延续性护理对精神分裂症病人服药依从性和生活质量的影响

目的 探讨延续性护理对精神分裂症病人服药依从性和生活质量的影响。方法 选取2017年1月—2018年1月来本院就诊的精神分裂症患者70例,依据随机数字表法将其分为实验组和对照组,每组35例,其中对照组患者采用常规性护理,实验组患者在此基础上采用延续性护理,对比其护理效果。结果 实验组患者生活质量显著优于对照组,差异有统计学意义(P<0.05)。实验组患者服药依从性显著优于对照组,差异有统计学意义(P<0.05)。结论 延续性护理对于提高精神分裂症患者服药依从性和生活质量有较好的护理效果。     

精神分裂患者生命质量与经济负担关系

目的探讨精神分裂患者的生命质量和患者经济负担的关系。方法采用流行病学现场调查方法进行研究。结果调查69例患者,各影响因素中不同程度病情和起病形式导致的患者医疗总费用、不同居住地患者生命质量中环境领域和情感角色2项因子之间的差异均有统计学意义（P〈0.05）。逐步回归分析表明,患者医疗总费用与病程和病情程度呈正相关,与生存质量呈负相关。结论受多因素影响,精神病患者的经济负担较重,建议有关部门给予精神分裂症患者优惠政策,在减轻经济负担的基础上,提高患者的生命质量。     

Subjective quality of life in patients with chronic fatigue syndrome

The aim of this study was to (1) assess Subjective Quality of Life (SQOL) of patients with Chronic Fatigue Syndrome (CFS) using a generic concept and to compare the findings with those in groups with mental disorders and healthy subjects, and (2) investigate whether and, if so, to what extent socio-demographic and clinical variables predict SQOL in CFS patients. Seventy-three patients diagnosed with CFS were randomly selected and interviewed from two specialised clinics. CFS was diagnosed using the Oxford Criteria. SQOL was assessed on the Manchester Short Assessment of Quality of Life (MANSA) and Health-Related Quality of Life (HRQOL) on the Medical Outcome Study Short-Form 36 (MOS) SF-36. A battery of mood and symptom questionnaires, including the Symptom Checklist Questionnaire (SCL-90-R), was administered to assess various aspects of symptomatology as potential predictor variables. Multiple regression analyses were conducted to identify predictors of SQOL. Overall, SQOL was low in CFS patients and less favourable than in groups with mental disorders and healthy subjects. Satisfaction was particularly low with life as a whole, leisure activities and financial situation. Whilst SQOL was only moderately correlated with HRQOL, the SCL-90-R score, especially SCL-90-R Depression scale score, was the best predictor of SQOL explaining 35% of the variance. HRQOL and generic SQOL appear distinct despite some overlap. The findings underline that SQOL is significantly disrupted in CFS patients. Depressive symptoms are statistically the strongest ‘predictor’ of SQOL, although the direction of the relationship is not established. These data suggest that treatment of depression associated with CFS, regardless of causation, could help to improve SQOL in CFS patients.     

中年知识分子生命质量与生活满意度的关系

目的 研究中年知识分子生命质量与生活满意度之间的关系。方法 对463例40～59岁的大专院校和医院职工进行问卷调查和体能检查，对所得资料进行因子分析和典型相关分析。结果 中年人群生命质量与生活满意度之间呈正相关关系(典型相关系数r=0．6748)；而生活满意度主要由人际关系、家庭生活、医疗保健和身体健康来体现。结论 提高生活满意度是体现中年知识分子生命质量的关键。     

