京都大学 / 0048 / 新制・課程博士 / 博士(生命科学) / 甲第21976号 / 生博第416号 / 新制||生||55(附属図書館) / 京都大学大学院生命科学研究科統合生命科学専攻 / (主査)教授 藤田 尚志, 教授 朝長 啓造, 教授 野田 岳志 / 学位規則第4条第1項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(生命科学) / 甲第23341号 / 生博第459号 / 新制||生||61(附属図書館) / 京都大学大学院生命科学研究科高次生命科学専攻 / (主査)教授 朝長 啓造, 教授 野田 岳志, 教授 千坂 修 / 学位規則第4条第1項該当 / Doctor of Philosophy in Life Sciences / Kyoto University / DFAM

在此篇論文中，我們提出一個慢性Ｂ型肝炎病毒感染病程之數學模型。因為在病症間的轉移機率(Transition probability)是隨著患者的年齡變動，所以在過去的文獻中，已經有學者提出，在疾病轉移機率模型中，應加入國民生命表(Life table)，藉此讓機率模型更符合Ｂ型肝炎病患的生命歷程。但是過去的文獻中，學者並沒有利用加入國民生命表之後疾病模型做進一步的病程分析。在這篇論文當中，我們假設原始的疾病轉移模型是符合馬可夫鏈的性質，並且提出一種加入國民生命表的方法，賦予疾病有年齡相關特性之模型。根據文獻數據和類馬可夫機率性質，我們使用著名的Chapman-Kolmogorov公式計算Ｂ型肝炎的自然病程機率，並畫出病人的生存機率曲線(Survival curve)。文章最後將會藉由兩個例子來介紹此篇論文提出的模型。實驗數據結果證實，此模型不僅提供了一個更精確的方法去分析在病症與死亡間的轉移機率、平均餘命(Life expectancy)、以及在不同年齡的存活機率(Survival probability)，並且可以更進一步的分析且瞭解病情狀態之間的轉移狀況。 / In this thesis, we propose a new mathematical model extending the natural history of hepatitis B virus (HBV) prognosis progression on chronic HBV infection. Since the actual transition probabilities between symptoms are dependent of ages, it has been proposed that the life table should be accommodated to the HBV prognosis progression model so that it can more properly explain the disease progression of the HBV patients. But in the literature, no further disease analysis and applications of it with the life table are discussed. In this thesis, we assume that the original disease progression is described by a Markov model, and propose a new method to combine the HBV progression with the life table so that the proposed model integrates data from the life table and allows the accommodation of age-dependent properties of the target disease. With clinical data based on annual incidence rates, the entire model is Semi-Markov based in nature. Computation methods similar to the celebrated Chapman-Kolmogorov equation can be applied to study the associated probability of each likely trajectory with desired initial ages and health states under the scenarios of natural history and various treatment policies. This method provides a more accurate way to analyze the transitions between symptoms, such as the mean life expectancy or the survival probabilities at different ages. We will give examples to demonstrate the proposed method in this thesis. Numerical results show the proposed model not only provides a more accurate method to analyze the mean life expectancy, the survival probabilities at different ages, and the transition probabilities from symptoms to death but also helps us to understand the transitions between symptoms.

