Assessment of quality of life in various cardiovascular diseases. Criteria for quality of life in medicine and cardiology Assessment of quality of life in healthcare

Yu.F. FLORINSKAYA

The concept of “quality of life” includes the socio-economic, political, cultural and environmental environment in which the human community exists. A high quality of life implies that all aspects of people’s existence - from working conditions, living conditions, recreation, organization of services, healthcare, education and the state of the environment to the presence of political freedoms and the opportunity to enjoy all the achievements of culture - meet the needs of modern people.

Population health is the most striking and comprehensive indicator of living conditions. The World Health Organization (WHO) defines health as “a state of complete physical, mental (psychological) and social well-being and not merely the absence of disease or disability.” Therefore, from the sphere of purely medical research, the study of population health “stepped” into economics, sociology, geography, ecology and other sciences.

The connection between the socio-economic development of society and public health has been established for a very long time. Research of this kind was carried out back in the 18th century. For example, the work of the Padua physician Ramazzini (1663–1714) “On the diseases of artisans” is known. These studies received their greatest development in the 19th century. in England and Russia. The Russian school of hygienists is represented by a whole galaxy of outstanding researchers: A.M. Dobroslavin, F.F. Erisman, D.N. Zhbankov, N.I. Tezyakov and others.

The problem of the relationship between health and various aspects of human life has three aspects: individual health, i.e. individual health, public or population health; types of health.

The state of health of an individual is largely a random phenomenon. It can be caused primarily by endogenous factors (gender, age, physique, heredity, race, type of nervous system, etc.), often associated with the environment of the individual’s ancestors. The level of health of a fairly representative group of people (the average level of health) is formed as a result of the interaction of endogenous and exogenous factors and is an indicator of the adaptation of a particular community of people to certain social, natural, environmental and hygienic living conditions, and serves as a criterion for the beneficial or negative influence of the environment.

To assess public, or population, health, the following indicators are used: average life expectancy, general and infant mortality, causes of death, morbidity, disability, etc. Such assessments make it possible to judge the viability of a community of people and its working capacity, physical development, average life expectancy, morbidity , ability to reproduce healthy offspring.

The health of a population varies significantly from place to place under the influence of environmental factors and biological characteristics of the population. The level of health of city residents and its specificity differs from the level of health of rural residents, the level of health of mountaineers is not the same as that of people living on the plain, etc.

Experts are still arguing about which indicators are best used to assess health levels. So far, for a particular population of people, such an assessment is carried out empirically on the basis of statistical material. As an example, we can cite the approach that is used in modern domestic social-hygienic research.

The entire population of people surveyed is divided into five groups:

1) healthy;
2) healthy with functional and some morphological changes (persons who do not have chronic diseases, but have various functional diseases or the consequences of previous diseases, injuries, etc.);
3) patients with chronic diseases with preserved functional capabilities of the body (compensated state);
4) patients with long-term (chronic) diseases (subcompensated state);
5) seriously ill patients on bed rest, disabled people of groups I–II (decompensated state).

This classification becomes objective when selecting groups of people of the same age (according to WHO recommendations, these people should be one year old, 15, 45 and 65 years old at the time of medical examination).

Since public health depends on many different causes, it is of great interest to assess the role of various factors in premature mortality in people. Premature mortality, and therefore a decline in health, largely depends on people’s lifestyle (including socio-economic factors), the state of the environment and heredity.

Social development and types of health

The level of population health is closely related to the development of society. Improving living conditions is accompanied by an increase in the level of health of the population. At the same time, war, famine, and economic crises inevitably led to a sharp decline in the level of public health. If the increase in the level of health occurs, as a rule, gradually, then the deterioration is rapid, avalanche. Nevertheless, the process of changing the level of public health, common to humanity, is progressive.

The second epidemiological revolution began in developed countries, when their population became so healthy that almost all diseases that could be completely cured with the help of immunotherapy, chemotherapy, and surgery disappeared from the causes of death. All that remains are diseases that are incurable at the current level of development of world science. Well-known specialist in the field of social hygiene V.I. Krichagin believes that further leaps are possible: life extension from pre-retirement ages to the limits of biologically justified life expectancy; saving premature babies with low body weight and reducing the number of accidental deaths in all age groups by changing working and living conditions.

Each stage of human evolution corresponded to its own characteristic level of health quality - a type of population health.

To understand the current situation with population health, we will conduct a retrospective analysis of changes in population health and try to create a multivariate forecast of this change. Let us turn to the statement of the prominent Russian geographer Yu.G. Saushkina: “Districts located in a certain territorial sequence often reflect different stages of historical development.” Indeed, if different regions are ranked in terms of population health indicators, for example, the primitive tribes of the Amazon --> residents of Guinea (in the recent past) --> Sierra Leone --> Haiti --> Zimbabwe --> Mexico --> Argentina - -> Canada --> Japan, then, to a first approximation, it is possible to recreate a picture of the general patterns of changes in health during the gradual transition of humanity from a pre-class society to a post-industrial one.

On this scale you can also find a point that characterizes the population health of Russian residents. This point is located much closer to Zimbabwe than, for example, to Argentina, and some Russian regions lag behind Zimbabwe in life expectancy.

According to the Information Bulletin of the Center for Demography and Human Ecology in countries such as Japan, Canada, the United States and most industrialized countries, the average life expectancy is between 76 and 79 years. In developing countries, the average life expectancy is 61 years, and in some - 50 years or less. Infant mortality rates are also uneven: in developed countries, out of 1 thousand newborns, no more than 12 infants die during the first year of life; in developing countries, on average, 71 newborns die, and in Guinea, Sierra Leone, Rwanda, and Somalia, more than 100 newborns die. In the 1990s. the listed indicators were even worse. Thus, in Guinea in 1955, infant mortality was 216 per 1000 births, and average life expectancy was 27 years. At the same time, the welfare of residents, for example, Haiti, is 38 times lower than the United States.

To bring into unified system of various types of health, their classification was carried out in territorial and temporal terms - from primitive society to the present day (which historical eras this or that type of health corresponded to). Five successively changing types of population health have been identified: primitive; post-primitive; quasi-modern; modern and postmodern. Let us give a description of these types of health, their subtypes and local variants.

