HRQOL Concepts | CDC

Why is quality of life of important?

Quality of life is important to everyone. Although the World Health Organization (WHO) defined health very broadly as long as a half century ago, health in the United States has traditionally been measured narrowly and from a deficit perspective, often using measures of morbidity or mortality. But, health is seen by the public health community as a multidimensional construct¹ that includes physical, mental, and social domains.

As medical and public health advances have led to cures and better treatments of existing diseases and delayed mortality, it was logical that those who measure health outcomes would begin to assess the population’s health not only on the basis of saving lives, but also in terms of improving the quality of lives.

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What is quality of life?

Quality of life (QOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life.² What makes it challenging to measure is that, although the term “quality of life” has meaning for nearly everyone and every academic discipline, individuals and groups can define it differently. Although health is one of the important domains of overall quality of life, there are other domains as well—for instance, jobs, housing, schools, the neighborhood. Aspects of culture, values, and spirituality are also key domains of overall quality of life that add to the complexity of its measurement. Nevertheless, researchers have developed useful techniques that have helped to conceptualize and measure these multiple domains and how they relate to each other.

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What is health-related quality of life?

The concept of health-related quality of life (HRQOL) and its determinants have evolved since the 1980s to encompass those aspects of overall quality of life that can be clearly shown to affect health—either physical or mental.^3-6

• On the individual level, HRQOL includes physical and mental health perceptions (e.g., energy level, mood) and their correlates—including health risks and conditions, functional status, social support, and socioeconomic status.
• On the community level, HRQOL includes community-level resources, conditions, policies, and practices that influence a population’s health perceptions and functional status.
•  On the basis of a synthesis of the scientific literature and advice from its public health partners, CDC has defined HRQOL as “an individual’s or group’s perceived physical and mental health over time.”³

The construct of HRQOL enables health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners, and business groups.⁷

HRQOL questions have become an important component of public health surveillance and are generally considered valid indicators of unmet needs and intervention outcomes. Self-assessed health status is also a more powerful predictor of mortality and morbidity than many objective measures of health.^9-10 HRQOL measures make it possible to demonstrate scientifically the impact of health on quality of life, going well beyond the old paradigm that was limited to what can be seen under a microscope.

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Why is it important to track HRQOL?

Focusing on HRQOL as an outcome can bridge boundaries between disciplines and between social, mental, and medical services. Several recent federal policy changes underscore the need for measuring HRQOL to supplement public health’s traditional measures of morbidity and mortality. Healthy People 2000, 2010, and 2020 identified quality of life improvement as a central public health goal.

• HRQOL is related to both self-reported chronic diseases (diabetes, breast cancer, arthritis, and hypertension) and their risk factors (body mass index, physical inactivity, and smoking status).³
• Measuring HRQOL can help determine the burden of preventable disease, injuries, and disabilities, and can provide valuable new insights into the relationships between HRQOL and risk factors.
• Measuring HRQOL will help monitor progress in achieving the nation’s health objectives.

Analysis of HRQOL surveillance data can identify subgroups with relatively poor perceived health and help to guide interventions to improve their situations and avert more serious consequences. Interpretation and publication of these data can help identify needs for health policies and legislation, help to allocate resources based on unmet needs, guide the development of strategic plans, and monitor the effectiveness of broad community interventions.

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How can HRQOL be measured?

During the early 1990s, CDC’s Division of Adult and Community Health, Disability Prevention Program, Women’s Health Program, National Center for Health Statistics Questionnaire Development Research Lab, and Epidemiology Program Office worked to develop and validate a compact set of measures that states and communities could use to measure HRQOL.⁸ These are the Healthy Days measures, an integrated set of broad questions about recent perceived health status and activity limitation. On the basis of a synthesis of the scientific literature and advice from its public health partners, the CDC has defined HRQOL as “an individual’s or group’s perceived physical and mental health over time.”³

Learn more about how CDC measures HRQOL on the Methods and Measures page.

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Resources

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References

1. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no 2, p. 100) and entered into force on 7 April 1948.
2. The WHOQOL Group. The World Health Organization Quality of Life Assessment (WHOQOL). Development and psychometric properties. Soc Sci Med 1998;46:1569-1585.
3. Centers for Disease Control and Prevention. Measuring healthy days: Population assessment of health-related quality of life. Centers for Disease Control and Prevention, Atlanta, Georgia 2000.
4. Gandek B, Sinclair SJ, Kosinski M, Ware JE Jr. Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financ Rev 2004;25(4):5-25.
5. McHorney CA. Health status assessment methods for adults: past accomplishments and future directions. Annual Rev Public Health 1999; 20:309-35.
6. Selim AJ, Rogers W, Fleishman JA, Qian SX, Fincke BG, Rothendler JA, Kazis LE. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res. 2009;18(1):43-52.
7. Kindig DA, Booske BC, Remington PL. Mobilizing Action Toward Community Health (MATCH): metrics, incentives, and partnerships for population health. Prev Chronic Dis 2010;7(4). http://www.cdc.gov/pcd/issues/2010/jul/10_0019.htm.
8. Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R. Measuring health-related quality of life for public health surveillance. Public Health Rep 1994;109(5):665–672.
9. Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res 2002;14(6):499–508.
10. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. J. Mortality prediction with a single general self-rated health question. A meta-analysis. Gen Intern Med2006;21(3):267-75.

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What Has Happened and How to Move On

Top Spinal Cord Inj Rehabil. 2014 Summer; 20(3): 167–180.

, PhD¹

Marcel W.M. Post

¹Center of Excellence in Rehabilitation Medicine, De Hoogstraat, Utrecht, Netherlands

¹Center of Excellence in Rehabilitation Medicine, De Hoogstraat, Utrecht, Netherlands

Corresponding author.Corresponding author: Marcel W.M. Post, Center of Excellence in Rehabilitation Medicine, De Hoogstraat, Paranadreef 2, 3563AZ Utrecht, Netherlands; e-mail: [email protected] © 2014 Thomas Land Publishers, Inc.This article has been cited by other articles in PMC.

Abstract

Background:

Quality of life (QOL) is an important outcome in spinal cord injury (SCI) rehabilitation, but it is unclear how to define and measure it.

Objective:

The aims of this article are to (a) show how the concepts of QOL and health-related quality of life (HRQOL) have evolved over time, (b) describe the various ways QOL has been defined and measured, and (c) provide recommendations on how to be as clear and consistent as possible in QOL research.

Method:

A narrative review of the QOL literature was performed.

Results:

Roots of the term “quality of life” in health care can be traced back to the definition of health by the World Health Organization in 1948. The use of the word “well-being” in this definition is probably a main factor in the continuing confusion about the conceptualization of QOL. Within the field of SCI rehabilitation, the Dijkers’s QOL model, distinguishing between utilities, achievements, and subjective evaluations and reactions, has been very influential and the basis for several reviews and databases. Nevertheless, literature shows that it is still difficult to consistently use the term “quality of life” and categorize QOL measures. Several aspects of QOL that are specific for individuals with SCI have been identified.

Conclusions:

Researchers should be as specific and clear as possible about the concept and operationalization of QOL in their studies. Readers should not take the term “quality of life” for granted, but should inspect the topic of the study from the actual measures used.

Key words: health status, outcome assessment, quality of life, spinal cord injuries

Introduction

Because of improvements in medical care, the average life expectancy of people with spinal cord injury (SCI) has increased considerably in recent decades.¹ However, SCI still is a major life event that leads to serious physical disability and a large number of secondary health conditions (SHCs), the most frequent being pain, bowel and bladder regulation problems, muscle spasms, fatigue, heart burn, and osteoporosis.² Research clearly shows an overall negative impact of SCI on labor market participation, leisure activities, and social relations³; an elevated prevalence of depression, anxiety, and posttraumatic stress disorder (PTSD) compared to the general population⁴; and on average substantially lower life satisfaction compared to the general population.⁵

Due to the wide range of consequences of SCI, it is clear that outcome measures covering basic activities of daily living such as the Functional Independence Measure⁶ or the Spinal Cord Independence Measure⁷ are insufficient to capture the complexities of living with SCI and thereby to measure rehabilitation outcomes after SCI.^8,9 Many agree that quality of life (QOL) should be measured in tandem with traditional outcomes assessing functional rehabilitation, because such measurements provide different yet complimentary information that aids clinicians in their efforts to help those with SCI.^10,11

There is a wealth of data on QOL of individuals with SCI. A PubMed search (May 4, 2014) revealed more than 1,000 hits using the combination of the search terms “spinal cord injury” and “quality of life.” The interpretation of the results of these studies is severely limited by the general lack of consensus on how to define and measure QOL.¹¹ Consequently, our understanding of QOL among individuals with SCI is still limited. Authors have pled for consensus on a concrete, universal definition of QOL.¹¹ However, such a consensus among researchers and clinicians across diagnostic groups is unlikely to emerge in the near future. Nevertheless, we should do our best to minimize the confusion and to learn as much as possible from the QOL studies that have been and are being performed. The aims of this article are therefore to (a) show how the concepts of QOL and healthrelated quality of life (HRQOL) have evolved over time, (b) describe the various ways QOL has been defined and measured, and (c) provide recommendations on how to be as clear and consistent as possible in QOL research.