Adolescent health-related quality of life and perceived satisfaction with life

Purpose: To explore the relationship between perceived satisfaction with life and health-related quality of life (HRQOL) in a state-wide sample of 13–18-year-old adolescents (n=4914) in South Carolina, USA. Methods: Questions were added to the self-report Centers for Disease Control (CDC) Youth Risk Behavior Survey (YRBS) asking about perceived life satisfaction in six domains (self, family, friends, living environment, school, and overall) and HRQOL (self-rated health; and the number of poor physical health days, poor mental days, and activity limitation days during the past 30 days). Results: Adjusted logistic regression analyses and multivariate models constructed separately revealed that self-rated health, poor physical days (past 30 days), poor mental health days (past 30 days), and activity limitation days (past 30 days) were significantly related (p < 0.05) to reduced life satisfaction, regardless of race or gender. Moreover, as the number of reported poor health days increased, the greater the odds of reporting life dissatisfaction. Conclusions: This is the first study to document the relationship between poor physical health and perceived life satisfaction. This adds to the mounting evidence that life satisfaction is related to a variety of adolescent health behaviors and that life satisfaction may add additional information in longitudinal databases that track adolescent health because it appears to be related to HRQOL.     

家庭护理干预对精神分裂症患者生活质量的影响

目的观察和分析家庭护理干预对精神分裂症患者生活质量的影响。方法 82例精神分裂症患者随机分为对照组和干预组各41例,对照组实施常规护理;干预组在对照组基础上实施家庭护理干预。观察两组患者出院时和干预6个月后日常生活能力和生活质量及社会支持、6个月复发率、治疗依从性。结果出院时两组患者日常生活能力和生活质量及社会支持评分比较,差异无统计学意义(P>0.05);护理干预6个月后,两组患者日常生活能力和生活质量及社会支持评分均得到明显改善,且干预组优于对照组(P<0.05)。干预组治疗依从率显著高于对照组(χ2=14.19,P<0.05),6个月复发率显著低于对照组(χ2=6.27,P<0.05)。结论对精神分裂症患者实施家庭护理干预,可有效提高患者治疗依从性和生活质量,改善患者社会功能,降低复发率。     

Assessing quality of life in eating disorder patients

Objective: To examine quality of life among subgroups of eating disorder patients. Method: Self-report questionnaires which included two quality of life measures were completed by 87 individuals referred for treatment to the Australian Capital Territory Eating Disorders Day Program. Health-related quality of life, as measured by the Medical Outcomes Study 12-item Short Form Mental Component Summary scale, and subjective quality of life, as measured by subscales of the World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF), were compared among individuals who received the diagnosis of anorexia nervosa purging subtype (n=15), anorexia nervosa restricting subtype (n=19), bulimia nervosa (n=40) and binge eating disorder (n=10), and among a general population sample of young adult women employed as a control group (n=495). Results: Eating disorder patients, when considered together, showed marked impairment in both health-related and subjective quality of life relative to normal control subjects. However, in both domains, restricting anorexia nervosa patients reported significantly better quality of life than other patient groups, after controlling for levels of general psychological distress. Scores on the Social Relationships subscale of the WHOQOL-BREF among individuals in this subgroup were similar to those of normal control subjects. Conclusions: Reliance on any one instrument is likely to be misleading in assessing the quality of life of eating disorder patients. Careful consideration needs to be given to the assessment of restricting anorexia nervosa patients in particular.     

慢性乙型肝炎住院患者生存质量分析

目的评价慢性乙型肝炎住院患者生存质量(QOL),探讨其影响因素。方法采用分层整群抽样方法,于2010年3-9月连续性收集调查宁夏银川市、石嘴山市、吴忠市共6家综合医院636例慢性乙型肝炎住院患者,并应用生存质量量表(SF-36)对其进行生存质量调查。结果慢性乙型肝炎住院患者生理职能、躯体疼痛、一般健康状况、社会功能、情感职能维度得分分别为(15.6±35.1)、(59.2±16.7)、(37.5±20.9)、(64.0±26.0)、(19.0±37.6)分,与中国常模的(81.2±33.6)、(81.5±20.5)、(56.7±20.2)、(83.0±17.9)、(84.4±32.4)分比较,差异均有统计学意义(t=1.218、1.256、0.992、0.978、1.223,P<0.05);不同性别、年龄组患者生存质量得分差异均有统计学意义(P<0.05);慢性乙肝住院患者一般健康状况的主要影响因素为年龄、性别、民族;生理机能主要的影响因素为年龄、合并症、性别;精神健康的主要影响因素为吸烟情况、年龄、医疗保障。结论慢性乙型肝炎住院患者的生存质量普遍较低,并受多种因素影响。     