Primitive type of population health

This type is characteristic of the earliest and most long period human history. It can be characterized as the simple survival of human communities under the constant threat of violent death. People lived in an appropriative economy by collecting edible plants, hunting and fishing. Groups of hunter-gatherers, usually consisting of 20–25 people, led a semi-sedentary lifestyle.

Various painful changes were discovered on the bone remains of primitive hunters and gatherers: ankylosis, osteomyelitis, necrosis, rickets, dental caries, jaw diseases, periostitis, exostasis, lesions of the spinal joints, deforming arthritis. Bone calluses indicate trauma, which does not always lead to death. Common cause various ailments there was hunger.

The average human life expectancy was 20–22 years, infant mortality was 500 or more per 1 thousand newborns. And at older ages, infant mortality was very high. In particularly unfavorable years, within a particular group or tribe, not only all newborns, but also older children and elderly people could die.

Even then, at the early stage of human development, his connection with the biogeochemical situation was evident - among the fossil remains, jaws with teeth damaged by caries and completely destroyed crowns are often found. Residents of tropical areas undoubtedly suffered from malaria and helminthiasis.

Postprimitive type of population health

An important step in the development of human society was the transition from hunting and gathering to agriculture. It is often called the Neolithic revolution: from an appropriating economy, man moved to a producing economy. Distinctive features the life of Neolithic man - his sedentary or semi-sedentary lifestyle, close contact with the territory that he cultivated. Agriculture became a more reliable source of food than hunting and gathering. A gradual increase in population began. People began to live in larger communities, 10 or more times larger than the groups of nomadic hunters. They mastered the craft of pottery, stone grinding techniques, and the use of a plow.

The average life expectancy at this stage of evolution is already slightly higher. The proportion of deaths from injuries and hunger decreased, but infant and child mortality was still high.

If in the pre-agricultural era the size of human groups and the life expectancy of people were regulated mainly by the amount of food, then with the development of agriculture, diseases became the main regulating factor. Agriculture and livestock farming have dramatically changed the economic and everyday way of life and had a tangible impact on the environment. natural environment, and therefore on the nature of the morbidity of residents of ancient agricultural and agricultural-pastoral communities.

Man has spread widely across the Earth. Entering into various forms of interaction with many representatives of the animal world (hunting, eating, domestication, economic use, staying in the same territory, etc.), he became infected with animal diseases (zoonoses), to which he turned out to be susceptible.

Around the settlements of the first farmers, waste and sewage began to accumulate, and fecal contamination of the soil and water bodies occurred. The deterioration of the sanitary condition of the population led to the spread of pathogens and invasions. Grain storage facilities in villages and landfills attracted wild animals - carriers of pathogens of many natural focal infections. In human settlements, mice and rats began to become domesticated, which over time became the causes of outbreaks infectious diseases. Pathogens were transmitted by blood-sucking vectors to domestic animals from wild animals.

Ixodid ticks are carriers of a wide range of pathogens serious illnesses– in nature they feed on wild animals, but can feed on domestic and farm animals and become dangerous to humans. In Africa, monkeys are the main carriers of the yellow fever virus. The virus is transmitted from monkeys to humans by mosquitoes. A sick person himself becomes a source of infection, which mosquitoes can transmit from him to other people.

By building their homes, people, often without suspecting it themselves, created biotopes for the existence of many species of animals - carriers of diseases. Thus, in the walls of adobe houses could live: triatomine mite - a carrier of Chagas disease (American trypanosomiasis), mosquitoes - carriers of visceral and cutaneous leishmaniasis, ticks - carriers of tick-borne relapsing fever. Mosquitoes, carriers of wuchereriosis (or “elephantiasis”), etc., spend their days in homes and utility rooms.

Deforestation created good conditions for mosquitoes to breed in open waters, which contributed to the infection of people with malaria, one of the most common and debilitating diseases for humans.

Artificial irrigation in arid areas from the very beginning was accompanied by the appearance of reservoirs with standing water. Working in irrigated fields (for example, rice fields), cleaning irrigation canals, bathing, and drinking water led to the emergence of many infections and infestations among the population. Mollusks that live in irrigation canals, rice fields, and ponds serve as intermediate hosts of schistosomiasis (intestinal, genitourinary, Japanese).

Animal husbandry also influenced the health of Neolithic people. For example, the causative agent of brucellosis (the most pathogenic form for humans) multiplies in the body of small livestock - sheep and goats, and it was they who were primarily domesticated by Neolithic man. The spread of leptospirosis is also associated with farm animals. When consuming insufficiently heat-treated animal meat, people became infected with helminths and fell ill with taeniarinhoz, taeniasis, and trichinosis. The severe course of trichinosis subsequently led to the fact that the ancient Jewish religion, and then Islam, banned the consumption of pork. In Africa, hunting and livestock farming were the cause of trypanosomiasis (sleeping sickness).

The transition of farmers to plant foods led to the spread of vitamin deficiencies and hypovitaminosis, which, apparently, were not known to primitive hunters who ate mainly meat. Protein starvation is the cause of kwashiorkor disease, which mainly affects children. Lack of thiamine (vitamin B1) causes beriberi disease, which has been common since ancient times in rice-growing areas where polished rice is eaten. With a lack of nicotinic acid, tryptophan and riboflavin in the diet, pellagra developed.

The predominance of products of plant origin in food rations also affected the population’s exposure to biogeochemical endemics. In areas with iodine deficiency, endemic goiter appeared in the soil. And a lack of calcium and an excess of strontium in plant foods led to Urovsky (Kashin-Beck) disease.

To be continued

UDC 159.9.072.5 © Evsina O.V., 2013 QUALITY OF LIFE IN MEDICINE - AN IMPORTANT INDICATOR OF THE PATIENT’S HEALTH STATE (literature review)

Annotation. The science of health-related quality of life research has not only taken a certain stage in modern medicine, but also continues to develop progressively. The article provides a review of the literature on the concepts of “quality of life”, “health-related quality of life”, methodology, and areas of application of quality of life.