QOL in Medicine

Since its introduction in the medical literature in the 1960s, the term “quality of life” has become increasingly popular in recent decades. In 1975, quality of life was introduced as a key word in medical literature databases. A PubMed search for studies with quality of life in the title retrieved only 0 to 1 articles/year in the 1960s, but this number has grown to almost 4,000 references in 2013 alone (search performed on May 4, 2014).

One of the earliest publications on QOL is an editorial in the Annals of Internal Medicine.¹² In this editorial, Elkington addressed the new ethical issues associated with the increase of treatment success with sometimes adverse effects for the patients involved:

What every physician wants for every one of his patients old or young, is not just the absence of death but life with a vibrant quality that we associate with a vigorous youth. This is nothing less than a humanistic biology that is concerned, not with material mechanisms alone, but with the wholeness of human life, with the spiritual quality of life that is unique to man. Just what constitutes this quality of life for a particular patient and the therapeutic pathway to it often is extremely difficult to judge and must lie with the consciousness of the physician.^12(p714)

Another root of the QOL concept goes back to the 1947 World Health Organization (WHO) definition of health as a “state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity.^13(p13) The use of the term “well-being” in this definition of health has contributed significantly to the conceptual confusion about what is health and what is QOL. However, despite much disagreement about whether the WHO definition best describes health or perfect happiness, the majority of methodologists in the health sciences and in the social sciences have followed this definition and adopted a policy of incorporating at least 3 dimensions in any scale or index purporting to measure health or QOL, namely physical function, mental status, and ability to engage in normative social interactions.¹⁴ In a similar way, Karnofsky outlined as early as 1949 that the evaluation of new chemotherapeutic agents in cancer patients should include not only performance status, length of remission, and prolongation of life, but also the patient’s subjective improvement in terms of mood and attitude; general feelings of wellbeing; and activity, appetite, and the alleviation of distressing symptoms, such as pain, weakness, and dyspnea.¹⁵ In contemporary terms, these subjective improvement criteria can be recognized as QOL considerations.¹⁶

The first QOL measure that was named as such is Spitzer’s QL-Index.¹⁷ It was based on the notion that measures of sociopersonal or QOL variables should include physical, social, and emotional function; attitudes to illness; personal features of patients’ daily lives, including family interactions; and the cost of illness.¹⁷ Items concerned activities, self-care, general health, social support, and outlook on life. Untypically, it was designed to be used by physicians. The QL-Index is displayed in .

The Spitzer QL-Index. Reprinted, with permission, from Spitzer WO, Dobson AJ, Hall J, et al. Measuring the quality of life of cancer patients. A concise QL-Index for use by physicians. J Chronic Dis. 1981;34:591. Copyright © 1981 by C.V. Mosby.

At the Portugal Conference on Measuring QOL and Functional Status in Clinical and Epidemiologic Research, Spitzer¹⁴ noted that considerable confusion had emerged because the terms QOL, health, and health status were being used interchangeably:

What is said, what is written and what is done seems to be determined at times by the theme of the conference one attends or the title of the book to which one contributes a chapter.^14(p467)

Ware,¹⁸ at the same Portugal conference, attributed the increasing popularity of the QOL concept in the health care literature to an increasing comprehensiveness of health measures. Whereas health used to be defined primarily in terms of death and the extent of morbidity (ie, disease), the emerging conceptualization of health encompassed how well people function in everyday life and personal evaluations of wellbeing. Ware, however, preferred a more limited definition when measuring the health of an individual:

The goal of the health care system is to maximize the health component of quality of life, namely health status. Measures of health outcomes should be defined accordingly. ^18(p474)

In the mid-1980s, the term “health-related quality of life” (HRQOL) appeared in titles of published articles for the first time. A paper by Torrance¹⁹ is one of the first. He defined HRQOL as the subset of QOL, relating only to the health domain of that existence; this is similar to the approach advocated by Ware¹⁸ but uses a different term. It is useful to note that some of the most well-known HRQOL measures were never presented as such: The Nottingham Health Profile was presented as a measure of perceived health,²⁰ the Sickness Impact Profile as a measure of health status,²¹ and the SF-36 as a health status survey.²² At some point, however, it became customary to characterize these as HRQOL measures.^23,24 From that time on, the terms “health,” “perceived health,” “health status,” “HRQOL,” and “QOL” are treated as synonymous by many researchers and clinicians.

In the field of medical rehabilitation, QOL measurement commonly involved health status or was qualified by the term “health-related.”²⁵ To some, this was a subversion of construct of QOL, bringing it into conformity with the biomedical model.²⁵ Some suggested an alternative approach, with the view that individuals must be allowed to judge their own experiences. To distinguish it from health status, Fuhrer suggested that QOL could be understood from the individual’s perspective, commonly referred to as subjective QOL or subjective well-being (SWB).¹⁰ Dijkers²⁶ made a similar distinction between the objective and the subjective approach to QOL measurement. The subjective approach defines QOL as the congruence between aspirations and accomplishments, as perceived by the person involved. Measurement of life satisfaction, happiness, and positive and negative affect fall within this category.²⁶ According to Dijkers, HRQOL is part of objective QOL and refers to components of QOL that center upon or are directly and indirectly affected by health, disease, disorder, and injury (signs, symptoms, treatment side effects, physical, cognitive, emotional and social functioning, etc) and as such overlaps with the concept of health status.²⁶

From the beginning, critics have raised their voices against the uncritical use of the term“quality of life.” Gill and Feinstein²⁷ reviewed 75 papers with quality of life in the title and found that investigators conceptually defined QOL in only 11 (15%) of the 75 articles, identified the targeted domains in only 35 (47%), and gave reasons for selecting the chosen QOL instruments in only 27 (36%). No article distinguished “overall” QOL from HRQOL.²⁷ To reverse this situation, many theorists, researchers, organizations, and consensus groups have proposed a definition of QOL or HRQOL. The next section of this article will describe a number of approaches.

Definitions and Models of QOL

A number of attempts to define QOL have been made, reflecting different approaches to the topic. A nonexhaustive selection is presented in . Most of these definitions refer explicitly to an evaluation by the person involved (“satisfaction”; numbers 1-5, 8). Some specify multiple domains (1, 3, 6, 7), and others refer to a more global judgment (2, 4, 5, 8). One definition (7) is more function-oriented than the others, whereas one most explicitly refers to cultural and societal norms that influence the experience of QOL (5). One definition (3) includes both objective and subjective QOL. Only one definition includes the word “health,” although some more are clearly founded in the HRQOL tradition (3, 7).

Table 1.

Examples of definitions of quality of life in the literature

As it proved impossible to agree on any definition of QOL, a more practical approach to move the field forward turned out to be to describe aspects of QOL. The distinction between HRQOL and SWB made by Fuhrer et al¹⁰ is one attempt to clarify what QOL should encompass.

According to Aaronson,¹⁶ there are 2 common threads in the structure and content of measures that carry the QOL label. First, such measures tend to reflect a multidimensional conceptual approach. Four broad health dimensions are frequently incorporated:

1. Physical health, ie, somatic sensations, disease symptoms, treatment side effects

2. Mental health, ranging from a positive sense of well-being to nonpathological forms of psychological distress to diagnosable psychiatric disorder

3. Social health, including assessment of both quantitative and qualitative aspects of social contacts and interactions

4. Functional health, including both physical functioning in terms of self-care, mobility, and physical activity level and social role functioning in relation to family and work

Beyond these core dimensions, many measures incorporate variables that are specific to a given disease, treatment, or research situation. Thus, for example, QOL evaluations in breast cancer will often include measures of sexuality and body image, studies in rheumatoid arthritis may include expanded assessment of joint mobility and pain, and so forth.¹⁶ The second feature common to most QOL measures is their primary reliance on the subjective judgment of the patients’ themselves rather than on ratings provided by physicians, nurses, family members, or other third parties.¹⁶

Dijkers ^8,28 proposed a comprehensive model of aspects of QOL and its evaluation (). The main distinction is made among 3 major groups: QOL as subjective well-being (SWB), QOL as achievements, and QOL as utility. Achievements, box C, reflect the current situation of the individual involved. This situation can be evaluated against individual norms and values (box D), resulting in a certain level of SWB (box E), or against societal norms and values (box B), resulting in a utility rating (box A). Utility measures reflect a societal view because their scores are based on valuation of the selected health aspects (mobility, sensory status, symptoms) by laypeople or professionals, instead of by the individual.

