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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 方啟泰,林先和 | |
dc.contributor.author | Sung-Ching Pan | en |
dc.contributor.author | 盤松青 | zh_TW |
dc.date.accessioned | 2021-05-14T17:42:17Z | - |
dc.date.available | 2019-01-01 | |
dc.date.available | 2021-05-14T17:42:17Z | - |
dc.date.copyright | 2016-02-26 | |
dc.date.issued | 2015 | |
dc.date.submitted | 2016-01-07 | |
dc.identifier.citation | Chap 1 1. WHO. Global tuberculosis report 2014. 2014 [cited 2014 Nov. 1]; Available from: http://www.who.int/tb/publications/global_report/en/ 2. WHO. Global strategy and targets for tuberculosis prevention, care and control after 2015. 2013 [cited 2014 July 25]; Available from: http://www.who.int/tb/post2015_TBstrategy.pdf?ua=1 3. Dye C, Lonnroth K, Jaramillo E, Williams B, Raviglione M. Trends in tuberculosis incidence and their determinants in 134 countries. Bull World Health Organ. 2009; 87(9): 683-91. 4. L ouml;nnroth K, Castro KG, Chakaya JM, Chauhan LS, Floyd K, Glaziou P, et al. Tuberculosis control and elimination 2010–50: cure, care, and social development. The Lancet. 2010; 375(9728): 1814-29. 5. Jeon CY, Murray MB. Diabetes Mellitus Increases the Risk of Active Tuberculosis: A Systematic Review of 13 Observational Studies. PLoS Med. 2008; 5(7): e152. 6. Baker M, Harries A, Jeon C, Hart J, Kapur A, Lonnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: A systematic review. BMC Medicine. 2011; 9(1): 81. 7. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. The Lancet. 2011; 378(9785): 31-40. 8. Odone A, Houben RMGJ, White RG, L ouml;nnroth K. The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. The Lancet Diabetes Endocrinology. 2014; 2(9): 754-64. 9. Stevenson C, Forouhi N, Roglic G, Williams B, Lauer J, Dye C, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health. 2007; 7(1): 234. 10. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. The Lancet infectious diseases. 2009; 9(12): 737-46. 11. Dye C, Bourdin Trunz B, L ouml;nnroth K, Roglic G, Williams BG. Nutrition, Diabetes and Tuberculosis in the Epidemiological Transition. PLoS ONE. 2011; 6(6): e21161. 12. Murray M, Oxlade O, Lin HH. Modeling social, environmental and biological determinants of tuberculosis. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2011; 15 Suppl 2: S64-70. 13. Cohen T, Lipsitch M, Walensky RP, Murray M. Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations. Proc Natl Acad Sci U S A. 2006; 103(18): 7042-7. 14. Dye C, Garnett G, Sleeman K, Williams B. Prospects for worldwide tuberculosis control under the WHO DOTS strategy. Directly observed short-course therapy. Lancet. 1998; 352(9144): 1886-91. 15. United Nations Population Division. World population prospects, the 2010 revision. [cited 2012 Nov. 10]; Available from: http://esa.un.org/wpp/Excel-Data/population.htm 16. Kontis V, Mathers CD, Rehm J, Stevens GA, Shield KD, Bonita R, et al. Contribution of six risk factors to achieving the 25x25 non-communicable disease mortality reduction target: a modelling study. Lancet. 2014; 384(9941): 427-37. 17. Disease WIUATL. Collaborative framework for care and control of tuberculosis and diabetes. Geneva, Switzerland: WHO; 2011. 18. Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S, et al. The Burden of Mortality Attributable to Diabetes. Diabetes Care. 2005; 28(9): 2130-5. 19. Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, et al. Diabetic Control and Risk of Tuberculosis: A Cohort Study. American Journal of Epidemiology. 2008; 167(12): 1486-94. 20. Granich R, Gilks C, Dye C, De Cock K, Williams B. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009; 373(9657): 48-57. 21. L ouml;nnroth K, Williams BG, Cegielski P, Dye C. A consistent log-linear relationship between tuberculosis incidence and body mass index. International Journal of Epidemiology. 2010; 39(1): 149-55. 22. Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 2005; 9(7): 777-83. 23. Nigatu T. Integration of HIV and noncommunicable diseases in health care delivery in low- and middle-income countries. Prev Chronic Dis. 2012; 9: E93. 24. Marais BJ, Lonnroth K, Lawn SD, Migliori GB, Mwaba P, Glaziou P, et al. Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts. The Lancet infectious diseases. 2013; 13(5): 436-48. 25. Harries AD, Jahn A, Zachariah R, Enarson D. Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in sub-Saharan Africa. PLoS Med. 2008; 5(6): e124. 26. Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world--a growing challenge. The New England journal of medicine. 2007; 356(3): 213-5. 27. Farzadfar F, Finucane MM, Danaei G, Pelizzari PM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet. 2011; 377(9765): 578-86. 28. WHO. Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases 2013 [cited; Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_8-en.pdf 29. Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006; 368(9548): 1673-9. 30. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344(18): 1343-50. Chap 2. 1. Menzies D, Joshi R, Pai M (2007) Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 11:593-605. 2. CDC (1995) Proportionate mortality from pulmonary tuberculosis associated with occupations--28 states, 1979-1990. Morb Mortal Wkly Rep 44:14-9. 3. Bang KM, Weissman DN, Wood JM, Attfield MD (2005) Tuberculosis mortality by industry in the United States, 1990-1999. Int J Tuberc Lung Dis 9:437-42. 4. Pleszewski B, FitzGerald JM (1998) Tuberculosis among health care workers in British Columbia. Int J Tuberc Lung Dis 2:898-903. 5. Centers for Disease Control, R.O.C. (Taiwan) Epidemiology of TB in Taiwan [updated Oct. 21, 2012; cited 2014 May, 1]. Available from: http://www.cdc.gov.tw/professional/page.aspx?treeid=BEAC9C103DF952C4 nowtreeid=CB23B72EFE6C912C. 6. Wang F, Chang C, Su W, Shih J, Hsiao K, Chern M, et al (2006) Screening of hospital workers for pulmonary tuberculosis in a medical center in Taiwan. Infect Control Hosp Epidemiol 27:510-1. 7. Chou M, Sun C, Yeh P (2004) TB diagnosis among HCWS in SARS period. Morb Mortal Wkly Rep 51:321-2. 8. Centers for Disease Control, R.O.C. (Taiwan) Taiwan Guidelines for TB Diagnosis and Treatment. Taipei, Taiwan: CDC, Taiwan; 2013. 9. Statistics Do. Abridged Life Table Taiwan: Ministry of Interior; 2014 [cited 2014 May 5]. Available from: http://sowf.moi.gov.tw/stat/year/list.htm. 10. Chiang C, Chang C, Chang R, Li C, Huang R (2005) Patient and health system delays in the diagnosis and treatment of tuberculosis in Southern Taiwan. Int J Tuberc Lung Dis 9:1006-12. 11. World Health Organization. Policy guidance on TB drug susceptibility testing (DST) of second-line drugs. WHO/HTM/TB/2008392. World Health Organization, Geneva, Switzerland; 2008. 