本文選題：肺結(jié)核 + 捕獲再捕獲��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]通過(guò)利用捕獲再捕獲方法(Capture-recapture)估算不同疫情地區(qū)的肺結(jié)核患者數(shù),評(píng)估不同疫情地區(qū)的確診肺結(jié)核患者漏報(bào)率、漏失率,進(jìn)一步估計(jì)云南省肺結(jié)核患者的漏失水平。了解醫(yī)院的疫情管理制度及院內(nèi)臨床醫(yī)生對(duì)傳染病網(wǎng)絡(luò)報(bào)告知識(shí)和肺結(jié)核網(wǎng)絡(luò)報(bào)告知識(shí)的知曉情況。提出減少肺結(jié)核患者的漏報(bào)與漏診,提高云南省肺結(jié)核患者發(fā)現(xiàn)率的對(duì)策及建議。[方法]本研究按分層隨機(jī)整群抽樣的方法抽取3個(gè)縣(市、區(qū))及其轄區(qū)內(nèi)的36家醫(yī)療機(jī)構(gòu),采用定量和定性的研究方法。定量研究首先使用捕獲再捕獲方法,利用對(duì)數(shù)線(xiàn)性模型估計(jì)出每個(gè)疫情地區(qū)的肺結(jié)核患者數(shù),計(jì)算出每個(gè)疫情地區(qū)肺結(jié)核患者的漏報(bào)率與漏失率。緊接著,將每個(gè)疫情地區(qū)的數(shù)據(jù)合并,進(jìn)一步估計(jì)出全省3縣(市)肺結(jié)核患者的漏失水平。其次,采用問(wèn)卷法收集資料,在查閱相關(guān)醫(yī)務(wù)人員傳染病報(bào)告知曉情況文獻(xiàn)的基礎(chǔ)上,設(shè)計(jì)了 “云南省醫(yī)療機(jī)構(gòu)臨床醫(yī)生傳染病報(bào)告基本情況調(diào)查表”。問(wèn)卷內(nèi)容主要包括三個(gè)部分:人口社會(huì)學(xué)特征、傳染病網(wǎng)絡(luò)報(bào)告知識(shí)與肺結(jié)核病例相關(guān)知識(shí)。采用Epidata3. 1、R3.4. 0、SPSS19.0軟件進(jìn)行統(tǒng)計(jì)分析,采用構(gòu)成比、率等進(jìn)行統(tǒng)計(jì)描述,通過(guò)卡方檢驗(yàn)分析不同疫情地區(qū)之間的漏報(bào)率、漏失率有無(wú)差異。定性研究通過(guò)一對(duì)一、面對(duì)面訪(fǎng)談的方式對(duì)醫(yī)院疫情管理人員進(jìn)行訪(fǎng)談,以此來(lái)了解不同醫(yī)院疫情管理工作制度的執(zhí)行情況。訪(fǎng)談內(nèi)容包括院內(nèi)關(guān)于法定傳染病網(wǎng)絡(luò)直報(bào)的管理制度、傳染病報(bào)告工作的運(yùn)行程序。[結(jié)果]1在不同性別組中,男性與女性之間的漏報(bào)率無(wú)統(tǒng)計(jì)學(xué)差異;在不同年齡組中65歲以上組的漏報(bào)率最高;在不同級(jí)別醫(yī)療機(jī)構(gòu)中,一級(jí)醫(yī)院與三級(jí)醫(yī)院的漏報(bào)率高于二級(jí)醫(yī)院。2高疫情地區(qū)的漏報(bào)率均高于中疫情與低疫情地區(qū),中疫情地區(qū)與低疫情地區(qū)之間的漏報(bào)率相比無(wú)統(tǒng)計(jì)學(xué)差異。3云南省總體肺結(jié)核患者漏失率為45. 6%,發(fā)現(xiàn)率為54. 4%。在性別組中,男性漏失率高于女性;在年齡組中,65歲以上組的漏失率最高。將未報(bào)告的肺結(jié)核患者作為已發(fā)現(xiàn)的肺結(jié)核患者,肺結(jié)核病人的漏失率為29. 56%,肺結(jié)核病人的發(fā)現(xiàn)率升高至70.44%。因此,云南省肺結(jié)核病人的漏失現(xiàn)象除了由肺結(jié)核的漏報(bào)導(dǎo)致,還與肺結(jié)核患者的未就診和漏診有關(guān)。而肺結(jié)核患者的未就診和漏診也與醫(yī)療衛(wèi)生服務(wù)的可及性、醫(yī)務(wù)人員的診斷水平及群眾的經(jīng)濟(jì)水平與健康意識(shí)有著密切的聯(lián)系。4高疫情地區(qū)的肺結(jié)核患者漏失率為48. 43%,發(fā)現(xiàn)率為51. 57%。在性別組中,男性組漏失率高于女性組漏失率;在年齡組中,65歲以上組的漏失率最高。將未報(bào)告的肺結(jié)核患者作為已發(fā)現(xiàn)的肺結(jié)核患者,高疫情地區(qū)肺結(jié)核病人的漏失率為26. 7%,發(fā)現(xiàn)率升高至73. 3%。因此,高疫情地區(qū)肺結(jié)核病人的漏失現(xiàn)象一半是由肺結(jié)核的漏報(bào)導(dǎo)致。5中疫情地區(qū)肺結(jié)核患者的漏失率為22. 5%,發(fā)現(xiàn)率為77. 5%。在性別組中,男性與女性的漏失率無(wú)統(tǒng)計(jì)學(xué)差異;在年齡組中,45-64歲組與65歲以上組的漏失率均高于15-44歲組。將未報(bào)告的肺結(jié)核患者作為已發(fā)現(xiàn)的肺結(jié)核患者,中疫情地區(qū)肺結(jié)核病人的漏失率為18. 05%,發(fā)現(xiàn)率升高至81. 95%。因此,中疫情地區(qū)肺結(jié)核病人的漏失現(xiàn)象主要是由肺結(jié)核病人的漏診導(dǎo)致,特別應(yīng)該關(guān)注45-64歲組與65歲以上組病人的漏失情況。6低疫情地區(qū)肺結(jié)核患者的漏失率為22.6%,發(fā)現(xiàn)率為77.4%。在性別組中,男性與女性的漏失率無(wú)統(tǒng)計(jì)學(xué)差異;在年齡組中,15-44歲組的漏失率最高。將未報(bào)告的肺結(jié)核患者作為已發(fā)現(xiàn)的肺結(jié)核患者,低疫情地區(qū)肺結(jié)核病人的漏失率為17.85%,發(fā)現(xiàn)率升高至82. 15%。因此,低疫情地區(qū)肺結(jié)核病人的漏失現(xiàn)象主要是由肺結(jié)核的漏診導(dǎo)致,特別應(yīng)該關(guān)注15-44歲組病人的漏失情況。7云南省總體疑似肺結(jié)核患者的漏報(bào)率為10.34%。在性別組中,女性漏報(bào)率高于男性漏報(bào)率;在年齡組中,15-44歲組的漏報(bào)率最高;在不同醫(yī)療機(jī)構(gòu)的漏報(bào)情況中,三級(jí)醫(yī)院的漏報(bào)率最高。8本次調(diào)查36家醫(yī)療機(jī)構(gòu)的臨床醫(yī)生,共發(fā)放329份問(wèn)卷,獲得有效問(wèn)卷306份,有效應(yīng)答率為93%。