卡前列素氨丁三醇、米索前列醇联合缩宫素预防高危产后出血疗效观察

目的 观察卡前列素氨丁三醇、米索前列醇联合缩宫素预防高危产后出血产妇的临床效果.方法 将380例疑似具有引起产后出血高危因素产妇按随机数字表法分为观察组190例和对照组190例,对照组产妇在胎儿娩出后,肌肉或子宫体注射缩宫素20 U,舌下含服米索前列醇200 μg,观察组产妇在胎儿娩出后,肌肉或子宫体注射卡前列素氨丁三醇250 μg和缩宫素20U.观察两组产妇不同时间出血量、产后出血发生率,产前、产后进行血常规检测,计算产前与产后24h的血红蛋白下降值、红细胞下降值,比较第三产程时间.结果 观察组产后15 min、30 min、2h、24 h出血量均明显低于对照组,观察组产后24 h血红蛋白下降值、红细胞下降值均明显低于对照组,观察组第三产程时间较对照组明显缩短,观察组产后出血发生率为10.0％(19/190),明显低于对照组的30.5％(58/190),差异均有统计学意义(P＜0.01).结论 具有产后出血高危因素的产妇分娩后给予卡前列素氨丁三醇可刺激整个子宫收缩,缩宫素可刺激子宫上段收缩,二者联合预防产后出血可协同止血,降低了产后大出血的发生率,预防产后出血,且效果优于米索前列醇联合缩宫素治疗,值得临床推广使用.     

胎盘早剥产后大出血行缩宫素及米索联合卡前列素氨丁三醇的效果

目的 分析胎盘早剥产后大出血行缩宫素及米索联合卡前列素氨丁三醇的效果。方法 选择本院在2019年2月-2020年10月接收的94例胎盘早剥产后大出血者作为观察对象,通过随机数表法将其分为参照组和研究组,参照组共计47例,治疗药物选择卡前列素氨丁三醇,研究组共计47例,治疗药物选择缩宫素、米索、卡前列素氨丁三醇,观察两组治疗前后的各项凝血指标变化,同时比较其治疗后不同时段的产后出血量、止血时间、住院时间以及治疗满意率差异。结果 治疗前,组间各项凝血指标比较无统计学意义（P>0.05）;治疗后,研究组APTT明显低于参照组,PT明显低于参照组,TT明显低于参照组,D-D明显低于参照组,Fbg明显高于参照组,不同时段的产后出血量均明显少于参照组,止血时间明显短于参照组,住院时间明显短于参照组,治疗总满意率明显高于参照组,差异均有统计学意义（P<0.05）。结论 缩宫素联合米索和卡前列素氨丁三醇在胎盘早剥产后大出血者中具有良好治疗效果,对其凝血指标具有良好改善作用,能够快速控制出血,提高患者治疗满意度。     

产后出血治疗采用卡前列素氨丁三醇与缩宫素的临床疗效对比研究

目的:针对产后出血治疗采用卡前列素氨丁三醇与缩宫素的临床疗效对比进行研究。方法:选择我院收治的可能出现产后出血的高危产妇98例,随机分为对照组及观察组,对照组采用缩宫素同米索前列醇治疗,观察组在对照组的基础上加用卡前列素氨丁三醇治疗,记录产妇活动性出血症状消失对间、出血量。结果:观察组产妇活动性出血症状消失时间、出血量显著小于对照组,观察组显效率为90.00%,总有效率为98.00%,对熙组显效率75.00%,总有效率为89.53%,差异显著(P0.05),具有统计学意义。结论:卡前列素氨丁三醇联合缩宫素对宫缩乏力产后出血疗效显著,有理想的缩宫止血效果,值得临床推广使用。     

