健康管理理念下公务员体质健康评价系统的研究与应用
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摘要
研究目的
大量研究表明，近些年来公务员体质健康状况令人担忧，呈逐年下降之势，“三高一低”、超重现象严重，处于典型的亚健康状态。公务员事关国家繁荣兴旺、长治久安，因此对公务员健康状态的研究刻不容缓。计划生育造成的“4-2-1”问题、公务员公费医疗沉重以及《国家中长期科学和技术发展规划纲要（2006－2020）》提出的未来以治疗向预防转移的方针等我国国情，与当前健康管理理念趋势相吻合。坚持健康管理理念下，构建适用于我国公务员体质健康综合评价系统具有重要的指导意义和现实意义。
人体健康若用模糊数学隶属度进行描述时，“1”表示健康，“0”则表示疾病，而介于“0~1”之间则表示亚健康。其中，对于疾病人群，非常规健康促进手段能解决，主要依赖于医务治疗；而占人群75%以上的亚健康人群处于健康与疾病的中介状态，呈动态平衡状况，是健康促进的主要对象，即对人体体质健康实施健康促进的内涵就在于如何保证处于“1”的人群和“0~1”的人群继续保持“1”或者更贴近“1”。然而，当前的现实是“亚健康”概念及诊断手段备受争议，无一个公认的结论。鉴于此，提出研究目的一：基于功能内稳态理论和健康风险分级理念，重新认识亚健康的内涵和外延。
当前国民体质评价标准在大面积推广和使用时，表现出两个问题：（1）存在部分指标临界点上下数值相差不大但等级相差很大，与事实不符的现象，比如血压139mmHg为正常血压（高值）而141mmHg为高血压；（2）当前的体质健康评价方法在实践中评价效能不高，即大多数人只关心测试结果是否及格，而并不关心某些指标的“弱化”。基于此，提出研究目的二：探讨一种适合于我国公务员体质健康的评价方法。
体质健康综合评价结果得到的仅仅是好坏，体质研究的目的不是局限于现状描述，而应该是如何借用评价结果提供健康促进决策支持。提出研究目的三：如何依据体质健康评价结果为个体、群体提供健康促进供决策支持。
当前，市面上存在许多网页版体质评价系统，但多数仅依靠用户自己输入数据，数据不可靠，智能化程度不高，导致评价结果受到质疑；评价指标基本上都用的等权方式，除针对儿童人群评价的软件较多，很少针对如公务员等特殊人群。国外的评价标准是否适用于中国值得商榷。鉴于此，提出研究目的四：依据专家系统结构，构建一套适用于我国公务员体质健康评价系统。
研究方法
文献资料法：重点是重新认识亚健康的内涵和外延，确定风险等级分级临界点。
问卷调查法：通过10名专家问填写1~9标度法问卷，从而构建两两判断矩阵，为确定权重系数服务。
层次分析法：确定指标权重系数。
偏移度算法：对指标权重进行分层，以确定综合评价时应单列的高风险指标，作为风险分级的判断依据；实现个体体质健康在所属群体排名。
模糊数学法：建立综合评价模型时的核心工具之一，确定个体和群体体质健康综合评价模型。
软件工程法：以专家系统结构为主体，构建我国公务员体质健康评价系统。
实验法：以A、B两单位43名年龄为42.3±1.7岁的男性受试者的体质健康测试数据对所建立模型及系统进行验证，以检验其是否科学、有效。
研究结果
确定了公务员体质健康评价内涵，即对占有绝大部分比例的亚健康状态人群的评价，并依据评价结果提供相应的健康促进决策支持，将处于“1”状态的健康人群和处于“0~1”状态下的亚健康人群保持或贴近“1”。
通过对过去和当前有关亚健康的辨析，基于功能内稳态理论与健康风险分级理念以新的角度界定亚健康的内涵和外延。
应用层次分析法确定各个指标权重，并应用偏移度算法对指标进行分层，选取“正向”偏移的指标作为综合评价时的判定依据。
依据体质健康特点，采用梯形模型构造隶属函数。个体评价时，考虑到权重系数的引入，着眼点是考虑主要因素，故选择主因素决定性模型，即M（∧，∨）；群体评价时，所有因素依权重大小均衡兼顾，需兼顾各个因素，故选择加权平均模型，即M（,+）。判断评价结果时的依据为最大隶属原则。最终建立我国公务员体质健康综合评价模型，并根据实验测试的数据代入模型进行验证，结果表明，该模型与事实相符，具有一定的科学性、有效性。
运用软件工程法，按照专家系统结构，构建知识库、事实库和规则库、推理机，最终建立我国公务员体质健康评价系统。
研究结论
（1）建立了我国公务员个体体质健康综合评价模型和群体体质健康综合评价模型，并依据专家系统结构，构建和实现了我国公务员体质健康评价系统。评价系统将身体形态、机能、素质、代谢四个模块依据模糊数学获得的评价结果与单列指标的评价结果按照取低原则进行综合评价，提高了评价效能。
（2）引入模糊数学法对人体体质健康进行综合评价，不仅与人体的体质好坏无一个明确的衡量标准，“优”、“良”这类概念又具有明显的模糊性保持高度一致性，同时，解决了过去的评价标准在大面积推广和使用时造成部分指标临界点上下数值相差不大但等级相差很大、与事实不符合的问题。
（3）首次基于功能内稳态理论与健康风险分级理念重新界定亚健康的内涵和外延。
（4）首次将偏移度算法引入个体体质健康综合评价中，利用偏移度对权重进行分层，从而为个体体质健康最终评价等级的判定提供科学依据；根据偏移度的大小，有效地实现了个体在该群体中的排名。
Objectives
