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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 陳端容 | |
dc.contributor.author | Wen-Ting Kuo | en |
dc.contributor.author | 郭玟婷 | zh_TW |
dc.date.accessioned | 2021-05-16T16:26:48Z | - |
dc.date.available | 2015-03-04 | |
dc.date.available | 2021-05-16T16:26:48Z | - |
dc.date.copyright | 2013-03-04 | |
dc.date.issued | 2013 | |
dc.date.submitted | 2013-02-05 | |
dc.identifier.citation | 1. 行政院衛生署胸腔病院。關於本院-醫院介紹-本院沿革。網址:http://www.ccd.doh.gov.tw/?aid=101&iid=3。引用時間:2012/09/30。
2. 台灣行政院衛生署疾病管制局網站,網址:http://www.cdc.gov.tw/ 引用於2012/5/14。 3. 行政院95年7月7日院臺衛字第0950031290號函核定:結核病十年減半全民動員第一期計畫。 4. 行政院99年11月8日院臺衛字第0990062307號函核定,行政院 101年8月29日院臺衛字第1010053142號修訂:結核病十年減半全民動員第二期計畫。 5. 陸坤泰等:結核病診治指引。第四版。行政院衛生署疾病管制局 2011年1月。 6. 黃淑華、王貴鳳、詹珮君、楊靖慧、陳昶勳:我國多重抗藥性結核病防治策略演進。疫情報導 2012;28:296-302。 7. 許建邦、羅秀雲、李政益、楊祥麟、王貴鳳、楊世仰:台灣都治(DOTS)執行經驗及成效初探。疫情報導 2008;24:188-203。 8. 吳麗均、索任、莊人祥、馮琦芳、李政益、楊祥麟、羅秀雲:世界衛生組織推估結核病負擔之指標介紹。疫情報導 2010;26:34-41。 9. 王培東:北臺灣結核病發生率性別差異之研究。北市醫學雜誌 2007; 4(4):286-293。 10. 許翰琳、白冠壬、林賢君、李俊年、余明:多重抗藥性結核病。內科學誌 2009;20:524-531。 11. Salmaan Keshavjee, M.D., Ph.D., and Paul E. Farmer, M.D., Ph.D. Tuberculosis, Drug Resistance,and the History of Modern Medicine. N Engl J Med 2012; 367:931-936. 12. Giovanni Di Perri, Stefano Bonora. Which agents should we use for the treatment of multidrug-resistant Mycobacterium tuberculosis? Journal of Antimicrobial Chemotherapy 2004; 54:593-602. 13. Stephen C. Resch1, Joshua A. Salomon, Megan Murray, Milton C. Weinstein. Cost-Effectiveness of Treating Multidrug-Resistant Tuberculosis. PLoS Med 3(7): e241. DOI: 10.1371/journal.pmed.0030241. 14. C. I. Mohan, D. Bishai, S. Cavalcante, R. E. Chaisson. The cost-effectiveness of DOTS in urban Brazil. Int J Tuberc Lung Dis. 11(1):27-32. 15. Ricardo Steffen et al. Patients’ Costs and Cost-Effectiveness of Tuberculosis Treatment in DOTS and Non-DOTS Facilities in Rio de Janeiro, Brazil. PLoS ONE 5(11): e14014. doi:10.1371/journal.pone.0014014. 16. Jimmy Volmink, Patrice Matchaba, Paul Garner. Directly observed therapy and treatment adherence. The Lancet 2000; 355:1345-1450. 17. Sharath Burugina Nagaraja et al. How Do Patients Who Fail First-Line TB Treatment butWho Are Not Placed on an MDR-TB Regimen Fare in South India? PLoS ONE 6(10): e25698. doi:10.1371/journal.pone.0025698. 18. Edward D. Chan, et al. Treatment and Outcome Analysis of 205 Patients with Multidrug-resistant Tuberculosis. Am J Respir Crit Care Med 2004; 169:1103-1109. 19. Cohen T, Colijn C, Wright A, et al. Challenges in estimating the total burden of drug-resistant tuberculosis. Am J Respir Crit Care Med 2008; 177: 1302-6. 20. Abhijit Mukherjee, Indranil Saha, Anirban Sarkar, Ranadip Chowdhury. Gender differences in notification rates, clinical forms and treatment outcome of tuberculosis patients under the RNTCP. Lung India. 2012 Apr-Jun;29(2): 120–122. 21. Diwan VK, Thorson A: Sex, gender, and tuberculosis. Lancet. 1999; 353:1000-01. 22. Y-F. Yen et al. DOT associated with reduced all-cause mortality among tuberculosis patients in Taipei, Taiwan, 2006-2008. Int J Tuberc Lung Dis. 2012;16(2):178-184. 23. E. Bloss, P-C. Chan, N-W. Cheng, K-F. Wang, S-L. Yang, P. Cegielski. Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan. Int J Tuberc Lung Dis. 16(4):462-67. 24. WHO. Tuberculosis: Case Detection, Treatment, and Monitoring.2nded.(WHO/HTM/TB/2004.334). 25. WHO. Guidelines for the management of drug-resistant tuberculosis. Geneva, WHO, 1996(WHO/TB/96.210(Rev.1)). 26. WHO. Treatment of Tuberculosis: Guidelines for National Programmes, 4th ed. World Health Organization Document. 27. WHO. Treatment of Tuberculosis Guidelines 4th ed. (WHO/HTM/TB/2009.420.) 28. Dick Menzies, Anne Fanning, Lilian Yuan, Mark Fitzgerald. Tuberculosis among health care workers. N Engl J Med 1995; 332:92-8. 29. Dermot Maher , Mandy Mikulencak .What is DOTS? A Guide to Understanding the WHO-recommended TB Control Strategy Known as DOTS. World Health Organization, 1999;8。 30. WHO. An expanded DOTS framework for effective tuberculosis control. 2002。 WHO. The global plan to stop TB 2011-2015. 31. WHO. Stop TB Working Group on DOTS-Plus for MDR-TB Strategic Plan 2006-2015. 32. Lara M. Jacobson , et al. Changes in the geographical distribution of tuberculosis patients in Veracruz, Mexico, after reinforcement of a tuberculosis control programme. Tropical Medicine and International Health 2005; 10(4):305-311. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/6350 | - |
dc.description.abstract | 研究目的
2006年衛生署疾病管制局委託衛生署胸腔病院執行「免費抗結核二線藥物管理及寄送計畫」,旨在以DOTS五大面向中「穩定供應有品質的藥品」進行結核防治策略介入。計畫已行之有年,政府耗費大量人力、物力及資金,卻未知計畫與國內結核病治療成效是否有關連性,因此以本研究進行驗證計畫執行成效。 方法 為求政策執行背景一致,收集2008年至2011年之計畫申請資料,將歷年案例分為MDR-TB組、一般抗藥非MDR-TB組及藥物副作用組,並登入結核病通報系統查詢治療結果。預期在全國免費抗結核二線藥物做為策略介入後,以描述性統計分析觀察四年內申請案例、性別及年齡等人口學變項比例,再以卡方檢定及羅吉斯回歸進行統計分析。 結果 經卡方檢定後得知年齡(P<0.0001)、性別(P=0.0003)及申請用藥原因(P=0.0009)等達到統計顯著;而申請用藥年度(P=0.26)及申請用藥區域(P=0.32)、有無跨縣市(P=0.23)等變項統計未達顯著。 再以羅吉斯回歸(logistic regression)分析後可知年齡、性別及用藥原因達統計顯著。年齡部分以65歲以上群組做為參考組,20歲以下完治率是5.27倍,21歲至34歲完治率是13.6倍,35歲至49歲完治率是3.78倍,50歲至64歲完治率是2.44倍,各分組整體完治率均優於65歲以上群組。 而性別部分以男性作為參考組時,女性完治率是1.48倍。申請用藥原因部分以藥物副作用組作為參考組,一般抗藥非MDR組的完治率是1.53倍,MDR完治率是0.96倍,一般抗藥非MDR組治療成效最佳。 結論 經由統計分析後得知,國內免費抗結二線藥的管理控制策略對於結核病防治是有所助益的。但仍然需注意的是,WHO多次呼籲DOTS策略應全面施行才容易達到成效,我國政府單位多年來投入大量人力物力與資金,本次研究中仍發現有部分案例只申請免費用藥而未加入DOTS,形同結核防治死角。因此如何徹底落實DOTS,讓DOTS全面覆蓋我國所有結核病人,才是未來防治的一大挑戰。 | zh_TW |
dc.description.abstract | Research purpose
In 2006, Taiwan Center for Disease Control commissioned Chest hospital, department of health to implement one of the TB control strategies: free second-line anti-tuberculosis drugs management and sending plan. The plan connects one of DOTS elements, uninterrupted supply of quality-assured drugs, which uses free drugs to be an intervention in Taiwan TB control policy. It has been executed in many years, the Government consumed lots of personnel, material and funds, but the relative between this plan and domestic TB treatment is still unknown. In this study, we will investigate the effectiveness of the plan. Method For the sake of consisting with the background of police implementation, data is collected from 2008 to 2011. In this study, cases are divided into three groups: MDR-TB, drug-resistant but not MDR-TB, and side-effects, and then logged in TB notification system to confirm all case information. When sending free second-line drugs as an anti-TB strategy intervention, descriptive statistical analysis and statistical