由於不同的行業，其工作內涵差別極大，而不同的工作，其特性更是相去甚遠，自然，對於工作所需之人員，其應具備之資格條件也就大不相同，例如社會各種職場之報考者常常面臨著體格檢查限制的壓力，日常的生活、人際交往、求學、就業、失業、等等問題無時無刻不在困擾著他們，甚至在人生的每一個階段，他們都必須在縫隙中尋求生存的空間。 有些人事用人機關認為體格檢查限制並非是一種歧視行為，而是基於公共利益的需要而給予的合理的差別待遇，所謂「歧視」一詞具有多義性，在此應從侵害「國民就業機會平等」理解之。針對體格檢查限制之問題，本文擬先就體格檢查之意涵予以說明，並舉例說明公務人員考試之體格檢查限制，例如對B型肝炎帶原者限制其報考各類國家考試，這樣一個涉及健康標準的問題，其所設限之體檢標準是否合理？其唯一標準是「醫學標準」，如果科學證明B型肝炎帶原者對他人不構成傳染或雖有傳染性但並不嚴重且可以採取措施加以預防，則上開有關體檢之資格限制標準，構成對B型肝炎帶原者平等競爭公職權利的侵犯，是違憲的，因大量的醫學證明，B型肝炎帶原者並不會對公眾的健康構成威脅。 本文係以有關人民參加需經國家考試公務人員就業體格檢查限制所涉及之基本權利之保障與限制（干預）為研究之課題，人民就業體格檢查是否可以予以差別待遇？而該差別待遇是否合理？合乎比例原則？手段與目的之間如不符比例原則，恐有違憲之虞，故國家於設定體格檢查限制條件時，必須有合理的限制標準，並能依據合理的判斷基準予以救濟，避免侵害人民之權利，且立法、司法及行政各部門，更應負起積極的責任，研擬相關配套措施，以保障人民憲法上的基本權利，全文共分6章：第一章緒論，旨在說明本文之研究動機並界定研究範圍，同時提出本文之研究目的和方法。第二章體格檢查之基本概念，先敘明體格檢查之意涵，包括體格檢查之概念、目的（功能）、意義及特點（執行機構），再加以整理公務人員體格檢查標準之法規依據。第三至第五章構成本文之本論。旨在依序探討公務人員就業體格檢查限制所涉之基本權利保障與限制（干預），並檢討相關行政救濟案例，各章內容以我國憲法所保障之就業基本權利探討為主，並以憲法對於限制人權之相關原則的討論為輔。第六章結論，則在將前述各章之研究結果作綜合性的簡要陳述，並嘗試提出檢討及建議作為本論文之歸結。 / Each career has unique requirements for employees due to the different entity of the career. Therefore the job applicants have to face the pressure of physical examination during application to a new job frequently. Some human resource organizations consider “the abridgement of physical examination” as a rational differential treatment based on the public interests, rather than a discriminative behavior. As the term “discrimination” has versatile meanings, it will be interpreted as an interference of “the equal opportunity for civil employment” in this thesis. In this article, the meaning of the abridgement of physical examination on employment will be illustrated, followed by an example from the abridgement of the physical examination on professional examination. For example, it should be scrutinized whether it is appropriate to abridge a hepatitis B carrier of attending the civil examination, which is concerned from a view of health judged by the medical standard. Some researchers argued that the scientific evidences showed hepatitis B will not be transmitted via carriers, or even can be transmitted but not severely and can be prevented. Then standards of the physical examination on employment would invade the right of equal competition for civil service. Those would be unconstitutional because hepatitis B carriers would not make any threat to public health, which were proved through lots of medical evidences. The main purpose of this thesis concentrated on the protection and interference of basic rights involved in the abridgement of physical examination on civil service. The study will scrutinize the appropriateness, rationality, equality of discriminative treatment in the physical examination on civil service. If the goal and the means of public deeds are not proportional, it would be unconstitutional. To set up the conditions for the abridgement of physical examination, the government should have reasonable standards of restriction and also reasonable judgment criteria of relief for the abridgement of physical examination to avoid invading civil rights. The organization of legislation, justice and administration should take the responsibility of drafting relevant integrated measures to guard the civil privilege. The thesis consists of six chapters. Chapter one (prolegomenon) includes the motive, scope, goal and methods of this study. Chapter two (introduction) elucidates the concept, goal (function), construction and characteristics (an executive body) of the physical examination, and regulations related to standards for the physical examination on the civil service. Chapter three to five (main body) center on the protection and abridgement (interference) of basic rights and the review of administrative relief cases involved in the physical examination of employment. We will study the protection of right of work in our constitution mainly, accompanied by discussion of the relative principles of interference of human rights as well. Chapter six (conclusion) summarizes the research results in previous chapters and make conclusions and suggestions.