肝移植儿童生命质量评估量表的系统综述

摘要：目的:探索更适合肝移植儿童的健康相关生命质量（HRQoL）评估量表，为药物经济学研究提供参考。方法:计算机检索PubMed、Embase、Cochrane Library、CNKI、WanFang Data、VIP、SinoMed数据库，搜集使用标准HRQoL评估量表对肝移植儿童生命质量进行评估的文献，检索时限为2011年1月～2021年5月，比较纳入文献涉及量表的适用情况、异同点、优缺点。结果:共检索到919篇文献，纳入37篇，包括13种标准HRQoL评估量表，最常用的普适性量表为儿童生命质量评估模型核心量表（PedsQL4.0）,最常用的疾病特异性量表为PedsQL移植模块（PedsQL3.0TM）,对肝移植儿童针对性最强的量表为儿童肝移植生命质量（PeLTQL）,最便于得到健康效用值的量表为9维儿童健康效用量表（CHU9D）。结论:推荐使用PedsQL3.0TM评估肝移植儿童生命质量，使用CHU9D得到健康效用值。PeLTQL仍需进一步翻译和验证。     

某市临床护士健康相关生命质量及其与应激源关系的探讨

目的调查某市临床护士健康相关生命质量及其与应激源的关系。方法对某市500名临床护士应用一般情况调查表、护士工作压力源量表、家庭功能量表、社会支持量表及生命质量评价量表进行问卷调查,并对结果进行分析。结果护士生命质量的各个维度得分均低于常模分值,8个维度均与应激源有明显的相关性。通过回归分析可见人际沟通应激源中护士与护士关系压力,社会心理应激源中学习与晋升压力对护士生命质量的影响具有统计学意义。日常生活和工作中的应激源、家庭功能及社会支持均可影响护士生命质量得分。结论通过改善劳动条件、家庭支持功能及增加社会支持行动,可以改善其临床护士的健康相关生命质量。     

成本-效用分析的概念与应用

目的：介绍药物经济学成本一效用分析及其中的几个重要概念。方法：探讨了成本一效用方法测量的几种重要方法．包括直接测量法中的刻度法、标准博弈法和时间权衡法,以及健康量表测量中的四大量表体系：健康指数量表（Quality of Well—Being,QWB）,健康效用指数（Health Utilities Index．HUI）．欧洲生命质量量表（EQ-5D）和6维健康调查短表{ShortForm6D．SF-6D）,及各种量表测量方法的选择原则。结果与结论：为药学及相关人员提供成本一效用分析方法的基本概念与应用。     

武汉大学离退休知识分子生活质量研究

目的:了解武汉大学离退休知识分子生活质量现状及其相关影响因素。方法:采用多阶段分层整群抽样法,利用美国简明健康测量量表SF-36中文版和社会人口特征调查问卷以入户访谈方式对武汉大学322名60岁及以上离退休知识分子进行调查,对其生活质量及相关因素进行横断面研究。结果:武汉大学离退休知识分子SF-36量表健康总体自评(GH)得分最低,社会功能(SF)得分最高;生理健康影响因素为:性别、退休前职称、文化程度;心理健康影响因素为:经济收入。年龄、是否患有慢性病、居住情况是两者共同的影响因素。结论:离退休老人的生活质量不仅要注意疾病、居住情况等方面的问题,更要注重引导老年人养成科学文明健康生活方式,最终提高老年人的生活质量。     

黑龙江省医疗卫生机构药学人员生命质量调研

目的:为针对医疗卫生机构药学人员制订健康干预策略提供依据,并为其他相关研究提供参考。方法:采用工作满意度MMSS量表(经修改)及生命质量SF-36量表对180名黑龙江省医疗卫生机构药学人员进行调查和测评,并对相关数据进行统计和分析。结果:共发放问卷180份,回收有效问卷134份,有效回收率为74.44%。受访者工作满意度平均得分为(3.44±0.79)分,处于中等水平,其中得分最高的维度是与同事的关系,得分最低的维度是福利待遇。受访者生命质量相关的躯体功能、生理职能及社会功能维度得分均高于"中国常模",而躯体疼痛、总体健康、活力、情感职能及精神健康维度得分均低于"中国常模",统计学分析显示,除生理职能及活力维度外,其他各维度得分与"中国常模"比较差异均有统计学意义(P<0.05)。多因素分析结果显示,其性别、职务、学历、工龄及工作满意度得分对生命质量得分有影响(P<0.05),其中工作满意度得分与生命质量得分呈正相关。结论:医疗卫生机构药学人员生命质量仍有待提高,与多种影响因素相关,其中工作满意度是一个重要的影响因素。     

