健康管理生活方式问卷设计的概念框架与核心数据元研究

目的构建健康管理生活方式问卷设计的概念框架,定义概念框架的维度、子维度及各子维度的核心数据元。方法遵循业务规范和国内外信息标准,参考WHO及国内外有关生活方式的研究,并以国内大型健康管理体检机构生活方式问卷和纸质健康档案为基础,采用自顶向下和自底向上相结合的建模方法。核心数据元依据数据的重要性、方便采集、现有的健康体检生活方式问卷已采用及专家意见相结合确定。结果建立了生活方式问卷设计的概念框架,共9个维度（吸烟、饮酒、膳食、饮水、体力活动、体育锻炼、生活起居、睡眠、危险因素暴露）,29个不同的子维度,如吸烟包括吸烟类别、吸烟强度、吸烟持续时间、烟草种类4个子维度,最后提取24个核心数据元并定义部分代码值。结论生活方式问卷设计的概念框架可作为设计生活方式问卷的参考依据,标准化数据元可作为不同机构不同结构问卷的信息交换标准,但生活方式问卷的数据元标准化工作还有待进一步完善。     

Internal consistency,reproducibility, responsiveness,and construct validity of the Chinese (HK) version of the asthma quality of life questionnaire

The purpose of this study was to test the acceptability, psychometric properties and construct validity of a Chinese translation of the Asthma Quality of Life Questionnaire (AQOL) and to determine whether it has any advantage over the Chinese (HK) version of the generic MOS SF-36 Health Survey that has been validated on Chinese in Hong Kong. Fifty-two patients with asthma were interviewed using the Chinese (HK) AQOL and the Chinese (HK) SF-36. Thirty-four of the 52 patients were interviewed a second time 6 months later using the same questionnaires. The Cronbach's α coefficients were above 0.7 for all four domains of the AQOL questionnaire. Significant correlations were found between the scores of each of the four domains of the Chinese (HK) AQOL and forced expiratory volume in 1 s (FEV₁) (%predicted) during the initial visit and between changes in the mean scores of most of the domains of Chinese (HK) AQOL and changes in FEV₁ between visits. The Chinese (HK) AQOL was found to be reproducible in those with stable asthma, and for those whose asthma severity changed between visits, there was significant change in one of the domains. It can detect differences in quality of life in asthma patients of varying severity. We conclude that the Chinese (HK) translation of the AQOL is reliable, valid, reproducible and discriminative and can be used to supplement generic instruments in evaluating the quality of life of patients with asthma. This revised version was published online in June 2006 with corrections to the Cover Date.     

Health-related quality of life in asthma: A comparison between the St George's respiratory questionnaire and the asthma quality of life questionnaire

The aim of the study is to compare the performance of the Juniper Asthma Quality of Life Questionnaire (AQLQ) and the St George's Respiratory Questionnaire (SGRQ) in a sample of asthmatic patients, representative of a broad spectrum of asthma severity. We studied 116 patients with a mean age (SD) of 42.6 (18.3) year. Patients were assessed twice, at recruitment and after 2 months, to determine the reliability, validity and responsiveness of the AQLQ and the SGRQ. Both questionnaires showed good reliability coefficients (0.70) which reached the standards for comparison at individual level (0.90) in the case of activity, impacts and overall SGRQ scores as well as symptoms, activities and overall AQLQ scores. Both AQLQ and SGRQ were able to discriminate among groups of patients based on asthma severity and control and showed, except for the symptoms domain of the SGRQ, large (standardized response means >0.8) and significant changes in the group of patients that improved at follow-up. We conclude that the AQLQ and SGRQ have shown high reliability and validity and, with the exception of the SGRQ symptoms, a high level of responsiveness. In overall terms, not one of these instruments seems to behave better than the other.     

