健康相关生命质量评价研究与应用现状

健康相关生命质量(HRQOL)是近年来发展起来的一种全新的医学概念,在国外已得到广泛的应用.着重介绍了健康相关生命质量的概况、研究与应用进展,阐述了健康相关生命质量的研究背景,以及新近发展的有关健康相关生命质量的观点和测评工具.对健康相关生命质量评价研究的前景和启示作了相关探讨.     

健康相关生命质量的研究概况

健康相关生命质量已在发达国家广泛应用，对健康相关生命质量的历史，内涵，测定方法，应用和资料的统计分析进行阐述。研究显示，现有的健康相关生命质量测定表发展较快，其趋势越来趋向疾病专门化，但其效度，信度还有待提高。     

医学生生命质量评价研究回顾与展望

生命质量（quality of life,QOL）又称为生存质量或生活质量,是一种用于评价人体健康水平的指标体系。随着生命质量及健康相关生命质量的概念被越来越普遍的接受与应用,各个群体及各类人群的健康相关生命质量都受到了关注。对医学生生命质量及健康相关生命质量的评价不仅有利于了解医学生群体总体的健康体验与健康状况,了解其相关影响因素,还能因此采取相应的措施来提高和改善医学生的健康体验与健康状况,对医学教育政策的研究与制定以及医学课程改革都有重要的指导意义。本文通过检索并筛选医学生健康生命质量评价的相关文献,来分析与介绍相关的评价方法以及研究结果,对影响医学生健康相关生命质量的因素进行总结分析,从而为进一步的研究提供参考。     

我国肿瘤患者生命质量评价研究现状及特点

近年来，肿瘤患者健康相关生命质量（health-related quality of life，HRQOL）评价越来越受关注，相关评价方法在国外也得到广泛应用。本文着重介绍肿瘤患者健康相关生命质量的概况、研究与应用进展，以及生命质量的相关测量工具的使用。对肿瘤患者健康相关生命质量评价研究的特点进行了探讨。     

健康相关生命质量简介及其国际应用

健康相关生命质量(HRQOL)是近年来发展起来的一种全新的医学概念,在国外已得到广泛的应用.本文综述健康相关生命质量的定义、量表及其应用.     

个性化生命质量测量及其在卫生服务领域的应用

本文从个性化生命质量测量的概念、内容、应用及发展前景等方面出发,介绍个性化生命质量测量工具。个性化生命质量能反映研究对象的个人感知和对健康的关注点。个性化生命质量测量工具在国外已有较广泛的应用,但是国内相关研究缺乏。个性化生命质量测量能敏感、准确地评价特定人群有关生活状态的感受,是疾病管理、健康管理和卫生政策制定的适宜工具。     

生命质量—健康评价的发展方向

生命质量为健康评价提供了一种全面的手段，对生命质量的定义，研究的历史和现状，以及生命质量在健康评价中的应用进展做了综述，展示了生命质量在健康评价中的应用前景。     

生命质量在医学领域中的应用现状

生命质量 (Q OL ,Quality of L ife)是一个与健康有关的多变量指标 ,涉及的内容广泛而综合 ,其概念是美国学者 30年代提出的 ,最初用于社会学 ,70年代引入医学领域。我国有关生命质量的研究从 80年代中期开始 ,以社会学界开展的工作最多 ,在医学界开展较多的为生命质量调查及其评价指标的研究。随着人们的健康观念和疾病谱的转变 ,医学界更关心健康生活、生命的质量及相关正向特质〔1〕 ,这一变化使生命质量的应用在世界范围内日益广泛。1　生命质量的应用现状1.1　在肿瘤方面的应用1980年以来 ,欧美、日本等国对癌症病人的生命质量均进行…     

健康相关生命质量的研究进展

健康相关生命质量是对生理和心理健康的综合评价，在临床治疗、药物研究、预防保健、卫生决策和卫生经济评价等方面都发挥着不可取代的作用。本文从健康相关生命质量的内涵、研究概况、测量工具和影响因素等方面进行综述，为今后更好的开展健康生命质量研究提供参考和借鉴。     

