1型糖尿病儿童及青少年患者生存质量调查分析

目的调查1型糖尿病儿童及青少年患者的生存质量。方法采用儿童生存质量普适性核心量表和应对方式问卷分别对63例1型糖尿病儿童、青少年患者及63名患者家长进行调查。结果 1型糖尿病儿童及青少年患者生存质量总均分为(84.84±11.31)分,糖尿病患者家长的应对方式主要以成熟的应对方式(例如:解决问题、求助)为主,糖尿病儿童及青少年患者的年龄、是否独生子女、测血糖者、胰岛素注射工具和家长自责影响患者生存质量。结论关注非独生子女、青少年糖尿病患者的生存质量,鼓励儿童及青少年患者自己测血糖,以提高其自我管理能力。     

Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes

OBJECTIVE: To estimate the health-related quality of life (HRQOL) and treatment satisfaction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associated with quality of life and treatment satisfaction. RESEARCH DESIGN AND METHODS: For a sample of 1,348 type 2 diabetes patients, recruited by 29 general practitioners, we collected data regarding HRQOL. This study was performed as part of a larger European study (Cost of Diabetes in Europe - Type 2 [CODE-2]). We used a generic instrument (Euroqol 5D) to measure HRQOL. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire. RESULTS: Patients without complications had an HRQOL (0.74) only slightly lower than similarly aged persons in the general population. Insulin therapy, obesity, and complications were associated with a lower HRQOL, independent of age and sex. Although higher fasting blood glucose and HbA1c levels were negatively associated with HRQOL, these factors were not significant after adjustment for other factors using multivariate analysis. Overall treatment satisfaction was very high. Younger patients, patients using insulin, and patients with higher HbA1c levels were less satisfied with the treatment than other patients. CONCLUSIONS: Obesity and the presence of complications are important determinants of HRQOL in patients with type 2 diabetes.     

Health-related quality of life among Canadians with migraine

The objective was to determine the impact of migraine on health-related quality of life (HRQOL) among Canadians. Analysis was based on the public use microdata set of the Canadian Community Health Survey (CCHS), limited to those aged ≥15 residing in Manitoba. HRQOL was measured using the SF-36 survey, which covers 8 health concepts. Multivariate linear regression was used to model each SF-36 scale against age, gender, education, income, migraine status and presence of mood or anxiety disorders. Of the 7236 CCHS respondents, 9.7% reported a diagnosis of migraine. Reported migraine predicted statistically significant (p<0.0001) lower HRQOL in all SF-36 domains with profound impairment of physical role, bodily pain and general health. Those reporting a mood disorder scored significantly lower in all domains with pronounced effects on emotional role, social functioning and general health. Reported anxiety disorder was associated with lower HRQOL in 6/8 domains. Canadians with migraine report significant impairment in HRQOL compared to the general population, independent of psychiatric morbidity.     

Health-related quality of life and metabolic control in children with type 1 diabetes: a prospective cohort study

OBJECTIVE: To assess change in health-related quality of life (HRQOL) in children with diabetes over 2 years and determine its relationship to change in metabolic control. RESEARCH DESIGN AND METHODS: In 1998, parents of children aged 5-18 years attending a tertiary diabetes clinic reported their child's HRQOL using the Child Health Questionnaire PF-50. Those aged 12-18 years also self-reported their HRQOL using the analogous Child Health Questionnaire CF-80. HbA(1c) levels were recorded. In 2000, identical measures were collected for those who were aged < or =18 years and still attending the clinic. RESULTS: Of 117 eligible subjects, 83 (71%) participated. Parents reported no significant difference in children's HRQOL at baseline and follow-up. However, adolescents reported significant improvements on the Family Activities (P < 0.001), Bodily Pain (P = 0.04), and General Health Perceptions (P = 0.001) scales and worsening on the Behavior (P = 0.04) scale. HbA(1c) at baseline and follow-up were strongly correlated (r = 0.57). HbA(1c) increased significantly (mean 7.8% in 1998 vs. 8.5% in 2000; P < 0.001), with lower baseline HbA(1c) strongly predicting an increase in HbA(1c) over the 2 years (r(2) = 0.25, P < 0.001). Lower parent-reported Physical Summary and adolescent-reported Physical Functioning scores at baseline also predicted increasing HbA(1c). Poorer parent-reported Psychosocial Summary scores were related to higher HbA(1c) at both times but did not predict change in HbA(1c). CONCLUSIONS: Changes in parent and adolescent reports of HRQOL differ. Better physical functioning may protect against deteriorating HbA(1c), at least in the medium term. While the HRQOL of children with diabetes does not appear to deteriorate over time, we should not be complacent, as it is consistently poorer than that of their healthy peers.     