Assessing the needs and quality of life of patients with HIV infection: development of theHIVOverview ofProblems-EvaluationSystem (HOPES)

Objective: To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool. Design: Cross-sectional, patient completed written surveys and interviews. Setting: The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic. Patients: Patients (n=318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites. Measurements: The patients self-administered the newly developed instrument, the HOPES (HIVOverview ofProblems-EvaluationSystem), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification. Main results: The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity. Conclusions: The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.This paper is dedicated to the memory of Jimmy Stophel who died of AIDS and whose sense of humour improved the quality of many people's lives.This research was supported in part by the UCLA AIDS Clinical Research Center and CARES Consultants. To obtain information about the HOPES, please contact C. A. Coscarelli Schag, CARES Consultants, 2210 Wilshire Blvd., Suite 359, Santa Monica, CA 90403, USA.     

长春市社区脑卒中患者生活质量满意度调查

目的 了解吉林省长春市社区脑卒中患者生活质量满意度及其影响因素,为有效提高脑卒中患者的生活质量满意度提供依据。方法 采用分层随机整群抽样的方法,抽取长春市城乡共15家社区卫生服务中心或卫生院,对其健康档案登记的520例脑卒中患者进行问卷调查,利用简明幸福与生活质量满意度问卷(Q-LES-Q-SF)评估其生活质量满意度。结果 长春市社区脑卒中患者Q-LES-Q-SF总分范围在21~66分,平均分为(45.86±6.81)分,低于国内健康人群的(51.50±6.35)分,差异有统计学意义(t=-18.561,P<0.01);多元线性回归分析结果显示,影响脑卒中患者生活质量满意度的主要因素有日常生活活动能力(β'=-0.298,P<0.01)、负性生活事件(β'=-0.276,P<0.01)、社会支持(β'=0.192,P<0.01)、应对方式(β'=0.111,P<0.01)、年龄(β'=0.085,P<0.01)以及收入(β'=0.085,P<0.05)。结论 长春市社区脑卒中患者生活质量满意度水平较低;年龄、收入、躯体因素、社会心理因素等均可影响脑卒中患者的生活质量满意度。     

A reformulation of quality of life for medical science

Current quality of life measuring tools are suited for economic decision making, not to investigate causal processes which lead to patients making evaluations of their lives. An alternative approach is presented based on research into positive versus negative life-satisfaction. Quality of life is a causal sequence of psychological states where perceived symptoms cause problems and the problems and symptoms cause evaluations, and where the causal sequence is a complex interaction between morbidity and psychological factors. Different types of medical intervention affect different stages in the causal sequence and so different types of quality of life instrument are needed for different kinds of medical research.     

精神分裂症患者生存质量及影响因素分析

目的 了解精神分裂症患者出院后的生存质量情况及其影响因素。方法 采用整群抽样的方法,选择唐山市精神病医院经临床治愈、出院复诊的215例精神分裂症患者为研究对象,采用自行编制的一般状况量表、阳性与阴性症状量表（PANSS）、世界卫生组织生存质量测定简表（WHOQOL-BREF）进行测评。结果 精神分裂症患者出院后生存质量在生理领域、心理领域、社会关系领域得分分别为（54.91±15.94）、（52.69±13.07）、（52.97±19.37）分,均低于中国常模（P<0.01）;环境领域为（50.79±15.96）分;在生存质量的生理领域,年龄≥36岁、农村患者、文化程度初中及以下、不工作或劳动者得分较低（P<0.05）,在心理领域,农村患者、文化程度初中及以下、无配偶、不工作或劳动者得分低（P<0.05）,在社会关系领域,年龄≥36岁、农村患者、文化程度初中及以下、不工作或劳动、残存阴性症状分值高者得分低（P<0.05）,在环境领域,年龄≥36岁、文化程度初中及以下者得分低（P<0.05）;多元线性回归分析显示,精神分裂症患者生存质量的主要影响因素为年龄、文化水平、残存阴性症状和社会回归情况。结论 精神分裂症患者临床治愈出院后生存质量情况较差,并与多种因素密切相关。     