Keywords: quality

life; health-related quality of life; questionnaire.

© Evsina O.V., 2013 THE QUALITY OF LIFE IN MEDICINE - AN IMPORTANT INDICATOR OF PATIENT HEALTH STATUS (review)

Abstract. Studying of the health-related quality of life does not even play an important role in modern medicine, but also continues to develop progressively. The article presents the review of currently available data on the concept of “quality of life” and “health-related quality of life”, the methodology, the applications of quality of life.

Key words: quality of life,

health-related quality of life, questionnaire.

Historical background and definition of the concept “quality of life”. Progress in the development of medical science, changes in the structure of morbidity in the population and an emphasis on respect for the rights of the patient as an individual have led to the creation of a new paradigm for understanding the disease and determining the effectiveness of treatment methods. When doctors began to increasingly realize that an objective reduction in pathological changes (physical, laboratory and instrumental methods examinations) is not necessarily accompanied by an improvement in the patient’s well-being and that the patient should be satisfied with the outcome of treatment, in

medicine has become interested in the patient’s quality of life. IN last years publications dedicated to the quality of life on the Internet have exceeded 4.5 million, and this trend of increased attention to the quality of life is growing every year. In addition to information on the Internet, special methodological manuals and periodicals. Thus, judging by the frequency of use of this term in modern literature, quality of life in medicine is a widely used concept, being an integral indicator that reflects the degree of adaptation of a person to the disease and the ability of him to perform habitual functions corresponding to his socio-economic status.

The term “quality of life” (QOL) first appeared in Western philosophy, and later quickly penetrated into sociology and medicine.

The history of QoL research in medicine begins in 1949, when Columbia University Professor D.A. Karnovsky published the paper “Clinical Evaluation of Chemotherapy in Cancer.” In it, using the example of cancer patients, he showed the need to study the whole variety of psychological and social consequences diseases, not limited only to generally accepted medical indicators. This work marked the beginning of a comprehensive study of the patient’s personality, and from this date the history of the science of QOL began. Actually, the term QOL was first used in 1966 by J.R. Elkington in the Annals of Internal Medicine in the article “Medicine and Quality of Life,” focusing on this problem as “harmony within a person and between a person and the world, the harmony that patients, doctors and society as a whole strive for.” The term QOL was officially recognized in medicine in 1977, when it was first included as a category in the Cumulated Index Medicus. In the 1970-1980s, the foundations of the concept of QOL research were laid, and in the 1980-1990s, the methodology for QOL research in various nosologies was developed.

Since 1995, an international non-profit organization studying QoL has been operating in France - the MAPI Research Institute - the main coordinator of all research in the field of QoL in the world. The Institute annually holds congresses on quality of life research (International Society for Quality of Life Research

ISOQOL), introducing into practice the thesis that the goal of any treatment is to bring the quality of life of patients closer to the level of practically healthy people. The ISOQOL branch in Russia has been operating since 1999, and since 2001, the concept of research into quality of life in medicine, proposed by the Ministry of Health of the Russian Federation, has been declared a priority; scientific research conducted using universal tools that meet the requirements of social, regional and linguistic differences is also recognized as a priority. Despite this, QOL research in our country is not widely used, mainly in conducting clinical studies and writing dissertations.

To date, there is no single comprehensive definition of “quality of life”. Below are definitions, each of which to a greater or lesser extent reflects the concept of “quality of life”.

Quality of life is an integral characteristic of the physical, psychological, emotional and social functioning of a healthy or sick person, based on his subjective perception (Novik A.A. et al., 1999).

Quality of life is the degree of a person’s comfort within himself and within the society in which he lives (Senkevich N.Yu., Belevsky A.S., 2000).

Quality of life is the functional impact of a health condition and/or subsequent therapy on the patient. Thus, the concept is subjective and multidimensional, covering physical and occupational functions, psychological state, social interaction and somatic sensations.

According to WHO experts, quality of life is “an individual correlation of one’s position in the life of society in the context of the culture and value systems of this society with the goals of a given individual, his plans, capabilities and the degree of general disorder.” WHO has developed fundamental criteria for QOL and their components:

Physical (strength, energy, fatigue, pain, discomfort, sleep, rest);

Psychological (positive emotions, emotions, thinking, learning, remembering, concentration, self-esteem, appearance, negative experiences);

Level of independence (daily activities, work capacity, dependence on treatment and medications);

Social life (personal relationships, social value of the subject, sexual activity);

Environment(well-being, safety, everyday life, security, accessibility and quality of medical and social security, availability of information, opportunities for training and advanced training, leisure, ecology).

In modern medicine, the term “health-related quality of life” has become widespread, denoting the assessment of parameters associated and not associated with the disease, and allowing for a differentiated determination of the impact of the disease and treatment on the psychological, emotional state of the patient, his social status.

The concept of “quality of life” is multidimensional at its core. Its components are: psychological well-being, social well-being, physical well-being, spiritual well-being.

Methodology for studying quality of life. There are no uniform generally applicable criteria and norms for the study of QOL. The assessment of QoL is influenced by a person’s age, gender, nationality, socio-economic status, the nature of his work activity, religious beliefs, cultural

national level, regional characteristics and many other factors. This is a purely subjective indicator of objectivity, and therefore assessment of the QOL of respondents is possible only in a comparative aspect (sick - healthy, patient with one disease - patient with another disease) with the maximum leveling of all external factors.

The main tools for studying QoL are standardized questionnaires (indices and profiles) compiled using psychometric methods. The first tools for studying QOL - psychometric scales created 30-40 years ago for the needs of psychiatry - were a brief summary of a clinical conversation between a doctor and a patient and were initially cumbersome. Special centers have been created in the USA and Europe to develop such questionnaires. In modern questionnaires, the features contained in the scales are selected using standardization methods and then studied on large samples of patients. Subsequently, the selected features form the basis for carefully formulated questions and answer options selected using the method of summing the ratings.

Thus, in international practice, standardized questionnaires are used, tested in clinical studies and clinical practice.

