13卷3期

• Link 原著 Original Article
• 南投縣山地國小學童缺席情形與其相關因素之探討A Survey of School Absence and Health Problems among Aboriginal Elementary School Children in Nan-Tou County
• 黃子庭、蔡慈儀、尹祚芊
  Tzu-Ting Huang, Tzu-Yi Tsai, Jeo-Chen Yin
• 原住民；國小學童；缺席情形
  Aboriginal ; School Absence ; Elementary School Children
• 本研究乃針對南投縣山地國小學童缺席情形及其相關因素之探討。 本研究以分層集束隨機抽樣法，選取南投縣五所山地國小全體學童為研究對象，計有459名學童。研究結果顯示，南投縣山地國小學童於79學年度上學期（六個月）當中缺席情形為－每人平均缺席4.35天（病假2.02天、事假0.65天、曠課1.68天）：缺席情形分佈為病假佔46.2%、曠課佔38.8%、事假為15.0%。在請假原因中，生理方面以「感冒」最為常見；在非生理方面，以「在家幫忙」而缺席居於首位。 在影響學童缺席之相關因素中顯示：年級愈高，請病假的學童愈多，而年級愈低，請事假的學童愈多；沒有慢性病的學童有較高的請事假天數；家庭社經地位對學童缺席率並不影響；有人督導功課之學童有較少因作業沒寫而缺席的比例，但與請病、事假的天數無關。 根據研究結果，為減少山地國小學童缺席情形，提出下列幾點建議： 1．造成山地國小非生理因素方面主要缺席原因是「在家幫忙」，尤其是農忙時，或可在農忙季節，可授權校長酌情調整假期以減少學童因此缺席的情形。 2．在學校衛生教育方面，應加強老師們的衛生知識及提供急救訓練及諮商技巧之課程，使老師成為學童身、心健康問題的諮詢者、早期發現者及提供心理輔導者。 3．向於山地國小地區偏遠，交通不便，就更需要建立完善的醫療設備及專業醫護人員的支援、轉介系統。
  The purposes of this study were to investigate the school absence rates and reasons of native-inhabetant elementary school-children, and to understand the potential factors that affected absence rates. Stratified-cluster random sampling was used to select 459 subjects from five aboriginal elememtary school in Nan-Tou county, Taiwan. The Research was carried out by using structured questionnaire and personal interview in the spring, 1991. Results of this study showed that during the six months studying period, the absence rate were 46.2%, 38.8% and 15.0% due to illness, no excuse or personal reason, respectively. Common cold or upper-respiratory tract infection and GI tract infection were the two most common illness which caused schoolchildren to stay home during school day. In the aspect of non-physical reason for absence, doing family chores was the frequent excuse. Absence due to illness was prevalent for higher grade students, while helping to do family chores was the common reason for lower graders to be absent in school. These was no statistical difference in absence rate between healthy students and those with chronic illness. Students from different socioeconomic status had similar absence rates. Results of this study suggested that the absence rate of nativeinhabitant elementary school-children could be reduced if 1) the school day or school hour could be adjusted during the harvest season; 2) school teachers' health knowledge, emergency care and consulting abilities could be strengthened through in-service education or seminars; and 3) the supporting and referred systems of medical service could be established.
• 203 - 213
• 10.6288/CJPH1994-13-03-01

• Link 原著 Original Article
• 吸菸是否會增加利用醫療服務？Does Smoking Increase the Use of Medical Services?
