Quality of Well-being in People of the Clinical Physical Examination
|Course||Social Medicine and Health Management|
|Keywords||Quality of life Quality of well-being Sensitivity Clinical health physical examination|
Background:The health related quality of life (HRQOL) was accepted and used widely at the quality of life of general people, clinical experiment .research and the decision-making of health economy. HRQOL measures usually incorporate perceptions, role functions, social health, and general well-being, and may even measure aspects of spirituality, sexual function, life satisfaction, and environment. Quality of well-being (QWB) was one of HRQOL tools.The QWB scale combined preference-weighted measures of symptoms and functioning, been definition and detected by common people and patients .The list of symptom/problem complex was in-service use and check-up, consistented with the list of clinical history and physical examination. QWB’s recondition included psychics evaluation. QWB scale provided a numerical point-time expression of well-being including death situation. It ranges from 0.0(representing death) to 1.0( asymptomatic full function ). QWB scale included four subscales: mobility( MOD), physical activity(PAC), social activity(SAC), and complex(CPX).The abroad reports showed that QWB scale was used at evaluation of the quality of life in the patients with various kinds of diseases widely. The sensitivity and validity were approved at different special disease, such as post-trauma.musculoskeletal disease, total hip or knee replacement, human immunodeficiency virus infection, tumor, HIV-infected, disorder of pathergasiology and psychology, lung disease, et al. QWB scale was used widely at the quaLity of life of people in different diseases, clinical experiment and research, the decision-making of health economy Comparing with other tools, QWB was shorter, less expansive, reliability and validity of QWB were satisfaction. Further more, QWB was greater sensitivity at change of symptom in disease.A few of domestic research of QWB were reported in general people and in people with special disease.On the other hand, with the development of national economy and people’ s life, new health protection system beening set up,the clinical health physical examination was been welcomed by more and more people. At the same time, the modern medical mode had been changed, the family medicine was set up and developed. Fami ly medicine and society medicine provided a set up of service including of prevent, medical treatment, healthcare, healing, health education and instructor of family planning. The base work of family medicine was the health evaluation of every people in community site, so the clinicalhealth physical examination was import. But the plan of clinical physical examination was not established by health situation of every body, not individual, no filter. This was not fit for health evaluation.Objectives:The aim of this study was to analysi s the health si tuation of the cl inical heat th physical examination people, calculate distribution of disease and detection rate of disease of the clinical physical examination, and then we evaluated the quality of I ife of people of the clinical physical examination and analysis the influencing factors at QOI. of the people of clinical physical examination. We also analysised the relationship between the results of QWB and clinical health physicalexamination, in order to evaluate the sensitivity and validity of QWB as a filter tool of the clinical health physical examination.Methods:From November 2004 to March 2005, the people were obtainer who did clinical health physical examination at health physical examination center of zhejiang university affiliaed Sir Run Run Shaw hospital, and they agreed with admission of this reach. Excluding the patients having the history of severe disease, acute attach of chronic disease, function failure of important organ, disease of spirit and mind, less comprehend and could not understand the question. The investigation included the results of clinical health physical examination, general information, and the results of QWB.At the beginning of research, the doctors and nurses of the center of the clinical physical examination were exercised. The important of this exercitation was how to fill in QWB table. AT the day of the clinical physical examination, the doctor or nurse who was been exercised finished QWB table face to face, at same time noted general information including gender, age, marriage status, profession status, inhabitancy. The clinical physical examination was health physical examination and assistant test, separate of the form and function of organ of respiration system, digestive system, blood system, circulation system, nerve system, athletics system, endocrine system.After the information of everyone doing clinical physical examination was collected, these were sent to doctor of" the center of the clinical physical examination. The doctor integrated and analyzed, and made a conclusion (include diagnose). All of information were integrated and analyzed, rate of detection of disease and distribution of disease were accounted and analyzed.We evaluated Inequality of 1 i fe of people of the cl inical physical examination,The four department preference-weighted score of QWB were accounted, and the total score of QWB were accounted with expressions: W=l+ (CPX) + (MOB) + (PAC) + (SAC), total score, average score, score of four department were accounted and analysized the influencing factors at QOL of the people of clinical physical examination as gender, age, situation of marriage, culture level, profession and inhabitancy.Analysis the relation between the QWB score and the result of the clinical health physical examination,.