A large number of studies have shown that the health condition of the civilservice is worrying and their physique is on a declining trend and in a typicalsub-health state, with the characteristics of “three-high and one-low” and overweight.As the civil service involves prosperity, thriving and stability of the state, study ontheir health condition admits of no delay. China’s national conditions such as the“4-2-1” problem caused by the family planning, heavy free medical care burden of thecivil service as well as the cure to prevention policy proposed in the “NationalOutlines for Medium and Long-term Planning for Scientific and TechnologicalDevelopment (2006-2020)” agree with the current trend of health managementphilosophy. Therefore, to build a physical health evaluation system applicable toChina’s civil service under the health management philosophy has important guidingand practical significance.
If fuzzy mathematics membership is used to describe human health,“1”,“0” and“0~1” indicate health, disease and sub-health separately. As to the crowd with disease,conventional health promotion means can not solve their problems and they mainlyrelay on medical treatment; the sub-healthy crowd, accounting for75%of the total, isin a dynamic equilibrium state between health and disease, who is the main healthpromotion object, that is, the connotation of health promotion to human physicalhealth is to make the healthy crowd in “1” state and the sub-healthy crowd in the“0~1” state to maintain at or close to “1”. However, the current reality is that theconcept and diagnosis of “sub-health” is controversial and there is no recognizedconclusion. In view of this, the first objective of this study is to re-recognize theconnotation and denotation of sub-health based on function-specific homeostasistheory and health risk classification concept.
There are two problems emerged in wide promotion and use of current nationalphysique evaluation standard:(1) difference in the top and bottom values of thecritical points of part indexes is not significant but difference in grade is significant,which do not tally with the fact, for example,139mmHg means normal blood pressure(top value) but141mmHg means high blood pressure;(2) the efficiency of the currentphysical health evaluation method in practice is not high, that is, most people onlycare for the test results rather than “reduction” of some indexes. For this reason, thesecond objective of this study is to explore a physical health evaluation methodsuitable to China’s civil service.
As the physical health comprehensive evaluation results only indicate good or bad state, the objective of physique study shall not be limited to description of currentsituation and it is how to use the evaluation results to provide decision support tohealth promotion. The third objective of this study is how to use the physical healthevaluation results to provide decision support to health promotion for individuals andcrowds.