Microalbuminuria and mortality in long-duration type 1 diabetes

OBJECTIVE: Microalbuminuria is a recognized risk factor for increased mortality and renal failure in type 1 diabetes. Whether it remains a powerful predictor in patients with a long duration of type 1 diabetes is not known. We ascertained the prognostic significance of abnormal urinary albumin excretion in a cohort of patients with at least 30 years of type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 190 patients with a disease duration of type 1 diabetes of at least 30 years with baseline and 5 years of follow-up. RESULTS: At baseline 66% were normoalbuminuric, and at 5 years 11% of this cohort had died. Of the 22% who were microalbuminuric at baseline, 26% had died, and of the 8% with persistent proteinuria at baseline, 44% had died. Of the 4% with end-stage renal failure at baseline, 71% had died within 5 years. Death was attributable to a cardiovascular cause in two-thirds of the cases in all groups. CONCLUSIONS: Even in those with a long duration of type 1 diabetes, the presence of abnormal urinary excretion remains a powerful predictor of increased mortality.     

2型糖尿病患者生存质量及其与糖尿病心理痛苦的关系

目的调查2型糖尿病患者生存质量现状,并分析其与糖尿病心理痛苦的关系。方法采用一般资料调查表、世界卫生组织生存质量测定量表简表、糖尿病痛苦量表对南京市某三级甲等医院290例2型糖尿病患者进行调查。结果 290例2型糖尿病患者的生存质量得分为(67.74±13.40)分;糖尿病心理痛苦、失眠和并发症是2型糖尿病患者生存质量的影响因素。结论 2型糖尿病患者的生存质量较以往有所改善,对糖尿病心理痛苦较严重、夜间失眠和有并发症的患者应予以更多的重视,积极改善其生存质量。     

Significance of microalbuminuria in long-duration type 1 diabetes

OBJECTIVE: The value of microalbuminuria (MA) in predicting renal disease and premature mortality in longer duration type 1 diabetes is unclear. RESEARCH DESIGN AND METHODS: We followed 135 patients with long-standing type 1 diabetes (>30 years' duration) over a 7-year period, recording albuminuria and other clinical variables. Vital status was ascertained and cause of death was recorded. RESULTS: A total of 27 of 135 patients (20%) died during the follow-up period. Patients with MA (10 of 30, 33.3%) or proteinuria (5 of 6, 83.3%) at initial examination were more likely to die during follow-up than patients who had normal albumin excretion at baseline (12 of 99, 12%; chi(2) for trend 21.9, P < 0.0001). The presence of abnormal albumin excretion and low BMI were independent risk factors of premature death. The causes of death were similar in patients with normal and abnormal urine albumin excretion. A total of 24.4% of initially normoalbuminuric survivors developed MA, and persistent proteinuria developed in 3.5%. Progressors had significantly higher albumin excretion rate at baseline compared with those who remained normoalbuminuric: 9.0 microg/min (3.8-18) vs. 4.0 microg/min (0.4-17.5); P < 0.001. A total of 21% of patients with MA at baseline reverted to normoalbuminuria, and persistent proteinuria developed in 32%. The likelihood of progression to persistent proteinuria was significantly greater in those with baseline MA compared with those with normal albumin excretion (P < 0.001). CONCLUSIONS: Even in long-standing type 1 diabetes of >30 years' duration, MA and proteinuria predict all-cause mortality. MA is a good predictor of persistent proteinuria.     