其中一級(jí)醫(yī)院與二級(jí)醫(yī)院以30歲以下為主,人員偏年輕化,三級(jí)醫(yī)院則以30-49歲為主;文化程度方面,學(xué)歷在大專(zhuān)以下的構(gòu)成比隨著醫(yī)療機(jī)構(gòu)級(jí)別的升高而減少,反之,研究生的構(gòu)成比也隨著醫(yī)療機(jī)構(gòu)級(jí)別的升高而增加。9將不同級(jí)別醫(yī)療機(jī)構(gòu)傳染病網(wǎng)絡(luò)報(bào)告知識(shí)掌握情況相比發(fā)現(xiàn),二級(jí)醫(yī)院與三掌握程度都高于一級(jí)醫(yī)院;將不同疫情地區(qū)醫(yī)療機(jī)構(gòu)傳染病網(wǎng)絡(luò)報(bào)告知識(shí)掌握情況相比發(fā)現(xiàn),低疫情地區(qū)掌握的人數(shù)高于中疫情與高疫情地區(qū)。10定性研究發(fā)現(xiàn),在傳染病網(wǎng)絡(luò)報(bào)告管理工作中,部分醫(yī)院的獎(jiǎng)懲制度流于形式;醫(yī)生由于門(mén)診量大,工作繁重,因此導(dǎo)致填寫(xiě)傳染病報(bào)告卡的時(shí)間有限;疫情人員在登錄網(wǎng)絡(luò)直報(bào)系統(tǒng)中遇到困難,對(duì)直報(bào)系統(tǒng)的操作不熟悉。[結(jié)論]1通過(guò)本研究可以為進(jìn)一步估計(jì)全省的肺結(jié)核患者數(shù)提供指導(dǎo)與依據(jù)。2肺結(jié)核的漏失一半是由漏報(bào)導(dǎo)致,因此要解決好肺結(jié)核的漏報(bào)現(xiàn)象,讓肺結(jié)核病人的發(fā)現(xiàn)率不斷提高。3高疫情地區(qū)不僅結(jié)核病疫情嚴(yán)峻,肺結(jié)核漏報(bào)率與漏失率也高,所以應(yīng)引起重視,應(yīng)該不斷加大對(duì)高疫情地區(qū)的培訓(xùn)與督導(dǎo)。
[Abstract]:[Objective] to estimate the number of tuberculosis patients in different epidemic areas by capture recapture method (Capture-recapture), evaluate the leakage rate and leakage rate of confirmed tuberculosis patients in different epidemic areas, and further estimate the leakage level of pulmonary tuberculosis patients in Yunnan province. In order to reduce the leakage and missed diagnosis of pulmonary tuberculosis, the countermeasures and suggestions to improve the detection rate of pulmonary tuberculosis patients in Yunnan province were proposed. [Methods] 3 counties (cities, districts) and 36 medical institutions in their jurisdictions were selected by stratified random cluster sampling, and the quantitative and qualitative methods were adopted. The quantitative study first uses the capture recapture method, uses the logarithmic linear model to estimate the number of tuberculosis patients in each epidemic area, and calculates the leakage rate and leakage rate in each area of the epidemic area. Then, the data of each epidemic area are combined to further estimate the tuberculosis patients in the 3 counties (cities) of the province. Secondly, using the questionnaire method to collect the information, and on the basis of consulting the relevant documents of the related medical personnel's infectious disease report, designed the basic situation questionnaire of the infectious disease report of the medical institutions in Yunnan province. The content of the questionnaire mainly includes three parts: the characteristics of the population Sociology, the knowledge of the network report of infectious diseases and the knowledge of the infectious diseases. Epidata3. 1, R3.4. 0, SPSS19.0 software were used to carry out statistical analysis. The statistical description of the composition ratio, rate and so on was used to analyze the leakage rate and the leakage rate between different epidemic areas through chi square test. Qualitative research conducted visits to hospital epidemic managers through one to one and face-to-face interviews. In order to understand the implementation of the system of epidemic management in different hospitals, the interview includes the management system on the direct report of the network of legal infectious diseases and the operation