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研究生:廖淑櫻
研究生(外文):Shu-Ying Liao
論文名稱:接受愛滋個案管理者門診個別衛教諮詢對其梅毒發生的影響
論文名稱(外文):The effect of individualized health education during outpatient clinical visit on syphilis occurrence among patients receiving HIV/AIDS case management
指導教授:簡莉盈簡莉盈引用關係
指導教授(外文):Li-Yin Chien
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
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:2019
畢業學年度:107
語文別:中文
論文頁數:98
中文關鍵詞:愛滋病個案管理個別衛教諮詢梅毒危險因子
外文關鍵詞:HIV/AIDS case managementindividualized education counselingsyphilisrisk factors
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目錄
論文電子檔著作權授權書............................. i
論文審定同意書................................... ii
中文摘要....................................... iii
英文摘要........................................ vi
目錄.......................................... viii
圖目錄........................................... x
表目錄...................................…..... xii
第一章 緒論.......................................1
第一節、研究背景及重要性............................1
第二節、動機.......................................3
第三節、研究目的...................................5
第四節、名詞界定...................................6
第二章 文獻探討....................................7
第一節、安全性行為及愛滋感染者之常見性病..............7
第二節、HIV/AIDS和梅毒共同感染.....................10
一、 HIV/AIDS和梅毒共感之相關性.................10
二、 HIV/AIDS和梅毒共感之發生率.................11
三、 HIV/AIDS合併梅毒感染之影響因子..............12
四、 HIV/AIDS感染梅毒之臨床表現..................14
五、 HIV/AIDS感染早期梅毒對CD4和HIV病毒量的影響...15
六、 HIV/AIDS感染神經性梅毒的影響................15
七、 梅毒的診斷與HIV/AIDS感染梅毒之治療.......... 16
第三章 研究方法....................................28
第一節、研究設計及研究對象..........................28
第二節、研究工具及資料收集......................... 29
第三節、研究倫理.................................. 32
第四節、資料分析.................................. 33
第四章 研究結果................................... 37
第一節、研究對象基本特性分佈........................37
第二節、存活分析推論門診個別衛教諮詢次數對梅毒感染之變化 45
一、梅毒設限資料涉險率、存活率及發生率.................45
二、Kaplan-Meier推論門診個別衛教諮詢次數對梅毒感染之影響47
三、整體Cox Proportional Hazard Regression Model....63
第三節、GEE(Generalized Estimating Equation;GEE)概化估計方程式推論門診個別衛教諮詢對梅毒感染之變化............. 65
第四節、門診個別衛教諮詢次數與HIV門診次數之關聯性.......69
第五節、愛滋病個案管理在梅毒感染之成本分析............. 71
第五章 討論.........................................75
第一節、愛滋病個案管理照顧與梅毒發生之分析..............75
第二節、愛滋病個案管理門診個別衛教諮詢次數對梅毒感染之分析76
一、以存活分析推論門診個別衛教諮詢次數對梅毒感染之討論 76
二、以GEE推論門診個別衛教諮詢對梅毒感染之討論.......... 77
第三節、愛滋病個案管理在梅毒感染之成本分析討論..........78
第六章 結論與建議................................... 79
第一節、結論....................................... 79
第二節、研究限制.................................... 81
第三節、未來研究建議................................ 82
參考文獻.......................................... 84


表目錄
表一 愛滋病個案管理初次收案時梅毒檢測陰性之人口學特質 40
表二 存活分析--設限資料涉險率、存活率及梅毒發生率 45
表三 不同年齡分組與梅毒發生之時間的平均數與中位數分析 47
表四 不同教育程度分組與梅毒發生之時間的平均數與中位數分析...50
表五 不同職業分組與梅毒發生之時間的平均數與中位數分析......52
表六 不同婚姻狀態分組與梅毒發生之時間的平均數與中位數分析...54
表七 HIV感染危險因子-性行為對象分組與梅毒發生之時間的平均數與中位數分析..............................................56
表八 不同個管師分組與個案梅毒發生之時間的平均數與中位數分析 58
表九 收案時梅毒狀態分組與梅毒發生之時間的平均數與中位數分析 59
表十 追蹤結束前訪視次數分組與梅毒發生之時間的平均數與中位數分析
.....................................................61
表十一 以Cox模型分析各危險因素與發生梅毒風險率之關聯性..... 63
表十二 不同年齡分組與梅毒發生之比較.......................65
表十三 不同教育程度分組與梅毒發生之比較...................66
表十四 不同婚姻狀態分組與梅毒發生之比較.................. 66
表十五 不同HIV感染危險因子-性行為對象分組與梅毒發生之比較...67
表十六 每三個月門診個別衛教諮詢分組與梅毒發生之比較....... 67
表十七 多變項分析每三個月門診個別衛教諮詢有無之分組與梅毒發生之比較..................................................68
表十八 收案日至追蹤結束前最後一次訪視日期之感染科HIV門診(非0BS)有執行衛教諮詢之百分比與接受門診個別衛教諮詢次數之相關係數分析 .....................................................69
表十九 依個案管理現有規模一年不同諮詢次數下發生梅毒之成本花費估算....................................................74

圖目錄
圖一 研究對象追蹤圖....................................37
圖二 不同年齡分組與梅毒發生時間之存活曲線圖.............. 48
圖三 性別分組與梅毒發生時間之存活曲線圖................. 49
圖四 不同教育程度與梅毒發生時間之存活曲線圖...............51
圖五 不同職業與梅毒發生時間之存活曲線圖.................. 53
圖六 不同婚姻狀態與梅毒發生時間之存活曲線圖.............. 55
圖七 HIV感染危險因子-性行為對象狀態分組與梅毒發生時間之存活曲線圖.................................................. 57
圖八 不同個管師分組與個案梅毒發生時間之存活曲線圖........ 58
圖九 收案時梅毒狀態與個案梅毒發生時間之存活曲線圖 ....... 60
圖十 追蹤結束前訪視次數分組與個案梅毒發生時間之存活曲線圖..62
圖十一 收案日至追蹤結束前最後一次訪視日期之感染科HIV門診(非0BS)有執行衛教諮詢之百分比與接受門診個別衛教諮詢次數之相關性分布圖 .....................................................69
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