Presentazione sul tema: "QUALITY OF LIFE - A FEW DEFINITIONS"— Transcript della presentazione:
1QUALITY OF LIFE - A FEW DEFINITIONS “.….gap between expectations and achievement: the smaller the gap, the higher the quality of life” Calman…..ability to function cognitively, physically, socially and sexually, to perform usual daily activities” Stewart & King“…..overall satisfaction with life and sense of personal well-being” Shumaker
2QUALITA’ DI VITASalvaguardare la salute di un individuo significa non solo assicurare il suo benessere fisico ma anche quello psicologico
3Menopause: factors that can affect QoL vasomotor and sleep disturbancespsychological and emotional stressgenitourinary and sexual complaintschanges in body imageop: backache, fracturesCVD: anginaAlzheimer disease
4QUALITA’ DI VITAUno dei principali sforzi del ginecologo dovrebbe essere quello di eliminare o migliorare questi sintomiHRT può essere utilizzata per mantenere l’efficienza fisica e psicologica quotidiana della donna in menopausa
5Women’s Health Questionnaire (WHQ) scores according to menopausal status in 928 women
6CONSEGUENZE DELLA MENOPAUSA A breve termine A medio termine A lungo termineArtralgieAnsiaSudorazioniVampate AtrofiaParestesie genito-urinariaPalpitazioniAsteniaDepressioneCefaleaInsonniaVertiginiPrecordialgieOsteoporosiMalattiecardiovascolariPeggioramentofunzioni cognitiveDanni cutanei e oculari
7Progetto Menopausa Italia sotto il patrocinio ed il coordinamento dell’AOGOI Obiettivi1) descrivere l’epidemiologia dell’approccio diagnostico- terapeutico alla menopausa nei centri specialistici in Italia2) descrivere le conseguenze della menopausa stessa sulla salute della donna.Eleggibili per lo studio tutte le donne osservate per la prima volta nel periodo di reclutamento presso i centri collaboranti
81 CED 240 SPAC 99.363 donne arruolate al 02/02/02 Progetto Menopausa Italia sotto il patrocinio ed il coordinamento dell’AOGOIdonne arruolate al 02/02/021 CED240 SPAC185 U.O.
9PROGETTO DONNA QUALITÀ DI VITA 74 Centri Universitari e Ospedalieri sul territorio NazionalePresidenteProf. A. R. Genazzani (Pisa)Comitato Scientifico Segreteria ScientificaProf. C. Campagnoli (Torino)Prof .C. Nappi (Napoli) Dr. M. Gambacciani (Pisa)Prof. GiovanBatttista Serra(RM)Comitato di CoordinamentoProf. D. de Aloysio (Bologna) Prof. C. Donati Sarti (Perugia)Prof. S. Guaschino (Trieste) Prof. A. Cianci (Catania)Prof. F. Petraglia (Udine) Prof. S.. Schonauer (Bari)Prof. A. Volpe (Modena) Prof . G. Palumbo (Catania)Dr. A. Genazzani (Modena) Prof. F. Bottiglioni (Bologna)
10The WOMEN’S HEALTH QUESTIONNAIRE WHQ (by Myra Hunter)36 items combined into nine factors describing:somatic symptomsdepressed moodcognitive difficultiesanxiety/fearsexual functionvasomotor symptomssleeps problemsmenstrual symptomsattractionAll the questions are rated on four-point scale.
11The MOS 36-Item Short-Form Health Survey (SF- 36)36 items combined into eight factorsphysical functionphysical rolebodily paingeneral healthvitalitysocial functionmental healthand two summarizing measuresphysical health
12The European Quality of Life Questionnaire EQ-5D Simple, generic measureMinimum number of questionsIt produces an overall single number, “an index” of health statusIncludes 5 dimensions:mobilitypersonal careusual activitiespain/discomfortanxiety/depression)(with 5 questions, 3 levels of response for each dimension)
13QUALITY OF LIFE EVALUATION IN ITALIAN MENOPAUSAL WOMEN Multicentric study on the quality of life (QoL ) in women aged between 45 and 65 years, attending menopause centres in Italy.Each of 64 menopause centres involved recruited up to 50 women, using random lists stratified by HRT (yes – no).
