequency of a past history of physical and/or sexual abuse in patients with chronic daily headache (CDH) versus migraine. BACKGROUND: A number of risk factors have been identified as risk factors for chronification of headache disorders. Limited data exist regarding the influence of physical and/or sexual abuse on primary headache disorders. METHODS: This was a retrospective chart review of 183 consecutive new headache patients seen from December 2004 through August 2005 at an outpatient tertiary-care center. Patients were included in the study if they had chronic daily headache (with criteria for medication over-use headache or chronic migraine), or migraine with or without aura. A history of physical and/or sexual abuse was systematically asked of all headache patients at their first visit in the clinic. This information was then transferred to a semi-standardized form and the relative frequency of abuse in both groups contrasted. RESULTS: Of the 161 patients included in the study, 90.1% were female with a mean age of 36.4 +/- 12.0. A total of 59.0% of the patients were diagnosed with CDH and 41.0% were diagnosed with migraine. Overall, 34.8% of all patients, 40.0% of CDH patients, and 27.3% of migraine patients had a history of physical and/or sexual abuse. The relative frequency of a history of physical and/or sexual abuse was higher in the CDH group as compared to the migraine group (P = .048). CONCLUSION: The relative frequency of abuse is higher in CDH sufferers than migraineurs, suggesting that physical and sexual abuse may be risk factors for chronification. 相似文献