臺灣博碩士論文加值系統

俄羅斯總體結核病流行病的惡化是在通貨膨脹、經濟改革環境及社會變遷為背景之下發生的。價格自由化加劇通貨膨脹；總經穩定化緊縮衛生預算、醫療投入減少；私有化及長期薪資欠款則進一步擴大所得差距。社會變遷產生許多社會經濟地位較低落的群體易於受到傳染病的感染。總體生活水準的下降導致俄羅斯結核病流行病情況的惡化。

結核病為與社會情況相當有關聯的疾病。俄羅斯結核病惡化的因素可以歸結於總體經濟瓦解、生活水準惡化、失業率及無家可歸人數上升，而這些危險因子又是政治、經濟及社會不穩定下的產物。經費不足及失業率上升導致X光受檢率下降、結核病部門人員老化及監獄受刑人出獄後之後續追蹤治療問題都是俄羅斯保健部結核病部門面臨的考驗。

俄羅斯結核病問題42%來自監獄，多重抗藥性問題亟待解決。此外，同時感染HIV及結核菌加速結核病的嚴重化。結核病採用不同統計方式〈例如將監獄受刑人、軍人、無家可歸者及移民納入八號統計〉對於俄羅斯結核病發生率及死亡率的上升也有重大的影響。

歐洲國家在過去十年間通報的結核病案例數在增加當中，尤其以中東歐國家及前蘇聯國家惡化情形較為嚴重。結核病在此地區增加的基本原因為：

一、管理不佳或過時的治療使得控管不當，導致抗藥性結核病例增加。
二、經濟衰退、貧窮、營養不良、酗酒及吸毒、擁擠的監獄、缺乏健康照顧的取得。
三、來自結核病盛行國家移民影響〈西歐〉。
四、HIV/AIDS感染加速結核病的傳播，感染HIV同時感染結核病導致高死亡率。

俄羅斯的情形又以第一、二、四項為主。

The deterioration of general TB epidemiological situation in Russia took place against a background of inflation, economic reform environment and a time of social change. Price liberalization deteriorated the situation of inflation. Macroeconomic stabilization tightened health budget and diminished medical inputs. Privatization and pro-longed wage arrears enlarged the income gap. Social environment change had caused a number of groups with low social-economic status to be easily affected by infectious diseases. The deterioration of standard of living made the TB situation even worse.

When it comes to tuberculosis, it is a disease that is bound to social conditions. Factors that affected the TB situation in Russia were macroeconomic destruction, worsening of standard of living, increasing number of unemployment and homeless, and these factors were due to political, economic, and social instability. Insufficient financing and the increase of unemployment rate, which caused the decline of X-ray coverage, aging of TB department medical member, and the follow-up treatment of patients from prisons are main tasks for the TB department (ministry of Public Health, RF) to face.

42% of the Russian TB problem is in prisons. The problem of MDR-TB is yet to be settled. Besides, HIV/TB coinfection speeds the deterioration of TB. The acceptance of different kind of statistics of TB epidemiology (for example, the inclusion of prisoners, armed forces, homeless, immigrants, in the list of form № 8) had a great influence on the raise of TB incidence and mortality rate in Russia.

European countries have registered rising tuberculosis (TB) over the last decade, and the situation in the countries of central and eastern Europe and the former Soviet countries is particularly serious. The principal reasons for the increase in TB in the region are:

1.poorly managed and outdated practices, which cause the increase in MDR-TB.
2.economic recession, poverty, malnutrition, alcohol/drug abuse, overcrowded prisons, lack of access to health care.
3.immigration from TB high-burden countries(to western Europe countries).
4.increasing rates of HIV infection, HIV/TB coinfection leads to high mortality rate.

Reasons 1,2,4 discussed above are the case in Russia.