Evaluation of the American version of the 30-item Endometriosis Health Profile (EHP-30)

OBJECTIVES: Health status instruments, which measure the subjective functioning and well-being of respondents, are increasingly being used in international, multi-centre trials of new treatments. If the results of such trials in different countries are to be pooled, it is vitally important for researchers to know how comparable the instruments are across cultures. In this study, we evaluated the response rate, data quality, score reliability and scaling assumptions of the 30-item Endometriosis Health Profile (EHP-30) in the USA. METHODS: Data were obtained from a multi-centre study which recruited 225 patients from 43 clinic sites in the United States of America. It was a randomised, evaluator-blinded, Phase III study. In the evaluation of the EHP-30 reported here, the two groups (Depot Medroxyprogesterone Acetate [DMPA] and Leuprolide Acetate [LA]) are combined, and analyses are based on the data gained at baseline. Questionnaires were self-completed by patients when they visited the clinics. RESULTS: Data completeness was very high, with 97.33% of respondents completing all of the items on the EHP-30. Furthermore, there were no more than a maximum of two missing responses for any given item. No floor and ceiling effects were found for any of the dimensions of the questionnaire. Internal consistency reliability was high for all dimensions (alpha ranged from 0.84 to 0.91). The psychometric properties of the instrument, outlined in the development of the UK version, are supported in the American context. CONCLUSIONS: The data presented here suggest that the EHP-30 is a valid and reliable measure that can be appropriately and meaningfully used in studies that include respondents from the USA.     

The migraine work and productivity loss questionnaire: Concepts and design

Our objectives were to: (1) develop a self-report questionnaire for measuring the impact of migraine headache on work; and (2) qualitatively assess aspects of its performance. Two samples of migraine sufferers provided the data. Sample 1 (n = 18) participated in a structured discussion group designed to elicit examples of migraine's on-the-job impact. Sample 2 (n = 11) completed a mail survey and participated in in-depth phone interviews. Interviews addressed item comprehensibility, consistency of interpretation, the cognitive processes by which certain answers were generated and response burden. The participants were currently employed men and women, at least 18 years of age, who met the International Headache Society (IHS) criteria for migraine headache [1]. Discussion group participants indicated that migraine attacks substantially diminished their job performance. Pain, photophobia, phonophobia, mental impairment and fatigue were perceived as interfering with even routine or relatively simple job tasks. The Migraine Work and Productivity Loss Questionnaire, Version 1.0^© (MWPLQ^©)* was written. Next, it was assessed in the context of the in-depth interviews. Result indicated that the MWPLQ was comprehended without difficulty, interpreted consistently and easy to complete. Thus, qualitative results provide initial support for the new questionnaire.     

腹腔镜治疗子宫内膜异位症112例疗效分析

目的:探讨应用腹腔镜治疗子宫内膜异位症的疗效。方法:对112例腹腔镜诊断为子宫内膜异位症的患者,按1985年美国生育协会修订的内异症分期标准(r-AFS)进行分期,并在腹腔镜下行卵巢子宫内膜异位囊肿剥除、分离粘连、异位病灶电凝,Ⅲ、Ⅳ期患者术后加用孕三烯酮联合米非司酮治疗。结果:112例均在腹腔镜下手术,随访1~2年,近期有效率100%,复发8例,复发率7.14%(8/112),38例合并不孕者妊娠21例,妊娠率55.3%(21/38)。结论:腹腔镜手术创伤小,恢复快,可用于检查、治疗各期子宫内膜异位症。     

Association of health-related quality of life with health examination including organic functions and lifestyles in Japanese employees

