本文選題：傳染病 + 癥狀監(jiān)測��； 參考：《復(fù)旦大學(xué)》2013年碩士論文

【摘要】：自SARS危機(jī)暴發(fā)后,我國于2004年建立了法定傳染病實時報告系統(tǒng),該系統(tǒng)以病例診斷為基礎(chǔ),自實施后有效地改善了傳染病報告的及時性。但是在農(nóng)村地區(qū),疫情的遲報和漏報現(xiàn)象依然非常嚴(yán)重,尤其在村級衛(wèi)生機(jī)構(gòu),因為人員、設(shè)備等資源匱乏,往往無法及時發(fā)現(xiàn)傳染病。癥狀監(jiān)測作為一種新興的公共衛(wèi)生監(jiān)測手段引起了普遍的關(guān)注。相對于傳統(tǒng)的疾病監(jiān)測,癥狀監(jiān)測是收集病人在疾病確診前的健康相關(guān)事件或行為。以醫(yī)療機(jī)構(gòu)為例,癥狀監(jiān)測不依賴特定診斷,而對人群中非特異性的臨床癥狀(如發(fā)熱、腹瀉等)的發(fā)生頻率進(jìn)行監(jiān)測,通過發(fā)現(xiàn)聚集性病例或可疑事件,對傳染病進(jìn)行早期預(yù)警。對于缺乏實驗室診斷條件的農(nóng)村地區(qū),癥狀監(jiān)測不失為一種有效的補充監(jiān)測手段。 癥狀監(jiān)測系統(tǒng)的設(shè)計與建立過程復(fù)雜,需要綜合考慮實際需求、現(xiàn)實條件以及可利用的資源等諸多因素。只有當(dāng)衛(wèi)生機(jī)構(gòu)的資源配置和能力水平與癥狀監(jiān)測的設(shè)計相適應(yīng)時,監(jiān)測系統(tǒng)才能正常運行。本研究依托于歐盟項目“中國農(nóng)村地區(qū)傳染病癥狀整合監(jiān)測系統(tǒng)”(Integrated Surveillance System in rural China, ISSC),以江西省的2個縣作為研究現(xiàn)場,探討了在農(nóng)村地區(qū)建立傳染病癥狀監(jiān)測的可行性及存在的問題,并對2個縣的村級衛(wèi)生機(jī)構(gòu)和村級衛(wèi)生人員開展傳染病癥狀監(jiān)測的能力進(jìn)行了綜合評價。第一部分江西省村級衛(wèi)生機(jī)構(gòu)建立傳染病癥狀監(jiān)測的可行性研究目的研究在村級衛(wèi)生機(jī)構(gòu)建立傳染病癥狀監(jiān)測是否可行及存在的問題。方法對江西省2個縣37個鄉(xiāng)鎮(zhèn)的355名村醫(yī)進(jìn)行問卷調(diào)查,了解村醫(yī)對癥狀監(jiān)測的認(rèn)知和接受度：在兩縣各開展1組小組訪談,定性研究癥狀監(jiān)測數(shù)據(jù)采集與報告的可行性及存在的問題。結(jié)果79.6%的村醫(yī)會在門診日志上詳細(xì)記錄每位病人的信息,僅2.0%從來不做門診記錄；74.8%的村醫(yī)門診日志記錄包含癥狀監(jiān)測所需的基本信息；“一村一所”管理模式下村醫(yī)門診日志的記錄情況(Χ2=22.036,P0.0001)和監(jiān)測信息的登記情況(Χ2=7.794,P0.0001)明顯好于“一村多所”分布模式下的村醫(yī)；網(wǎng)絡(luò)直報是村醫(yī)首選的監(jiān)測報告方式(56.4%)；60.6%的村醫(yī)認(rèn)為自己能夠每天記錄和上報監(jiān)測信息,但45.7%的村醫(yī)認(rèn)為工作量較大；村醫(yī)的傳染病癥狀知識得分平均為40.60±19.32分。結(jié)論在村級衛(wèi)生機(jī)構(gòu)建立傳染病癥狀監(jiān)測具有一定的可行性,但需對門診日志記錄進(jìn)行規(guī)范化管理,實現(xiàn)癥狀監(jiān)測數(shù)據(jù)源的電子化,簡化數(shù)據(jù)采集與報告流程,提高村醫(yī)對癥狀監(jiān)測的認(rèn)知水平。 第二部分江西省村級衛(wèi)生機(jī)構(gòu)建立傳染病癥狀監(jiān)測的能力現(xiàn)狀研究 目的研究江西省村級衛(wèi)生機(jī)構(gòu)建立傳染病癥狀監(jiān)測的能力現(xiàn)狀及資源條件。方法采用多階段整群抽樣的方法,調(diào)查并分析了江西省2個縣15個鄉(xiāng)鎮(zhèn)155家村衛(wèi)生室的基本設(shè)置、硬件配備、信息化程度以及經(jīng)營管理狀況。結(jié)果村衛(wèi)生室的平均服務(wù)人口為1657人,最遠(yuǎn)的居民步行到村衛(wèi)生室的平均時間為37.6分鐘；91.0%的村衛(wèi)生室一周7天都開診,“一村一所”管理模式下村衛(wèi)生室開診的穩(wěn)定性優(yōu)于“一村多所”模式(P0.05)；在聽診器、體溫計、血壓計、出診箱、紫外燈等診療設(shè)備的配置上,“一村一所”模式下的村衛(wèi)生室明顯多于“一村多所”模式(P0.01)；村衛(wèi)生室的電腦配備率為95.5%,網(wǎng)絡(luò)覆蓋率為86.5%,但35.5%網(wǎng)速較慢,17.4%經(jīng)常斷網(wǎng),26.5%有時會停電。