The quality of life, mental health, and perceived stigma of leprosy patients in Bangladesh

The present study aims to determine the quality of life (QOL) and general mental health of leprosy patients compared with the general population, and evaluate contributing factors such as socio-economic characteristics and perceived stigma. A total of 189 patients (160 outpatients, 29 inpatients) and 200 controls without leprosy or other chronic diseases were selected from Dhaka district, Bangladesh, using stratified random sampling. A Bangladeshi version of a structured questionnaire including socio-demographic characteristics-the Bangla version of the World Health Organization Quality of Life Assessment BREF (WHOQOL-BREF)-was used to assess QOL; a Self-Reporting Questionnaire (SRQ) was used to evaluate general mental health; the Barthel Index to control activities of daily living (ADL); and the authors' Perceived Stigma Questionnaire was used to assess perceived stigma of patients with leprosy. Medical records were examined to evaluate disability grades and impairment. QOL and general mental health scores of leprosy patients were worse than those of the general population. Multiple regression analysis revealed that factors potentially contributing to the deteriorated QOL of leprosy patients were the presence of perceived stigma, fewer years of education, the presence of deformities, and a lower annual income. Perceived stigma showed the greatest association with adverse QOL. We conclude that there is an urgent need for interventions sensitive to the effects of perceived stigma, gender, and medical conditions to improve the QOL and mental health of Bangladeshi leprosy patients.     

Adolescent distinctions between quality of life and self-rated health in quality of life research

Background  

In adult quality of life (QOL) research, the QOL construct appears to differ from self-rated health status. Although increased QOL continues to be recognized as an important outcome in health promotion and medical intervention, little research has attempted to explore adolescent perceptual differences between self-rated health and QOL.     

The use of focus groups in evaluating quality of life components among elderly Chinese people

In Taiwan, to measure the quality of life (QOL) of elderly Chinese, one must rely on instruments developed in other Chinese or Western populations and not specifically for the elderly. The purpose of this study is to understand the components of QOL for elderly Chinese from Taiwan living in residential homes or in their communities. Forty-four elderly men and women divided into six focus groups were interviewed on video tape and the resultant recording was analyzed qualitatively by six independent researchers. The study yielded 15 QOL domains grouped into six dimensions: physical health (physical well-being, impact of illness, medical care), psychological health (mood states, life attitude and retrospection, philosophy of living, self-efficacy), social function (connectedness, exercise and leisure activities, social activities and services), living environment (living environment and arrangements, institutional factors), economic status, and religion and death (religion, death). For elderly Chinese in Taiwan, positive and negative life domains are equally important in the perception of life quality; person-environment interaction is a major consideration in the evaluation of QOL; family ties are an important component of QOL; traditional Chinese beliefs exert a positive influence on perceived QOL; and social functioning and vitality have a different meaning in Chinese compared to Western cultures.     

糖尿病和糖耐量低减患者生命质量评价

目的 了解糖尿病和糖耐量低减患的生命质量,并探讨其影响因素。方法 采用SF-36量表评价：108例糖尿病、109例糖耐量低减和116例糖耐量正常的生命质量,并研究其影响因素。结果 糖尿病患中,自我确认健康感觉非常好或很好占12．04％,与同龄人比较,健康感觉好或较好占62．04％;糖耐量低减患中上述比例较高,分别为13．76％和69．72％;生命质量综合评分很好或好的比例在糖尿病患为72．23％,糖耐量低减患为83．49％。糖尿病患生命质量已普遍下降,生命质量各维度评分最低为情绪角色功能,最高为躯体功能,波动在58．33-87．38之间,其中躯体功能、躯体角色功能、总体健康、精力和综合评分显低于糖耐量正常,精力、心理健康和综合评分显低于糖耐量低减;糖耐量低减患生命质量各维度有不同程度的损害,但其生命质量评分与糖耐量正常无统计学差异。相关分析显示,年龄、职业、离退休、病程、糖尿病症状数、并发症数量、空腹血糖和餐后2h血糖水平对糖尿病患生命质量有影响。结论 提高糖尿病患的生命质量,应该从疾病早期开始。控制血糖稳定,重视患的心理治疗和采取有针对性的措施,可提高不同特征患的生命质量。     

