农村妇女健康生命质量分析

目的了解不同年龄及文化程度农村妇女健康生命质量状况。方法采用分层整群随机抽样方法抽取四川省安岳县、安徽省临泉县、山东省曹县和茌平县妇女1653人,利用欧洲生存质量测定量表(EQ-5D)测定生命质量。结果调查的农村妇女平均健康指数为70.3分,曹县最高,为75.8分,安岳县最低,为62.6分;随着年龄的增长,调查妇女健康指数呈下降趋势,青年组分别比中年组、老年组平均高8分、16分;随着文化程度的提高,农村妇女健康指数升高,不识字/识字少妇女的健康指数为66.6分,而初中及以上文化程度者为77.6分;从健康的5个维度看,差异主要表现在疼痛/不舒服、焦虑/沮丧2个维度,存在问题的比例分别为34.3%和27.5%。结论提高农村妇女文化素质、改善生存环境、进行有效心理干预,有助于改善该人群生命质量。     

Changes in quality of life among persons with HIV infection

Health-related quality of life (QOL) is an important component of the evaluation of patient outcome in HIV infection where disease is progressive and debilitating. This paper compares patient-reported QOL obtained from questionnaires which cover functional ability, social functioning, cognition, mental health, disability days, disease symptoms, and overall health in the previous 3 months. These scales have been validated on HIV populations. We compared changes in health status over 12 months for 669 patients with varying HIV disease severity: 134 asymptomatic, 416 symptomatic (previously termed ARC), and 119 AIDS. Groups were evaluated at baseline for demographic and health status differences (i.e., age, CD4+). Declines in health status and psychosocial status were found over the year for all persons. Individuals with symptomatic disease or AIDS had significant declines of 10–20% (p<0.001) in all aspects of role functioning (social, daily activities, energy, and global health) and increased disease symptoms, but no significant declines in cognition or mental health. Persons with AIDS had greater declines than those with symptomatic disease. AIDS and symptomatic patients also reported significantly fewer hours at work and more disability days than asymptomatic patients. The impact that HIV disease has on the health status of non-AIDS symptomatic patients is especially striking.This research was supported by a grant from the Agency for Health Care Policy and Research (HS06211) to James F. Fries, Principal Investigator. This paper was presented at the VIII International Conference on AIDS, Amsterdam, July 1992.     

Health-related quality of life among adults with serious psychological distress and chronic medical conditions

Objective Determine the prevalence of serious psychological distress (SPD) among adults with and without chronic medical conditions and examine the association between SPD and health-related quality of life (HRQOL). Methods Cross-sectional data from the 2005 Los Angeles County Health Survey were used to estimate prevalence of SPD. The association between SPD and HRQOL was evaluated using logistic regression and analysis of covariance, adjusting for sociodemographic variables and number of chronic conditions. Results SPD was significantly associated with younger age, lower income, being unemployed or disabled, being unmarried, fair or poor health, and having one or more chronic conditions. Adults with three or more chronic conditions were six times as likely to have SPD as those with no conditions. Adults with SPD reported significantly more unhealthy days (mental and physical) and activity limitation days than adults without SPD. The adjusted mean number of unhealthy days was highest among adults with SPD (23.3), followed by adults with depression (14.1), and diabetes (10.6). Conclusions SPD is associated with decreased HRQOL and presence of chronic medical conditions. Mental health should be routinely assessed when addressing health needs of individuals and communities. Persons with chronic diseases may benefit from targeted mental health screening and programs that employ treatment approaches that jointly manage physical and mental health and provide improved links and access to services.     

Individual quality of life in the healthy elderly

Quality of life research with the elderly has usually focused on the impact of decline in function, and used a pre-determined model of quality of life in old age. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) allows individuals to nominate, weigh and assess those domains of greatest relevance to their quality of life. The SEIQoL was administered to 56 healthy elderly community residents at baseline and 12 months later. Quality of life levels were significantly higher at baseline (t=–2.04; p=0.04) than that of a previously studied sample of healthy adults below 65 years of age, and did not change significantly over the study period. The domains nominated by both samples as relevant to their quality of life differed notably. Health status was not correlated with the perceived importance of health at baseline, and showed only a low correlation (r=0.27) at 12 months. The weight placed on health did not increase over the study period despite a significant decline in health status. The value of allowing the individual to define personal quality of life values in a research context is explored.Funding for this study was provided by Ciba Ltd, the Dhole Bursary of the British Geriatrics Society and by the Royal College of Surgeons in Ireland.     

Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population

The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n=1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n=1,097) and 86% of them returned the questionnaire (n=948), of which n=795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisions. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.     

Health-related quality of life among people with HIV disease: Results from the Multicenter AIDS Cohort Study

To examine the effect of HIV status, symptomatology and CD4+ lymphocyte level on health-related quality of life, the Medical Outcomes Study Short-Form Health Survey (SF-36) was administered to 2,295 gay men enrolled in the Multicenter AIDS Cohort Study (MACS) in 1994. Distinct physical and mental health factors of the SF-36 were found. Seropositive asymptomatic individuals and seropositive individuals with CD4+ lymphocytes 500/mm³ scored as well as seronegative participants on all of the mental health domain scales, but lower on the general health perceptions and physical health composite score. Seropositive individuals with at least one symptom or with CD4+ lymphocytes below 200/mm³ scored significantly lower on all of the SF-36 scales and summary scores than seronegative controls. The SF-36 was found to exhibit similar mental and physical health factors for an adult gay male population to that previously seen in general population samples and in patient groups with other diseases. In conclusion, HIV-positive men who are asymptomatic or have CD4+ lymphocytes above 500/mm³ have similar perceived mental health but worse perceived physical health than seronegative men. HIV-positive men who are symptomatic or have CD4+ lymphocytes below 200/mm³ have worse perceived mental and physical health than seronegative men.     

Health-related quality of life following liver transplantation

The objectives of this study were to report on the health-related quality of life (QoL) experienced by patients following liver transplantation and to investigate the factors associated with its variation. A questionnaire comprising the SF-36 and EuroQol EQ-5D instruments was sent by post to 147 patients who had received a liver transplant, indicated by a chronic liver disease, in the previous 8 years. The scores of the respondents were compared to population norm scores. The variation in both the SF-36 and EQ-5D scores was explored. Many liver transplant patients experienced most satisfactory QoL levels post- transplantation although, in general terms, the levels were poorer than those seen in the general population. The variation in the post-transplant health-related QoL scores was found to be associated with a number of pre-transplant factors: disease severity (proxied by Child Pugh class), disease duration at the time of transplantation and liver transplant history (whether the patient had received a single or multiple transplants). In making clinical decisions about the use of transplantation for chronic liver diseases, consideration should be given to the key factors likely to affect subsequent health-related QoL.     

Health-related quality of life and the transformation of symptoms

This paper traces the development of health-related Quality of Life instruments over the last half century. It identifies the emergence of key components of quality of life measurement in other health status questionnaires between about 1950 and 1980 and their formalization in Quality of Life instruments in the mid 1980s. The common developmental thread that linked these Quality of Life instruments and their precursors was the identification of 'distal symptoms' that represented the impact of illness beyond its immediate bodily manifestations. The measurement of distal symptoms through Quality of Life instruments also served to detach symptoms from their customary patho-physiological referent. Other contemporary examples of these free-floating symptoms reinforce the argument that the nature and meaning of symptoms has been transformed over recent decades.     

Health-related quality of life as a predictor of mortality among community-dwelling older persons

Health-related quality of life (HRQOL) measures predict cause-specific mortality, but few studies have explored whether generic self-reported HRQOL measures are independently associated with mortality in community-dwelling older persons. We postulated that a general measure of HRQOL, the short form 36-item questionnaire (SF-36), would be independently predictive of mortality among community-dwelling older persons. To evaluate this hypothesis, we followed a fixed cohort of 4,424 community-dwelling older persons recruited from a 2000 population-based survey in Taiwan until 2003 and investigated whether HRQOL was predictive of 3-year mortality, even after adjusting for traditional clinical risk variables. The data were collected via a door-to-door survey, and interviewers collected information on the subjects’ demographics, medical history, utilization of health services, functional ability, falls, and self-reported physical and mental symptoms. Of the 6053 eligible subjects, 4,424 residents agreed to participate in the baseline survey and were contacted in 2003. During the 3-year period, the 3-year cumulative mortality rate for the study population was 5%. Mortality was significantly higher among males (5.57% vs. 4.27%, p = 0.049), and cumulative mortality increased with age (χ ²-test for trend; χ ² = 7.734, p = 0.001). For all scales except bodily pain, there was a significant relationship between a 10-point lower baseline score and mortality. Our primary multivariate risk model, which included two summary measures of HRQOL and significant clinical variables, demonstrated that a 10-point decrease in either the baseline Physical Component Summary (PCS) score or the baseline Mental Component Summary (MCS) score was associated with higher mortality (PCS: RR: 1.60, 95% CI: 1.39–1.83; p < 0.001; MCS: RR: 1.16, 95% CI: 1.01–1.34; p = 0.036). The findings suggested that low baseline PCS and MCS scores were important independent risk factors for 3-year mortality among community-dwelling older persons, even after adjusting for other risk factors.     