結(jié)論村衛(wèi)生室基本具備癥狀監(jiān)測信息化建設(shè)的資源和條件,監(jiān)測頻率可以日為單位進(jìn)行；“一村一所”管理模式下村衛(wèi)生室的硬件配置和經(jīng)營狀況優(yōu)于“一村多所”模式,更適合癥狀監(jiān)測的開展。 第三部分江西省村級衛(wèi)生人員傳染病癥狀監(jiān)測能力評價及對策研究 目的研究江西省村級衛(wèi)生人員開展傳染病癥狀監(jiān)測的綜合能力及意愿并提出對策和建議。方法采用多階段整群抽樣的方法,通過問卷調(diào)查分析江西省2個縣15個鄉(xiāng)鎮(zhèn)253名村醫(yī)的基本衛(wèi)生服務(wù)能力及電腦操作能力、傳染病防控能力和提供公共衛(wèi)生服務(wù)的意愿及經(jīng)濟(jì)驅(qū)動因素等。結(jié)果村醫(yī)平均年齡44.56±11.92歲；160名監(jiān)測報告員中約有12.5%不會使用電腦；村醫(yī)最常接診的疾病主要有上呼吸道感染、急性和慢性胃腸道感染、高血壓和糖尿病；“一村一所”管理模式下村醫(yī)接診的病人數(shù)明顯多于“一村多所”模式(Z=-8.105,P0.0001)；村醫(yī)接觸最多的五種傳染病是流感、其他感染性腹瀉、流行性腮腺炎、水痘和痢疾；75.9%的村醫(yī)發(fā)現(xiàn)傳染病人后會立即報告鄉(xiāng)鎮(zhèn)衛(wèi)生院；”一村多所”模式下村醫(yī)提供公共衛(wèi)生服務(wù)的意愿(Χ2=4.827,P=0.028)和獲得的公共衛(wèi)生服務(wù)補貼(Z=83.863,P0.0001)要高于“一村一所”管理模式下的村醫(yī)。結(jié)論村醫(yī)的衛(wèi)生服務(wù)能力和傳染病防控能力基本滿足開展癥狀監(jiān)測的要求；發(fā)熱、咽痛、咳嗽、腹瀉、皮疹應(yīng)作為優(yōu)先關(guān)注的目標(biāo)監(jiān)測癥狀；“一村一所”管理模式下的村醫(yī)開展癥狀監(jiān)測的能力更強,但其依從性會受經(jīng)濟(jì)因素的影響。
[Abstract]:Since the outbreak of the SARS crisis, a real time reporting system for notifiable infectious diseases was established in 2004. The system is based on case diagnosis and has effectively improved the timeliness of infectious disease reports. However, in rural areas, the delay and failure of the epidemic are still very serious, especially in village level health institutions, because of personnel, equipment and other funds. Symptoms monitoring, as a new means of public health monitoring, has aroused general concern. Compared with traditional disease monitoring, symptom monitoring is the collection of health related events or behaviors before the diagnosis of the disease. The frequency of non specific clinical symptoms (such as fever, diarrhoea, etc.) in the group is monitored, and early warning of infectious diseases is carried out by discovering clustered cases or suspicious events. For rural areas lacking laboratory diagnostic conditions, symptom monitoring is an effective supplementary monitoring method.