Quality of life in coronary patients

This study compared measures of quality of life (QOL) in two groups of coronary heart disease patients: one with myocardial infarction (MI) and one with angina (A). The population studied consisted of 49 patients from Group MI and 27 patients from Group A. A questionnaire was used to identify socio-demographic and clinical data, as well as data from the SF-36 instrument, to assess the patients' QOL. It was observed in both groups that the QOI declined in the following aspects: physical functioning, pain, general health condition, vitality, social functioning, and mental health. Socio-demographic and clinical variables influenced the QOL score. Studies aiming at a larger number of individuals and a better understanding of the effects of the variables above upon the QOL of coronary patients are needed.     

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.     

糖尿病患者生命质量影响因素的病例对照研究

目的定量评价糖尿病(DM)患者的生命质量(QOL),探讨有关影响因素。方法采用SF-36量表中关于生命质量及其影响因素调查表,对245例DM患者和248例血糖正常者(NGT)进行病例对照研究。结果DM患者在总体健康感觉、躯体健康功能和心理健康方面均有不同程度的受损,尤其在总体健康感觉方面。DM组QOL处于好以及很好状态的有41.22%,显著低于NGT组的56.45%。logistic回归分析发现19个变量对DM患者QOL的各维度产生影响。服降糖药治疗、定期进行健康检查、定时监测血/尿糖、自费医疗比例低等有利于提高患者的QOL;负向影响以DM症状数量、餐后高血糖、DM并发症等为主,饮食控制对DM患者的心理健康有着极大的负向影响。结论采取措施控制血糖、预防和治疗并发症、通过健康教育和医疗咨询提高患者对DM生活制度的依从性和给予患者更多的精神支持是改善和提高DM患者QOL的重要手段。     

Self-reported physical and mental health status and quality of life in adolescents: a latent variable mediation model

Background  

We examined adolescents' differentiation of their self-reported physical and mental health status, the relative importance of these variables and five important life domains (satisfaction with family, friends, living environment, school and self) with respect to adolescents' global quality of life (QOL), and the extent to which the five life domains mediate the relationships between self-reported physical and mental health status and global QOL.     

Influence of exercise activity on quality of life in long-term breast cancer survivors

Background: Behavioral and lifestyle factors may influence quality of life (QOL) outcomes in breast cancer survivors. Methods: Information on QOL (Short Form-36, SF-36), lifestyle and survivorship was collected during telephone interviews with 374 breast cancer patients, diagnosed between 1983 and 1988 at ages 40 years or younger and interviewed, on average 13.2 years following diagnosis. These women previously participated in a case-control study soon after their diagnoses, providing information on breast cancer risk factors including exercise activity. We examined the impact of changes in exercise activity (comparing pre- to post-diagnosis levels) on the SF-36 mental and physical health summary scales using regression analyses. Results: A positive change in exercise activity was associated with a higher score on the SF-36 physical health summary scale at follow-up (p= 0.005). Change in exercise activity was not associated with the SF-36 mental health summary scale score. Patients who increased their activity levels did not differ from those who did not in terms of medical or demographic characteristics. Conclusion: This study provides one of the longest follow-up periods of breast cancer survivors to date among studies that focus on QOL and is unique in its focus on women diagnosed at a young age. Our results confirm high levels of functioning and well-being among long-term survivors and indicate that women whose exercise activity increased following diagnosis score higher on the SF-36 physical health summary scale. These findings suggest a potential role for exercise activity in maintaining well-being after a cancer diagnosis.     