卡前列素氨丁三醇预防宫缩乏力性产后出血的临床研究

目的 观察卡前列素氨丁三醇联合缩宫素预防宫缩乏力性产后出血的临床效果.方法 选择120例有宫缩乏力性产后出血高危因素的产妇,随机分为试验组和对照组,比较两组第三产程时间,产后2 h及24 h出血量及产后出血发生率.试验组：胎儿娩出后宫体注射卡前列素氨丁三醇250 μg同时静滴缩宫素20 U.对照组：胎儿娩出后舌下含服米索前列醇200 μg同时静滴缩宫素20 U.结果 试验组比对照组产后2 h及24 h平均出血量减少,第三产程时间缩短,产后出血率降低,差异均有显著性.结论 卡前列素氨丁三醇比米索前列醇更有效预防产后出血,且具有安全,高效,迅速,方便的特点.     

多种药物联合应用治疗产后出血的临床效果分析

目的分析卡前列素氨丁三醇、米索前列醇和缩宫素联合应用治疗产后出血的临床效果。方法选取医院2017年2月-2018年12月收治的92例产后出血患者为研究对象,随机将其分为A、B两组,其中,A组为对照组,仅采用缩宫素,B组为观察组,采用卡前列素氨丁三醇、米索前列醇和缩宫素联合治疗,对比两组患者出血量、疗效与并发症发生率。结果B组患者出血量(24 h)的(337.51±11.26)mL优于A组的(547.36±14.27)mL;B组有效率的97.83%优于A组的80.43%;B组并发症发生率的8.70%优于A组的28.26%,均显示P<0.05。结论对产后出血产妇进行治疗时,采用缩宫素联合卡前列素氨丁三醇、米索前列醇的方式治疗,能够有效控制产妇出血量,提高治疗效果,减少并发症的出现,具有较高的临床应用价值。     

垂体后叶素联合卡前列素氨丁三醇治疗胎盘早剥产后大出血患者的临床效果

目的:评价垂体后叶素联合卡前列素氨丁三醇治疗胎盘早剥产后大出血患者的临床效果。方法:选取我院2016年8月-2017年8月期间,所收治的70例胎盘早剥产后大出血患者,通过随机抽取单双数方式,将患者分为观察组(n=35)、对照组(n=35)。观察组采取垂体后叶素、卡前列素氨丁三醇治疗,对照组采取卡前列素氨丁三醇治疗,对比两组出血量、止血时间及不良事件情况。结果,两组产后出血量、止血时间比较,差异性显著,P0.05。治疗后,观察组、对照组的不良事件发生率分别为:8.57%、40%,统计学意义存在,P0.05,结论:胎盘早剥产后大出血患者通过垂体后叶素联合卡前列素氨丁三醇治疗,临床效果较好,并能减少出血量,在短时间内实现止血的目的,控制不良事件发生率。     

卡前列素氨丁三醇治疗产后出血的效果分析

目的：探讨卡前列素氨丁三醇治疗产后出血的临床疗效。方法：选取本院2011年3月-2014年1月收入院的61例产后出血患者，随机分为观察组31例和对照组30例，观察组患者采取卡前列素氨丁三醇治疗，对照组患者采取米索前列醇联合缩宫素治疗。对比两组患者治疗后2h出血量、止血时间、不良反应的发生率和临床疗效情况。结果：观察组患者治疗后2h出血量少于对照组，止血时间明显短于对照组，不良反应的发生率低于对照组，差异均有统计学意义（P〈0.05）；观察组治疗的总有效率（93.55%）显著高于对照组（83.33%），差异具有统计学上意义（P〈0.05）。结论：对于产后出血的孕妇使用卡前列素氨丁三醇治疗，止血快，出血少，效果显著。     