The following requirements are imposed on QOL questionnaires: multidimensionality, simplicity and brevity, acceptability, applicability in various linguistic and social cultures.

After the cultural and linguistic adaptation procedure, each questionnaire is tested for its psychometric properties: reliability, validity and sensitivity:

Reliability is the ability of a questionnaire to provide consistent and accurate measurements;

Validity is the ability of a questionnaire to reliably measure the main characteristic that it contains;

Sensitivity to change is the ability of the questionnaire to give reliable changes in QoL scores in accordance with changes in the respondent’s condition (for example, during treatment).

Such a complex methodology for the development, transcultural adaptation and testing of questionnaires before their widespread implementation in clinical practice fully complies with the requirements of Good Clinical Practice (GCP).

Novik A.A., Ionova T.I. proposes the following classification of QOL research tools.

Depending on the application:

1. General questionnaires (for children and adults).

2. Special questionnaires:

By field of medicine (oncology, neurology, rheumatology, etc.).

By nosology (breast cancer, peptic ulcer, rheumatoid arthritis, etc.).

Condition-specific questionnaires.

Depending on the structure, there are:

Profile questionnaires are several digital values ​​that represent a profile formed by the values ​​of several scales.

Indexes are a single digital value.

The most common general questionnaires include:

MOS - SF-36 - Medical Outcomes Study-Short Form.

European Quality of Life Scale - European quality of life assessment questionnaire.

WHOQOL-YO Questionnaire QOL-100 of the World Health Organization.

Nottingham Health Profile - Nottingham Health Profile.

Sickness Impact Profile - Sickness Impact Profile.

Child Health Questionnaire - Child Health Questionnaire.

The first six of the above questionnaires can be used in adults, regardless of health status.

The latter questionnaire is used to assess the quality of life of children (under 18 years of age), also regardless of their health status.

One of important features QOL research in children is the participation of the child and parents in the research procedure. Parents fill out a special questionnaire form. Another feature of the study of QoL in children is the presence of questionnaire modules by age.

General questionnaires (non-specific, used regardless of the specific disease) are designed to assess quality of life in both healthy people and patients, regardless of the disease, age or treatment method. The advantage of general questionnaires is that they have a wide coverage of QOL components and allow the study of QOL norms in a healthy population. However, their disadvantage is their low sensitivity to changes in QoL within a particular disease. For example, questions like “How far can you walk?” or “What is the intensity of the pain?” may be useful for patients with cardiac or oncological diseases, but will be less relevant for patients with neurological disease(for example, epilepsy).

General questionnaires may not be sensitive to the most important aspects of a particular disease. Specific questionnaires have advantages in this regard, but they do not allow comparisons between patients with different diseases or with healthy populations.

In many areas of medicine, special questionnaires for assessing quality of life have been developed. They are considered the most sensitive methods of monitoring

the treatment of specific diseases, which is ensured by the presence of components specific to these pathologies. Using special questionnaires, any one category of QoL is assessed (physical or mental condition), or quality of life for a specific disease, or certain types of treatment:

In cardiology:

The Seattle Angina Questionnaire (SAQ) (1992) - in patients with coronary artery disease.

Minnesota Living with Heart Failure Questionnaire (1993) - in patients with CHF.

Study of quality of life in arrhythmia (1998) - in patients with arrhythmia and others.

In pulmonology:

Asthma Symptom Checklist (1992) - for patients with bronchial asthma

St George's Hospital Respiratory Questionnaire (SGRQ) (1992) and others.

In rheumatology:

Arthritis Impact Measurement Scales (AIMS, AIMS2, AIMS2-SF) (1980, 1990, 1997) and others - in patients with joint diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis) and others.

Each questionnaire differs in the scope of the study, the time required to fill out the questionnaires, the methods of completion and the quantitative assessment of QOL indicators. Most questionnaires have been translated into all major languages ​​with appropriate adaptation to them.

But not everything is smooth in this scientific field. In addition to supporters of the method, there are opponents of studying QoL and creating questionnaires. Thus, Wade D., in his famous book “Measurement in Neutrogical Rehabilitation,” writes that without a clear definition of QoL, it is impossible to measure. He and his co-authors believe that QoL is a concept that is so individual, so dependent on the level of culture, public

education or other factors that it cannot be measured or assessed; in addition, in addition to the disease, the assessment of quality of life is influenced by many other factors that are not taken into account when creating questionnaires.

Goals of studying quality of life in medicine. In the book “Guide to the study of quality of life in medicine” Novik A.A., Ionova T.I. pay attention to two key aspects. On the one hand, the concept made it possible to return to the most important principle at a new stage of evolution clinical practice“to treat not the disease, but the patient.” Previously not entirely clearly defined tasks in the treatment of patients with various pathologies, clothed in vague verbal categories, have gained certainty and clarity. In accordance with the new paradigm, the patient's quality of life is either a primary or secondary goal of treatment:

1) QOL is the main goal of treating patients with diseases that do not limit life expectancy;

2) QOL is an additional goal of treating patients with life-limiting diseases (the main goal in this group is to increase life expectancy);

3) QoL is the only goal of treating patients in the incurable stage of the disease.

On the other hand, the new concept offers a well-developed methodology that allows one to obtain reliable data on the parameters of patients’ QoL, both in clinical practice and during clinical research.

The applications of QoL research in healthcare practice are extensive:

Standardization of treatment methods;

Examination of new treatment methods using international criteria accepted in most developed countries.

Providing comprehensive individual monitoring of the patient’s condition with assessment of early and long-term treatment results.

Development of prognostic models for the course and outcome of the disease.

Conducting socio-medical population studies identifying risk groups.

Development of fundamental principles of palliative medicine.

Providing dynamic monitoring of risk groups and assessing the effectiveness of prevention programs.

Improving the quality of examination of new drugs.

Economic justification of treatment methods taking into account such indicators as “price-quality”, “cost-effectiveness” and other pharmacoeconomic criteria.