EQ-5D量表在出院患者自我健康状况评价的应用

随着我国医学科学发展的进步,一些一直被用来衡量健康的指标(如死亡率等)日趋稳定,失去了原有的灵敏度,不足以反映健康的发生发展变化。欧洲生命质量(EQ-5D)量表作为一种有效测量生命质量的量表,具有良好的效度、信度,获得了广泛的应用。EQ-5D量表是由欧洲生命质量组织(EuroQoL Group)于1990年发布的一个标准化的生命质量测量工具[1],主要由两个部分构成,第一部分是五维度     

农村哮喘患儿家长健康相关生命质量的影响因素分析

目的探讨封开县农村哮喘患儿家长健康相关生命质量的影响因素,为哮喘患儿家长制定针对性的教育计划提供理论支持。方法采用便利抽样法,对在广东省封开县第二人民医院和封开县人民医院门诊就诊269例封开县农村哮喘患儿的家长进行家长健康相关生命质量现场问卷调查,采用家长健康相关生命质量量表和相关因素分析筛选有统计学意义的家长健康相关生命质量的影响因素。结果封开县农村哮喘患儿的家长健康相关生命质量总评分为(63.54±12.14)分,其中生理功能评分为(61.33±13.90)分,情感功能评分为(60.58±15.43)分,社会功能评分为(77.12±11.62)分,认知功能为(66.06±8.95)分。家长健康相关生命质量的相关因素分析结果显示:近一个月患儿激素使用情况、患儿病情控制情况、患儿家长文化程度、患儿家庭的社会支持情况及患儿哮喘对家庭经济的影响程度等是封开县农村哮喘患儿家长健康相关生命质量的重要影响因素。结论家长作为农村哮喘患儿的监护者和主要照顾者,其身心健康状况直接影响着哮喘患儿的治疗依从性和预后。护理工作者需要更多帮助患儿家长正确认识哮喘,以提高其哮喘管理能力,从而促进患儿哮喘的有效控制。     

健康效用值测量中的映射法及其相关模型概述

目的:为将非效用量表测量结果转化为健康效用值提供方法学参考。方法:查阅国内外文献,总结健康效用值测量中的映射法及其相关模型,并以生存质量量表测量结果转换成欧洲五维健康量表效用值为例,介绍各模型在概率映射中的应用。结果:映射法可通过建立非效用量表和效用量表之间的映射关系,进而得到健康效用值;其常用模型包括普通最小二乘法(OLS)模型、最小绝对离差法(CLAD)模型、Tobit模型、多元Logistic回归(MNL)模型、贝叶斯网络(BN)模型等。其中,OLS模型相对简单,预测效度较好,但会受到天花板效应的限制;Tobit模型不受天花板或地板效应的限制,当误差项满足方差齐性及正态性时,其预测结果优于OLS模型;CLAD模型可用于误差项非方差齐性不适用Tobit模型的情况;MNL模型先通过回归分析确定一种健康状态,再确定其效用值;BN模型预测效度较好,且不涉及计量经济学中的诸多假设和限制条件,但其构建过程受领域专家的影响较大。使用MNL或BN模式计算健康效用值的方法主要有蒙特卡洛模拟法、期望效用值法和最大可能概率法等。利用拟合优度、调整拟合优度、平均误差、均方误差、平均绝对误差等指标进行模型性能评价,可选出最优模型,进而计算健康效用值。结论:由于各映射模型各有优缺点,在临床研究中需要根据实际情况选择不同的映射模型。     

临床研究人文结局指标及评价

传统的临床指标通常包括临床有效性、安全性和经济学评价指标,人文结局作为重要补充,是一种独特的评价治疗效果的指标。现有的人文结局主要包括健康相关生命质量、药物依从性和患者满意度三大类,测量工具众多。结局的测量使医疗保健者全方位地了解患者对治疗的看法,可作为不同干预措施的参考,对改善医疗服务大有裨益。目前,大部分临床研究仍依赖于医师主导,唯有以人文结局为主要指标的研究,临床药师可独立开展。因此,本文概述了与人文结局相关的指标及评估量表,并简述了常用评估量表的内容特点,以期为临床药师独立开展研究时人文结局指标及相应量表的选择提供参考。     