12. Chien JY, Chen YT, Wu SG, Lee JJ, Wang JY, Yu CJ (2015) Treatment outcome of patients with isoniazid mono-resistant tuberculosis. Clin Microbiol Infect 21:59-68. 13. Adult toxicity table. Division of Microbiology and Infectious Diseases (DMID). November, 2007 draft. Accessed June 23, 2015. Available from: http://www.niaid.nih.gov/LabsAndResources/resources/DMIDClinRsrch/Documents/dmidadulttox.pdf. 14. Statistics of Communicable Diseases and Surveillance Report. Centers for Disease Control, Ministry of Health and Welfare, R.O.C. (Taiwan). Accessed Sep. 1, 2015. Available from http://www.cdc.gov.tw/professional/infectionreport.aspx?treeid=56ca56252a0fa705 nowtreeid=ca20fc0dab36f820. 15. Rothman K, Greenland S (2008) Modern Epidemiology. 3rd edition, pages 267-8. 16. Babus V (1997) Tuberculosis morbidity risk in medical nurses in specialized institutions for the treatment of lung diseases in Zagreb. Int J Tuberc Lung Dis 1:254-8. 17. Wilkinson D, Gilks CF (1998) Increasing frequency of tuberculosis among staff in a South African district hospital: impact of the HIV epidemic on the supply side of health care. Trans R Soc Trop Med Hyg 92:500-2. 18. Harries A, Nyirenda T, Banerjee A, Boeree M, Salaniponi F (1999) Tuberculosis in health care workers in Malawi. Trans R Soc Trop Med Hyg 93:32-5. 19. Skodric V, Savic B, Jovanovic M, Pesic I, Videnovic J, Zugic V, et al (2000) Occupational risk of tuberculosis among health care workers at the Institute for Pulmonary Diseases of Serbia. Int J Tuberc Lung Dis 4:827-31. 20. Alonso-Echanove J, Granich RM, Laszlo A, Chu G, Borja N, Blas R, et al. (2001) Occupational transmission of Mycobacterium tuberculosis to health care workers in a university hospital in Lima, Peru. Clin Infect Dis 33:589-96. 21. Kruuner A, Danilovitsh M, Pehme L, Laisaar T, Hoffner S, Katila M (2001) Tuberculosis as an occupational hazard for health care workers in Estonia. Int J Tuberc Lung Dis 5:170-6. 22. Cuhadaroglu C, Erelel M, Tabak L, Kilicaslan Z (2002) Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey. BMC Infect Dis. 2002;2:14. 23. Eyob G, Gebeyhu M, Goshu S, Girma M, Lemma E, Fontanet A (2002) Increase in tuberculosis incidence among the staff working at the Tuberculosis Demonstration and Training Center in Addis Ababa, Ethiopia: a retrospective cohort study. Int J Tuberc Lung Dis 6:85-8. 24. Kilinc O, Ucan ES, Cakan MDA, Ellidokuz MDH, Ozol MDD, Sayiner A, et al (2002) Risk of tuberculosis among healthcare workers: can tuberculosis be considered as an occupational disease? Resp Med 96:506-10. 25. Rao KG, Aggarwal AN, Behera D (2004) Tuberculosis among physicians in training. Int J Tuberc Lung Dis 8:1392-4. 26. Dimitrova B, Hutchings A, Atun R, Drobniewski F, Marchenko G, Zakharova S, et al (2005) Increased risk of tuberculosis among health care workers in Samara Oblast, Russia: analysis of notification data. Int J Tuberc Lung Dis 9:43-8. 27. Hosoglu S, Tanrikulu A, Dagli C, Akalin S (2005) Tuberculosis among health care workers in a short working period. Am J Infect Control 33:23-6. 28. van Deutekom H, Gerritsen JJJ, van Soolingen D, van Ameijden EJC, van Embden JDA, Coutinho RA (1997) A Molecular Epidemiological Approach to Studying the Transmission of Tuberculosis in Amsterdam. Clin Infect Dis 25:1071-7. 29. McKenna M, Hutton M, Cauthen G, Onorato I (1996) The association between occupation and tuberculosis. A population-based survey. Am J Respir Crit Care Med 154:587-93. 