Health-related quality of life among disease-free stomach cancer survivors in Korea

Previous studies about the quality of life (QOL) in stomach cancer survivors focused on selected clinical parameters and did not consider the broader implications for overall health and QOL. We evaluated the impact of demographic and treatment-related factors on the QOL of stomach cancer survivors. We asked 391 stage I–III stomach cancer survivors who had been disease-free for at least 1 year after surgery to complete a demographic questionnaire, the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, and its stomach module, QLQ-STO22. Survivors undergoing total gastrectomy reported greater eating restrictions than those undergoing subtotal gastrectomy. Receiving chemotherapy or radiotherapy did not significantly affect any QLQ-C30 or QLQ-STO22 scores. Role and emotional functioning improved with increasing age, and stomach-specific symptoms (pain, eating restrictions, and anxiety) lessened. Compared with female survivors, male survivors had better physical and role functioning. Smoking status was also a significant negative predictor of physical functioning and anxiety. Comorbidities and selected demographic characteristics had a greater effect than type of treatment on the QOL of post-operative stomach cancer patients. Notes: Drs Jae-Moon Bae and Sung Kim contributed equally to this work as first authors. An erratum to this article can be found at     

Long-term quality of life changes after primary septorhinoplasty

Purpose

Health-related quality of life measurements are gaining in importance in clinical medicine. Little is known about the long-term quality of life changes after septorhinoplasty. This study was designed to analyse the long-term quality of life impacts of septorhinoplasty, using disease-specific instruments—rhinoplasty outcome evaluation (ROE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17); as well as a generic instrument—Short-Form 36 Health Survey (SF-36).

Methods

Patients completed the FROI-17, the ROE and the SF-36 preoperatively and at 12 and 60 months postoperatively. General demographic and clinical information (age, gender, allergies, medication, medical and surgical history) were collected from all patients.

Results

We report a significant increase in disease-specific QOL after primary septorhinoplasty (as measured with the ROE & FROI-17) and in two scales of the SF-36 generic instrument (role-functioning physical and mental health) 1 year after surgery. Our patients showed further significant increase in disease-specific QOL (FROI-17) after their primary septorhinoplasty (1 year vs. 5 years postoperatively). SF-36 results showed significant improvements 5 years postoperatively (compared to preoperative scores) in six out of eight scales (physical functioning, role-functioning physical, bodily pain, vitality, social functioning and mental health).

Conclusion

Septorhinoplasty can improve disease-specific and non-disease-specific QOL in the short- and long-term postoperative period. These improvements remain measurable 5 years after surgery.

     

四川部分地区阿片类药物依赖人群生命质量及其影响因素的研究

目的调查四川地区三城市阿片类药物依赖人群生命质量,找出影响生命质量的因素。方法用SF-36量表和PSSS量表来评估阿片类药物依赖人群的生命质量和社会支持,同时用自编量表调查该人群的一般特征及其与药物依赖相关的因素。用t检验、相关分析、方差分析和多元线形逐步回归等统计分析对资料进行分析。结果①阿片类药物依赖人群的生命质量显著性低于正常对照人群(P<0.001);该人群的社会支持在PSSS量表所测的不同领域均低于对照人群(P<0.001)。②单因素分析时,年龄、婚姻状况、文化程度、职业、收入、吸烟、患有慢性病、社会支持的3个维度、吸毒方式、共用针管、家庭成员吸毒、吸毒时间、吸毒剂量、戒毒方式及复吸次数等17种因素与研究人群生命质量的各领域或部分领域均有关系。③多因素分析后发现,对研究人群生命质量的主要影响因素是吸毒时间、吸毒剂量、家庭外源性社会支持、全部社会支持、共用针管和收入。婚姻状况、家庭内源性社会支持、吸毒方式、患有慢性病、吸烟、家庭成员吸毒、戒毒方式及复吸次数等因素则对个别领域有影响。结论四川地区三城市阿片类药物依赖人群生命质量较低,且缺乏足够的社会支持。     

Health-related quality of life among persons with epilepsy--Texas, 1998

Epilepsy is a central nervous system disorder characterized by unprovoked, recurrent seizures that may affect physical, mental, or behavioral functioning. In 1995, approximately 2.3 million persons residing in the United States had epilepsy. Approximately 181,000 new cases of epilepsy are diagnosed each year, with annual estimated costs of $12.5 billion in medical care and lost productivity. Because epilepsy has a substantial impact on health (e.g., physical and psychosocial difficulties, side effects of anticonvulsant therapy, lifestyle restrictions, and perceived stigmatization), self-reported physical and mental health-related quality of life (HRQOL) measures are useful in gauging the impact of epilepsy on persons with the disorder. Persons with chronic health disorders are at risk for impaired HRQOL. Few studies have examined the HRQOL of persons with epilepsy, and none has used a representative sample of adults residing in the United States. This report examines data from the 1998 Texas Behavioral Risk Factor Surveillance System (BRFSS) that included a question about epilepsy; findings indicate that persons with epilepsy reported substantially worse HRQOL than persons without epilepsy. Community-based interventions such as the Sepulveda Epilepsy Education Program that address medication self-management, psychosocial self-management, and other education interventions can improve the quality of life for persons with epilepsy.     