(1 )To analysis the relationship between the QWB score and the health severi ty of the result of clinical health physical examination. People was dividatured in 4 terms, A: good health people without disease or disorder;B: people with 1~3 kinds of disease or disorder;C: people with 4-—6 kinds of disease or disorder;D: people with more than 6 kinds of disease or disorder. The total score, 4 part scales of QWB were compared among 4 terms.(2) To analysis the relationship between the QWB score and the disease or di sorder of sysytem of the result of cl inical health physical examination. The total score, 4 part scales of QWB were compared between the people in different disease or disorder of sysytem and good health people without disease or disorder .(3) To analysis the relat ionship between the QWB score and the different kinds of the result of clinical health physical examination. The total score, 4 part scales of QWB among were compared between the people in different kind of disease or disorder and the good health people without disease or disorder.Statistical Analysis method: measurement datawas indicated by X±S. The t test , Variance analysis were used. All analyses were carried out using SPSS1O. 0.Results:2337 peoples of the clinical physical examination were studied at the Sir Run Run Shaw hospital. All peoples completed the QWB. 17 peoples were not concludedbecause they didn’ t finish the clinical physical examination. 1419 were male, 793 were female. The average age was 41.61 ±9. 42, range of age was 17 ~ 80, 91.4% peoples’ s age were range from 15 to 55, and 46.5% peoples’ s age were range from 35 to 45.The result of the clinical physical examination: 128 kinds of diseases/disorders were found, the 20 kinds of list were hyperlipemia, lobule of mammary gland, midrang adiposis hepatica, errors of refraction, disfunction of 1 ive, prostatic hypertrophy, external hemarrhords, high blood glucose, bigger of body mass, hypertension, polypi of cholecyst, 1 ight adiposis hepatica, increased of lung marking, chronic cholecystitis, chronic pharyngolaryngitis, hepatic cyst, hysteromyoma, kidney stone, hypersplenotrophy, flection of anasalseptum. A lot of them were chronic diseases,. The decection rate of turmer was 0.8%. The first 3 of list of masculine disease were augmentation of prostatic hypertrophy, calcification, redundant prepuce. The first 3 of feminine disease were lobule of mammary gland, hysteromyoma, chronic cervicitis.The scores of 5 scales of the QWB in peoples of the clinical physical examination were accunted: totle score:0.8766000 + 0.1240000, MOD: -0.0007920 ± -0. 009720, PAC :-0. 0007012±-0.006586, AC: -0.0004268 ±-0. 005493, CPX: -0.1215000 ±-0. 121500.LJnivariate analysis of QWB in peoples of the clinical physical examination: the scores of MOB. PAC. SAC> CPX. W of QWB Were not significant change between the male and female;the scores of CPX. W of QWB were significant change with the age increased, but PAC. SAC. CPX were not;the scores of SAC of QWB were significant improvement at marriage and single hood;the scores of PAC CPX. W of QWB were significant higher in peoples with higher education level;the scores of SAC. CPX, W of QWB were significant higher in peoples who lived in city or town.Relationship analysis between the QWB score and the result of the clinicalphysical examination :(1) The different of QWB score could not found among the different healh severity people of the clinical physical examination , P>0. 05.(2) The different in the scores of MOB, SAC, PAC, CPX, W of QWB were not found between the people in disease or disorder of system and the goood health peoples without disease or disorder. The system included medical department, surgerg, gynaecoligy and obstetrics, neuology and pathergasiology, dermatopathy and cypridology, ophthalmology, disease of ear nose throat, P>0.05.(3) Except the score of PAC in people with prostatic hypertrophy and redundant prepuce, the different in the scores of MOB, SAC, PAC, CPX, W of QWB were not found between the people in different kinds of disease or disorder and the peoples wi thout disease or disorder, P>0. 05.Conclusion:The kind and detection rate of disease of result of the clinical physical examination showed that the chronic disease were main, according with spectrum of disease in China.The scores of QWB in people of the clinical physical examination was 0. 8766000, was higher than the score of norm abroad , but it was not concluded that the QOL of the clinical physical examination was better than normal, because the domestic norm was not established. The influence factors of QWB were age, marital status, education level, profession and inhabitancy.The sensibility of QWB in peoples of the clinical health physical examination was not good. Except the change of PAC score in people with prostatic hypertrophy and redundant prepuce, QWB scores were not sensitive in peoples of the clinical health physical examination, no matter the different severity level of disease or disorder, the disease or disorder of the different system and the different kindsof diseases or disorders. So the QWB scale was not applicable to evaluation the QOL of the people of the clinical health physical examination, but this study was the beginning using of QWB scale in China, also provided the data of QWB scale in being assailanted by the Chinese, evaluation of QOL, evaluating treatment effects, cost-effectiveness analysis and monitoring in health polity.