30. Sepkowitz KA, Friedman CR, Hafner A, Kwok D, Manoach S, Floris M, et al (1995) Tuberculosis Among Urban Health Care Workers: A Study Using Restriction Fragment Length Polymorphism Typing. Clin Infect Dis 21:1098-102. 31. Menzies D, Fanning A, Yuan L, Fitzgerald M (1995) Tuberculosis among Health Care Workers. N Engl J Med 332:92-8. 32. Centers for Disease Control, R.O.C. (Taiwan). Taiwan Tuberculosis Control Report 2013. Centers for Disease Control, R.O.C. (Taiwan), editor. Taiwan: Centers for Disease Control, Department of Health, R.O.C. (Taiwan); 2014. 33. Holty JE, Sista RR (2009) Mycobacterium tuberculosis infection in transplant recipients: early diagnosis and treatment of resistant tuberculosis. Curr Opin Organ Transplant 14:613-8. 34. El-Sadr WM, Tsiouris SJ (2008) HIV-associated tuberculosis: diagnostic and treatment challenges. Semin Respir Crit Care Med 29:525-31. 35. Kawatsu L, Ishikawa N (2014) Socio-economic factors that influence tuberculosis death among the youth and middle-aged population: a systematic review. Kekkaku 89:547-54. 36. Virenfeldt J, Rudolf F, Camara C, Furtado A, Gomes V, Aaby P, et al (2014) Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study. BMJ open 4:e004818. 37. Lee CH, Lee MC, Lin HH, Shu CC, Wang JY, Lee LN, et al (2012) Pulmonary tuberculosis and delay in anti-tuberculous treatment are important risk factors for chronic obstructive pulmonary disease. PloS one 7:e37978. 38. Liu YC, Lin HH, Chen YS, Su IJ, Huang TS, Tsai HC, et al (2010) Reduced health provider delay and tuberculosis mortality due to an improved hospital programme. Int J Tuberc Lung Dis 14:72-8. 39. Vasankari T, Holmstrom P, Ollgren J, Liippo K, Kokki M, Ruutu P (2007) Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study. BMC public health 7:291. 40. Taki H, Ogawa K, Murakami T, Nikai T (2008) Epidemiological survey of hyperuricemia as an adverse reaction to antituberculous therapy with pyrazinamide. Kekkaku 83:497-501. 41. Jarand J, Shean K, O'Donnell M, Loveday M, Kvasnovsky C, Van der Walt M, et al (2010) Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa. Trop Med Int Health 15:1179-84. 42. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, et al (2009) Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis 9:153-61. 43. Chan PC, Huang SH, Yu MC, Lee SW, Huang YW, Chien ST, et al (2013) Effectiveness of a government-organized and hospital-initiated treatment for multidrug-resistant tuberculosis patients--a retrospective cohort study. PloS one. 8:e57719. 44. Centers for Disease Control, Taiwan. HIV Statistics Taipei, Taiwan: CDC, Taiwan; 2015 [cited 2015 March 19]. Chap 3. 1. WHO. Global tuberculosis report 2013. 2014. [cited 2015 Jan. 24] Available from: http://www.who.int/tb/publications/global_report/en/ 2. WHO. Global strategy and targets for tuberculosis prevention, care and control after 2015. 2013 [cited 2015 Jan. 24]. Available from: http://www.who.int/tb/post2015_TBstrategy.pdf?ua=1. 3. Dye C, Glaziou P, Floyd K, Raviglione M. Prospects for tuberculosis elimination. Annual review of public health 2013; 34: 271-286. 4. Menzies D, Joshi R, Pai M. Risk of tuberculosis infection and disease associated with work in health care settings [State of the Art Series. Occupational lung disease in high- and low-income countries, Edited by M. Chan-Yeung. Number 5 in the series]. The International Journal of Tuberculosis and Lung Disease 2007; 11: 593-605. 