Wie „repräsentativ“ sind GKV-Daten?

Using data obtained from a statutory health insurance (AOK) in the federal state of Lower Saxony, this study examined whether there were differences between the insured population compared with that of Lower Saxony (Niedersachsen) and of Germany with respect to social structural characteristics. Data for the comparisons were provided by the statistical office of Germany, and all datasets were coded according to the same criteria. The differences in gender distribution and age distribution between the AOK, Lower Saxony, and Germany were small. The share of employed individuals among the insured compared with those of Lower Saxony and Germany did not differ for males, but it was lower in women. In the insured population a higher proportion of individuals had lower qualification levels than in Lower Saxony or in Germany; the number of individuals with higher qualifications was, however, sufficient to permit statistical analyses. There were differences in the distributions of social structural characteristics between the health insurance population on the one hand and the populations of Lower Saxony and of Germany on the other. Due to the high number of cases, it is nevertheless possible to analyze associations between social structural variables, health impairments, and patterns of health care utilization.     

公立医院医保工作人员生活质量调查与分析

目的了解医保工作人员生活质量状况,提出合理化建议。方法选取某市两家公立医院72名医保工作人员为研究对象,采用SF-36生活质量调查表进行调查。结果SF-36生活质量表显示,医保工作人员生活质量各维度得分明显偏低,生活质量不容乐观。结论应从建立资本补偿机制,加强专业技术培训及继续教育,建立规范的医保专业队伍,重视身心健康发展等方面付出努力,不断提高医保工作人员生活质量。     

沈阳市新贫困人群生命质量调查

目的评价城市新贫困人群的生命质量,并探讨其主要影响因素.方法用SF-36量表对某社区103名新贫困人口的生命质量进行评价,采用logistic回归分析生命质量的主要影响因素.结果患病、医疗花费、债务、性别、文化程度对新贫困人群的生理健康有影响;债务对心理健康有影响.36～50岁人群中,新贫困人群的生理功能、社会功能、精神健康、活力、总体健康等维度高于贫困组;全部维度均低于非贫困组.结论SF-36量表适用于城市新贫困人群.对于36～50岁组人群,新贫困人群的生命质量接近于贫困人群,但低于非贫困人群.     

Health insurance coverage and health-related quality of life: analysis of 2000 Medical Expenditure Panel Survey data

This study investigated relationships between health insurance status and health-related quality of life (HRQOL) using the 2000 Medical Expenditure Panel Survey data. Health-related quality of life was measured using the SF-12 Physical Component Summary (PCS) and SF-12 Mental Component Summary (MCS). The analysis controlled for sociodemographic and attitudinal variables and medical conditions. The analysis also investigated and controlled for possible reverse causality between HRQOL and health insurance in the models. After adjusting for covariates, individuals without health insurance had significantly lower mean PCS scores (beta=-5.8; SE=0.4) than those with health insurance. The adjusted association between no health insurance and MCS scores (beta=-1.1; SE=0.4) also was significant. The adjusted difference in HRQOL among people with health insurance and those without it exceeds or is comparable to adjusted differences in HRQOL between people with each of various medical conditions and people without them.     

The MOS 36-item short form health survey. A conceptual analysis

The SF-36 is a practical and widely-tested instrument for measuring health status and medical outcomes. This article is not a critique of the SF-36, rather, it underscores its viability as an instrument for measuring physical and mental health and well-being. The article is a conceptual analysis of the SF-36, from the viewpoint of four models of health: medical, World Health Organization, wellness, and environmental. All four models suggest that the SF-36 be expanded to include other dimensions of health, especially mental and social. Specific dimensions to be included are: incidents of morbidity, satisfaction with quality of life, absence of mental disorders, social adjustment, social support, higher states of functioning, and adjustment to the environment. The end result of the suggested additions would be an instrument with greater conceptual meaning, for use in medical outcomes studies or surveys of the general population.     

Health-Related Quality of Life in Spanish Women with Eating Disorders

People with eating disorders show impaired health-related quality of life (HRQoL). We aimed to investigate the relative role of physical and mental factors and stage of change as possible predictors of HRQoL in a group of Spanish women (n = 124) with eating disorders. For this purpose, initial and follow-up data were obtained after 6 months from patients attending an outpatient treatment unit for eating disorders. The determinants of the physical and mental domains of the Medical Outcomes Survey Short-form Health Survey (SF-36) questionnaire were investigated in the total sample and separately based on the eating disorder diagnosis by multiple linear regression. Lower scores in the physical component of the SF-36 questionnaire were associated with the presence of a higher body mass index (BMI) at follow-up as well as a higher score in the “action” component of the Attitudes towards Change in Eating Disorders Questionnaire (ACTA). Conversely, a higher index in the EuroQoL-5D overall quality of life questionnaire (EQ-5D) and the presence of obsessive compulsive disorder were associated with a higher score in the physical dimension. The instrument used demonstrated the ability to assess changes associated with the physical component of these patients over the period studied, and the analysis provided more information and specific data on different aspects of HRQoL, thus allowing a more detailed analysis of the information.     