OBJECTIVE: The objective of this study was to compare the association of each item of a health examination including organic functions and lifestyles with health-related quality of life (HRQoL) by gender. METHODS: A cross-sectional survey by a self-administered questionnaire using the 36-Item Short Form Health Survey (SF-36) was conducted for Japanese employees from October 1999 to September 2000. Participants in this study consisted of 458 men and 321 women systematically selected from the health examinees. MAIN RESULTS: The determination of organic functions including 'body mass index', 'blood pressure', 'liver functioning', and 'blood sugar control' was hardly associated with HRQoL, except for the body mass index in women. All the lifestyle items including smoking cigarettes, drinking alcohol, eating breakfast, doing exercise, adhering to bedtime, and working overtime were associated with HRQoL in the multiple regression models. In the mental component summary (MCS), the standardized regression coefficient of 'hours of overtime' was -0.235 in the men and -0.212 in the women (p < 0.001). In the physical component summary (PCS), that of 'energy consumed in exercise' was 0.149 in the women (p < 0.01). CONCLUSION: This study reveals that the association between lifestyle and HRQoL was stronger than that between organic function and HRQoL.     

Literature review of instruments to assess health-related quality of life during and after menopause

Background and objectives: Menopause is a physiological event occurring in women at about the age of 50. It signals the end of the reproductive years and is associated with signs of estrogen deficiency having a considerable impact on womens health-related quality of life (HRQoL). The most common form of treatment is hormone replacement therapy (HRT). Studies have shown negative events can arise from long-term use of HRT. The aim of this review is to determine if there are any HRQoL instruments that address the impact of menopausal symptoms including positive and negative effects of HRT. Methods: The following eight instruments were identified: Greene Climacteric Scale, Womens Health Questionnaire (WHQ), Qualifemme, Menopause-Specific QOL Questionnaire (MENQOL), Menopausal Symptoms List (MSL), Menopause Rating Scale (MRS), Menopausal Quality of Life Scale (MQOL), and the Utian Quality of Life Scale (UQOL). Results: All instruments reviewed proved to be reasonably structured and have their place in applied research. None were found that addressed all aspects of the impact of HRT on HRQoL. Conclusion: In order to capture the possible short-term side effects of HRT on HRQoL, it is necessary to modify one or more of the existing instruments or develop a new instrument applicable in many different countries and languages.     

PDCA管理模式对白血病患者健康知识掌握程度及生活质量的影响

目的 探讨持续质量改进管理模式对白血病患者健康知识掌握程度和生活质量的影响。方法 根据入院日期,将2012年的104例和2013年的103例急性白血病患者分别纳入对照组和实验组,对照组给予常规管理模式,实验组在常规管理模式的基础上给予持续质量改进管理模式,比较2组患者健康知识掌握程度、生活质量功能、生活质量症状、护理满意度及住院时间的差异。结果 干预后,生活质量量表（quality of life questionnaire,QLQ-C30）功能评分均高于对照组（均有P<0.05）,除经济困难外,QLQ-C30症状评分实验组各指标评分均低于对照组（均有P<0.05）;干预后,实验组患者健康知识掌握合格率、患者满意率均优于对照组（均有P<0.05）,平均住院天数少于对照组,两组差异有统计学意义（t=13.78,P<0.001）。结论 应用持续质量改进管理模式能缩短患者住院时间,提高护理满意度和患者生活质量,应加强其在白血病护理工作中的推广应用。     

Evaluation of the life satisfaction questionnaire (LSQ) using structural equation modelling (SEM)

The life satisfaction questionnaire (LSQ) was developed for use in conventional and complementary/anthroposophic care to assess the quality of life/life satisfaction of Swedish women with breast cancer. The first attempt to test the reliability and validity was in a sample of women with breast cancer (n = 362), the second in a random sample of Swedish women (n = 257). A theoretical model with six latent and 34 manifest variables was formulated. The aim of the present study was to perform confirmatory factor analyses using structural equation modelling. The software STREAMS was used. An additional sample of men (n = 263) was randomly selected from the Swedish population register. Confirmatory factor analyses were performed for the combined sample of women and men (n = 520) and for the women with breast cancer. The result of the confirmatory factor analyses showed that the factor structure of the original model was confirmed. The factors were called physical symptoms (PS), sickness impact (SI), quality of everyday activities (QDA), socio-economic situation (SES), quality of family relation (QFA), and quality of close friend relationship (QFR).     