海南地区高血压病患者健康相关生命质量及影响因素调查

目的了解海南地区高血压病患者的健康相关生命质量,并探讨其影响因素。方法以2012年3月—2013年2月在解放军总医院海南分院进行健康查体的海南地区居民为调查对象,应用自行设计的健康调查问卷及世界卫生组织制定的生命质量测定量表(中文版)进行一般情况、高血压病病史及健康相关生命质量调查。对检出的高血压病患者(高血压病组)与非高血压病患者(非高血压病组)进行相关项目的对比分析,同时对高血压病患者生命质量的影响因素进行多元线性回归分析。结果共收回有效问卷2215份,检出高血压病513例,高血压病患病率为23.2%。与非高血压病组比较,高血压病组年龄大、男性构成比高(P<0.05),两组文化程度和职业差异有统计学意义(P<0.05)。高血压病组生理功能、心理功能和社会关系领域及总体生命质量得分低于非高血压病组(P<0.05)。多元线性回归分析显示,年龄、职业是总体生命质量的危险因素,文化程度是保护因素(P<0.05)。结论海南地区高血压病患者生命质量受多种因素影响,在海南地区高血压病防治中应充分运用生命质量这一指标,并根据影响因素,从生理、心理和社会生活等方面有针对性地实施干预。     

Health related quality of life (SF-36) survey in Butajira, rural Ethiopia: normative data and evaluation of reliability and validity

The SF-36 health survey, a generic measure of health related quality of life (HRQOL), has been translated, evaluated in various languages and used in over 40 countries worldwide, although it has not been used in Ethiopia. OBJECTIVE: To measure the reliability and validity of the SF-36, to establish general population norms for various sex and age groups, to describe the effects of socio-demographic factors on SF-36 scores, and SF-36 scores in patients with major mental disorders. METHODS: Following the standard procedures of forward and back translation and adaptation, an Amharic SF-36 was developed This was subsequently used in a health survey of a general rural population of 1.990 in Butajira. The instrument was also used to interview a group of patients with schizophrenia, bipolar and depressive disorders. RESULTS: Mean scores of all of the eight domains of the SF-36 general population of Butajira decreased (indicating poorer HRQOL) with increasing age in both males and females. The odds of being in the lowest quartile of the PCS were 3.6 times higher in those aged 40-49 years when compared to those younger than 20 years Adjusted Odds Ratio (95% CI) = 3.62 (2.32, 5.66). In both males and females, the SF-36 scores for the eight domains and the two summary scales were significantly lower among all the three cases of major mental disorders compared to the general population. CONCLUSION: The SF-36 appears to be an appropriate measure for measuring health related quality of life in various population groups in Ethiopia.     

山西省煤矿接尘工人工作相关因素与生存质量关系研究

目的评价山西省煤矿接尘工人的生存质量,并探讨其与工作相关因素的关系。方法选取山西省7家煤矿的2 300名接尘工人为调查对象,采用自编的工作相关因素问卷以及健康状况量表(SF-36)生存质量量表进行调查,采用SPSS 13.0统计软件进行分析。结果煤矿接尘工人生存质量7个维度的得分偏低。总的工作年限、井下工作年限、接尘工龄等16种因素与生存质量的生理领域和心理领域有关系(P<0.05)。结论影响煤矿接尘工人生存质量的工作相关因素是多方面的,需采取综合措施提高其生存质量。     

Measuring quality of life in inflammatory bowel disease

In this study, the authors developed a disease-specific health related quality-of-life (HRQOL) measure that differentiated patients with ulcerative colitis (with and without surgery) from patients with Crohn's disease (with and without surgery). The purpose of the measure, which was facilitated by a questionnaire, was to produce a patient-orientated HRQOL index applicable to physicians' day-to-day management, and to provide a quality assurance mechanism to assess outcomes for these chronic diseases. The interview-directed questionnaire contained 47 items covering the following 4 domains: functional/economic, social/recreational, affect/life, and medical/symptoms. The items were selected by the authors from clinical experience and literature review, and showed good test-retest reliability over a 2-week period. The questionnaire had construct validity based on those items that correlated with the Sickness Impact Profile (SIP), a standardised generic health profile measure. From the 47 questions, a quality-of-life index was constructed by condensing the questionnaire to include only those 18 items that significantly differentiated between the 4 patient groups. Using this questionnaire, the authors studied 164 ambulatory patients (94 with ulcerative colitis, 70 with Crohn's disease) from a registry developed at the Cleveland Clinic. All patients had had their illness for at least 10 years, and 62% had undergone surgery because of it. When comparing the groups, the authors found that patients with ulcerative colitis had a better quality of life than those with Crohn's disease. In addition, patients who had not had surgery for their disease had a better quality of life than those who had.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health-related quality-of-life measurement in hypertension. A review of randomised controlled drug trials

