肺功能及抽煙和SF-36健康量表相關性之研究; The Relationship among Lung Function, Smoking and SF-36 Health Questionnaire

中國醫藥大學機構典藏 China Medical University Repository, Taiwan > 公共衛生學院 > 環境醫學研究所(已停用) > 博碩士論文 > Item 310903500/23904

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題名:	肺功能及抽煙和SF-36健康量表相關性之研究;The Relationship among Lung Function, Smoking and SF-36 Health Questionnaire
作者:	林保萱
貢獻者:	中國醫藥學院環境醫學研究所
關鍵詞:	生活品質;肺活量;吸菸;信效度;quality of life;tobacco;reliability;validity
日期:	1999
上傳時間:	2009-11-30
摘要:	近年來醫療照顧的目的不只是延長病人生命，更重要的是提昇其生活品質。肺部功能的好壞，直接影響病人的活動量，進而可能影響病人的生活品質。文獻顯示白種人族群中，吸菸者的肺部功能和SF-36健康量表分數都明顯較非吸菸者低。臨床上主要評估SF-36健康量表的建構效度為探討臨床指標或診斷與SF-36健康量表的相關，此可增加SF-36健康量表在臨床上的應用及其分數的解釋。因此，本研究主要目的為探討肺功能(包括用力吐氣量、第一秒鐘最大吐氣量及第一秒鐘最大吐氣量率)及吸菸習慣和SF-36健康量表之相關，以提供SF-36健康量表在臨床和公共衛生上的運用。本研究設計為橫斷面研究，以1996至1999年到中國醫藥學院附設醫院家庭醫學科自費做二日健康檢查的456位民眾為對象。每位民眾完成自填式問卷，其內容包括社會人口變項、吸菸狀態和SF-36健康量表等，且從健檢結果中得到肺功能的生理值。研究對象的平均年齡為51.6±13.4歲，SF-36健康量表八個量表的平均分數為43.0~82.0分，平均而言比台灣一般民眾的分數低1至2個標準差內；內部一致性(Cronbach’sα值)都大於0.7；整體的輻合效度為100%，辨別效度為95.6%；因素分析之結果顯示，萃取因素與八個量表間相關強度的結果與理論上預期的相關情況不太吻合。調整年齡和性別後，除了個人評估身體健康之程度量表外，吸菸者七個量表的分數都顯著低於無吸菸者(p<0.05)。調整年齡、性別、吸菸狀態、身高和體重後，用力吐氣量和第一秒鐘最大吐氣量與身體活動功能量表呈現弱度的相關，兩者均為0.14，且達統計上顯著(p<0.05)。依性別和吸菸狀態下分層的肺活量最佳預估，除了年齡和身高的一次項外，有一半的模式包含身高的二次項，而體重和交互作用則無顯著的效應。在所有的最佳預估模式中加入身體活動功能量表，只有男性的模式中此參數有達統計上的顯著。本研究之主要結論為，SF-36健康量表適合用於探討健康檢查民眾的健康狀況，吸菸者的自覺健康狀態較無吸菸者差。建立肺活量預估模式時可考量放入身高和年齡的二次項，以及體活動功能量表之分數。因本研究為橫斷面研究，而此結果還需有賴未來研究作更進一步的探討。; Recently the objective of medical care was not only to prolong the life of patients, but also it to improve their quality of life. The lung function directly influences the physical activity of patients and perhaps quality of life. Previous studies revealed that the lung function and short-form 36(SF-36) scores of smokers were significantly lower than those of nonsmokers in the white race. Therefore it is important to investigate whether the relationship exists in Chinese. The most common validity assessment for SF-36 in clinical setting is construct validity. Construct validity of SF-36 should explore the relationship of clinical index or diagnosis and the scores of SF-36 to strengthen the application of SF-36 in clinical setting and interpretation of its scores. The objective of the study is to examine the relationship among lung function, smoking and SF-36 to enhance the understanding of the construct validity and interpretation of SF-36 scores in clinically setting. A cross-sectional study was conducted. All subjects admitted for health checkup in Family Medicine Department of China Medical College Hospital during 1996-1999 were recruited. Four hundred and fifty-six volunteers completed a questionnaire, which included demographic characteristics, smoking status and SF-36. Lung function was obtained from health checkup of result. The mean age of the subjects is 51.6±13.4 years old. Eight dimensions of the SF-36 range from 43 to 82, and Cronbach’s α reliabilities are all above 0.7. The overall convergent validity is 100.0% and discrimininant validity is 95.6%, but the factorial validity is not consistent with the theory proposed by John Ware. After adjusting age and sex, SF-36 scores of smoker is significantly lower than those of non-smoker except general health. After adjusting age, sex, height, weight and smoking status, the partial correlation coefficients physical functioning with FVC and FEV1 are both 0.14. In addition to age and height, the best prediction of lung capacity models included square of height but weight and interaction items are not included into the best model. After physical function scale added in all best predictive models, it is statistically significant only for man’s model. To summarize, SF-36 is can be used to measure the health status of population of health check-up, and SF-36 of smokers was worse than non-smokers. Our study suggested that one might improve the precision of the prediction of FVC and FEV1 by including the physical functioning and square of height into the regression equation. A longitudinal study should be conducted to further explore the changes of SF-36 on the prediction of FVC and FEV1.
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