Adaptive responses among Dutch elderly: the impact of eight chronic medical conditions on health-related quality of life.

OBJECTIVES: This study analyzed the impact of eight common chronic medical conditions on functional, social, and affective domains of health-related quality of life among community-based Dutch elderly (n = 5279). METHODS: Health-related quality of life was measured with six domains of the MOS Short-Form General Health Survey. The impact of the selected chronic conditions on health-related quality of life was analyzed by means of Student's t tests, analyses of variance, and multiple regression analyses. RESULTS: Compared with other domains of health-related quality of life, mental health was the least affected by chronic medical conditions. Back problems and rheumatoid arthritis/other joint complaints accounted for relatively high proportions of the variance in health-related quality of life (from 35.5% to 68.3%), except for health perceptions (22.6%), indicating that health-related quality of life is most affected by these two conditions. CONCLUSIONS: Subjective well-being is by far the domain least affected by chronic medical conditions, while physical functioning and health perceptions are most affected. Back problems and rheumatoid arthritis/other joint complaints affect health-related quality of life strongly.     

Suburban sprawl and physical and mental health

OBJECTIVE: To study the association between objective measures of suburban sprawl and chronic medical conditions and mental health disorders in the USA. METHODS: Cross-sectional analysis of survey data merged with objective measures of suburban sprawl. Outcomes are self-reported medical conditions, mental health disorders and health-related quality of life. RESULTS: Sprawl significantly predicts chronic medical conditions and health-related quality of life, but not mental health disorders. An increase in sprawl from one standard deviation less to one standard deviation more than average implies 96 more chronic medical problems per 1000 residents, which is approximately similar to an aging of the population of 4 years. CONCLUSIONS: A robust association between sprawl and physical (but not mental) health suggests that suburban design may be an important new avenue for health promotion and disease prevention.     

Leisure time physical activity and health-related quality of life: Cross-sectional and longitudinal associations

Studies that relate change in physical activity to change in health-related quality of life in the general population are needed to confirm associations suggested by cross-sectional studies. In the present study, cross-sectional as well as longitudinal associations between leisure time physical activity and health-related quality of life were studied in an apparently healthy population. The present study showed cross-sectional associations between at least moderately intense leisure time physical activity and general health perceptions, vitality, physical functioning and role limitations due to physical health problems. No associations were present for total leisure time physical activity. Change in leisure time physical activity was associated with change in social functioning in men as well as in women, irrespective of the intensity of physical activity. Only in men, change in total leisure time physical activity was associated with change in vitality and general mental health. In our study, cross-sectional associations were not confirmed by longitudinal analyses. Cross-sectional associations were mainly found for physical components of health-related quality of life, whereas longitudinal associations were predominantly observed for mental components of health-related quality of life. Confirmation of our results by those of other studies is needed in order to quantify health promotion messages.     

Health-related quality of life and mental health problems after a disaster: Are chronically ill survivors more vulnerable to health problems?

Studies have shown that the chronically ill are at higher risk for reduced health-related quality of life (HRQL) and for mental health problems. A combination with traumatic events might increase this risk. This longitudinal study among 1216 survivors of a disaster examines whether chronically ill survivors had a different course of HRQL and mental health problems compared to survivors without chronic diseases. HRQL and mental health problems were measured 3 weeks, 18 months and 4 years post-disaster. Data on pre-disaster chronic diseases was obtained from the electronic medical records of general practitioners. Random coefficient analyses showed significant interaction effects for social functioning, bodily pain and emotional role limitations at T2 only. Chronically ill survivors did not consistently have a different course of general health, physical role limitations, and mental health problems. In conclusion, chronic diseases were not an important risk factor for impaired HRQL and mental health problems among survivors.     

