Modern approaches to the study of social conditioning of public health. health related quality of life

Everyone will die one day. But what kind of life will each one live? Will be sick from childhood, or the disease will overtake in adulthood? Will the disease be excruciating, will the person suffer without getting out of bed, go to doctors and examinations, or will it overtake in an instant, fall asleep and not wake up?

Death is a natural physiological process that occurs as a result of illness, accident or naturally(old age). Everyone will die one day.

But what kind of life will each one live?

Will it hurt from childhood, or will the disease overtake in adulthood?

Will the disease be excruciating, will the person suffer without getting out of bed, go to doctors and examinations, or will it overtake in an instant, fall asleep and not wake up?

Will the diagnosis be one or like a bouquet of wild flowers, with different smells, shades, shapes and sizes?

A person dies at 90. By today's standards, he is considered a long-liver. But, at the same time, for the last 10-20 years he was bedridden and we can say that he did not live, but lived out his term.

What is the essence of such survival, because it is not a fact that the long-liver was in a strong mind, and even more so - he could be unconscious. Or, for example, a person dies in a plane crash, while never sneezing in his life.

The quality of life is what needs to be valued above all. A person experiencing pain, no matter how hard he tries to look happy, projects it into the outside world. It is not difficult for people around him to read this information.

IN modern world It is customary to shift responsibility for the quality of your health, and hence the quality of life, into the hands of professionals, in fact, into the hands of people you do not know.

Those who see you for the first time and have no idea about what happened to you before coming to them and they, to a greater extent, do not care what will happen to you after. This attitude towards their health is considered the norm. They studied - they know, so they will help me defeat the disease.

Do they know and will they help?

There is a popular expression of N. Amosov "Do not hope that doctors will make you healthy."

I'll tell you a secret - not all doctors can cope with their health, they themselves seek help from their own colleagues. A person is accustomed to trust doctors.

I do not aim to devalue the contribution and work of doctors. I just want to draw the reader's attention to the fact that no one hears your body better than you. Only you can hear and recognize the signals from your body.

Healthy lifestyle - what does it mean?

Taking care of your health is not the same as being healthy.

Going to the gym, jogging, adhering to an incredibly healthy diet - does not at all mean knowing and feeling your body, organs and systems. Patients come to me.

Someone is in love with their pain and under no circumstances, on a subconscious level, does not want to part with it.

They benefit from being sick. With their illness, they can easily manipulate others, receive love and attention to themselves.

They supposedly need from me magic pill from which the pain will pass.What they really need is my time, attention and my energy.

It is beneficial for someone to constantly be treated, thereby creating imaginary employment for themselves: today I passed such and such tests, went through such and such doctors.

Such comrades come stably once a week, while they themselves do nothing for themselves, although I have opened all the cards. But there are patients who benefit from being healthy.

They need information from me “how to make it so as not to get sick”. At the appointment, I introduce patients to their body, tell organ and system relationships, teach them to hear myself and find the cause of ailments. And how much the patient is ready to cope on his own (under my control) depends on his commitment, talent, motivation and aspiration. Curing a patient is not an end in itself for me.

To teach the patient to improve the quality of his life is my task. After all, it is a great thing not to depend on a doctor, pills, physical examinations.

Live easy life in a light body. Do not think about a runny nose, headache and menstrual pain, and back pain, do not creak your knees and fall asleep quickly sound sleep and wake up with a fresh look and a bright head.

In recent years, people have ceased to be aware of how much money they leave in the pharmacy: vitamins, immunostimulants, antispasmodics, anti-chichins, antitussives and something else, just in case, to have it, otherwise suddenly - but I don’t have an enema, or something “from the heart”.

And now, you are already a happy owner of a “half-pharmacy”, stuffing something into yourself in packages, not understanding what it is and why all this is needed. It also happens that I listen to the patient and feel like I am at a lecture on pharmacy.

It surprises me at such moments how patients manage to keep all this in their heads, why do they need all this knowledge and, most importantly, if all these pills do not help you, why do you study them with enviable diligence, buy them and push them into yourself?

Apparently, the person is trying to be healthy. But, is it possible to talk about the quality of life in such cases? A quality life is when it doesn’t hurt, and if it hurts, then you know how to cope with it without a pharmacy.

The quality of life is when the female gender does not leave thousands of dollars in cosmetic stores (because the night cream is over) and offices (because I'm 30, and I look 35 and I have teenage acne).

The quality of life is when a 35-year-old man is not taken to the ambulance with a heart attack, because he has never had any pain.

The quality of life is when a child is born in a family and parents do not need to collect huge sums money for a child for an emergency operation in Israel.

Healthy parents do not give birth to children with disabilities. Give birth - it will be easier for you with health, today “the moon is in Capricorn” I urgently need to get pregnant, we will go to India and we will close the baby there because there is a place of power, but at the same time the woman has a bouquet of sores - food is not digested, acne is not only on the face, the man is a hard raw foodist and infantile.

But everyone is sure that God loves them and will give them a healthy child, and as a result, unfortunate cheburashkas are born.

And this is considered a quality life?

It is said that sick children are given to parents for their sins. Yes it is. Before you give life to another, put yours in order. Learn to know yourself, listen to your body.

Learn to stop the development of pathology and restore your body. Learn to easily cope with a cold without pills and then life will sparkle with other rays and colors.

Then it will be possible to say: "I live a quality life thanks to quality health."

Anna Klyueva

Introduction

The tasks of cardinal socio-economic transformations in Russian society at the present time, improvement of democratic relations, market mechanisms significantly actualize the problems of the qualitative composition of the population, its compliance with modern requirements. Consideration of life processes in their unity is both of scientific interest and an extremely important condition for the development of a system of measures for effective socio-economic and demographic policy, for demographic planning and forecasting. The concepts of "quality of the population" and "quality of life of the population" are acquiring ever-increasing importance, including for the security of the state, in modern conditions.

The determining indicator in assessing the quality of the population is public health as one of the most important indicators of the well-being of society, on which all other characteristics depend. Public health reflects the health of the individuals that make up society, but is not the sum of the health of individuals. Even the WHO has not yet come up with a concise and comprehensive definition of public health. "Public health is such a state of society that provides conditions for an active productive lifestyle, not constrained by physical and mental illnesses, i.e. this is something without which society cannot create material and spiritual values, this is the wealth of society" (Yu .P. Lisitsin).

