14卷6期

• Link 原著 Original Article
• 台灣地區毒蛇咬傷概況(1988-1991)Venomous Snake Bites in Taiwan (1988-1991)
• 繆柏齡、黃瑞禎、胡門興、廖明一
  Bor-Lin Miao, Ruey-Jen Huang, Men-Shing Hu, Ming-Yi Liau
• 毒蛇咬傷 ； 台灣
  Snake Bite ; Taiwan
• 台灣地處亞熱帶，常有民眾被毒蛇咬傷，被毒蛇咬傷復，如能知道被何種毒蛇咬傷，對醫師之治療工作有很大助益，因此進行本研究。本研究回收189例有效樣本其中被龜殼花、赤尾鮐咬傷者最多，分別佔45%及37%。被毒蛇咬傷的季節以夏秋兩季為多，惟龜殼花及赤尾鮐兩種毒蛇咬傷的案例全年均有發生。被龜殼花咬傷的時問多發生在夜問，被赤尾鮐咬傷的時問則多發生在白天。咬傷場所，龜殼花常發生在住屋周圍，赤尾鮐則在野外較常發生。咬傷的部位，龜殼花以胸部較多、赤尾鮐以手部較多。分析傷者被咬傷後送醫時間，88%的傷者，約能在被咬傷後4小時內送達醫院治療。
  There are six well-known venomous snakes in Taiwan, Three species induce hemorrhagic symptoms (Trimeresurus mucrosquamatus, TM; Trimeresurus stejnegeri, TS; and Deinagkistrodon acutus, DA); two species induce neurotoxic symptoms (Naja naja atra, NA; and Bungarus multicinctus, BM); the other species induces hemorrhagic and neurotoxic symptoms (Vipera russelli formosensis. VR). In this investigation, we report 189 snake bite cases in which 45% were from TM, 37% were from TS, 12% were from NA, and others were from BM, DA or VR. Most of the snake bites occurred during summer and autumn Males were bitten three times more frequently than females, Thirty-eight percent of the total bites occurred around residences. Of the total bites, 52% occurred on upper extremities and 44% on lower ones, Most of the TM bites occurred on lower extremities, at night and around residences. TS bites occurred on upper extremities, during the day-time and outdoors. Eighty-eight percent of the patients with snake bite envenomation in Taiwan reached the hospital for treatment within four hours. Antivenom produced by National Institute of Preventive Medicine (NTPM) was available for all the victims who were bitten.
• 455 - 460
• 10.6288/CJPH1995-14-06-01

• Link 原著 Original Article
• 女醫師專業生涯、婚姻與家庭之研究Career, Marriage and the Family of Female Physicians in Taiwan
• 劉慧俐、藍忠孚、藍采鳳
  Hui-Li Liu, Chung-Fu Lan, Phylis-Lan Lin
• 女醫師 ； 職業 ； 婚姻 ； 家庭
  female physician ; career ; marriage and family
• 為了解台灣地區女醫生專業生涯與婚姻家庭關係，以及對國內婦女研究、醫療服務有所貢獻，於1984年6月，以自行設計問卷，調查159位女醫師及206位男醫師，透過描述性探究法，結果要點如下：(1)女醫師對專業有高度期許，工作帶給她們內在外在報酬。與男醫師相同，女醫師也多活躍參與專業組織和會議活動，但在科別選擇及職業型態上則各有所好。在專業活動上女醫師顯示有「專業中斷」的困擾。(2)約有80%的女醫師已婚且養育子女，他們結婚對象以醫師或其他專業者為主。家務及育兒責任多由她們擔當。有四分之三的女醫師認為家庭與事業是可以兩全的，「丈夫的協助」是該理想的重要條件。當專業生涯與婚姻家庭生有衝突時，僅2嗎表示選擇「永久放棄事業」。而多以「減少工作時間」或「暫時放棄，隔段日子再工作」來做彈性適應。
  The purpose of this study was to investigate the relationship between career and family life of physicians in Taiwan. The subjects consisted of 159 female physicians and 206 male physicians who responded to a questionnaire and a personal interview. The following results were obtained: (1)Female physicians were found to have a higher career commitment. They were also awarded externally and internally in their career. Compared to their male counterparts, the female physicians also participated in more activities at medicial associations and conferences. Between male and female physicians, there were differences as to the choices of specialities and the type of practice. The female physicians' practice was often interruppted by marriage and children. (2) About 80% of the female physicians in the study are married and have children. The majority of them are married to another physician or a professional. They also assumed the role of a housewife at home seventyfive percent of the female respondents considered that their family and their career were compromised. However, help from the husband was an important factor in dealing with the stress of having a career and a family. When conflicts between career and family life aroses, most of the female physicians adapted by a ”reduction in working hours” or by a ”temporary abandonment of career”.