杭州市空巢老人身心健康和社会支持对生命质量的影响调查

目的探讨杭州市空巢老人身心健康状况和社会支持现状对生命质量的影响及交互作用,为提高空巢老人生命质量研究提供科学依据。方法利用分层整群随机抽样法抽取杭州市2个城区和3个郊县的992名空巢老人进行健康相关生活质量量表(ED-5Q)、社会支持量表(SSRS)以及老年抑郁量表(GDS-15)调查,分析不同特征空巢老人生命质量得分情况,根据各量表得分,利用Pearson相关性分析研究身心健康和社会支持与生命质量的相关关系。结果身体健康得分为(73. 41±13. 52)分,抑郁量表得分为(4. 11±1. 79)分;社会支持量表测得调查对象社会支持总分为(28. 79±6. 66)分,客观支持为(6. 09±2. 59)分,主观支持为(15. 92±4. 00)分,社会支持利用度得分为(6. 78±2. 28)分,EQ-5D效用值为(0. 75±0. 13)分。已婚组空巢老人生命质量得分高于离婚组和丧偶/单身组,差异有统计学意义(F=8. 462,P <0. 01);收入水平越高的空巢老人生命质量得分越高,差异有统计学意义(F=18. 329,P <0. 01);患有慢性病的空巢老人生命质量得分低于不患慢性病的空巢老人,差异有统计学意义(F=-2. 919,P <0. 01);担心养老的空巢老人生命质量得分低于不担心养老的空巢老人,差异有统计学意义(F=16. 78,P <0. 01)。经Pearson相关性分析,客观支持(r=0. 141)、主观支持(r=0. 291)、支持利用度(r=0. 071)和社会支持总得分(r=0. 254)与生命质量呈正相关,抑郁得分与生命质量呈负相关(r=-0. 252)。结论得到客观支持和主观支持越多,对社会支持的利用度越高,身心健康状况越好,空巢老人健康相关生命质量越优;减轻抑郁状况,有利于提高空巢老人健康相关生命质量。     

高血压性脑卒中患者日常生活活动能力与生存质量的关系

目的探讨高血压性脑卒中患者日常生活活动能力与生存质量的关系。方法选取2016年6月至2018年10月在本院门诊或住院部就诊的原发性高血压合并脑卒中患者232例。收集患者人口学特征,使用Barthel指数评定量表评估患者的日常生活活动能力,使用简明健康状况调查表(SF-36)评估患者的生存质量。结果年龄<60岁的患者日常生活活动能力得分为(80.93±17.11),明显高于M60岁患者的(72.76±15.08),差异有统计学意义(P<0.05);不同受教育程度和月收入患者的日常生活活动能力和总体健康水平之间比较差异均有统计学意义(均P<0.05)。脑力劳动者和医保患者的日常生活活动能力和总体健康水平明显高于体力劳动者和自费患者,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,日常生活活动能力与总体健康、生理功能、情感功能、生理职能、躯体疼痛、精神健康及活力呈正相关(均P<0.05),与社会功能无明显相关性(P>0.05)。多元逐步回归分析显示,受教育程度、职业类型、医保类型、月收入是患者日常生活活动能力和总体健康水平的独立影响因素(均P<0.05)。结论髙血压性脑卒中患者日常生活活动能力和生存质量均偏低,应针对受教育程度、职业类型、医保类型及月收入不同的患者制订针对性干预措施。     

Can patient satisfaction improve health among patients with angina pectoris?

OBJECTIVE: To identify and explore the components of patient satisfaction that have the strongest association with health-related quality of life among patients with angina. DESIGN: Cross-sectional study with postal questionnaires sent to patients 6 weeks after discharge from hospital, followed-up by one reminder. SETTING: The Central Hospital of Akershus in Norway. STUDY PARTICIPANTS: All 589 angina patients discharged between January 1 1995 and December 31 1996. The response rate was 67% (n=395). MAIN OUTCOME MEASURES: Physical and mental component summary scales in SF-36. RESULTS: When adjusted for relevant background factors such as age, sex, education, social network, health behaviour and sense of coherence, patient satisfaction explained 9% of the variation in the physical, and 7% of the variation in the mental component summary scales. In particular, satisfaction with medical treatment (P=0.002) and with information (P=0.003) were associated with improved physical and mental health-related quality of life. Patients who experienced their physicians as caring and competent were more likely to be satisfied with the medical treatment and with the information. Sense of coherence contributed to health-related quality of life both directly, and through improving patient satisfaction. CONCLUSION: This cross-sectional study supports the hypothesis that patient satisfaction contributes to both physical and mental health-related quality of life. Other research designs are needed to assess whether the associations identified are truly causal.     

Factors Associated With Health-Related Quality of Life Among an Older Population in a Largely Rural Western Region

CONTEXT: As elderly people become a larger proportion of the rural population, it is important to identify those at risk for poor health. Predictors of health-related quality of life can be useful in designing interventions. PURPOSE: One objective of the present study was to profile the health-related quality of life of community-dwelling, elderly people in a southwestern region of the United States. A related objective was to identify the principal factors associated with health-related quality of life, thereby identifying population subgroups in greatest need of health or social services. METHODS: A telephone survey of approximately 5,000 individuals 65 years and older collected data on need for assistance with activities of daily living, physical and mental health-related quality of life, and worry about health status measures. A modified version of the Behavioral Model was used to more clearly distinguish the different groups at risk for poor health. FINDINGS: Those groups of community-dwelling, elderly people in the poorest health were older than 75 years, had less than a high school education, were retired or unemployed, and had low household income. No differences were found by urban, rural, and frontier residence. CONCLUSIONS: To maintain the physical, social, and psychological health of older people residing in rural and urban areas, social services, medical care, and supportive services are needed, particularly among the most socially and economically disadvantaged.     