5. Cauthen GM, Snider DE, Jr., Onorato IM. Boosting of tuberculin sensitivity among Southeast Asian refugees. Am J Respir Crit Care Med 1994; 149: 1597-1600. 6. Menzies R, Vissandjee B, Amyot D. Factors associated with tuberculin reactivity among the foreign-born in Montreal. The American review of respiratory disease 1992; 146: 752-756. 7. Bass JA, Jr., Serio RA. The use of repeat skin tests to eliminate the booster phenomenon in serial tuberculin testing. The American review of respiratory disease 1981; 123: 394-396. 8. El-Helaly M, Khan W, El-Saed A, Balkhy HH. Pre-employment screening of latent tuberculosis infection among healthcare workers using tuberculin skin test and QuantiFERON-TB Gold test at a tertiary care hospital in Saudi Arabia. Journal of infection and public health 2014; 7: 481-488. 9. Balmelli C, Zysset F, Pagnamenta A, Francioli P, Lazor-Blanchet C, Zanetti G, Zellweger JP. Contact tracing investigation after professional exposure to tuberculosis in a Swiss hospital using both tuberculin skin test and IGRA. Swiss medical weekly 2014; 144: w13988. 10. Zwerling A, van den Hof S, Scholten J, Cobelens F, Menzies D, Pai M. Interferon-gamma release assays for tuberculosis screening of healthcare workers: a systematic review. Thorax 2012; 67: 62-70. 11. Metcalfe JZ, Cattamanchi A, McCulloch CE, Lew JD, Ha NP, Graviss EA. Test variability of the QuantiFERON-TB gold in-tube assay in clinical practice. Am J Respir Crit Care Med 2013; 187: 206-211. 12. Centers for Disease Control, R.O.C. (Taiwan). Taiwan Tuberculosis Control Report 2013. Taiwan: Centers for Disease Control, Department of Health, R.O.C. (Taiwan); 2014. 13. Wang F, Chang C, Su W, Shih J, Hsiao K, Chern M, Chen T, Lin M, Chen Y, Lee C. Screening of hospital workers for pulmonary tuberculosis in a medical center in Taiwan. Infect Control Hosp Epidemiol 2006; 27: 510-511. 14. Chou M, Sun C, Yeh P. TB diagnosis among HCWS in SARS period. Morb Mortal Wkly Rep 2004; 51: 321-322. 15. Infection Contron Center NTUH. 2011 Annual report of Infection control in NTUH. Taipei, Taiwan: Infection Contron Center, National Taiwan University Hospital; 2012. 16. Qiagen. QuantiFERON Package Inserts. 2015 [cited 2015 Jan. 24]. Available from: http://www.quantiferon.com/irm/content/package-inserts.aspx?RID=346. 17. Lee SW, Oh DK, Lee SH, Kang HY, Lee CT, Yim JJ. Time interval to conversion of interferon-gamma release assay after exposure to tuberculosis. The European respiratory journal 2011; 37: 1447-1452. 18. Kazama H, Nigorikawa H, Kashiwa M, Miyokawa S, Tanaka M, Ichioka M, Harada N, Mori T. Contact investigation using QuantiFERON-TB Gold test to evaluate TB exposure in 61 subjects in a hospital setting--(2) Change in QuantiFERON response during one year after exposure. Kekkaku 2013; 88: 411-416. 19. Levin ML. The occurrence of lung cancer in man. Acta - Unio Internationalis Contra Cancrum 1953; 9: 531-541. 20. Torres Costa J, Silva R, Sa R, Cardoso M, Nienhaus A. Serial testing with the interferon release assay in Portuguese healthcare workers. Int Arch Occup Environ Health 2011; 84: 461-469. 21. Nienhaus A, Ringshausen FC, Costa JT, Schablon A, Tripodi D. IFN-γ release assay versus tuberculin skin test for monitoring TB infection in healthcare workers. Expert Review of Anti-infective Therapy 2013; 11: 37-48. 22. Rafiza S, Rampal K. Serial testing of Malaysian health care workers with QuantiFERON reg;-TB Gold In-Tube. Int J Tuberc Lung Dis 2012; 16: 163-168. 23. Yoshiyama T, Harada N, Higuchi K, Nakajima Y, Ogata H. Estimation of incidence of tuberculosis infection in health-care workers using repeated interferon-gamma assays. Epidemiol Infect 2009; 137: 1691-1698. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/4442 | - |