software SAS 9.2 are used to observe demographic variables. In the last, chi-square test and logistic regression statistical analysis would be used to evaluate effectiveness. Result By the chi-square test, age (P <0.0001), gender (P = 0.0003) and apply medication reasons (P = 0.0009) are statistical significance; application medication annual (P = 0.26) and the application of medication area (P = 0.32), and whether the city and the county (P = 0.23) are not statistically significant. Then, logistic regression analysis revealed that age, sex and apply medication reasons of statistical significance when outcome is treatment complete. In age part, more than 65 years group as the reference, the odds ratio of below 20 years is 5.27(OR=5.27, 95%CI 0.69-40.43), 21years to 34years is 13.6(OR=13.6, 95%CI 4.26-43.36) ,35 years to 49 years is 3.78(OR=3.78, 95%CI 2.5-5.72), 50 years to 64years is 2.44(OR=2.44, 95%CI 1.88-3.18).The whole treatment complete is better than above 65 years group. In sex part, male as the reference group, treatment complete rate of female is 1.48(OR=1.48, 95%CI 1.17-1.87). In apply medication reasons part, side-effects as the reference, the odds ratio of MDR-TB is 0.96(OR=0.96, 95%CI 0.56-1.64); drug-resistant but not MDR is 1.53 (OR=1.53, 95%CI 1.16-2.01). The drug-resistant but not MDR group is better than others. Conclusions According to statistical analysis, it shows that the free second-line anti-tuberculosis drugs strategy is effective for TB control. WHO repeatedly appeals the DOTS strategy must be fully implemented to make achieve effectiveness. However, some cases only apply for free medication without adding DOTS in this study. Therefore, how to fully implement DOTS and DOTS comprehensive coverage of all TB patients in Taiwan, is a big challenge for future prevention. | en |
dc.description.provenance | Made available in DSpace on 2021-05-16T16:26:48Z (GMT). No. of bitstreams: 1 ntu-102-R99847032-1.pdf: 1074699 bytes, checksum: 6e97c59be1df6ebc3071a2ebf7935dd1 (MD5) Previous issue date: 2013 | en |
dc.description.tableofcontents | 目錄
第一章 導論 12 第一節 文獻回顧 15 第二節 我國結核病政策推進 18 第三節 實習單位特色與簡介 20 第四節 實習內容 20 第五節 研究目的 21 第六節 研究假設 22 第二章 方法 23 第一節 計畫流程簡介 23 第二節 申請免費抗結核二線藥物條件 26 第三節 目前發放之免費抗結核二線藥物簡介 27 第四節 研究方法 29 第三章 結果 30 第一節 申請人數、區域及醫療院所分析 30 第二節 人口學資料及治療結果分析 35 第三節 申請用藥原因分析 39 第四節 統計檢定 44 第四章 討論 47 第一節 三組案例治療成效 47 第二節 藥物副作用組之預期成效落差 48 第三節 政策成效驗證 50 第四節 結核病性別比例 51 第五節 對於實務實習單位的回饋 52 第六節 改善建議 53 參考文獻 55 附錄 名詞定義 58 | |
dc.language.iso | zh-TW | |
dc.title | 臺灣結核病照護政策之成效評估:以2008-2011全國免費抗結核二線藥管理控制為例 | zh_TW |
dc.title | Evaluated effectiveness of tuberculosis care policy in Taiwan:Management and control free second-line anti-tuberculosis drug, 2008-2011. | en |
dc.type | Thesis | |
dc.date.schoolyear | 101-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 簡順添,黃瑞明 | |
dc.subject.keyword | 結核病,抗藥性結核,多重抗藥性結核,都治,抗結核二線藥, | zh_TW |
dc.subject.keyword | tuberculosis,drug-resistance tuberculosis,multidrug-resistance tuberculosis,DOTS,second-line anti-tuberculosis drugs, | en |
dc.relation.page | 59 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2013-02-05 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
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