procedure of the report on infectious diseases. [results]1 has no statistical difference between male and female in different sex groups; in different age groups, the group is over 65 years old. In different levels of medical institutions, the leakage rates of the first and three level hospitals were higher than those in the two level hospitals, which were higher than those in the middle and low epidemic areas, and there was no statistical difference between the epidemic areas and the low epidemic areas, and the leakage rate of the total pulmonary tuberculosis patients in Yunnan province was 45.6%, which was.3 in Yunnan province. The rate of discovery was 54. 4%. in the sex group. The loss rate of male was higher than that of the female; in the age group, the loss rate was the highest in the group of 65 years old. The loss rate of tuberculosis patients in the unreported pulmonary tuberculosis patients was 29.56% and the detection rate of pulmonary tuberculosis patients increased to 70.44%., so the loss of tuberculosis patients in Yunnan province was lost. The phenomenon is not only caused by the leakage of tuberculosis, but also related to the untreated and missed diagnosis of tuberculosis patients. The untreated and missed diagnosis of tuberculosis patients is also related to the accessibility of medical and health services. The diagnosis level of the medical staff and the economic level of the masses and health awareness are closely related to the leakage rate of tuberculosis patients in the high epidemic area of.4. 48.43%, the rate of discovery was 51. 57%. in the sex group. The loss rate of the male group was higher than that of the female group; in the age group, the loss rate was the highest in the group of 65 years old. The rate of tuberculosis in the unreported tuberculosis patients was 26.7% and the rate of discovery increased to 73. 3%. in the high epidemic area, and the rate of discovery was higher than that in the high epidemic area. The loss of pulmonary tuberculosis was half caused by the leakage of tuberculosis resulting in the loss rate of 22.5% in the epidemic area of.5, and the rate of discovery was 77. 5%. in the sex group. The loss rate of male and female was not statistically significant. In the age group, the loss rate of the 45-64 year old group and the 65 year old group was higher than that of the 15-44 year old group. As a discovered tuberculosis patient, the loss rate of tuberculosis patients in the epidemic area is 18.05%, and the rate of discovery increases to 81. 95%.. Therefore, the loss of tuberculosis patients in the epidemic area is mainly caused by the missed diagnosis of tuberculosis patients, and the leakage situation of the 45-64 year old group and the 65 year old group should be paid special attention to the low epidemic situation of the.6 epidemic situation. The loss rate of the patients with pulmonary tuberculosis was 22.6%, and the rate of discovery was 77.4%. in the sex group. The loss rate of male and female was not statistically significant. In the age group, the loss rate of the 15-44 year old group was the highest. The loss rate of tuberculosis patients in the unreported pulmonary tuberculosis patients was 17.85% and the rate of discovery increased to 17.85%. 