1. The concept of quality of life

In recent years, in economically developed countries, where basic material goods are available to most of the population, the concept of "quality of life" has become widely used, but so far this term itself does not have a generally accepted definition. As the human society the attitude towards this concept will obviously change. Each next generation, having put forward its own requirements for life, will itself determine the criteria for its "normality" and "quality".

The World Health Organization (1999) proposed to consider the quality of life as an optimal state and degree of perception individuals and the population as a whole about how their needs are met (physical, emotional, social, etc.), how opportunities are provided for achieving well-being and self-realization. In the future, this definition changed somewhat, however, rather in form than in content, and today it sounds in the following way: quality of life (life quality) is the perception by the individual of his position in life in the context of the culture and value system in which the individual lives, and in connection with the goals, expectations, standards and interests of this individual.

Despite the existing definitions, the discussion continues. Some authors define the quality of life as existence (being), usually limited by psychosocial attributes. Others try to quantify this category in terms of illness, death, symptoms, prognosis, and so on. Still others consider the quality of life in terms of meeting the material and cultural (spiritual) needs of people: the quality of food, the comfort of a home, the quality and modernity of clothing, the structure of leisure, the quality of health care, etc. The fourth understand the quality of life as a complex indicator of physical, mental and social well-being, i.e. identify it with the concept of health.

The concept of QOL, of course, should be recognized as closely related to the definition of health given by the World Health Organization (WHO): "Health is a state of complete physical, social and mental well-being of a person, and not just the absence of a disease."

In turn, the quality of life is an integral characteristic that implements the physical, social and psychological functioning of the patient. In accordance with the above definition of health, WHO defines QoL as an individual relationship between a person's position in society, in the context of his culture and value system, with the goals of this individual, his plans, opportunities and degree of disorder. As you can see, the fundamental properties of QOL are multicomponent and subjective assessments.

A similar definition of quality of life was proposed by Wenger N.K.: QoL is "satisfaction with psychosocial and other forms of activity under the conditions of restrictions associated with the disease."

The Medical Encyclopedia of QOL, published in the USA, gives a simpler definition: "The quality of life is the degree to which human needs are met."

The famous author of the St. George's Hospital Quality of Life Questionnaire (SGRQ) P. W. Jones corrects the definition of QoL from the point of view of a doctor. It sounds like "the correspondence of desires to the possibilities that are limited by the disease."

The concept of QoL has experienced a real boom in medicine in the last decade. On the one hand, an assessment of the severity of the disease and the effectiveness medicines And rehabilitation activities should include an assessment of QoL. On the other hand, this concept is often manipulated, since not all methodological and methodological aspects of its use are correct.

The quality of life structure is based on three main components: living conditions, i.e. the objective, independent of the person himself side of his life (natural, social environment, etc.); lifestyle, i.e. the subjective side of life created by the individual himself (leisure, spirituality, etc.); satisfaction with conditions and lifestyle.

At present, more and more attention has been paid to the study of the quality of life in medicine, which has made it possible to significantly change the traditional views on the problem of the disease and the patient. In recent years, there has even appeared special term"health-related quality of life". Health-related quality of life studies allow studying the impact of disease and treatment on indicators of the quality of life of a sick person, assessing all components of health - physical, psychological and social functioning. In our country, health-related quality of life is understood as a category that includes a combination of life support conditions and health conditions that allow achieving physical, mental, social well-being and self-realization.

Quality of life studies have a wide range of applications in the health care of economically developed countries. They are used: in population studies and in monitoring the health of the population; to evaluate the effectiveness of health care programs and reforms; V clinical research dedicated to evaluating the effectiveness of new drugs and new treatments; V clinical practice to assess the effectiveness of traditional methods of treatment, individual monitoring of the patient's condition; in pharmacoeconomics; in health economics.

In recent years, the assessment of the quality of life has become widely used in domestic healthcare and has significantly expanded the possibilities: standardization of treatment methods; examination of new methods of treatment using international criteria adopted in most developed countries; ensuring full-fledged individual monitoring of the patient's condition with an assessment of early and long-term results of treatment; development of prognostic models for the course and outcome of the disease; conducting medical and social population studies with the identification of risk groups; development of fundamental principles of palliative medicine; ensuring dynamic monitoring of risk groups and evaluating the effectiveness of preventive programs; improving the quality of expertise of new drugs; economic substantiation of treatment methods, taking into account such indicators as "price-quality", "cost-effectiveness".

2. The impact of the quality of life on the health status of the population

The complexity and variety of changing social conditions and factors that determine and mediate the health of the population required taking into account several or many interacting factors that determine various manifestations of vital activity, indicators of people's health. Health is not limited to individual indicators, indices, it is a complex, complex system. Multidimensional or inter- and multidisciplinary studies were also required, including clinical, psychological, sociological, sanitary-hygienic, mathematical-statistical methods and approaches, the so-called complex socio-hygienic and clinical-social studies.

Such studies allow not only to comprehensively analyze the role of social conditions and factors, to show the social conditionality of the health of the population and its groups, but also to come close to studying the medical and social aspects of lifestyle as a set of the most characteristic, typical types of activity of people social groups, layers, classes, population in the unity and diversity of living conditions. Such studies reveal the direct impact of lifestyle on the health of the population (as opposed to the indirect impact of many social conditions).

Socio-hygienic and especially comprehensive research, including observations of patients (clinical and social studies), established correlations between the quality of life and health indicators of the population.

Particularly clear are the examples of so-called complex family studies, covering all aspects family life- material security, level of culture, living conditions, nutrition, upbringing of children, intra-family relations, provision of medical care, etc.

Family climate, intra-family relations, marital status largely shape the state of health. clearly shown adverse effect conflict situations in the family, the position of women in the family and other factors on the outcome of childbirth. Premature births are 4 times more likely to occur in unmarried women.

The composition and condition of families significantly affect the prevalence of individual diseases. For example, in single-parent families (usually without a father), there are 1.5-2 times more frequently ill children in the first 3 years of life than in complete ones. The incidence of pneumonia in children in single-parent families is 4 times higher than in complete families. Tensions in the family, unfavorable psycho-emotional climate contribute to the occurrence and more severe course of rheumatism in children and adolescents, in such families there are 2.3 times more children with stomach ulcers and 1.7 times more children with gastroduodenitis.

Even with such diseases, the occurrence of which, it would seem, is associated with specific physical influences, the influence of the family factor, sometimes significant, is established. For example, in a socio-hygienic study of lumbosacral osteochondrosis, along with the importance of anatomical defects, trauma, significant physical tension, cooling, shows the big role of industrial and family factors especially strained family relationships.

