Rearch On Quality Of Life And Its Influencing Of Farmers Who Exposed To High Fluoride In Liaoning Province

PrefaceEndemic fluorosis is a chronic disease resulted from long-term exposure to high fluoride environment and intake of excessive fluoride, with dental fluorosis and skeletal fluorosis as the main clinical symptoms. In severe cases deformed limbs, hump-back deformity, and even paralysis may occur, leading to loss of self-care ability and the ability to work. For decades, researchers at domestic and abroad in the physiological role and the hazards and mechanisms of toxicity of fluoride have made extensive and thorough scientific researches and gained great achievements. Even though there are a lot of reports about endemic fluorosis, but few of the studies were on health-related quality of life in peasants exposed to high fluoride.SF-36 quality of life scale is developed by American Medical Outcomes Study (MOS) as a universal measurement scale. MOS SF-36 has been translated and validated in many countries, with good reliability, validity and practicability, as the world's most widely used assessment instrument of the quality of life. Chinese scholars have translated the scale into Chinese version and applied it to investigate the health status of different kinds of people, to compare the quality of life of the general and specific groups to assess the relative burden of different diseases, and to detect differences in healthy condition between treatment and control groups. In order to study the quality of life in farmers with high fluoride exposure and its influencing factors, Faku County, Kangping County, Zhangwu County, Linghai County were selected as locations for investigation in Liaoning province, using Chinese version of SF-36 health questionnaire to evaluate the quality of life of farmers with high fluoride exposure in Liaoning province, to analysis the differences in quality of life between high fluoride exposure and normal control groups and to identify the factors affecting their physical and mental health, finally to provide scientific evidence for planning policies to the prevention and treatment of endemic fluorosis by government departments. Subject and methods1,Choice of survey locations and subjectsAccording to the information from Liaoning Provincial Center for Disease Control and Prevention, we chose four typical villages, Yellow Wasteland in Faku County, Wangshan in Kangping County, South Jianye Village in Linghai Jinzhou and Fengtian Village in Zhangwu County in Liaoning province. Selected adult permanent settlers as subject and carried out the survey in every household in these four villages. After the survey and verification of the questionnaires, a total of 461 valid subjects were collected with 208 men and 253 women.2,Survey methodPostgraduate students were trained as investigators for this study, with uniform survey standards. In the pattern of assessment by others, the questionnaires were read by the investigators, and then the respondents chosed the most suitable answer to them. The respondents were required to have understanding ability and clear mind.3,Contents of investigationThe contents of questionnaires included the general state and SF-36 Health Survey scales portion. Contents of the general condition were basic information of informants and their families, including name, sex, age, occupation, marriage, health status, total income and expenditure, housing, source of drinking water, condition of liabilities, knowledgement about fluorosis. 10ml Urine sample of each respondent was collected to measure the urinary fluoride levels.SF-36 health survey questionnaire included 36 items, except the item about health transition (HT), all other items constituted eight dimensions: the physical functioning (PF), role-physical (RP), bodily pain (BP) , general health (GH), vitality (VT), social function (SF), role-emotional (RE) and mental health (MH). Using factor analysis, 8 dimensions could form 2 measurements of the overall health. PF, RP, BP and GH measurements belonged to the physical component summary (PCS), while VT, SF, RE and MH belonged to the mental component summary (MCS).4,Analysis methodsSPSS16.0 software was used for data collation, entry, verification and statistical analysis, with Excel software to organize and plot the results. In this study, Cronbach's a coefficient was used to test SF-36 scale's internal consistency reliability. We used of set validity, discriminant validity and construct validity to analysis the scale's validity. The data that met the conditions of normality was analyzed by t test and variance analysis, those that should not be transformed into normal distribution were analyzed by non-parametric test. Correlation analysis was used to analyze the correlation between urinary fluoride and the dimensions of quality of life of peasants. Single and multiple factor analysis were used to analyze the influencing factors of dimensional scoring about quality of life of the peasants.ResultsSF-36 scale, used for evaluating peasants' quality of life in Liaoning high fluoride exposure regions, has a good reliability and validity. In all respondents, the eight dimensional scores of quality of life negatively correlated with urinary fluoride levels. PF, RP, BP, GH, VT, MH dimensional scores of the quality of life in peasants of high fluoride exposure group were lower than those of normal control group, the difference had statistical significance. High fluoride exposure only affected the physiological functions and overall health of male, while women's physical and mental health scores were affected. As to being stratified by age, the high fluoride exposure had more severe influence on young farmers than on middle-aged ones, while no obvious influence to the elderly farmers. Stratified by income, high fluoride exposure affected those with total annual income below 5000 yuan in four dimensions of physical health condition, affected those with total annual income above 10000 yuan in physical health condition in PH and GH dimensions, while no obvious impact on those with total income from 5000 to 10000 yuan. Prevalence of disease and annual revenues affected the quality of life in eight dimensions, the current illness, age, gender, liability were risk factors for the quality of life, while the total annual income and education were protective factors.Conclusions1,Exposed to high fluoride for long-term can reduce the quality of life scores of farmers.2,High fluoride exposure impacted more on women than men in the quality of life. The impact on the young group was more serious than on the middle-aged group. High fluoride exposure affected those with total annual income below 5000 yuan in physical health condition in four dimensions, and for those with the income of more than 10000 yuan, the main impact was on physical health condition.3,For those factors that influenced the quality of life, current disease and annual revenues affected the quality of life in eight dimensions. The current illness and liability might be risk factors for the farmers' psychological health. The current illness, age, gender, and liability might be risk factors for the quality of life, while the total annual income and education might be protective factors.