云南省3县（市）肺结核病例存量研究

发布时间：2018-04-25 12:27

本文选题：肺结核 + 捕获再捕获　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]通过利用捕获再捕获方法(Capture-recapture)估算不同疫情地区的肺结核患者数,评估不同疫情地区的确诊肺结核患者漏报率、漏失率,进一步估计云南省肺结核患者的漏失水平。了解医院的疫情管理制度及院内临床医生对传染病网络报告知识和肺结核网络报告知识的知晓情况。提出减少肺结核患者的漏报与漏诊,提高云南省肺结核患者发现率的对策及建议。[方法]本研究按分层随机整群抽样的方法抽取3个县(市、区)及其辖区内的36家医疗机构,采用定量和定性的研究方法。定量研究首先使用捕获再捕获方法,利用对数线性模型估计出每个疫情地区的肺结核患者数,计算出每个疫情地区肺结核患者的漏报率与漏失率。紧接着,将每个疫情地区的数据合并,进一步估计出全省3县(市)肺结核患者的漏失水平。其次,采用问卷法收集资料,在查阅相关医务人员传染病报告知晓情况文献的基础上,设计了 “云南省医疗机构临床医生传染病报告基本情况调查表”。问卷内容主要包括三个部分:人口社会学特征、传染病网络报告知识与肺结核病例相关知识。采用Epidata3. 1、R3.4. 0、SPSS19.0软件进行统计分析,采用构成比、率等进行统计描述,通过卡方检验分析不同疫情地区之间的漏报率、漏失率有无差异。定性研究通过一对一、面对面访谈的方式对医院疫情管理人员进行访谈,以此来了解不同医院疫情管理工作制度的执行情况。访谈内容包括院内关于法定传染病网络直报的管理制度、传染病报告工作的运行程序。[结果]1在不同性别组中,男性与女性之间的漏报率无统计学差异;在不同年龄组中65岁以上组的漏报率最高;在不同级别医疗机构中,一级医院与三级医院的漏报率高于二级医院。2高疫情地区的漏报率均高于中疫情与低疫情地区,中疫情地区与低疫情地区之间的漏报率相比无统计学差异。3云南省总体肺结核患者漏失率为45. 6%,发现率为54. 4%。在性别组中,男性漏失率高于女性;在年龄组中,65岁以上组的漏失率最高。将未报告的肺结核患者作为已发现的肺结核患者,肺结核病人的漏失率为29. 56%,肺结核病人的发现率升高至70.44%。因此,云南省肺结核病人的漏失现象除了由肺结核的漏报导致,还与肺结核患者的未就诊和漏诊有关。而肺结核患者的未就诊和漏诊也与医疗卫生服务的可及性、医务人员的诊断水平及群众的经济水平与健康意识有着密切的联系。4高疫情地区的肺结核患者漏失率为48. 43%,发现率为51. 57%。在性别组中,男性组漏失率高于女性组漏失率;在年龄组中,65岁以上组的漏失率最高。将未报告的肺结核患者作为已发现的肺结核患者,高疫情地区肺结核病人的漏失率为26. 7%,发现率升高至73. 3%。因此,高疫情地区肺结核病人的漏失现象一半是由肺结核的漏报导致。5中疫情地区肺结核患者的漏失率为22. 5%,发现率为77. 5%。在性别组中,男性与女性的漏失率无统计学差异;在年龄组中,45-64岁组与65岁以上组的漏失率均高于15-44岁组。将未报告的肺结核患者作为已发现的肺结核患者,中疫情地区肺结核病人的漏失率为18. 05%,发现率升高至81. 95%。因此,中疫情地区肺结核病人的漏失现象主要是由肺结核病人的漏诊导致,特别应该关注45-64岁组与65岁以上组病人的漏失情况。6低疫情地区肺结核患者的漏失率为22.6%,发现率为77.4%。在性别组中,男性与女性的漏失率无统计学差异;在年龄组中,15-44岁组的漏失率最高。将未报告的肺结核患者作为已发现的肺结核患者,低疫情地区肺结核病人的漏失率为17.85%,发现率升高至82. 15%。因此,低疫情地区肺结核病人的漏失现象主要是由肺结核的漏诊导致,特别应该关注15-44岁组病人的漏失情况。7云南省总体疑似肺结核患者的漏报率为10.34%。在性别组中,女性漏报率高于男性漏报率;在年龄组中,15-44岁组的漏报率最高;在不同医疗机构的漏报情况中,三级医院的漏报率最高。8本次调查36家医疗机构的临床医生,共发放329份问卷,获得有效问卷306份,有效应答率为93%。其中一级医院与二级医院以30岁以下为主,人员偏年轻化,三级医院则以30-49岁为主;文化程度方面,学历在大专以下的构成比随着医疗机构级别的升高而减少,反之,研究生的构成比也随着医疗机构级别的升高而增加。9将不同级别医疗机构传染病网络报告知识掌握情况相比发现,二级医院与三掌握程度都高于一级医院;将不同疫情地区医疗机构传染病网络报告知识掌握情况相比发现,低疫情地区掌握的人数高于中疫情与高疫情地区。10定性研究发现,在传染病网络报告管理工作中,部分医院的奖惩制度流于形式;医生由于门诊量大,工作繁重,因此导致填写传染病报告卡的时间有限;疫情人员在登录网络直报系统中遇到困难,对直报系统的操作不熟悉。[结论]1通过本研究可以为进一步估计全省的肺结核患者数提供指导与依据。2肺结核的漏失一半是由漏报导致,因此要解决好肺结核的漏报现象,让肺结核病人的发现率不断提高。3高疫情地区不仅结核病疫情严峻,肺结核漏报率与漏失率也高,所以应引起重视,应该不断加大对高疫情地区的培训与督导。
[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.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521

【参考文献】