The design and establishment of the symptom monitoring system is complex and requires a comprehensive consideration of practical needs, realistic conditions and available resources. Only when the resources allocation and ability level of the health institutions adapt to the design of symptoms monitoring, the monitoring system can be carried out normally. This research is based on the EU project "China rural areas." Integrated Surveillance System in rural China (ISSC) and 2 counties of Jiangxi province were used as the research sites. The feasibility and problems of establishing the symptoms monitoring of infectious diseases in rural areas were discussed, and the surveillance of infectious diseases in village level health institutions and village health workers in 2 counties was carried out. The first part of the village level health institutions in Jiangxi province to establish the feasibility of monitoring the symptoms of infectious diseases in the village level health institutions to establish infectious disease symptoms monitoring is feasible and existing problems. Methods of 37 villages and towns in 2 counties in Jiangxi Province, 355 village doctors to investigate the symptoms of village doctors to understand the symptoms of the symptoms Cognition and acceptance of monitoring: 1 groups of group interviews were conducted in two counties to determine the feasibility and problems of symptom monitoring data collection and report. Results 79.6% of the village doctors recorded each patient's information in the outpatient log, only 2% never made outpatient records, and 74.8% of the village medical clinic logs included symptom surveillance. The basic information needed is to be measured; the records of the village medical clinic log (2=22.036, P0.0001) and the registration of monitoring information (2=7.794, P0.0001) are obviously better than the village doctors under the "one village and many" distribution pattern under the "one village and one village" management model; the network direct report is the monitoring report of the village medical first selection (56.4%); and 60.6% of the village doctors believe that We can record and report monitoring information every day, but 45.7% of the village doctors think the workload is large; the average knowledge score of the infectious disease symptoms of village doctors is 40.60 + 19.32 points. Conclusion it is feasible to establish the symptoms monitoring of infectious diseases in the village health institutions, but it is necessary to standardize the records of the log records in the outpatient department to realize the symptom monitoring number. According to the electronization of source, simplify the process of data collection and reporting, and improve the cognition level of village doctors for symptom monitoring.
The second part is about the current situation of the monitoring of infectious disease symptoms in village health organizations in Jiangxi.
Objective to study the status and resource conditions of establishing infectious disease symptoms monitoring in Jiangxi village health institutions. Methods using multi stage cluster sampling method, the basic settings, hardware, information level and management status of 155 village health rooms in 15 villages and towns in 2 counties of Jiangxi province were investigated and analyzed. The service population was 1657 people, the average time for the farthest residents to walk to the village health room was 37.6 minutes, and 91% of the village health rooms were open for 7 days a week. The stability of the village clinics was better than the "one village multiple" model (P0.05) under the management mode of "one village one house"; and the diagnosis and treatment of the stethoscope, thermometer, blood pressure meter, the outpatient box, and the ultraviolet lamp were set up. In the configuration, the village health room was obviously more than the "one village and many" model (P0.01). The village health room's computer allocation rate is 95.5%, the network coverage rate is 86.5%, but the 35.5% network speed is slower, 17.4% often breaks the net, and the 26.5% is sometimes blackout. Conclusion village Wei Sheng room basically has the resources and article of symptom monitoring information construction. The monitoring frequency can be carried out in a day, and the hardware configuration and management of the village health room is better than the "one village" model under the management mode of "one village one house".
The third part is the evaluation and countermeasure research of infectious disease symptom monitoring ability of village level health personnel in Jiangxi province.
Objective to study the comprehensive ability and willingness of village health workers to monitor the symptoms of infectious diseases in Jiangxi, and to put forward countermeasures and suggestions. Methods using multi stage cluster sampling method, the basic health service ability and computer operation ability of 253 village doctors in 15 villages and towns in 2 counties of Jiangxi province were investigated and analyzed. The average age of village doctors was 44.56 + 11.92 years old. The average age of village doctors was 44.56 + 11.92 years old; about 12.5% of the 160 monitoring Rapporteur would not use the computer; the most common diseases of the village doctors were upper respiratory tract infection, acute and chronic gastrointestinal infection, hypertension and diabetes; "one village one" management model village. The number of patients receiving medical treatment is obviously more than "one village and many" models (Z=-8.105, P0.0001); five kinds of infectious diseases that the village doctor contact most are influenza, other infectious diarrhea, mumps, chickenpox and dysentery; 75.9% of the village doctors will report the township health care hospital immediately after the infection of the patients; and the village doctor provides the public sanitation under the "one village" model. 2=4.827 (P=0.028) and public health service subsidies (Z=83.863, P0.0001) are higher than the "one village one village" management model. Conclusion the health service ability and infectious disease prevention and control ability of village doctors basically meet the requirements of symptom monitoring; fever, sore throat, cough, diarrhea, rash should be the priority attention. Objective monitoring symptoms; village doctors have stronger ability to carry out symptom monitoring, but their compliance will be affected by economic factors.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R181.8

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