深圳市医务人员职业紧张对生命质量影响的路径分析

目的 调查深圳市医务人员的职业紧张和生命质量状况,定量分析职业紧张对生命质量的影响。 方法 采用分层随机抽样的横断面调查方法,调查使用自行设计的基本情况调查表和《职业紧张量表》《SF-36 量表》。共调查1 114名医务人员,获得合格问卷992份,使用路径分析等方法对资料进行统计分析。 结果 深圳市医务人员躯体健康评分、精神健康评分和总体生命质量评分分别为73.04±16.83、69.69±17.99和71.36±16.11,均低于中国常模。职业任务、个体紧张反应和个体应对资源间存在相关关系,三个维度与总体生命质量间也存在相关关系。路径分析发现性别和个体紧张反应对总体生命质量有直接效应;职业任务通过个体紧张反应为中介变量对总体生命质量产生间接效应;工龄既直接影响总体生命质量,也通过职业紧张的三个维度为中介变量间接影响总体生命质量;个体应对资源既直接影响总体生命质量,也通过个体紧张反应为中介变量间接影响总体生命质量。 结论 职业紧张影响医务人员生命质量,应加强对重点人群的关注,通过缓解职业紧张反应和增加应对资源的方式,改善和提升医务人员的生命质量。     

广州市花都区农村老年高血压患者生活质量及影响因素调查

目的探讨广州市花都区农村老年高血压患者的生活质量及其影响因素。方法采用简明健康状况调查表（SF-36）及自编调查问卷对分层随机整群抽样取得的广州市花都区480例农村老年高血压患者的生活质量进行调查。结果患者各评分：生理功能（78.32±13.80）分、生理职能（67.33±32.85）分、躯体疼痛（20.63±18.17）分、总体健康（62.50±7.95）分、活力（68.36±15.29）分、社会功能（71.42±14.81）分、情感职能（76.28±38.87）分,生存质量总分（456.83±120.70）分;单因素分析显示,不同性别、文化程度、收入水平、婚姻状况、精神状况、运动情况、不良生活方式、有无合并其他慢性病、医疗保险情况、对高血压的态度的组之间,生存质量总分差异有统计学意义（P<0.05）。线性回归分析显示,性别、文化程度、收入水平、婚姻状况、精神状况、运动情况、不良生活方式、有无合并其他慢性病、医疗保险情况、对高血压的态度是农村老年高血压患者生活质量的影响因素（P<0.05或P<0.01）。结论性别、文化程度、收入、婚姻、精神状态、运动、不良生活方式、慢性病、医疗保险情况、对高血压的态度是影响农村老年高血压患者生活质量的因素。     

SF-36 health survey reliability, validity and norms for New Zealand

OBJECTIVE: To assess the acceptability, reliability and validity of the SF-36 health survey in the New Zealand population and provide key population norms. METHOD: The SF-36 questionnaire was part of the 1996/97 New Zealand health survey, a cross-sectional, nationally representative survey of 7,862 adults (15 years and over). RESULTS: Overall, in the New Zealand population the questionnaire performed as well as or better than in other national surveys, but there was variability in data completeness across subgroups, and responses were skewed towards the healthy end of the scales. Males scored higher than females on almost all scales; increasing age was associated with decreasing scores (with the exception of the mental health scale); and New Zealand Europeans tended to report better health than the other ethnic groups. CONCLUSIONS: Satisfactory psychometric performance was demonstrated for the SF-36 in the New Zealand population, but researchers need to find ways of increasing data completeness in population groups shown here to have lower completion rates. The questionnaire may be better at discriminating patient rather than population subgroups. The SF-36 normative data confirm in kind, if not in degree, population subgroup disparities in health status observed using objective measures. IMPLICATIONS: Overall, the SF-36 questionnaire appears to be a valid and reliable measure of health-related quality of life for the New Zealand population. However, this paper highlights issues for researchers using the SF-36, such as the skewed nature of responses obstained in a population sample.     