卡前列素氨丁三醇及卡前列酸栓与缩宫素联用预防高危剖宫产产妇产后出血的对比研究

目的对比观察卡前列素氨丁三醇及卡前列酸栓与缩宫素联用预防高危剖宫产产妇产后出血的疗效。方法回顾性分析2015年1月至2017年8月在廊坊市第四人民医院有产后出血倾向的高危产妇195例的临床资料,根据用药不同分为A组、B组及对照组,每组65例。3组剖宫产术后立即行子宫按摩,同时静脉滴注缩宫素10 IU。在此基础上A组阴道给药卡前列酸栓1 mg; B组宫体注射卡前列素氨丁三醇250μg;对照组宫体注射缩宫素10 IU。比较3组术中出血量、产后2 h内出血量、产后2 h～24 h出血量、产后24 h血红蛋白下降值、产后出血率、输血率、其他止血措施使用率、用药后不良反应发生率。结果 (1) A组和B组术中出血量、产后2 h内出血量、产后2 h～24 h出血量及产后24 h血红蛋白下降值低于对照组,B组以上指标低于A组,差异均有统计学意义(P <0. 05)。(2)与对照组比较,A组和B组产妇产后出血率、输血率下降,差异均有统计学意义(P <0. 05)。(3) 3组产妇用药后均有恶心呕吐、腹泻、高血压、体温升高等轻度不良反应,但发生率比较,差异无统计学意义(P>0. 05)。结论卡前列素氨丁三醇及卡前列酸栓与缩宫素联用可明显减少高危产妇出血量和输血率,卡前列素氨丁三醇与缩宫素联用效果更为显著。     

卡前列素氨丁三醇注射液治疗产后出血的疗效分析

目的探讨卡前列素氨丁三醇注射液治疗产后出血的临床疗效。方法选取该院2015年4月-2016年11月收治的72例有产后出血倾向患者作为研究对象,按照随机原则,分为观察组和对照组,每组各36例。对照组使用缩宫素治疗,观察组予以卡前列素氨丁三醇注射液治疗。观察两组患者临床效果、出血量、止血时间以及不良事件发生情况。结果观察组总有效率明显高于对照组(P0.05);观察组止血时间、产后2 h出血量、产后24 h出血量均低于对照组(均P0.05);观察组不良事件发生率低于对照组(P0.05)。结论卡前列素氨丁三醇注射液治疗产后出血效果较好,可有效控制出血。     

卡前列素氨丁三醇联合缩宫素治疗前置胎盘出血的临床观察

目的:观察卡前列素氨丁三醇联合缩宫素在治疗前置胎盘出血的临床疗效。方法:选取2016年10月至2017年10月于我院治疗的前置胎盘剖宫产患者共96例,随机分为实验组(应用卡前列素氨丁三醇联合缩宫素治疗)、对照组(缩宫素治疗),实验组产妇术中胎儿娩出后静脉注射缩宫素注射液20U,胎盘娩出后即宫体注射卡前列素氨丁三醇注射液250μg,必要时术后重复给药(卡前列素氨丁三醇注射液250μg肌注);对照组产妇术中胎儿娩出后静脉注射缩宫素注射液20U,必要时宫体注射缩宫素针20U,术后20U加入0.9%氯化钠注射液静脉滴注。结果:观察组出血量(术中、术后2h、术后24h)、手术时间明显低于对照组,两组比较有统计学意义(P 0.05)。结论:卡前列素氨丁三醇联合缩宫素在治疗前置胎盘出血中有效减少出血量,缩短手术时间,不增加不良反应发生率等。     

Re-assessment of the influence of polymorphisms of phase-II metabolic enzymes on renal cell cancer risk of trichloroethylene-exposed workers

