Scandinavian journal of primary health care. Supplement最新文献

Minor Symptoms Evaluation Profile (MSE-profile) is an instrument for the assessment of subjective CNS-related symptoms and has recently been documented. This self-applied questionnaire includes 24 items and uses a visual analogue scale to record perceived symptoms. Based on a subjective grouping followed by a principal component analysis of the results of 374 individuals to confirm the grouping, 15 out of the 24 items were formed into three dimensions: Contentment (7 items), Vitality (5 items) and Sleep (3 items). The Cronbach's alpha coefficient used to evaluate the internal consistency of these dimensions was 0.81, 0.81 and 0.77, respectively. Compared with the equivalent dimensions of other questionnaires for measurement of health-related quality of life, the dimensions of the MSE-profile were found to be relevant. Furthermore, the MSE-profile showed good discriminative ability to distinguish symptom profiles of patients with other diseases/complaints than hypertension. It can be concluded that the MSE-profile is practically useful, reliable and sensitive enough for the assessment of subjective CNS-related symptoms that might affect the patient's well-being/quality of life.

In this study the prognostic significance of a set of quality of life measures was tested with regard to mortality regardless of its cause, cardiovascular mortality, cancer mortality and mortality from other causes. From the population register of Gothenburg, Sweden, a sample was drawn consisting of one third of all 60-year-old men. The 945 men who met the criteria were invited to a medical examination. Information on the occurrence of 30 symptoms and 15 measures of well-being was obtained by questionnaire. Mortality data were obtained through official registers, death certificates and medical records. Of the symptoms at 60, breathlessness, cough, depression, bad appetite and feeling cold, all were significantly related to mortality during 15 years of follow-up. Of the well-being variables, the same was true of perceived health, physical fitness and appetite. This means that the quality of life has a strong bearing not only on the present life situation for these men but also for their future health.

Clinically used calcium antagonists are derivatives of either verapamil (verapamil), dihydropyridines (e.g. felodipine and nifedipine), or benzothiazepines (diltiazem). The principal side effects are mostly predictable, dose-dependent, and related to their main actions: vasodilatation, negative inotropic effects and antiarrhythmic effects. All calcium antagonists have demonstrated a pronounced hypotensive effect. Conduction disturbances and bradycardia are seen more often after verapamil and diltiazem, while tachycardia, headache, ankle oedema; and flush are more frequent after felodipine and nifedipine. Another side effect is constipation, which is frequent after verapamil. Important interactions have been reported with, for instance, digoxin and beta-adrenergic blocking agents. Calcium antagonists may have favourable effects on serum lipids, and there is no indication of consistent changes in basal glucose metabolism. Uric acid is unchanged or reduced. Regarding the effects on the quality of life exerted by the different calcium antagonists, very little is known since such studies have not been performed so far.

This brief review summarizes the background and principles for the development of a new psychometric instrument (Assessment of Symptoms and Psychological Effects in Cardiovascular Therapy--ASPECT Scale). The test consists of two parts, one for assessment of three aspects of global well-being (hedonic tone, relaxation, and activity) and one for evaluation of 34 commonly experienced symptomatic side-effects of cardiovascular drugs. All items are assessed by visual-analogue scales, and six clusters of symptoms have been identified: cardiac symptoms, central nervous system or cognitive symptoms, fatigue, local/cutaneous symptoms, sleeping disturbances, and other symptoms.

"The Göteborg quality of life instrument" (GQL-instrument) has been used to assess the quality of life of men born in 1913 and 1923. On a population basis, it was possible to show that the well-being variables were stable over time and that excellent well-being showed a great variation. A high level of well-being was common in variables such as family and housing but more uncommon in variables such as fitness, vision, hearing and memory. Symptoms were often significantly related to biomedical variables such as body mass index, blood pressure, lung function, blood lipids, fasting blood sugar and fasting insulin. The GQL-instrument seems to provide a reliable and stable assessment of well-being and symptoms and is useful both as a descriptive tool, and as a help in evaluating treatment, and it also has predictive power.

beta-receptor antagonists have for many years been considered appropriate alternatives in the primary management of mild to moderate hypertension. Generally, they have been shown to be safe with a low frequency of serious side-effects. Among the predictable and usually doserelated side-effects are bradycardia, bronchospasm, hypotension, muscle fatigue and cold extremities. Examples of unexpected side-effects are gastrointestinal symptoms such as nausea and disturbed intestinal motility, skin reactions, sexual dysfunction, as well as effects related to the central nervous system (CNS) such as emotional disturbances. The CNS-related side-effects, the mechanisms of which are unclear, consist of subtle effects on general well-being, decreased initiative, a depressed frame of mind and disturbed sleep. Generally, however, beta-blockers in therapeutic dosages do not affect the qualitative functions of the brain. Thus, all beta-blockers on the market seem to have high benefit-risk ratio, but independent of their physiochemical properties and pharmacodynamic profile, they seem to cause side-effects to about the same extent. The results so far available have been obtained by primarily using objective methods. Further comparison has now been initiated using documented subjective methods to investigate whether the objectively documented differences are of any clinical relevance to the patient's quality of life. Although it cannot be claimed with certainty, nonselective beta-blockers seem to cause CNS-related side-effects to a greater extent than beta 1-selective blockers. Differences in the degree of hydrophilicity of the beta-blocker are apparently of no clinical relevance in this respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurements of life quality have recently been included in drug trials on hypertension. In literature, not one single reference was found on life quality in non-pharmacological therapy of hypertension. More or less a tacit understanding is, however, that the life quality is unchanged, or at least not impaired, during non-pharmacological therapy. Experiences from a study of 400 patients with the aim to reduce or withdraw antihypertensive drugs, at the same time as non-pharmacological methods were introduced, show the difficulties to evaluate changes of life quality in a non-pharmacological study.

The interest for quality of life assessments in health care has grown during recent years. From the economist's point of view, quality of life is an appropriate outcome measure in economic assessments of health care as a tool in priority settings. In quality adjusted life-years (QALYs) improvements in the length of life and in its quality are amalgamated into one single index. Different types of medical interventions can be compared by calculations of costs per gained QALY. Unsolved problems still remain with QALYs but with scarce resources within the health care sector measures like QALYs provide a powerful guidance in priority settings.

The North Karelia Project started in 1972 as a response to the request of the local people. It was aimed at reducing the exceptionally high mortality and morbidity from cardiovascular diseases in the area. The Project's activities have been directed towards inducing behavioural changes amongst the entire population. Equally, the care of those already sick (such as hypertensives) has also simultaneously been reorganized. The Project has involved the whole of that society, in addition to the health care system, and has collaborated with the food industry, schools and various voluntary organizations. The most recent new activity is a programme to promote marketing of local vegetables and berries to have a substitution for dairy farming, as consumption of dairy products reduce with new dietary habits. The results are encouraging. The individually reported health behavioural changes are reflected by a clear net reduction in biological risk factors (serum cholesterol, blood pressure) compared to the reference community. Also statistics show that mortality from ischaemic heart disease has been reduced more significantly in North Karelia (-22%) than in the rest of Finland (-11%) during the period 1974-1979. The activities tested in North Karelia, and found to be feasible, have been recommended for implementation nationwide in Finland. For instance, anti-smoking activities were first tested in North Karelia before the introduction of national legislation, and experiences obtained in health education have been conveyed to other sectors of the Finnish population through national television in several programmes. The county of North Karelia continues to be a demonstration area in Finland, at present for the Integrated Programme for the Prevention of Noncommunicable Diseases.