Assessing Quality of Life in Individuals with Hereditary Blood Coagulation Disorders

The aim of this study was to test the reliability and validity of the SF-36 questionnaire among the patients with hereditary blood coagulation disorders, to compare their quality of life (QoL) to that of healthy controls, and to identify the dimensions of life the patients consider most important. Results showed that the SF-36 questionnaire had good internal consistency reliability and construct and known group validity in individuals with hereditary blood coagulation disorders. Leisure activities/hobbies, availability of work/ study, followed by relationships with other people, own health and relationships with family/relatives appeared most frequently across the patients' and controls' priority ranks. The areas affected most by the disease were financial security, own health and relationships with family/relatives. A comparison of standardized scale scores suggests that blood coagulation disorders are diseases with a predominantly physical impact. Patients with blood coagulation disorders had health-related quality of life that was lower in most domains compared to healthy controls. However, when a wider concept of QoL was applied no differences between the patients' and controls' perceived QoL could be noted.     

医学院校教师个体紧张与生命质量关系的研究

目的 调查沈阳市医学院校教师生命质量现况和紧张反应状况,分析生命质量的影响因素.方法 采用整群抽样的方法,抽取沈阳市2所医学院校共293名教师作为调查对象,应用职业紧张量表( occupational stress inventory-revised,OSI-R)和SF-36健康量表(36 short form health survey,SF-36),评价其个体紧张反应程度和生命质量水平.结果 35岁以下教师个体紧张反应得分高于其他年龄组(P＜0.05);女教师个体紧张反应得分较男性高(P＜0.05);教师的学历越高,其个体紧张反应得分越高(P＜0.05);患有慢性病的教师个体紧张反应得分高于未患病教师(P＜0.05);个体紧张反应与教师的生命质量间存在线性关系( P＜0.001),紧张反应得分越高,生命质量越差.结论 医学院校教师的个体紧张程度与生命质量密切相关,降低教师的紧张程度,将有助于改善教师的生命质量.     

SF-36量表中文版的应用及分级截断点选择的研究

目的 探讨美国简明健康测量量表SF-36用于中国老年人生活质量测量的可行性,并依据中国调查表来划分美国SF-36量表中文版的总分分级范围。方法 采用SF-36量表和中华医学会研制的老年人生活质量调查表同时对苏州市区167名老年人的生活质量进行测定,并对比分析其信度、效度。结果 中国老年人生活质量调查表和SF-36量表经因子分析产生的8个共因子与理论结构基本一致,结构效度的累积方差贡献为74.244％和72.081％,其分半信度分别为0.6676和0.9384。SF-36量表的同质性信度系数除生活活力、社会功能和心理健康3个维度,其他5个维度变化范围为0.81～0.89,满足群组比较的要求。SF-36量表较中国老年人生活质量量表的信度、效度更好。同时,确定划分SF-36量表的总分良好与中等的最佳截断点为117分,Kappa值为0.58。结论SF-36量表可以用于中国老年人的健康状况测量评估,划分生活质量“良”与“中”的最佳截断点为117分,为衡量老年人生活质量水平提供参考。     

The MOS SF-36 health survey questionnaire in severe chronic airflow limitation: Comparison with the Nottingham health profile

This study documents the cross-sectional, health-related quality of life (HRQOL) measures obtained at baseline for patients with severe chronic airways limitation (CAL) being assessed for home oxygen therapy (HOT) at the Flinders Medical Centre, Adelaide, South Australia. Two generic quality of life instruments, the Nottingham Health Profile (NHP) and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36), were administered by interview to the same patients to permit comparisons to be made between the two instruments. SF-36 mean scores were also compared with scores obtained in separate studies of a South Australian elderly general population and of groups of Australian subjects with various medical and psychiatric conditions. NHP mean scores were compared with scores from an elderly group of Adelaide residents from a household survey. HRQOL measures were obtained for 60 patients, 32 males and 28 females. At assessment for HOT, patients with severe CAL were experiencing severe impairment in their quality of life in comparison to age-matched South Australian norms, with physical disability the major limitation. There were several significant correlations between the domains of the SF-36 and the NHP which were predominantly gender-specific. Only small decrements in mental health were found with the SF-36 questionnaire. The SF-36 and the NHP appear to provide discrepant information for severely disabled CAL patients for the subjective domains of emotional and mental health.     

Low back pain and comorbidity clusters at 17 years of age: a cross-sectional examination of health-related quality of life and specific low back pain impacts