Problem Individual differences in susceptibility to trichloroethylene-induced nephrocarcinogenicity may be conferred by genetic polymorphisms of glutathione S-transferases (GST), because enzymes of this group are pivotal for the metabolic activation of trichloroethylene. Because of a potential involvement of N-acetylation in the detoxication of reactive trichloroethylene metabolite(s) to N-acetyl-cysteine derivatives, polymorphisms of the NAT2 gene may also be relevant. Methods The primary collective used for a re-investigation of these questions was that of a hospital-based case-control study by Brüning et al. (Am J Ind Med 43:274–285, 2003) of 134 renal cell cancer cases (20 cases exposed to trichloroethylene) and 401 matched controls. Genetic polymorphisms of GSTT1, GSTM1, GSTP1 and NAT2 were studied. Additional control collectives of non-diseased persons were used for comparison of allele frequencies. Results No genetic influences on the development of renal cancer due to trichloroethylene were apparent, related to the deletion polymorphisms of GSTT1 and GSTM1, as well as to the NAT2 rapid/slow acetylator states. However, renal cell cancer cases displayed a somewhat higher proportion of the homozygous GSTP1 313A wild type (GSTP1*A), although this was not statistically significant (χ² test: P = 0.1071, when using only the original controls of Brüning et al. (2003); P = 0.0781 with inclusion of the additional controls). Conclusion The re-investigation does not confirm the working hypothesis of an influence of the deletion polymorphisms of the glutathione S-transferases GSTT1 and GSTM1 on renal cell cancer development due to high occupational exposures to trichloroethylene.     

Screening of tropical estuarine water in south-west coast of India reveals emergence of ARGs-harboring hypervirulent Escherichia coli of global significance

The goal of this study was to investigate the involvement of a tropical Indian estuary in the emergence of antibiotic resistance genes (ARGs)-harboring hypervirulent E. coli of global significance. A total of 300 E. coli isolates was tested for antibiotic susceptibility to β-lactams, aminoglycosides, chloramphenicol, quinolones, sulphonamides, tetracyclines, and trimethoprim. The E. coli isolates were screened for the presence of antibiotic resistance genes (bla_TEM, bla_CTX-M, tetA, tetB, sul1, sul2, strA, aphA2, catI, dhfr1, and dhfr7), integrase (int1, int2, and int3), Shiga toxin genes (stx1 and stx2) and extraintestinal virulence genes (papAH, papC, sfa/focDE, kpsMT II, and iutA). The highest prevalence of antibiotic resistance was observed for ampicillin, followed by tetracycline, and nalidixic acid. Among E. coli isolates, 64% were resistant to at least one of the 15 antibiotics tested, and approximately 40% were multiple antibiotic-resistant (MAR). More than 40% (n?=?122) of E. coli isolates had ARGs. Integrase 1 (int1) was found in 7.6% of E. coli isolates. Among E. coli isolates, 16.3% (n?=?49) were extraintestinal pathogenic E. coli (ExPEC), and approximately 34.6% (n?=?17) of ExPEC had ARGs. A hypervirulent ARGs-harboring STEC was isolated. The prevalence of Shiga toxin-producing E. coli (STEC) was low (n?=?1). The prevalence of ARGs-harboring pathogenic E. coli isolates was higher in stations close to the City (urban area), than that of other stations. ERIC-PCR (enterobacterial repetitive intergenic consensus sequence polymerase chain reaction) analysis revealed a high degree of genetic diversity among the ARGs-harboring E. coli isolates. The results demonstrate a high prevalence of ARGs-harboring E. coli in estuarine water and confirm the need for a better wastewater treatment facility and proper control measures to reduce the discharge of sewage and wastewater into the aquatic environments.     

Issues of causality in the history of occupational epidemiology

Summary Occupational epidemiology has its roots in classical medicine. However, it became a quantitative discipline only in the 20th century, through the pioneering work of individuals such as Case, Lloyd, and Selikoff and organizations such as the Division of Occupational Health of the U.S. Public Health Service. Studies of chemical dye workers, bituminous coal miners, smelting workers, and uranium miners have been especially important sources of innovations in methodology and in development of logical reasoning leading to acceptance of causal relationships of occupational exposures that lead to respiratory diseases and cancer. The cooperation of labor unions, such as those of steel and asbestos workers, has often been a crucial factor in providing essential data.