At present, there are many web version physical evaluation systems on market,but most of them relay on input of data by users; as the data is not reliable and thesystem is of low level of intelligence, the evaluation results is questioned; theevaluation indexes use the equal weight basically; there are more software applicablefor children and few for special crowd such as the civil service; whether the foreignevaluation standard is suitable to China is debatable. In regard to this, this forthobjective of this study is to build a set of physical health evaluation system suitable tothe Chinese civil service according to expert system structure.
Research Methods
Literature data: Re-recognize the connotation and denotation of sub-health anddecide the risk grade classification critical points.
Questionnaire survey: Built comparison and judgment matrix to decide theweight coefficients by asking10experts to fill out the questionnaire of1~9scales.
Analytic hierarchy process: Decide the index weight coefficients.
Mean shift algorithms: Layering the index weight to decide the index with highrisk to be listed separately in comprehensive evaluation and take it as the judgmentbasis for risk classification; realize ranking of physical health of individual in thecrowd.
Fuzzy mathematical method: One of the core tools to build the comprehensiveevaluation model, decide individual and crowd physical health comprehensiveevaluation model.
Software engineering method: Build the physical health evaluation system forChinese civil service by taking the expert system structure as the subject.
Experimental method: Physical health test data of43male subjects with the ageof42.3±1.7and from A and B units is used to verify scientificity and validity of themodel and system built.
Research results
It determines the connotation of physical health evaluation for civil service, thatis, evaluation of the sub-healthy crowd of the vast majority and provision of corresponding decision support based on the evaluation results in order to achieve thepurpose of health promotion; it makes the healthy crowd in “1” state and thesub-healthy crowd in the “0~1” state to maintain at or close to “1”.
It defines the connotation and denotation of sub-health from a new angle andbased on the function-specific homeostasis theory and health risk classificationconcept through analysis of the past and current information on the sub-health.
The analytic hierarchy process is used to determine various index weights, themean shift algorithms is used to layering the indexes and the indexes with “positive”shift are selected as judgment basis for comprehensive evaluation.
Trapezoid model is used to build the membership function according to thephysical health characteristics. In individual evaluation, main factor deterministicmodel M (∧,∨) is chosen as the weight coefficient is introduced and the mainfactors are emphatically considered; in crowd evaluation, weight average model M(,+) is chosen as all factors shall be taken into account according to their weights.The maximum membership principle is the basis to judge the evaluation results. Thecivil service physical health comprehensive evaluation model is built and theexperimental test data is substituted in the model for verification. The results showthat the model agrees with the facts and is scientific and valid to some degree.
China’s civil service physical health evaluation system is established by usingsoftware engineering method to build the knowledge base, the fact base, the rule baseand the inference engine according to the expert system structure.
Research Conclusions
(1) Individual and crowd physical health comprehensive evaluation models ofthe Chinese civil service were built and the physical health evaluation system wasconstructed and realized according to expert system structure. The evaluation systemevaluated body shape, function, quality and metabolism modules comprehensivelyaccording to the principle of taking the lowest value of the evaluation resultsaccording to fuzzy mathematics and from the indexes listed separately, whichimprove the evaluation efficiency.
(2) Introduction of fuzzy mathematics is an effective way for comprehensiveevaluation of physical health, as there is no specific measurement to decide whetherthe physique of the human body is good or bad and the concepts such as “excellent”and “good” is ambiguous obviously; meanwhile, it solved the problem emerged inwide promotion and use of the past evaluation standard, that is, difference in the topand bottom values of the critical points of part indexes is not significant but difference in grade is significant, which do not tally with the fact.
(3) It redefines the connotation and denotation of sub-health based on thefunction-specific homeostasis theory and health risk classification concept for the firsttime.
(4) The mean shift algorithm is introduced in individual physical healthcomprehensive evaluation for the first time; mean shift is used to layering the weights,which provides scientific base for judgment of the final evaluation grade of individualphysical health; the value of the mean shift effectively ranks the individual in thecrowd.
