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10ASSESSMENT OF THE QUALITY OF LIFE OF PATIENTS IN MODERN
MEDICINE
Khujakulov Davron Abdikhakimovich
Assistant of the Department of Microbiology, Virology and Immunology, Samarkand State Medical University.
Shakarbaeva is the daughter of Aydin Khojam Student of Samarkand State Medical University, Faculty of Medicine No.1,group - 217 https://doi.org/10.5281/zenodo.7583175
Annotation: Health status, functionality and quality of life -these are the three concepts that are most often combined with the term "Health". The definition of the boundaries of health (negative to positive at the moment of happiness, active state) depends on who evaluates health: patient, attending physician, observer-researcher. Recently, in foreign literature, the combination - health and its impact on the quality of life (Health - related quality of life - HRQL) is increasingly used. This is due to the fact that, as a rule, in the broad sense of the word, one cannot be limited to one word "health", since how it is necessary to take into account at the same time the level of income that allows maintaining a certain level of health; freedom of movement, which depends on the state of health; the quality of the environment that can be detrimental or beneficial to health. All these problems are, as it were, separated from health, or rather, from its medical side. However, modern European physicians are focused on Health and its impact on the quality of life, because when a person falls ill or is ill, various aspects of life can affect health.
Keywords. Quality of life (QoL), World Health Organization (WHO), health-related quality of life (HRQOL), nosology, Physical Functioning (PF).
Аннотация. Состояние здоровья, функциональные возможности и качество жизни -это три понятия, которые чаще всего объединяют термином «Здоровье».
Определение границ здоровья (отрицательных в положительных в момент счастья, деятельного состояния) зависит от того, кто оценивает здоровье: пациент, лечащий его врач наблюдатель-исследователь. Последнее время в зарубежной литературе все чаще употребляют сочетание - здоровье и его влияние на качество жизни (Health - related quality of life - HRQL). Это связано с тем, что как правило, в широком смысле слова нельзя ограничиваться одним словом «здоровье», так как необходимо учитывать одновременно и уровень доходов, позволяющий поддерживать определенный уровень здоровья; свободу перемещения, которая зависит от состояния здоровья; качество окружающей
среды, которая может губительно или благотворно влиять на здоровье. Все эти проблемы как бы отделены от здоровья или точнее, от его медицинской стороны. Тем не менее современные европейские врачи сосредоточены на Здоровье и его влиянии на качество жизни, так как, когда человек заболевает или болеет, самые разные аспекты жизни могут влиять на здоровье.
Ключевые слова. Качество жизни (КЖ), Всемирная организация здравоохранения (ВОЗ), качество жизни, связанное со здоровьем (КЖССЗ), нозология, физическое функционирование (ФФ).
Scientific purpose. For a long time, the main result of the treatment of diseases was considered to be the prevention of death and disability of patients. With the development of pharmacology, laboratory and instrumental technologies, new approaches in surgery, therapy and other branches of medicine, doctors have the opportunity to pay attention to quality of life issues. Assessment and improvement of patients' quality of life is one of the urgent problems of modern medicine.
Materials and methods. A review of modern medical literature on this subject has been made.
Results.Quality of life (QoL) assessment is used in many branches of medicine, such as cardiology, oncology, psychiatry, gerontology, palliative medicine, and others. To determine QoL, questionnaires are most often used, which have a high degree of reliability. Their diversity allows you to choose the most suitable for any particular study.
Discussion. There is no single definition of the term "quality of life". Thus, according to the World Health Organization, "the 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 the goals, expectations, norms and concerns [1]. And by definition Novik A. A., Ionova T. I.
"Quality of life is an integral characteristic of the physical, psychological, emotional and social functioning of the patient, based on his subjective perception" [2]. QoL is determined by the physical, social and emotional factors of a person's life that are important for him and affect him [1]. Thus, this concept is subjective, multidimensional, covering physical and professional functions, psychological state, somatic sensations and social interactions [3]. In modern medicine, the term "health-related quality of life" (HRQOL) is widely used, which means an assessment of parameters related and not related to the disease, and allows you to determine the impact of the disease and treatment on the psychological, emotional state of the patient, as well as on his social status. [4].