The daily routine of family members is one of the complex indicators that characterize the way of life. Violation of the rhythm of rest, sleep, nutrition, schooling statistically significantly contributes to the emergence of various diseases and negatively affects their course, adversely affects morbidity, contributes to the development of defects and the lag in physical and intellectual development negatively affects other indicators of health. So, violation of sleep, nutrition, walks already in the first years of life of children dramatically affects their health. Every 3rd child who did not observe the daily regimen had poor health indicators - frequent acute and chronic diseases, low rates physical development and etc.

The prevalence of certain diseases also significantly depends on the mode of study, life, social work, family climate, etc.

In families where the daily routine was observed, the state of health of 59% of the surveyed was good, 35% - satisfactory and 6% - unsatisfactory, and in those families where the rational regime of the day was not observed, these figures were 45, 47 and 8%, respectively.

The decisive influence on the morbidity of the composition of families and relationships in them is shown. The leading factor in the emergence and development of coronary artery disease, gastric ulcer and duodenum, diabetes in men are the unfavorable aspects of lifestyle (smoking, neuropsychic overload, eating disorders, alcohol, low medical activity etc.). Their participation in diseases exceeded 60%. Similar data were obtained from family studies of the health status of single, divorced women or the health of single-parent families. An unhealthy lifestyle was also the leading factor in the pathology.

The importance of negative lifestyle factors has been shown in many other studies. Morbidity in children, which district pediatricians deal with, is associated with an unhealthy lifestyle - alcoholism, drunkenness not only of adults, but of children and adolescents. The leading role of lifestyle factors is shown not only in the formation of chronic pathology, but also acute diseases(60% incidence or more).

Particularly convincing are the results of studying diseases in which it would seem impossible or difficult to determine the influence of social conditions and lifestyle factors, since traditionally such diseases are considered exclusively from medical and biological positions.

Here are some examples from comprehensive socio-hygienic research. The occurrence and spread of stomach cancer in Western Siberia is affected by dietary disorders (irregular meals, systematic dry food, heavy meals at night, overeating, eating overcooked and very hot food, spices, etc.) in combination with alcohol abuse and smoking, as well as contact with occupational hazards, hard physical labor, neuropsychic stress, etc. By the age of 40, a stable unhealthy lifestyle is formed that contributes to the occurrence of stomach cancer.

Another study showed that the incidence lung cancer affect place of residence geographical conditions), population migration, alcohol abuse and especially smoking; the incidence of skin cancer is influenced by the same factors and, in addition, unhealthy habits (washing the face hot water, abuse of sunbathing). A number of risk factors can be assessed in points, which makes it possible to measure the strength of their impact.

Similar data were obtained in a socio-hygienic study of the prevalence malignant neoplasms among car drivers. The influence of an unfavorable regime of work and rest has been proven, especially in connection with a changing work schedule, the lack of a stable diet, alternating work and rest, and other risk factors that contribute to a higher incidence of cancer of the stomach, larynx, and lung than in men in the population.

Special note great importance alcohol abuse and smoking.

According to the general opinion of experts, lingering alcohol traditions, a condescending, complacent and sometimes even encouraging attitude towards drunkenness, defects in education in the family, school, work collective, shortcomings in sanitary and educational work, family conflicts, troubles and other subjective factors lead to the abuse of alcoholic beverages. As a rule, the impetus for the emergence of the habit of drinking and smoking is the example of others. These habits, sometimes turning into illness, are developed on the basis of low culture, inability to use leisure, ignorance of the principles of a healthy lifestyle. Such factors create the prerequisites for setting the abuse of alcohol. Today, one of the main circumstances has become the flooding of the market with relatively cheap (including surrogate) alcoholic beverages, the lack of control over their sale in the context of the socio-economic and psychological crisis.

Note the surprising persistence of the stereotype of behavior. Let us refer to just one example from a socio-hygienic study of the time budget of pensioners. Thirty-seven lifestyle factors were studied for people who retired by age and live in major city(use of free time, bad habits, seeking medical help, fulfillment of medical prescriptions, self-treatment). After retirement, the majority of the surveyed retained the old stereotype of behavior. Despite the increase in free time and favorable conditions for relax, vigorous activity, cultural leisure, only 1/5 pensioners rationally used free time to maintain your health. The rest, as before retirement, irrationally, unhygienically, wastefully spend this time. Most pensioners belong to risk groups, which is due not only to chronic diseases, but also to an unreasonable attitude towards their health, bad habits, low sanitary literacy, self-treatment, neglect medical appointments and advice, congestion at home, underdevelopment of spiritual interests and needs.

These few examples (and there are many) confirm the above statements about the decisive role of the quality of life in the formation of health and pathology. These examples also confirm the conclusion about the direct impact of quality of life on health.

health quality of life population

Conclusion

The concept of "quality of life" includes the socio-economic, political, cultural and environmental environment in which there is a human community. A high quality of life implies that all aspects of people's existence - from working conditions, living conditions, recreation, organization of the service sector, healthcare, education and state environment to the availability of political freedoms and the ability to use all the achievements of culture - meet the needs of modern man.

The health of the population 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 the health of the population "stepped" into economics, sociology, geography, ecology and other sciences.

Good is an indicator of the life of a modern person, and the pursuit of it should be a paramount social task. Improving the health of the population, preventing chronic diseases in adulthood reduce the costs associated with both the provision medical care, and with economic damage due to disability.

Bibliography

1. Bobkov V.N. Questions of theory, methodology for studying and assessing the quality and standard of living of the population // Level of life of the population of regions of Russia. 2009. No. 6. C.3-15

2. Kapustin E.I. The level, quality and lifestyle of the population of Russia. M., 2011

3. The quality and standard of living of the population in the conditions global crisis// The standard of living of the population of Russian regions. 2009. No. 8-9. S.3-34

4. Kremlev N.D. Problems of assessing the standard of living of the population // Questions of statistics. 2007. No. 8. pp.18-23

5. Lisitsin Yu.P. Public health and healthcare. M., 2009

To obtain a more complete picture of the state of health of the population, indicators characterizing the social conditionality of public health are important. They accumulate a group of social, cultural, psychological and informational factors that objectively influence the attitude of citizens to health and, therefore, determine the state and dynamics of public health at the level of individual social groups and populations.