82. 15%. therefore, the leakage of tuberculosis patients in the low epidemic area is mainly caused by the missed diagnosis of tuberculosis, especially the loss of patients in the 15-44 year old group,.7 in Yunnan Province, the overall misrepresentation rate of suspected tuberculosis patients is 10.34%. in the sex group, the rate of female leakage is higher than the male leakage rate; in the age group, the rate of leakage of the 15-44 year old group is in the age group. In the case of different medical institutions, the rate of failure to report the three level hospitals was the highest in the 36 medical institutions, with a total of 329 questionnaires and 306 effective questionnaires, with the response rate of the first grade hospital and the two level hospital under the age of 30, the younger of the staff, and the 30-49 years old in the three level hospitals. With respect to the degree of education, the proportion of educational background below the tertiary level decreases with the level of medical institutions. On the contrary, the ratio of postgraduates to the level of medical institutions increases with the increase of.9. Compared with the knowledge of the network reports of infectious diseases in different levels of medical institutions, the level of two level hospitals and three is higher than the level of first-degree medicine. Comparing the knowledge of the network reports of infectious diseases in the medical institutions of different epidemic areas, it is found that the number of people in the low epidemic areas is higher than the.10 qualitative research in the epidemic area and the high epidemic area. In the management of the infectious disease network report, the reward and punishment system of some hospitals is in the form, and the doctors are heavy and heavy because of the outpatient quantity and the heavy work. The time for filling the infectious disease report card was limited; the epidemic personnel encountered difficulties in the network direct reporting system and were unfamiliar with the operation of the direct reporting system. [conclusion]1 can provide guidance for further estimation of the number of tuberculosis patients in the province through this study and the loss of half of the loss of pulmonary tuberculosis in the.2 is caused by the leakage of the lung, so the lung can be solved well. The phenomenon of tuberculosis leakage has made the detection rate of tuberculosis patients increasing in.3 high epidemic area, not only the severe epidemic situation of tuberculosis, but also the high leakage rate and leakage rate of tuberculosis. Therefore, attention should be paid to the training and supervision of the high epidemic areas.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R521

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 成瑤;趙平;;肺結(jié)核實(shí)時(shí)監(jiān)管系統(tǒng)在醫(yī)院傳染病信息化管理中的應(yīng)用研究[J];醫(yī)療衛(wèi)生裝備;2016年12期

2 胡雅飛;常s，

本文編號(hào)：1801321