In hypertension, tolerability of drug treatment is important because individuals may see the use of antihypertensive medications as more troubling than their seemingly symptomless disease. This may result in noncompliance and ineffectual long term treatment. In the past 15 years, new antihypertensive medications have been marketed on the basis of the advantages they offer with regard to adverse effects and the unavoidable impact of such adverse effects on a person's quality of life. When related to health, quality of life refers to the physical, psychological and social dimensions of health that are influenced by a person's experiences, beliefs, expectations and perceptions. To measure this concept, many instruments, either generic or specific, may be used. The purpose of this study is to describe, by way of a critical review of the literature, the instruments that are most often used in the measurement of health-related quality of life (HR-QOL) in people using antihypertensive drug treatments. We carried out a search of the literature published in English in the period January 1966 to July 2000, looking for randomised controlled trials of antihypertensive drugs. Using the Medline database, we included 77 papers in our review. Our main finding suggests that HR-QOL changes associated with antihypertensive treatment are measured with many different instruments. In almost all studies, at least 1 instrument specific to a health dimension was used, whereas not many used a generic instrument only. The most commonly measured HR-QOL dimensions were cognitive function, symptomatic well-being, sexual function, psychological well-being, sleep dysfunction, social participation and general health perception. Since the choice of dimensions to measure depends not only on the disease but also on the drug, this review adds further evidence that a generic instrument as well as a preference measurement should be added to a specific instrument.     

山西医科大学硕士研究生生存质量现况及其影响因素研究

目的:了解山西医科大学硕士研究生生存质量的整体状况及影响因素,为制定提高研究生生存质量的干预措施提供科学依据。方法:随机抽取3个年级研究生各100名,以问卷形式调查了解研究生的一般情况,采用世界卫生组织QOL-BREF量表对研究生生存质量进行现况研究。结果:经单因素与多元线性回归分析,生存质量生理、心理、社会和环境4个领域得分与诸多因素存在相关关系。结论:山西医科大学硕士研究生的生存质量较好。据分析结果,可制定相应的卫生保健干预措施。     

Health-related quality of life in morbid obesity: the impact of laparoscopic sleeve gastrectomy

Our aim in this prospective study was to determine the impact of laparoscopic sleeve gastrectomy on the quality of life of patients with morbid obesity in comparison with population standards. The study evaluated 76 morbidly obese patients who underwent laparoscopic sleeve gastrectomy. The short version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) was used to evaluate quality of life in the following four areas: physical health, mental health, social relations, and environment. Patients completed the questionnaire before their planned operation and again 3 and 6 months after surgery. Compared with the population standard, patients with morbid obesity had significantly lower quality of life scores in the physical and mental health domains, including on independent questions related to of overall health and quality of life (p<0.001). Women scored lower on indicators of mental health than men. Three and 6 months following surgery a significant trend of body mass index (BMI) reduction was seen, as well as increased quality of life in all indicated areas (p<0.001). Laparoscopic sleeve gastrectomy treatment in morbidly obese patients reduced BMI on a long-term basis, a change seen as early as 3 months after surgery. By 6 months after surgery, patients had the same quality of life scores as the reference population.     

Development of a new dyspepsia impact scale: the Nepean Dyspepsia Index

BACKGROUND: There is not at present a suitable disease-specific health-related quality of life instrument for uninvestigated dyspepsia and functional (non-ulcer) dyspepsia. AIM: To develop a new multi-dimensional disease-specific instrument. METHODS: The Nepean Dyspepsia Index (NDI) was designed to measure impairment of a subject's ability to engage in relevant aspects of their life and also their enjoyment of these aspects; in addition, the individual importance of each aspect is assessed. A 42-item quality of life measure was developed and tested, both in out-patients presenting to general practice with upper gastrointestinal complaints (n = 113) and in a randomly chosen population-based sample (n = 347). RESULTS: Adequate face and content validity was documented by an expert panel. Factor analysis identified four clinically relevant subscales: interference with activities of daily living, work, enjoyment of life and emotional well-being; lack of knowledge and control over the illness; disturbance to eating or drinking; and disturbance to sleep because of dyspepsia. These scales had high internal consistency. Both symptoms and the quality of life scores discriminated dyspepsia from health. CONCLUSION: The Nepean Dyspepsia Index is a reliable and valid disease-specific index for dyspepsia, measuring symptoms and health-related quality of life.     

美沙酮维持治疗海洛因依赖者的生存质量的变化及影响因素分析

目的:探讨接受美沙酮维持治疗后海洛因依赖者生存质量改善情况,以及影响其改善的因素。方法:采用《生存质量简表(WHO-QOL-BREF)》分别在患者入组治疗时、治疗后6个月随访调查,分析接受美沙酮维持治疗后以及不同特征患者生存质量改善情况。结果:150名海洛因依赖者在参加美沙酮维持治疗6个月以后"生理领域"、"生存质量总分"、"总的生存质量"和"总的健康状况"上升明显,差异有统计学意义,其生存质量得以改善率为58.0%。结论:社区美沙酮维持治疗能够提高和改善海洛因依赖者的生存质量。有、无工作,吸毒年限和婚姻状况是影响生存质量改善的影响因素。