It should be noted that assessment of QoL may be a prerequisite for testing medicines, new medical technologies and treatment methods at any stage, including phase 2-4 drug trials. QoL criteria are indispensable in comparing different treatment approaches:

If the treatment is effective but toxic;

If the treatment is long-term, the possibility of complications is low, and patients do not experience symptoms of the disease.

Studying a patient’s QoL before and during therapy allows one to obtain valuable information about a person’s individual response to the disease and treatment. The main principle of M.Ya. Mudrova “to treat not the disease, but the patient” can be realized using QOL assessment.

The study of quality of life is a highly informative tool that determines the effectiveness of the medical care delivery system and allows us to give an objective assessment of the quality of medical care at the level of its main consumer - the patient. Currently, the problem of improving the quality of life (including in medicine) is key in Russian public policy.

BIBLIOGRAPHY:

1. Novik A.A., Ionova T.I. Guidelines for quality of life research in medicine. 2nd edition / ed. acad. RAMS Yu.L. Shevchenko. M.: ZAO Olma Media Group, 2007. 320 p.

2. Novik A.A., Ionova T.I. Research on quality of life in medicine. Textbook for universities / ed. Yu.L. Shevchenko. M.: GEOTAR-MED. 2004.

3. Shevchenko Yu.L. The concept of researching the quality of life in Russian healthcare. Bulletin of the International Center for Quality of Life Research, 2003. P.3-21.

4. The WHOQOL Group // World Health Forum. 1996. V. 17. No. 4. P. 354.

5. World Health Organization. Quality of life group. What is it Quality of life? Wid. Hth. Forum. 1996.V.1. P.29.

6. http://www.quality-life.ru/

7. Cultural Adaptation of QoL Instruments // News Letter QoL. 1996. N° 13. P. 5.

8. Juniper E.F. From Genetics to QoL. The Optimal Treatment and Management of Asthma. Hogrete&Huber Publishers, 1996.

9. Juniper E.F. et al. /Determining a minimal change in a disease-specific quality of life questionnaire / J. Clin. Epidemiol. 1994. V. 47. No. 1. P. 81-87.

10. Karnovsky D.A. et al. / Evaluation of Chemotherapeutic Agents / Ed. by Maclead C.M. Columbia University Press, 1947. P. 67.

11. Elkinton J. R. Medicine and the quality of life // Annals of Internal Medicine. 1966. Vol. 64. P. 711-714.

12. Novik A.A., Ionova T.I., Kind P. The concept of studying the quality of life in medicine. St. Petersburg: Elbi, 1999. 140 p.

13. George M.R. et al. A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma // Arch. Intern. Med. 1999. V. 159. No. 15. P. 1710.

14. McSweeny A.J., Grant I., Heaton R.K. et al. Life quality of patients with chronic obstructive pulmonary disease. /Arch Intern Med. 1982. R.473-478.

15. Wenger N.K., Mattson M.E., Furberg C.D. et al. Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies // Am.J.Cardiol. 1984. - Vol.54. -P.908-913.

16. http://www. isoqol. org/

17. Kovalev V.V. The role of the mental factor in the origin, course and treatment of somatic diseases. M.: 1972. 47 p.

18. Senkevich N.Yu. Quality of life is a subject of scientific research in pulmonology / N.Yu. Senkevich // Ter. archive. 2000. T. 72, No. 3. P.36-41.

19. Cella D. Measuring quality of life in palliative care. Seminars in Oncology 1995:73-81.

20. Schipper H., Clinch, J.J., Olweny C.L. Quality of life studies: definitions and conceptual issues, In Spilker B Quality of Life and Pharmacoeconomics in Clinical Trials // Lippincott-Raven Publishers: Philadelphia. 1996. P.11-23.

21. Bowling A. Measuring Disease: a review of disease-specific quality of life measurement scales. - Buckingham: Open University Press, 1996. 208 p.

22. Aaronson N.K. Quality of life assessment in clinical trials: methodological issues // Control Clin. Trials. 1989. Vol.10. P.195-208.

23. Bowling A. Measuring Health: a review of quality of life measurement scales // 2nd edition. - Open University Press: Philadelphia, 1997. 160 rub.

24. Guryleva M.E., Zhuravleva M.V., Aleeva G.N. Criteria for quality of life in medicine and cardiology // Russian Medical Journal, vol. 14. No. 10. 2006. pp.761-763.

25. Chuchalin A.G., Senkevich N.Yu. Belyavsky A.S. Methods for assessing the quality of life of patients with chronic obstructive pulmonary diseases: A manual for doctors. M., 1999.

26. Aaronson N.K., Cull A., Kaasa S., Sprangers M. The European Organization for Research and Treatment of Cancer (EORTC) modular approach to quality of life assessment in oncology // Int.J.Ment. Health. 1994. Vol.23. P.75-96.

27. Bullinger M., Power M.J., Aaronson N.K. et al. Creating and evaluating cross-cultural instruments // Quality of life and Pharmacoeconomics in Clinical Trials. 2nd edition. Philadelphia: Lippincott-Raven Pulishers, 1996. P.659-668.

28. Calvert M, Blazeby J, Altman DG et al Reporting of patient-reported outcomes in randomized trials: the CONSORT PRO extension. JAMA. 2013 Feb 27; 309(8):814-22.

29. Pollard W.E., Bobbitt R.A., Berner M. et al. The sickness impact profile: reliability of a health status measure // Medical Care. 1976. Vol. 14. P. 146-155.

30. Staquet M.J. Quality of life assessments in clinical trials/ Oxford University Press: Oxford, New York, Tokyo, 1998. 360 p.

31. User’s guide to Implementing Patient-Reported Outcomes Assessment in Clinical Practice, International Society for Quality Life Research, 2011.

32. Guideline for Good Clinical Practice. ICN Harmonized Tripartite Guideline / Recommended for Adoption at Step 4 of the ICN Process on 1 May 1996 by ICN Steering Committee / WHO. Geneva, 1996. 53 p.

33. Ware J.E. SF-36 Physical and Mental Health Summary Scales: A User's Manual / J.E. Ware, M. Kosinski, S.D. Keller. Boston (Mass): The Health Institute; New England Medical Center, 1994.