Health-related quality of life in endstage renal failure

The objective of this study was to describe the health-related quality of life (HRQOL) of patients on different forms of treatment for endstage renal failure in such a way that the data could be used in a cost-utility analysis of renal failure treatment in Britain. Twenty-four British renal units participated in this study. 997 adult dialysis and transplant patients were randomly selected from these units using the European Dialysis and Transplant (EDTA) Registry Database. The Health Measurement Questionnaire was compieted by 705 of the 900 patients who were alive at the time of the survey (response rate of 78%). The HRQOL data were linked with comorbidity data and with clinical data from the EDTA Registry. Compared to the general population, patients with endstage renal failure experienced a lower quality of life. Many factors contributed to this, but uncertainty about the future and lack of energy emerged as key components. Transplant recipients reported better HRQOL than dialysis patients, they reported fewer problems with physical mobility, self-care, social and personal relationships and usual activities. They also experienced significantly less distress, while dialysis patients reported problems with depression, anxiety, pain and uncertainty about the future. These differences remained after controlling for age and comorbidity.     

Health related quality of life in immigrants and native school aged adolescents in Spain

OBJECTIVES: To compare health related quality of life (HRQL) between native and immigrant adolescents aged 12 to 18 years, and to analyse psychosocial factors associated with HRQL. DESIGN: A cross sectional study of adolescents (12-18 years old) who answered a self administered questionnaire. SETTING: All the secondary schools from Lloret de Mar (Girona, Spain). PARTICIPANTS: 1246 participants (88.9% of the eligible students). MAIN OUTCOME MEASURES: Main outcome was the Spanish version of the Vecu et Sante Percue de l'Adolescent (VSP-A), a HRQL measure addressed to adolescents. Mean scores of the VSP-A index of natives and immigrants were compared, as well as their sociodemographic and health related factors. Multiple regression examined the relation between HRQL and psychosocial factors, controlling for the effect of socioeconomic variables. RESULTS: Half of the sample were boys, in the middle socioeconomic status, and 18.2% were immigrants (n = 226). HRQL score was higher in native Spanish adolescents than immigrants (p<0.01). Multiple regression model explaining 48.1% of the VSP-A variance showed that migration in itself has no statistically significant impact on HRQL, and age, socioeconomic status, social support, discrimination, and psychological distress do play a part. CONCLUSIONS: Migrants have worse HRQL than natives but it seems to be mediated by their disadvantage in socioeconomic status, social support, and psychological distress.     

Health-related quality of life in asthma: A comparison between the St George's respiratory questionnaire and the asthma quality of life questionnaire

The aim of the study is to compare the performance of the Juniper Asthma Quality of Life Questionnaire (AQLQ) and the St George's Respiratory Questionnaire (SGRQ) in a sample of asthmatic patients, representative of a broad spectrum of asthma severity. We studied 116 patients with a mean age (SD) of 42.6 (18.3) year. Patients were assessed twice, at recruitment and after 2 months, to determine the reliability, validity and responsiveness of the AQLQ and the SGRQ. Both questionnaires showed good reliability coefficients (0.70) which reached the standards for comparison at individual level (0.90) in the case of activity, impacts and overall SGRQ scores as well as symptoms, activities and overall AQLQ scores. Both AQLQ and SGRQ were able to discriminate among groups of patients based on asthma severity and control and showed, except for the symptoms domain of the SGRQ, large (standardized response means >0.8) and significant changes in the group of patients that improved at follow-up. We conclude that the AQLQ and SGRQ have shown high reliability and validity and, with the exception of the SGRQ symptoms, a high level of responsiveness. In overall terms, not one of these instruments seems to behave better than the other.     