大量研究表明，近些年来公务员体质健康状况令人担忧，呈逐年下降之势，“三高一低”、超重现象严重，处于典型的亚健康状态。公务员事关国家繁荣兴旺、长治久安，因此对公务员健康状态的研究刻不容缓。计划生育造成的“4-2-1”问题、公务员公费医疗沉重以及《国家中长期科学和技术发展规划纲要（2006－2020）》提出的未来以治疗向预防转移的方针等我国国情，与当前健康管理理念趋势相吻合。坚持健康管理理念下，构建适用于我国公务员体质健康综合评价系统具有重要的指导意义和现实意义。
人体健康若用模糊数学隶属度进行描述时，“1”表示健康，“0”则表示疾病，而介于“0~1”之间则表示亚健康。其中，对于疾病人群，非常规健康促进手段能解决，主要依赖于医务治疗；而占人群75%以上的亚健康人群处于健康与疾病的中介状态，呈动态平衡状况，是健康促进的主要对象，即对人体体质健康实施健康促进的内涵就在于如何保证处于“1”的人群和“0~1”的人群继续保持“1”或者更贴近“1”。然而，当前的现实是“亚健康”概念及诊断手段备受争议，无一个公认的结论。鉴于此，提出研究目的一：基于功能内稳态理论和健康风险分级理念，重新认识亚健康的内涵和外延。
当前国民体质评价标准在大面积推广和使用时，表现出两个问题：（1）存在部分指标临界点上下数值相差不大但等级相差很大，与事实不符的现象，比如血压139mmHg为正常血压（高值）而141mmHg为高血压；（2）当前的体质健康评价方法在实践中评价效能不高，即大多数人只关心测试结果是否及格，而并不关心某些指标的“弱化”。基于此，提出研究目的二：探讨一种适合于我国公务员体质健康的评价方法。
体质健康综合评价结果得到的仅仅是好坏，体质研究的目的不是局限于现状描述，而应该是如何借用评价结果提供健康促进决策支持。提出研究目的三：如何依据体质健康评价结果为个体、群体提供健康促进供决策支持。
当前，市面上存在许多网页版体质评价系统，但多数仅依靠用户自己输入数据，数据不可靠，智能化程度不高，导致评价结果受到质疑；评价指标基本上都用的等权方式，除针对儿童人群评价的软件较多，很少针对如公务员等特殊人群。国外的评价标准是否适用于中国值得商榷。鉴于此，提出研究目的四：依据专家系统结构，构建一套适用于我国公务员体质健康评价系统。
研究方法
文献资料法：重点是重新认识亚健康的内涵和外延，确定风险等级分级临界点。
问卷调查法：通过10名专家问填写1~9标度法问卷，从而构建两两判断矩阵，为确定权重系数服务。
层次分析法：确定指标权重系数。
偏移度算法：对指标权重进行分层，以确定综合评价时应单列的高风险指标，作为风险分级的判断依据；实现个体体质健康在所属群体排名。
模糊数学法：建立综合评价模型时的核心工具之一，确定个体和群体体质健康综合评价模型。
软件工程法：以专家系统结构为主体，构建我国公务员体质健康评价系统。
实验法：以A、B两单位43名年龄为42.3±1.7岁的男性受试者的体质健康测试数据对所建立模型及系统进行验证，以检验其是否科学、有效。
研究结果
确定了公务员体质健康评价内涵，即对占有绝大部分比例的亚健康状态人群的评价，并依据评价结果提供相应的健康促进决策支持，将处于“1”状态的健康人群和处于“0~1”状态下的亚健康人群保持或贴近“1”。
通过对过去和当前有关亚健康的辨析，基于功能内稳态理论与健康风险分级理念以新的角度界定亚健康的内涵和外延。
应用层次分析法确定各个指标权重，并应用偏移度算法对指标进行分层，选取“正向”偏移的指标作为综合评价时的判定依据。
依据体质健康特点，采用梯形模型构造隶属函数。个体评价时，考虑到权重系数的引入，着眼点是考虑主要因素，故选择主因素决定性模型，即M（∧，∨）；群体评价时，所有因素依权重大小均衡兼顾，需兼顾各个因素，故选择加权平均模型，即M（,+）。判断评价结果时的依据为最大隶属原则。最终建立我国公务员体质健康综合评价模型，并根据实验测试的数据代入模型进行验证，结果表明，该模型与事实相符，具有一定的科学性、有效性。
运用软件工程法，按照专家系统结构，构建知识库、事实库和规则库、推理机，最终建立我国公务员体质健康评价系统。
研究结论
（1）建立了我国公务员个体体质健康综合评价模型和群体体质健康综合评价模型，并依据专家系统结构，构建和实现了我国公务员体质健康评价系统。评价系统将身体形态、机能、素质、代谢四个模块依据模糊数学获得的评价结果与单列指标的评价结果按照取低原则进行综合评价，提高了评价效能。
（2）引入模糊数学法对人体体质健康进行综合评价，不仅与人体的体质好坏无一个明确的衡量标准，“优”、“良”这类概念又具有明显的模糊性保持高度一致性，同时，解决了过去的评价标准在大面积推广和使用时造成部分指标临界点上下数值相差不大但等级相差很大、与事实不符合的问题。
（3）首次基于功能内稳态理论与健康风险分级理念重新界定亚健康的内涵和外延。
（4）首次将偏移度算法引入个体体质健康综合评价中，利用偏移度对权重进行分层，从而为个体体质健康最终评价等级的判定提供科学依据；根据偏移度的大小，有效地实现了个体在该群体中的排名。
Objectives
A large number of studies have shown that the health condition of the civilservice is worrying and their physique is on a declining trend and in a typicalsub-health state, with the characteristics of “three-high and one-low” and overweight.As the civil service involves prosperity, thriving and stability of the state, study ontheir health condition admits of no delay. China’s national conditions such as the“4-2-1” problem