qualityoflife-190304071555.pptx

qualityoflife-190304071555.pptx

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  Dr. Dalia El-Shafei Assist.Prof.,Community Medicine Department, Zagazig University http://www.slideshare.net/daliaelshafei
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  LEARNING OBJECTIVES: 1) Definequality of life. 2) Identify component of quality of life. 3) Understand and calculate measures of quality of life.
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  DEFINITION OF QOL WHO: “an individual’s perception of their position in life in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards and concerns”. The degree of well being, satisfaction and standardized living. Afeeling, function and future of happiness, health and hope. With increase life expectancy all over the world, the aim of health services is to make these added life years of good quality.
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  COMPONENT OF QUALITYOF LIFE • Energy & Mobility /Activities of daily living / Work capacity Physical Health • Feelings, fear, depression / Self-esteem / Thinking, learning, memory and concentration. Psychological • Religion/ Personal internal power Spirituality • Personal relationships / Social support / Role in the family, profession and social groups of friends& relatives Social Relations • Physical, chemical & biological (pollution, noise, traffic, and climate) / Transport/ home environment Environment
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  ASSESSMENT OF QUALITYOF LIFE Questionnaire, tests and /or instruments which must be: Valid Accurate Adequate Reliable
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  IMPORTANCE OF ASSESSMENTOF HEALTH RELATED QOL (SCOPE OF APPLICATION) Assess effect of community medicine programs after health policy changes. Measuring the burden of disease for estimating the degree of morbidity & mortality (economic evaluation assist decision makers). Assess patient satisfaction after clinical treatment. Assess quality of life of handicapped.
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  INSTRUMENTS FOR ASSESSMENTOF HEALTH RELATED QUALITY OF LIFE Quality adjusted life years (QALYs) Disability adjusted life years (DALYs)
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  QUALITY ADJUSTED LIFEYEARS (QALYS) Any year lived with less than optimal health = less than one Utility: is the patient's perception (opinion) of his/her QOLalong a line starting from 0 to 1 (indifference from death & life) (1 = the best life). 1 year in perfect health = 1year x 1 utility =1 QALY It’s used in economic evaluation especially cost utility analysis. Assess years lived with high quality of health without disability or premature death.
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  Example: For 2years bed ridden (utility = 0.5) QALY = 2 x 0.5 = 1 year
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  DISABILITY ADJUSTED LIFEYEARS (DALYS) WHO considered DALYs as a measure of the global burden of disease. It is the international quantitative indicator of burden of disease as it sums the years lost (YLL) because of premature mortality and years lived with disability (YLD) adjusted for the severity of the disability. DALY= YLL+YLD
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  CALCULATION OFTOTALDALY FORADISEASEIN POPULATION YLL • No. of deaths X years lost from expectancy YLD • No. of cases X disability % X average duration of disability till cure or death. DALY • YLL + YLD (+ YLL after death from disability).
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  Example for understanding“DALY” calculation: In 16 years old adolescents: due to accident 100 deaths (consider life expectancy = 60 years) 70 with disability divided into: 60 with disability 25% for 4 years till cure 10 with disability 30% for 3 years then died YLL= No. of deaths x years lost from expectancy =100 x (60-16)= 4400 years YLD= No. of cases x disability percent x average duration of disability till cure or death = (60 x 25/100 x 4 = 60 years) + (10 x 30/100 x 3 = 9 years) DALY = YLL + YLD DALY = 4400+60+ 9= 4469 years (+ YLL after death from disability = 10 x (60-19) = 410 years) DALY =4400+60+ 9+410= 4879 years
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  RELATION BETWEEN QALY& DALY QAL Y assess years lived with high quality. DAL Y assess years lost of healthy life. They are completing each other
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  A man livefor 50 years with blindness (since birth) & utility of blindness = 0.45. Considering life expectancy =80 years, calculate QALY& DALY. QAL Y = years x utility = 50 x 0.45 = 22.5 years DAL Y = YLL+YLD YLL = years lost from expectancy = 80 – 50 = 30 years YLD = disability (1- utility) x years = (1- 0.45) x 50 = 0.55 x 50 = 27.5 years DAL Y = 30 + 27.5 = 57.5 years DAL Y + QALY = 57.5 +22.5= 80 years