Dijkers’s model of quality of life and its evaluation. Reprinted, with permission, from Dijkers MP. Quality of life of individuals with spinal cord injury: A review of conceptualization, measurement, and research findings. J Rehabil Res Dev. 2005;42:89.

Dijkers’s model is a great example of a comprehensive QOL model that covers and integrates various approaches to QOL measurement. The main disadvantage of the model might be the lack of incorporation of personal and environmental factors, as described in the International Classification of Functioning, Disability and Health (ICF).²⁹ Also, the psychological and emotional sequelae, such as coping and adjustment, depression, disability acceptance, and control, might fit in different boxes at the same time. These concepts are part of HRQOL (the mental component), but they reflect subjective QOL at least to some degree.²⁸

A popular model of QOL is provided by Wilson and Cleary.³⁰ This conceptual model links physiological variables, symptom status, functional health, general health perceptions, and overall QOL (). The arrows in represent the hypothesized linkages between the dimensions. In the model, the evaluation of physiological variables centers on cells, organs, and organ systems, whereas the assessment of symptom status shifts to the organism as a whole.³⁰ Functional health has been defined in this model as the ability of an individual to perform and adapt to the environment, measured both objectively and subjectively over a given period. General health perceptions represent an integration of all the previous health concepts plus others, such as mental health. Overall QOL is described as the discrepancy between a person’s expectations or hopes and his or her present experiences. In this model, general health (HRQOL) is a determinant of overall QOL or SWB.

The Wilson and Cleary model of quality of life. Reprinted, with permission, from Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273(1):59-65. Copyright © 1995 by the American Medical Association.

The Wilson and Cleary model is one of the few models that have been tested in empirical research.³¹ The main part of the model, without personal and environmental characteristics, was found to fit the data, although this fit could be improved after allowing paths from symptom status to general health perceptions and between symptom status and overall QOL, indicating that symptoms are associated with health and QOL independent from their association with functional status.³¹

A model that is strongly founded in the WHO definition of health is the PROMIS conceptual model, displayed in .³² The mission of PROMIS is to use measurement science to create a state-of-the-art assessment system for self-reported health. Although the term “quality of life” is not used by PROMIS to characterize the framework, it is clear that a broad operationalization of health as physical, mental, and social health was intended. Within the mental health item banks, PROMIS covers psychosocial illness impact with both a positive and a negative item bank. The positive item bank measures positive psychosocial (emotional and social) outcomes of illness, previously conceptualized in various ways including posttraumatic growth, benefit finding, and meaning making. Positive psychosocial illness impact refers to positive psychosocial outcomes of illness that can occur as a result of confrontation with mortality, such as greater life appreciation, interpersonal relationships, and personal resources (http://www.nihpromis.org/measures/domainframework1). Thereby PROMIS covers SWB as a subset of HRQOL instead of the reverse or as the ultimate outcome.

An original approach to QOL measurement is provided by the developers of the Function-Neutral Health-Related Quality of Life Measure ().³³ The authors object to the inclusion of functional status items in HRQOL measures. According to them, functional ability was important in the early days of HRQOL measurement, but subsequent conceptualizations of HRQOL have emphasized the importance of distinguishing function from health to define the relationship between these constructs³⁴ and to examine health outcomes within the context of longstanding functional limitations.³⁵ According to these authors, the ICF²⁹ recognizes the possibility that persons can be disabled and healthy and emphasizes the importance of environment on the disabling process. The Function-Neutral Health-Related Quality of Life Measure therefore does not contain any functional status item, and its physical health scale contains items such as energy and pain instead.³³

Conceptual framework of the Function-Neutral Health-Related Quality of Life Measure. Reprinted, with permission, from Krahn GL, Horner-Johnson W, Hall TA, et al. Development and psychometric assessment of the function-neutral health-related quality of life measure. Am J Phys Med Rehabil. 2014;93(1):60. Copyright © 2014 by Lippincott Williams & Wilkins.

QOL in SCI Research

Crewe appears to be the first researcher to publish a QOL study in persons with SCI. She used a life satisfaction measure to determine QOL.³⁶ Another early publication came from Sweden.³⁷ These authors used a health status measure, the Sickness Impact Profile,²¹ to measure overall and physical and psychological functioning, the Mood Adjective Checklist³⁸ and the Hospital Anxiety and Depression Scale³⁹ to measure mood disturbances and feelings of anxiety and depression, and a series of self-developed items to measure accessibility of the environment. They also included one item on overall QOL, thereby covering health status or HRQOL and SWB.

Until recently, SWB measures were used more often than HRQOL measures in SCI research. Dijkers reviewed the QOL literature in 1997 and included mainly life satisfaction and happiness measures.²⁶ He included 22 studies in which results from 18 different samples were reported using a total of 12 different SWB measures.

Tate et al²⁵ focused on studies using subjective QOL measures in her review of QOL measurement in SCI. These authors described 4 ways in which QOL was conceptualized in the studies they reviewed:

1. As a subjective evaluation of the good characteristics of a person’s life

2. As a composite variable referring to an individual’s subjective overall satisfaction with life

3. As a multidimensional construct primarily based on a person’s subjective appraisal of physical, functional, emotional, and social well-being

4. As the fit between a person’s expectations and his/her achievements, as experienced by the person and within a time perspective

The third operationalization refers to HRQOL: Two studies were included in which the SF-36 or the SF-12 were used, despite the focus on subjective QOL.

Tate et al²⁵ also described their experiences with HRQOL measures. In addition to various measurement issues, they noted one conceptual problem with the use of the term “health” in the SF-12. Some participants had difficulty interpreting the word “health.” As one individual said, “What do you mean by health? I’m healthy and my health doesn’t limit me but my spinal cord injury does.” There was a substantial difference in the interpretation of whether or not functional limitations resulting from SCI were included in the concept of health.³⁰ Of all respondents, 21% never included their SCI, 28% sometimes included it, and 51% always interpreted health as including the effects of their SCI.²⁵

The developers of the Participation and Quality of Life (PARQoL) Toolkit (www.parqol.com) adopted Dijkers’s model of aspects of QOL to categorize the included QOL measures. This was not easy, as many measures were listed in multiple boxes, for example, both in the Achievements box and in the Societal Standards and Priorities box (). The PARQoL effort is one of the few to discuss the relationship between SHCs due to SCI and QOL.⁴⁰ SHCs are prevalent in SCI, hence, it is a challenge to identify a measure that is sensitive to the impact of SCI when it is likely that the individuals are contending with one or more additional SHCs. Also, to assess health condition impact, the outcome measures that are used must be sensitive to the impact of a particular SHC.⁴⁰ Both the PARQoL and the Spinal Cord Injury Rehabilitation Evidence (SCIRE) Web sites provide information on a number of outcome measures specific to certain SHCs, such as the Qualiveen tool⁴¹ for the perceived impact of urinary incontinence and the Patient Reported Impact of Spasticity Measure.⁴²

The Spinal Cord Rehabilitation Evidence team reviewed QOL measures that are used in SCI, and they followed the objective/subjective distinction proposed by Dijkers.²⁶ They included 8 objective and 5 subjective QOL instruments.¹¹ Objective measures included HRQOL measures such as the SF-36 and SHC-specific measures such as the PRISM. Subjective measures included the SWLS and the WHOQOL-BREF.¹¹ The authors also included a utility measure, the Quality of Well-Being (QWB) scale. The QWB is the only measure included in this review that provides quality-adjusted life years for health economic analyses, representing the Outsider perspective in Dijkers’s model.²⁸

Hill et al¹¹ state that many authors agree that the use of subjective QOL measures is more appropriate than objective QOL measures in individuals with SCI. Objective measures are based on the assumption that all individuals prioritize common life domains and goals and that success and achievement in these domains and goals are directly proportional to happiness and life satisfaction. Such instruments have the potential to miss many aspects of the individual’s life.¹¹ However, this is not a general consensus. HRQOL is frequently measured in many SCI studies. A recent review found no fewer than 174 SCI studies in which the SF-36 or SF-12 was used.⁴³

Utility measures, the societal valuation of the QOL of persons with SCI, are rarely used in SCI studies. A review identified 22 articles that used 10 different measures or versions of measures.⁴⁴ Eleven papers reported mean utility scores (from 6 different instruments). No studies used preference-based measures in their conventional form, that is, to calculate quality-adjusted life years using patient-level data.⁴⁴

There are numerous instruments for measuring QOL, and there is a wealth of data on QOL in individuals with SCI. However, comparability of QOL results is limited due to the diverging definitions, operationalizations, and measures. These problems are not specific to SCI research; they are also found in the general QOL literature. Specific challenges in SCI research are the distinction many people make between having SCI and being healthy²⁵ and the major impact SHCs have on HRQOL and SWB in addition to functional limitations.⁴⁵

How to Move On

The many definitions and operationalizations of QOL elicit little optimism about the possibility for reaching a consensus among researchers and clinicians. The best researchers can do is to be very clear about (a) the concept, (b) the “what,” and (c) the “how.” The final part of this article will be dedicated to an exploration of these 3 issues.