caused by the family planning, heavy free medical care burden of thecivil service as well as the cure to prevention policy proposed in the “NationalOutlines for Medium and Long-term Planning for Scientific and TechnologicalDevelopment (2006-2020)” agree with the current trend of health managementphilosophy. Therefore, to build a physical health evaluation system applicable toChina’s civil service under the health management philosophy has important guidingand practical significance.
If fuzzy mathematics membership is used to describe human health,“1”,“0” and“0~1” indicate health, disease and sub-health separately. As to the crowd with disease,conventional health promotion means can not solve their problems and they mainlyrelay on medical treatment; the sub-healthy crowd, accounting for75%of the total, isin a dynamic equilibrium state between health and disease, who is the main healthpromotion object, that is, the connotation of health promotion to human physicalhealth is to make the healthy crowd in “1” state and the sub-healthy crowd in the“0~1” state to maintain at or close to “1”. However, the current reality is that theconcept and diagnosis of “sub-health” is controversial and there is no recognizedconclusion. In view of this, the first objective of this study is to re-recognize theconnotation and denotation of sub-health based on function-specific homeostasistheory and health risk classification concept.
There are two problems emerged in wide promotion and use of current nationalphysique evaluation standard:(1) difference in the top and bottom values of thecritical points of part indexes is not significant but difference in grade is significant,which do not tally with the fact, for example,139mmHg means normal blood pressure(top value) but141mmHg means high blood pressure;(2) the efficiency of the currentphysical health evaluation method in practice is not high, that is, most people onlycare for the test results rather than “reduction” of some indexes. For this reason, thesecond objective of this study is to explore a physical health evaluation methodsuitable to China’s civil service.
As the physical health comprehensive evaluation results only indicate good or bad state, the objective of physique study shall not be limited to description of currentsituation and it is how to use the evaluation results to provide decision support tohealth promotion. The third objective of this study is how to use the physical healthevaluation results to provide decision support to health promotion for individuals andcrowds.
