跳到主要內容

臺灣博碩士論文加值系統

(44.222.104.206) 您好!臺灣時間:2024/05/30 00:13
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:鄧麗琳
研究生(外文):Lilian Teng
論文名稱:利用馬可夫鏈模式探討非胰島素依賴型糖尿病自然病史及篩檢之效益
論文名稱(外文):Markov chain models to study the natural history of non-insulin dependent diabetes mellitus and the efficacy of screening
指導教授:陳秀熙陳秀熙引用關係周碧瑟周碧瑟引用關係
指導教授(外文):Chen, Hsiu-HsiPesus Chou
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:1997
畢業學年度:85
語文別:中文
論文頁數:53
中文關鍵詞:公共衛生衛生健康馬可夫胰島素
外文關鍵詞:PUBLIC-SANITATIONSANITATIONHEALTH
相關次數:
  • 被引用被引用:0
  • 點閱點閱:126
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
本研究利用馬可夫鏈模式探討非胰島素依賴型糖尿病(non-insulin dependent diabetes mellitus)其從正常、無症狀期、症狀期至死於非胰島素依賴型糖尿病或心臟血管疾病(Cardiovascular disease)之自然病史,並以埔里社區性糖尿病篩檢資料聯結死亡資料估計其參數,並將估計結果應用以評估篩檢之效益。將模式估計之參數應用於評估四年間隔之篩檢(現行篩檢)相對於不接受篩檢,其死亡率統計上有顯著意義降低RR=0.59(95% CI=0.38∼0.99),此與埔里社區參加篩檢者較非參加篩檢者降低40%的死亡率(95% CI=1%-62%)之追蹤結果相似。由模式估計出症狀期之十年存活率為0.80,而無症狀期之十年存活率則為0.90;無症狀期長為6.7∼8.1年。如此證明四年間隔之社區性非胰島素依賴型糖尿病篩檢應該合理且可以降低死亡率。
本研究於方法學上之突破為首次利用多階段馬可夫鏈模式探討非胰島素依賴型糖尿病之無症狀期、症狀期至死亡之自然病史,並將其他競爭死因列入考慮。利用此模式的另一優點為不需對照組即可評估篩檢之效益,此模式可應用於其他慢性病篩檢之評估。
Background: Although it was believed that early diagnosis of NIDDM can lead to the reduction of complication and mortality empirical evidence to demonstrate such efficacy is, however, limited partly because evaluation of the efficacy of NIDDM based on randomised trails or prospective studies was impracticable and partly because the natural history of NIDDM on asymptomatic phase is unclear. Since the efficacy of screening was highly dependent on how screening was able to alter the natural history of the disease to throw light on the disease progression from normal, asymptomatic, symptomatic phase to deaths from NIDDM was of paramount importance while there were lacking of randomised trials. Difficulties to estimate the natural history of NIDDM are several-fold. First, as the onset of NIDDM is usually left-censored the baseline incidence was rarely estimated in previous study. Second, it is difficult to estimate the transition rate from asymptomatic to symptomatic phase in that this process is usually occult. Third, the progression rate from symptomatic phase to death is also difficult to obtain because symptomatic cases were hardly identified in a mass screening regime. Finally, to assess the survival of NIDDM is hardly achieved due to long term follow-up required.
Objectives: The aims of this study are to
(1)estimate transition parameters pertaining to the natural history of NIDDM including estimation of the baseline incidence rate of NIDDM, the transition rate from asymptomatic to symptomatic phase and the transition rate from symptomatic to death;
(2)estimate the mean sojourn time (MT) based on (1);
(3)predict the efficacy of different screening frequencies on mortality reduction based on (1);
(4)assess how the lead time bias and the length bias can affect the efficacy of screening
Methods:
Data resource are derived from a community-based screening regime in Taiwan. There were three rounds of screening taking place in 1987-1988,1991-1992 and 1994-1995 respectively. As rear deaths were identified from the third round of screen, we only use two rounds of screen to estimate parameter. Criteria for defining NIDDM are based on a modified WHO criteria. The original cohort was linked to mortality registry to ascertain deaths from NIDDM. Estimation of transition parameters was based on a four-state Markov chain model and a five-state Markov chain model .
Major findings: One-year baseline incidence rate for NIDDM is estimated as 0.012 (95%CI:0.9~1.6). The mean sojourn time (MST) is 6.7~8.1 years. The predicted ten-year survival rate for symptomatic and asymptomatic cases is approximately 80% and 90% respectively. A four-yearly screening regime for NIDDM can reduce 40% (95% CI=1%~62%) death as a result of NIDDM or CVD related to NIDDM.
Conclusion: A 40% reduction of mortality predicted from Markov Chain models suggests the efficacy of a four-yearly screening regime for NIDDM might be feasible.



QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