PurposeComorbidities in adults negatively affect the course of low back pain (LBP). Little is known of the presence and/or impact of LBP comorbidities in adolescents.MethodsSubjects from the Raine Study cohort at age 17 years (n = 1,391) provided self-report of diagnosed medical conditions/health complaints, health-related quality of life (36-Item Short Form Health Survey [SF-36]), lifetime experience of LBP, and specific LBP impacts (taking medication, missing school/work, interference with normal/physical activities). Latent class analysis was used to estimate clusters of comorbidities based on diagnosed disorders. Profiles of SF-36 and impact were examined between clusters.ResultsFour distinct comorbidity clusters were identified: cluster 1: Low probability of diagnosed LBP or any other medical condition (79.7%); cluster 2: High probability of diagnosed LBP and neck/shoulder pain, but a low probability of other diagnosed health conditions (9.6%); cluster 3: Moderate probability of diagnosed LBP and high probability of diagnosed anxiety and depression (6.9%); cluster 4: Moderate probability of diagnosed LBP and high probability of diagnosed behavioral and attention disorders (3.8%). The clusters had different SF-36 and LBP impact profiles, with clusters 3 and 4 having poorer SF-36 scores, and clusters 2 to 4 having greater risk for specific LBP impacts, than cluster 1.ConclusionsIdentified comorbidity clusters support adolescent and adult studies reporting associations between LBP, other pain areas, psychological disorders, and disability. Tracking these clusters into adulthood may provide insight into health care utilization in later life, whereas identification of these individuals early in the life span may help optimize intervention opportunities.     

Quality of Life of Post-stroke Patients

IntroductionStroke is a disease whose consequences have a considerable impact on the quality of the patient’s life. It is a widespread disease that has a disabling impact on life and, in addition to physical changes, brings about a number of psychological and cognitive processes.GoalThe goal of the study was to identify and describe the quality of life of post-stroke patients.MethodologyThe study design was quantitative. A questionnaire of the authors’ own design and the SF-36 questionnaire were used to obtain the data.ResultsSignificant differences in patient quality of life were identified in relation to patient gender. Moreover, the quality of life in all individual SF-36 dimensions, except for mental health, deteriorated with age. With regard to occupational placement, employed respondents gave the highest evaluation of quality of life according to SF-36 and old-age pensioners the lowest. The analysis shows that quality of life in individual dimensions is positively influenced by respondents’ higher education. The evaluation in individual dimensions improves with the time that has passed since the stroke.ConclusionThe quality of life of post-stroke patients deteriorates with age. The deteriorating level of patient quality of life in older age requires programmes that include assessments and interventions that lead to the treatment of these patients.     

影响老年军人生活质量的相关因素研究

目的 探讨影响驻西安地区军队老年人群生活质量的相关因素。方法 采用M0ssF一36量表的中文版对西安地区军队934名老干部进行生活质量测量。结果 西安地区军队老年人的生活质量与年龄、家人对自己关心程度、健康自评、看病自付费用和对自己所患疾病治疗效果的评价呈显著相关，而与他们的性别、人均收入、原职称、子女同住情况和学历均无显著相关。结论 军队干休所医痘卫生工作的重点不仅要放在医疗保健，而且也要注重老年人的心理卫生保健，才能全面地提高老年军人的生活质量。     

The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments

OBJECTIVE: The Short Form-36 Health Survey (SF-36) is one of the most widely used and evaluated generic health-related quality of life (HRQL) questionnaires. After almost a decade of use in Spain, the present article critically reviews the content and metric properties of the Spanish version, as well as its new developments. METHODS: A review of indexed articles that used the Spanish version of the SF-36 was performed in Medline (PubMed), the Spanish bibliographic databases IBECS and IME. Articles that provided information on the measurement model, reliability, validity, and responsiveness to change of the instrument were selected. RESULTS: Seventy-nine articles were found, of which 17 evaluated the metric characteristics of the questionnaire. The reliability of the SF-36 scales was higher than the suggested standard (Cronbach's alpha) of 0.7 in 96% of the evaluations. Grouped evaluations obtained by meta-analysis were higher than 0.7 in all cases. The SF-36 showed good discrimination among severity groups, moderate correlations with clinical indicators, and high correlations with other HRQL instruments. Moreover, questionnaire scores predicted mortality and were able to detect improvement due to therapeutic interventions such as coronary angioplasty, benign prostatic hyperplasia surgery, and non-invasive positive pressure home ventilation. The new developments (norm-based scoring, version 2, the SF-12 and SF-8) improved both the metric properties and interpretation of the questionnaire. CONCLUSIONS: The Spanish version of the SF-36 and its recently developed versions is a suitable instrument for use in medical research, as well as in clinical practice.     

对医务人员实施员工帮助计划干预效果评价

目的 评估医务人员的心理现状,并通过员工帮助计划(EAP)服务及其效果评价,探索出一套适合于医疗卫生领域的EAP服务方案.方法 为北京市某综合医院提供为期1年的EAP服务,采用SF-36健康调查量表和JSS量表,对医务人员的生命质量和工作满意度进行调查.结果 工作压力是医务人员最主要的压力源,占63.7%.接受EAP服务组的SF-36量表及JSS量表中各维度(工作性质和上司维度除外)的得分显著高于对照组,差异有统计学意义(P<0.01).结论 医务人员的工作压力较大,对EAP的需求意愿强烈.EAP服务是维护医务人员心理健康、提高生命质量和工作绩效的有效手段,可以推广使用.