【作者】 李刚；

【导师】 倪宗瓒；

【作者基本信息】 四川大学 ， 流行病与卫生统计学， 2004， 博士

【摘要】 目的 对世界部分国家、全国和全军口腔卫生服务资源及其利用进行系统分析和评价,对全国不同地区居民和军队人员口腔健康水平、口腔卫生服务的需要进行调查和分析,探讨统计学方法在口腔卫生服务现况评价与人力资源预测研究中的应用。 方法 采用从国内外公开出版的期刊论文、网站获取和调查世界部分国家的口腔卫生服务现况,采用世界卫生组织口腔健康调查基本方法、修改美国海军牙科标准分类法和自己设计的问卷调查表对全国进行家庭口腔健康询问调查,对全军进行军队人员口腔健康捷径调查,以及对全国和全军进行口腔卫生资源状况通信调查。采用logistic回归方法对全国居民与全军人员口腔卫生服务利用的影响因素进行定量分析,采用特尔斐法设计“牙科人力指数”和“口腔医疗时间需要指数”,引入TOPSIS法、主成份分析法、岭回归法、新兴的支持向量机和组合评价法对世界部分国家口腔卫生人力进行综合评价研究。采用随机前沿成本函数方法对全国和全军口腔医疗机构口腔卫生服务的经济效益和军事效益进行综合评价,采用时间序列模型对全国口腔卫生人力资源进行预测。 结果 全国家庭口腔健康询问调查共调查6个样本县/区587户1558人,其中发达地区193户501人、中等地区194户494人、发展中地区200户563人。全军口腔健康捷径调查共调查总人数为1269人,其中陆军419人、海军437人、空军413人。建立了世界部分国家口腔卫生资源和口腔健康状况、全国家庭口腔健康询问调查和全军口腔健康调查、全国和全军口腔卫生服务资源现况数据厍。全国家庭成员患龋率为52.05%,龋齿均数为1.76,牙龈炎患病率为16.05%,牙结石检出率为39.35%,早期牙周病患病率为4.43%,晚期牙周病患病率为1.73%,2002年曾经到口腔医疗机构就诊过的人员占35.88%。全军现役人员患龋率为26.71%,龋齿均数为0.49,牙龈炎患病率为21.12%,牙结石检出率为44.05%,早期牙周病患病率为2.75%,晚期牙周病患病率为0.39%,第三磨牙阻生率为27.02%,入伍后曾到口腔科看过口腔病的人员占25.7%,共有48.62%人需要按期后送口腔医疗,有45.63%人需要及早后送口腔医疗,有2.13%人需要紧急后送口腔医疗,有28.61%人不需要任何后送口腔医疗。分析了影响全国家庭和全军人员口腔医疗服务利用的主要影响因素。设计了“牙科人力指数”,设更多还原

【Abstract】 Objectives and Meaning This study focused on assessing oral health services resources and utilization of dental services, surveying oral health status and dental treatment needs of partial nation, our country and army. It explored statistical method applying to comprehensive assessment on oral health services and prediction of oral health humanpower.Methods The data of oral health services status of partial nation were collected from the WHO net station and journal reports. A questionnaire was prepared for household oral health interview survey and military recruits oral health pathfinder survey in China, based on the basic methods on oral health surveys of WHO, the modified dental classification of US navy, and the classification of our own design. The data of oral health services status of our country and army were collected via post survey. The related factors were investigated on utilization of dental services of our country and army using logistic regression. The dental manpower index and the dental treatment needs index were developed by mean of Delphi’s method. They were applied to the comprehensive evaluation of the dental manpower of partial nation, in comparing of severe evaluation methods including Topsis, principal component analysis, ridge regression, support vector machines and combined evaluation. A random cost function model was built using data from differences Dental hospitals to assessed the economic and military efficiency. The time series analysis use applied to predict the oral health humanpower of our country.Results The data of 587 houses and 1558 residents had been collected from 3 samples of different economic areas in China stratified acarding to the GDP level. 193 houses and 501 residents were in developed area, 194 houses and 494 residents were in middle area, and 194 houses and 494 residents were in developing area by household oral health interview survey. Data of 1269 military persons (army 419, navy 419, air force413) were collected from 3 sampling spots by military recruits oral health pathfinder survey. The data bank was build for the oral health statue and oral health services resources of partial nation, our country and army with FoxPro6.0. The survey results showed that the prevalence rate of dental caries was 52.05%, the mean DMFT was 1.76, the prevalence rate of gingivitis was 16.05%, dental calculus rate was 39.35%, early periodontitis rate was 4.43%, late periodontal disease rate was 1.73%, and the prevalence rate of dental visits was 35.88% among residents in samples. The survey results showed that the prevalence rate of dental caries was 26.71%, the mean DMFT was 0.49, the prevalence rate of gingivitis was 21.12%, dental calculus rate was 44.05%, early periodontitis rate was 2.75%, late periodontal disease rate is 0.39%, the percentage of third impacted molars was 27.02%, the prevalence rate of dental visits was 25.7%, among military persons of samples. It was showed 28.61% for oral health, 48.62% for oral health care in regularly, 45.63% for oral health care in quickly, 2.13% fordental emergencies among military persons of samples. The related factors on utilization of dental services of our country and army, were investigated The dental manpower index, the dental treatment needs index, the dental services price index and the general assessment index of oral health were designed. The method of replace missing value in the time series data was explored. The prediction of oral health humanpower was 50711 at 2010 and 72284 at 2025 (only in our national hospital) from the time series analysis. The dental services model was build on army division at peace and before fight. The data "have multicolliearity on oral health humanpower evaluation index. Rank was not significant between evaluation and in fact on oral health humanpower of our country through to do comprehensive evaluation of the dental manpower of partial nation. It was build on evaluator system to assessed the economic and military efficiency for different dental hospitals in our country and army. The average inefficiency of hospitals at general hospital level, the highest was 82.7%, at dental clinic, the lower at was 10.7%. The military efficiency was the highest in army division. The goals and project for oral health services in the year 2000-2050 in our country and army were proposed.Conclusions It was a global problem on the imbalance of oral health humanpower resources. The main factor to influence residents visiting dentist were dental price, live area and dental caries. The main factor to influence military persons visiting dentist were age, rank, where are from, treatment needs, dental carries and third impacted molars. The general assessment index of oral health was higher in developing area than in developed and middle areas. It suggested that oral health statue was poor in developing area of our country. Dental manpower index is a good measure to evaluate dental manpower resources between different country. We advance it is essential duty of the dental services model before fight to preventive dental treatment needs at fight. It may be applied to the comprehensive evaluation of the dental manpower of partial nation, using Topsis, principal component analysis, ridge regression, support vector machines and combined evaluation. The results from support vector machines and combined evaluation. Seems more reasonable, it is important point to improve services quality and to reform humanpower structure. The random cost function model increased returns to scale on the economic efficiency for different dental hospitals in our country, whilst it was unchanged in the returns to scale on the economic efficiency for different dental hospitals in our army. We must consider reforms in oral health services structure of our country for oral health services continuous develop in future.更多还原