14QoL variables Age marital status employment, partners’ employment Employment was considered as a proxy for socio-economic status. To this purpose, a socio-economic score (SES) was created, ranging from 1 to 6. The score was assigned as follows: unemployed, housewife=1; retired=2; unskilled worker=3; skilled worker, artisan=4; technical, clerical=5; professional, managerial=6. For married women, the profession scoring higher between wife and husband was considered.geographic areamenopause durationpresence of chronic diseasespresence of HRT
15Percent distribution of the 2760 PMW according to HRT ( on HRT, n=1342, 49%). Women on HRT were significantly more likely to have a menopause duration >3 years and significantly less likely to suffer from chronic diseases.0.0003
16Percent distribution of the 2760 PMW according to geographic area. PMW attending menopause centres in northern Italy are older, with lower education, lower socio-economic score and longer menopause duration.
17QUALITY OF LIFE EVALUATION IN ITALIAN MENOPAUSAL WOMEN Correlates of QoL were first investigated with a series of bivariate analysesTo adjust for the possible confounding effects, multiple logistic regression analyses were applied to evaluate the independent role of variables investigated in predicting QoL
18Results of the stepwise logistic regression analyses with SF-36 scores as dependent variables. school education (the higher the education, the better the QoL),socio-economic score (the higher the SES, the better the QoL),geographic area (women in southern Italy showing worse QoL),presence of chronic conditions (associated with poorer QoL)marital status and menopause duration are not related with any of the SF-36 areas
19Independent predictors of SF-36 domains HRT associated with better QoL in all of the areas investigated***********p< 0.05
20Stepwise logistic regression analyses with SF-36 scores as dependent variables. the use of HRT represents an independent predictor for limitations due to emotional problemsNSPCS0.0051.01.3HRTYesNoMCSVitalitySocial functionRole physicalRole emotionalAttivitàfisicaSalutementalegeneraleDolorecorp.
21WHQ scores according to HRT use A high score (lower QoL) is associated with:low school educationlow SESliving in Southern Italypresence of chronic diseases*******
22Results of the stepwise logistic regression analyses with WHQ scores as dependent variables according to HRT1.02.6.000NS1.5 .0031.4.0001HRTYesNopVasomotor sympt.Odds RatioSomatic sympt.Sleep problemsSexual problemsMenstrual symptomsMemory/ concentr.DepressionAttractivenessAnxiety/ fearsOddsRatioUntreated women showed a 40% increased risk of reporting anxiety/fears, a 50% increased risk of sexual problems and a more than two-fold increased risk of vasomotor symptoms
23EQ-5D: Percentages of respondents referring absence of problems **** p< 0.05
24EQ-5D Results of the stepwise logistic regression analyses MobilitySelf-careUsual activitiesPain/discomfortAnxiety/ depressionThermometerpNS 0.020.03 HRT No1.0HRT Yes1.41.2The presence of chronic conditions and the geographic area represent the most important predictors.After adjusting for the other variables investigated, women not treated with HRT show an increased risk of reporting problems in the areas of usual activities and pain/discomfort
25Progetto Menopausa Italia in Lombardia Coordinatore: Massimo Luerti
26Situazione delle 18 SPAC della Lombardia al 24/02/2000
27Età: media e deviazione standard Numero soggetti: 5820
38IDENTIKIT DELLE UTILIZZATRICI DI HRT reddito familiare e livelli di scolarità superiorepiù magre, praticano più esercizio fisico, hanno un assetto lipidico più favorevolefumano di più e assumono più alcoolicisono più spesso isterectomizzatelamentano più spesso una sintomatologia climaterica (specie artralgie)
39CONCLUSIONI“Perceptions of well-being in healthy, post-menopausal women depend less upon biology than on socio-economic circumstances, individual experiences, resources and cultural morals”Hunt SM. Quality of Life Res 2000;9:
40Cross-sectional Evaluation of QoL, Menopause and HRT different factors play an important rolelow education is associated with a higher risk of reporting somatic and vasomotor symptoms,low Social Economic Scores exerts a negative effect on attractiveness, depression and sleep problemsHRT is a factor that can modify at least some aspects of QoL in symptomatic PMW
41HRT users CONCLUSIONI have a shorter duration of menopause have less chronic diseasestend to be slightly more educated and to belong to higher socio-economic classes, but these differences were marginal