The impact of mental illness on quality of life: A comparison of severe mental illness,common mental disorder and healthy population samples

Patient-centred outcomes such as quality of life (QOL) are valued and used extensively in mental healthcare evaluations, but concerns remain about their practical application due to perceived measurement issues, including responsiveness and relationships with objective indicators and depression. Evidence from general population studies challenge some assumptions, suggesting that measurement difficulties might relate to the characteristics of mental health samples, rather than measurement itself. This paper assesses the impact of mental illness on QOL and its measurement, examining whether the life-conditions, opportunities and QOL of different mental health-status groups vary, and if explanatory models of domain-specific and global QOL differ. Objective life-conditions, access to life-opportunities and subjective QOL were assessed over 2 years, using the same methodology in severe mental illness (SMI; n = 149 (baseline)/n = 126 (follow-up)), common mental disorder (CMD; n = 794/354) and no disorder (n = 1119/583) groups. Objective life-conditions were worse in the SMI group than in mentally healthy population and CMD groups, but the opportunities available to the SMI group were no more restricted than the CMD group. Subjective QOL ratings reflected this; SMI group scores were lower than the healthy population and in some life-domains the CMD group. Models of QOL suggested that life-quality was explained differently in the three groups. QOL studies combining mental health samples should control for health-status group, and domain-specific and global indicators of lifestyle and opportunity.     

康复运动对冠心病再血管化患者生存质量的影响

目的了解冠心病再血管化患者的生存现状,研究活动平板运动试验指导下康复运动（包括行为心理健康康复治疗）对患者生存质量（QOL）的影响。方法所有患者常规药物治疗同时接受康复运动治疗6周,治疗前后通过简明健康调查问卷（SF-36量表）对患者进行QOL的状况评估并分析评分。结果冠心病再血管化患者在生存质量受损的严重程度平均分依次为：生理功能（PF）（37．86）、社会功能（SF）（43．67）、精力（45．58）、躯体职能（RP）（65．45）、精神卫生（MH）（68．73）、情感职能（RE）（71．30）、躯体疼痛（BP）（79．52）和一般健康状况（GH）（86．75）;通过康复运动包括心理治疗,在PF[（37．86±8．49）、（62．134-10．53）],SF[（43．67±26．23）、（56．984±18．89）],精力[（45．58±27．01）、（77．42±23．48）],BP[（79．52±9．05）、（87．32±13．14）]4个维度评分差异有统计学意义。结论规范的康复运动及行为心理治疗有利于患者生存质量的提高。     

Factors associated with quality of life in older adults in the United States

Purpose  

According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen’s behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 years and older.     

Perceived neighborhood problems and quality of life, physical functioning, and depressive symptoms among adults with asthma

OBJECTIVES: We investigated associations between perceived neighborhood problems and quality of life (QOL), physical functioning, and depressive symptoms among adults with asthma. METHODS: Using cross-sectional data from adults with asthma in northern California (n=435), we examined associations between 5 types of perceived neighborhood problems (traffic, noise, trash, smells, and fires) and asthma-specific QOL (Marks instrument), physical functioning (Short Form-12 physical component summary), and depressive symptoms (Center for Epidemiological Studies-Depression). We used multivariate regression analysis. RESULTS: When asthma severity and sociodemographics were taken into account, people reporting a score of 8 or higher on a scale of 0 to 25 for serious problems (the top quartile of seriousness) in their neighborhoods had significantly poorer QOL scores (mean difference=5.91; standard error [SE]=1.63), poorer physical functioning (mean difference=-3.04; SE=1.27), and almost a fivefold increase in depressive symptoms (odds ratio=4.79; 95% confidence interval=2.41, 9.52). CONCLUSIONS: A high level of perceived neighborhood problems was associated with poorer QOL, poorer physical functioning, and increased depressive symptoms among people with asthma when disease severity and sociodemographic factors were taken into account.     