World Health Organization (WHO) has developed the following criteria for assessing HRQOL [1]: physical (strength, energy, fatigue, pain, discomfort, sleep,
rest); psychological (positive emotions, thinking, learning, self-esteem, appearance, negative experiences); level of independence (daily activity, performance, dependence on drugs and treatment); public life (personal relationships, social value of the subject); environment (well-being, safety, ecology, security, accessibility and quality of medical care, information, learning opportunities, life, ecology). One of the most effective methods for assessing QoL is considered to be a questionnaire [5]. Three groups of questionnaires have been developed: general (non-specific), particular, and disease-specific [6]. General are used for both healthy and sick people with any nosology. The advantage of such questionnaires is the breadth of coverage of QOL components, the possibility of studying the norms of QOL in a healthy population [3]. The disadvantages include low sensitivity to changes in QoL within a particular disease [3]. Specific questionnaires refer to the method of monitoring any particular pathology and treatment, but they do not allow comparison of results in patients with various diseases and with a healthy population [3]. Private questionnaires are used to study individual symptoms, such as headache, dizziness, etc. [6]. The most common general questionnaires include [3]: MOS SF-36 (The Medical Outcomes Study-Short Form) Brief form of health assessment; The World Health Organization Quality of Life (WHOQOL)-BREF - a short WHO questionnaire for assessing QoL; European Quality of Life Scale (EuroQol) - European questionnaire for assessing the quality of life; Nottingham Health profile -Nottingham Health Profile.
MOS SF-36 is a questionnaire designed to study the nonspecific quality of life associated with health, regardless of the existing disease, gender, age characteristics, and the specifics of a particular treatment [7]. As a result of the study, 8 factors of quality of life were established, the most frequently measured, and the most strongly changing in the population under the influence of the disease and treatment [1]:
1. Physical Functioning (PF) - physical functioning (self-care, walking, climbing stairs, etc.)
2. Role-Physical (RP) - the influence of physical condition on role functioning (work, daily activities)
3. Bodily Pain (BP) - the intensity of pain and its impact on the ability to carry out daily activities, including work at home and outside the home
5. Vitality (VT) - vitality (implies feeling full of strength and energy or, on the contrary, exhausted)
6. Social Functioning (SF) - social functioning, is determined by the degree to which the physical or emotional state limits social activity (communication)
7. Role-Emotional (RE) - the impact of the emotional state on role functioning, involves assessing the degree to which the emotional state interferes with the performance of work or other daily activities (including an increase in time spent, a
decrease in the volume of work performed, a decrease in the quality of its performance, etc.)
8. Mental Health (MH) - self-assessment of mental health, characterizes mood (the presence of depression, anxiety, a general indicator of positive emotions).
All the scales of this questionnaire are combined into two dimensions: the physical component of health (1-4 scales) and mental (5-8 scales) [7]. To calculate the values, the formula is used: (actual value of the indicator - the minimum possible value of the indicator) ^ (possible range of values) * 100 [7]. Thus, the value of each scale changes from 0 to 100.
The WHOQOL-BREF is an abbreviated version of the WHO Core Questionnaire (WHOQOL-100), consisting of 26 items that assess the following broad areas: physical health, psychological health, social relationships and the environment [8]. The first two questions are taken into account in isolation, the remaining 24 points are formed into 4 scales [9]. It may be more convenient for use in large scientific studies or clinical trials [8].
The EuroQol questionnaire was developed in 1991 by researchers from the UK, Finland, the Netherlands, Norway and Sweden. Thanks to this questionnaire, the patient's QoL can be expressed using one indicator - the index, therefore the questionnaire is also called the health index. EuroQol consists of 2 parts. The first part includes 5 components related to such aspects of life as mobility, self-care, activity in daily life, pain and depression.
Each component is divided into three levels depending on the severity of the problem. The results of the respondents' responses can be presented in the form of a health status profile or an EQ 5 Qutility health index.
The second part of the questionnaire is a scale presented in the form of a vertical graduated ruler, on which 0 corresponds to the worst, and 100 to the best state of health. The respondent makes a mark on the scale in the place that reflects the state of his health at the time of filling. Thus, a quantitative assessment of the overall health status is visualized [9].
The Nottingham Health profile was developed in the UK in 1981 by S. Hunt et al. Consists of two parts. The first contains 38 questions covering 6 spheres of life. For each question, two answers are provided: "yes" - 1 and "no" - 0. By summing up the values of positive answers in each section, the value of the QOL indicator is obtained. The final score varies from 0 to 100. The second part contains a self-assessment of the impact of health status on 7 areas of daily life: work, housekeeping, social life, personal life, sexual life, hobbies and outdoor activities [4].
Findings.
Thus, in modern medicine there are many informative, reliable, adapted methods for assessing QoL. The most effective questionnaires are MOS SF-36, WHOQOL-
BREF, EuroQol, Nottingham Health profile, etc. All these questionnaires have been tested in many countries of the world and have a high degree of proven effectiveness. At present, the problem of improving the quality of life is the most important in the state policy of the Russian Federation.
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