Chronic disease and mental disorder

The aim of this study was to achieve a better understanding of the relationship between chronic medical illness and mental distress. Therefore, the association between chronic medical illness and mental distress was analysed, taking into account the modifying effects of generic disease characteristics (concerning course, control and possible stressful consequences), physical quality of life indicators and social and relationship problems. Panel data from the Dutch national Panel of Patients with a Chronic Disease (PPCZ) were used. Data from 1788 chronically medical ill patients (nine disease categories) concerning their mental and physical health have been used in a cross-sectional, multivariate analysis. Somatic disease, generic disease characteristics and physical quality of life were assessed by medical doctors. Mental distress and social/ relationship problems were assessed by questionnaire (respectively, GHQ-12 and Biopro). Members of the panel had more mental distress than a random community sample. However, there were no differences between specific somatic diseases. Relationship, job-related and financial problems increased the probability of mental disorder considerably. Relationship problems may be considered a generic characteristic of chronically ill patients, causing an increased risk of mental disorder. Poor physical health condition contributed to a higher probability of mental disorder as well. General practitioners, home care providers and medical specialists should be aware that people with chronic diseases are in general more at risk of mental disorder. For many chronically ill people, this risk is further exacerbated by social/relationship problems, and a poor level of perceived health.     

新医改十年甘肃省糖尿病患者健康相关生命质量及其影响因素研究

目的 调查新医改前后甘肃省糖尿病患者健康相关生命质量（HRQoL）并分析其影响因素,为提高糖尿病患者HRQoL提供科学依据。方法 利用新医改前（2008年）及医改后（2018年）在甘肃省开展的第四次、第六次国家卫生服务入户调查数据,采用基于我国的欧洲五维健康量表（EQ-5D）效应值积分体系计算EQ-5D健康效用指数。结果 新医改前后甘肃省≥ 15岁居民EQ-5D均有明显变化：行动能力改善8.08%（27.43% vs. 19.35%）、自我照顾改善16.16%（26.55% vs. 10.39%）、日常活动改善8.97%（28.32% vs. 19.35%）、疼痛/不适恶化1.38%（38.05% vs. 39.43%）、焦虑/抑郁恶化1.83%（16.81% vs. 18.64%）,EQ-VAS评分提高3.36（60.53 vs. 63.89）,健康效用指数升高0.04（0.83 vs. 0.87）。多因素回归分析结果显示,各维度影响因素不完全一致,总的来看,年龄越高、文化程度低、从不锻炼、多重慢病的糖尿病患者HRQoL较差（P<0.05）,其中多重慢病对糖尿病患者的健康状况影响最大,城镇职工医保及新医改后的糖尿病患者HRQoL较好（P<0.05）。结论 新医改对甘肃省糖尿病患者HRQoL有着积极的影响。医疗保健提供者和决策者应当重视多重慢病对HRQoL的影响以及糖尿病患者的心理健康。     

Relationship of Household Food Insecurity to Health-Related Quality of Life in a Large Sample of Rural and Urban Women

The authors examined the associations of household food insecurity and other characteristics with fair-to-poor general health, poor physical health, and frequent mental distress among 1,367 rural and urban women in Texas. The 2006 Brazos Valley Community Health Assessment provided data on demographic characteristics, economic risk factors, health-related quality of life, household food insecurity, and geographic residence. Multivariable logistic regression models were estimated for the three health-related quality of life measures: fair-to-poor health, poor physical health, and frequent mental distress, adjusting for confounding variables. Having less than 12 years of education, not being employed full-time, and being household food insecure were independently significantly associated with increased odds for all health-related quality of life outcomes. Rural residence and being nonwhite were associated with fair-to-poor general health, but not physical or mental health. Results from the separate urban and rural models indicated that household food insecurity was associated with fair-to-poor general health among rural women, not among urban women. Poverty and being nonwhite were also associated with increased odds of reporting fair-to-poor general health, but were significant only among urban women. These results emphasize the need for health promotion and policy efforts to consider household food access and availability as part of promoting healthful food choices and good physical and mental health among women, especially rural women.     