dc.description.abstract | Chap 1. 以數理模式分析糖尿病對13個結核高盛行率國家結核防治的影響 一、 背景: 糖尿病會增加患者發生結核病的風險,及造成糖尿-結核患者更高的死亡率,由於糖尿病的盛行率在中低收入國家逐漸上升,而此些國家同時有較高的結核病盛行率,因此預防糖尿病可望能協助全球結核病的防治。 二、 方法: 我們使用結核病傳播的數理模式,來分析糖尿病對13個結核高盛行率國家流行病學的影響。我們使用在各個國家過去糖尿病盛行率的資料,建置未來不同模擬狀態下的糖尿病盛行率情境。各國結核病的模式,同樣以過去結核病的資料加以校正,以推估未來不同糖尿病情境下,結核病盛行率的變化,並計算在不同糖尿病盛行率下,可避免結核患者發生及死亡的人數。 三、 發現: 若各國糖尿病的盛行率如現況增加,則可預期在現有結核病防治策略下,至2035年可避免結核發生率8.8% (95%可信區間為4.0~15.8%),及下降結核死亡率34.0% (95%可信區間30.3~39.6%)。但若能降低糖尿病的盛行率,則可能使結核的發生減少11.5~25.2%及8.7%~19.4%的死亡率。和背景情境相比,停止糖尿病盛行率的上升,在未來20年間(2015~2035)共可減少六百萬結核發生及一百一十萬的結核死亡人口;進一步若能使糖尿病發生率,於2025年下降至35%,則可減少七百八十萬結核發生及一百五十萬結核死亡人口。 四、 結論: 糖尿病的盛行可影響高結核盛行率國家的流行病學。傳染性疾病與非傳染性疾病的防治單位,應去除之間的疆界,以共同防治糖尿病及結核病的發生。 Chap 2.以配對世代研究分析醫療工作者的結核病 一、 背景: 過去研究發現,醫療工作者與其他職業工作者相比,具有較高的結核病死亡率,但這可能同時來自於醫療工作者結核病發生率較高,或醫療工作者結核病治療預後較差,或兩者共同的影響。為了釐清醫療工作者的職業風險,我們分析在台灣醫療工作者結核病的發生率及治療的癒後。 二、 方法: 我們以2004年至2012年間,台灣某大型醫學中心之醫療人員結核病發生率,與全國人口進行比較。肺結核醫療人員,與同時期在同一醫學中心接受治療的結核病患進行年齡、性別配對後,進行治療預後的比較,並與同時期國內結核病通報的病患治療預後進行比較。 三、 結果: 醫療工作者之標準化結核病發生比率為一般民眾的1.9倍(95%信賴區間為1.2~2.9倍)。研究期間內30名肺結核醫療工作人員,與同時期同醫院接受治療的年齡性別配對後之120名病患相比,具有較少的其他疾病、較短的肺結核診斷及治療延後時間,及較少的治療副作用(p值小於0.05)。在治療癒後方面,醫療工作者具有較好的癒後(結核病醫療人員死亡率0.0% VS.病患的死亡率5.8%,p值為0.008),同時期全國結核病患治療中的標準化死亡率為1.08% (95%信賴區間0.96~1.2%)。 四、 結論: 與一般大眾相比,醫療工作者具有較高的結核病發生率,為了減少職業傷害,我們應努力減少醫療工作者在職場暴露的風險;而健康勞工效應,快速診斷及快速的起始治療,均可能為醫療工作者有較少死亡率的原因。 Chap. 3以前瞻性世代研究探討醫療工作者潛伏性結核病的危險因子 一、 背景: 結核病為醫療工作者可能的職業風險之一,但何種情境,可能導致醫療工作者罹患潛伏性結核病仍缺乏相關的資料。 二、 目標: 我們以前瞻性世代研究來追蹤醫療院所中,有結核病暴露後之醫療工作者,以了解其發生潛伏性結核病(丙型干擾素血液測驗IGRA陽轉)的風險。 三、 結果: 自2011年1月1日至2013年12月31日,在台灣某大型醫學中心中共追蹤303位醫療工作新進人員,及104位有肺結核暴露的醫療工作者。在新進人員中,有19位於就職時即為IGRA陽性,除此19位外,後續7位發生陽轉,陽轉發生率為2.5%。在肺結核暴露之醫療工作者中,9位於第一次測試即為陽性,除此9位外,另9位於後續追蹤陽轉,陽轉發生率為9.5%。其中發生陽轉的危險因子,經年齡及性別校正後,為暴露對象痰液抹片4架之患者(風險比188.32倍,95%信賴區間5.90~6013.21倍),及為肺結核患者抽痰(風險比29.92倍,95%信賴區間2.56~349.04倍)。 四、 結論: 在結核中度盛行率之國家,肺結核暴露會造成醫療工作者潛伏性結核病的風險,其主要的危險因子為暴露對象痰液抹片架數高,及為結核病患執行抽痰動作。本研究發現此二項高危險暴露可能增加醫療工作潛伏性結的風險。 | zh_TW |
dc.description.abstract | 1. Impact of diabetes on tuberculosis control in 13 high tuberculosis burden countries: a modelling study Background: Diabetes increases the risk of tuberculosis incidence and the risk of adverse treatment outcomes among tuberculosis patients. Since the diabetes prevalence is increasing in low- and middle-income countries where the burden of tuberculosis is high, prevention of diabetes carries the potential to assist global tuberculosis control. Methods: We used dynamic tuberculosis transmission models to analyze the potential effect of diabetes on tuberculosis epidemiology in 13 high tuberculosis burden countries. We used data on past diabetes prevalence in each country and constructed scenarios to represent the potential ranges of future diabetes prevalence. The country-specific model was calibrated to the estimated trend of tuberculosis incidence. We estimated the tuberculosis burden that can be reduced by alternative scenarios of diabetes prevention. Findings: If the prevalence of diabetes continues to rise as it has been in the 13 countries (base case scenario), the cumulative reduction in tuberculosis incidence and