研究健康相关生命质量影响因素的分位数回归分析

目的介绍分位数回归这一方法在健康相关生命质量量表数据分析中的适用性,并通过实例数据展示该方法的应用价值。方法分别应用分位数回归和传统线性回归模型分析汉中农村居民健康调查中获得1781例女性的SF-36量表数据及问卷调查资料,了解健康相关生命质量的影响因素,比较两种方法的结果及其适用性。结果传统线性回归分析显示患有高血压是影响农村女性健康相关生命质量的独立危险因素(β_(生理机能)=-4.39;β_(躯体疼痛)=-2.81;β_(一般健康状况)=-8.27;β_(精力)=-3.04;β_(情感职能0=-3.00;β_(精神健康状态0=-2.82;β_(躯体健康综合状况)=-1.90)。分位数回归分析结果确证了上述结论,并进一步探索患有高血压在不同健康相关生命质量得分百分位上的影响程度的差异。结论分位数回归与传统线性回归模型的结论并不完全一致,前者获取信息更多,结果更稳健。故分位数回归应用于人群健康相关生命质量的研究具有较高的应用价值。     

Two Kinds of Items in Quality of Life Instruments: ‘Indicator and Causal Variables’ in the EORTC QLQ-C30

Two kinds of variables may be differentiated within instruments measuring health-related quality of life (HRQOL). Physical symptoms may be called causal variables because their occurrence can cause a change in HRQOL, but poor HRQOL need not necessarily imply that a patient suffers from these symptoms. Other items can be regarded as indicator variables. They reflect the level of HRQOL and a patient with a poor HRQOL is likely to have low scores on all indicator variables. The aim of this study was to test the relationship of the latent HRQOL construct to items and domains on the EORTC QLQ-C30. Confirmatory factor analysis was performed on EORTC QLQ-C30 data from 205 gastrointestinal cancer patients assessed one month after surgery. Functioning scales were established as variables indicating the level of HRQOL whereas all other subscales and items were established as variables causing a change in HRQOL. The model-data fit was satisfactory. Results support the hypothesis that two kinds of variables may be differentiated within HRQOL instruments. Further research should investigate whether both kinds of variables could be combined into a higher order, aggregate score for HRQOL.     

Health‐related quality of life in children with myelomeningocele: a systematic review of the literature

Myelomeningocele (MMC) is the most complex congenital birth defect compatible with life. To provide the best health care for children with MMC, clinicians and researchers have to understand health and functional status of their patients as well as factors influencing their quality of life (QOL). The objective is to review studies that assess health‐related quality of life (HRQOL) and determinants of HRQOL in children with MMC. The data sources include MEDLINE, along with reference lists of relevant reviews and included articles. Study eligibility criteria are quantitative studies that assess HRQOL using validated HRQOL instrument. Participants include children aged 0–18 years with diagnosis of MMC or spina bifida. Risk of bias was assessed using the Hayden system for non‐randomized studies. Narrative synthesis and tables of results of HRQOL studies were conducted. Children with MMC have decreased HRQOL compared with normative population. Physical HRQOL is the most exposed aspect of QOL, while discrepancies in psychosocial domains vary by study. Many determinants of QOL have been found, and it is still not clear which determinant can be described as the strongest predictor. Psychosocial factors are the most consistent determinants of HRQOL.Heterogeneous study sample size, study designs, determinant and outcomes measures limited synthesis of findings. The HRQOL in children with MMC is complex and mediated by a number of associated medical problems, together with a variety of psychosocial and environmental factors. Future research is needed (a) on the relation between complex medical problems, functional independence, parent's and clinician's expectation and HRQOL in children and (b) to assess the differences in HRQOL by social environment and healthcare system.     

Determinants of health-related quality of life in Nigerian stroke survivors

Stroke is a leading cause of disability in developing countries. It is crucial to identify factors influencing health-related quality of life (HRQOL) in stroke survivors in this setting so that such factors can be efficiently manipulated in order to maximize HRQOL improvement. This is the first study of these determinants in Nigerian stroke patients. One hundred consecutive consenting stroke survivors were studied in Ibadan. The stroke levity scale (SLS) was used to assess stroke severity. HRQOL was assessed using the psychometrically robust HRQOL in stroke patients (HRQOLISP) questionnaire. HRQOL determinants were sought among variables such as age, gender, socio-economic class (SEC), post-stroke duration, side, type and number of strokes, SLS, modified Rankin scale (mRS), social support, and Likert-graded responses to laughter and negative feelings frequencies. Gender, aphasia, handedness, stroke side, type and frequency as well as SEC had no significant impact on HRQOL. The determinants of HRQOL were SLS, mRS, social support, laughter and negative feelings frequencies. Aside from stroke levity and disability, psychosocial factors such as emotional responses and social support determine HRQOL in stroke survivors. Both neuroscience and clinical management of stroke might benefit from a corresponding broader integrative conceptual framework for life after stroke.     