The concept

It would have been a easier if researchers could have agreed long ago to abandon the term “quality of life” completely, or to use the term “quality of life” only to refer to subjective well-being – global judgments of the individual involved, that is, overall subjective QOL, happiness, general well-being, or overall life satisfaction – acknowledging that there are subtle differences between these concepts.⁵ Now in excellent papers, we read complicated phrases such as, “understanding physical, psychological and social well-being factors that affect the quality of life of persons with SCI [italics added].”^43(p128) Without knowledge of the WHO definition of health and making the assumption that QOL refers to subjective QOL, it is not easy to understand this statement, because well-being as a determinant of QOL seems to make little sense. Such a statement would be easier to understand if it were rephrased as understanding physical, psychological, and social health factors that affect SWB of persons with SCI.

It would also be helpful to clarify whether paralysis, pain, unemployment, and so on are aspects of QOL or determinants of QOL. It might make sense to study the consequences of SCI on the level of body functions (motor and sensory impairment, SHCs), activities (mobility, self-care), and participation and QOL, as hypothesized in the Wilson and Cleary model (). This view on QOL is incorporated in a model of rehabilitation outcomes research we published some years ago ().^9,46 Using this view, it would also not be necessary to develop a function-neutral QOL measure.³³

A comprehensive model of quality of life. Reprinted, with permission, from Post M, Noreau L. Quality of life after spinal cord injury. J Neurol Phys Ther. 2005;29:140. Copyright © 2005 by Lippincott Williams & Wilkins.

In a QOL article, it would be useful to have a definition of QOL that fits the topic of the study or, alternatively, for the term “quality of life” to be used only as an umbrella for any aspect of living with illness or disability. All who use the term “quality of life” should be aware that there are many meanings of the phrase and they should specify what exactly they mean with the label.⁴⁷ The reader of a QOL article is advised to not infer any content or focus of the study from the use of this term, but to look for what is actually measured in the study. Even if a definition is provided in the article, it is not certain that the measures the researchers used fit this definition.

The “what”

Apart from general SWB measures such as the SWLS, QOL measures usually include items on different aspects or domains of QOL. Ware¹⁸ suggested that QOL measures need to include measurement of at least 5 distinct dimensions: physical health, mental health, everyday functioning in social activities, everyday functioning in role activities, and general perceptions of well-being. The aspects or domains that are included (eg, mobility, communication, material or spiritual life) vary strongly between measures. Selection of a measure should therefore be based on the goal of the study and inspection of the contents of promising measures. The model in provides a basis for the selection of aspects to study.⁹ Few generic HRQOL measures contain items on neuropathic pain or spasticity or other SHCs; so if these are important to measure in an SCI study, additional domain-specific measures have to be included in the protocol.⁴⁰

Measures differ in the way items on specific aspects are grouped into scales or an overall score, and the number of items on a certain aspect determines the weight of that aspect in the scale or total score. It is therefore less useful to make comparisons between total scores of different measures. Results should be reported on a scale level and not on a subtotal or total score level. However, even labels of scales are only rough indicators, and it is by no means guaranteed that one mobility scale is comparable to another mobility scale. The development of the SCI-Functional Index⁴⁸ with internally homogenous item banks for ambulation, basic mobility, hand function, and other aspects of functioning is a good example of this approach. The drawback of course is that it might increase the number of outcome scores in a QOL study to infinite.

The “how”

An aspect of measures that is neglected too often is the type of rating. The first distinction to be made is between measures of performance and measures of experience. Apart from physical tests, such as a 10-meter walking test, performance is usually measured with questionnaires. Performance can be rated in terms of frequency of behaviors, time, speed or distance, independence, and so on.

Measures of experience are called subjective, because they rely completely on self-report. Assessment of experiences is generally impossible without the individuals involved giving information. Experiences can be rated as perceived difficulty, satisfaction, or importance. The type of rating that is used makes a difference; the correlation between experienced participation restrictions and satisfaction with participation was not higher than 0.49 in an SCI study.⁴⁹

A special case of rating is the outsider rating used by utility measures, as described previously. This type of measurement is still relatively rare in SCI studies.⁴⁴ The principle of an outsider rating²⁸ contradicts the principle of QOL measurement, that is, the rating by the individual involved should count and not the rating by someone else, either a health professional or the general public.¹⁶

Conclusion

Even without consensus on the definition of QOL, substantial gains can be made in the clarity and comparability of QOL research in individuals with SCI.

Acknowledgments

The author declares no conflicts of interest.

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What is quality of life? Definition and examples

Quality of life refers to how well we live, i.e., the general well-being of people and societies. It is the standard of happiness, comfort, and health that a person or group of people experience.

It is an inherently ambiguous and subjective term. People who love sports may feel that their quality of life has suffered if local facilities close down. For a couch potato, on the other hand, the loss of sports facilities makes no difference.

Some people say quality of life is about wealth and owning things, while others may define it in terms of physical, mental, and emotional well-being.

Collins Dictionary has the following definition of the term:

“A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”

Quality of life vs. standard of living

We can use the term in several different contexts, including politics, economic or international development, and healthcare.

We should not confuse the term with ‘standard of living,’ which focuses mainly on economic factors.

According to Wikipedia, quality of life observes “life satisfaction, including everything from physical health, family, education, employment, wealth, safety, security to freedom, religious beliefs, and the environment.”

Standard of living

Standard of living refers to people’s level of prosperity (wealth), comfort, material possessions, and necessities.

When we calculate a society’s standard of living, we take into account factors such as employment, poverty rates, affordable housing, and GDP. GDP stands for Gross Domestic Product. We also take into account inflation, the cost of goods and services, infrastructure, and economic and political stability.

When calculating a person’s or society’s standard of living, we use things that we can quantify easily. GDP, prices, and employment/unemployment are factors we can measure.

Quality of life

The factors that make up quality of life are abstract, intangible, and subjective. The factors include the freedom to do things and freedom from bad things. Freedom of movement, of thought, and of religion, for example, are some of these factors. So are freedom from discrimination, slavery, and torture.

We also measure quality of life according to people’s rights, such as the right to education, human dignity, fair pay, and to have a family.

Most people would agree that we must consider levels of happiness when calculating quality of life. However, measuring or rating happiness is not easy. Happiness is a subjective thing.

We could, for example, send out a team of people to determine how often people smile. Researchers could then compare the same people today and in five years’ time. We could also compare how often people in the UK smile compared to Canadians.

Even with smiling, there are cultural factors that we would need to consider. In some countries, for example, telling jokes with a serious face makes it funnier. In other cultures, on the other hand, not smiling kills the joke.

Objective vs. subjective

Put simply, quality of life is subjective while standard of living is objective.

Medical treatment vs. quality of life

The instinct of most doctors and other healthcare professionals is to treat patients. In other words, to extend a person’s lifespan as long as possible.

However, especially with terminal illnesses, at which point should treatment stop? At which point should the quantity of life give way to quality of life? Especially if there is not much time left.

If a person has six months left to live, or seven months with treatment, which option is best?

Treatment and side-effects

Treatment often comes with side-effects such as pain, nausea, depression, diarrhea, and lethargy. If we chose to offer the terminal patient palliative/hospice care, would their last few months of life be better? Palliative care focuses on providing relief from pain and other unpleasant symptoms, as well as physical and mental stress.

This issue is going to get bigger as people in most advanced and emerging economies live longer and medical capabilities advance.

In a Psychology Today article, Ethan Remmel Ph.D. quotes Atul Gawande, who said:

“The soaring cost of health care is the greatest threat to the country’s long-term solvency, and the terminally ill account for a lot of it.”

“Twenty-five percent of all Medicare spending is for the five percent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.”

Quality of life – happiness

The World Happiness Report ranks 156 countries according to how happy they are. It also ranks 117 countries according to the happiness of their immigrants.

The report ranks Finland as the happiest country in the world. The rest of the top ten, in order, are Norway, Denmark, Iceland, Switzerland, Netherlands, Canada, New Zealand, Sweden, and Australia. The United States and United Kingdom ranked 18th and 19th respectively.

The least happy country, according to the Report, is Burundi.

The World Happiness Report shows that standard of living and happiness are closely related. The happiest countries in the world also have the highest standards of living.

Notes on “Quality of Life”

What Does ‘Quality of Life’ Mean for Seniors?

Many conversations about aging often involve the topic of quality of life for seniors. However, a recent Forbes article highlights a flaw in the use of “quality of life” as a blanket term: Not only is it subjective, but it’s also inherently dynamic. Given the ambiguity surrounding the oft-used phrase and its meaning, it follows that there’s often confusion regarding how best to support quality of life for elderly people. 