• 461 - 469
• 10.6288/CJPH1995-14-06-02

• Link 原著 Original Article
• 時間、所得與中西醫療價格對中醫門診利用之影響The Effects of Time, Income and Price on the Demand for Chinese Medicine Ambulatory Care
• 李卓倫、紀駿輝、賴俊雄
  Jwo-Jeun Lee, Chun-Huei Chi, Jim-Shoung Lai
• 中醫醫療 ； 門診 ； 需求 ； 彈性
  Chinese Medicine ; Ambulatory Care ; Demand ; Elasticity
• 中華民國於1995年實施的全民健康保險已給付中醫門診，目前重要的相關政策議題包括：保險對中醫門診需求的影響，中西醫門診問的替代或互補關係，中醫門診的部份負擔額度，以及中醫院所的特約幅度。本研究嘗試以中醫門診患者為樣本來作部份解答。研究結果顯示中醫門診病人存在明顯的複向求醫行為。對於所有的中醫門診病人而言，中醫門診的時問彈性係數為－0.260，無保險者的價格彈性為－0.197，有保險者的自付額彈性為－0.100，對西醫門診價格的交叉彈性為－0.005，所得彈性未達顯著水準。對於同時使用中西醫門診的中醫門診病人而言，中醫門診的時問彈性為－0.361，無保險者的價格彈性為－0.293，有保險者的自付額彈性為－0.149，所得彈性和對西醫門診價格的交叉彈性未達統計相關水準。保險政策欲單獨以高額部份負擔來抑制中醫門診需求的效果可能有限，且本研究中並未發現中西醫門診使用之間存在互補性或替代性關係的證據。中醫門診的時問彈性大淤價格彈性則為值得重視的數據。
  The new National Health Insurance (NHI) program of Taiwan that was implemented in 1995 now covers Chinese medicine ambulatory care. A major concern of this coverage is whether and how much the NHI will affect the demand for Chinese medicine. Moreover, the relationship between the demand for Chinese and modern Western medicine is likely to affect the net change in the demand for both. This study, based on a national sample interview, examines whether the demand for Chinese medicine ambulatory care is a complement or a substitute for ambulatory care in modern Western medicine. Based on the results of this study, the authors also try to predict the future demand for Chinese medicine ambulatory care. Results from this study suggest that there is little evidence that the demand for ambulatory care in Chinese medicine and modern Western medicine are related, as was shown by the low cross elasticity (-0.005) between the two. Furthermore, the data indicates that there is a low price elasticity of demand for Chinese medicine, which suggests that relying on cost-sharing alone to prevent the overuse of Chinese medicine ambulatory care may not be very effective. Another new finding of this study is that time, which has a higher elasticity of demand than price, is an important factor in predicting demand for Chinese medicine.
• 470 - 476
• 10.6288/CJPH1995-14-06-03

• Link 原著 Original Article
• 自費安養機構老人的健康維護需求及其相關因素之探討Health Maintenance Demands and Related Factors of the Elderly in Self-Paid Residential Care Homes
• 楊瑞珍、黃璉華、白璐、胡幼慧
  R.J. Yang, L.H. Huang, L. Pai, Y.H. Hu
• 自費安養機構 ； 老人 ； 健康維護 ； 需求
  Self-paid residential care homes ; Elderly ; Health maintenance ; Demands
• 為瞭解自費安養機構老人健康維護的需求是什麼，以便能提拱真正合適的護理。本研究自四所自費安養機構1333位合乎選樣標準的老人中隨機抽出150位，以問春巡行面對面訪談，完成訪談者共142位。所得資料分析結果如下： 1本研究老人認為所謂健康是：沒有病痛、心情愉快、行動自如、能自我照顧二等，其中特別強調身體(54.2%)和心理(51.4%)的功能狀態。在健康行為(health behaveior)方面，老人認為維護健康必須要注意飲食(50%)、保持活動(46.5%)、維持規律生活(31.7%)…等。2便康維護項目中老人「最需要」的是：(1)維持心情愉快(2)預防意外傷害(3)有醫療保險(4)有穩定的經濟來源(5)尊重自己，被人尊重。 3影響健康維護需求程度的因素中，最具影響力的變項為：(1)健康維護滿足程度(2)健康知覺(3)進住主因(4)社經階層(5)有與保險等。從這些因素來看，可用Maslow的需要理論及Deway等的動機理論來說明自費安養機構老人在健康維護需求上的重要機制。 4自費安養機構的功能，主要在提供一個隱和的領域、聞放的環境，並增加了老人活動的機會和人際互動的範圍，在飲食方面亦發揮了重要的功能；但未能滿足老人自專及情緒上的需求。