mortality would only be 8.8% (95% credible interval [CrI]: 4.0-15.8%) and 34.0% (95% CrI: 30.3-39.6%) respectively by 2035. Lowering the prevalence of diabetes could accelerate the decline of tuberculosis incidence by an absolute level of 11.5-25.2% and tuberculosis mortality by 8.7-19.4%. Compared to the base case scenario, halting the rise of diabetes would avoid incident tuberculosis cases by 6.0 million (95% CrI: 5.1-6.9) and tuberculosis deaths by 1.1 million (95% CrI: 1.0-1.3) in 13 countries over 20 years. If interventions reduce diabetes incidence by 35% by 2025, 7.8 million (95% CrI: 6.7-9.0) tuberculosis cases and 1.5 million (95% CrI: 1.3-1.7) tuberculosis deaths will be saved. Interpretation: The diabetes epidemic could substantially affect tuberculosis epidemiology in high burden countries. The communicable disease sector and the noncommunicable disease sector need to move beyond the conventional boundary and link with each other to form a joint response to diabetes and tuberculosis. 2. Tuberculosis in healthcare workers: a matched cohort study in Taiwan Background. Proportional mortality ratio data indicate that healthcare workers (HCWs) have an elevated tuberculosis (TB) mortality. Whether this is caused by an increased TB incidence, a worse TB treatment outcome, or a combination of effects, remains unclear. To elucidate the hazard components of occupational TB, we assessed TB incidence and TB treatment outcome among HCWs in Taiwan. Methods. We compared the incidence of active TB among HCWs at a major medical center in Taiwan with that of Taiwan general population in 2004-2012. We also compared the TB treatment outcome of HCWs with that of age/sex-matched non-HCW patients treated at the same hospital, as well as that of nationally registered TB patients. Results. The standardized TB incidence ratio of the HCWs was 1.9 (95% confidence interval [CI]: 1.2-2.9), compared with the general population. HCWs with pulmonary TB (n=30) were less likely to have underlying diseases, delay in diagnosis, delay in treatment, or side effects of treatment, compared with age/sex-matched non-HCW TB patients (n=120) (all Ps<0.05). The TB treatment outcome of HCWs was significantly better than that of non-HCW patients (TB-related mortality: 0.0% vs. 5.8%, P=0.008, Mantel-Haenszel test). The standardized TB-related mortality rate was 1.08% [95% CI: 0.96% - 1.20%] for all of the nationally registered TB patients in Taiwan. Conclusions. HCWs are at increased risk of active TB, compared with general population. To mitigate this occupational hazard, more efforts need to be directed towards the prevention of nosocomial TB transmission. Healthy worker effect, more rapid diagnosis, and less delay in treatment contribute to a lower TB-related mortality in HCWs. 3. Risk factors for incident latent tuberculosis among health care workers: a prospective follow-up study Rationale: TB has been recognized as an occupational hazard for health care workers (HCWs). However, there is a lack of data on specific circumstances that put exposed HCWs at risk for incident latent TB infection (LTBI). Objective: We sought to identify the risk factors for incident LTBI (with IGRA conversion) among HCWs, using a prospective followed study for TB exposed HCWs. Results: During Jan.1, 2011 to Dec.31 2013, there were 303 new HCWs and 104 TB exposed HCWs enrolled. Among new HCWs, 19 HCWs had initial