The SIP68: An abbreviated sickness impact profile for disability outcomes research

The Sickness Impact Profile (SIP) is one of the most widely recognized generic health status instruments, but its length has often left it out of consideration for outcomes research. We assess a short alternative, the Sickness Impact Profile 68 (SIP68), for retest and proxy reliability, validity, and scaling properties, in a population of adults with disability (PWD). For convergent validity, the SIP68 was compared to the instrumental activities of daily living (IADLs), activities of daily living (ADLs) and the short-form 36 (SF-36). We completed 398 interviews with PWD, 131 index–proxy sets, and 40 retests. Retest intraclass correlations were above 0.75 for all scales and dimensions except the physical dimension (0.61). Proxy reliability ranged from 0.26 (psychological autonomy and communication) to 0.85 (somatic autonomy). Correlation between the SIP68 and SIP was 0.94 overall; between the SIP68 and similar scales of the SF-36 correlations was moderate, and highest for physical health scales. We repeated the SIP68 development factor analysis and reproduced a structure of the full SIP that included 65 of SIP68 items. However, 36 additional items were retained that are not part of the SIP68. Overall, the SIP68 shows promise for use as a disability outcomes tool.     

Validation of the cancer needs questionnaire (CNQ) short-form version in an ambulatory cancer setting

The short-form Cancer Needs Questionnaire (CNQ) is a self-administered cancer-specific questionnaire designed to assess patients' needs across several domains. The purpose of this study is to further evaluate its internal consistency and construct validity, in a group of ambulatory patients with cancer. Four hundred and fifty patients with a variety of cancer types participated. Factor analysis reproduced five domains: psychological; health information; physical and daily living; patient care and support; and interpersonal communication needs. Cronbach's alpha coefficients ranged from 0.94 to 0.77, indicating substantial consistency across items grouped in the five domains. A priori predictions regarding convergent and contrasting groups construct validity were explored using bivariate relationships between domains of the short-form CNQ, the EORTC QLQC-30 and Beck Depression Inventory (short-form), with support provided for most of the predictions. The current study provides supportive evidence that the short-form CNQ is a reliable and valid instrument for assessing the needs of patients with cancer in an ambulatory care setting.     

Sexual function and quality of life in genitourinary medicine (GUM) outpatients and preliminary validation of a self-report questionnaire measure

A cross-sectional questionnaire survey of 216 men and 191 women attending a genitourinary medicine (GUM) clinic was undertaken to explore the relationship between sexual symptoms and quality of sexual life, and to test the psychometric validity of a pilot self-report measure of Sexual Function and Quality of Sexual Life (SFQoSL). Statistical comparisons were made with three reference groups: volunteers attending GUM for psychosexual counselling, outpatients at an Obstetrics and Gynaecology Department, and staff. Exploratory principal components analysis (with varimax rotation) of questionnaire item responses suggested an 11 (in women) and 13 (in men) factor solution, incorporating four multi-item scales. Internal consistency (Cronbach's ) of core items was 0.84 in 186 women (19 items) and 0.87 in 210 men (22 items). Construct validity was supported in comparisons with reference groups using one-way analysis of variance and post-hoc Scheffé testing. Overall, 116 (54%) male and 132 (69%) female GUM outpatients had scores indicating sexual dysfunction. Thirty-seven (17%) men reported erectile dysfunction; 54 (28%) women reported vaginal dryness affecting sex; 48 (25%) women reported genital changes affecting sex; 45 (21%) men and 64 (34%) women reported problems reaching orgasm.     

Is a Generic Quality of Life Instrument Helpful for Evaluating Women with Urinary Incontinence?