34. Anderson R.T., Aaronson N.K., Wilkin D. Critical review of the international assessments of health-related quality of life // Qual. Life Res. 1993. Vol.2. p. 369-395.

35. Murphy B, Herrman H, Hawthorne G, Pinzone T, Evert H (2000). Australian WHOQoL instruments: User’s manual and interpretation guide. Australian WHOQoL Field Study Centre, Melbourne, Australia.

36. McEwen J, McKenna S: Nottingham Health Profile. In Quality of Life and Pharmacoeconomics in Clinical Trials. Second edition. Edited by Spilker B. Philadelphia, Lippincott-Raven Publishers; 1996. R. 281-286.

37. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. // Med Care. 1981. 19(8). R.787-805.

38. Landgraf JE, Abetz LN. Functional status and well-being of children representing three cultural groups: initial self-reports using CHQ-CF87 // Psychol Health 1997. 12 (6). R. 839-854.

39. Kots Ya.I., Libis R.A. Quality of life in patients with cardiovascular diseases // Cardiology. 1993. No. 5. P. 66-72.

40. Libis R.A. Evaluation of the effectiveness of treatment of patients with chronic heart failure, taking into account the dynamics of quality of life indicators: Dis. ... Ph.D. Orenburg, 1994.

41. Libis R.A., Prokofiev A.B., Kots Ya.I. Assessing the quality of life in patients with arrhythmias // Cardiology. 1998. No. 3. P. 49-51.

42. Myasoedova N.A., Tkhostova E.B., Belousov Yu.B. Assessment of quality of life in various cardiovascular diseases // Qualitative clinical. practice. 2002. No. 1.P.53-57.

43. Development and evaluation of Seattle Angina Questionnaire: a new functional status measure for coronary artery disease / J.A. Spertus // Journal of American College of Cardiology. 1995. Vol. 78. P. 333-341.

44. Rector TS, Kubo SH, Cohn JN. Patients" self-assessment of their congestive heart failure. Part 2: Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure questionnaire. // Heart Failure. 1987. P. 198-209.

45. Libis R.A. Assessing the quality of life of patients with arrhythmias / R.A. Libis, A.B. Prokofiev, Ya.I. Kots // Cardiology. 1998. No. 3. P. 49-51.

46. ​​Juniper EF, Buist AS, Cox FM, Ferrie PJ, King DR. Validation of a standardized version of the Asthma Quality of Life Questionnaire // Chest. May 1999; 115(5). R.1265-1270.

47. Jones P.W., Quirk F.H., Baveystock C.M. The St. George's Respiratory Questionnaire. // Resp Med. 1991; Vol. 8. P.525-531.

48. Meenan R.F., Gertman P.M., Mason J.H. et al. The arthritis impact measurement scales // Arthritis and Rheumatism. 1992. Vol.25, No. 9. P.1048-1053.

49. Ren X.S., Kazis L., Meenan R.F. Short-form arthritis impact measurement scales 2 tests of reliability and validity among patients with osteoarthritis // Arthritis Care and Research. 1999. Vol.12, No.3. R.163-173.

50. Pushkar D.Yu., Dyakov V.V., Bernikov A.N. Quality of life - a new paradigm of medicine // Pharmateka No. 11. 2005. pp. 15-16.

51. Wade D. “Measurement in Neutrogical Rehabilitation” Oxford: Oxford University Press. 1992.

The measurement of quality of life is based on the patient's assessment of his level of well-being in physical, mental, social and economic terms. QoL is a dynamic state, a function that changes over time, and therefore it should be assessed over a certain period as a changing parameter, depending on the type and course of the disease, the treatment process and the medical care system.

The process of working with such a subtle matter as the patient’s sense of his own quality of life is very complex and time-consuming, and requires a professional approach. Quality of life studies are typically part of a broader clinical research protocol, conducted in accordance with Good Clinical Practice (GCP). The main components of QoL can be measured separately or as a whole using various questionnaires, tests, scales, and indices. Data can be obtained from a personal conversation with the patient, by telephone, based on responses to a questionnaire.

Collecting standard answers to standard questions is the most effective method of assessing health status. Carefully constructed connections between questions and answers, compiled for calculation using the method of summing ratings, formed the basis of modern QOL questionnaires (currently more than 60). Instruments to measure quality of life should be simple, reliable, brief, sensitive, understandable and objective. Modern instruments Quality of life assessments are developed using psychometrics - a science that translates people's behavior, feelings and personal assessments into indicators accessible to quantitative analysis.

Each instrument must have psychometric properties such as reliability, objectivity, reproducibility and sensitivity.

The objectivity of an instrument implies that it can be used to measure what it was intended to measure. Within this property, meaningful objectivity is distinguished, i.e. the degree to which the measured attribute represents the phenomenon under study, and constructive objectivity, i.e. correlation of this test with others that measure related characteristics.

Instrument reliability is the degree of freedom from random errors.

Sensitivity is the ability to reflect changes occurring over time, often minimal but clinically significant.

A number of other requirements are also applied to questionnaires studying quality of life:

• 1 versatility (coverage of all health parameters);
• 2 reproducibility;
• 3 ease of use and brevity;
• 4 standardization (offering a single version of standard questions and answers for all groups of respondents);
• 5 assessment (quantitative assessment of health parameters).

In assessing the quality of life, two groups of questionnaires are used - general and special. General questionnaires are designed to assess the health of the population as a whole, regardless of pathology, so it is advisable to use them to assess health care tactics in general and when conducting epidemiological studies. The advantage of general questionnaires is that their validity has been established for various nosologies, which allows for a comparative assessment of the impact of various medical programs on the quality of life of both individual subjects and the entire population. The disadvantage of general questionnaires is their inadequate sensitivity to changes in health status within the framework of a particular disease.

Special questionnaires are designed to measure the quality of life of patients with a specific group of diseases, which allows the researcher to focus on a specific nosology and its treatment. Special questionnaires allow you to capture changes in the quality of life of patients that have occurred in the last 2-4 weeks.