Examining the relationship between encouragement and health-related quality of life among Muslims

This study examines the relationship between encouragement and health-related quality of life (HRQOL) among a sample of American Muslims, in tandem with the potential mediating effects of depression and spirituality. To conduct this cross-sectional study, a model was developed and tested using structural equation modeling (SEM) with a community sample of Muslims (N = 284). The results indicate that encouragement has a direct, positive effect on HRQOL. Neither depression nor spirituality mediated the relationship between encouragement and HRQOL. Rather, both variables exhibited a direct, independent effect on HRQOL. In addition, spirituality exhibited an indirect effect on HRQOL through attenuating depression. The findings underscore the importance of encouragement as a pathway to enhance HRQOL among Muslims in post-9/11 America. The results also suggest that spirituality can play a significant role in fostering HRQOL among Muslims, both directly and indirectly by reducing the effects of depression on HRQOL.     

Health-Related Quality of Life in Adolescents With Inflammatory Bowel Disease: The Relation of Parent and Adolescent Depressive Symptoms

Adolescents with IBD are at risk for depressive symptoms and lower HRQOL. The association of adolescent and parent depressive symptoms with adolescent HRQOL is examined while controlling for disease activity. Adolescents (N = 86) and their caregivers completed measures of depressive symptoms. Adolescents completed an IBD-specific HRQOL measure. Parent depression significantly moderated the relation between adolescent-reported depressive symptoms and HRQOL. HRQOL decreased as adolescent depressive symptoms increased. This relation was only significant among adolescents with parents reporting higher depressive symptoms. Adolescent depressive symptoms are associated with lower HRQOL. The presence of parent depressive symptoms intensifies this relation.     

Patterns of health-related quality of life and patterns associated with health risks among Rhode Island adults

Background  

Health-related quality of life (HRQOL) has become an important consideration in assessing the impact of chronic disease on individuals as well as in populations. HRQOL is often assessed using multiple indicators. The authors sought to determine if multiple indicators of HRQOL could be used to characterize patterns of HRQOL in a population, and if so, to examine the association between such patterns and demographic, health risk and health condition covariates.     

Health-related quality of life of patients with overactive bladder receiving immediate-release tolterodine

Overactive bladder (OAB) imposes a burden on many aspects of a patient's life. The health-related quality of life (HRQOL) of OAB patients has been shown to be lower than healthy or control patients. A goal of successful treatment is to improve the HRQOL of OAB patients. With newer OAB treatments becoming available, HRQOL is an important outcome to measure. Thus, the objective of this study was to compare the HRQOL of patients being treated with tolterodine immediate-release (IR) versus placebo for OAB. The King's Health Questionnaire (KHQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered at baseline and end of treatment (12 weeks) in a randomized, parallel groups, placebo-controlled, double-blind, multinational study designed to compare the clinical efficacy and safety of tolterodine to placebo in the treatment of OAB. At end of treatment KHQ domains selected a priori as primary HRQOL endpoints (incontinence impact and role limitations) significantly improved (P≤0.0001) with tolterodine IR. Domains selected a priori as secondary HRQOL or symptom endpoints (physical limitations, emotions, sleep and energy, severity (coping) measures, and symptom severity) were also significantly improved (P≤0.0074) following treatment with tolterodine IR. The tolterodine IR group had less severity of individual symptoms and significantly better patient rating of bladder control than the placebo group at end of treatment. As expected, the SF-36 did not detect treatment differences. In conclusion, many aspects of HRQOL, as measured by the KHQ, significantly improved with tolterodine IR treatment. These HRQOL improvements were consistent with clinical efficacy results. The findings demonstrate that tolterodine IR patients experience overall improvement in their condition that resulted in important impacts on their HRQOL.     