  The purpose of this study was to understand the demands of the elderly in self-paid residential care homes in order to provide them with quality nursing care. A sample of 150 elderly persons was drawn by random sampling from 1333 institutionalized elderly for this study. Subjects were interviewed with a structured questionnaire. The analysis was based on data collected from 142 completed interviews. The elderly defined health as not being sick, having a joyful mind, being able to move around, and being able to perform self-care. Physical function (54.2%) and psychological status (51.4%) were especially emphasized. The elderly considered the following behaviors as necessary for them to maintain health: good dietary habits (50%), ability to move around on their own (46.5%), and keeping a regular life style (31.7%). The most demanding health maintenacnce items were keeping a joyful mind, preventing accidents, having medical insurance, having stable economic resources, respecting oneself and being respected by others. The most influential factors of health maintenance demands were degree of satisfaction with health maintenance, health perception, reasons for residing in the institutions, social-economic status, and whether one has insurance or not. Maslow's self-fulfillment theory and Deway's motivation theory could explain the important mechanism of health maintenance demands of the institutionalized elderly. Residential care homes provided the elderly with privacy and an open environment to develop social life, These institutions also played an important role in providing the elderly with a proper diet, but somehow self-respect and emotional demands were not fulfilled.
• 477 - 486
• 10.6288/CJPH1995-14-06-04

• Link 原著 Original Article
• 子宮切除盛行率的初探A Preliminary Study on Hysterectomy Rate in Taiwan
• 張珏、張菊惠、顧淑芬、胡幼慧
  Chuen Chang, Chu-Hui Chang, Shu-Fen Ku, Yow-Hwer Hu
• 子宮切除 ； 盛行率 ； 卵巢切除
  Hysterectomy ; Prevalence ; Oophorectomy
• 本篇報告為子宮切除盛行率之初探，資料來源為社區婦女調查與醫院病歷資料。社區婦女調查分為都會區與鄉鎮區兩部份，都會區以大臺北為研究地區，訪視期間為1991年7-11月，共訪視674位40-60歲婦女。鄉鎮區則向全省隨機取樣三處，分屬花東地區、南部地區和桃竹訪地區，訪視期間為1992年1-4月，共訪視626位40-60歲婦女，花東地區149人，南部地區197人，桃竹苗地區280人。醫院資料以臺北某大型教學醫院1984-1993年病歷室登記子宮與卵巢切除資料做分析。 將四個地區的切除率做年齡標?化，以作都會區與鄉鎮區的比較。結果發現標準化後的子宮切除率以臺北地區最高為10.1%，花束地區其次為9.5%，南部地區最低為6.4%。卵巢切除率也是臺北地區最高為5.4%，其次為桃竹苗地區5.2%，最低的也是南部地區為2.6%。醫院方面，全子宮切除與全了宮及單側卵巢切除的人數由1984年至1993年，約增加了一倍，單側卯巢切除，約增加了一半。卵巢雙側切除則不變。 國外關於子宮切除的探討已有二、三十年，內容超越單純的盛行率報導，而退一步分析盛行率與地理區分布、醫療資源分佈、病人人口特色、醫師特性等因素之相關性，以了解影響子宮切除的相關因素，更進而制訂相關衛生政策與監測系統以控制切除率。而國內在這方面仍闕如，日後需要投注更多研究與探討
  In order to understand the hysterectomy and oophorectomy rates as well as the surgical trends of Chinese women in Taiwan, a community survey and hospital medical records examination has been studied. The community survey covered 1300 women aged 40 to 60 years. There were 674 women from the Taipei metropolitan area, 197 from southern Taiwan rural areas, 149 from Hualien county in the east, and 280 from Hsinchu county in central Taiwan. The hospital medical records came from the Obstetrics and Gynecology Department of one Teaching hospital in Taipei area. After age adjusted the community subjects, the hysterectomy rates were 10.1% in Taipei, 9.5% in Hualien, 8.1% in Hsinchu county, and 6.4% in the southern Taiwan rural area, The oophorectomy rates were from 5.4% to 2.6%. After examining the medical records from 1984 to 1993, the number of removals of the whole uterus in 1993 was double the number of removals in 1984 (from 600 to 1200). The number of partial removals of the ovary increased from 300 in 1984 to 450 in 1993. However, the number of removals of both ovaries and partial removals of the uterus remained constant. It is suggested that large- scale studies of the prevalence of hysterectomies are needed. Further studies on related factors of hysterectomy, especially from the policy viewpoint of preventing malpractice and de-medicalizing physician-patient interactions, are also recommended.