There are no uniform criteria and standard standards of QoL. Each questionnaire has its own criteria and rating scale. The calculation is carried out on each scale separately (profile measurement) or by summing the data from all scales (calculating the sum of points).

The first official methodology was the WHO scale. In the WHO scale, the score obtained from the analysis of questionnaire data is assigned to a certain characteristic of the standard of living. There are 6 possible gradations in the scale:

• 0 - normal condition, full activity;
• 1 - symptoms of the disease are present, activity is reduced, the patient can be at home;
• 2 - severe symptoms of the disease, disabled, spends less than 50% of the time in bed;
• 3 - severe condition, spends more than 50% of the time in bed;
• 4 - the condition is very severe, 100% or more of the time in bed;
• 5 - death.

The scale, apparently, is the most general and does not assess the patient’s functional activity and his acceptance of his condition, the reasons that led to this condition. This scale became the prototype of modern methods.

Among general questionnaires, the most popular is the SF-36 (Short Form), a relatively simple questionnaire designed to meet minimum psychometric standards. SF-36, having a fairly high sensitivity, is short. It contains only 36 questions, which makes it very convenient to use for group comparisons, taking into account general concepts of health or well-being, that is, those parameters that are not specific to different age or nosological groups, as well as groups receiving certain treatments. The SF-36 questionnaire contains the 8 health concepts that are most frequently measured in population-based studies and that are most affected by disease and treatment. The SF-36 is suitable for self-administration, computer-based interviewing, or completion by a trained interviewer in person or by telephone for patients 14 years of age and older.

The questionnaire contains 8 scales:

• 1. Limitations of physical activity due to health problems (illness).
• 2. Limitations in social activity due to physical or emotional problems.
• 3. Limitations in normal role activities due to health problems.
• 4. Bodily pain (body pain).
• 5. General mental health (psychological distress or psychological well-being).
• 6. Limitations in normal role activities due to emotional problems.
• 7. Vitality (vigor or fatigue).
• 8. General perception of your health.

Quality of life criteria according to SF-36 are:

• 1. Physical activity (PA). Subjective assessment of the volume of daily physical activity, not limited by the current state of health. Direct connection: the higher the PA, the more physical activity, in the opinion, he can perform.
• 2. The role of physical problems in limiting life activity (RF). Subjective assessment of the degree of limitation in daily activities caused by health problems over the past 4 weeks. Feedback: the higher the indicator, the less health problems limit his daily activities.
• 3. Pain (B). Characterizes the role of subjective pain in limiting his daily activities over the last 4 weeks. Feedback: the higher the indicator, the less painful sensations interfere with his activities.
• 4. General health (OH). Subjective assessment of the general state of your health at the present time. Direct connection: the higher the indicator, the better one perceives one’s health in general.
• 5. Viability (VC). Subjective assessment of your vitality (vigor, energy) over the last 4 weeks. Direct connection: the higher the indicator, the higher he evaluates his vitality (he spent more time over the last 4 weeks feeling cheerful and full of energy).
• 6. Social activity (SA). Subjective assessment of the level of your relationships with friends, relatives, work colleagues and other teams over the last 4 weeks. Direct connection: the higher the indicator, the higher the level of your social connections.
• 7. The role of emotional problems in disability (LI). Subjective assessment of the degree of limitation of one's daily activities caused by emotional problems over the last 4 weeks. Feedback: the higher the RE, the less the emotional status interferes with everyday activities.
• 8. Mental health (MH). Subjective assessment of your mood (happiness, calmness, peace) over the last 4 weeks. Direct connection: the higher the indicator, the better the mood.

One of the features of our life has become a new understanding of generally accepted values. The desire to live in harmony with oneself, surrounding nature for modern people it becomes almost the main guideline in life. We can say that the life of a modern individual is largely expressed through achievements in a healthy lifestyle. For a person to have a comfortable existence, his standard of living must have a certain quality - a positively charged factor, for example, the presence of a spouse, the health of children, the presence or absence of friends, work, leisure, etc. The study of these numerous factors and their influence on a person is quality of life (QoL). Now more than ever, the words of Kant are true, calling on everyone to “treat humanity, both in one’s own person and in the person of everyone else, as an end, and never only as a means.”

I would like to quote the words of F. Engels wrote: “The relationship between quality and quantity is mutual... Quality also turns into quantity, just as quantity into quality... here there is an interaction.” In connection with the above, “the content of medical activity can be disclosed in quantitative and qualitative aspects.” On the one hand, this is “a person’s progressive mastery of the conditions of his own life...: maintaining baseline, correction, regulation, management and, finally, design of human life.” On the other hand, medicine is “the fight against diseases, and the protection of health, and its strengthening, and the extension of the period of active working capacity, and the physical improvement of a person, etc.” .

Positive or negative perception of QOL by the person himself has a huge impact on the duration (amount) of life. Centenarians have a way of life, the conditions in which they live, their spiritual component are in harmony and are ideal for them. Moreover, it is not so important what layer of society they occupy. For them, an important indicator becomes some kind of goal, peace, love, life itself... A striking example is the life of the same Immanuel Kant. The great philosopher, who was born a very sick child, developed and throughout his life observed an individual system of work, rest, and nutrition. Thanks to his fortitude, he maintained his body in an active creative state until a very old age. Unfortunately, there are many more examples of the inability to enjoy life as it is. Constant stress, suppressing the immune system, promoting the development of the so-called. diseases of civilization, ultimately shortens the “joyless” life.

But the “quantity” of a person’s life cannot be ignored. It can have both positive and negative effects on its quality. If we take into account that the average life expectancy of men in Russia does not exceed 60 years, and for women on average 67 and it is sharply decreasing, then now people choose pleasures - tobacco, drugs, alcohol, unhealthy diet... But if a person realizes that his behavior entails a reduction in the “amount” of life, and, most importantly, sees the real dependence of maintaining a healthy lifestyle and its duration, then his quality of life will improve.