Social conditioning of public health- a complex of factors characterizing the lifestyle and living conditions of citizens, social organization at the level of society, the local community and the social microenvironment, influencing the state and dynamics of public health.

Social conditionality is an objective dependence of the state of health, behavior and attitude of people to health from social inequality, types of culture, social stereotypes and stable sets social roles in the local community.

Statistical analysis social conditioning of public health is fundamentally new for health researchers and practitioners, goes beyond the established set of indicators of state and departmental statistics and is possible using the methods of social statistics and applied sociology.

Acad. RAMS Yu.P. Lisitsyn notes that the assessment of social conditioning is not an addition to generally accepted statistical indicators of health, but a causal analysis of their nature, an approach that has not yet been sufficiently used in health and health statistics.

For statistical analysis of the social conditionality of public health, special indicators are used.

Value attitude of citizens (groups, population) to their health- an indicator that reveals deep differences in the value attitude to health between individual social groups and strata of the population.

The problem of public health and the place of health in the system of values cannot be understood without the meaning that citizens representing different social groups put into this concept. At the ordinary level, it semantically gravitates towards the current state of health, and most people perceive the problem of health through the prism of disaster - acute pain, suffering. Unfortunately, in individual and group value systems, health often falls out of the value core under the pressure of the surrounding social and cultural environment.

In the absence of a developed value attitude to health, citizens in everyday situations affecting health are often unable to assess the existing risks and choose decisions that actually lead to an immediate or delayed loss of part of the health potential, for example, the desire to spend time in front of the TV to the detriment of such necessary for normal functioning organism of motor activity.

According to the results of a study carried out in Russian Federation in 2010 (Medic V.A., Osipov A.M.). some differences in the value attitude to health between men and women were revealed. Almost 50% of the women surveyed constantly take care of their health. On the contrary, more than 55% of men care little or nothing about their health.

In the absence of a motivated and developed value attitude, health is not perceived by the population as a necessary life resource; in this regard, as a rule, there is no individual and corporate health planning. World experience shows that the presence of a developed value attitude towards health plays a leading role in reducing mortality from socially significant diseases.

The healthcare system, relying only on its own capabilities, is not able to change the value attitude of the population towards health. To solve this problem, it is necessary to involve other social institutions of society ( political power, legislation, education, mass media). Statistical analysis of the state and dynamics of the value attitude of the population towards health is a necessary component in making effective solutions for the protection of the health of citizens.

Public awareness of existing diseases- an indicator that, in combination with a certain value attitude of citizens towards health, acts as a personal basis for motivation and behavior to maintain health. Analysis of this indicator based on the results of medical and sociological studies allows us to draw the following conclusions:

About 1/4 of the adult population (according to certain social groups - up to 1/2) do not know anything about their diseases;

More than 3/4 of patients do not know about half of their diseases and do not receive appropriate treatment.

To study the awareness of the population about existing diseases, use disease awareness index- the ratio of the number of diseases known to the patient to the number of diseases established when contacting a medical institution.

Self-assessment of health (satisfaction with his condition)- statistically significant indicator the value attitude of citizens to their health and their behavior to preserve it.

An analysis of the results of a study conducted in 2010 in Russia (Table 2.13) shows that about 1/3 of respondents positively assess their health,

negative assessments are given by 10.8% of the respondents. Moreover, women are more critical in assessing their health: 12.8% of women and 8.2% of men rated it as “bad” or “very bad”.

Self-assessment of health due to insufficient awareness of the population about existing diseases often diverges from objective data and from behavioral strategies in relation to health. More than 1/3 of patients with disabilities consider their health to be satisfactory. Such a self-assessment of health leads to an inadequate behavioral strategy of the population in relation to health.

Self-assessment of health expresses the ratio of two characteristics: the current state of health and life claims. It is associated with external information and cultural (social-normative) influences, which emphasizes the need to correct self-esteem in order to optimize behavioral strategies in relation to health.

Behavioral strategies of the population in the field of health characterize relatively stable social role models in which citizens and groups somehow use the resources of their own health and the health care system. The fundamentally important characteristics of these strategies are commitment healthy lifestyle life and the main types of interaction of the population with existing system healthcare.

The results of the conducted medical and sociological studies indicate that the behavioral strategies of the population in relation to health are dominated by an orientation towards self-treatment and ignoring medical care in case of illness. There are three main behavioral models of people:

Always seek medical attention;

Appeal only in severe cases;

They practically do not seek medical help.

Patients seeking medical help for any disease is the optimal behavioral model; it is characteristic, according to the conducted medical and sociological studies, 1/5 of the adult population.

The last two behavioral patterns are essentially ignoring medical care. It comes in two forms of rejection: soft and hard. Soft refusal - seeking medical help only in case of a severe course of the disease - is characteristic of 2/3 of the adult population. Rigid refusal - an orientation towards self-treatment in any situation - is characteristic of an average of every eighth adult.

It is fundamentally important to determine the threshold values for the prevalence of a particular strategy as a social norm. In this case, we can refer to the widespread “two-thirds concept”, according to which the social

the norm, covering the majority of individuals in society, tends to actively spread. If, according to a representative study, the withdrawal strategy exceeds 2/3 of the population, this norm objectively becomes a cultural barrier that prevents efficient use population of opportunity operating system healthcare. Overcoming this barrier will require significant resources, and its underestimation can reduce the effectiveness of using the potential of society in protecting the health of citizens.

A state with a developed economy focuses healthcare on providing different social groups and strata of the population with equal access to quality medical care in the amount of social guarantees provided for by law. In this case, one of the main criteria for the social conditionality of public health is an indicator of the population's perception of access to medical care, which is measured in terms of real time and material costs of various social groups of the population when receiving guaranteed (free) medical care. This indicator is a mass social assessment, which should be taken into account as a subjective prerequisite for a particular behavioral strategy in relation to health.

At the same time, an objective indicator of the availability of medical care in the case of, for example, the rural population (as a special social group) can be an indicator of the average distance of local medical institutions from care recipients or the average time spent villagers to receive medical care. Moreover, this time should include not only travel, but also the forced waiting of patients in the queues of medical institutions.

Perceptions of access to health care can also be measured by means of a standardized survey.

It is advisable to apply the indicator of the population's perception of the availability of medical care in a differentiated manner to its individual types: primary health care, specialized, emergency, etc. In public opinion, the perception of the availability of medical care at the level of the regional community, as shown by long-term monitoring of the medical and social situation, remains generally stable. . However, some differences are noted. If only one in nine adults critically assesses the availability of PHC, then one in three adults speaks about permanent and episodic difficulties regarding the availability of specialized medical care.