42CONCLUSIONIAt univariate analyses, HRT users showed a significantly better QoL in all the areas investigated by the SF-36, in three of the six items of the EQ-5D and in all the symptoms scores of the WHQ, with the only exceptions of menstrual symptoms and memory/concentration.After adjusting the analyses for a large array of different socio-economic and clinical variables, several associations between HRT use and QoL became not significant, suggesting that they were mediated by the other factors considered in this study.Nevertheless, HRT users showed a lower probability of reporting role limitations due to emotional problems (SF-36) and anxiety/fears (WHQ).HRT was also associated with a lower probability of reporting problems in the usual activities and pain/discomfort items of the EQ-5D
43CONCLUSIONIWhen looking at menopause symptoms, HRT users showed highly significant better outcomes in vasomotor symptoms and sexual problems (particularly vaginal dryness).HRT can be of benefit for many of the postmenopausal mood changes, pain perception and social functioning, sexual problems and vasomotor symptomsuntreated women have a 40-50% increase in the risk of suffering from anxiety and sexual problems, with an almost 3- fold increase in the incidence of hot flushes and sweats
49HRT AND QoL 0.0003 409 (29%) 306 (23%) Chronic diseases 0.00002 Women on HRT were significantly more likely to have a menopause duration >3 years and significantly less likely to suffer from chronic diseases.0.0003409 (29%)306 (23%)Chronic diseases782 (64%)444 (36%)627 (55%)510 (45%)Duration of menopause< 3 years> 3 yearsHRT freeHRT“Healthy user effect” should be considered when we evaluate the HRT effects in Italy
50Progetto Menopausa Italia sotto il patrocinio ed il coordinamento dell’AOGOI Obiettivomigliorare la qualità di assistenza alle donne in menopausa favorendo la diffusione culturale tra medici, istituzione e diverse componenti del tessuto sociale, organizzando relazioni e programmi interdisciplinari. Si propone inoltre di istituire un laboratorio di epidemiologia al fine di valutare l'adeguatezza e la compliance delle strategie mediche, promuovere, partecipare e monitorare trials sperimentali
51VALUTAZIONE DELLA QUALITA’ DI VITA NELLE DONNE ITALIANE IN MENOPAUSA Questionario WHQ(Women’s Health Questionnaire)Questionario sviluppato in Inghilterra per valutare un ampio spettro di sintomi fisici e della sfera emotiva nelle donne di mezza età, con particolare attenzione alle modificazioni nello stato di salute e di benessere, legate alla menopausa.Il questionario è costituito di 36 domande con risposte su una scala a 4 punti.Le 36 domande si combinano in 9 fattori.
52VALUTAZIONE DELLA QUALITA’ DI VITA NELLE DONNE ITALIANE IN MENOPAUSA SF36 Health Survey InstrumentStrumento generico più utilizzato in diversi paesi per la valutazione della QdVContiene 36 items che concorrono a formare 8 scale (physical function, role physical, bodily pain, general health, vitality, social function, role emotional, mental health) e 2 misure riassuntive (stato di salute fisico e mentale)
53* M. Hunter. Psychology and Health 1992; 7: 45-54 PROGETTO DONNA QUALITÀ DI VITAConfronto fra popolazione Italiana e Inglese** M. Hunter. Psychology and Health 1992; 7: 45-54
55PROGETTO DONNA QUALITÀ DI VITA Valori SF-36 nelle due popolazioni *Mann-Whitney U-test
56“Progetto Donna Qualità di Vita” Prima Fase RisultatiLo studio ha dimostrato che :la versione Italiana del WHQ è valida e riproducibilenon esistono differenze sostanziali in termini di percezione della qualità della vita tra la popolazione italiana e popolazioni dei Centri della Menopausa
57Independent predictors of SF-36 domains HRT associated with better QoL in all of the areas investigated, including also the two summary measures (physical and mental component scores).p=0.00849±848±8PCSp=0.0345±1144±1159±1957±19p=0.0274±2172±22p=0.00974±3569±37p=0.00371±3766±3985±1782±1964±1962±20p=0.00164±1861±18p=0.00567±2464±23HRTYesNoMCSVitalitySocial functionRole physRole emotioPhysical activityMental healthGeneral healthBodily pain
58EQ-5D : Percentages of respondents referring absence of problems and mean values of the thermometer, according to HRT use73.9±1533%40%86%97%88%Yes72.7±16NSThermometer28%34%82%96%85%Nop=0.04p=0.02p=0.01HRTAnxiety/ depressionPain/discomfortUsual activitySelf-careMobilityWomen on HRT reported less often to have problems in the areas of usual activities, pain/discomfort and anxiety/depression
59WHQ scores according to HRT use A high score (lower QoL) is associated with low school education, low SES, living in Southern Italy and presence of chronic diseasesp<0.00010.28±0.40.48±0.4p=0.0060.44±.30.47±.4p=0.00040.47±0.40.53±0.40.34±0.30.38±0.3NS0.23±0.30.24±0.30.50±0.4p=0.030.26±0.20.29±0.2p=0.020.33±0.40.37±0.4p=0.00080.36±0.30.41±0.3HRTYesNoVasomotor sympt.Somatic sympt.Sleep problemsSexual problemsMenstrual symptomsMemory/ concentr.DepressionAttractivenessAnxiety/ fears