• 江東亮、林瑞雄
  Tung-Liang Chiang, Ruey-Shiung Lin
• 吸菸 ； 醫療服務利用 ； 利用型態
  smoking ; use of health services ; utilization pattern
• 本研究旨在利用臺灣地區1990年國民健康調查收集之資料，探討吸菸對醫療服務利用的影響。該次國民健康調查共訪查4196名樣本，完訪率為85.7%，但本研究祇分析其中3000名15歲以上樣本的資料。依受訪者的自迷，本研究將吸菸習慣分為從不吸菸、已戒菸及目前吸菸三組。探討的醫療服務種類則包括：住院、急診、西醫門診、中醫門診、自服西藥，以及自服中藥。結果顯示：(1)已戒菸者除中醫門診外，其他各類醫療服務的利用率與利用量皆高於從不吸菸者，但在控制其他自變項以後，祇有急診次數（增加4.5%）以及自服西藥的比率（增加1.39倍）與天數（增加18.7%）上的差異具統計顯著意義；(2)目前吸菸者則祇在住院、急診以及自服西藥的利用率與利用量上皆高於從不吸菸者，但控制其他自變項以後，亦衹有自服西藥的比率（增加0.63倍）與天數（增加6.6%）上的差異具統計顯著意義。因此，本研究並未充分支持吸菸會顯著增加利用醫療服務的假說。
  This study examined the impact of smoking on the use of medical services in Taiwan. The data for the analysis came from the 1990 Taiwan Health Interview Survey (THIS). 4196 persons were interviewed in the 1990 THIS (with a response rate of 85.7%), but only 3000 persons aged 15 and over were included in the analysis. Individuals were grouped into three groups: never smokers, current smokers, and former smokers. Six types of medical services were analyzed: hospital care, emergency care, physician care, herb doctor care, self-medication with western drugs, self-medication with herb drugs. The results showed that: (1) compared with never smokers, former smokers used more medical services of all types with the except of herb doctor care. but only differences in number of emergency visits (by 4.5%), rate of and number of days of self-medication with western drugs (by 1.39 times and 18.7%, respectively) were statistically significant after adjusting for other sociodemographic variables; and (2) compared with never smokers, current smokers used more hospital care, emergency care and self-medication with western drugs, but only differences in rate of and number of days of self-medication with western drugs (by 0.63 times and 6.6%, respectively) were statistically significant after adjusting for other socio-demographic variables. Thus, the findings of this study did not affirmatively confirm the contention that smoking increases the use of medical services.
• 214 - 222
• 10.6288/CJPH1994-13-03-02

• Link 原著 Original Article
• 牙醫師對全民健康保險實施後執業安排舆支付制度的意見調查An Opinon Survey of Dentists on Practice Arrangement and Payment System under National Health Insurance
• 江東亮、李彩萍、林芸芸
  Tung-Liang Chiang, Tsai-Ping Lee, Yun-Yun Lin
• 牙醫師 ； 全民健康保險 ； 執業安排 ； 支付制度
  dentist ; national health insurance ; practice arrangement ; payment system
• 為探?牙醫師對全民健康保險實施後執業安排與支付制度的意?，本研究以中華民國牙醫師公會聯合之會之所有登記會員為研究對象，於1989年年底進行郵寄問卷調，共收集1303名有效樣本?料，回收率為24.9%。調查?果顯示：(1)九成以上牙醫師都願意接受全民健康保險特約，但祇有三分之一的牙醫師?成?經評鑑合格才准特?；(2)大多?牙醫師?成專診制度，但祇有半數同意限制牙醫師前往牙醫師人力過剩地區執業；(3)牙醫師大都?成論量計酬制度，但對於支付標?，?診所牙醫師?向於主張同病／同項同酬，而醫院牙醫師?尚支持依?鑑等級與牙醫師資歷支付診療報酬；以及(4)近半數的牙醫師?成差額?擔。根據上述發?，本研究進一步討論對全民健康保險政策的?示與未?研究方向。
  This study examines dentists' opinions on practice arrangement and payment system under national health insurance (NHI). The data for the analysis came from a mail survey of 1303 members from the China Dental Association in late 1989 (response rate of 24.9%). The results of this study showed that (1) more than 90% of dentists are in favor of making a contract with NHI to provide services, but less than one third agree with the requirement of accrediation for contract; (2) most dentists support the policy of referral system, but only half agree with the restriction of the number of dentists practicing in communities with an oversupply of dentists; (3) most dentists prefer to be paid on the basis of fee-for-service; in particular, office-based dentists like 'equal payment for equal diagnosis/service' while hospital-based dentists like being paid according to accrediation and professional merits; and (4) approximately half of dentists are in favor of balancing billing. Based on the findings, this study discussed the implications for national health insurance policy and future research.
