Scandinavian journal of primary health care. Supplement最新文献

In recent years, there has been increasing interest in incorporating the concept of "Quality of Life" in the evaluation of medical interventions. The lack of a general definition which can function as a basis for the scientific evaluation of medical treatment is, however, a problem. The definition proposed in this paper contains three main factors: Subjective well-being, Health and Welfare. "Subjective well-being" is the central component in the evaluation of Quality of Life, referring to the individual's perception of his life situation, "Health" is a subjective as well as objective evaluation of physical and mental status, while "Welfare" reflects the objective environmental factors. Thus, the evaluation of Quality of Life in medicine should ideally address these three main factors. Although the importance of any particular component may vary, subjective well-being and health should always be included.

Assessment of quality of life has attracted increasing interest in recent years. A standardized way of evaluating quality of life is by using questionnaires. One such, the Nottingham Health Profile (NHP), measures health-related quality of life within the sections of energy, sleep, emotions, pain, mobility and social isolation as well as the frequency of health-related problems pertaining to paid employment, housework, hobbies, family life, social life, sex life and holidays. The NHP is well-documented with regard to reliability and validity, and is useful in describing the impact of chronic disease. The NHP is, moreover, a useful evaluative tool in patients with more pronounced disability.

To see whether well-being and symptoms are affected by age, job satisfaction, and cardiovascular diseases a quality of life assessment of men born in 1913 and 1923 and living in Göteborg was performed. Age influenced both well-being and symptoms in different ways. Many well-being variables declined and many symptoms decreased with age. Symptoms were strongly related to both global health and job satisfaction--more symptoms were found in participants with low global health or low job satisfaction. Participants with cardiovascular disease and diabetes mellitus showed considerable variation in their quality of life. Hypertensive and diabetic patients showed only small deviations in the well-being and symptom profile. Congestive heart failure patients generally had a low quality of life. It was not possible to decide if the lack of well-being was caused by the diseased state, the treatment, or the patients' awareness of having a specific disease.

Quality of life has emerged as an important outcome in evaluating medical care. With an increasing number of patients with chronic disease, it is necessary not only to assess an intervention regarding its ability to effect cures, but also regarding its ability to improve the quality of life. Self-administered patient questionnaires provide a reliable and valid means of assessing how patients respond to therapy. Basically, there are two types: specific and general questionnaires. Whereas general questionnaires give a comprehensive evaluation of the quality of life summarized in a global score, specific questionnaires are focused on a particular problem or patient group. Benefits and disadvantages of generic compared with specific questionnaires are discussed.

Diuretic drugs seem to be well tolerated during long-term antihypertensive treatment. Although they induce severe side effects necessitating withdrawal more often than placebo, the frequency of such withdrawals seem to be equal to that induced by beta-blocker treatment. The subjective tolerability as judged by questionnaires for symptoms and well being scores seems to indicate an over-all small improvement in patient well being. The effects in this respect seem to be similar to those exerted by a selective beta-blocker.

Safety deals with the surveillance and detection of possible threats that can arise against a patient. It might not be an obvious one, like an anaphylactic shock, but a bizarre syndrome of late onset preceded by vague signs or symptoms. To be able to conclude about a possible causal relationship between a drug and such a state with as short a delay in time as possible, the collection and analysis of adverse events during the total clinical trial program of a drug is mandatory. To ask investigators for adverse drug reactions instead is to produce an effective filter, which may help in keeping the incidence figures down in the international data sheet but which also may prove to be hazardous for the pharmaceutical industry in the long run.

The SSA-profile is a specific, self-administered questionnaire for measurement of subjective symptoms in untreated and treated hypertensives. Forty-two of the most frequently occurring symptoms among untreated and treated hypertensives have been included. Based on factor analysis, 25 of the items combine into dimensions covering the areas Emotional distress, Gastro-intestinal symptoms, Peripheral vascular symptoms, Cardiac symptoms, Sex life and Dizziness. The reliability and circulatory of the questionnaire have been established. For improved sensitivity in detecting subjective symptoms and comparability of results obtained in different studies the use of the SSA-profile provide valuable information. The questionnaire has been shown capable of describing subjective symptoms among untreated hypertensives. Currently, the questionnaire is being used in evaluating subjective symptoms among patients treated with different classes of antihypertensive agents.

To evaluate adverse reactions in the treatment of hypertension correctly, it is important to know the symptom profile of hypertensives per se. In the present study, a random sample of 60-year-old men, untreated for hypertension, was studied. The concept of the quality of life has largely been based on data obtained from the self-recording of subjective symptoms. Subjective symptoms were recorded by means of a self-administered questionnaire, "The Göteborg Quality of Life Instrument", which includes 30 items. Nine of the symptoms were found to be correlated to blood pressure. When the effect of confounding factors, such as smoking habits and situation at work was taken into account, seven symptoms remained. Most of the symptoms that were correlated to blood pressure may be regarded as related to aetiological factors rather than caused by the blood pressure.

A review of the literature concerning quality of life aspects on ACE-inhibitors in hypertensive patients is given. In the first part of the eighties two prospective multi-center randomised trials were conducted to determine the effect of captopril in comparison to methyldopa or an unselective beta-blocker on the quality of life in patients with mild to moderate hypertension (Hill et al. and Croog et al.). Both studies revealed slight but significant positive effects on indices of quality of life in captopril treated patients compared to those who had methyldopa or an unselective beta-blocker. Later, another ACE-inhibitor, enalapril, has been compared with a selective beta-blocker (Edmonds et al. and Herrick et al.) with respect to side-effects and the quality of life. The measurements of the quality of life tended to favour enalapril, but the differences were small and the over-all tolerability of the two drugs was similar. In conclusion, comparisons with more long standing forms of antihypertensive therapy suggest a slightly more favourable effect of ACE-inhibitors on the quality of life.