Toward a general model of health-related quality of life

A health-related quality of life (HRQOL) model that fitted data collected in previous studies from two separate samples—patients with chronic physical illness and patients with chronic mental illness—was adapted and tested on a representative sample drawn from the normal population. This model, which implied that both physical and mental health influenced number of friendships, personal growth, and job satisfaction, fitted the data very well. However, an alternative model reversing the directions of the pathways so that friendships, personal growth, and job satisfaction affected physical health and mental health, with the latter two having a mutual effect on each other, fitted the data even better. This suggests that, although a medical model of HRQOL may be more important when it comes to alleviating illness, a psychosocial model of HRQOL may be more important when it comes to maintaining health and preventing illness. Moreover, the fact that essentially the same five-factor structural model fits three distinct populations, healthy and unhealthy, suggests that there may be a general model of quality of life applicable to all populations. The implications of these findings for clinical theory, policy, and practice are discussed.     

Relation between level or change of hemoglobin and generic and disease-specific quality of life measures in hemodialysis

Objective We sought to examine the relation between meeting or exceeding the current minimum guideline for hemoglobin (11 g/dl) in dialysis patients and generic and disease-specific QOL scores at 1 year. Methods In 438 incident hemodialysis patients from a national prospective cohort study, we used regression models to predict QOL score (all scaled 0–100) at 1 year using 6-month values of hemoglobin, adjusting for potential confounders. Results Compared to values <11 g/dl, hemoglobin ≥11 g/dl at 6 months was associated with higher scores for the general domains of physical functioning, role physical, mental health, social functioning, and bodily pain at 1 year; cognitive function, diet restriction, and dialysis access dialysis-specific domain scores were also higher for these patients. Each 1 g/dl greater hemoglobin was also statistically significantly associated with higher QOL scores for most domains. In longitudinal analyses, most of the domains showed that, with each 1 g/dl increase in hemoglobin concentration from baseline to 6 months, QOL score increased significantly over the first year. Conclusions Hemodialysis patients who attain higher hemoglobin concentration at 6 months, especially ≥11 g/dl, have better QOL at 1 year, with regard to important physical, mental, social, and cognitive domains.     

城市外卖送餐员生命质量现状及影响因素研究

目的 了解城市外卖送餐员的职业健康状况和生命质量,分析其生命质量的影响因素,为提高外卖送餐员的职业健康和生命质量提供理论依据。 方法 采取随机抽样的方法,使用自制外卖送餐员基本情况调查表与SF-36生命质量量表,通过问卷星对240名外卖送餐员进行在线问卷调查。采用t检验、方差分析、非参数检验、多元线性回归进行统计分析。 结果 本次调查共发放电子问卷240份、回收有效问卷236份、问卷有效率98.33%;被调查对象中,男性229人(占97.03%)、女性7人(占2.97%);平均年龄为(31.28±7.69)岁;生命质量8个维度平均得分由高到低依次为生理功能(92.48±16.59)分、生理职能(87.39±29.85)分、躯体疼痛(87.14±6.47)分、社会功能(86.65±17.61)分、情感职能(84.74±32.15)分、总体健康(83.25±16.54)分、精神健康(70.64±17.08)分和活力(69.41±19.08)分。自觉受尊重者生理健康和心理健康得分均较高,每日睡眠时间长、与家人同住者生理健康得分较高,小学及以下文化程度和年龄在45岁及以上者心理健康得分较高。多元逐步回归分析结果显示,生理健康的影响因素有文化程度、家人同住、睡眠时长;心理健康的影响因素有性别、年龄、文化程度和受尊重程度。 结论 城市外卖送餐员生命质量各维度得分较高,年龄、文化程度、睡眠时长、受尊重程度、家人同住是城市送餐员生命质量的主要影响因素,应重点关注该人群的心理健康。