Since the advent of “healing,” doctors have strived to prolong the lives of patients. But it was only by the mid-twentieth century that these attempts became global. Many authors currently highlight one of the reasons for the growing interest in the problem of QoL in healthcare - this is the development of nanotechnology. The scientific and technological progress of medicine over the past decades has led to the fact that the majority of today's people are unconditionally confident that the independent decision they made is the only correct one. There are more and more patients with chronic diseases that not only progress, but cannot be cured radically. These people rightly demand improved quality of life.

“I’d rather die with my own hair on my head,” as the heroine of D. Longe’s novel “News from Paradise” said, refusing chemotherapy for cancer.

The main method for assessing quality of life is questionnaires, both general and specific. A general questionnaire is widely used short form Medical Outcomes Study Short Form (SF-36). There is its Russian form, which is actively used to study the quality of life of patients. The study of quality of life indicators in patients with CVD is also carried out using three questionnaires: Physical Activity Scale, Nottingham Health Profile (NHP), Psychological General Well Being index. In European countries, the NHP questionnaire is more common. The higher the score on the scale, the worse the quality of life. In the USA (Seattle Veterans Affairs Medical Center, Seattle, Washington), quality of life parameters are assessed mainly using two questionnaires: general (SF-36) and special (Seattle Angina Questionnaire-SAQ).

But frequently used questionnaires are designed for patients to fill out independently and are absolutely not suitable for certain groups. For example, those who cannot read or write, the elderly, people with serious musculoskeletal disorders, etc. There is a percentage of error in which patients do not know what to answer, or find it difficult, and this leads to the fact that not all questions are answered, and this entails data loss. There are no such difficulties when interviewing, but this process is quite labor-intensive and requires additional time and labor costs.

One way or another, the dominant method for assessing quality of life is questionnaires, both general and specific. The general Medical Outcomes Study Short Form (SF-36) questionnaire is widely used. There is its Russian form, which is actively used to study the quality of life of patients. The study of quality of life indicators in patients with CVD is also carried out using three questionnaires: Physical Activity Scale, Nottingham Health Profile (NHP), Psychological General Well Being index. In European countries, the NHP questionnaire is more common. The higher the score on the scale, the worse the quality of life. In the USA (Seattle Veterans Affairs Medical Center, Seattle, Washington), quality of life parameters are assessed mainly using two questionnaires: general (SF-36) and special (Seattle Angina Questionnaire-SAQ).

In the SF-36 methodology, higher scale values ​​correspond to a higher quality of life, and in the MLHFQ and Nottingham methodology, on the contrary, a higher indicator corresponds to a lower quality of life. Brief ones are the scale for assessing the clinical condition of a patient with CHF (modifications of Mareeva V.Yu., 2000), which includes 10 questions, and the EQ-5D questionnaire, which provides a three-point scale for assessing answers to five questions.

Initially, the quality of life of patients with heart disease was assessed using general questionnaires: NHP, SF-36, EuroQol. The authors of these studies came to the conclusion that none of the existing tests fully allows adequate assessment of QOL in heart pathology, since a poor reflection of some symptoms inherent in a particular disease was revealed. All of the above demonstrated the need to develop a separate questionnaire for cardiac patients, taking into account the characteristics of QoL.

In addition to supporters of the method, there are also opponents of studying QoL and creating questionnaires. Thus, D. Wade in his book “Measurement in Neurological Rehabilitation” writes that it is impossible to measure QOL without having a clear definition. He believes that QOL is a purely individual concept and depends on the level of culture, education and other factors, which is impossible to evaluate or measure. In addition, in addition to the disease, the assessment of QoL is influenced by many other factors that are not taken into account when creating questionnaires. This point of view is shared by S. Hunt, who believes that quality of life is a hypothetical, theoretical construct that is not subject to quantitative measurement.

The overall assessment of QoL represents exactly that missing information in treatment - the patient’s reaction to his disease and its treatment, thereby helping to clarify the prognosis and, as a result, recovery. This issue was raised at the Russian National Congress of Cardiologists in Kazan in September 2014.

Since over the past ten years the problems of QoL have acquired an international scale, the first question that arises is: how comparable are studies of the QoL of patients performed in different countries? different languages, in different countries, in different cultures (minorities)? For this purpose, before starting to use the questionnaire instrument, it is necessary to determine all possible compatible parameters and only then evaluate the initial result.

Thus, we can conclude that a person’s quality of life is becoming the main indicator of the health of the nation as a whole and determines the country’s health development strategy.

Bibliography

1. Gilerevsky S.R., Orlov V.A., Bendeliana N.G. and others. Study of the quality of life in patients with chronic heart failure: current state Problems. Russian Journal of Cardiology, 2001, P.72.

2. Kant I. Works. M. 1965. T. 4. Part 1. P. 270.

4. National leadership. Cardiology. /Ed. Yu.N. Belenkova, R.G. Oganova.M.: GEOTAR-Media, 2013.1056 p.

5. National recommendations of VNOK (All-Russian Scientific Society of Cardiologists) 2011, 2005-2010 Source of information - official website of VNOK www.scardio.ru

6. Engels F. Dialectics of nature. OGIZ. Gospolitizdat, 1941, p. 203.

7. Tsaregorodtsev G.I., Erokhin V.G. Dialectical materialism and theoretical foundations of medicine. M.: Medicine, 1986. P. 21-22.

8. Hunt S.M. The problem of quality of life. Quality Life Res 1997; 6:205-210.

9. Lamping D.L., Schroter, Kurz X. et al. Evaluation of outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life. J Vasc Surg 2003;37:2:410-419.

10. Launois R., Reboul-Marty J., Henry B. Construction and validation of quality of life questionnaire in Chronic Lower Limb Venous Insufficiency (CIVIQ). Quality Life Res 1996; 5:539-554.

11. Longe D. Paradise news. Harmondsworth: Penguin Books, 1992:26.

12. Rector T.S., Tschumperline L.K., Kubo S.H. et al. Use of the Living with Heart Failure Questionaire to ascertain patients` perspectives on improvement in quality of life versus risk of drug-induced death//J.Cardiol.Fail.1995.Vol.1, No. 3. P.201-206.

13. Wade D.T. Measurement in neurologinal rehabilitation. Oxford: Oxford University Press 1992.