Objectives: The aim of this study was to determine whether a generic health outcome instrument would be helpful for evaluating women with stress urinary incontinence (UI) combined with or without urge UI. Methods: A total of 109 women with UI and 80 controls participated in the study. Health-related quality of life (QOL) was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and the Incontinence Quality of Life (I-QoL) questionnaire. Results: Among eight domains of the SF-36 questionnaire, only four domains, namely, ‘role-physical functioning’ (p<0.05), ‘vitality’ (p<0.05), ‘mental health’ (p<0.05) and ‘bodily pain’ (p<0.05) were significantly different between the groups. Comparing the I-QoL sores in the two groups, patients with UI had significantly poorer subscale scores of I-QoL than the controls (p<0.05 for all domains). When women with UI were subdivided into groups of stress and mixed UI, only 2 domains of the SF-36 questionnaire, ‘role-physical functioning’ (p<0.05) and ‘bodily pain’ (p<0.05), were significantly different. The mixed UI group had higher scores only on these two domains compared to the stress UI group. In the ‘role-physical functioning’ domain, there was no significant difference between the mixed UI group and the controls. In ‘bodily pain’ domain, there was no significant difference between the stress UI group and the controls. The mixed group had the highest scores observed. Patients with mixed UI had significantly lower total scores compared to those with stress UI, including the subscale score of ‘avoidance behavior’ of the I-QoL. Among eight domains of the SF-36, only ‘physical functioning’ (r = 0.281, p<0.01) and ‘social functioning’ (r = 0.239, p<0.05) were weakly correlated with ‘psychological impact’ of the I-QoL. Conclusion: Our findings show that the generic QOL instrument is not sensitive measure of QOL in women with UI.     

中重度子宫内膜异位症术后不同药物治疗患者的生存质量分析

目的:探讨中重度内异症患者术后辅助不同药物治疗的生存质量。方法:将96例中重度内异症患者随机分成A、B两组,A组(47例)术后辅助促性腺激素释放激素激动剂(GnRHa)治疗,B组(49例)术后辅助孕三烯酮治疗,对每组患者进行术前1周、术后1月、3月、6月的随访并行生存质量评分,分析两组的生存质量。结果:A、B两组患者的缓解率、复发率差异无统计学意义;A组患者副反应发生率高于B组(P<0.05),B组患者术后3月、6月生存质量明显高于A组患者。结论:术后辅助GnRHa和孕三烯酮治疗中重度内异症其短期疗效(缓解率和复发率)无明显差异,对生存质量的改善后者优于前者。     

The MOS SF-36 health survey questionnaire in severe chronic airflow limitation: Comparison with the Nottingham health profile

This study documents the cross-sectional, health-related quality of life (HRQOL) measures obtained at baseline for patients with severe chronic airways limitation (CAL) being assessed for home oxygen therapy (HOT) at the Flinders Medical Centre, Adelaide, South Australia. Two generic quality of life instruments, the Nottingham Health Profile (NHP) and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36), were administered by interview to the same patients to permit comparisons to be made between the two instruments. SF-36 mean scores were also compared with scores obtained in separate studies of a South Australian elderly general population and of groups of Australian subjects with various medical and psychiatric conditions. NHP mean scores were compared with scores from an elderly group of Adelaide residents from a household survey. HRQOL measures were obtained for 60 patients, 32 males and 28 females. At assessment for HOT, patients with severe CAL were experiencing severe impairment in their quality of life in comparison to age-matched South Australian norms, with physical disability the major limitation. There were several significant correlations between the domains of the SF-36 and the NHP which were predominantly gender-specific. Only small decrements in mental health were found with the SF-36 questionnaire. The SF-36 and the NHP appear to provide discrepant information for severely disabled CAL patients for the subjective domains of emotional and mental health.     