Health-related quality of life and comorbidity among older women veterans in the United States

Purpose

This paper examines the predictors of quality of life among older women (≥65 years of age) veterans in the United States focusing on the effect of comorbidity on health-related quality of life (HRQOL).

Methods

Data from the National Survey of Women Veterans, a cross-sectional nationally representative population-based, stratified random sample of women veterans, were used with an analytic sample size of 1,379 older women veterans. The SF12 physical and mental composite scores (PCS and MCS) were used as outcome measures, and a weighted comorbidity index was used as a covariate.

Results

Older women veterans who are married, employed, with higher income, and higher education have better physical health (PCS). For mental health, education is positively correlated, whereas depression and posttraumatic stress disorder are negatively correlated with MCS. After adjusting for socio-demographic, mental health, and chronic health indicators, the results showed that SF12 PCS varied by VA use status for each level of Seattle Index of Comorbidity. The same pattern was not found for MCS.

Conclusion

For each level of comorbidity, VA users have worse HRQOL which might suggest that case mix adjustments comparing VA users and non-VA users must take into account more than comorbidity alone.     

慢性中度乙型肝炎住院患者生存质量的分析

目的:调查并评价慢性中度乙型肝炎患者的生存质量。方法:采用补充修订的SF-36对50例慢性中度乙型肝炎患者和正常人进行自评测量。结果:患者生存质量的各个方面得分都低于正常人,除健康感觉和经济方面外,其余均有显著性差异。总体健康、食欲、最近一个月的生活状况、健康转变等的得分在70-80分之间,精力/疲劳、躯体机能、心理机能、认知机能、经济、睡眠、健康感觉、社会机能等的得分在80～90分之间,日常活动能力,疼痛等方面的得分在90分以上。结论:慢性中度乙型肝炎患者的生存质量比正常人显著降低。     

Messung der gesundheitsbezogenen Lebensqualität mit dem SF-8

The SF-8, a relatively new instrument for measuring health-related quality of life, was used in the German National Telephone Health Survey 2003. The SF-8 provides results which are comparable to those of the SF-36, the instrument most commonly used internationally. The German National Telephone Health Survey provides nationally representative data for the residential population in Germany aged 18 and older. In addition to the measurement of health-related quality of life, comprehensive information on chronic illnesses and complaints, health care needs, utilisation of health care, risk factors, risk behaviour and social status is also collected, making differentiated analyses possible. According to the data collected, men rate their quality of life in all dimensions higher than women. With increasing age, quality of life for both men and women decreases in the physical dimensions, while increasing in the mental health dimensions. Apart from chronic disease and pain having a negative impact on health-related quality of life, social differences are also observable, in that worse health-related quality of life is reported by respondents with lower socioeconomic status.     

Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women

The authors examined the associations of household food insecurity and other characteristics with fair-to-poor general health, poor physical health, and frequent mental distress among 1,367 rural and urban women in Texas. The 2006 Brazos Valley Community Health Assessment provided data on demographic characteristics, economic risk factors, health-related quality of life, household food insecurity, and geographic residence. Multivariable logistic regression models were estimated for the three health-related quality of life measures: fair-to-poor health, poor physical health, and frequent mental distress, adjusting for confounding variables. Having less than 12 years of education, not being employed full-time, and being household food insecure were independently significantly associated with increased odds for all health-related quality of life outcomes. Rural residence and being nonwhite were associated with fair-to-poor general health, but not physical or mental health. Results from the separate urban and rural models indicated that household food insecurity was associated with fair-to-poor general health among rural women, not among urban women. Poverty and being nonwhite were also associated with increased odds of reporting fair-to-poor general health, but were significant only among urban women. These results emphasize the need for health promotion and policy efforts to consider household food access and availability as part of promoting healthful food choices and good physical and mental health among women, especially rural women.     

Does obesity contribute as much to morbidity as poverty or smoking?