The good news? Data from Pew Research sheds new invaluable light on the subject by going straight to the source: Seniors themselves. Here’s a closer look at the study, along with what it reveals about how caregivers can support quality of life in older age. 

The “Satisfaction” Over-Simplification

A body of evidence tells us that happiness contributes to the quality of life. However, while this concept is simple in theory, it’s more complicated in the real world — particularly when you factor in age-related changes and perceptions.

While 76 percent of U.S. residents aged 75 and older say they’re satisfied with their lives today, only 19 percent of them believe that their lives will improve over the next decade, according to a Pew Research survey on aging and quality of life. Compare this to 71 percent of people under the age of 50 who expect better lives 10 years from now. At the same time, just 30 percent of adults in the 75-and-older age group feel like the lives their currently living are better than they were a decade ago.

The takeaway? 

While seniors may report that they’re satisfied with their lives overall, their satisfaction is less than it once was and likely to decline in the future.

Supporting Senior Quality of Life

The data shared by Pew can be viewed as both heartening and disheartening. After all, feeling generally satisfied with life — even if it’s less than it once was and more than it will be — is a good thing. However, this doesn’t mean seniors (and their caregivers) should settle for bleak expectations regarding quality of life in the future.  Pew Research survey takes things a helpful step further by identifying which aspects adults in various age groups feel are particularly important when influencing the quality of life in older age.

Regardless of the age group, the relative order of characteristics supporting quality of life remains consistent, which one thing topping the list for all: The ability to talk and communicate. 

Also viewed as important, is the order they were ranked by adults of all ages. 

1. Being able to feed oneself
2. Getting enjoyment out of life
3. Living without severe, lasting pain
4. Having long-term memory
5. Feeling what one does is worthwhile
6. Being able to dress oneself
7. Having good short-term memory. 

Older people view all of these things as less important than their younger counterparts with one exception: the ability to dress themselves.

Key Takeaways

While caregiving for the elderly isn’t easy, the key to helping older adults lead more satisfying lives doesn’t have to be a mystery thanks to insights from Pew Research into senior perceptions. 

For starters, communication is key. Talking with seniors, encouraging them to share their feelings, and welcoming their input is an invaluable way to support quality of life. 

Also important? Helping them to connect with others, continue cherished activities and hobbies, and feel useful and needed in everything from everyday tasks to volunteering within their capabilities. 

As far as more logistical concerns, such as eating and dressing, everything from consulting with their healthcare teams to learning more about assistive devices can help support senior independence for as long as possible. 

One last thing to keep in mind? Ultimately, some quality of life-impacting, age-related changes are unavoidable. However, keeping the lines of communication open throughout these changes is a vital part of helping not only meet their basic needs but also their expectations. 

If you’re looking for a comprehensive resource for family caregivers, check out our online Family Caregiver Guide.

mmLearn.org offers a large library of free videos for caregivers of older adults, covering topics pertaining to senior care. Whether you are a healthcare professional or a family caregiver, if you are caring for an older adult we know that you will find mmLearn.org an essential learning and guidance tool for all of your caregiver training needs.  Access our database of free online caregiver videos to start learning today.

What does quality of life mean to older frail and non-frail community-dwelling adults in the Netherlands?

15 Essential Tips to Improve Your Quality of Life

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What is the first thing that comes to your mind when you think about quality of life? Some mistake it to mean just your “standard of living” but it goes far beyond that.

Your standard of living is mostly associated with your income and only has a marginal effect on your quality of life. Quality of life goes beyond your standard of living to include the totality of your happiness, health, leisure, vitality, and of course, income as well.

It is said that “money makes the world go round” mostly because the availability of money makes it easier for someone to improve the quality of their life. Yet, not everyone with money is happy; not all enjoy a quality life.

How To Improve Your Quality of Life

Irrespective of how the quality of life is defined, the fact remains that in the pursuit of a good life, we tend to find fulfillment in positive expectations.

It doesn’t really matter what your idea of what a good life is, the most important thing is that you create for yourself a life that you enjoy every day.

Do you wake up each day looking forward to the day’s activity and enjoying every moment of the day?

Almost everyone is seeking ways of improving their life, but how aren’t always aware of how to achieve that. There are different things you can do to improve your life’s quality.

You have to start with being optimistic, living in the present, understanding what you want out of life, celebrating yourself, loving yourself, appreciating your uniqueness, and then connecting with other people.

15 Essential tips to improve your quality of life

1. Focus on eating well

What you consume affects your health and living healthy should be a priority for everyone. Feed more on healthy diets like fruits, vegetables, proteins, low-calorie carbohydrates, and healthy fat.

2. Practice personal hygiene

There is that feeling of joy that comes when you look around you and see that everything is in order. Keep your surroundings clean and keep your body clean as well.

3. Identify what makes you happy

What do you want out of life, and what gives you real satisfaction? You should think about that. Everyone deserves to be happy irrespective of whether you have some millions stacked up somewhere or not.

4. Stop stressing so much

Life is full of troubles, and they are most likely never going to end until you die. Would you rather allow stress to shorten your life span?

Get off that train and de-stress yourself. Don’t make life harder than it already is.

5. Spend more time with loved ones

What beats the feeling of being around people you care for and who care for you? Are you in a relationship?

Even while going through the busy schedules of life, don’t forget to spend ample time with your loved one. Or better yet, yourself.

6. Get into your productivity zone

A good life also entails being highly productive. Surely, you don’t plan on going through life without getting anything done, affecting lives. Discover your productivity zone if you haven’t.

7. Keep moving forward

Choose not to be static, and believe in the power of growth. You ought to improve in everything you are doing and in that way you attain growth.

8. Get some good sleep while you’re at it

The importance of sleep in our everyday life cannot be overemphasized. The quality of sleep you get affects both your physical and mental health.

Whatever you do, ensure you get at least 7 hours of sleep each night.

9.  Exercise regularly

Several studies have highlighted the importance of exercise to health and quality of life. A sedentary lifestyle has been shown to predispose to certain medical conditions.

Get your workout boots on!

10. Develop and maintain healthy relationships

Relationships play a crucial role in people’s mental health. Go out and meet new people, socialize, and develop supportive relationships.

Study shows that a healthy relationship can add to your happiness, increase psychological well-being and reduce depression.

11. Find meaning in your job

Your job is a vital part of your life. If you work in a toxic environment, certainly, it would affect you negatively.

Are you happy with your job? Do you find meaning, direction, and purpose in it? Discover what makes it truly meaningful and if you need to change it.

12. Set aside time for leisure

There is the saying that “all work and no play makes Jack a dull boy”. Yes, life is always busy that some days, you’d even feel like 24 hours is not enough to accomplish your plans for the day.

But, in the midst of it all, give yourself some time to relax and have fun.

13. Disconnect from unhealthy relationships

Just as healthy relationships can increase your quality of life, you have no idea how toxic, unhealthy relationships can be.

Unhealthy relationships can cause conflicts and bring stress which reduces your quality of life. Hence, the need to cut them off.

14. Smiling and meditating

Smiling shows you have lots of positive energy around you, irrespective of what life throws at you. It takes you away from depression and elevates your mood.

Meditation, just like smiling, works to relieve stress, ease anxieties, and lower blood pressure.

15. Read, learn every day

Knowledge is the key to unlocking many doors. Advancement in your education would lead to progress in your career.

Learning affects various spheres of your life and improves the quality of life. Learn new skills, read books, get informed about things happening around you!

The Importance of Improving your Quality of Life Every Day

At this point, it will be imperative to ask, “why is having a good quality of life important?” Quality of a person’s life is paramount.

Here are some reasons why you should seek to improve your life’s quality:

• You are happier when you have a good quality of life.

• It sees to it that you are in a complete state of physical and mental well-being.

• It affects your social life positively.

• People with enhanced quality of life experience a more fulfilling and satisfying life.

• You tend to be more productive when you have a good quality of life.

We hope you enjoyed these tips on improving your quality of life. Which one will you apply today? Share in the comments below!

Quality of life

The quality of life is the degree of satisfaction of the material, cultural and spiritual needs of a person, as well as the level of compliance of economic opportunities, educational, legal system and the quality of the natural environment with modern scientific ideas about the standards of the living environment and life support.

Improving the quality of life is one of the pivotal elements of the implementation of the main goal set by the world community – the achievement of sustainable development of socio-economic systems at all levels:

• region;
• states;
• of the world system as a whole.

One of the definitions of sustainable development, formulated by the International Commission on Environment and Development (ICED), directly relates to the quality of life: the individual and the safety of man and the environment (society and the natural environment) ”.

Two integral indicators (“indicators”) are widely used in the official UN documents to characterize and assess the quality of life:

• social development index;
• Human Rights Index.