---

Zusammenfassung Fragen der Kausalität in der Geschichte der ArbeitsepidemiologieDie Arbeitsepidemiologie hat ihre Wurzeln in der klassischen Medizin. Allerdings wurde sie erst im 20. Jahrhundert zu einer quantitativen Wissenschaft. Dies dank der Pionierarbeiten von Personen und Organisationen wie Case, Lloyd und Selikoff und der "Division of Occupational Health" (Abteilung für Arbeitsschutz) des "U.S. Public Health Service" (öffentliches Gesundheitswesen). Studien mit Arbeitern in der chemischen Farbenindustrie, in Bitumenkohleminen, Erzhütten und Uranminen haben ganz besonders zu Neuerungen in methodischer Hinsicht, aber auch zur Entwicklung einer logischen Beweisführung beigetragen, was letztendlich zur Akzeptanz von kausalen Zusammenhängen zwischen Umweltbelastungen am Arbeitsplatz und dem Auftreten von Atemwegerkrankungen und Krebs führte. Die Kooperation mit Gewerkschaften, wie jenen der Stahl- und Asbestarbeiter, war für die Erfassung bedeutungsvoller Daten oft ausschlaggebend.

---

Résumé Questions de causalité dans l'histoire de l'épidémiologie des maladies professionnellesL'épidémiologie des maladies professionnelles plonge ses racines dans la médecine classique. Cependant, elle n'est devenue une discipline quantitative qu'au 20ème siècle, grâce au travail de pionnier d'individus tels que Case, Lloyd et Selikoff, ainsi que des organisations telle que la Division de Santé au Travail du service américain de Santé Publique. Des études sur les ouvriers de l'industrie chimique de la teinture, des mines de charbon, des fonderies ou des mines d'uranium ont été des sources particulièrement importantes d'innovation méthodologique et de développement du raisonnement logique aboutissant ä l'acceptation de relation causale entre des expositions professionnelles et des maladies respiratoires ou le cancer. La collaboration de syndicats professionnels, tels que ceux des ouvriers de la sidérurgie ou travaillant avec l'amiante, a souvent été déterminante pour l'obtention de données essentielles.

     

Evaluation of antioxidant and anti-inflammatory efficacy of caffeine in rat model of neurotoxicity

Objective: The present study aims to investigate the neuroprotective effect of caffeine against aluminum chloride (AlCl₃)-induced neurotoxicity in rats.

Methods: Twenty-one male albino rats were divided into 3 groups: control, AlCl₃-intoxicated group that received daily oral administration of AlCl₃ (100?mg/kg for 30 days) and protected group injected daily with caffeine (20?mg/kg intraperitoneally) one hour before oral administration of AlCl₃ for 30 days. Levels of lipid peroxidation, reduced glutathione, and nitric oxide and the activities of acetylcholinesterase (AchE) and Na⁺/K⁺-ATPase were measured spectrophotometrically. Tumor necrosis factor-α (TNF-α) was evaluated by ELISA kit.

Results: The data revealed evidence of oxidative and nitrosative stress in the cerebral cortex, hippocampus, and striatum of AlCl₃-intoxicated rats. This was indicated from the increased levels of lipid peroxidation and nitric oxide together with the decreased level of reduced glutathione. Moreover, the daily AlCl₃ administration increased AchE and Na⁺/K⁺-ATPase activities and the level of TNF-α in the selected brain regions. Protection with caffeine ameliorated the oxidative stress induced by AlCl₃ in the cerebral cortex, hippocampus, and striatum. In addition, caffeine restored the elevated level of TNF-α in the hippocampus and striatum. This was accompanied by an improvement in the activities of AchE and Na⁺/K⁺-ATPase in the studied brain regions.

Discussion and conclusions: The present findings clearly indicate that caffeine provides a significant neuroprotection against AlCl₃-induced neurotoxicity mediated by its antioxidant, anti-inflammatory, and anticholinesterase properties.     

An Examination of the Validity of Retrospective Measures of Suicide Attempts in Youth

Purpose

This study used prospective data to investigate the validity of a retrospective measure of suicide attempts from four different perspectives.