Socio-economic strata of the population with low level those with material well-being are 2.5 times more likely than those in the well-to-do strata to experience difficulties in obtaining quality medical care (Table 2.14).

Thus, the analysis of indicators of social conditionality in combination with other indicators characterizing public health can serve as an information basis for developing a strategy in the field of maintaining and improving the health of the population of the Russian Federation.

THE QUALITY OF LIFE. HEALTH RELATED

To assess the level of socio-economic well-being of citizens, social groups of the population, the population, the availability of basic material goods to them, the concept of "quality of life" is often used. WHO (1999) proposed to define this concept as the optimal state and degree of perception by individuals and the population as a whole of how their needs (physical, emotional, social, etc.) are met in achieving well-being and self-realization. Based on this, the following definition can be formulated: the quality of life- an integral assessment by a citizen of his position in the life of society, the system universal values, the relationship of this position with their goals and capabilities. In other words, the quality of life reflects the level of comfort of a person in society and is based on three main components:

Living conditions - an objective, independent side of a person's life (natural, social environment, etc.);

Lifestyle - a subjective side of life created by the citizen himself (social, physical, intellectual activity, leisure, spirituality, etc.);

Satisfaction with conditions and lifestyle.

Currently, more and more attention is paid to the study of the quality of life in medicine, which allows you to delve deeper into the problem of the patient's attitude to his health. A special term "health-related quality of life" has appeared, which means an integral characteristic of the patient's physical, psychological, emotional and social state, based on his subjective perception.

The modern concept of studying the quality of life associated with health is based on three components.

Multidimensionality. Health-related quality of life is assessed by characteristics associated and not associated with the disease, which allows differentially determining the impact of the disease and treatment on the patient's condition.

Variability in time. The quality of life associated with health varies over time depending on the condition of the patient. Data on the quality of life allow for constant monitoring of the patient's condition and, if necessary, to correct the treatment.

Participation of the patient in the assessment of his condition. Assessment of the quality of life. related to health, made by the patient himself - important indicator his general condition. Data on the quality of life, along with the traditional medical opinion, allow a more complete picture of the disease and the prognosis of its course.

The methodology for studying the quality of life associated with health includes the same stages as any medical and social research. As a rule, the objectivity of the results of the study depends on the accuracy of the choice of method. Most effective method assessment of the quality of life - a sociological survey of the population with standard answers to standard questions. Questionnaires use general, used to assess the quality of life associated with the health of the population as a whole, regardless of the disease, and special ones. used in specific diseases.

A correct study of health-related quality of life in order to obtain reliable information is possible only when using questionnaires that have passed validation, i.e. who have received confirmation that the requirements imposed on them correspond to the tasks set.

The advantage of general questionnaires is that their reliability is established for various diseases, which allows a comparative assessment of the impact of various medical and social programs on the quality of life of patients suffering from both certain diseases, and belonging to different classes. The disadvantage of such statistical tools is low sensitivity to changes in the state of health, taking into account a single disease. General Questionnaires it is advisable to use when conducting epidemiological studies to assess the quality of life associated with health, certain social groups of the population, the population as a whole.

Examples of common questionnaires are SIP (Sickness Impact Profile) and SF-36 (The MOS 36-Item Short-Form Health Survey). SF-36 is one of the most popular questionnaires. This is due to the fact that, being general, it allows assessing the quality of life of patients with various diseases and comparing this indicator with that in a healthy population. In addition, SF-36 allows respondents aged 14 and over to be covered, unlike other adult questionnaires that have a minimum threshold of 17 years. The advantage of this questionnaire is its brevity (only 36 questions), it is convenient to use it.

Special questionnaires are used to assess the quality of life of patients with a particular disease, the effectiveness of their treatment. They allow you to catch changes in the quality of life of the patient that have occurred over a relatively short span time (usually 2-4 weeks). Special questionnaires are also used to evaluate the effectiveness of treatment regimens for a particular disease. In particular, they are used in clinical trials. pharmacological preparations. There are many special questionnaires - AQLQ (Asthma Quality of Life Questionnaire) and AQ-20 (20-Item Asthma Questionnaire) for bronchial asthma, QLMI (Quality of Life after Myocardial Infarction Questionnaire) for patients with acute myocardial infarction, etc.

The coordination of the development and adaptation of questionnaires to various linguistic and economic formations is carried out by the international non-profit organization for the study of the quality of life - MAPI Institute (France).

There are no unified criteria and standards for health-related quality of life norms. Each questionnaire has its own criteria and rating scale. For certain social groups of the population living in different administrative territories, in different countries, it is possible to determine the conditional norm of the quality of life of patients and subsequently compare it with it.

Analysis of international experience of use different methods Studying the quality of life associated with health allows us to raise a number of questions and point out the typical mistakes that researchers make.

First of all, the question arises: is it appropriate to talk about the quality of life in a country where many people live below the poverty line, the public health system is not fully funded, and the prices of medicines in pharmacies are not affordable for most patients? Probably not. The availability of medical care is considered by the WHO as important factor affecting the quality of life of patients.

Another question that arises when studying the quality of life is: “Is it necessary to conduct a survey of the patient himself or can his relatives be interviewed?”. When examining health-related quality of life, it is necessary to take into account. that there are significant discrepancies between quality indicators

life, evaluated by the patient himself and "outside observers", for example, relatives, friends. In the first case, when relatives and friends overdramatize the situation, the so-called bodyguard syndrome is triggered. In the second case, the "benefactor syndrome" is manifested, when they overestimate the real level of the quality of life of the patient. In most cases, only the patient himself can determine what is good and what is bad, in assessing his condition. Exceptions are some questionnaires used in pediatric practice.

A common mistake is the attitude to the quality of life as a criterion for the severity of the disease. It is not necessary to draw a conclusion about the effect of any method of treatment on the quality of life of the patient, based on the dynamics clinical indicators. The quality of life is determined not by the severity of the course of the disease, but by how the patient tolerates it. So, some patients with a long-term illness get used to their condition and stop paying attention to it. They observe an increase in the level of quality of life, which, however, does not mean remission.