Health-related quality of life in 975 patients with complex regional pain syndrome type 1

There are limited data available on health-related quality of life (QoL) in patients with complex regional pain syndrome (CRPS). In the present study we examined QoL in 975 CRPS patients attending 6 different clinics in the Netherlands. QoL was assessed using the MOS 36-Item Short-Form Health Survey (SF-36) with the Mental Health Summary Score (MHS) and the Physical Health Summary Score (PHS) as dependent variables. The influences of gender, type of affected limb, disease duration, pain scores, CRPS severity and set of diagnostic criteria used were investigated. We found the lowest scores of QoL in the physical domains of the SF-36, with lower-limb CRPS patients reporting poorer results than patients with an affected upper limb. Influence of gender on QoL was not observed, and correlations of QoL with disease duration and the CRPS severity score were weak. Pain correlated moderately with QoL. In addition, patients fulfilling stricter diagnostic criteria (ie, the Budapest criteria) had lower QoL scores than patients fulfilling less strict criteria (ie, the Orlando criteria). We conclude that loss of QoL in CRPS patients is due mainly to reduced physical health. A comparison with data available from the literature shows that CRPS patients generally report poorer QoL than patients with other chronic pain conditions, particularly in the physical domains. Pain correlated moderately with QoL and therefore deserves ongoing attention by physicians. Finally, patients meeting the diagnostic Budapest criteria have lower QoL scores than patients meeting the Orlando criteria, highlighting the impact of different sets of criteria on population characteristics.     

Health-related quality of life and physical activity in persons at high risk for type 2 diabetes

Purpose. The aim of this study was to compare the health-related quality of life (HRQOL) of persons at risk for type 2 diabetes to that of the Finnish general population. In addition, the associations between physical activity and HRQOL at-risk persons were studied.

Methods. One hundred thirty-two at-risk persons were recruited from health care centres in Central Finland. Participants filled out questionnaires including demographic characteristics, HRQOL (SF-36), frequency of vigorous physical activity (≤2 times a week, once a week, less than once a week) and comorbidities.

Results. HRQOL of at-risk persons differed significantly from that of the Finnish population in four of the eight dimensions of SF-36. Compared with reference values of the general population, the values of at-risk persons were worse for general health and pain, but better for mental health and role limitation (emotional) dimensions. Among at-risk persons those physically more active had less depressiveness and lower body weight. HRQOL decreased linearly with decreasing physical activity in all dimensions.

Conclusions. People with elevated risk for type 2 DM have reduced HRQOL in general health and body pain dimensions, but mental health and emotional role dimensions were better compared with that of the population. Among at-risk persons, the benefits of physical activity on HRQOL were seen in all HRQOL dimensions. Regular exercise and body weight control may improve subjective health and reduce risk for type 2 DM and its consequences.     

Health-related quality of life among informal caregivers assisting people with multiple sclerosis

Objective.?To identify factors affecting the health-related quality of life (HRQOL) of informal caregivers assisting people with (multiple sclerosis) MS who have greater functional impairment.

Methods.?Data were collected in a national survey of 530 people who provided informal care to people with MS. Multiple linear regression models analyzed these data.

Results.?Poorer overall health for the person with MS, stronger agreement by caregivers that care giving was burdensome or emotionally draining, and the caregiver's need for mental health counseling in the past 12 months were associated with lower mental dimensions of HRQOL for the informal caregiver. Greater caregiver satisfaction with the access the person with MS had to MS-focused care was associated with higher mental dimensions of HRQOL among caregivers.

Conclusions.?Increasing access to MS-focused care could improve not only the health of people with MS, but also improve the mental dimensions of caregiver HRQOL. Our findings highlight the importance of addressing the mental health needs of informal caregivers assisting people with MS.     