At present, there are many web version physical evaluation systems on market,but most of them relay on input of data by users; as the data is not reliable and thesystem is of low level of intelligence, the evaluation results is questioned; theevaluation indexes use the equal weight basically; there are more software applicablefor children and few for special crowd such as the civil service; whether the foreignevaluation standard is suitable to China is debatable. In regard to this, this forthobjective of this study is to build a set of physical health evaluation system suitable tothe Chinese civil service according to expert system structure.
Research Methods
Literature data: Re-recognize the connotation and denotation of sub-health anddecide the risk grade classification critical points.
Questionnaire survey: Built comparison and judgment matrix to decide theweight coefficients by asking10experts to fill out the questionnaire of1~9scales.
Analytic hierarchy process: Decide the index weight coefficients.
Mean shift algorithms: Layering the index weight to decide the index with highrisk to be listed separately in comprehensive evaluation and take it as the judgmentbasis for risk classification; realize ranking of physical health of individual in thecrowd.
Fuzzy mathematical method: One of the core tools to build the comprehensiveevaluation model, decide individual and crowd physical health comprehensiveevaluation model.
Software engineering method: Build the physical health evaluation system forChinese civil service by taking the expert system structure as the subject.
Experimental method: Physical health test data of43male subjects with the ageof42.3±1.7and from A and B units is used to verify scientificity and validity of themodel and system built.
Research results
It determines the connotation of physical health evaluation for civil service, thatis, evaluation of the sub-healthy crowd of the vast majority and provision of corresponding decision support based on the evaluation results in order to achieve thepurpose of health promotion; it makes the healthy crowd in “1” state and thesub-healthy crowd in the “0~1” state to maintain at or close to “1”.
It defines the connotation and denotation of sub-health from a new angle andbased on the function-specific homeostasis theory and health risk classificationconcept through analysis of the past and current information on the sub-health.
The analytic hierarchy process is used to determine various index weights, themean shift algorithms is used to layering the indexes and the indexes with “positive”shift are selected as judgment basis for comprehensive evaluation.
Trapezoid model is used to build the membership function according to thephysical health characteristics. In individual evaluation, main factor deterministicmodel M (∧,∨) is chosen as the weight coefficient is introduced and the mainfactors are emphatically considered; in crowd evaluation, weight average model M(,+) is chosen as all factors shall be taken into account according to their weights.The maximum membership principle is the basis to judge the evaluation results. Thecivil service physical health comprehensive evaluation model is built and theexperimental test data is substituted in the model for verification. The results showthat the model agrees with the facts and is scientific and valid to some degree.
China’s civil service physical health evaluation system is established by usingsoftware engineering method to build the knowledge base, the fact base, the rule baseand the inference engine according to the expert system structure.
Research Conclusions
(1) Individual and crowd physical health comprehensive evaluation models ofthe Chinese civil service were built and the physical health evaluation system wasconstructed and realized according to expert system structure. The evaluation systemevaluated body shape, function, quality and metabolism modules comprehensivelyaccording to the principle of taking the lowest value of the evaluation resultsaccording to fuzzy mathematics and from the indexes listed separately, whichimprove the evaluation efficiency.
(2) Introduction of fuzzy mathematics is an effective way for comprehensiveevaluation of physical health, as there is no specific measurement to decide whetherthe physique of the human body is good or bad and the concepts such as “excellent”and “good” is ambiguous obviously; meanwhile, it solved the problem emerged inwide promotion and use of the past evaluation standard, that is, difference in the topand bottom values of the critical points of part indexes is not significant but difference in grade is significant, which do not tally with the fact.
(3) It redefines the connotation and denotation of sub-health based on thefunction-specific homeostasis theory and health risk classification concept for the firsttime.
(4) The mean shift algorithm is introduced in individual physical healthcomprehensive evaluation for the first time; mean shift is used to layering the weights,which provides scientific base for judgment of the final evaluation grade of individualphysical health; the value of the mean shift effectively ranks the individual in thecrowd.
引文
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