目錄


第一章 緒論 …………………………………………………………1

第一節 研究動機……………………………………………………1
第二節 研究目的……………………………………………………2
第三節 研究方法、研究理論及範圍………………………………4
第四節 研究限制……………………………………………………7

第二章 經濟轉型期間俄羅斯經濟社會環境對公共衛生的影響…9

第一節 經濟轉型期間俄羅斯經濟環境……………………………9
第二節 經濟轉型期間俄羅斯社會環境……………………………23
第三節 經濟社會環境變遷對於俄羅斯公共衛生影響……………28
第四節 小結…………………………………………………………36

第三章 俄羅斯結核病問題描述……………………………………38

第一節 疾病自然史及三段五及預防措施…………………………38
第二節 結核病指標…………………………………………………41
第三節 結核病概述…………………………………………………43
第四節 俄羅斯防治結核病史………………………………………51
第五節 俄羅斯結核病問題描述……………………………………53
第六節 小結…………………………………………………………65

第四章 俄羅斯經濟社會變遷造成結核病健康危險因子…………67

第一節 經濟轉型對於俄羅斯結核病防治所造成影響……………67
第二節 俄羅斯結核病危險群………………………………………73
第三節 社會心理及新物質解釋探討........................79
第四節 社會經濟及傳染疾病流行之決定因素……………………81
第五節 小結…………………………………………………………91

第五章 結論…………………………………………………………93

第一節 討論…………………………………………………………93
第二節 經濟社會環境及醫療面探討………………………………93
第三節 後續研究的建議……………………………………………97

參考書目 ………………………………………………………………99


圖表目錄

圖1.1 俄羅斯經濟轉型期間結核病發生率、失業率及難民遊民增加對照圖 …………………………………………………………………6
圖3.1 俄羅斯結核病發生率〈1985~2000〉 〈每十萬人口〉……55
圖3.2 俄羅斯兒童發生率〈1985~1999〉 〈每十萬人口〉………56
圖3.3 俄羅斯結核病死亡率〈1985~2000〉 〈每十萬人口〉……58
圖3.4 俄羅斯結核病盛行率〈1987~2000〉 〈每十萬人口〉……59
圖3.5 1997年俄羅斯各地區結核病發生率...................60
圖3.6 俄羅斯內政部職員結核病發生率指標〈1987~2000〉 〈每十萬人口〉………………………………………………………………61
圖4.1 俄羅斯及西伯利亞聯邦區結核病死亡率〈1987~2000〉〈每十萬人口〉………………………………………………………………78


表2.1 蘇聯經濟年平均成長率〈1961~85〉 〈物質生產淨額〉..10
表2.2 蘇聯薪資年成長率〈%〉 〈1986~1991〉...............11
表2.3 通貨及貸款〈年平均成長率〉 〈1981~1990〉..........12
表2.4 通貨年增長率〈十億名目盧布〉 〈1985~1990〉........13
表2.5 俄羅斯的通貨膨脹〈1992~1994〉.....................15
表2.6 俄羅斯通貨膨脹率〈1991~1994〉.....................17
表2.7 俄羅斯總體經濟〈1992~1999〉.......................23
表2.8 俄羅斯人均酒類消費〈1984~1994〉...................25
表2.9 1989至2002年人口減少數概要.......................31
表3.1 2004年全球結核病發生率及死亡率 ………………………44
表4.1經濟轉型措施對健康機構的影響 ……………………………68

參考書目

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期刊

1.司晏芳〈2003〉，「小心肺結核病捲土重來」，《康健》，55，58-59。
2.何衞〈2004〉，「對原蘇聯國家經濟轉軌進程中若干問題認識」，《俄羅斯中亞東歐研究》，5，34-41。
3.吳怡君〈2005〉，「台灣結核病現況及政府的防治措施」，《台灣醫界》，48：2，74-77。
4.李玉珍〈1992〉，「俄羅斯經改初探」，《問題與研究》，31：11，62-72。
5.李志學〈2004〉，「休克療法啟示錄」，《俄羅斯中亞東歐研究》，2，30-33。
6.徐坡岭〈2004〉，「俄羅斯轉軌以來經濟走勢的公共選擇分析」，《俄羅斯中亞東歐研究》，3，28-35。
7.朗光輝、張鑾英〈2005〉，「兒童結核病」，《台灣醫界》，4：4，11-17。
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11.許建邦〈2002〉，「有效防治結核病」，《常春》，227：2，138-139。
12.劉美玲〈2001〉，「肺結核捲土重來的大麻煩」，《常春》，235：10，132-134。
13.薩公強〈1993〉，「俄羅斯國營企業私有化述評」，《問題與研究》，32：3，55-68。
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期刊

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報紙

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