Methods

Data were retrieved from 883 participants in the Raising Healthy Children project, a longitudinal study of youth recruited from a Pacific Northwest school district. The retrospective measure was collected when participants were 18–19 years of age and results were compared with measures of depressive symptoms collected prospectively.

Results

Results showed strong corroboration between retrospective reports of first suicide attempt and prospective measures of depression, with attempters experiencing significantly more depression than their nonattempting peers, t (df = 853) = 10.26, p < .001. In addition, within the attempter group, depression scores during the year of their reported first attempt were significantly higher than the average depression score across previous years, t (df = 67) = 3.01, p < .01.

Conclusions

Results from this study suggest that the reports of older adolescents regarding their suicide attempts are corroborated by their prospective reports of depression in childhood and earlier adolescence. Thus, there is support that retrospective measures of suicidal behavior, namely suicide attempts, may be a valid method of assessment.     

Cross-Cultural Adaptation and Validation of the Italian Version of the Observational Scale of Level of Arousal

ObjectivesAlong with deficit of attention, level of arousal is a primary criterion for the diagnosis of delirium. The Observational Scale of Level of Arousal (OSLA) is a quick, simple, and observational instrument used to evaluate the variation of arousal for rapid screening of delirium in clinical practice. The current study aims to perform a cross-cultural adaption of and to validate the Italian version of the OSLA scale to detect delirium in older aged, hospitalized patients.DesignLongitudinal study.Setting and ParticipantsIn hospital and transitional care setting. Old age patients.MethodsA cross-cultural adaptation of the OSLA from English into Italian was conducted, including back-translation. The validation of the OSLA was assessed in 116 older patients (age >65 years) admitted to geriatric, internal medicine, and transitional care wards. The 4 “A”s Test serves as the gold standard for the measurement of delirium.ResultsIncident delirium was assessed longitudinally at different time points during hospitalization. The Italian version of OSLA demonstrated adequate internal consistency, specificity, sensitivity, agreement, test-retest reliability, and sensitivity to change, indicating adequate its clinometric properties in the detection of delirium in a real world hospitalized cohort of older adults.Conclusions and ImplicationsThe current study is among the few studies to assess arousal as a core feature of delirium by virtue of a longitudinal assessment of delirium, moving a step forward in the implementation of a brief and easy to use delirium-screening tool for the measurement of important clinical outcomes in a frail, old aged hospitalized population.     

Heritability of the timing of food intake

Our study investigates the relative contribution of genetic and environmental factors to the timing of food timing and related behaviors. Our results show that the heritability of the midpoint of intake, the midpoint between breakfast and dinner, was 64%. In addition, trait heritability was higher for breakfast than lunch, whereas no heritability was detected for dinner. These results suggest that interventions related to food timing may be more effective when targeting afternoon/evening behaviors, such as lunch or dinner times.

1. Download high-res image (112KB)
2. Download full-size image

     

Global monitoring of average volume of alcohol consumption

SummaryObjectives To estimate the prevalence of different categories of average volume of alcohol consumption for World Health Organization (WHO) regions. To check how the monitored indicator of average volume relates to prevalence of alcohol dependence. To discuss conclusions for establishing a global monitoring system.Methods Prevalence of different categories of average volume of alcohol consumption was estimated by a triangulation of survey results, production, and sales figures. The relation between average volume of consumption and prevalence of alcohol dependence was analysed by regression techniques.Results Alcohol consumption varies widely by sex, age, and region. It can predict prevalence of dependence with about 74% of the variation of the latter explained.Conclusions With current data, global monitoring of alcohol is possible. However, more and better surveys are necessary for the future. They should include, patterns of drinking to improve prediction of other health outcomes like coronary heart disease (CHD) and accidents.