慢性乙型肝炎患者生命质量影响因素分析

目的分析影响慢性乙型肝炎患者生命质量(QOL)的因素,为改善患者QOL提供参考。方法采用SF-36量表测量慢性乙型肝炎患者的QOL,Morisky量表测量患者的服药依从性,分析影响慢性乙型肝炎患者QOL的因素。结果 357例慢性乙型肝炎患者中,271例(75.91%)为已婚患者,107例(29.97%)有大专及以上学历,163例(45.66%)家庭人均月收入在2 000~5 000元,家庭成员中有患乙型肝炎者138例(38.66%),吸烟患者198例(55.46%),喝酒患者150例(42.02%)。慢性乙型肝炎患者服药依从性平均得分为(2.15±1.29)分。影响慢性乙型肝炎患者QOL的因素有患者年龄、受教育水平、患病时间、是否住院、是否饮酒和服药依从性6个方面,其中年龄、饮酒、乙型肝炎患病时间和既往住院史是影响慢性乙型肝炎患者QOL的消极因素,受教育水平和患者服药依从性是影响慢性乙型肝炎患者QOL的积极因素。结论加强慢性乙型肝炎患者对疾病的认识,提高其服药依从性,可以帮助患者改善QOL。     

The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients

In schizophrenic patients, quality of life (QoL) studies often find high levels of general life satisfaction and satisfaction in various life domains despite deprived living conditions. Therefore, the usefulness of QoL as an outcome indicator has been questioned. Since social comparison processes have been postulated to be related to the level of satisfaction, this hypothesis was analysed empirically by the present study in schizophrenic patients. Satisfaction and social comparisons of 148 schizophrenic inpatients and 66 mentally healthy controls were examined with regard to the domains ‘health’ and ‘family’ by means of a standardised interview. The schizophrenic patients had a history of either long-term (n = 75) or short-term (n = 73) restricted and deprived living conditions. Long-term patients showed significantly higher satisfaction levels than short-term patients. They compared themselves predominantly laterally or downwards with fellow inpatients. Significant relationships between the direction of social comparisons and satisfaction ratings were found in all three samples. Social comparisons proved to be important for the level of satisfaction in schizophrenic patients. Results indicate that experiences of restricted and deprived living conditions induce accommodation processes and response-shifts that should be taken into account in the interpretation of quality-of-life data. This revised version was published online in June 2006 with corrections to the Cover Date.     

广东省慢性病患者生存质量及健康调整期望寿命分析

目的 分析广东省慢性病患者生存质量及健康调整期望寿命。方法 基于广东省第五次全国卫生服务调查数据,通过欧洲五维度三水平健康量表对人群生存质量进行评价。运用多重线性回归和等级logistic回归评价慢性病对人群生存质量的影响,并用期望寿命和健康调整期望寿命指标评价慢性病对人群健康的综合影响。结果 共纳入68 550名居民数据进行分析,等级logistic回归显示在校正了社会人口学特征后,慢性病对生存质量各个维度的影响均有统计学意义,其中对疼痛/不舒服维度的影响最大[OR=4.48（95% CI：4.20~4.77）],其余依次为焦虑/抑郁[OR=3.95（95% CI：3.62~4.31）]、日常活动[OR=3.69（95% CI：3.37~4.04）]、行动[OR=3.63（95% CI：3.34~3.94）]和自我照顾[OR=3.30（95% CI：2.98~3.66）]。慢性病患者期望寿命比非慢性病人群平均少12.7年,健康调整寿命平均减少14.6年（男性减少17.8年,女性减少9.7年）。人群去慢性病健康调整期望寿命收益为3.8年（男性为5.1年,女性为2.0年）。结论 慢性病会影响患者生存质量的各维度,从而减少患者的健康调整期望寿命,给人群和社会带来沉重的健康负担。从卫生政策和卫生资源优化配置的角度看,需为慢性病患者尤其是为老年患者提供更全面可及的医疗照护,照护需不仅关注生理健康也要注重心理健康。     