Social Development Index is a combination of three indicators:

• Health (longevity), as a criterion for which the average life expectancy is used. Long life increases the likelihood for a person to maximize their abilities and achieve their goals.
• Knowledge (awareness), the criterion of which is the length of the period of time allotted in society for the education of a person (knowledge provides a person with the necessary conditions for obtaining information that allows him to realize his potential in an optimal way, to carry out successful economic transformations).
• Consumption level, the criterion of which is the gross national product per capita, expressed in the purchasing power parity of the national currency.

The human rights index is calculated using a special method and is expressed in relative units in the range 0-1:

0 – complete lack of civil rights among members of society;

1 – their complete satisfaction.

Of the noted private indicators of the quality of life, the average life expectancy (MLLS) is of great practical importance.This indicator also characterizes the second goal of the transition to sustainable development – ensuring the safety of man and his environment, since only if this goal is achieved can the maximization of the LSSI be achieved. The value of the LSS depends on many factors that determine certain needs of a person and affect the conditions of his life. At the same time, it depends on the size of the gross national product and deductions from it for improving the quality of life and developing the security system.

BMD can differ significantly from biological life expectancy (BML). With a known value of the life span and quantitative indicators of the factors that determine the change in life expectancy, it is possible to determine the life span of the life span. These quantitative indicators include:

• Decrease in LSSL due to the constant (background) component of man-made, natural and environmental impacts;
• increase in the LSSL by improving the quality of the natural environment, regular deductions from GDP for consumption and development of the security system, etc.

There are other approaches to the interpretation of the concept of “quality of life”. Sometimes quality of life characteristics include:

• economy;
• education;
• human rights.

At the same time, the indicator related to health, and therefore the LSS, is referred to as safety. However, the quality of life and safety are considered within the framework of achieving the goal of sustainable development.

Sources: Kuzmin I.I., Makhutov N.A., Khetagurov S.V. Safety and risk. Environmental and economic aspects. – SPb., 1997; Izmalkov A.V. Security management of socio-economic systems and assessment of its effectiveness. – M., 2003.

90,000 3. Quality of life in medicine

The International Health Organization (WHO) has developed a large list of criteria for human health and its impact on quality of life. Here are the main ones.

At present, more and more attention has begun to be paid to the study of the quality of life in medicine, which made it possible to delve deeper into the problem of a person’s attitude to their health.

There was even a special term “quality of life associated with health”, which means an integral characteristic of the physical, psychological, emotional and social state of a person, based on his subjective perception.

An important and relevant in this set of signs of quality of life is the state of health of a particular person , and hence the quality of life of his family, loved ones, when communicating at work, including with a temporarily acquaintance or a random person.All these factors of trustful interaction of people with each other also pass into interaction with nature, flora and fauna, which in general form a new environment – according to the definition of Academician V.I. Vernadsky – “noosphere”. That is, in the sphere of reasonable relations in nature, despite the different levels of their development and state.

Going directly to the various spheres of human activity, his undoubtedly main quality is his state of health, which, as they say, you cannot buy it anywhere in advance, but you still have to pay at a high price later.Sometimes it is priceless, because it is irretrievably wasted.

There is an opinion that at the birth of a person, the Almighty tirelessly protects him for some time, and then, as it were, provides these functions to him: live yourself, manage your health yourself, strengthen it physically and spiritually, preserve it for many years.

Many experts and those who have experienced all the hardships and deprivations of this heavy burden, even the struggle for health, write about this. Only the strong in spirit were able to withstand the defeat of the ailments, and continue life, improving its quality.They became idols, famous and respected people, an example for others: how to help oneself and how to pass on their experience of survival to others who found themselves in a difficult situation. Tell me, this is not a feat performed by Miya Gogulan. She overcame all her illnesses and wrote the book “Say Goodbye to Illness” for others.

Or the feat of the national hero of Canada, who was able to overcome everything and, being disabled, walked his country from the east to the western coast of the Pacific Ocean more than 9 thousand kilometers on prostheses in order to raise money for funding for cancer research.His name was Teri Fox. He is featured on one of the new Canadian banknotes.

Humanity remembers other examples of courageous people who helped themselves and others, withstood and conquered ailments.

The famous doctor, professor V.I.Neumyvakin writes about the properties of a person, the secrets of his physical and spiritual reserve. in the book “The Energy Essence of Man”, which for a long time studied psychology, bioenergetics, methods of recovery and healthy nutrition in the extreme conditions of our cosmonauts.

These and other similar works deserve attention. It is important not only to read and study them, but also to use them in your practice: some for health promotion, and some for recovery.

In our health promotion or recovery project, we will look at only one direction that promotes a healthy lifestyle – movement.

It seems that the concept of “movement” should be in all the improvement of a person: gaining knowledge, professional growth, spiritual and physical development, that is, as they say, it is important to have a harmonious development.Fortunately, it is now available to everyone. And only, as the well-known developer of information technology Steve Jobs wrote: “Take the first step and the road will open for you.”

Article 2. Basic concepts used in this Federal Law / Consultant Plus

Article 2. Basic concepts used in this Federal Law

1. For the purposes of this Federal Law, the following basic concepts are used:

1) health – a state of physical, mental and social well-being of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body;

2) protection of the health of citizens (hereinafter – health protection) – a system of measures of a political, economic, legal, social, scientific, medical, including sanitary and anti-epidemic (preventive), nature, carried out by state authorities of the Russian Federation, state authorities of constituent entities The Russian Federation, local authorities, organizations, their officials and other persons, citizens in order to prevent diseases, preserve and strengthen the physical and mental health of each person, maintain his long active life, provide him with medical care;

3) medical care – a set of measures aimed at maintaining and (or) restoring health and including the provision of medical services;

4) medical service – a medical intervention or a complex of medical interventions aimed at preventing, diagnosing and treating diseases, medical rehabilitation and having an independent complete meaning;

5) medical intervention – performed by a medical worker and other worker who has the right to carry out medical activities in relation to a patient, affecting the physical or mental state of a person and having a preventive, research, diagnostic, therapeutic, rehabilitation orientation, types of medical examinations and (or) medical manipulations, as well as artificial termination of pregnancy;

(as amended byFederal Law of December 29, 2015 N 389-FZ)

6) prevention – a set of measures aimed at maintaining and strengthening health and including the formation of a healthy lifestyle, prevention of the onset and (or) spread of diseases, their early detection, identification of the causes and conditions of their occurrence and development, as well as aimed at eliminating harmful influence on human health of the factors of his habitat;

7) diagnostics – a complex of medical interventions aimed at recognizing conditions or establishing the presence or absence of diseases, carried out by collecting and analyzing patient complaints, data from his anamnesis and examination, conducting laboratory, instrumental, pathological and anatomical and other studies in order to determine the diagnosis , the choice of measures for the treatment of the patient and (or) control over the implementation of these measures;

8) treatment – a set of medical interventions performed as prescribed by a medical worker, the purpose of which is to eliminate or alleviate the manifestations of a disease or disease or a patient’s conditions, to restore or improve his health, ability to work and the quality of life;

9) patient – an individual to whom medical assistance is provided or who has applied for medical assistance, regardless of whether he has a disease or his condition;

10) medical activities – professional activities related to the provision of medical care, medical examinations, medical examinations and medical examinations, sanitary and anti-epidemic (preventive) measures and professional activities related to the transplantation (transplantation) of organs and (or) tissues, circulation of donor blood and (or) its components for medical purposes;

11) medical organization – a legal entity, regardless of its organizational and legal form, carrying out medical activities as the main (statutory) type of activity on the basis of a license issued in accordance with the procedure established by the legislation of the Russian Federation on licensing certain types of activities.The provisions of this Federal Law regulating the activities of medical organizations apply to other legal entities, regardless of their organizational and legal form, carrying out medical activities along with their main (statutory) activities, and apply to such organizations in the part related to medical activities. For the purposes of this Federal Law, individual entrepreneurs engaged in medical activities are equated to medical organizations;

(as amended byFederal Laws of December 29, 2015 N 408-FZ, of December 27, 2019 N 478-FZ)

12) pharmaceutical organization – a legal entity, regardless of its organizational and legal form, carrying out pharmaceutical activities (organization of wholesale trade in medicines, pharmacy organization). For the purposes of this Federal Law, individual entrepreneurs engaged in pharmaceutical activities are equated to pharmaceutical organizations;

13) a medical worker – an individual who has a medical or other education, works in a medical organization and whose labor (official) duties include the implementation of medical activities, or an individual who is an individual entrepreneur directly carrying out medical activities;

14) a pharmaceutical worker is an individual who has a pharmaceutical education, works in a pharmaceutical organization and whose labor duties include wholesale trade in drugs, their storage, transportation and (or) retail trade in drugs for medical use (hereinafter – drugs) , their manufacture, release, storage and transportation;

15) attending physician – a doctor who is entrusted with the functions of organizing and directly providing medical care to a patient during the period of observation and treatment;