对子宫内膜异位症发生恶变过程的连续观察

目的:通过对子宫内膜异位症(EMT)患者的随访,追踪反复发作的顽固病例,以观察其恶变情况。方法:将1991年1月~2003年12月在本院确诊的各期EMT患者作为研究对象,共4 519例。每年随访1次,对症状顽固的病例则密切追踪观察。结果:随访率79%~82%,恶变1例,占0.02%。此1例最初为阴道残端EMT恶变,之后发展为异位子宫内膜不典型增生,最后转变为子宫内膜样腺癌。经历了从良性病变、癌前病变到癌变的完整演变过程。本例病变发展的特点是病灶顽固生长、反复发作,虽然患者激素水平一直处于绝经状态,但病灶仍然继续生长,最终恶变。结论:异位的子宫内膜可以发生恶性变,但恶变率很低,恶变前可以经历癌前病变的过程,其生长转变似乎不依赖卵巢分泌的性激素。     

Obesity and health related quality of life in the general adult population of the Canary Islands

Purpose  To explore the relationship between excess weight and health related quality of life (HRQL) in the general population by means of the EuroQol-5D questionnaire. Methods  The relationship between excess weight and HRQL was explored by the 2004 Canary Islands Health Survey. Survey participants from 16 years of age and older were classified according to their body mass index (BMI). The relationship between excess weight and the dichotomized EuroQol-5D was examined by multiple logistic regression analysis, adjusting by socio-demographic variables, smoking status, alcohol consumption, and self-reported disease status. Results  People with excess weight were older, less educated, and had more associated diseases than the population without excess weight. Excess weight and HRQL are inversely correlated. Severely obese participants showed EuroQol-5D index scores significantly lower than those of normal weight participants (0.65 vs. 0.87). The adjusted odds ratio for the lower HRQL is 3.17 for severely obese people compared to normal weight people. Conclusions  Excess weight has a negative impact on HRQL, even for people without chronic diseases. A better understanding of the relationships between excess weight, its associated comorbidities, and HRQL may have important implications for the design and assessment of prevention and treatment strategies.     

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): Validation Study of the Thai Version

The objective of this study was to assess the psychometric properties of the Thai version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) version 3.0. The questionnaire was completed by 310 cancer patients during their follow-up at 2 teaching hospital oncology clinics. About 70% of participants had advanced stage of cancer and 72% had been receiving chemotherapy. Cronbach’s α coefficients of the six scales were above 0.7, except for cognitive and social function scales. All test–retest reliability coefficients were high. Multitrait scaling analysis showed that all item-scale correlation coefficients met the standards of convergent and discriminant validity. Most scales and items could discriminate between subgroups of patients with different clinical status assessed with the Eastern Cooperative Oncology Group (ECOG) scale. The results suggested that the EORTC QLQ-C30 and the Functional Assessment of Cancer Therapy – General (FACT-G) measured different aspects of quality of life and should be independently used. Testing psychometric properties of the EORTC QLQ-C30 in heterogeneous diagnostic group yield similar results as found in homogeneous group. These results support that the EORTC QLQ-C30 (version 3.0) has proven to be a reliable and valid measure of the quality of life in Thai patients with various types of cancer.     

腹腔镜下骶骨韧带切除术联合病灶电灼术治疗子宫内膜异位症痛经的疗效观察

目的:探讨腹腔镜下骶骨韧带切除术联合病灶电灼术治疗子宫内膜异位症痛经的疗效。方法:对21例子宫内膜异位症痛经患者行腹腔镜下骶骨韧带切除术联合病灶电灼术治疗,对合并子宫内膜异位囊肿和子宫腺肌瘤患者同时行囊肿剥除术和子宫腺肌瘤电消融术,盆腔局部病灶予以电灼,术后观察痛经程度。结果:16例(76.2%)痛经完全消失,4例(19.0%)痛经明显缓解,1例(4.8%)痛经部分缓解。术后疼痛评分、分级均明显降低(P<0.01)。结论:腹腔镜下骶骨韧带切除术联合病灶电灼术是治疗子宫内膜异位症痛经的新方法,治疗痛经效果显著。