不同养老模式下的离退休老年人健康相关生命质量分析

目的评价不同养老模式下离退休老年人健康相关生命质量(HRQo L)状况及其影响因素。方法采用欧洲五维健康量表(EQ-5D)对居家和机构养老者的HRQo L进行调查,并分析其影响因素。结果老年人健康问题最多的是疼痛或不适维度。机构养老者中行动能力、自我照顾能力、日常活动、焦虑或抑郁4个维度存在问题的比例显著高于居家养老者(P0.05);居家养老者EQ-5D指数和视觉模拟评分为(0.792±0.074)分、(77.352±10.240)分,均高于机构养老者[(0.745±0.105)分、(72.681±12.019)分],差异有统计学意义(P0.01)。居家养老者EQ-5D指数的影响因素主要有睡眠质量、性别、运动锻炼和慢性病,机构养老者EQ-5D指数影响因素有运动锻炼、慢性病和年龄。结论不同养老模式下离退休老人的HRQo L有明显差异且受多因素影响,应积极采取措施改善离退休老人的生命质量。     

Health-related quality of life in myotonic dystrophy type 1 and its relationship with cognitive and emotional functioning.

OBJECTIVE: To evaluate the health-related quality of life in myotonic dystrophy type 1 and its relationships with clinical, genetic, neuropsychological and emotional factors. DESIGN: Case-control study of a continuous series of patients with myotonic dystrophy type 1. PATIENTS AND METHODS: Twenty patients, and 20 age-, sex- and education-matched healthy controls underwent the MOS 36-Item Short-Form Health Survey (SF-36), an extensive neuropsychological battery and emotional functioning tests. RESULTS: Patients' SF-36 mean scores were lower than those of controls in all dimensions. The neuropsychological study showed a significant impairment in visuospatial and verbal abstract reasoning (p=0.001), visuospatial memory (p=0.002) and attentive functions (p=0.03) in patients with myotonic dystrophy type 1. The emotional assessment showed significantly high scores in anxiety (p=0.002) and depression (p=0.001), which occurred in approximately 50% of patients. Both physical and mental SF-36 areas were inversely correlated with age, duration and grade of disease, depression and anxiety and positively correlated with attentive control. SF-36 areas were not correlated with cytosine thymine guanidine expansion. CONCLUSION: Health-related quality of life is severely impaired in myotonic dystrophy type 1 and it is negatively influenced by severity and duration of disease as well as by specific cognitive deficits and changes in emotional functioning. Therapeutic intervention in this field could contribute to ameliorate health-related quality of life in myotonic dystrophy type 1.     

社区老年2型糖尿病患者低血糖反应及生存质量现状研究

目的：调查社区老年2型糖尿病患者自我感知的低血糖反应发生频率和生存质量现状。方法：采用自行设计的问卷调查上海市某一社区203例老年2型糖尿病患者过去一年内和过去一个月内发生低血糖反应的情况;采用中文版糖尿病患者生存质量特异性量表（DSQL）对患者进行生存质量测评。结果：有22.2%的患者在过去一年内出现过至少1次的低血糖反应,有12.8%的患者在过去一个月内出现过至少1次的低血糖反应;患者生存质量评价得分为（41.9±8.6）分。结论：城市社区老年2型糖尿病患者生存质量水平处于中等水平,尚有提升的空间;应减少患者低血糖反应发生的频率,提高其生存质量。     

Health-related quality of life among patients undergoing percutaneous transluminal coronary angioplasty

A randomized clinical trial was recently conducted to investigate whether a new antiplatelet agent could prevent restenosis in patients who had undergone percutaneous transluminal coronary artery angioplasty (PTCA). Approximately 1,200 patients were enrolled at 13 separate clinical sites. To assess the impact of this intervention on health-related quality of life, a patient questionnaire for telephone administration was developed. This questionnaire focused attention on several specific dimensions likely to be important in this patient population: physical well-being, perceived health, emotional well-being, home management, work, recreation, and social and sexual functioning. This paper describes the instrument that was used in this trial and reports on its psychometric [corrected] properties based on completed interviews with approximately 500 patients at study entry and 1 month after PTCA.