• 487 - 493
• 10.6288/CJPH1995-14-06-05

• Link 原著 Original Article
• 台灣鄉村婦女對“子宮頸防癌抹片檢查”的認知及參與之調查研究Cognition and Participation of Pap Test among Village Women in Taiwan
• 陳錫中、周碧瑟
  His-Chung Chen, Pe-Sus Chou
• 子宮頸防癌抹片檢查 ； 知識 ； 態度與行為
  Pap Test ; KAP knowledge, attitude and practice
• 本研究根據國立陽明大學學生組成的陽明十字軍於1990至1993年四年暑假期間，透過群體醫療執業中心於全省20個鄉鎮，針對40歲以上婦女所作之調查加以分析研究。藉以瞭解台灣鄉村婦女對子宮頸防癌抹片檢查的認知與行為。本研究根據戶籍名冊，預定訪視9471人，實際完成之有效問卷計8390份，訪視率達88.6%。 本研究發現受訪婦女中有27.0%聽過「子宮頸防癌抹片檢查」，17.8%曾作過抹片檢查，作過者中44.4%近三年內有追蹤檢查；51.4%第一次檢查原因純為預防。分析「第一次作抹片檢查的時間」發現19.5%的婦女是在調查當時一年內初次受檢。 年齡愈大者，對子宮頸防癌抹片檢查的認知與接受百分比愈低，且作過者中近三年內有追蹤檢查者以45-49歲婦女百分比最高。教育程度愈高、觀念愈進步，對子宮頸防癌抹片檢查的態度與行為也愈好。籍貫別的分析中，客家籍婦女僅在「聽過子宮頸防癌抹片檢查」一項的百分比高於閔南藉。而結婚年齡在25歲以上的婦女在認知、接受程度與預防檢查的觀念都比24歲以前結婚的好。
  This survey was based on the data collected by the Yang-Ming Crusade, organized by students of National Yang-Ming University, during the summer vacations in 1990-1993. Arranged by the local Group Practice Center, women over 40 years old in 20 villages were interviewed by the crusaders in order to understand the cognizance and adoption of the Pap test among women in rural areas. There were 9471 female residents to be interviewed and 8390 of them completed the interview, the response rate is 88.6%. The results showed that there were 27.0% of respondents had heard of the Pap test and 17.8% of them had had a Pap test. And 44.4% of those badthe Pap test, had the test within the previous three years. As to the motivation for the first Pap test, 51.4% was for prevention. Analyzing the year of the first time of the Pap test, we found that about 19.5% women had their first Pap test during previous year of this survey. The cognizance rate of the Pap test decreased with age. Among those with the Pap test, the age group of 45-49 years old had the bigbest rate of check-up in the past three years. The concept, cognizance and adoption of the Pap test increased with level of education. Those with Haka ethnicity had a higher percentage of recognition than Fukien ethnicity. Women married after 25 years old had a better rate of cognizance and the concept of prevention than those married before 25 years old.