---

ZusammenfassungFragestellung Schätzung der Prävalenz verschiedener Kategorien des Durchschnittskonsums von Alkohol für die Region nach Definition der Weltgesundheitsorganisation (WHO). Ermittlung der Beziehung zwischen Durchschnittskonsum und der Prävalenz von Alkoholabhängigkeit. Diskussion von implikationen für ein globales Monitoringsystem.Methoden Die Prävalenz des Durchschnittskonsums von Alkohol wurde mittels der Triangulation von Survey-Daten, Produktions-und Verkaufszahlen geschätzt. Die Beziehung zwischen Durchschnittskonsum und Alkoholabhängigkeit wurde durch Regressionstechniken ermittelt.Ergebnisse Durchschnittlicher Alkoholkonsum variiert weltweit nach Geschlecht, Alter und Region. Der Durchschnittskonsum kann die Prävalenz von Alkoholabhängigkeit gut vorhersagen mit 74% erklärter Varianz.Schlussfolgerungen Die derzeitigen Daten erlauben ein globales Monitoring des durchschnittlichen Alkoholkonsums. Dennoch sind für die Zukunft mehr und bessere Surveys notwendig. Diese Surveys sollten auch Trinkmuster mit einschliessen, um auch andere Gesundheitsindikatoren als Abhängigkeit wie koronare Herzkrankheiten oder Unfälle besser vorhersagen zu können.

---

RésuméObjectifs Estimer la prévalence de différentes catégories de volume moyen de consommation d'alcool dans les régions de l'Organisation Mondiale de la Santé (OMS). Examiner si les indicateurs de monitoring du volume moyen sont corrélés à la prévalence de la dépendance à l'alcool. Discuter les implications pour un système de monitoring global.Méthodes La prévalence de différentes catégories de volume moyen de consommation d'alcool, a été estimée à partir de données provenant d'enquêtes et de statistiques de, production et de vente. La relation entre le volume moyen de consommation et la prévalence de la dépendance à l'alcool a été analysée par des techniques de régression linéaire.Résultats La consommation de l'alcool varie selon le sexe, l'âge et la région. La consommation peut prédire la prévalence de dépendance pour environ 74% de la variance expliquée.Conclusions Un système de monitoring global de la consommation moyenne d'alcool est possible avec les données courantes. Pourtant, de nouvelles enquêtes sont nécessaires. Elles doivent inclure des profils de consommation pour améliorer la prédiction d'autres indicateurs de santé, comme par exemple l'infarctus du myocarde et les accidents.

     

Models of health-related quality of life in a population of community-dwelling Dutch elderly

Objective: Though health-related quality of life (HRQoL) is now commonly measured as an outcome in clinical trials, the relationships between its components remain unclear. The relation of physical symptoms, physical function, and psychological symptoms to each other and to overall quality of life is of special interest. Method: Cross-sectional data from 5279 community-dwelling elders who participated in the Groningen Longitudinal Aging Study were analyzed using structural equation modeling techniques. Three models were examined. One “Linear” model included: number of chronic medical conditions, physical symptoms, physical functioning, activity interference, social function, perceived health and overall quality of life in a simple linear progression. Another ‘non-linear’ model included these variables, but allowed effects between non-adjacent variables. A third ‘non-linear’ model included these variables plus anxiety and depressive symptoms. Results: The Linear Model did not satisfactorily account for the observed data [X ²(15_df) = 2946.96], so the saturated Non-Linear Model, incorporating paths between non-adjacent components, is described. When anxiety and depressive symptoms were added to this Non-Linear Model, they fit best in a position mediating the relation between perceived health and overall quality of life [X ²(5_df) = 136.78]. Conclusions: Overall quality of life appears to be related to symptom status as directly as it is related to functional status. Anxiety and depressive symptoms appear to mediate the relation between general health perceptions and overall quality of life. Quality of life measures should therefore include assessments of physical and psychological symptom severity as well as functional status if they are to truly reflect what matters to patients. The disability-adjusted life year (DALY) measure used by the WHO may inadequately reflect the effect of symptoms on patient's quality of life. This revised version was published online in June 2006 with corrections to the Cover Date.