The prevalence of obesity is increasing in America, but its impact on morbidity relative to other health risks is unclear. This paper compares the effects of overweight, poverty, smoking and problem drinking on occurrence of chronic conditions and health-related quality of life. The data were collected from a nationally representative household telephone survey of 9585 adults fielded in 1998, using self-reported measures of height and weight, poverty, smoking status, problem drinking, chronic conditions and SF-12 global scales. Regression analyses were used to estimate effects of health risk factors on morbidity. Thirty-six percent of adults are overweight but not obese (25< or =BMI<30) and another 23% are obese (BMI> or =30). Controlling for demographics, obesity is associated with more chronic conditions and worse physical health-related quality of life (P<0.01). Smoking history and poverty predict having chronic conditions, but their effect sizes are significantly smaller. Even after controlling for chronic conditions, obesity predicts physical health-related quality of life, in that case with an effect size similar to poverty. The effect of problem drinking is always smaller. Obesity is highly prevalent and associated with at least as much morbidity as are poverty, smoking and problem drinking. Nevertheless, the latter have achieved more consistent attention in recent decades in clinical practice and public health policy.     

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。     

基于EQ - 5D效用积分体系的慢性病患者健康相关生命质量研究

目的 分析慢性病患者健康相关生命质量及其影响因素。方法 利用2018年江苏省第六次卫生服务调查数据,该调查采用多阶段分层整群随机抽样的方法,选择15岁及以上患慢性病的居民为研究对象（3 646人）,基于EQ - 5D健康效用值,利用秩和检验、Tobit回归研究慢性病患者健康相关生命质量的影响因素。结果 58.06%的慢性病患者在EQ - 5D各维度没有任何困难;城市、已婚或其他婚姻状况、文化程度提高、家庭人均年收入增加、BMI升高、参加健康体检、进行体育锻炼是健康的保护因素（OR＜1）,年龄增长是健康的危险因素（OR＞1）。结论 慢性病患者健康相关生命质量较低,提高慢性病患者收入水平、文化程度并改善其健康行为对于提高这类人群的生命质量具有重要意义。     

Health Screening and Health Promotion Programs for the Elderly

As the population of elderly people worldwide continues to grow, successful aging has risen to the top of the health policy agenda. The definition of successful aging includes the maintenance of physical and mental function, as well as continued social engagement. Given this definition, maintaining health-related quality of life (HR-QOL) should be a key goal for nutrition and physical activity programs targeted toward the elderly. HR-QOL encompasses physical functioning necessary for unassisted living, as well as broader domains of mental functioning and overall life satisfaction. This review examines the relationship between health parameters and HR-QOL, and assesses the degree to which these relationships are addressed in existing screening and promotion programs. In many cases, nutrition screening and evaluation tools have focused on biomedical measures, such as bodyweight, body fat, or plasma lipids, without taking QOL into account. While HR-QOL has been considered in a few health promotion campaigns, a more balanced perspective on wellness and health among the elderly is needed for the design of effective policies and programs. Successful aging can depend on such factors as race, ethnicity, education, and access to economic and social resources. Intervention programs reviewed include those that address nutritional status, physical activity, and mental health issues among community-dwelling elderly. A comprehensive approach to promoting health in aging would incorporate indicators of wellbeing, and would specifically address nutrition and physical activity issues alongside HR-QOL. Public health policies reviewed here are designed to create an infrastructure to promote healthy aging and offer support to the growing elderly population.     

唱歌、打太极等活动对50岁以上的社区慢性病患者及高危人群心理健康作用研究

目的通过应用唱歌、打太极、舞蹈、器乐演奏等干预措施,观察其对慢性病及高危人群心理健康的影响,为进一步开展慢性病干预工作提供依据。方法将617名50岁以上的社区慢性病患者和高危人群以自愿原则分成五组,分别为唱歌组、太极组、舞蹈组、器乐演奏组和对照组,干预组分别给予不同的课程,对照组参加与干预措施无关的其它课程,干预措施持续15个月,分析各组健康效果、复原力、抑郁患病率等心理健康情况。结果各干预组干预后健康效果测量得分显著高于对照组(P<0.05),包括大脑执行功能、心理健康、精神状态、体力活动、自尊心等方面,在复原力方面干预组也高于对照组(P<0.05)。不同干预组的干预效果存在差异,唱歌组和太极组大脑执行功能得分最高,太极组和唱歌组健康相关生活质量得分最高,太极组和舞蹈组在自尊心方面得分最高,在复原力方面太极组得分也较高,器乐演奏组在大脑执行功能、精神健康等方面得分较高,但在社交技能、体力活动、复原力中的家庭关系、朋友支持等方面与对照组相比效果不显著(P>0.05)。结论对慢性病患者及高危人群,太极在促进大脑功能和预防抑郁方面效果显著,唱歌、舞蹈在预防大脑功能衰退和提高健康相关生活质量方面十分有效,器乐演奏能促进个体保持良好的心理健康状态。