16) disease – arising in connection with the impact of pathogenic factors, a violation of the body’s activity, working capacity, the ability to adapt to changing conditions of the external and internal environment while changing the protective-compensatory and protective-adaptive reactions and mechanisms of the body;

17) condition – changes in the body arising from the influence of pathogenic and (or) physiological factors and requiring the provision of medical care;

18) main disease – a disease that, by itself or due to complications, causes the primary need for the provision of medical care in connection with the greatest threat to working capacity, life and health, or leads to disability, or becomes the cause of death;

19) concomitant disease – a disease that does not have a causal relationship with the underlying disease, is inferior to it in the degree of the need for medical care, impact on working capacity, danger to life and health and is not the cause of death;

20) severity of a disease or condition – a criterion that determines the degree of damage to organs and (or) systems of the human body or dysfunctions of their functions caused by a disease or condition or their complication;

21) the quality of medical care – a set of characteristics reflecting the timeliness of the provision of medical care, the correct choice of methods of prevention, diagnosis, treatment and rehabilitation in the provision of medical care, the degree of achievement of the planned result;

22) telemedicine technologies – information technologies that ensure remote interaction of medical workers with each other, with patients and (or) their legal representatives, identification and authentication of these persons, documenting their actions during consultations, consultations, remote medical monitoring of the patient’s health ;

(p.22 introduced by the Federal Law of 29.07.2017 N 242-FZ)

23) clinical guidelines – documents containing structured information based on scientific evidence on prevention, diagnosis, treatment and rehabilitation, including protocols for the management (treatment protocols) of a patient, options for medical intervention and a description of the sequence of actions of a medical worker, taking into account the course of the disease, the presence of complications and concomitant diseases, other factors affecting the results of medical care.

(Clause 23 introduced by Federal Law No. 489-FZ of 25.12.2018)

2. The concepts specified in this article may be clarified in accordance with the program of the experimental legal regime in the field of digital innovations, approved in accordance with the Federal Law of July 31, 2020 N 258-FZ “On experimental legal regimes in the field of digital innovations in Russian Federation”.

(part 2 was introduced by the Federal Law of 02.07.2021 N 331-FZ)

90,000 How the rating of the regions was calculated RBC – RBC

1

Purchasing activity level

Retail trade turnover per capita.The weight of the indicator is 20%. The use of retail trade turnover as an indicator of well-being was chosen, since it is he that reflects the volume of expenditures of citizens on current consumption , in contrast to salaries, which also include expenses for housing and communal services, payment of loans, savings, and so on.

2

Housing affordability

The ratio of the average salary in the region and the cost of one square meter of housing. The weight of the indicator is 5%. The indicator describes the ability of citizens to purchase housing in the region without taking into account the use of borrowed funds. The higher the value of the indicator, the greater part of the acquired living space citizens can pay with their own funds.

3

Ability of the population to service loans

Ratio of overdue debt on loans to individuals and the average salary in the region. The weight of the indicator is 7.5%. Accounting for overdue debts is preferable to using the total debt burden per inhabitant, the NKR believes.In economically developed regions, bank loan products are highly popular and the debt-to-wage ratio does not reflect the real debt burden.

4

Official employment rate

The share of the employed with official labor income. The weight of the indicator is 7.5%. It describes the extent to which citizens living in the region are involved in the shadow economy. Informal employment is viewed negatively in comparison with formal employment, since it does not provide a citizen with adequate protection of labor rights, and is also subject to significant fluctuations in income.

5

Level of savings of the population

Ratio of bank deposits per capita to average wages. The weight of the indicator is 7.5%. It characterizes the ability of the population to accumulate savings, assessing how many average monthly salaries citizens keep on average in deposits.

6

Provision of fixed assets of the social sphere

The cost of fixed assets (buildings, structures, equipment, etc.)in the spheres of education, health care, culture and sports per capita. The weight of the indicator is 12.5%. He estimates to what extent the social sphere of the region is provided with material assets.

7

Housing

The ratio of the total area of ​​the housing stock in the region and the population. The weight of the indicator is 10%. He assesses the extent to which the inhabitants of the region are provided with housing.

8

Provision of teaching staff

The ratio of the number of schoolchildren and the number of teachers. The weight of the indicator is 5%. It characterizes the sufficiency or shortage of teachers in preschool, school and secondary vocational educational institutions of the region.

9

Provision of doctors

The ratio of the number of inhabitants and the number of doctors in the region. The weight of the indicator is 5%, indicates the sufficiency or shortage of doctors in the constituent entity of the Russian Federation.

10

Climatic zone

The weight of the indicator – 20%, characterizes natural and climatic conditions in the region .

How to improve the quality of life

1. Take responsibility for your life
How do you feel when you hear the word “responsibility”? How comfortable is it for you? And how do you think that the one who is not afraid of this responsibility is really happy? The point here is precisely about responsibility not for everyone and everything, but for oneself. This means that if something bothers you, does not satisfy, upset, then the first thing you need to ask yourself is: have I done everything I could in this particular situation to change it?
Do you often face the temptation to shift the responsibility for failure onto your boss, the state, or your bum spouse? Yes, it is important for us to be able to separate it and clearly see where our zones of influence end.Fortunately, nobody took the right to choose from us. Therefore, only you decide whether to stay with this partner, in this state and with this boss. Next time, when faced with a life obstacle and honestly said to myself: yes, I did everything I could, move on to the next items on our list.

2. Master the skill of resistance to stress
This skill includes the ability to calm yourself, comfort and distract your attention. Of course, if you know for sure that you did everything you could.It is strongly discouraged to use this skill just to better endure discomfort. For example, a woman suffers from the destructive behavior of her alcoholic husband, but does not fundamentally solve the problem. She just endlessly consoles herself, soothes and endures, while continuing to collapse.
So, the skill of self-consolation is to remember and name all the favorable facts and circumstances that were or are at the moment in life in a stressful situation. For example: “Yes, I didn’t have time to make a high-quality report this month and listened to the remark, but six months ago I was the best employee of the month, received a bonus, raising my qualifications with this money!”.
Learn to notice more of the good things in your life, focus on it. Make it a rule before bed to do the practice of gratitude: write down at least five things for which you thank the past day. Let it be even insignificant trifles, for example: “I thank this day for feeling good, for the opportunity to eat well, for the health of my loved ones, for the smile of a passer-by,” etc. Our brain is so arranged that it notices in space what is about we think most of the time. So focus on the good!
It is also important to be able to set yourself up for a better future and train the skill of positive thinking.Look for arguments in your favor, motivate yourself. Finally, take your mind off negative thoughts! After you have already done everything you could, direct your energy to your development and creation. Use self-regulation techniques: breathing techniques, relaxation, meditation, yoga. This will help raise the level of happiness hormones in the blood, which is scientifically proven fact.

3. Master the skill of emotional self-regulation
This skill implies the ability to understand (name), be aware, and express your emotions.That is, if something upset you, it is important to stop at the moment and ask yourself the question: what am I feeling now? And clearly recognize what it is: anger, irritation, resentment, disappointment? After that, analyze the context of the situation: I got angry because this person violated my boundaries. After that, it is important to express your emotions in a non-violent way, without suppressing them. About this in the next paragraph.

4. To master the skill of nonviolent communication
Suppression of emotions leads to undesirable consequences, including psychosomatics (the occurrence of bodily diseases due to a psychological factor).Therefore, it is important to learn how to properly respond to your feelings so as not to endanger your health.
So how can you properly express your emotions without ruining your relationships with others? The i-message technique is perfect for this purpose. It is especially recommended when communicating with the close and middle circle of people (spouses, children, relatives, colleagues, friends). Its essence is to speak about your feelings in the first person, without criticizing the other person and without using the word “you” in the sentence.For example, the phrase: “How can you throw your things all over the place, slob! How long can I clean up after you? ” should be replaced with: “I am very unhappy to see things scattered about, I would like them to be in place, please, let’s keep order.” Do you feel the difference? In the first case, a person is likely to respond with aggression or close in himself. In the second case, the chances of being heard are multiplied.

5. Finding time to live
“I don’t have time for this!” “I am constantly at work!” Sound familiar? So, if you really want to improve the quality of life, it is important to learn how to properly plan your time, allocate it for really important things.
For example, instead of surfing the waves of social networks, do a warm-up, pay attention to your body, your hobbies. Plan cultural events a month in advance. Write down when and where you will go, plan trips, training, possible travel. Consciously set aside time for this in advance, and not on a leftover basis, and follow the planned plan – this will discipline. Make your life and development a priority, because things and tasks never end!