• 223 - 228
• 10.6288/CJPH1994-13-03-03

• Link 原著 Original Article
• 某醫院日間照護室收案病患及其家庭状况之研究A Study on the Enrolled Clients and Their Family Status in a Hospital-Based Day Care Center
• 徐宗福、 許國敏
  Tsung-Fu Hsu, Kuo-Min Hsu
• 以醫院為基礎之日間照護中心 ； 日常生活功能 ； 心理社會功能
  hospital-based day care center ; activities of daily living ; psychosocial activities
• 本研究主要目的在瞭解日間照護收案病患之家庭及社會經濟?況，?估其日常生活功能、精神功能及心理社會功能，探討病患醫療需及其家屬幫助病患之意願，並根據調查?果及辨理?驗，提出適切可行之建議，以供國?衛生主管單位、醫療保險機構及醫界專家制定政策之?考。 研究?果發?：收案病患的特徵為男性、年?70歲以上、閩南人、已婚、具農保身份、?有工作、小學教育程度、留院期間一個月?、有腦血管疾病，其日常生活功能為部份依賴?助者，精神功能?況為中型腦障礙，心理社會功能?況為較高程度部份依賴，與配偶兒孫共同居住在豐原地區，其家庭功能為無功能障礙，社會經濟狀況屬上階層，病患需要服務項目為物理治療、社會化娛樂、營養照顧、口服藥治療等。病患之主要照顧者的特徵為女性、年?61-70歲、閩南人、已婚、有職業、小學教育程度、由配偶或子女?擔任。 以相關分析來分析病患日常生活功能、精神功能、心理社會功能、家庭功能、社會經濟?況及家屬幫助病患意願六項指標，顯示病患日常生活功能低者，其精神功能與心理社會功能亦低；社會經濟狀況差者，其家庭功能亦差；日常生活功能、精神功能、心理社會功能與家庭功能較佳者，其家屬幫助病患意願亦?高。且發現心理社會功能與家庭功能是家屬幫助病患意願的重要影響因素。 最後，強調推展以醫院為基礎之日間照護中心符合社區需求之必要措施，不僅可解決一般性短期醫院、家庭及社會難題，同時也是健全醫療網計畫，促進我國醫療制度正常發展之重要策略。
  The objectives of this study were to: (1) understand the family and socioeconomic status of the enrolled clients in a day care center; (2) evaluate their activities of daily living, mental status and psychosocial activities; (3) explore the needs of clients and the helping willingness given by their families. A profile of the typical participant was male, more than 70 years of age, a native of Taiwan, married, with farmer health insurance, no occupation, graduated from elementary school, within one month of stay, ill with cerebrovascular disease, living in the Fengyuan area with sons and grandchildren. The activities of daily living were partially dependent, the mental status appeared moderately disordered, and the psychosocial activities were high-level partially dependent. Their families were not functionally impaired and their socioeconomic status belonged to high level. The participants' needs were physical therapy, socialized recreation, nutritional care, medicine therapy, etc. The typically primary caregiver was female, 61-70 years of age, a native of Taiwan, married, with occupation, graduated from elementary school, participant's spouse or child. Six indices which consisted of the activities of daily living, mental status, psychosocial activities, family functional status, socioeconomic status and the helping willingness for clients were analyzed. The findings were: (1) The worse the participants' activities of daily living, the worse their mental status and psychosocial activities. (2) The worse the participants' socioeconomic status, the worse their family functional status. (3) The better the participants' activities of daily living, mental status, family functional status and psychosocial activities, the higher the helping willingness for clients. And, the most important factors affecting the helping willingness for clients were psychosocial activities and family functional status. As a whole, what we must emphasize is developing hospital-based day care center is an essential measure catering for needs in an aging community. It will not only solve the problems existing in the acute short-stay hospital, in the participant's family and in society, but integrate to achieve medical care network and thoroughly promote national health care services.