A large number of clinical research programs are aimed at choosing the optimal algorithm for treating diseases. At the same time, the quality of life is considered as an important integral criterion for the effectiveness of treatment. For example, it is used for a comparative assessment of the quality of life of patients suffering from stable angina tension, who underwent a course of conservative treatment and underwent percutaneous transluminal coronary angioplasty, before and after treatment. This indicator is also used in the development of rehabilitation programs for patients who have undergone serious disease and operation.

Quality of life data obtained before treatment is used to predict the disease, its outcome and, thus, help the doctor in choosing the most effective program treatment. Assessment of quality of life as a prognostic factor is useful in stratifying patients in clinical trials and choosing a strategy individual treatment sick.

Studies of the patient's quality of life play an important role in monitoring the quality of medical care provided to the population. These studies are an additional tool for evaluating the effectiveness of medical care based on the opinion of its main consumer - the patient.

Thus, the study of health-related quality of life is new and effective tool evaluation of the patient's condition. during and after treatment. Extensive international experience in studying the quality of life of patients shows its promise in all areas of medicine.

Health related quality of life

QUALITY OF LIFE ASSOCIATED WITH HEALTH AS A SUBJECT OF STUDYING THE SOCIOLOGY OF MEDICINE

The concept of quality of life as a key factor in the interaction between a doctor and a patient began to emerge at the end of the 19th century. Most accurately, its origins are reflected in the well-known principle formulated by the professor of the Military Medical Academy S.P. Botkin: "Treat not the disease, but the patient." Evolution of paradigms clinical medicine 20th century proceeded in parallel with trends in public health. Academician Yu.P. Lisitsyn wrote: “Up until about the middle of the 20th century, most physicians believed that most of the diseases depended on “internal factors”: heredity, weakening of the body’s defenses, and others - although by the beginning of the century there was a conviction about the primacy of external environmental factors. In the 1960-1970s, when the doctrine of the epidemiology of non-epidemic (non-communicable, chronic) diseases gained popularity, in parallel with the justification of the system of risk factors for health, the concept of the social conditionality of health was substantiated. At the same time, WHO expands the concept of health and defines it as a state of physical, psychological and social well-being, and not just the absence of disease. The concept of social conditioning of health laid the foundation for the development of a new paradigm of clinical medicine - the concept of quality of life, which came into its own in the late 1990s. During this period, WHO recommends considering the quality of life as an individual ratio of a person's position in society, in the context of the culture and value systems of this society with the goals of this individual, his plans, opportunities and the degree of general disorder: "The quality of life is the degree of perception by individuals or groups people that their needs are met, and the opportunities necessary for achieving well-being and self-realization are provided. In other words, the quality of life is the degree of comfort of a person both within himself and within his society.

HISTORICAL AND MODERN APPROACHES TO STUDYING THE QUALITY OF LIFE

Interest in studies of the quality of life in sociology arose in the early 1960s, for the first time among American sociologists who were working on the problem of the effectiveness of federal social programs. At the same time, the quality of life became the subject of study of other sciences: psychology (primarily social), sociology, and economics. For initial period The study of the quality of life is characterized by the lack of a unified approach to both the concept itself and the research methodology. Psychologists primarily focused on the affective and cognitive structural components of the quality of life. Sociologists have focused on the study of subjective and objective components, which has led to the emergence of appropriate methodological approaches. "Subjective" approaches focused on the consideration of values and experiences, while objective - on factors such as food, housing, education. In the first case, the elements of the quality of life structure are well-being and satisfaction with life, in the second, the quality of life is defined as "the quality of the social and physical environment in which people try to realize their needs and requirements."

The first monograph that offered the Russian scientific community of doctors the basics of the methodology for studying the quality of life in medicine was published in Russia in 1999. One of the fundamental principles of the concept of quality of life in medicine was the postulate that a universal criterion is needed to assess the state of the basic functions of a person. , which includes a description of at least four components of well-being: physical, psychological, social and spiritual. This criterion was considered as a meaningful content of the concept of "quality of life".

IN modern medicine wide use also received the term "health-related quality of life". It was first proposed in 1982 in order to distinguish aspects of quality of life related to health and care from the broad general concept of quality of life. In 1995, a formulation of this concept was given, according to which the health-related quality of life is an assessment by people subjective factors that determine their health this moment health care and actions to promote it; the ability to achieve and maintain a level of functioning that enables people to follow their life goals and would reflect their level of well-being.

According to Russian authors, health-related quality of life implies a category that includes a combination of life support conditions and health status, allowing to achieve physical, mental, social well-being and self-realization. It is a complex of psychological, social, physical and spiritual well-being.

QUALITY OF LIFE ASSOCIATED WITH HEALTH IN THE MODERN PARADIGM OF CLINICAL MEDICINE

According to the modern paradigm of clinical medicine, the concept of "health-related quality of life" is the basis for understanding the disease and determining the effectiveness of its treatment methods. The quality of life associated with health evaluates the components of this quality that are not associated and associated with the disease, and allows you to differentiate the impact of the disease and treatment on the patient's condition. Quality of life is the main goal of treatment for diseases that do not limit life expectancy, additional - for diseases that limit life expectancy, the only one - for patients in the incurable stage of the disease. The study of the quality of life, as pointed out by A.A. Novik and T.I. Ionov, is a highly informative, sensitive and economical method of assessing the health status of both the population as a whole and individual social groups, generally accepted in international practice. The study of the quality of life in medicine is currently especially important in such areas as pharmacoeconomics, standardization of treatment methods and examination of new ones using international criteria, ensuring full monitoring of the patient's condition, as well as in conducting socio-medical population studies with the identification of risk groups, ensuring dynamic monitoring these groups and evaluating the effectiveness of prevention programs.

The modern concept of quality of life in medicine includes three main components:

) multidimensionality (the quality of life carries information about all the main areas of human life);

) variability over time (depending on the patient's condition, these data allow monitoring and, if necessary, correcting treatment and rehabilitation);

) participation of the patient in the assessment of his condition (the assessment should be carried out by the patient himself).

HEALTH-RELATED QUALITY OF LIFE AS A SOCIOLOGICAL CATEGORY

Health-related quality of life attracts the attention of not only medical professionals, since its population studies are a reliable and effective method for assessing the well-being of the population. A number of social sciences, the subject of which is human health, is focused on the study of the quality of life as an integral parameter associated with health.