6. Taking care of ourselves through beneficial rituals
In pursuit of a sense of security and stability, many of us turn on the function of hypercontrol, believing that in this way they will save ourselves from unwanted consequences.It is important to realize here a proven axiom: we cannot change other people and their behavior. But we are quite capable of doing this with our own state. This can be accomplished with beneficial rituals that, when performed regularly, increase a sense of security and life satisfaction. After all, their implementation is precisely subject to our control!
Find an opportunity for full physical training twice a week and for exercises every day in the morning. Try to wake up at least 30 minutes early to do a set of exercises and a short meditation.This will give your body the right dose of the hormone of joy, increasing your resistance to stress and bad moods.
During the day, take your mind off work and do joint exercises during breaks. Before going to bed, as noted above, write down five reasons why you are grateful today. To sleep better, listen to yoga nidra. This is just an example of possible rituals, your imagination is not limited by anything.

7. Helping others
Nothing saturates with a feeling of happiness and satisfaction like the opportunity to do a good deed and see gratitude in the eyes of another person.But it is important not to forget to stay in the resource yourself. There are people who chronically live in the role of lifeguard, doing good where it was not asked for. Always ask yourself test questions before helping someone else: Will my help here be helpful and appropriate? Do I really have an opportunity to help or am I doing it with the last bit of strength in order to receive recognition and gratitude? The instruction on airplanes to put the mask on yourself and then on the child has become a popular aphorism.But it perfectly reflects the essence of the fact that a person is able to qualitatively help another only when he is in order.

Psychologist of the Moscow psychological aid service Natalya Legovtseva for “Motherhood.ru”.

Healthy lifestyle – Hospital KSC SB RAS

A healthy lifestyle is an active participation in labor, social, family and household, leisure forms of human life. Unfortunately, many people do not follow the simplest, science-based norms of a healthy lifestyle.Some become victims of inactivity, which causes premature aging, others overeat in food with the development of obesity, vascular sclerosis, which is almost inevitable in these cases, others do not know how to rest, be distracted from work and household worries, are always restless, nervous, suffer from insomnia, which ultimately leads to numerous diseases of internal organs.

There are three types of health: physical, mental and moral (social).

Physical health is the natural state of the body, due to the normal functioning of all its organs and systems.If all organs and systems work well, then the entire human body (a self-regulating system) functions and develops correctly.

Mental health depends on the state of the brain, it is characterized by the level and quality of thinking, the development of attention and memory, the degree of emotional stability, the development of volitional qualities.

Moral health is determined by those moral principles that are the basis of a person’s social life, i.e.e. life in a particular human society. Distinctive features of a person’s moral health are, first of all, a conscious attitude to work, mastery of cultural treasures, active rejection of morals and habits that contradict the normal way of life.

A healthy lifestyle is a prerequisite for the development of various aspects of human life, the achievement of active longevity and the full performance of social functions. The relevance of a healthy lifestyle is caused by an increase and change in the nature of the load on the human body due to the complication of social life, an increase in the risks of a technogenic, environmental, psychological, political and military nature, provoking negative changes in the state of health.

A healthy lifestyle includes the following basic elements: “fruitful work, a rational regime of work and rest, the eradication of bad habits, an optimal motor regime, personal hygiene, hardening, rational nutrition, etc.”

Productive work is an important element of a healthy lifestyle. Human health is influenced by biological and social factors, the main of which is work. A rational mode of work and rest is a necessary element of a healthy lifestyle.With the correct and strictly observed regime, a clear and necessary rhythm of the body’s functioning is developed, which creates optimal conditions for work and rest and thereby contributes to health improvement, improved efficiency and increased labor productivity.

The next link in a healthy lifestyle is elimination of bad habits (smoking, alcohol, drugs). These health impairments are the cause of many diseases, dramatically reduce life expectancy, reduce working capacity, and adversely affect the health of the younger generation and the health of future children.

The next component of a healthy lifestyle is rational nutrition . When talking about it, you should remember about two basic laws, violation of which is dangerous to health.

The first law is the balance of received and consumed energy. If the body receives more energy than it consumes, that is, if we receive more food than is necessary for the normal development of a person, for work and well-being, we gain weight.

The second law is “the correspondence of the chemical composition of the diet to the physiological needs of the body for nutrients.”The diet should be varied and provide the needs for proteins, fats, carbohydrates, vitamins, minerals, dietary fiber. Many of these substances are irreplaceable, since they are not formed in the body, but only come with food. The absence of at least one of them, for example, vitamin C, leads to illness and even death. We obtain B vitamins mainly from wholemeal bread, and the sources of vitamin A and other fat-soluble vitamins are dairy products, fish oil, and liver.

It has been established that a healthy middle-aged person with normal body weight consumes 7 kilocalories per hour per kilogram of body weight. The first rule in any natural food system should be: eating only when you feel hungry; refusal to eat for pain, mental and physical ailments, with fever and increased body temperature; refusal to eat immediately before bedtime, as well as before and after serious work, physical or mental. It is very important to have free time to digest food.The idea that exercise after meals helps digestion is a blunder.

The meal should consist of mixed foods that are sources of proteins, fats and carbohydrates, vitamins and minerals. Only in this case it is possible to achieve a balanced ratio of nutrients and essential nutritional factors, to ensure not only a high level of digestion and absorption of nutrients, but also their transportation to tissues and cells, and their complete assimilation at the cell level.Rational nutrition ensures the correct growth and formation of the body, contributes to the maintenance of health, high efficiency and prolongation of life.

It has an important effect on health and the state of the environment. Human intervention in the regulation of natural processes does not always bring the desired positive results. Violation of at least one of the natural components “leads, due to the existing interrelationships between them, to the restructuring of the existing structure of natural-territorial components.”Pollution of the land surface, hydrosphere, atmosphere and the oceans, in turn, affects the health of people, the effect of the “ozone hole” affects the formation of malignant tumors, air pollution on the state of the respiratory tract, and water pollution – on digestion, sharply worsens the general condition health of mankind, reduces life expectancy. However, the health received from nature depends only 5% on the parents, and 50% on the conditions around us.

In addition, it is necessary to take into account another objective factor of impact on health – heredity.Affect our health and biological rhythms. One of the most important features of the processes taking place in a living organism is their rhythmic nature. It has now been established that over three hundred processes occurring in the human body are subordinate to the daily rhythm.

An optimal motor regime is the most important condition for a healthy lifestyle. It is based on systematic physical exercises and sports, which effectively solve the problems of strengthening the health and development of the physical abilities of young people, maintaining health and motor skills, and strengthening the prevention of unfavorable age-related changes.At the same time, physical culture and sports are the most important means of education.

For effective recovery and prevention of diseases, it is necessary to train and improve first of all the most valuable quality – endurance in combination with hardening and other components of a healthy lifestyle, which will provide a growing body with a reliable shield against many diseases.

Personal hygiene is another important element of a healthy lifestyle. Personal hygiene includes a rational daily regimen, body care, clothing and footwear hygiene.The daily routine is also of particular importance. With its correct and strict observance, a clear rhythm of the body’s functioning is developed. This, in turn, creates the best conditions for work and recovery.

Unequal living, working and living conditions, individual differences of people do not allow recommending one variant of the daily regimen for everyone. However, its main provisions must be observed by everyone: “performing various types of activities at a strictly defined time, correct alternation of work and rest, regular meals.Particular attention should be paid to sleep – the main and irreplaceable type of rest. Constant lack of sleep is dangerous because it can cause depletion of the nervous system, weakening of the body’s defenses, decreased performance, deterioration of well-being.

The regime has not only health-improving, but also educational value. Strict adherence to it fosters such qualities as discipline, accuracy, organization, purposefulness. The mode allows a person to rationally use every hour, every minute of his time, which significantly expands the possibility of a versatile and meaningful life.Each person should develop a regime based on the specific conditions of his life.

Health helps us fulfill our plans, successfully solve basic life tasks, overcome difficulties, and if necessary, significant overloads. Good health, reasonably maintained and strengthened by the person himself, ensures him a long and active life.

90,000 Russia is aimed at a noticeable increase in the quality of life in villages, Putin said

https://ria.ru/20191226/1562883909.html

Russia aims at a noticeable increase in the quality of life in the villages, Putin said

Russia aims at a noticeable increase in the quality of life in the villages, Putin said – RIA Novosti, 03.03.2020

Russia aims at a noticeable increase in the quality of life in the villages, Putin said

The principle of sustainable development means Russia’s focus on a noticeable increase in the quality of life in rural areas and the priority of environmentally friendly agricultural technologies, said … RIA Novosti, 03.03.2020

2019-12-26T14: 20

2019-12-26T14: 20

2020-03-03T18: 35

economy

vladimir putin

russia

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MOSCOW, 26 Dec – RIA Novosti. The principle of sustainable development means Russia’s focus on a noticeable increase in the quality of life in rural areas and the priority of environmentally friendly agricultural technologies, said Russian President Vladimir Putin. As the President noted, environmentally friendly, safe, high-quality food can become a competitive advantage of Russia in global markets.

https: // ria.ru / 20191226 / 1562883457.html

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