• 229 - 241
• 10.6288/CJPH1994-13-03-04

• Link 原著 Original Article
• 台北市護理人員對自行開業的認知與態度Knowledge and Attitude of Registered Nurses in Taipei toward the Establishment of Nursing Institutions
• 楊麗芬、楊銘欽
  Li-Fen Yang, Ming-Chin Yang
• 護理人員 ； 護理機構 ； 政策分析
  registered nurses ; nursing institutions ; policy analysis
• 本研究目的在探討台北市護理人員，對護理人員法中自行聞業相關條文之認知與態度，並分析其影響因素。研究者以隨機抽樣方式，自台北市曾辦理執業登記之護理人員中，抽取二十分之一計898人進行郵寄問卷調查，經二次催復共292人回函，回收率為33.2%。重要研究結果如下： 1．受訪者對護理人員法自行開業相關規定之認知分數平約為8.7分（滿分10分）。 2．受訪者中94.5%認為財務損失風險是自行開業最主要的風險，96.2%認為資金是自行開業最重要的關心條件。 3．受訪者中31.2%有開業意願，並以個人興趣(94.5%)、專業自主性大(93.4%)、擁有自己事業(87.9%)為重要的開業原因。 4．假設受訪者會開業，則有51.7%優先選擇開設的護理機構為?後護理機構，選擇護理之家者最少(11.1%)。影響選擇開業護理機構之原因中，以已有相關科別臨床經驗重要程度最高(94.2%)。 5．年齡大於35歲，服務於公營機構，現任職護士者，較會認為自行開業將導致個人心理挫折。未婚及無子女者，較重視自行開業各項關心條件。年齡小於24歲者、已婚者及認為病人來源不確定為重要風險者，自行開業意願較低。 依據本研究結果，建議護理機構有關單位： 一、將護理機構有關知識納入學校教育課程，並著重生計規劃與生計輔導。 二、安排護理機構經營之專業訓練，輔以經營管理等課程。 三、規劃護理人員自行開業輔導措施並辦理說明會推廣或印製開業指引。
  The objectives of this study were to investigate the knowledge and attitude of registered nurses in Taipei toward the establishment of nursing institutions, and to analyze the associated factors. A sample of 898 nurses were randomly selected from the nurse registration file of Taipei City Health Bureau using an 1/20 ratio. A self-administered structured questionnaire was sent to each of these nurse. The response rate was 32.3% after two follow-up telephone calls. Major findings of this study are as follows: 1. The average score of the knowledge regarding establishing nursing institutions was 8.7 at a ten point scale. 2. Among the respondents, 94.5% chose financial risk as the most important risk of running a nursing institution, while 96.5% chose capital as the most important consideration of starting a nursing institution. 3. Among those who were willing to to start a nursing institution 31.2% of total respondents), three of the most important reasons for that attitude were personal interest 94.5%), professional self-esteem (93.4%), and independent practice 87.9%). 4. Regarding types of nursing institution if the respondents were going to start a nursing institution, 51.7% chose post partum nursing institution, 37.2% chose home care institutions, and 11.1% chose nursing homes. 5. Multivariate analyses indicated that those who were under age 24, married, and worried about sources of clients, were less likely to start a nursing institution. In order to facilitate the establishment of nursing institutions, the health authority should work with education authority to offer courses related to nursing institutions and to enhance the services of career planning. In addition, the health authority should also give seminars and distribute booklets to nurses in practice to explain the know-how's of establishing and managing a nursing institution.