Impact of oral health status on oral health-related quality of life in Chinese hospitalised geriatric patients

Objectives To examine the oral health status of Chinese hospitalised geriatric patients and identify its impacts on their oral health-related quality of life (OHRQoL). Design Cross-sectional correlational study. Setting Geriatric wards of a regional hospital in Hong Kong. Subjects A consecutive sample of Chinese hospitalised geriatric patients (N = 155) aged ≥ 65 years who were communicable. Measurements The Brief Oral Health Status Examination (BOHSE) was used to evaluate oral status. The General Oral Health Assessment Index (GOHAI) was used to assess OHRQoL. Results The oral health status of the Chinese hospitalised geriatric patients was fair, with the more prominent problems being decayed teeth, lack of occluded teeth, coated tongue, excessive tartar, dry and rough red oral tissue and diseased gum. The GOHAI score indicated their compromised OHRQoL. By using hierarchical regression analysis, fewer than eight pairs of occluding teeth (β = −0.33, P < 0.001), unhealthy gum (β = −0.26, P = 0.03) and perceived oral dryness (β = −0.18, P = 0.04) significantly accounted for 17% of variance in the OHRQoL of Chinese hospitalised geriatric patients. Conclusion This study suggests that routine screening for dental and gum problems, providing adequate adaptation of denture prosthesis and reducing oral dryness of geriatric patients may be important care to optimise the OHRQoL of Chinese hospitalised geriatric patients. The study needs to be replicated in larger-scale multicentre settings and incorporate the use of more-comprehensive oral assessment indices.     

The role of nutritional status in the relationship between diabetes and health-related quality of life

BACKGROUND/OBJECTIVESThe association between nutritional status and health-related quality of life (HRQoL) among patients with type 2 diabetes mellitus (T2DM) is not fully understood. This study was conducted to understand the role of nutritional status on HRQoL among people with and without T2DM.SUBJECTS/METHODSStructured survey and direct measurement of anthropometric data were conducted among people with and without T2DM. Nutritional status was measured with Mini Nutritional Assessment tool and HRQoL was measured with a 36-item Short Form Healthy Survey. Data collection was conducted in Chuncheon, South Korea with 756 participants who are older than 40 yrs of age.RESULTSThis study found that overall HRQoL were significantly lower in people with T2DM than people without T2DM after controlling for key covariates. When stratified by nutritional status, a greater degree of negative impact of T2DM on overall physical HRQoL was observed among well-nourished or at risk of malnutrition, whereas significant and more evident negative impact of diabetes on overall psychological HRQoL was observed only among malnourished.CONCLUSIONSThe study results suggest the role of nutritional status among people with T2DM on overall, especially psychological aspects of HRQoL. Future longitudinal or intervention studies are warranted to test the impact of nutritional status on HRQoL among people with T2DM.     

Health-related quality of life changes among users of depot medroxyprogesterone acetate for contraception

Background

Depot medroxyprogesterone acetate (DMPA) may have other noncontraceptive effects that could impact on the quality of life. The objective of this study was to assess the health-related quality of life changes associated with the use of DMPA for contraception.

Study Design

A prospective, observational study using the Short Form-36 quality of life questionnaire.

Results

After 6 months of use, the participants had an improved physical summary score, mean change [5.64 (95% confidence interval [CI], 1.87–9.4), p=.054]. There was no significant change in sexual function [5.33 (95% CI, −2.15 to 12.81), p=.0858] and mental summary score [−0.51 (95% CI, −1.90 to 2.92), p=.432]. The main side effect of DMPA was menstrual irregularity (32.5%); 17.2% of the participants found amenorrhea desirable.

Conclusion

Besides its contraceptive efficacy, DMPA is associated with an improvement in perceived physical health with no apparent adverse effect on mental health and sexual function.     

四川省空巢老人生命质量及影响因素研究

目的 了解四川省空巢老人的生命质量现状并探讨其影响因素,为提高空巢老人生命质量提供参考依据。 方法 本资料来源于2018年国家第六次卫生服务调查四川省调查数据,健康相关生命质量用EQ-5D效用值和EQ-VAS得分进行衡量。采用两水平方差成分模型探索空巢老人生命质量的影响因素。结果 共调查4587名空巢老人, EQ-5D 效用值平均为(74.05±1.39) 分,VAS评分平均为(66.54±0.278) 分。年龄较小、文化程度较高、就业状态为在业、12个月内未饮酒、经常参加体育锻炼、无高血压和糖尿病的空巢老人EQ-5D效用值较高。结论 空巢老人的生命质量整体偏低。可通过倡导健康行为、提高健康意识、加强慢性病防控等途径来提高空巢老人生命质量。     

Distinguishing between quality of life and health status in quality of life research: A meta-analysis

Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.