• 494 - 501
• 10.6288/CJPH1995-14-06-06

• Link 原著 Original Article
• 烏腳病盛行地區缺血性心臟病之病例對照研究Arsenic and Ischemic Heart Disease in the Blackfoot Disease-Endemic Area
• 林莉茹、洪申發、廖崑富、 薛玉梅、邱弘毅、江明禧、戴東原、曾慶孝、陳建仁
  Li-Ju Lin, Shan-Fa Horng, Kun-Fu Liaw, Yu-Mei Hsueh, Hung-Yi Chiou, Jiang Ming-Shi, Tung-Yuan Tai, Chin-Hsiao Tseng, Chien-Jen Chen
• 砷 ； 缺血性心臟病 ； 病例對照研究
  Arsenic ; Ischemic Heart Disease ; Case-Control Study
• 為探討砷致動脈粥狀硬化的毒性，本研究乃以烏腳病盛行地區居民缺血性心臟病盛行病例及其健康對照，探討缺血性心臟病與長期累積砷暴露及其他危險因子的相關，藉以推斷砷所扮演的角色。根據布袋鎮好美、復興、新民三里居民在民國八十二年二月至三月接受健康檢查及問春調查的結果，選出78名經靜止心電圖診斷患有缺血性心臟病的病例及384名健康對照。研究結果顯示此地區缺血性心臟病之多重危險因子，除年齡、性別、高血壓、總膽固醇對高密度脂蛋白膽固醇比值、肥胖指數及喝酒習慣等已知危險因子之外，砷暴露指標被發現和缺血性心臟病的盛行率有顯著的劑量效應關係。與未曾暴露於含砷深井水者比較，累積砷暴露量以年‧ppm為單位，暴露量為0.1-14.9和15.0以上者，其罹患缺血性心臟病的多變項調整化相對危險性分別為1.6和3.6倍。本研究結果顯示砷為烏腳病盛行地區缺血性心臟病的一個重要且獨立危險因子。
  Arsenic-induced atherogenicity has been well documented. Morbidity of ischemic heart disease was examined among residents in the blackfoot disease-endemic area in southwestern Taiwan to explore the relationship between long-term arsenic exposure and ischemic heart disease. A total of 78 prevalent cases of electrocardiogram-diagnosed ischemic heart disease identified from a community-based surrey and 384 age-sex-matched healthy controls were included. Multiple logistic regression analysis showed a statistically significant association of ischemic heart disease with long-term arsenic exposure. After adjustment for age, sex, hypertension, diabetes mellitus, ratio of total cholesterol to high-density lipoprotein cholesterol, body mass index, and alcohol consumption, the odds ratio of developing ischemic heart disease was 1.60 and 3.60, respectively, for those who had a cumulative arsenic exposure of 0.1-14.9 and >=15.0ppm-years compared with those who had no exposure to arsenic through drinking water. Arsenic is an important and independent risk factor for ischemic heart disease in the blackfoot disease-endemic area.
• 502 - 511
• 10.6288/CJPH1995-14-06-07

• Link 原著 Original Article
• 胰島素依賴型糖尿病童的福利需求與相關因素之研究The Study of Welfare Needs and Related Variables for Children with IDDM
• 鄭麗香、蕭淑貞、高碧霞、蔡麗美
  Lee-Hsiaing Cheng, Shu-Jen Shiau, Li-Mey Tsai, Bih-Shya Gau
• 家庭壓力 ； 家庭功能 ； 糖尿病控制 ； 福利需求
  Family Stress ; Family Function ; Diabetes Control ; Welfare Needs
• 本研究採量性研究法，由中華民國糖泳病學會「臺北市IDDM登錄小組」及康泰塞金會IDDM聯誼會之會員中，國小四年級到高中三年級之病患的母親為研究對象共計62位，運用結構問卷之方法收集資料，以探討家庭壓力、家庭功能、糖尿病控制與福利需求的關係。 研究發現對IDDM病童的家庭而言，感到最需要的前去項福利需求依序為：「希望社會大?能接納我的糖尿病小孩」、「糖尿病衛教中心的設置」、「心理諮商中心的設立」、「納入殘障福利法」、「加強學校老師、護士對胰烏素依賴型糖床病的認識」、「舉辦糖床病座談會」。 整體自我照顧執行情形、生理健康照顧功能與醫療知識、技術與諮詢方面的需求成正相關；整體家庭壓力、生活型態改變的壓力與整體福利需求、經濟補助方面的需求成正相關；糖化血色素與學校生活適應方面的需求成負相關。同時，母親的教育程度、生活形態改變的壓力、母親的職業、家庭的情感功能、參加病友團體的情形等變項對整體福利需求具有47.7%的預測力。
  The purpose of this quantitative study was to understand the welfare needs and the influencing variables. The variables in this study involved personal characteristics, family characteristics, family stress and family function. Sixty-two subjects, ranging from the fourth grade of primary school to the third year of senior high school, were recruited from the enrollment list of the Taipei IDDM (Insulin-Dependent Diabetes Mellitus) Registry and from the list of the Kang-Tai IDDM Association. Structural questionnaire was used to gather research data from subjects' mothers. The top six perceived welfare needs of these families were: society acceptance, a diabetes center, a psychological counseling center, being included in the handicapped welfare law, enhancing teachers and school nurses knowledge of IDDM and a symposium on diabetes. Whole self-management, physical care function were positively correlated with the needs of medical knowledge technology and counseling. Whole family stress, life change stress were positively correlated with the whole welfare needs and economics aid needs. HbA1c and the need for school adaptation, howere, were negatively correlated. The mother's level of education, life-change stress, working status, family's affection function and the patient group explained 47.7% of the variance of the perceived welfare needs.
• 512 - 521
• 10.6288/CJPH1995-14-06-08