• 242 - 257
• 10.6288/CJPH1994-13-03-05

• Link 原著 Original Article
• B型肝炎表面抗原帶原者肝硬化之多重危險因子研究Multifactorial Study of Liver Cirrhosis among HBsAg Positive Carriers
• 王姿乃、于明暉、廖運範、林燈寅、陳建仁
  Tsu-Nai Wang, Ming-Whei Yu, Yun-Fan Liaw, Deng-Yn Lin, Chien-Jen Chen
• 肝硬化 ； B型肝炎表面抗原 ； B型肝炎e抗原 ； 流行病學 ； 多重危險因子
  Liver cirrhosis ; HBsAg ; HBeAg ; Epidemiology ; Multifactorial
• 台灣地區是B型肝炎病毒(HBV)的盛行地區，全人口當中有85%-90%曾經被感染，15%-20%成為HBV表面抗原(HBsAg)帶原者。雖然HBV被認為是台灣地區肝硬化最重要的危險因子，但是HBV並非肝硬化唯一的危險因子。本研究係以92名HBsAg陽性之肝硬化病例，與322名按性別、年齡配對選出之HBsAg陽性之健康帶原者對照為研究對象，以探討肝硬化的多重危險因子。研究結果顯示HBV e抗原(HBeAg)帶原狀況與肝硬化有密切相關，危險對比值達8.7倍。至於喝酒累積暴露量偏高、喝酒年數在20年以上、每月攝食3次以上醃製食品、有抽煙習慣、D型肝炎病毒抗體(anti-HDV)陽性者皆有偏高的危險性。進一步分析HBeAg與其他危險因子之交互作用，結果顯示HBeAg與抽煙、喝酒、anti-HDV、醃製食品攝食頻率，皆有協同作用存在。
  Independent and interactive effects related to the development of liver cirrhosis (LC) were assessed using a hospital-based case-control study for hepatitis B virus, hepatitis D virus, alcohol drinking, cigarette smoking and pickled food consumption. All of the 92 liver cirrhosis patients tested HBsAg positive were serially recruited from the HBV carriers clinic of the Chang-Gung Memorial hospital. The HBsAg positive but healthy controls who were matched one to three or four with liver cirrhosis cases on age, sex were selected from the same clinic. Liver cirrhosis risk factors were obtained from the study subjects through standardized interviews according to a structured questionnaire. The carrier status of HBsAg, HBeAg, anti-HBe and antibody of hepatitis D virus were determined by radioimmunoassay. A positive significant association with HBsAg positive liver cirrhosis was observed for the carrier status of HBeAg with an matched odds ratio of 8.7. Liver cirrhosis was with positive relationships to cumulative alcohol consumption, duration of alcohol drinking, pickled food consumption, cigarette smoking and anti-HDV. The data analyzed by conditional multiple logistic regression analysis showed significant interactive effects of HBeAg on habitual alcohol drinking, cigarette smoking, anti-HDV and pickled food consumption.
• 258 - 268
• 10.6288/CJPH1994-13-03-06

• Link 原著 Original Article
• 未來環境空氣品質標準訂定之探討Study on the Standard Setting of the Future Ambient Air Quality
• 毛義方、陳美蓮、林宜長
  I-Fang Mao, Mei-Lien Chen, Yi-Chang Lin
• 環境空氣品質標準 ； 標準制定 ； 不良健康效應
  ambient air quality ; standard setting ; adverse health effect
• 國家環境空氣品質標準制定之目的是為保障國民健康，增進公共福址為目的，本文提出未來我國環境空氣品質標準之展望，內容除了目前之標準制定程序外，尚包括衝擊評估和成本效益分析；文中並提出採用安全數於高危險群之必要性，以及保護最大多數人群之考量，是由經濟、社會及政治因素所綜合決定的；未來國家空氣品質之目標，是在達成階段標?即：能忍受水準、可能接受水準以後，完成理想水準之目標。分析未來10年內我國空氣品質標準可能增列之項目有粒徑2μm~5μm之間的懸浮微粒，多環芳香族碳氫化合物及苯，可能被刪除之項目則為鉛。文中並提出各空氣污染物之未來標準以為參考。
  The purpose of this study is to evaluate and discuss the future standard setting for the national ambient air quality. The goal of the standard is to safeguard human health and promote public welfare. In this article we proposed the procedure of standard setting, including the economic impacts and cost/benefit analysis of the regulations. We also brought forward the definition of adverse health effect and non-health adverse effect taken in the secondary standard. The primary standard allows a margin of safety to protect more sensitive segments of the population. In this study, we suggested three standard levels to comply with: the tolerable level, the acceptable level and the desirable level. We perspected that the poly-aromatic hydrocarbons, PM2-5 and benzene would become criteria pollutants in air quality standard, but lead would be ruled out.