positive IGRAs result and 7 HCWs had conversion during follow-up. The cumulative risk of conversion was 2.5%. For TB exposed HCWs, 9 HCWs had initial positive IGRA result and 9 HCWs with subsequent conversion. The cumulative risk of conversion was 9.5%. The risk of LTBI attributable to TB exposure was 7.0%. The risk factors for conversion was high amount the AFS smear of the index case (4+) (Hazard ratio (HR): 188.32, 95% CI 5.90-6013.21, P value=0.003) and performing suction for the index case (HR: 29.92, 95% CI 2.56-349.04, P value=0.007) after adjusted by age and sex. Conclusion: In countries with an intermediate TB burden, TB exposure significantly increase the risk for acquiring LTBI in HCWs. The risk factors for incident LTBI were performing suction for the index cases and extreme high AFS amount of the index cases. These findings identify the two high-risk circumstances for TB transmission to HCWs. | en |
dc.description.provenance | Made available in DSpace on 2021-05-14T17:42:17Z (GMT). No. of bitstreams: 1 ntu-104-D00849001-1.pdf: 6916251 bytes, checksum: a73564a745353279fa749c60ddc5bdc6 (MD5) Previous issue date: 2015 | en |
dc.description.tableofcontents | Table of Contents Table of contents……………………………………………………………………………………………….I Abstract……………………………………………………………………………………………….........II 中文摘要..............................................V Chapter I. Impact of diabetes on tuberculosis control in 13 high tuberculosis burden countries: a modelling study…………………………………………………………………………………1 1.1 Introduction…………………………………………………………………………………………………2 1.2 Methods…………………………………………………………………………………………………3 1.3 Results…………………………………………………………………………………………………………6 1.4 Discussion………………………………………………………………………………………………8 1.5 Supplemental material……………………………………………………………………………….21 Chapter II. Tuberculosis in healthcare workers: a matched cohort study in Taiwan…………………..………………………………………………………………………….………………44 2.1 Introduction………………………………………………………………………………………………45 2.2 Methods……………………………………………………………………………………………………46 2.3 Results…………………………………………………………………………………………………51 2.4 Discussion…………………………………………………………………………………………………54 2.5 Supplemental material………………………………………………………………………………64 Chapter III. Risk factors for incident latent tuberculosis among health care workers: a prospective follow up study………………………………………………………….……………………77 3.1 Introduction………………………………………………………….………………………………..78 3.2 Methods………………………………………………………….………………………………..……79 3.3 Results………………………………………………………….……………………………..…………82 3.4 Discussion………………………………………………………….……………………………………84 3.5 Supplemental material………………………………………………………….…………………96 | |
dc.language.iso | en | |
dc.title | 流行病學方法在結核病防治上的應用:以全球衛生與院內感染問題為例 | zh_TW |
dc.title | Application of Epidemiologic Methods in Tuberculosis Prevention and Control: Examples in Global Health and Nosocomial Infection Control Settings | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-1 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 張上淳,盛望徽,江振源,余明治 | |
dc.subject.keyword | 結核病,糖尿病,數理模式,醫療人員,職業風險,結核病暴露,潛伏性結核, | zh_TW |
dc.subject.keyword | tuberculosis,diabetes mellitus,mathematical model,healthcare workers,TB-related mortality,occupational hazards,TB exposure,incident latent tuberculosis, | en |
dc.relation.page | 96 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2016-01-08 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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