Health-related quality of life of patients with overactive bladder receiving immediate-release tolterodine

Overactive bladder (OAB) imposes a burden on many aspects of a patient's life. The health-related quality of life (HRQOL) of OAB patients has been shown to be lower than healthy or control patients. A goal of successful treatment is to improve the HRQOL of OAB patients. With newer OAB treatments becoming available, HRQOL is an important outcome to measure. Thus, the objective of this study was to compare the HRQOL of patients being treated with tolterodine immediate-release (IR) versus placebo for OAB. The King's Health Questionnaire (KHQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered at baseline and end of treatment (12 weeks) in a randomized, parallel groups, placebo-controlled, double-blind, multinational study designed to compare the clinical efficacy and safety of tolterodine to placebo in the treatment of OAB. At end of treatment KHQ domains selected a priori as primary HRQOL endpoints (incontinence impact and role limitations) significantly improved (PА.0001) with tolterodine IR. Domains selected a priori as secondary HRQOL or symptom endpoints (physical limitations, emotions, sleep and energy, severity (coping) measures, and symptom severity) were also significantly improved (PА.0074) following treatment with tolterodine IR. The tolterodine IR group had less severity of individual symptoms and significantly better patient rating of bladder control than the placebo group at end of treatment. As expected, the SF-36 did not detect treatment differences. In conclusion, many aspects of HRQOL, as measured by the KHQ, significantly improved with tolterodine IR treatment. These HRQOL improvements were consistent with clinical efficacy results. The findings demonstrate that tolterodine IR patients experience overall improvement in their condition that resulted in important impacts on their HRQOL.     

Impact, distress and HRQoL among Malaysian men and women with a mobility impairment

Background

Health-Related Quality of Life (HRQOL) has received much attention in recent years. HRQOL indicators have been used to track population trends, identify health disparities, and monitor progress in achieving national health objectives for 2010. Prior studies have examined health risks and HRQOL at the national level as well as at the state level. This paper examines multiple indicators of HRQOL by demographic characteristics and selected health behaviors for Rhode Island adults.

Methods

Data from Rhode Island's 2002 Behavioral Risk Factor Surveillance System (BRFSS), a random digit dialled telephone survey, were used for this study. The state wide sample contained a total of 3,843 respondents ages 18 and older. Multiple Imputation (MI) was applied to handle missing data, and data were modelled for each of 10 HRQOL indicators using multivariable logistic regression.

Results

By examining HRQOL through a multivariable approach we identified the strongest predictors for multiple indicators of poor HRQOL as well as predictors for specific indicators of poor HRQOL. Predictors for multiple indicators of poor HRQOL were: disability, inability to work, unemployment, lower income, lack of exercise, asthma, and smoking (specifically associated with poor mental health).

Conclusion

Using multiple measures of HRQOL can help to assess the burden of poor health in a population, identify subgroups with unmet HRQOL needs, inform the development of targeted interventions, and monitor changes in a population's HRQOL over time. Use of these HRQOL measures in longitudinal and intervention studies is needed to increase our understanding of the causal relationships between demographics, health risk behaviors, and HRQOL.     

Predictors of quality of life among women with coronary heart disease

Background Health-related quality of life (HRQOL) is an increasingly relevant outcome as the population ages and associated morbidities increase. The purpose of this study was to evaluate predictors of HRQOL among ethnically diverse women hospitalized for coronary heart disease (CHD) and determine the impact of a brief, educational intervention on HRQOL 6 months post-hospitalization. Methods Women (n = 160; mean age 63 years, 53% minority) admitted for CHD at three academic hospitals who completed a 6 month secondary prevention trial were studied. The SF-36 was administered at admission and 6 months. Multiple linear regressions were used to identify significant independent predictors of 6 month HRQOL. Results Significant improvements in HRQOL were noted from admission to 6 months post-hospitalization. Subjects reporting better HRQOL at 6 months included those who were employed, married, physically active, enrolled in cardiac rehabilitation, and not depressed. Women who received an educational intervention had significantly less bodily pain at 6 months compared with usual care in a model adjusted for baseline HRQOL and physical activity goal adherence (p = 0.04). Conclusions Baseline HRQOL (8 SF-36 subscales), physical activity (3 SF-36 subscales) and marital status (1 SF-36 subscale) were the major determinants of HRQOL at 6 months post-hospitalization. Future interventions and preventive efforts should be targeted to women with CHD who have impaired HRQOL and may be at increased risk of poor clinical outcomes.