So, exploring such a sociological category as the satisfaction of an individual with health and life in general, I.V. Zhuravleva writes: "The indicator of an individual's satisfaction with his health is an integral psychosocial empirical indicator, since, on the one hand, it characterizes precisely the self-assessment of health and the attitude of the individual to his self-assessment, on the other hand, it is in complex interaction with the assessments of the parameters of the quality of life ... This is evidenced by VTsIOM data on the study of the quality of life. Therefore, the quality of life associated with health can be indirectly characterized by the indicator of satisfaction with health. I.V. Zhuravleva also emphasizes the influence of the gender factor on health satisfaction and quality of life components. The relationship between the indicator of life satisfaction and health is also shown in the works of I.B. Nazarova (in particular, the employed population was studied). The author states: "Health is one of the indicators of the quality of life."

The interdependence of the quality of life and health is explained by sociological theories of health, such as the theory of capital (human and social), the theory of social status, the theory of inequality and social justice. Methodological approaches to the study of the quality of life in its relationship with health are very diverse in terms of content.

So, Nazarova points out that in the studies of the Institute of Socio-Economic Problems of Population of the Russian Academy of Sciences quality state of the population was "represented in terms of the potentials of such important properties of a person, as health (physical, mental, social), education and qualifications (intellectual level), culture and morality ( social activity). Special meaning attached to the measurement of the ability to work ( labor potential)". It should be noted that in medicine, it is precisely the factors associated with disability that are the main ones in the assessments of social, medical and economic efficiency healthcare.

Nazarova also notes that the quality of life can be viewed through health-preserving behavior (self-preservation, health-saving behavior). This assumption is based on her conceptual model of interaction between behavior, health status and quality of life: health behavior → health status → quality of life. As we can see, the model links health behavior with the level of health, and the level of health - with the perceived quality of life.

PRINCIPAL APPROACHES TO THE STUDY OF THE QUALITY OF LIFE IN THE MOTSIOLOGY OF MEDICINE

As has already been shown, the quality of life in general, including those related to health, is the subject of study of the complex of social sciences. Summarizing the methodological approaches to the study of this problem, one should recall the words of Botkin that it is not the disease that should be treated, but the patient. It is this principle, undeservedly forgotten for a while and again becoming dominant in the relationship between healthcare and the population in recent years, that most clearly emphasizes that the quality of life belongs to the subject of research in the sociology of medicine. After all, it is precisely the sociology of medicine that "is interested in the whole personality in the context of its medical and social environment." Close to the sociology of medicine in the subject field, science - public health and health care - studies, first of all, the health of the population, population health. At the same time, it is possible to build a model of the medical and social behavior of a person, population groups in relation to health and healthcare, justify ways to optimize such behavior, predict the social results of the use of new organizational technologies, reforms in healthcare, only by studying whole person in the context of her medical and social environment.

Despite the variety of methods, the only tool for studying the quality of life is a questionnaire. Common to the content side of the methods for studying the quality of life in relation to health is the combination of analysis conditions, lifestyle and satisfaction with them. At the same time, the quality of life is a category that characterizes not so much the interests and values of the individual and society as needs. So, N.S. Danakin believes that "the quality of life characterizes the structure of human needs and the possibility of satisfying them." An important place in this structure is occupied by the needs associated with health. In turn, needs are the regulator of human behavior. Therefore, the study of health-related quality of life must necessarily include lifestyle factors and health behaviors(self-preserving, health-saving behavior). Thus, four components are key in assessing the quality of life associated with health: living conditions, lifestyle, satisfaction with them, behavior towards health. Since the sociology of medicine is a branch of the science of society, the main methodological principles of the medical and sociological study of the quality of life associated with health are obviously the following. Health related quality of life at the individual levelbased on social status and social relations individual; as a complex indicatorhealth of the population (groups, society) is formed on the basis of social processes affecting value orientations, attitudes, motivation of behavior in the field of health. social behavior in the field of health (self-preserving, health-saving) regulates the quality of life by influencing the level of health.

The institutional form of organizing relations to meet the needs of society in a high quality of life associated with health are relations in the field of public health protection. In activity organizational structures medicine as a social institution and the health care system as its tool, the regulatory functions of the medical culture of society are realized.

The methodological apparatus of the sociology of medicine, combining the approaches of social and medical sciences, gives ample opportunities to most fully substantiate the concept social management health of the population and medical and social behavior within the framework of the priority of the quality of life associated with health.

BIBLIOGRAPHY

quality of life medicine health

1.)Lisitsyn Yu. P. Theories of medicine of the XX century. M., 1999. C. 72.

.)Health21: Policy framework for health for all in the WHO European Region. European Health for All Series. 1999. No. 6. S. 293.

.)See: Kovyneva O. A. The structure of quality of life and factors of its improvement // Healthcare Economics. 2006. No. 8. S. 48-50.

.)See: Nugaev R. M., Nugaev M. A. Quality of life in the writings of US sociologists // Sotsiol. research 2003. No. 6. S. 100-105.

.)See: Abbey A., Andrews F. Modeling the Psychological Determinants of Life Quality // Social Indicators Research. 1985 Vol. 16. P. 1-34.

6.)See: Shuessler K.F., Fisher G.A. Quality-of-life research and sociology // Annual Review of Sociology. 1985 Vol. 11. P. 131.

7.)See: Wingo L. The Quality of Life: Toward a micro-economic definition // Urban Studies. 1973 Vol. 10. P. 3-8.

8.)Nugaev R. M., Nugaev M. A. Decree. op. S. 101.

.)See: Novik A. A., Ionova T. I. Guidelines for the study of quality of life in medicine. St. Petersburg; M., 2002.

.)See: Tat'kova A. Yu., Chechelnitskaya S. M., Rumyantsev A. G. To the question of the methodology for assessing the quality of life caused by health // Probl. social hygiene, health and medical history. 2009. No. 6. C. 46-51.

According to the WHO, quality of life is the perception by individuals of their position in life in the context of the culture and value system in which they live, in accordance with goals, expectations, norms and concerns. The quality of life is determined by the physical, social and emotional factors of a person's life that have for him importance and influencing him. The quality of life is the degree of comfort of a person both within himself and within his society.

Quality of life (English - quality of life, abbreviated - QOL; German - Lebensqualitat, abbreviated LQ) - a category that characterizes the essential circumstances of the life of the population, which determine the degree of dignity and freedom of the personality of each person.

The quality of life is not identical to the standard of living, including the most sophisticated types of its definition, for example, living standards (living standards), since different economic indicators income are only one of many (usually at least 5) criteria for the quality of life.