• 269 - 275
• 10.6288/CJPH1994-13-03-07

• Link 原著 Original Article
• 胰島素依賴型糖尿病病患自我照顧之情形及對糖尿病控制之影響Self-Management of Insulin-Dependent Diabetes Mellitus Patients and Its Influence on Diabetic Control
• 蕭淑貞、陳月枝、蔡世澤、林瑞祥、李燕晉、宣立人、戴東原
  Shu-Jen Shiau, Yueh-Chih Chen, Shih-Tse Tsai, Boniface-Juisiang Lin, Yen-Chin Li, Li-Ren Shian, Tong-Yuan Tai
• 胰島素依賴型糖尿病 ； 自我照顧 ； 糖尿病控制
  Insulin-Dependent Diabetes Mellitus ; Self-Management ; Diabetic Control
• 本研究主要目的在於探討胰島素依賴型糖尿病病患之自我照顧情形，及其對糖尿病控制的影響。以中華民國糖尿病學會組織的「台北市胰島素依賴型糖尿病調查小組」所登綠的個案及「康泰幼年型糖尿病聯誼會」會員中曾接受體檢並完成自我照顧調查之個案為主，採敘述性與相關性調查研究法。 本研究工具之項目包括：(1)自我照顧調查表(2)家人態度量表(3)心理適應量表(4)糖尿病知識評估表(5)體檢所得血糖值及糖化血色素值。結果顯示在130病例中，年齡以7歲～12歲所佔比率最多（43人，33.1%），有63%（82人）病患發病在12歲以下。82.2%（106人）病例於最近一個月內有檢查血糖；91.5%（118人）每天能按時規則注射胰島素；但只有33.3%（43人）的患者常按照營養師所設計食譜進食。 130位病患中有73位參予體檢。經由推論統計分析相關值，發現自我照顧較好者其糖化血色素值較低，有關糖尿病知識愈多者，其糖化血色素值則愈低。複迴歸統計進一步分析發現，自我照顧行為可以解釋35%的HbA(下? 1C)之變異量，自我照顧行為及知識可以解釋47%的HbA(下? 1C)之變異量。本研究證實自我照顧與知識對糖尿病控制的重要性。
  This study was conducted with a descriptive and correlational design to investigate the self-management of patients with insulin-dependent diabetes (IDDM), and to analyze its influence on diabetic control. The subjects were recruited from the enrolled list of a survey project of Taipei IDDM Registry and from the list of the Kang-Tai IDDM association. One hundred and thirty subjects either completed the questionnaires by themselves or being interviewed by well trained nurses. Seventy-three subjects participated the annual physical examination which was supported by the Department of Health, Executive Yuan, the diabetic association and the Kang-Tai IDDM association of this country. The questionnaires included: (1) the self-management assessment based on self-monitoring of blood sugar, diet, insulin injection, exercise, safety procedure, foot care, etc., (2) the IDDM knowledge assessment, (3) the psycho-social assessment, (4) the diabetic family behavior checklist, (5) the blood sugar value and HbA(subscript ID) value simultaneously done at the physical examination. These assessments were approved with the content validity and the adequacy reliability in this study. Results indicated: the most IDDM patients were at the ages from 7 to 12 years old (33.1%); The majority of patients developed diabetes before the age of 12 (63.0%); 82.2% of patients did the blood sugar test within recent one month; and 91.5% of patients had regular insulin injections; however, only 33.3% of patients followed the diet instructed by dietician; The self-management negatively associated with the HbA(subscript ID). The better the self- management was, the lower the value of HbA(subscript 1D) would be. The negative association also existed between diabetic knowledge and HbA(subscript 1D). Using a stepwise multiple regression, self- management was found to explain 35% variance of HbA(subscript ID) level, and combining with knowledge which could explain 47% variance of HbA(subscript ID) level. This study confirmed the importance of self-management and knowledge relevant to the diabetic control.
• 276 - 284
• 10.6288/CJPH1994-13-03-08