慢性乙型肝炎病人生活质量及影响因素分析

目的分析慢性乙型肝炎病人生活质量的主要影响因素,为增进慢性乙型肝炎病人生活质量提供参考依据。方法用SF-36量表评价441名慢性乙型肝炎病人的生活质量,同时调查可能影响生活质量的社会经济、文化因素,以及被调查对象的个人特征和患病情况。用t检验、方差分析和逐步回归对每一种影响因素分别分析,找出主要影响因素。结果单因素分析时,性别、年龄、文化程度、职业、是否在岗、婚姻状况、经济收入、医疗费用负担形式、医疗花费、家庭住房面积、疾病的炎症程度、病程、住院次数、病情进展情况、是否共患其他疾病等15种因素与生活质量的各领域或大多数领域均有关系。进一步多因素分析,在排除了各因素之间的相互影响后,对生活质量的主要影响因素是文化程度、医疗费用、职业、病情进展情况、病程、婚姻状况。结论对疾病本身的积极治疗,遏制过高的医疗费用,建立有效的社会医疗保障体系,改善医疗水平,提高人民的文化教育水平,倡导和谐稳定的婚姻观念,是提高慢性乙型肝炎病人生活质量的关键。     

高血压病患者症状与生命质量关系

目的 探索高血压病患者症状和生命质量之间的关系.方法 运用横断面调查方法,以统一印制的调查表对644例高血压病患者实施问卷调查.以Spearman等级相关检验症状计数和症状引起痛苦值与SF-36量表各维度相关性,以逐步回归分析影响因素.结果 症状及由症状引起的痛苦与SF-36的8个维度均显著相关.在多变量模型中,无论是服用降压药组还是未服用降压药组,症状计数及由症状引起的痛苦值均进入模型;但是在服用降压药组,症状及由症状引起的痛苦比其他因子如年龄、血压等对生命质量的影响更严重.结论 高血压病患者的症状对生命质量有显著影响,测定并处理症状对提高患者的生命质量具有重要意义.     

Assessment of quality of life in later life: Development and validation of the QuiLL

The aim was to develop a quality of life (QOL) instrument, informed by older people, carers and professionals in older peoples services, for use by community care staff as part of their assessment, care-planning and outcome monitoring procedures. The multi-phase development project involved: qualitative interviews to generate the item pool; pre-testing; preliminary field-testing; and final testing in a community survey and in health and social care settings. The process was informed by over 100 interviews with older people, carers, professionals, academics and policy-makers. Two products emerged following data-reduction: a research instrument (64 items), and a shorter assessment tool suitable for routine use in clinical, therapeutic or case-management practice (27 items, taking 7–15 min to complete). A community survey using the research instrument achieved a 71 response rate (n=249). Ninety six percent of people found the domain content of the assessment tool relevant, and 80 considered the items covered were important. Both instruments have good internal consistency (=0.85). Inter-rater reliability was good for research staff, but poor between them and operational staff. Little objective change took place during the 3-month follow-up study, but where it did the direction was consistent with subjective change. The instrument needs to be applied in different contexts to assess interventions of known impact. Together with daily living and health status measures it can form part of a comprehensive assessment for older people.     

2种量表测定慢性病患者生命质量效果评价

目的比较健康状况调查（SF-36）与慢性病患者生命质量测定量表体系共性模块（OLICD-GM）量表用于慢性病患者生命质量测定的效果。方法用SF-36和QLICD-GM 2个量表同时测定607例慢性病患者生命质量并对比分析其信度、效度和反应度。结果2个量表的信度、效度和反应度均比较好,但QLICD-GM更敏感。结论2个量表均能用于慢性病患者生命质量测定,但QLICD-GM更有针对性和敏感性。     

Treatment and quality of life in patients with chronic obstructive pulmonary disease

Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting -2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting -2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score ( = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting -2 agonists ( = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs ( = 6.1, p < 0.001; and = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.