The composition of the concept

Government work to determine and implement a given quality of life is carried out through the legislative introduction of standards (indices) of the quality of life, which usually include three blocks of complex indicators.

The first block of indicators of the quality of life characterizes the health of the population and demographic well-being, which are assessed by the levels of fertility, life expectancy, and natural reproduction.

The second block reflects the satisfaction of the population with individual living conditions (prosperity, housing, food, work, etc.), as well as social satisfaction with the state of affairs in the state (fairness of power, access to education and healthcare, security of existence, ecological well-being). To evaluate them, sociological surveys of representative samples of the population are used. An objective indicator of extreme dissatisfaction is the suicide rate.

The third block of indicators assesses the spiritual state of society. The level of spirituality is determined by the nature, range and number of creative initiatives, innovative projects, as well as by the frequency of violations of universal moral commandments: "do not kill", "do not steal", "honor your father and mother", "do not make yourself an idol", etc. As units of measurement, official statistics are used on social anomalies, which are considered "sin" - violation of the relevant commandments: murders, robberies, serious bodily injuries, abandoned elderly parents and children, alcoholic psychoses. Where such transgressions are more common, the level of morale is worse.

According to the UN, the social category of quality of life includes 12 parameters, of which health is in the first place. The Economic Commission for Europe has systematized eight groups of social indicators of quality of life, while health is also put in first place. Therefore, the quality of life associated with health can be considered as an integral characteristic of the physical, mental and social functioning of a healthy and sick person, based on his subjective perception

Health-driven quality of life

There is a concept of "health-related quality of life", which made it possible to single out the parameters that describe the state of health, care for it and the quality of medical care from the general concept of quality of life. Currently, WHO has developed the following criteria for assessing the quality of life due to health:

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

psychological (emotions, level of cognitive functions, self-esteem);

level of independence (daily activity, working capacity);

public life (personal relationships, social value);

environment (safety, ecology, security, accessibility and quality of medical care, information, learning opportunities, everyday life).

Measurement principles

The assessment of the quality of life is carried out with the help of special questionnaires containing options for standard answers to standard questions, compiled for calculation using the summation of ratings method. They are subject to very strict requirements. General questionnaires are aimed at assessing the health of the population as a whole, regardless of pathology, and special questionnaires are aimed at assessing specific diseases. It is advisable to use general questionnaires to assess the effectiveness of the functioning of health care in general, as well as when conducting epidemiological studies. The overall measure of quality of life correlates with the health status or level of well-being of the individual. Special questionnaires are designed for a particular group of diseases or a specific nosology and its treatment. They allow capturing even small changes in the quality of life of patients over a certain period of time, especially when using new organizational forms of medical care for the population, new methods of treating a disease, or using new pharmacological preparations. Each questionnaire has its own criteria and rating scale, with their help it is possible to determine the conditional standard of quality of life, and in the future to compare with this indicator. This allows you to identify trends in the quality of life in a particular group of patients. Currently, research programs have been developed relating to rheumatology, oncology, hematology, gastroenterology, dentistry, hepatology, neurology, transplantology, pediatrics, etc.

It cannot be a reliable assessment of the patient's quality of life by relatives, relatives or medical staff, since they cannot be objective. Relatives and relatives have the so-called "guardianship syndrome", while they usually give an exaggerated assessment of the suffering of a person whose health they are concerned about. Conversely, health workers always report a higher quality of life than it actually is ("benefactor syndrome"). As we have already indicated, the quality of life does not always correlate with objective data. So, with all possible objective parameters, one should not forget that the main method of assessment is the opinion of the patient himself, since the quality of life is an objective criterion of subjectivity.

When assessing the quality of life in patients, it is important to understand that it is not the severity that is assessed. pathological process, but how the patient tolerates his disease and evaluates the medical care provided to him. The concept of quality of life is the basis of a new paradigm for understanding the disease and determining the effectiveness of its treatment methods. That is why the patient, being the main consumer medical services, gives the most objective assessment received medical care. It can be considered the most highly informative tool in determining the effectiveness of the functioning of the health care system.

Data on the quality of life can be effectively used at the level of the individual patient and his attending physician. Interaction and understanding between the patient and the doctor is improved because the doctor, using quality of life measurements and discussing the results with the patient, better understands exactly how this disease affects the patient's experience of their situation. This gives more meaning to the work of the doctor and leads to an improvement in the quality of patient care. In addition, patients themselves can better understand their state of health and related life problems.

In modern medicine, the study of quality of life is increasingly used in clinical practice, in clinical trials, interest in assessing the quality of life is growing among healthcare organizers and a wide range of patients.

Thus, the study of the quality of life can be considered a new, reliable, highly informative, sensitive and economical tool for assessing the health status of the population, certain groups of patients and specific individuals, the effectiveness of using new organizational, medical and pharmacological methods treatment. Quality of life research also plays an important role in quality control of medical care. The widespread use of quality of life assessment provides health authorities with a tool for additional analysis of the work of medical services, as well as for making decisions on priority areas for funding. The criterion for assessing the quality of life should be taken into account when complex analysis effectiveness of public health management.

W. Spitze et al. identify 10 necessary conditions that must satisfy the methods of assessing the quality of life:

simplicity (briefness, clarity for understanding)
breadth of coverage of quality of life aspects;
compliance of the content of the methods with real social conditions and its determination empirically on the basis of a survey of patients, a survey of doctors and other healthcare workers;
quantitative assessment of quality of life indicators;
reflection of the quality of life of patients with the same efficiency, regardless of their age, gender, profession and type of disease;
careful determination of the validity (accuracy) of the newly created methodology;
the same ease of use of the technique for patients and researchers;
high sensitivity of the technique;
differences in the data obtained on the quality of life in the study of different groups of patients;
correlation of the results of assessing the quality of life using special methods with the results of other methods of examining patients.

Techniques

The most well-known questionnaires for studying the quality of life of patients are presented below.

World Health Organization Quality of Life Questionnaire, nuclear module - WHOQOL-100 - 100 questions, 24 sub-spheres, 6 spheres, 2 integral indicators

World Health Organization Quality of Life Questionnaire, Special Mental Health Module - WHOQOL-SM - 57 questions, 13 sub-domains, 1 integrated indicator

Short form of health assessment - MOS SF-36 (Medical Outcomes Study-Short Form) - 8 scales, 36 questions

European Quality of Life Assessment Questionnaire (EUROQOL - EuroQOL Group)

Hospital anxiety and depression scale (Hospital Anxiety and Depression Scale)